Godbold, Rosemary; Lees, Amanda
It is now widely accepted that ethics is an essential part of educating health professionals. Despite a clear mandate to educators, there are differing approaches, in particular, how and where ethics is positioned in training programmes, underpinning philosophies and optimal modes of assessment. This paper explores varying practices and argues for a values based approach to ethics education. It then explores the possibility of using a web-based technology, the Values Exchange, to facilitate a values based approach. It uses the findings of a small scale study to signal the potential of the Values Exchange for engaging, meaningful and applied ethics education. Copyright © 2013 Elsevier Ltd. All rights reserved.
Tetley, Josie; Dobson, Fiona; Jack, Kirsten; Pearson, Beryl; Walker, Elaine
Nurse education has found itself challenged to select and educate nurses who on completion of? of their programme? have: excellent technical skills, an ability to critically analyse care and work compassionately in ways that support the values of care that are important to service users. Recent reports of care suggest that nursing still needs to develop the values base of its student selection and education processes. Against this backdrop, this paper presents two examples from pre registration nurse education that illustrate how a values based approach is used as part of the selection process in one university and used to inform the development of a reflective poetry initiative in another university. Having presented the two examples the authors debate some of the wider benefits and challenges linked to these ways of working. For example, the importance of connecting nurses' personal beliefs, attitudes and assumptions to service user values in recruitment are discussed. The use of poetry as a way of thinking about practice that moves beyond traditional models of reflection in nursing are also considered. However, the authors recognise that if developments in nurse education are to have a real impact on nursing practice and patient care, there is the need for values based initiatives to be more directly connected to the delivery of healthcare. Copyright © 2015 Elsevier Ltd. All rights reserved.
Gilfoil, David M.; Focht, Jeffrey W.
Value-based delivery of healthcare has been discussed in the literature for almost a decade. The concept focuses on the patient and defines value as the improvement of patient outcomes divided by healthcare costs. Further refinements, called the Triple Aim model, focus on improving patient outcomes, reducing treatment costs, and improving patient…
Amir, Amizawati Mohd; Auzair, Sofiah Md; Maelah, Ruhanita; Ahmad, Azlina
Purpose: The purpose of this paper is to propose the concept of higher education institutions (HEIs) offering educational services based on value for money. The value is determined based on customers' (i.e. students) expectations of the service and the costs in comparison to the competitors. Understanding the value and creating customer value are…
Umoru, Titus Amodu
This study centered on values-based business education for empowerment, self-reliance and poverty reduction in Nigeria. The study identified 30 critical values business education students need to possess. 192 questionnaire items were constructed after careful review of literature (Njoku, 2007 and Living Values Education, 2013) and administered…
This thesis explores the teaching of values in Australian schools through a framework established by the Australian Federal government during the 2000s. This paper focuses on: the approaches employed by the Australian Federal government in the implementation of Values Education; and the application of cases of values-based education utilized by…
Markley Rountree, Melissa; Koernig, Stephen K.
Sustainable development has been a hot button issue for decades, and yet business schools continue to struggle with accessible, meaningful and effective strategies to incorporate the topic into their curricula. To extend the teaching toolbox of educators, we describe two complementary marketing courses that use values-based learning to incorporate…
Groothuizen, Johanna E; Callwood, Alison; Gallagher, Ann
A discussion of issues associated with Values Based Recruitment (VBR) for nurse education programmes. Values Based Recruitment is a mandatory element in selection processes of students for Higher Education healthcare courses in England, including all programmes across nursing. Students are selected on the basis that their individual values align with those presented in the Constitution of the National Health Service. However, there are issues associated with the use of values as selection criteria that have been insufficiently addressed. These are discussed. Discussion paper. This article is based on documents published on the website of the executive body responsible for the implementation of a policy regarding VBR in Higher Education Institutions up until June 2017 and our evaluation of the conceptualisation of VBR, underpinned by contemporary theory and literature. Values Based Recruitment influences who is accepted onto a nurse education programme, but there has been limited critical evaluation regarding the effectiveness of employing values as selection criteria. Values are subject to interpretation and evidence regarding whether or how VBR will improve practice and care is lacking. The issues discussed in this article show that Higher Education Institutions offering nursing courses, whether in England or in other countries, should be critical and reflective regarding the implementation of VBR methods. We call for a debate regarding the meaning and implications of VBR and further research regarding its validity and effectiveness. © 2017 John Wiley & Sons Ltd.
Maurer, Kristin A; Ryan, Andrew M
Value-based payment systems have been widely implemented in healthcare in an effort to improve the quality of care. However, these programs have not broadly improved quality, and some evidence suggests that they may increase inequities in care. No Child Left Behind is a parallel effort in education to address uneven achievement and inequalities. Yet, by penalizing the lowest performers, No Child Left Behind's approach to accountability has led to a number of unintended consequences. This article draws lessons from education policy, arguing that financial incentives should be designed to support the lowest performers to improve quality. © 2015 Society of Hospital Medicine.
Altamirano-Bustamante, Myriam M; Altamirano-Bustamante, Nelly F; Lifshitz, Alberto; Mora-Magaña, Ignacio; de Hoyos, Adalberto; Avila-Osorio, María Teresa; Quintana-Vargas, Silvia; Aguirre, Jorge A; Méndez, Jorge; Murata, Chiharu; Nava-Diosdado, Rodrigo; Martínez-González, Oscar; Calleja, Elisa; Vargas, Raúl; Mejía-Arangure, Juan Manuel; Cortez-Domínguez, Araceli; Vedrenne-Gutiérrez, Fernand; Sueiras, Perla; Garduño, Juan; Islas-Andrade, Sergio; Salamanca, Fabio; Kumate-Rodríguez, Jesús; Reyes-Fuentes, Alejandro
In recent years, medical practice has followed two different paradigms: evidence-based medicine (EBM) and values-based medicine (VBM). There is an urgent need to promote medical education that strengthens the relationship between these two paradigms. This work is designed to establish the foundations for a continuing medical education (CME) program aimed at encouraging the dialogue between EBM and VBM by determining the values relevant to everyday medical activities. A quasi-experimental, observational, comparative, prospective and qualitative study was conducted by analyzing through a concurrent triangulation strategy the correlation between healthcare personnel-patient relationship, healthcare personnel's life history, and ethical judgments regarding dilemmas that arise in daily clinical practice.In 2009, healthcare personnel working in Mexico were invited to participate in a free, online clinical ethics course. Each participant responded to a set of online survey instruments before and after the CME program. Face-to-face semi-structured interviews were conducted with healthcare personnel, focusing on their views and representations of clinical practice. The healthcare personnel's core values were honesty and respect. There were significant differences in the clinical practice axiology before and after the course (P ethical discernment, the CME program had an impact on autonomy (P ≤0.0001). Utilitarian autonomy was reinforced in the participants (P ≤0.0001). Regarding work values, significant differences due to the CME intervention were found in openness to change (OC) (P ethical discernment and healthcare personnel-patient relation were beneficence, respect and compassion, respectively. The healthcare personnel participating in a CME intervention in clinical ethics improved high-order values: Openness to change (OC) and Self Transcendence (ST), which are essential to fulfilling the healing ends of medicine. The CME intervention strengthened the role of
Heaslip, Vanessa; Scammell, Janet; Mills, Anne; Spriggs, Ashley; Addis, Andrea; Bond, Mandy; Latchford, Carolyn; Warren, Angela; Borwell, Juliet; Tee, Stephen
Within the United Kingdom (UK) there is an increasing focus on Values Based Recruitment (VBR) of staff working in the National Health Service (NHS) in response to public inquiries criticising the lack of person-centred care. All NHS employees are recruited on the basis of a prescribed set of values. This is extended to the recruitment of student healthcare professionals, yet there is little research of how to implement this. Involving Service Users in healthcare educational practice is gaining momentum internationally, yet involvement of service users in VBR of 'would be' healthcare professionals remains at an embryonic phase. Adult nurses represent the largest healthcare workforce in the UK, yet involvement of service users in their recruitment has received scant attention. This paper is an evaluation of the inclusion of service users in a VBR of 640 adult student nurses. This study used a participatory mixed methods approach, with service users as co-researchers in the study. The study consisted of mixed methods design. Quantitative data via an online questionnaire to ascertain candidates' perspectives (n=269 response rate of 42%), and academic/clinical nurses (n=35 response rate 34.65%). Qualitative data were gathered using focus groups and one to one interviews with service users (n=9). Data analysis included descriptive statistics and thematic analysis. 4 overarching themes were identified; increasing sense of humanness, substantiating care values; impact of involvement; working together and making it work, a work in progress. The findings from the study highlight that involving service users in VBR of student healthcare professionals has benefits to candidates, service users and local health services. Appreciating the perceptions of healthcare professionals is fundamental in the UK and internationally to implementing service users' engagement in service enhancement and delivery. Findings from this study identify there may be a dissonance between the policy
Tripken, Jennifer L.
Purpose: The purpose of this study was to assess the educational efficacy of an online software decision-making program, The Values Exchange. While ethics is a vital aspect of educating public health professionals, it is both difficult to teach and assess. There is a need to identify best practices in the pedagogy of public health ethics and in…
Goldratt, Miri; Cohen, Eric H.
This article explores encounters between formal, informal, and non-formal education and the role of mentor-educators in creating values education in which such encounters take place. Mixed-methods research was conducted in Israeli public schools participating in the Personal Education Model, which combines educational modes. Ethnographic and…
Amollo, Odundo P.; Lilian, Ganira K.
Value Based Education (VBE) is an essential element that impacts moral, ethical, cultural, social and spiritual ideals necessary for holistic development of children. Providing an education on values at an early age ensures that children are directed by these ideologies throughout life. Research indicates that children who adopt values at an early…
The main aim of the paper is to present the value-based pricing. Therefore, the comparison between two approaches of pricing is made - cost-based pricing and value-based pricing. The 'Price sensitively meter' is presented. The other topic of the paper is the perceived value - meaning of the perceived value, the components of perceived value, the determination of perceived value and the increasing of perceived value. In addition, the best company strategies in matrix 'value-cost' are outlined. .
Full Text Available The main aim of the paper is to present the value-based pricing. Therefore, the comparison between two approaches of pricing is made - cost-based pricing and value-based pricing. The 'Price sensitively meter' is presented. The other topic of the paper is the perceived value - meaning of the perceived value, the components of perceived value, the determination of perceived value and the increasing of perceived value. In addition, the best company strategies in matrix 'value-cost' are outlined. .
Gong, Jun; Pan, Kathy; Fakih, Marwan; Pal, Sumanta; Salgia, Ravi
Advancements in next-generation sequencing have greatly enhanced the development of biomarker-driven cancer therapies. The affordability and availability of next-generation sequencers have allowed for the commercialization of next-generation sequencing platforms that have found widespread use for clinical-decision making and research purposes. Despite the greater availability of tumor molecular profiling by next-generation sequencing at our doorsteps, the achievement of value-based care, or improving patient outcomes while reducing overall costs or risks, in the era of precision oncology remains a looming challenge. In this review, we highlight available data through a pre-established and conceptualized framework for evaluating value-based medicine to assess the cost (efficiency), clinical benefit (effectiveness), and toxicity (safety) of genomic profiling in cancer care. We also provide perspectives on future directions of next-generation sequencing from targeted panels to whole-exome or whole-genome sequencing and describe potential strategies needed to attain value-based genomics.
U.S. Department of Health & Human Services — Hospital Value-Based Purchasing (VBP) is part of the Centers for Medicare and Medicaid Services (CMS) long-standing effort to link Medicares payment system to a...
Wu, Chen-Yu; Fan, Chihhao
To assure the river water quality, the Taiwan government establishes many pollution control strategies and expends huge monetary investment. Despite all these efforts, many rivers still suffer from severe pollution because of massive discharges of domestic and industrial wastewater without proper treatment. A comprehensive evaluation tool seems required to assess the suitability of water pollution control strategies. Therefore, the purpose of this study is to quantify the potential strategic benefits by applying the water quality modelling integrated with cost-benefit analysis to simulating scenarios based on regional development planning. The Erhjen Creek is selected as the study example because it is a major river in southern Taiwan, and its riverine environment impacts a great deal to the neighboring people. For strategy assessment, we established QUAL2k model of Erhjen Creek and conducted the cost-benefit analyses according the proposed strategies. In the water quality simulation, HEC-RAS was employed to calculate the hydraulic parameters and dilution impact of tidal effect in the downstream section. Daily pollution loadings were obtained from the Water Pollution Control Information System maintained by Taiwan EPA, and the wastewater delivery ratios were calculated by comparing the occurrence of pollution loadings with the monitoring data. In the cost-benefit analysis, we adopted the market valuation method, setting a period of 65 years for analysis and discount rate at 2.59%. Capital investments were the costs of design, construction, operation and maintenance for each project in Erhjen Creek catchment. In model calibration and model verification, the mean absolute percentage errors (MAPEs) were calculated to be 21.4% and 25.5%, respectively, which met the prescribed acceptable criteria of 50%. This model was applied to simulating water quality based on implementing various pollution control policies and engineering projects in the Erhjen Creek. The overall
Miller, Sam Louise
Values-based recruitment is a process being introduced to student selection for nursing courses and appointment to registered nurse posts. This article discusses the process of values-based recruitment and demonstrates why it is important in health care today. It examines the implications of values-based recruitment for candidates applying to nursing courses and to newly qualified nurses applying for their first posts in England. To ensure the best chance of success, candidates should understand the principles and process of values-based recruitment and how to prepare for this type of interview.
Topeka Public Schools, KS.
Water is one of the most polluted resources in our environment. Since everyone has the same basic need for pure water, it follows that all people should have a basic knowledge of the causes, results and solutions to the water pollution problem. This unit is designed for use with Level II and III educable mentally retarded students to present…
Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and conver...
Brown, Melissa M; Brown, Gary C
To update concepts in Value-Based Medicine, especially in view of the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act assures that some variant of Value-Based Medicine cost-utility analysis will play a key role in the healthcare system. It identifies the highest quality care, thereby maximizing the most efficacious use of healthcare resources and empowering patients and physicians.Standardization is critical for the creation and acceptance of a Value-Based Medicine, cost-utility analysis, information system, since 27 million different input variants can go into a cost-utility analysis. Key among such standards is the use of patient preferences (utilities), as patients best understand the quality of life associated with their health states. The inclusion of societal costs, versus direct medical costs alone, demonstrates that medical interventions are more cost effective and, in many instances, provide a net financial return-on-investment to society referent to the direct medical costs expended. Value-Based Medicine provides a standardized methodology, integrating critical, patient, quality-of-life preferences, and societal costs, to allow the highest quality, most cost-effective care. Central to Value-Based Medicine is the concept that all patients deserve the interventions that provide the greatest patient value (improvement in quality of life and/or length of life).
Full Text Available Global healthcare in the 21st century is characterized by evidence-based medicine (EBM, patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research.
Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research. PMID:25773441
Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research.
Project WET Foundation, 2007
This award-winning, 350-page, full-color book provides a thorough study of Arizona water resources from a water conservation perspective. Its background section contains maps, graphs, diagrams and photos that facilitate the teaching of 15 interactive, multi-disciplinary lessons to K-12 students. In addition, 10 Arizona case studies are highlighted…
Carballo, Juan Antonio; Cohn, David L.; Belluomini, Wendy; Montoye, Robert K.
Effective design reuse in electronic products has the potential to provide very large cost savings, substantial time-to-market reduction, and extra sources of revenue. Unfortunately, critical reuse opportunities are often missed because, although they provide clear value to the corporation, they may not benefit the business performance of an internal organization. It is therefore crucial to provide tools to help reuse partners participate in a reuse transaction when the transaction provides value to the corporation as a whole. Value-based Reuse Management (VRM) addresses this challenge by (a) ensuring that all parties can quickly assess the business performance impact of a reuse opportunity, and (b) encouraging high-value reuse opportunities by supplying value-based rewards to potential parties. In this paper we introduce the Value-Based Reuse Management approach and we describe key results on electronic designs that demonstrate its advantages. Our results indicate that Value-Based Reuse Management has the potential to significantly increase the success probability of high-value electronic design reuse.
Hennink, Simone D; Hofland, N.; Gopie, J.P.; van der Kaa, C.; de Koning, K.; Nielsen, M.; Tops, C.; Morreau, H.; de Vos Tot Nederveen Cappel, W.H.; Langers, A.M.; Hardwick, J.C.; Gaarenstroom, K.N.; Tollenaar, R.A.; Veenendaal, R.A.; Tibben, A.; Wijnen, J.; van Heck, M.; van Asperen, C.; Roukema, J.A.; Hommes, D.W.; Hes, F.J.; Vasen, H.F.A.
Lynch syndrome (LS), one of the most frequent forms of hereditary colorectal cancer (CRC), is caused by a defect in one of the mismatch repair (MMR) genes. Carriers of MMR defects have a strongly increased risk of developing CRC and endometrial cancer. Over the last few years, value-based healthcare
Arnold, Daniel R
Payment reform has been at the forefront of the movement toward higher-value care in the U.S. health care system. A common belief is that volume-based incentives embedded in fee-for-service need to be replaced with value-based payments. While this belief is well-intended, value-based payment also contains perverse incentives. In particular, behavioral economists have identified several features of individual decision making that reverse some of the typical recommendations for inducing desirable behavior through financial incentives. This paper discusses the countervailing incentives associated with four behavioral economic concepts: loss aversion, relative social ranking, inertia or status quo bias, and extrinsic vs. intrinsic motivation. Copyright © 2016 Elsevier Inc. All rights reserved.
Weaver, Samuel C.; Weston, J. Fred
We identify four alternative performance metrics used in value based management (VBM). (1) Basic is an intrinsic value analysis (IVA), the discounted cash flow (DCF) methodology. (2) We show that this framework will be consistent with returns to shareholder (RTS, capital gains plus dividends) measured over appropriate time horizons. (3) Economic profit (EP) [also called economic value added (EVAÂ®)] takes from the DCF free cash flow valuation, net operating profits after taxes (NOPAT), divide...
Gross, Wendy L; Cooper, Lebron; Boggs, Steven; Gold, Barbara
The anesthesia market continues to undergo disruption. Financial margins are shrinking, and buyers are demanding that anesthesia services be provided in an efficient, low-cost manner. To help anesthesiologists analyze their market, Drucker and Porter's framework of buyers, suppliers, quality, barriers to entry, substitution, and strategic priorities allows for a structured analysis. Once this analysis is completed, anesthesiologists must articulate their value to other medical professionals and to hospitals. Anesthesiologists can survive and thrive in a value-based health care environment if they are capable of providing services differently and able to deliver cost-effective care. Copyright © 2017 Elsevier Inc. All rights reserved.
Ray, Jordan C; Kusumoto, Fred
Delivery of medical care is evolving rapidly worldwide. Over the past several years in the USA, there has been a rapid shift in reimbursement from a simple fee-for-service model to more complex models that attempt to link payment to quality and value. Change in any large system can be difficult, but with medicine, the transition to a value-based system has been particularly hard to implement because both quality and cost are difficult to quantify. Professional societies and other medical groups are developing different programs in an attempt to define high value care. However, applying a national standard of value for any treatment is challenging, since value varies from person to person, and the individual benefit must remain the central tenet for delivering best patient-centered medical care. Regardless of the specific operational features of the rapidly changing healthcare environment, physicians must first and foremost always remain patient advocates.
Bowman Peterson, Jill M; Duffy, Briar; Duran, Alisa; Gladding, Sophia P
Current health care costs are unsustainable, with a large percentage of waste attributed to doctor practices. Medical educators are developing curricula to address value-based care (VBC) in education. There is, however, a paucity of curricula and assessments addressing levels higher than 'knows' at the base of Miller's pyramid of assessment. Our objective was to: (1) teach residents the principles of VBC using active learning strategies; and (2) develop and pilot a tool to assess residents' ability to apply principles of VBC at the higher level of 'knows how' on Miller's pyramid. Residents in medicine, medicine-paediatrics and medicine-dermatology participated in a 5-week VBC morning report curriculum using active learning techniques. Early sessions targeted knowledge and later sessions emphasised the application of VBC principles. Medical educators are developing curricula to address value-based care in education RESULTS: Thirty residents attended at least one session and completed both pre- and post-intervention tests, using a newly developed case-based assessment tool featuring a 'waste score' balanced with 'standard of care'. Residents, on average, reduced their waste score from pre-intervention to post-intervention [mean 8.8 (SD 6.3) versus mean 4.7 (SD 4.6), p = 0.001]. For those who reduced their waste score, most maintained or improved their standard of care. Our results suggest that residents may be able to decrease health care waste, with the majority maintaining or improving their management of care in a case-based assessment after participation in the curriculum. We are working to further incorporate VBC principles into more morning reports, and to develop further interventions and assessments to evaluate our residents at higher levels on Miller's pyramid of assessment. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.
Full Text Available Peaceful co-existence and inclusion do not depend solely on the availability of goods and welfare systems, but primarily on shared cultural values. In order to build shared values, we propose a new concept, the worthy, as the pull-factor of the value. A value-based dialogue begins from making each ones’ worthies ‘speak to each other’ so each actor can enter into Alter’s point of view to gain, afterward, a sharing of values. Beginning from the worthy, we outline the path of an innovative integrative model: safeguard some features of the ‘diversity’ (multiculturalism and to build some ‘resemblances’ (interculturality. By this resemblances/differences trade-off both migrants, ethnic groups and autochthonous absorb something of Alter’s believes and values, and at the same time gain awareness about complementarity and interdependency with Alter, the core of an otherness mind and the requirement to manage conflicts. By this way, each actor embraces a wider and wider network of Alter (linking bonds without losing his own identity and belonging. Finally, this paper suggests operative ways involving, as game-changers of a ‘feasible’ society, school and social services from one side, and local, political entities and the civil society, from the other side (deliberative democracy.
Brown, Gary C; Brown, Melissa M
Pharmacoeconomics is assuming increasing importance in the pharmaceutical field since it is entering the public policy arena in many countries. Among the variants of pharmacoeconomic analysis are cost-minimization, cost-benefit, cost-effectiveness and cost-utility analyses. The latter is the most versatile and sophisticated in that it integrates the patient benefit (patient value) conferred by a drug in terms of improvement in length and/or quality of life. It also incorporates the costs expended for that benefit, as well as the dollars returned to patients and society from the use of a drug (financial value). Unfortunately, one cost-utility analysis in the literature is generally not comparable to another because of the lack of standardized formats and standardized input variables (costs, cost perspective, quality-of-life measurement instruments, quality-of-life respondents, discounting and so forth). Thus, millions of variants can be used. Value-based medicine® (VBM) cost-utility analysis standardizes these variants so that one VBM analysis is comparable to another. This system provides a highly rational methodology that allows providers and patients to quantify and compare the patient value and financial value gains associated with the use of pharmaceutical agents for example. © 2016 S. Karger AG, Basel.
Full Text Available In the fall of 2014, the new German grassroots political protest movement “Pegida” emerged. The movement’s targets of criticism include the pronounced ‘failures’ of German asylum and immigration policy, refugees, and a so-called “Islamization.” This contribution is an analysis of Pegida's programmatic publications. Pegida claims to promote national values and already has a positive image of Germany in particular and the nation state in general. Germany is seen as an agency of ‘humanity’ that fulfils a selfless moral mission in granting asylum to refugees. For Pegida, the consequences of this policy include ‘foreign infiltration,’ as well as so-called “Muslim parallel societies,” which are seen as dangerous imports of competing moralities. To save the ‘good order’ that said “patriotic Europeans” imagine as their home, the integration of foreign ‘national identities’ is seen as both necessary and hard to achieve. Therefore, Pegida demands the optimization of state force and its use to establish a requirement of integration and enforce the sanctioning of criminal immigrants and “asylum betrayers.” According to this logic, the preservation of home through a “zero tolerance policy” is a self-purpose, ensuring to prevent negative social consequences like poverty and unemployment. The result of this analysis proposes an explanation approach to the xenophobic logic of Pegida's value-based nationalism.
Obremskey, William T; Dail, Teresa; Jahangir, A Alex
Health care in the United States is known for its continued innovation and production of new devices and techniques. While the intention of these devices is to improve the delivery and outcome of patient care, they do not always achieve this goal. As new technologies enter the market, hospitals and physicians must determine which of these new devices to incorporate into practice, and it is important these devices bring value to patient care. We provide a model of a physician-engaged process to decrease cost and increase review of physician preference items. We describe the challenges, implementation, and outcomes of cost reduction and product stabilization of a value-based process for purchasing medical devices at a major academic medical center. We implemented a physician-driven committee that standardized and utilized evidence-based, clinically sound, and financially responsible methods for introducing or consolidating new supplies, devices, and technology for patient care. This committee worked with institutional finance and administrative leaders to accomplish its goals. Utilizing this physician-driven committee, we provided access to new products, standardized some products, decreased costs of physician preference items 11% to 26% across service lines, and achieved savings of greater than $8 million per year. The implementation of a facility-based technology assessment committee that critically evaluates new technology can decrease hospital costs on implants and standardize some product lines.
Huang, Pei-wen; Lamm, Alexa J.
Extension educators have diligently educated the general public about water conservation. Incorporating audiences' personal experience into educational programming is recommended as an approach to effectively enhance audiences' adoption of water conservation practices. To ensure the impact on the audiences and environment, understanding the…
Constabile, Kerry, Comp.; Craig, Heidi, Comp.; O'Laughlin, Laura, Comp.; Reiss, Anne Bei, Comp.; Spencer, Liz, Comp.
This guide provides basic information on the Clean Water Act, watersheds, and testing for water quality, and presents four science lesson plans on water quality. Activities include: (1) "Introduction to Water Quality"; (2) "Chemical Water Quality Testing"; (3) "Biological Water Quality Testing"; and (4) "What Can We Do?" (YDS)
Yusof, Ahmad Anas; Zaili, Zarin Syukri; Hassan, Siti Nor Habibah; Tuan, Tee Boon; Saadun, Mohd Noor Asril; Ibrahim, Mohd Qadafie
In promoting water hydraulics in Malaysia, this paper presents research development of water hydraulics educational training system for secondary and tertiary levels in Malaysia. Water hydraulics trainer with robotic attachment has been studied in order to promote the usefulness of such educational tools in promoting sustainability and green technology in the country. The trainer is being developed in order to allow constructive curriculum development and continuous marketing research for the effectiveness and usefulness of using water in hydraulic power trainer. The research on water-based hydraulic trainer is now possible with the current development in water hydraulics technology.
Miller, Harold D
Under fee-for-service payment systems, physicians and hospitals can be financially harmed by delivering higher-quality, more efficient care. The author describes how current "value-based purchasing" initiatives fail to address the underlying problems in fee-for-service payment and can be particularly problematic for academic health centers (AHCs). Bundled payments, warranties, and condition-based payments can correct the problems with fee-for-service payments and enable physicians and hospitals to redesign care delivery without causing financial problems for themselves. However, the author explains several specific actions that are needed to ensure that payment reforms can be a "win-win-win" for patients, purchasers, and AHCs: (1) disconnecting funding for teaching and research from payment for service delivery, (2) providing predictable payment for essential hospital services, (3) improving the quality and efficiency of care at AHCs, and (4) supporting collaborative relationships between AHCs and community providers by allowing each to focus on their unique strengths and by paying AHC specialists to assist community providers in diagnosis and treatment. With appropriate payment reforms and a commitment by AHCs to redesign care delivery, medical education, and research, AHCs could provide the leadership needed to improve care for patients, lower costs for health care purchasers, and maintain the financial viability of both AHCs and community providers.
Kok, Hans; Kessen, Shelly
Describes a program in which a rainfall simulator was used to promote water conservation by showing water infiltration, water runoff, and soil erosion. The demonstrations provided a good background for the discussion of issues such as water conservation, crop rotation, and conservation tillage practices. The program raised awareness of…
DeLorme, Denise E.; Hagen, Scott C.; Stout, I. Jack
Explores the relationship between population growth, development, and water resources to glean insight for environmental education campaigns. Reports high awareness and moderate concern about rapid growth and development, dissatisfaction with water resource quantity and quality, and varied water management strategies among consumers. (Contains 37…
Eggbeer, Bill; Sears, Kevin; Homer, Ken
Health systems pursing value-based contracts should address six important considerations: The definition of value. Contracting goals. Cost of implementation. Risk exposure. Contract structure and design. Essential contractual protections.
Powers, Matthew; Balch, Tucker
Value-Based Communication Preservation (VBCP) is a behavior-based, computationally efficient approach to maintaining line-of-sight radiofrequency communication between members of robot teams in the context of other tasks...
Henrikson, Nora B; Anderson, Melissa L; Hubbard, Rebecca A; Fishman, Paul; Grossman, David C
Value-based insurance designs (VBD) incorporate evidence-based medicine into health benefit design. Consumer knowledge of new VBD benefits is important to assessing their impact on health care use. To assess knowledge of features of a VBD. The eligible study population was employees receiving healthcare benefits in an integrated care system in the U.S. Pacific Northwest. In 2010, participants completed a web-based survey 2 months after rollout of the plan, including three true/false questions about benefit design features including copays for preventive care visits and chronic disease medications and premium costs. Analysis was completed in 2012. Knowledgeable was defined as correct response to all three questions; self-reported knowledge was also assessed. A total of 3,463 people completed the survey (response rate=71.7%). The majority of respondents were female (80.1%) Caucasians (79.6%) aged 35-64 years (79.0%), reflecting the overall employee population. A total of 45.7% had at least a 4-year college education, and 69.1% were married. About three quarters of respondents correctly answered each individual question; half (52.1%) of respondents answered all three questions correctly. On multivariate analysis, knowledge was independently associated with female gender (OR=1.80, 95% CI=1.40, 2.31); Caucasian race (OR=1.72, 95% CI=1.28, 2.32); increasing household income (OR for ≥$100,000=1.86, 95% CI=1.29, 2.68); nonunion job status (OR compared to union status=1.63, 95% CI=1.17, 2.26); and high satisfaction with the health plan (OR compared to low satisfaction=1.26; 95% CI=1.00, 1.57). Incomplete knowledge of benefits is prevalent in an employee population soon after VBD rollout. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Eriksson, Eva; Arvin, Erik; Ucendo, Inmaculada Maria Buendia
The Danish water sector is in dire need for competence development to accommodate the changes in Danish water governance (decentralisation,privatisation and larger entities) and the implementation of relevant EuropeanUnion (EU) directives. In parallel, the number of international students enrolled......, DTUEnvironment has created an e-learning platform called Water Education (WatEdu) scheduled to be operational in 2011....
Sullivan, Gregory P.; Elliott, Douglas B.; Hillman, Tim C.; Hadley, Adam; Ledbetter, Marc R.; Payson, David R.
The objective of this study was to develop, monitor, analyze, and report on an integrated resource-conservation program highlighting efficient residential appliances and fixtures. The sites of study were 50 homes in two water-constrained communities located in Oregon. The program was designed to maximize water savings to these communities and to serve as a model for other communities seeking an integrated approach to energy and water resource efficiency. The program included the installation and in-place evaluation of energy- and water-efficient devices including the following: horizontal axis clothes washers (and the matching clothes dryers), resource-efficient dishwashers, an innovative dual flush low-flow toilet, low-flow showerheads, and faucet aerators. The significance of this activity lies in its integrated approach and unique metering evaluation of individual end-use, aggregated residential total use, and system-wide energy and water benefits.
Tajima, Satohiro; Drugowitsch, Jan; Pouget, Alexandre
For decades now, normative theories of perceptual decisions, and their implementation as drift diffusion models, have driven and significantly improved our understanding of human and animal behaviour and the underlying neural processes. While similar processes seem to govern value-based decisions, we still lack the theoretical understanding of why this ought to be the case. Here, we show that, similar to perceptual decisions, drift diffusion models implement the optimal strategy for value-based decisions. Such optimal decisions require the models' decision boundaries to collapse over time, and to depend on the a priori knowledge about reward contingencies. Diffusion models only implement the optimal strategy under specific task assumptions, and cease to be optimal once we start relaxing these assumptions, by, for example, using non-linear utility functions. Our findings thus provide the much-needed theory for value-based decisions, explain the apparent similarity to perceptual decisions, and predict conditions under which this similarity should break down.
The European Society of Radiology (ESR) established a Working Group on Value-Based Imaging (VBI WG) in August 2016 in response to developments in European healthcare systems in general, and the trend within radiology to move from volume- to value-based practice in particular. The value-based healthcare (VBH) concept defines "value" as health outcomes achieved for patients relative to the costs of achieving them. Within this framework, value measurements start at the beginning of therapy; the whole diagnostic process is disregarded, and is considered only if it is the cause of errors or complications. Making the case for a new, multidisciplinary organisation of healthcare delivery centred on the patient, this paper establishes the diagnosis of disease as a first outcome in the interrelated activities of the healthcare chain. Metrics are proposed for measuring the quality of radiologists' diagnoses and the various ways in which radiologists provide value to patients, other medical specialists and healthcare systems at large. The ESR strongly believes value-based radiology (VBR) is a necessary complement to existing VBH concepts. The Society is determined to establish a holistic VBR programme to help European radiologists deal with changes in the evolution from volume- to value-based evaluation of radiological activities. Main Messages • Value-based healthcare defines value as patient's outcome over costs. • The VBH framework disregards the diagnosis as an outcome. • VBH considers diagnosis only if wrong or a cause of complications. • A correct diagnosis is the first outcome that matters to patients. • Metrics to measure radiologists' impacts on patient outcomes are key. • The value provided by radiology is multifaceted, going beyond exam volumes.
Values are those principles that govern behaviours, and values-based practice has been described as a theory and skills base for effective healthcare decision-making where different (and hence potentially conflicting) values are in play. The emphasis is on good process rather than pre-set right outcomes, aiming to achieve balanced decision-making. In this article we will consider the utility of this model by looking at leadership development, a current area of much interest and investment in healthcare. Copeland points out that 'values based leadership behaviors are styles with a moral, authentic and ethical dimension', important qualities in healthcare decision-making.
Naidu, Thirusha; Kumagai, Arno K
The idea of exporting the concept of reflective practice for a global medical education audience is growing. However, the uncritical export and adoption of Western concepts of reflection may be inappropriate in non-Western societies. The emphasis in Western medical education on the use of reflection for a specific end--that is, the improvement of individual clinical practice--tends to ignore the range of reflective practice, concentrating on reflection alone while overlooking critical reflection and reflexivity. This Perspective places the concept of reflective practice under a critical lens to explore a broader view for its application in medical education outside the West. The authors suggest that ideas about reflection in medicine and medical education may not be as easily transferable from Western to non-Western contexts as concepts from biomedical science are. The authors pose the question, When "exporting" Western medical education strategies and principles, how often do Western-trained educators authentically open up to the possibility that there are alternative ways of seeing and knowing that may be valuable in educating Western physicians? One answer lies in the assertion that educators should aspire to turn exportation of educational theory into a truly bidirectional, collaborative exchange in which culturally conscious views of reflective practice contribute to humanistic, equitable patient care. This discussion engages in troubling the already-muddy waters of reflective practice by exploring the global applicability of reflective practice as it is currently applied in medical education. The globalization of medical education demands critical reflection on reflection itself.
Tanenbaum, Sandra J
Value-based purchasing (VBP) is a widely favored strategy for improving the US health care system. The meaning of value that predominates in VBP schemes is (1) conformance to selected process and/or outcome metrics, and sometimes (2) such conformance at the lowest possible cost. In other words, VBP schemes choose some number of "quality indicators" and financially incent providers to meet them (and not others). Process measures are usually based on clinical science that cannot determine the effects of a process on individual patients or patients with comorbidities, and do not necessarily measure effects that patients value; additionally, there is no provision for different patients valuing different things. Proximate outcome measures may or may not predict distal ones, and the more distal the outcome, the less reliably it can be attributed to health care. Outcome measures may be quite rudimentary, such as mortality rates, or highly contestable: survival or function after prostate surgery? When cost is an element of value-based purchasing, it is the cost to the value-based payer and not to other payers or patients' families. The greatest value of value-based purchasing may not be to patients or even payers, but to policy makers seeking a morally justifiable alternative to politically contested regulatory policies. Copyright © 2016 by Duke University Press.
Full Text Available Ethical principles constitute a crucial area of debate and discussion in the global conversation around transitions to sustainability, and of particular relevance to the contribution of businesses and other organizations. Scholars in business ethics have recently identified several challenges in this area, such as problems of measurement, rigor, and meaningfulness to practitioners; corporate social responsibility; and institutionalization of ethics in businesses. In this paper, the impacts of a pragmatic values-based evaluation approach originally developed in another field—education for sustainable development—are shown to strongly contribute to many of these challenges. Impacts found across eight organizations include (i deep values conceptualization; (ii increased esteem (iii building capacity for assessment of values-based achievements; (iv values mainstreaming; and (v effective external values communications. It seems that the in-situ development and use of values-based indicators helped to conceptualize locally shared values that underpin decisions, thus embedding the application of (local ethics. Although this study is exploratory, it is clear that the values-based approach shows promise for meeting key challenges in business ethics and wider sustainability, and for new directions for future cross-disciplinary research.
Castilla Rho, J. C.; Mariethoz, G.; Rojas, R. F.; Andersen, M. S.; Kelly, B. F.; Holley, C.
Scientists rely on models of the water cycle to describe and predict problems of water scarcity in a changing climate, and to suggest adaptation strategies for securing future water needs. Yet these models are too often complicated for managers, the general public and for students to understand. Simpler modelling environments will help with finding solutions by engaging a broader segment of the population. Such environments will enable education at the earliest stages and collective action. I propose that simulation games can be an effective communication platform between scientists and 'non-experts' and that such games will shed light on problems of pollution and overuse of water resources. In the same way as pilots use flight simulators to become proficient at flying aircraft, simulation games—if underpinned by good science—can be used to educate the public, students and managers about how to best manage our water resources. I aim to motivate young scientists to think about using games to advance water education and management.
Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should include all domains of health in a full cycle of care. To implement value-based healthcare, transformations need to be done by both health providers and patients: establishing true health outcomes, strengthening primary care, building integrated health systems, implementing appropriate health payment schemes that promote value and reduce moral hazards, enabling health information technology, and creating a policy that fits well with a community.
Gupta, Krishan M.
Within the last few years, a host of value-based metrics like EVA, MVA, TBR, CFORI, and TSR have evolved. This paper attempts to analyze the validity and applicability of EVA and Balanced Scorecard for Internet based organizations. Despite the collapse of the dot-com model, the firms engaged in e- commerce continue to struggle to find new ways to account for customer-base, technology, employees, knowledge, etc, as part of the value of the firm. While some metrics, like the Balance Scorecard are geared towards internal use, others like EVA are for external use. Value-based metrics are used for performing internal audits as well as comparing firms against one another; and can also be effectively utilized by individuals outside the firm looking to determine if the firm is creating value for its stakeholders.
Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should ...
Feuz, Dillon M.
There is concern in the beef industry that present marketing practices may be impending the transmission of economic signals from consumers to producers. Presently, fed cattle may be sold on a show list, pen-by-pen, or on an individual head basis, and may be priced using live weight, dressed weight, or grid or formula pricing. Market signals are more likely to reach producers if cattle are priced individually. Current value-based pricing are discussed. Three grid pricing systems are evaluated...
Brooks, Gabriel A; Bosserman, Linda D; Mambetsariev, Isa; Salgia, Ravi
Clinical oncology is in the midst of a genomic revolution, as molecular insights redefine our understanding of cancer biology. Greater awareness of the distinct aberrations that drive carcinogenesis is also contributing to a growing armamentarium of genomically targeted therapies. Although much work remains to better understand how to combine and sequence these therapies, improved outcomes for patients are becoming manifest. As we welcome this genomic revolution in cancer care, oncologists also must grapple with a number of practical problems. Costs of cancer care continue to grow, with targeted therapies responsible for an increasing proportion of spending. Rising costs are bringing the concept of value into sharper focus and challenging the oncology community with implementation of value-based cancer care. This article explores the ways that the genomic revolution is transforming cancer care, describes various frameworks for considering the value of genomically targeted therapies, and outlines key challenges for delivering on the promise of personalized cancer care. It highlights practical solutions for the implementation of value-based care, including investment in biomarker development and clinical trials to improve the efficacy of targeted therapy, the use of evidence-based clinical pathways, team-based care, computerized clinical decision support, and value-based payment approaches.
Project WET Foundation, 2008
Clean water, proper sanitation and good hygiene form a solid foundation for a student's health education. This activities guide is designed to enable teachers to take an active role in making a real difference in the lives of children and their families. Its 40 pages are filled with engaging ways to impart an understanding about how common…
Grubbs, Michael E.; Deck, Anita
Water turbines have long been used to make work easier for humans while minimizing energy consumption. They are not only used in small- and large-scale operations, but also provide a great context for Integrative STEM education. Students can begin to understand the technological processes available by designing, building, and testing different…
The goal of the study was to investigate the impact of water shortages on educational delivery in selected schools in Harare East District. The population included school heads, teachers and pupils all drawn from selected schools of Harare East District. The sample consisted of five school heads, fifty teachers and one ...
Conrad, Douglas A
To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.
Babar, Muhammad Imran; Ghazali, Masitah; Jawawi, Dayang N A; Bin Zaheer, Kashif
Value-based requirements engineering plays a vital role in the development of value-based software (VBS). Stakeholders are the key players in the requirements engineering process, and the selection of critical stakeholders for the VBS systems is highly desirable. Based on the stakeholder requirements, the innovative or value-based idea is realized. The quality of the VBS system is associated with the concrete set of valuable requirements, and the valuable requirements can only be obtained if all the relevant valuable stakeholders participate in the requirements elicitation phase. The existing value-based approaches focus on the design of the VBS systems. However, the focus on the valuable stakeholders and requirements is inadequate. The current stakeholder identification and quantification (SIQ) approaches are neither state-of-the-art nor systematic for the VBS systems. The existing approaches are time-consuming, complex and inconsistent which makes the initiation process difficult. Moreover, the main motivation of this research is that the existing SIQ approaches do not provide the low level implementation details for SIQ initiation and stakeholder metrics for quantification. Hence, keeping in view the existing SIQ problems, this research contributes in the form of a new SIQ framework called 'StakeMeter'. The StakeMeter framework is verified and validated through case studies. The proposed framework provides low-level implementation guidelines, attributes, metrics, quantification criteria and application procedure as compared to the other methods. The proposed framework solves the issues of stakeholder quantification or prioritization, higher time consumption, complexity, and process initiation. The framework helps in the selection of highly critical stakeholders for the VBS systems with less judgmental error.
Muhammad Imran Babar
Full Text Available Value-based requirements engineering plays a vital role in the development of value-based software (VBS. Stakeholders are the key players in the requirements engineering process, and the selection of critical stakeholders for the VBS systems is highly desirable. Based on the stakeholder requirements, the innovative or value-based idea is realized. The quality of the VBS system is associated with the concrete set of valuable requirements, and the valuable requirements can only be obtained if all the relevant valuable stakeholders participate in the requirements elicitation phase. The existing value-based approaches focus on the design of the VBS systems. However, the focus on the valuable stakeholders and requirements is inadequate. The current stakeholder identification and quantification (SIQ approaches are neither state-of-the-art nor systematic for the VBS systems. The existing approaches are time-consuming, complex and inconsistent which makes the initiation process difficult. Moreover, the main motivation of this research is that the existing SIQ approaches do not provide the low level implementation details for SIQ initiation and stakeholder metrics for quantification. Hence, keeping in view the existing SIQ problems, this research contributes in the form of a new SIQ framework called 'StakeMeter'. The StakeMeter framework is verified and validated through case studies. The proposed framework provides low-level implementation guidelines, attributes, metrics, quantification criteria and application procedure as compared to the other methods. The proposed framework solves the issues of stakeholder quantification or prioritization, higher time consumption, complexity, and process initiation. The framework helps in the selection of highly critical stakeholders for the VBS systems with less judgmental error.
Babar, Muhammad Imran; Ghazali, Masitah; Jawawi, Dayang N. A.; Zaheer, Kashif Bin
Value-based requirements engineering plays a vital role in the development of value-based software (VBS). Stakeholders are the key players in the requirements engineering process, and the selection of critical stakeholders for the VBS systems is highly desirable. Based on the stakeholder requirements, the innovative or value-based idea is realized. The quality of the VBS system is associated with the concrete set of valuable requirements, and the valuable requirements can only be obtained if all the relevant valuable stakeholders participate in the requirements elicitation phase. The existing value-based approaches focus on the design of the VBS systems. However, the focus on the valuable stakeholders and requirements is inadequate. The current stakeholder identification and quantification (SIQ) approaches are neither state-of-the-art nor systematic for the VBS systems. The existing approaches are time-consuming, complex and inconsistent which makes the initiation process difficult. Moreover, the main motivation of this research is that the existing SIQ approaches do not provide the low level implementation details for SIQ initiation and stakeholder metrics for quantification. Hence, keeping in view the existing SIQ problems, this research contributes in the form of a new SIQ framework called ‘StakeMeter’. The StakeMeter framework is verified and validated through case studies. The proposed framework provides low-level implementation guidelines, attributes, metrics, quantification criteria and application procedure as compared to the other methods. The proposed framework solves the issues of stakeholder quantification or prioritization, higher time consumption, complexity, and process initiation. The framework helps in the selection of highly critical stakeholders for the VBS systems with less judgmental error. PMID:25799490
Full Text Available The article discusses the practical aspects of using the theory of value management in quality management. Presents the essence of value based management (VBM as a background of reflection on its links with quality management. Coherence of the concept in practice, been reviewed in the author’s own studies. The discovery of absence of sufficient procedural structure of the metrics of an economic – financial, to measure the value of the quality management system, points to a gap between the theoretical and practical considerations in managing the value of the company quality management system.
Gibson, Teresa B; Maclean, Ross J; Chernew, Michael E; Fendrick, A Mark; Baigel, Colin
As value-based insurance design (VBID) programs proliferate, evidence is emerging on the impact of VBID. To date, studies have largely measured VBID impact on utilization, and a few studies have assessed its impact on quality, outcomes, and cost. In this commentary we discuss these domains, summarize evidence, and propose the extension of measurement of VBID impact into areas including workplace productivity and quality of life, employee and patient engagement, and talent attraction and retention. We contend that VBID evaluations should consider a broad variety of programmatic dividends on both humanistic and health-related outcomes.
A new water tunnel is designed and tested for educational and research purposes at Northern Arizona University. The university currently owns an educational wind tunnel with a test section of 12in X 12in X 24in. However, due to limited size of test section and range of Reynolds numbers, its application is currently limited to very few experiments. In an effort to expand the educational and research capabilities, a student team is tasked to design, build and test a water tunnel as a Capstone Senior Design project. The water tunnel is designed to have a test section of 8in X 8in X 36in. and be able to test up to Re = 50E3. Multiple numerical models are used to optimize the flow field inside the test section before building the physical apparatus. The water tunnel is designed to accommodate multiple experiments for drag and lift studies. The built-in die system can deliver up to three different colors to study the streamlines and vortex shedding from the surfaces. During the first phase, a low discharge pump is used to achieve Re = 4E3 to test laminar flows. In the second phase, a high discharge pump will be used to achieve targeted Re = 50E3 to study turbulent flows.
Lum, Hillary D; Dukes, Joanna; Church, Skotti; Abbott, Jean; Youngwerth, Jean M
Advance care planning (ACP) promotes care consistent with patient wishes. Medical education should teach how to initiate value-based ACP conversations. To develop and evaluate an ACP educational session to teach medical students a value-based ACP process and to encourage students to take personal ACP action steps. Groups of third-year medical students participated in a 75-minute session using personal reflection and discussion framed by The Conversation Starter Kit. The Conversation Project is a free resource designed to help individuals and families express their wishes for end-of-life care. One hundred twenty-seven US third-year medical students participated in the session. Student evaluations immediately after the session and 1 month later via electronic survey. More than 90% of students positively evaluated the educational value of the session, including rating highly the opportunities to reflect on their own ACP and to use The Conversation Starter Kit. Many students (65%) reported prior ACP conversations. After the session, 73% reported plans to discuss ACP, 91% had thought about preferences for future medical care, and 39% had chosen a medical decision maker. Only a minority had completed an advance directive (14%) or talked with their health-care provider (1%). One month later, there was no evidence that the session increased students' actions regarding these same ACP action steps. A value-based ACP educational session using The Conversation Starter Kit successfully engaged medical students in learning about ACP conversations, both professionally and personally. This session may help students initiate conversations for themselves and their patients.
Murty, Vishnu; FeldmanHall, Oriel; Hunter, Lindsay E.; Phelps, Elizabeth A; Davachi, Lila
Prior research illustrates that memory can guide value-based decision-making. For example, previous work has implicated both working memory and procedural memory (i.e., reinforcement learning) in guiding choice. However, other types of memories, such as episodic memory, may also influence decision-making. Here we test the role for episodic memory—specifically item versus associative memory—in supporting value-based choice. Participants completed a task where they first learned the value associated with trial unique lotteries. After a short delay, they completed a decision-making task where they could choose to re-engage with previously encountered lotteries, or new never before seen lotteries. Finally, participants completed a surprise memory test for the lotteries and their associated values. Results indicate that participants chose to re-engage more often with lotteries that resulted in high versus low rewards. Critically, participants not only formed detailed, associative memories for the reward values coupled with individual lotteries, but also exhibited adaptive decision-making only when they had intact associative memory. We further found that the relationship between adaptive choice and associative memory generalized to more complex, ecologically valid choice behavior, such as social decision-making. However, individuals more strongly encode experiences of social violations—such as being treated unfairly, suggesting a bias for how individuals form associative memories within social contexts. Together, these findings provide an important integration of episodic memory and decision-making literatures to better understand key mechanisms supporting adaptive behavior. PMID:26999046
Koenig, Lane; Dall, Timothy M; Ruiz, David; Saavoss, Josh; Tongue, John
Among policy alternatives considered to reduce health care costs and improve outcomes, value-based insurance design (VBID) has emerged as a promising option. Most applications of VBID, however, have not used higher cost sharing to discourage specific services. In April 2011, the state of Oregon introduced a policy for public employees that required additional cost sharing for high-cost procedures such as total knee arthroplasty (TKA). Our objectives were to estimate the societal impact of higher co-pays for TKA using Oregon as a case study and building on recent work demonstrating the effects of knee osteoarthritis and surgical treatment on employment and disability outcomes. We used a Markov model to estimate the societal impact in terms of quality of life, direct costs, and indirect costs of higher co-pays for TKA using Oregon as a case study. We found that TKA for a working population can generate societal benefits that offset the direct medical costs of the procedure. Delay in receiving surgical care, because of higher co-payment or other reasons, reduced the societal savings from TKA. We conclude that payers moving toward value-based cost sharing should consider consequences beyond direct medical expenses. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Teng, Jen-Hao; Chen, Chi-Fa [Department of Electrical Engineering, I-Shou University, No. 1, Section 1, Syuecheng Road, Dashu Township, Kaohsiung Country 840 (Taiwan); Liu, Yi-Hwa [Department of Electrical Engineering, National Taiwan University of Science and Technology, Taipei (Taiwan); Chen, Chia-Yen [Department of Computer Science, The University of Auckland (New Zealand)
Distributed generator (DG) resources are small, self-contained electric generating plants that can provide power to homes, businesses or industrial facilities in distribution feeders. They can be used to reduce power loss and improve service reliability. However, the values of DGs are largely dependent on their types, sizes and locations as they were installed in distribution feeders. A value-based method is proposed in this paper to enhance the reliability and obtain the benefits for DG placement. The benefits of DG placement described in this paper include power cost saving, power loss reduction, and reliability enhancement. The costs of DG placement include the investment, maintenance and operating costs. The proposed value-based method tries to find the best tradeoff between the costs and benefits of DG placement and then find the optimal types of DG and their corresponding locations and sizes in distribution feeders. The derived formulations are solved by a genetic algorithm based method. Test results show that with proper types, sizes and installation site selection, DG placement can be used to improve system reliability, reduce customer interruption costs and save power cost; as well as enabling electric utilities to obtain the maximal economical benefits. (author)
Sudiajeng, L.; Parwita, I. G. L.; Wiraga, I. W.; Mudhina, M.
The previous research showed that there were indicators of water crisis in the northern and eastern part of Denpasar city and most of coastal area experienced on seawater intrusion. The recommended water conservation programs were rainwater harvesting and educate the community to develop a water saving and environmentally conscious culture. This research was conducted to built the community based educational model on water conservation program through ergonomics SHIP approach which placed the human aspect as the first consideration, besides the economic and technically aspects. The stakeholders involved in the program started from the problem analyses to the implementation and the maintenance as well. The model was built through three main steps, included determination of accepted design; building the recharge wells by involving local communities; guidance and assistance in developing a water saving and environmentally conscious culture for early childhood, elementary and junior high school students, community and industry. The program was implemented based on the “TRIHITA KARANA” concept, which means the relationship between human to God, human-to-human, and human to environment. Through the development of the model, it is expected to grow a sense of belonging and awareness from the community to maintain the sustainability of the program.
Korsgaard, Louise; Jensen, R.A.; Jønch-Clausen, Torkil
An important challenge of Integrated Water Resources Management (IWRM) is to balance water allocation between different users and uses. While economically and/or politically powerful users have relatively well developed methods for quantifying and justifying their water needs, this is not the case...... methodologies. The SPI approach is a pragmatic and transparent tool for incorporating ecosystems and environmental flows into the evaluation of water allocation scenarios, negotiations of trade-offs and decision-making in IWRM....
Jensen, Per Anker
Value has in recent years become a popular term in management theory and practice in general as well as in economic theory and architectural management. This paper attempts to clarify the various uses and meanings of concepts of value/values. Six different value concepts are identified. The ori......-gin and use of value concepts in classic and modern economic theory and in management theory is outlined. The question of objectivity and subjectivity is discussed in relation to economic value and customer value. Value creation is put in relation to development in products and processes and a number...... of design strategies are identified. The concept and methods of value based management and collaboration is discussed in this context. The paper is mainly theoretical and based on work during a MBA study in 2002-04 as well as many years of experience as building client and facilities manager....
Henkel, Robert J; Maryland, Patricia A
As healthcare systems across the country shift to value-based care, they face an enormous challenge. Not only must they reimagine how they identify, engage, and manage the care of patients, they also need to determine new ways of engaging and aligning physicians and other caregivers in creating better-coordinated care across the continuum. This article explores how healthcare systems making the transition from volume to value can maximize their reward while managing their risk. As the largest not-for-profit healthcare system in the United States and the largest Catholic healthcare system in the world, Ascension is committed to making its own transition, marked by broad-based innovation. We call this goal the Quadruple Aim: improving health outcomes, patient experiences, and provider experiences while lowering the overall cost of care. Healthcare systems and providers have many value-based models to choose from, including pay for performance (P4P), shared savings, bundled payments, shared risk, global capitation, and provider-sponsored health plans. Analysis of these options should include an evaluation of market readiness (i.e., the ability of a health system to align with the needs of employers or commercial insurers in a given market). Healthcare systems also must be prepared to invest in resources that facilitate effective transitions and continuity of care--for example, care management. In addition, they need to recognize that as they focus on wellness, inpatient volumes will decline, requiring cost-structure adjustments and added ancillary services to compensate for this decline. Some healthcare systems are even exploring the possibility of becoming their own payer, taking on more risk and responsibility for the health of patients and populations.
During the past decade, payment models for the delivery of health care have undergone a dramatic shift from focusing on volume to focusing on value. This shift began with the Affordable Care Act and was reinforced by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which increased the emphasis on payment for delivery of quality care. Today, value-based care is a primary strategy for improving patient care while managing costs. This shift in payment models is expanding beyond the delivery of health care services to encompass models of compensation between payers and biopharmaceutical manufacturers. Value-based contracts (VBCs) have emerged as a mechanism that payers may use to better align their contracting structures with broader changes in the health care system. While pharmaceuticals represent a small share of total health care spending, it is one of the fastest-growing segments of the health care marketplace, and the increasing costs of pharmaceuticals necessitate more flexibility to contract in new ways based on the value of these products. Although not all products or services are appropriate for these types of contracts, VBCs could be a part of the solution to address increasing drug prices and overall drug spending. VBCs encompass a variety of different contracting strategies for biopharmaceutical products that do not base payment rates on volume. These contracts instead may include payment on the achievement of specific goals in a predetermined patient population and offer innovative solutions for quantifying and rewarding positive outcomes or otherwise reducing payer risk associated with pharmaceutical costs. To engage national stakeholders in a discussion of current practices, barriers, and potential benefits of VBCs, the Academy of Managed Care Pharmacy (AMCP) convened a Partnership Forum on Advancing Value-Based Contracting in Arlington, Virginia, on June 20-21, 2017. The goals of the VBC forum were as follows: (a) agree to a definition
Patti, James C; Ore, Ana Sofia; Barrows, Courtney; Velanovich, Vic; Moser, A James
Current healthcare economic evaluations are based only on the perspective of a single stakeholder to the healthcare delivery process. A true value-based decision incorporates all of the outcomes that could be impacted by a single episode of surgical care. We define the value proposition for robotic surgery using a stakeholder model incorporating the interests of all groups participating in the provision of healthcare services: patients, surgeons, hospitals and payers. One of the developing and expanding fields that could benefit the most from a complete value-based analysis is robotic hepatopancreaticobiliary (HPB) surgery. While initial robot purchasing costs are high, the benefits over laparoscopic surgery are considerable. Performing a literature search we found a total of 18 economic evaluations for robotic HPB surgery. We found a lack of evaluations that were carried out from a perspective that incorporates all of the impacts of a single episode of surgical care and that included a comprehensive hospital cost assessment. For distal pancreatectomies, the two most thorough examinations came to conflicting results regarding total cost savings compared to laparoscopic approaches. The most thorough pancreaticoduodenectomy evaluation found non-significant savings for total hospital costs. Robotic hepatectomies showed no cost savings over laparoscopic and only modest savings over open techniques. Lastly, robotic cholecystectomies were found to be more expensive than the gold-standard laparoscopic approach. Existing cost accounting data associated with robotic HPB surgery is incomplete and unlikely to reflect the state of this field in the future. Current data combines the learning curves for new surgical procedures being undertaken by HPB surgeons with costs derived from a market dominated by a single supplier of robotic instruments. As a result, the value proposition for stakeholders in this process cannot be defined. In order to solve this problem, future studies
Tamir, Maya; Schwartz, Shalom H; Cieciuch, Jan; Riediger, Michaela; Torres, Claudio; Scollon, Christie; Dzokoto, Vivian; Zhou, Xiaolu; Vishkin, Allon
Values reflect how people want to experience the world; emotions reflect how people actually experience the world. Therefore, we propose that across cultures people desire emotions that are consistent with their values. Whereas prior research focused on the desirability of specific affective states or 1 or 2 target emotions, we offer a broader account of desired emotions. After reporting initial evidence for the potential causal effects of values on desired emotions in a preliminary study (N = 200), we tested the predictions of our proposed model in 8 samples (N = 2,328) from distinct world cultural regions. Across cultural samples, we found that people who endorsed values of self-transcendence (e.g., benevolence) wanted to feel more empathy and compassion, people who endorsed values of self-enhancement (e.g., power) wanted to feel more anger and pride, people who endorsed values of openness to change (e.g., self-direction) wanted to feel more interest and excitement, and people who endorsed values of conservation (e.g., tradition) wanted to feel more calmness and less fear. These patterns were independent of differences in emotional experience. We discuss the implications of our value-based account of desired emotions for understanding emotion regulation, culture, and other individual differences. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Value-based benefits and costs of demand-side management (DSM) were discussed in the context of local electricity resource planning in downtown Toronto. The analysis considered the effects on local customer interruption as a result of DSM, and the deferment in need for local transmission and distribution upgrades. The life cycle and cash flow benefits and costs of DSM were discussed from the perspectives of the electric utility, the DSM-participating and non-participating customers, and society as a whole. Cashflow and lifecycle analyses results were reconciled. The Toronto Integrated Electrical Service (TIES) study, the basis for this paper, was described. Two main conclusions were reached, i.e. since the savings in the generationg system as a whole were far greater than the local savings,the value of a specific DSM program would be similar across a utility's service area, and (2) while cashflow analysis illustrated the short and medium term benefits and costs in a way most people intuitively understand, in effect,the lifecycle-cost estimates produce a clearer indicator of long-run economics
Brown, Melissa M; Brown, Gary C; Brown, Heidi
The aim of this article is to review the patient value conferred by interventions for neovascular macular degeneration. Value-based medicine is the practice of medicine based upon the patient value (improvement in quality of life and length of life) conferred by an intervention. For ophthalmologic interventions, in which length-of-life is generally unaffected, the value gain is equivalent to the improvement in quality of life. Photodynamic therapy delivers a value gain (improvement in quality of life) of 8.1% for the average person with classic subfoveal choroidal neovascularization, while laser photocoagulation for the same entity confers a 4.4% improvement in quality of life. Preliminary data suggest the value gain for the treatment of occult/minimally classic choroidal neovascularization with ranibizumab is greater than 15%. The average value gain for statins for the treatment of hyperlipidemia is 3.9%, while that for the use of biphosphonates for the treatment of osteoporosis is 1.1% and that for drugs to treat benign prostatic hyperplasia is 1-2%. Interventions, especially ranibizumab therapy, for neovascular macular degeneration appear to deliver an extraordinary degree of value compared with many other interventions across healthcare.
Colldén, Christian; Gremyr, Ida; Hellström, Andreas; Sporraeus, Daniella
Purpose The concept of value is becoming increasingly fashionable in healthcare and various improvement approaches (IAs) have been introduced with the aim of increasing value. The purpose of this paper is to construct a taxonomy that supports the management of parallel IAs in healthcare. Design/methodology/approach Based on previous research, this paper proposes a taxonomy that includes the dimensions of view on value and organizational focus; three contemporary IAs - lean, value-based healthcare, and patient-centered care - are related to the taxonomy. An illustrative qualitative case study in the context of psychiatric (psychosis) care is then presented that contains data from 23 interviews and focuses on the value concept, IAs, and the proposed taxonomy. Findings Respondents recognized the dimensions of the proposed taxonomy and indicated its usefulness as support for choosing and combining different IAs into a coherent management model, and for facilitating dialog about IAs. The findings also suggested that the view of value as "health outcomes" is widespread, but healthcare professionals are less likely than managers to also view value as a process. Originality/value The conceptual contribution of this paper is to delineate some important characteristics of IAs in relation to the emerging "value era". It also highlights the coexistence of different IAs in healthcare management practice. A taxonomy is proposed that can help managers choose, adapt, and combine IAs in local management models.
van Deen, Welmoed K; Esrailian, Eric; Hommes, Daniel W
Increasing healthcare costs worldwide put the current healthcare systems under pressure. Although many efforts have aimed to contain costs in medicine, only a few have achieved substantial changes. Inflammatory bowel diseases rank among the most costly of chronic diseases, and physicians nowadays are increasingly engaged in health economics discussions. Value-based health care [VBHC] has gained a lot of attention recently, and is thought to be the way forward to contain costs while maintaining quality. The key concept behind VBHC is to improve achieved outcomes per encountered costs, and evaluate performance accordingly. Four main components need to be in place for the system to be effective:  accurate measurement of health outcomes and costs;  reporting of these outcomes and benchmarking against other providers;  identification of areas in need of improvement based on these data and adjusting the care delivery processes accordingly; and  rewarding high-performing participants. In this article we will explore the key components of VBHC, we will review available evidence focussing on inflammatory bowel diseases, and we will present our own experience as a guide for other providers. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: firstname.lastname@example.org.
Borah Bijan J
Full Text Available Abstract Background Medicare hospital Value-based purchasing (VBP program that links Medicare payments to quality of care will become effective from 2013. It is unclear whether specific hospital characteristics are associated with a hospital’s VBP score, and consequently incentive payments. The objective of the study was to assess the association of hospital characteristics with (i the mean VBP score, and (ii specific percentiles of the VBP score distribution. The secondary objective was to quantify the associations of hospital characteristics with the VBP score components: clinical process of care (CPC score and patient satisfaction score. Methods Observational analysis that used data from three sources: Medicare Hospital Compare Database, American Hospital Association 2010 Annual Survey and Medicare Impact File. The final study sample included 2,491 U.S. acute care hospitals eligible for the VBP program. The association of hospital characteristics with the mean VBP score and specific VBP score percentiles were assessed by ordinary least square (OLS regression and quantile regression (QR, respectively. Results VBP score had substantial variations, with mean score of 30 and 60 in the first and fourth quartiles of the VBP score distribution. For-profit status (vs. non-profit, smaller bed size (vs. 100–199 beds, East South Central region (vs. New England region and the report of specific CPC measures (discharge instructions, timely provision of antibiotics and beta blockers, and serum glucose controls in cardiac surgery patients were positively associated with mean VBP scores (p Conclusions Although hospitals serving the poor and the elderly are more likely to score lower under the VBP program, the correlation appears small. Profit status, geographic regions, number and type of CPC measures reported explain the most variation among scores.
Nakamura, Mariko; Esaka, Takao; Kamata, Masahiro
Hoping that use of natural radioactivity as teaching materials helps learners to understand the existence of radiation in nature, the authors developed several kinds of safe and inexpensive experiments for elementary and junior high school education using hot spring water taken from Misasa, situated in Tottori prefecture, Japan. Here, they report the details of experimental procedure to observe the radioactive equilibrium between Rn 222 released from the hot spring water and its daughters as well as the decay after isolation from Rn 222. The experiment needs no hazardous chemicals nor Bunsen burners, and can be carried out in normal classrooms without any special apparatus. (S. Ohno)
Markovitz, Adam A; Ramsay, Patricia P; Shortell, Stephen M; Ryan, Andrew M
To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. Publicly available data from Medicare's Physician Compare (n = 1,278; January 2012 to November 2013) and nationally representative physician practice data from the National Survey of Physician Organizations 3 (NSPO3; n = 907,538; 2013). We used regression analysis to examine practice-level relationships between prior exposure to performance incentives and participation in key Medicare value-based payment reforms: accountable care organization (ACO) programs, the Physician Quality Reporting System ("Physician Compare"), and the Meaningful Use of Health Information Technology program ("Meaningful Use"). Prior experience and success with financial incentives were measured as (1) the percentage of practices' revenue from financial incentives for quality or efficiency; and (2) practices' exposure to public reporting of quality measures. We linked physician participation data from Medicare's Physician Compare to the NSPO3 survey. There was wide variation in practices' exposure to performance incentives, with 64 percent exposed to financial incentives, 45 percent exposed to public reporting, and 2.2 percent of practice revenue coming from financial incentives. For each percentage-point increase in financial incentives, there was a 0.9 percentage-point increase in the probability of participating in ACOs (standard error [SE], 0.1, p Financial incentives were not associated with participation in Physician Compare. Among ACO participants, a 1 percentage-point increase in incentives was associated with a 0.7 percentage-point increase in the probability of being "very well" prepared to utilize cost and quality data (SE, 0.1, p financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment
Blangero, Annabelle; Kelly, Simon P
value biases in sensorimotor decision making have been widely studied, little is known about the neural processes that set these biases in place beforehand. Here, we report the discovery of a transient, spatially selective neural signal in humans that encodes the relative value of competing decision alternatives and strongly predicts behavioral value biases in decisions made ∼500 ms later. Follow-up manipulations of value differential, reward valence, response modality, sensory features, and time constraints establish that the signal reflects an active, feature- and effector-general preparatory mechanism for value-based prioritization. Copyright © 2017 the authors 0270-6474/17/3710725-13$15.00/0.
Deals with the issue of water education, including problems, what should be done, what can be done, and what to do. Presents two curricular units on water and two interdisciplinary, environmentally oriented courses for use in Israel. (YP)
... and 480 [CMS-3239-CN] RIN 0938-AQ55 Medicare Program; Hospital Inpatient Value-Based Purchasing... Value-Based Purchasing Program.'' DATES: Effective Date: These corrections are effective on July 1, 2011... for the hospital value-based purchasing program. Therefore, in section III. 6. and 7. of this notice...
Gupta, Reshma; Shah, Neel T; Moriates, Christopher; Wallingford, September; Arora, Vineet M
A national imperative to provide value-based care requires new strategies to teach clinicians about high-value care. We developed a virtual online learning network aimed at disseminating emerging strategies in teaching value-based care. The online Teaching Value in Health Care Learning Network includes monthly webinars that feature selected innovators, online discussion forums, and a repository for sharing tools. The learning network comprises clinician-educators and health system leaders across North America. We conducted a cross-sectional online survey of all webinar presenters and the active members of the network, and we assessed program feasibility. Six months after the program launched, there were 277 learning community members in 22 US states. Of the 74 active members, 50 (68%) completed the evaluation. Active members represented independently practicing physicians and trainees in 7 specialties, nurses, educators, and health system leaders. Nearly all speakers reported that the learning network provided them with a unique opportunity to connect with a different audience and achieve greater recognition for their work. Of the members who were active in the learning network, most reported that strategies gleaned from the network were helpful, and some adopted or adapted these innovations at their home institutions. One year after the program launched, the learning network had grown to 364 total members. The learning network helped participants share and implement innovations to promote high-value care. The model can help disseminate innovations in emerging areas of health care transformation, and is sustainable without ongoing support after a period of start-up funding.
Piper, Llewellyn E
Hospitals in America face a daunting and historical challenge starting in 2013 as leadership navigates their organizations toward a new port of call-the Patient Protection and Affordable Care Act. Known as the Affordable Care Act (ACA) was signed into law in March 2010 and held in abeyance waiting on 2 pivotal points-the Supreme Court's June 2012 ruling upholding the constitutionality of the ACA and the 2012 presidential election of Barack Obama bringing to reality to health care organizations that leadership now must implement the mandates of health care delivery under the ACA. This article addresses the need for value-based leadership to transform the culture of health care organizations in order to be successful in navigating uncharted waters under the unprecedented challenges for change in the delivery of quality health care.
Jonker, L.; van der Zaag, P.; Gumbo, B.; Rockström, J.; Love, D.; Savenije, H. H. G.
This paper reports the experience of a regional network of academic departments involved in water education that started as a project and evolved, over a period of 12 yr, into an independent network organisation. The paper pursues three objectives. First, it argues that it makes good sense to organise postgraduate education and research on water resources on a regional scale. This is because water has a transboundary dimension that poses delicate sharing questions, an approach that promotes a common understanding of what the real water-related issues are, results in future water specialists speaking a common (water) language, enhances mutual respect, and can thus be considered an investment in future peace. Second, it presents the WaterNet experience as an example that a regional approach can work and has an impact. Third, it draws three generalised lessons from the WaterNet experience. Lesson 1: For a regional capacity building network to be effective, it must have a legitimate ownership structure and a clear mandate. Lesson 2: Organising water-related training opportunities at a regional and transboundary scale makes sense - not only because knowledge resources are scattered, but also because the topic - water - has a regional and transboundary scope. Lesson 3: Jointly developing educational programmes by sharing expertise and resources requires intense intellectual management and sufficient financial means.
Teles, Alisson R; Righesso, Orlando; Gullo, Maria Carolina R; Ghogawala, Zoher; Falavigna, Asdrubal
The state of value-based management of spinal disorders and ongoing Brazilian strategies toward its implementation are highlighted in this article. The health care system, economic impact of spine surgery, use of patient-reported outcomes, ongoing studies about health economics, and current strategies toward implementation of quality assessment of spine care in Brazil are reviewed. During the past 20 years, there has been an increase of 226% in the number and 540% in the total cost of spine surgeries in the public health system. Examples of economic regulatory mechanisms involve the process of health technology assessment and the auditing processes imposed by health insurance companies. Some barriers to implementing clinical registries were identified from a large Latin American survey. Strategies based on education and technical support have been conducted to improve the quality of comparative-effectiveness research in spine care. Only 1 cost-utility study on spine care has been published until now. The paradigm of value-based management of spinal disorders is still incipient in Brazil. Some issues from our analysis must be emphasized: (1) Brazil presents many regional disparities and scarce resources for health care; it is crucial for the health system to allocate resources based on the value of interventions; (2) because of the high economic and social burden of developing new technologies for diagnosis and treatment, research in health economics of spine care in Brazil should be prioritized; (3) these efforts would help to provide a more accessible and effective health system for patients with spinal problems. Copyright © 2016 Elsevier Inc. All rights reserved.
This study investigated whether a water-handling hygiene education programme could improve the health-related microbiological quality of container water stored and used in households in a dense urban settlement in the Free State Province. Previous studies in the area indicated that stored container water became ...
The Songhai Center has produced and tested over 300 fully functional point-of-use drinking water filters. The holistic approach of incorporated water treatment, waste reduction, economic development and promoted environmental and health awareness in the community. The ...
The aim of this paper is to evaluate the school administrators' values-based management behaviours according to the teachers' perceptions and opinions and, accordingly, to build a model of values-based management process in schools. The study was conducted using explanatory design which is inclusive of both quantitative and qualitative methods.…
Watson, Doris L.; Newton, Maria; Kim, Mi-Sook
Examined the extent to which participants in a summer sports camp embraced values-based constructs, noting the relationship between perceptions of values-based constructs and affect and attitude. Data on ethnically diverse 10-13-year-olds indicated that care for others/goal setting, self-responsibility, and self-control/respect positively related…
Ritchie, Georgina; Ashworth, Lisa; Bades, Annette
The qualified district nurse (DN) role demands high levels of leadership. Attracting the right candidates to apply for the Specialist Practice Qualification District Nursing (SPQDN) education programme is essential to ensure fitness to practice on qualification. Anecdotal evidence suggested that the traditional panel interview discouraged candidates from applying and a need to improve the quality of the overall interview process was identified by the authors. The University of Central Lancashire in partnership with Lancashire Care NHS Foundation Trust adopted the National Values Based Recruitment (VBR) Framework to select candidates to gain entry onto the SPQDN course. This involved using 'selection centres' of varying activities including a multiple mini interview, written exercise, group discussion, and portfolio review with scores attached to each centre. The ultimate aim of utilising VBR was to align personal and profession values to both the nursing profession and the Trust whilst allowing a fairer assessment process. An evaluation of the VBR recruitment process demonstrated 100% pass rate for the course and 100% satisfaction with the interview process reported by all 16 candidates over three academic years. Interviewer feedback showed deeper insight into the candidates' skills and values aligned with the core values and skills required by future District Nurse leaders within the Trust.
Kirkpatrick, John R; Marks, Stanley; Slane, Michele; Kim, Donald; Cohen, Lance; Cortelli, Michael; Plate, Juan; Perryman, Richard; Zapas, John
Value-based analysis (VBA) is a management strategy used to determine changes in value (quality/cost) when a usual practice (UP) is replaced by a best practice (BP). Previously validated in clinical initiatives, its usefulness in complex systems is unknown. To answer this question, we used VBA to correct deficiencies in cardiac surgery at Memorial Healthcare System. Cardiac surgery is a complex surgical system that lends itself to VBA because outcomes metrics provided by the Society of Thoracic Surgeons provide an estimate of quality; cost is available from Centers for Medicare and Medicaid Services and other contemporary sources; the UP can be determined; and the best practice can be established. Analysis of the UP at Memorial Healthcare System revealed considerable deficiencies in selection of patients for surgery; the surgery itself, including choice of procedure and outcomes; after care; follow-up; and control of expenditures. To correct these deficiencies, each UP was replaced with a BP. Changes included replacement of most of the cardiac surgeons; conversion to an employed physician model; restructuring of a heart surgery unit; recruitment of cardiac anesthesiologists; introduction of an interactive educational program; eliminating unsafe practices; and reducing cost. There was a significant (p value (quality/cost) in a complex surgical system. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Itri, Jason N; Mithqal, Ayman; Krishnaraj, Arun
Health care reform is creating significant challenges for hospital systems and academic medical centers (AMCs), requiring a new operating model to adapt to declining reimbursement, diminishing research funding, market consolidation, payers' focus on higher quality and lower cost, and greater cost sharing by patients. Maintaining and promoting the triple mission of clinical care, research, and education will require AMCs to be system-based with strong alignment around governance, operations, clinical care, and finances. Funds flow is the primary mechanism whereby an AMC maintains the triple mission through alignment of the hospital, physician practices, school of medicine, undergraduate university, and other professional schools. The purpose of this article is to discuss challenges with current funds flow models, impact of funds flow on academic and private practice radiology groups, and strategies that can increase funds flow to support radiology practices achieving clinical, research, and teaching missions in the era of value-based health care. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Robertson-Cooper, Heidy; Neaderhiser, Bradley; Happe, Laura E; Beveridge, Roy A
Value-based payments are rapidly replacing fee-for-service arrangements, necessitating advancements in physician practice capabilities and functions. The objective of this study was to examine potential differences among family physicians who are owners versus employed with respect to their readiness for value-based payment models. The authors surveyed more than 550 family physicians from the American Academy of Family Physician's membership; nearly 75% had made changes to participate in value-based payments. However, owners were significantly more likely to report that their practices had made no changes in value-based payment capabilities than employed physicians (owners 35.2% vs. employed 18.1%, P value-based practice capabilities were not as advanced as the employed physician group: (1) quality improvement strategies, (2) human capital investment, and (3) identification of high-risk patients. Specifically, the employed physician group reported more quality improvement strategies, including quality measures, Plan-Do-Study-Act, root cause analysis, and Lean Six Sigma (P value-based payments, consideration of different population health management needs according to ownership status has the potential to support the adoption of value-based care delivery for family physicians.
You can take a horse to water ...environmental education theory and practice in the context of a simple freshwater ecology exercise. ... It questions the educational benefits of teaching and learning that rely on the transmission of information, and explores an alternative epistemological basis for such work. It suggests that a ...
Glazer, Richard B.
This report describes the model educational delivery system used by Ulster County Community College in its water quality monitoring program. The educational delivery system described in the report encompasses the use of behavioral objectives as its foundation and builds upon this foundation to form a complete system whose outcomes can be measured,…
Sullivan, Gregory P; Elliott, Douglas B; Hillman, Tim C; Hadley, Adam; Ledbetter, Marc R; Payson, David R
The objective of this study was to develop, monitor, analyze, and report on an integrated resource-conservation program highlighting efficient residential appliances and fixtures. The sites of study were 50 homes in two water-constrained communities located in Oregon. The program was designed to maximize water savings to these communities and to serve as a model for other communities seeking an integrated approach to energy and water resource efficiency. The program included the installation and in-place evaluation of energy- and water-efficient devices including the following: horizontal axis clothes washers (and the matching clothes dryers), resource-efficient dishwashers, an innovative dual flush low-flow toilet, low-flow showerheads, and faucet aerators. The significance of this activity lies in its integrated approach and unique metering evaluation of individual end-use, aggregated residential total use, and system-wide energy and water benefits
Zuzovsky, Ruth; Levinger-Dressler, Miri; Yakir, Ruth; Wubbles, Theo; Eijkelhof, Harrie
In 1994 an educational program aimed at changing prevailing attitudes to favor peace and coexistence in the region was launched in the Israeli educational system. The program focused on the crucial conflict over water resources between Israel and its neighboring Arab countries – an issue at the heart of the Israeli-Arab conflict. The rationale of the educational program was based on cognitive approaches to attitudinal change and conflict termination, assumption being that pr...
Edgar, L. A.; Anderson, R. B.; Gaither, T. A.; Milazzo, M. P.; Vaughan, R. G.; Rubino-Hare, L.; Clark, J.; Ryan, S.
"Water in the Solar System" is an out-of-school time (OST) science education activity for middle school students that was developed as part of the Planetary Learning that Advances the Nexus of Engineering, Technology, and Science (PLANETS) project. The PLANETS project was selected in support of the NASA Science Mission Directorate's Science Education Cooperative Agreement Notice, with the goal of developing and disseminating OST curriculum and related professional development modules that integrate planetary science, technology, and engineering. "Water in the Solar System" is a science activity that addresses the abundance and availability of water in the solar system. The activity consists of three exercises based on the following guiding questions: 1) How much water is there on the Earth? 2) Where can you find water in the solar system? and 3) What properties affect whether or not water can be used by astronauts? The three exercises involve a scaling relationship demonstration about the abundance of useable water on Earth, a card game to explore where water is found in the solar system, and a hands-on exercise to investigate pH and salinity. Through these activities students learn that although there is a lot of water on Earth, most of it is not in a form that is accessible for humans to use. They also learn that most water in the solar system is actually farther from the sun, and that properties such as salinity and pH affect whether water can be used by humans. In addition to content for students, the activity includes background information for educators, and links to in-depth descriptions of the science content. "Water in the Solar System" was developed through collaboration between subject matter experts at the USGS Astrogeology Science Center, and curriculum and professional development experts in the Center for Science Teaching and Learning at Northern Arizona University. Here we describe our process of curriculum development, education objectives of
Williams, Frederick D.
Presented are the results of a study to determine the perceived needs of environmental control education programs as seen by students, instructors, deans or program directors, and field-related employers in the field of water pollution control. Data were collected utilizing three approaches: survey instruments, information from Water Quality…
Thompson, Ruthanne; Serna, Victoria Faubion
Based on results from a 2008 research study of regional citizen knowledge concerning watershed issues, a water conservation education program was designed and implemented. Findings from the initial study demonstrated program success as evidenced by knowledge gain and willingness to "commit" to water saving behaviors in 94% of students. A…
Middlestadt, Susan; Grieser, Mona; Hernandez, Orlando; Tubaishat, Khulood; Sanchack, Julie; Southwell, Brian; Schwartz, Reva
An evaluation was conducted to measure the impact of a curriculum implemented through the Jordan Water Conservation Education Project. Examines the effect of recommending water conservation at the household level and the impact of using interactive teaching methods to promote conservation behaviors among students and their families. (Author/SAH)
Lee, AM; Oleson, E.B.; Diergaarde, L.; Cheer, J.F.; Pattij, T.
In recent years, disturbances in cognitive function have been increasingly recognized as important symptomatic phenomena in neurodegenerative diseases, including Parkinson's disease (PD). Value-based decision making in particular is an important executive cognitive function that is not only impaired
McGraw, Caroline; Abbott, Stephen; Brook, Judy
Values based recruitment emerges from the premise that a high degree of value congruence, or the extent to which an individual's values are similar to those of the health organization in which they work, leads to organizational effectiveness. The aim of this evaluation was to explore how candidates and selection panel members experienced and perceived innovative methods of values based public health nursing student selection. The evaluation was framed by a qualitative exploratory design involving semi-structured interviews and a group exercise. Data were thematically analyzed. Eight semi-structured interviews were conducted with selection panel members. Twenty-two successful candidates took part in a group exercise. The use of photo elicitation interviews and situational judgment questions in the context of selection to a university-run public health nursing educational program was explored. While candidates were ambivalent about the use of photo elicitation interviews, with some misunderstanding the task, selection panel members saw the benefits for improving candidate expression and reducing gaming and deception. Situational interview questions were endorsed by candidates and selection panel members due to their fidelity to real-life problems and the ability of panel members to discern value congruence from candidates' responses. Both techniques offered innovative solutions to candidate selection for entry to the public health nursing education program. © 2018 Wiley Periodicals, Inc.
Value based management is a process that can be used to determine a business’s value drivers. It attempts to determine how the drivers link to value creation, and then break down the value drivers into achievable activities that can be pursued by employees. Due to strict medicine pricing regulations in the country, it is becoming increasingly difficult for pharmacy businesses to stay profitable. This study set out to develop a value based management framework that could be used by pharmac...
Succeeding under Medicare's enterprise Comprehensive Care for Joint Replacement Model will require collaboration among caregivers and financial arrangements to align incentives Priorities for most organization's transition to becoming a value-based hospitals will be care redesign, supply-purchasing strategy, and post-acute care provider partnering. Pursuing value for your joint replacement program will chart a path for other service lines and lead your organization's transition to becoming a value-based enterprise.
Soo, P. W.; Cheam, C. S.
In recent years, water problems have become a vital issue in our country, due to increasing population growth and urbanization. According to Prof Ngai Weng Chan, the President of Water Watch Penang (WWP), Malaysia has experienced mounting environmental degradation, and urban environmental woes in main cities like Penang. One of the many water issues affecting Malaysians is the sustainability of water that is closely related to unsustainable water supply management (Chan, 2004). Traditionally in Malaysia, Water Supply Management (WSM) and Water Demand Management (WDM) are based on the top-down-approach hierarchy. However, consumers have not been factored into the decision-making. As a result of increasing water consumption, many states in Malaysia are facing water shortages. We believe that the water consumers like our students can assist in water conservation. Education begins in school. We are certain that students with positive awareness can ultimately result in a water saving society in Malaysia. We have planned for a project that will be carried out at a local secondary school in Penang (Penang Chung Ling High School). The objective of this project is to increase the awareness among secondary students on water issues locally and globally. An initial 100 students from Chung Ling High School will be targeted for our project. We proposed to carry out water auditing of Penang Chung Ling High School to bring about awareness of water usage in the school premises for a period of time. Next, we will identify practical steps to help conserve water in Chung Ling High School. Part of the project includes formulating a water quiz to instill water awareness among the students. Hopefully with the effort to quantify the amount of water loss in unattended leaky taps will help adopting positive behavioral traits to enhance water conservation. Finally, we will look into ways to harvest rainfall for the school with the participation of these students.
Pauly, Mark V
This article investigates the economic theory and interpretation of the concept of "value-based pricing" for new breakthrough drugs with no close substitutes in a context (such as the United States) in which a drug firm with market power sells its product to various buyers. The interpretation is different from that in a country that evaluates medicines for a single public health insurance plan or a set of heavily regulated plans. It is shown that there will not ordinarily be a single value-based price but rather a schedule of prices with different volumes of buyers at each price. Hence, it is incorrect to term a particular price the value-based price, or to argue that the profit-maximizing monopoly price is too high relative to some hypothesized value-based price. When effectiveness of treatment or value of health is heterogeneous, the profit-maximizing price can be higher than that associated with assumed values of quality-adjusted life-years. If the firm sets a price higher than the value-based price for a set of potential buyers, the optimal strategy of the buyers is to decline to purchase that drug. The profit-maximizing price will come closer to a unique value-based price if demand is less heterogeneous. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
McFarland, Daniel C.; Ornstein, Katherine; Holcombe, Randall F.
Background Hospital Value-Based Purchasing (HVBP) incentivizes quality performance based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population dense areas and could bias CMS reimbursement. Objective Assess nonrandom variation in patient satisfaction as determined by HCAHPS. Design Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized four highly predictive variables and hospitals were re-ranked accordingly. Setting 3,907 HVBP-participating hospitals. Patients 934,800 patient surveys, by most conservative estimate. Measurements 3,144 county demographics (U.S. Census), and HCAHPS. Results Hospital size and primary language (‘non-English speaking’) most strongly predicted unfavorable HCAHPS scores while education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals’ locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. Conclusions Demographic and structural factors (e.g., hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct. PMID:25940305
Westbroek, Hanna Barbara
This thesis addresses the question of how to involve students in meaningful chemistry education by a proper implementation of three characteristics of meaningful: a context, a need-to-know approach and attention for student input. The characteristics were adopted as solution strategies for
Full Text Available In modern conditions of management, the value of an enterprise becomes the main indicator, which is learned not only by scientists, but also by owners of enterprise and potential investors. Current assets take a very important place among the factors that affect the value of an enterprise, so management of current assets becomes more acute from the point of their impact on enterprise value. The purpose of the paper is to develop a system of value-based management of corporate construction companies’ current assets. The main tasks are: the study of current assets impact on the value of corporate construction companies, the definition of value-based approach to managing current assets of corporate enterprises and development of value-based management system of corporate construction companies’ current assets by elements. General scientific and special research methods were used while writing the work. Value-based management of current assets involves value-based management of the elements of current assets. The value-based inventory management includes the following stages of management: the assessment of reliability and choice of supplier according to the criterion of cash flow maximization, the classification of stocks in management accounting according to the rhythm of supply and the establishment of periodicity of supplies in accordance with the needs of the construction process. The value-based management of accounts receivable includes the following stages of management: assessment of the efficiency of investment of working capital into accounts receivable, the assessment of customers' loyalty and the definition of credit conditions and monitoring of receivables by construction and debt instruments. Value-based cash management involves determining the required level of cash to ensure the continuity of the construction process, assessing the effectiveness of cash use according to the criterion of maximizing cash flow, as well as budget
Brown, Gary C.; Brown, Melissa M.; Brown, Heidi C.; Kindermann, Sylvia; Sharma, Sanjay
Purpose To evaluate the comparability of articles in the peer-reviewed literature assessing the (1) patient value and (2) cost-utility (cost-effectiveness) associated with interventions for neovascular age-related macular degeneration (ARMD). Methods A search was performed in the National Library of Medicine database of 16 million peer-reviewed articles using the key words cost-utility, cost-effectiveness, value, verteporfin, pegaptanib, laser photocoagulation, ranibizumab, and therapy. All articles that used an outcome of quality-adjusted life-years (QALYs) were studied in regard to (1) percent improvement in quality of life, (2) utility methodology, (3) utility respondents, (4) types of costs included (eg, direct healthcare, direct nonhealthcare, indirect), (5) cost bases (eg, Medicare, National Health Service in the United Kingdom), and (6) study cost perspective (eg, government, societal, third-party insurer). To qualify as a value-based medicine analysis, the patient value had to be measured using the outcome of the QALYs conferred by respective interventions. As with value-based medicine analyses, patient-based time tradeoff utility analysis had to be utilized, patient utility respondents were necessary, and direct medical costs were used. Results Among 21 cost-utility analyses performed on interventions for neovascular macular degeneration, 15 (71%) met value-based medicine criteria. The 6 others (29%) were not comparable owing to (1) varying utility methodology, (2) varying utility respondents, (3) differing costs utilized, (4) differing cost bases, and (5) varying study perspectives. Among value-based medicine studies, laser photocoagulation confers a 4.4% value gain (improvement in quality of life) for the treatment of classic subfoveal choroidal neovascularization. Intravitreal pegaptanib confers a 5.9% value gain (improvement in quality of life) for classic, minimally classic, and occult subfoveal choroidal neovascularization, and photodynamic therapy
Brown, Gary C; Brown, Melissa M; Brown, Heidi C; Kindermann, Sylvia; Sharma, Sanjay
To evaluate the comparability of articles in the peer-reviewed literature assessing the (1) patient value and (2) cost-utility (cost-effectiveness) associated with interventions for neovascular age-related macular degeneration (ARMD). A search was performed in the National Library of Medicine database of 16 million peer-reviewed articles using the key words cost-utility, cost-effectiveness, value, verteporfin, pegaptanib, laser photocoagulation, ranibizumab, and therapy. All articles that used an outcome of quality-adjusted life-years (QALYs) were studied in regard to (1) percent improvement in quality of life, (2) utility methodology, (3) utility respondents, (4) types of costs included (eg, direct healthcare, direct nonhealthcare, indirect), (5) cost bases (eg, Medicare, National Health Service in the United Kingdom), and (6) study cost perspective (eg, government, societal, third-party insurer). To qualify as a value-based medicine analysis, the patient value had to be measured using the outcome of the QALYs conferred by respective interventions. As with value-based medicine analyses, patient-based time tradeoff utility analysis had to be utilized, patient utility respondents were necessary, and direct medical costs were used. Among 21 cost-utility analyses performed on interventions for neovascular macular degeneration, 15 (71%) met value-based medicine criteria. The 6 others (29%) were not comparable owing to (1) varying utility methodology, (2) varying utility respondents, (3) differing costs utilized, (4) differing cost bases, and (5) varying study perspectives. Among value-based medicine studies, laser photocoagulation confers a 4.4% value gain (improvement in quality of life) for the treatment of classic subfoveal choroidal neovascularization. Intravitreal pegaptanib confers a 5.9% value gain (improvement in quality of life) for classic, minimally classic, and occult subfoveal choroidal neovascularization, and photodynamic therapy with verteporfin confers
Wang, Yi-Tao; Tang, Jian-Shun; Hu, Gang; Wang, Jian; Yu, Shang; Zhou, Zong-Quan; Cheng, Ze-Di; Xu, Jin-Shi; Fang, Sen-Zhi; Wu, Qing-Lin; Li, Chuan-Feng; Guo, Guang-Can
The weak-value-based metrology is very promising and has attracted a lot of attention in recent years because of its remarkable ability in signal amplification. However, it is suggested that the upper limit of the precision of this metrology cannot exceed that of classical metrology because of the low sample size caused by the probe loss during postselection. Nevertheless, a recent proposal shows that this probe loss can be reduced by the power-recycling technique, and thus enhance the precision of weak-value-based metrology. Here we experimentally realize the power-recycled interferometric weak-value-based beam-deflection measurement and obtain the amplitude of the detected signal and white noise by discrete Fourier transform. Our results show that the detected signal can be strengthened by power recycling, and the power-recycled weak-value-based signal-to-noise ratio can surpass the upper limit of the classical scheme, corresponding to the shot-noise limit. This work sheds light on higher precision metrology and explores the real advantage of the weak-value-based metrology over classical metrology.
Raman K. Agrawalla
Full Text Available The present conceptual paper is an attempt to provide a Value-Based Business Approach (VBBA to product line software engineering. It argues that Product line software engineering should be seen as a system and considered as a means towards the end of appropriating more and more value for the business firm; contingent upon the fact that it provides value to customer and customer's customers operating its value creating system with agility, speed, economy and innovation; getting governed by the positive sum value creation outlook and guided by value- based management. With our value-based business triad, the product line engineering process can hope to achieve simultaneously value, variety and volume, product differentiation and cost leadership enabling the business firm to land on the virtuous value spiral.
Caspers, Barbara A; Pickard, Beth
With the health care environment shifting to a value-based payment system, Catholic Health Initiatives nursing leadership spearheaded an initiative with 14 hospitals to establish best nursing care at a lower cost. The implementation of technology-enabled business processes at point of care led to a new model for best value nursing care: Value-Based Resource Management. The new model integrates clinical patient data from the electronic medical record and embeds the new information in care team workflows for actionable real-time decision support and predictive forecasting. The participating hospitals reported increased patient satisfaction and cost savings in the reduction of overtime and improvement in length of stay management. New data generated by the initiative on nursing hours and cost by patient and by population (Medicare severity diagnosis-related groups), and patient health status outcomes across the acute care continuum expanded business intelligence for a value-based population health system.
Corlette, Sabrina; Downs, David; Monahan, Christine H; Yondorf, Barbara
Value-based insurance is a relatively new approach to health insurance in which financial barriers, such as copayments, are lowered for clinical services that are considered high value, while consumer cost sharing may be increased for services considered to be of uncertain value. Such plans are complex and do not easily fit into the simplified, consumer-friendly comparison tools that many state health insurance exchanges are formulating for use in 2014. Nevertheless some states and plans are attempting to strike the right balance between a streamlined health exchange shopping experience and innovative, albeit complex, benefit design that promotes value. For example, agencies administering exchanges in Vermont and Oregon are contemplating offering value-based insurance plans as an option in addition to a set of standardized plans. In the postreform environment, policy makers must find ways to present complex value-based insurance plans in a way that consumers and employers can more readily understand.
Full Text Available A conceptual framework was constructed for United Nations’ complex Sustainable Development Goal (SDG Target 4.7 focusing on education for sustainable development (ESD, and used to analyse the usefulness and character of indicators produced from a values-based approach called ESDinds, compared to a UN process. The analysis shows that the latter generated very few indicators concerning the wider aspects of knowledge such as ‘critical thinking’ or ‘learning to learn’. The values-based approach, created for a different purpose, produced complementary if not better coverage of Target 4.7, including finely-developed concepts for competencies and less tangible aspects. It is suggested that the UN process would benefit from ESDinds design elements such as intersubjective and slightly disruptive elements, purposeful contextualisation at group level, and a holistic and inductive consideration of values. The use of a reference ‘fuzzy framework’ of slightly generalised proto-indicators suited for deep contextualisation locally is recommended, rather than any rigid global-level indicator with unclear local value. It is recommended that ESD practitioners immediately develop localised interpretations of valid measures for whatever final Target 4.7 indicator is selected by the UN, as this localisation process will itself cause important learning towards local ESD achievements.
Elf, Marie; Flink, Maria; Nilsson, Marie; Tistad, Malin; von Koch, Lena; Ytterberg, Charlotte
There is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient's experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions. Achieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient's individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation. The shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient's perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.
Giesbrecht, Gordon G; Pretorius, Thea
Cold water temperature is a significant factor in North American drownings. These deaths are usually attributed to hypothermia. Survey questions were administered to 661 attendees of cold-stress seminars-including medical, rescue, law enforcement and lay attendees-to determine general knowledge of the effects of ice water immersion and responses to 2 public service educational slogans. Five questions were posed at the beginning of seminars to 8 groups (ranging in size from 46 to 195) during a 2-year period. Pi(2) analyses were used to determine if responses within any occupational category differed from the group responses. A high portion of respondents greatly underestimated the time to become hypothermic in ice water (correct answer >30 minutes; 84% stated 15 minutes or less) and the time until cooling was life threatening (correct answer >60 minutes; 85% stated 30 minutes or less). There were no occupational differences in these responses. Most of the respondents identified a correct cause of death during cold stress (81% stated cardiac arrest, hypothermia, or drowning). Although both educational slogans had some advantages, between 40% (Slogan #1) to 50% (Slogan #2) of respondents did not respond correctly. The majority of respondents underestimated the time available for survival during ice water immersion. It is important to educate the public accurately to decrease the probability of panic under these circumstances. More work is required to develop effective educational slogans that provide proper information and actions for victims of cold-water immersion.
Radziwill, Nicole M.; DuPlain, Ronald F.
Total Cost of Ownership (TCO) is a metric from management accounting that helps expose both the direct and indirect costs of a business decision. However, TCO can sometimes be too simplistic for "make vs. buy" decisions (or even choosing between competing design alternatives) when value and extensibility are more critical than total cost. A three-dimensional value-based TCO, which was developed to clarify product decisions for an observatory prior to Final Design Review (FDR), will be presented in this session. This value-based approach incorporates priority of requirements, satisfiability of requirements, and cost, and can be easily applied in any environment.
Desai, Neeraj R; French, Kim D; Diamond, Edward; Kovitz, Kevin L
Value-based care is evolving with a focus on improving efficiency, reducing cost, and enhancing the patient experience. Interventional pulmonology has the opportunity to lead an effective value-based care model. This model is supported by the relatively low cost of pulmonary procedures and has the potential to improve efficiencies in thoracic care. We discuss key strategies to evaluate and improve efficiency in Interventional Pulmonology practice and describe our experience in developing an interventional pulmonology suite. Such a model can be adapted to other specialty areas and may encourage a more coordinated approach to specialty care. Copyright © 2018. Published by Elsevier Inc.
Kaličanin Đorđe M.
Full Text Available The pressure of financial markets, which is a consequence of shareholder revolution, directly affects the solution to the following dilemma: is the mission of corporations to maximize shareholders' wealth or to satisfy interests of other stakeholders? The domination of shareholder theory has caused the appearance of the valuebased management concept. Value-based management is a relevant concept and a process of management in modern environment. The importance of shareholder value requires transformation of traditional enterprise into value driven enterprise. This paper addresses theoretical base, shareholder revolution and the main characteristics of value-based management.
Full Text Available Value-based medicine is the tendency of modern medicine.This paper elaborated the properties of value-based medicine,analyzed the role of model of value-based medicine in modern medicine,and put forward ideas and related measures with the model of value-based medicine to promote the development of private hospitals, which provided some reference for development of private hospitals.
Value-based medicine is the tendency of modern medicine.This paper elaborated the properties of value-based medicine,analyzed the role of model of value-based medicine in modern medicine,and put forward ideas and related measures with the model of value-based medicine to promote the development of private hospitals, which provided some reference for development of private hospitals.
Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth
To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society. © 2012 Sigma Theta Tau International.
U.S. Department of Health & Human Services — SUMMARY DDOD use case request to make Value-Based Payment Modifier (VBM) reporting more transparent for everyone. WHAT IS A USE CASE? A “Use Case” is a request that...
Dekker, H.C.; Groot, T.L.C.M.; Schoute, M.; Wiersma, E.
As value-based (VB) performance measures include firms' cost of capital, they are considered more congruent than earnings measures. Prior studies, however, find that their use for managerial performance evaluation is less extensive than their presumed benefits would suggest. We examine how the
Boerema, Simone Theresa; van Velsen, Lex Stefan; Vollenbroek-Hutten, Miriam Marie Rosé; Hermens, Hermanus J.
In the aging society, the need for the elderly to remain mobile and independent is higher than ever. However, many aids supporting mobility often fail to target real needs and lack acceptance. The aim of this study is to demonstrate how value-based design can contribute to the design of mobility
Protasova, Yelizaveta V.
The economic criteria of effectiveness and efficiency for the value-based management system have been proposed. Also, the methodological approach to the management of operational enterprise value on the basis of the definite limit values of influence factors is proposed.
This article focuses on a qualitative exploration of six core values embedded in the Choose Life Training Programme (CLTP), a value-based HIV and AIDS prevention programme. The article is based on a study that explored the possibility that the African interpretations of these values are different to the Western definitions.
C.J. Schwehm; P. Klinkhachorn; Charles W. McMillin; Henry A. Huber
This paper describes an expert system computer program which will determine the optimum way to edge and trim a hardwood board so as to yield the highest dollar value based on the grade, size of each board, and current market prices. The program uses the Automated Hardwood Lumber Grading Program written by Klinkhachorn, et al. for determining the grade of each board...
... 19 Customs Duties 3 2010-04-01 2010-04-01 false Calculation of normal value based on constructed value. 351.405 Section 351.405 Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE ANTIDUMPING AND COUNTERVAILING DUTIES Calculation of Export Price, Constructed Export Price, Fair Value, and...
Squitieri, Lee; Bozic, Kevin J; Pusic, Andrea L
The U.S. health care system is currently experiencing profound change. Pressure to improve the quality of patient care and control costs have caused a rapid shift from traditional volume-driven fee-for-service reimbursement to value-based payment models. Under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act, providers will be evaluated on the basis of quality and cost efficiency and ultimately receive adjusted reimbursement as per their performance. Although current performance metrics do not incorporate patient-reported outcome measures (PROMs), many wonder whether and how PROMs will eventually fit into value-based payment reform. On November 17, 2016, the second annual Patient-Reported Outcomes in Healthcare Conference brought together international stakeholders across all health care disciplines to discuss the potential role of PROs in value-based health care reform. The purpose of this article was to summarize the findings from this conference in the context of recent literature and guidelines to inform implementation of PROs in value-based payment models. Recommendations for evaluating key perspectives and measurement goals are made to facilitate appropriate use of PROMs to best benefit and amplify the voice of our patients. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Porter, Michael E; Guth, Clemens
... organizations and systems that embodied value-based delivery principles to learn from them. The seeds of this book grew out of one such example, the West German Headache Centre (WGHC). We wrote a Harvard Business School case study on WGHC, which is an innovative integrated practice unit focused on headache care. Patients are treated in an interdisciplinary fa...
Wallang, Paul; Kamath, Sanjith; Parshall, Alice; Saridar, Tahani; Shah, Mahek
Health-care companies around the world face an unprecedented challenge of rising health-care costs, increasing life expectancy and escalating demand. Although national health-care budgets have increased (as a percentage of gross domestic product) health care continues to impart significant upward pressure on national expenditure, particularly in the UK ( Licchetta and Stelmach, 2016 ). Additionally a substantial funding gap will continue to grow ( Gainsbury, 2016 ). In response to this challenge a 'value' based strategy has gained momentum over the last two decades. Several pioneers of this approach (Sir Muir Gray at Oxford University, Professor Michael Porter at Harvard University and Professor Elizabeth Teisberg at Dell Medical School) emphasize the importance of organizations focusing on 'value'. Porter and Teisberg (2006) highlight the 'value equation' as obtaining the very best patient outcomes for each unit of currency spent. Gray expands on this model, describing three types of value: allocative, technical and personal ( Gray, 2011 ). Although some global health-care organizations have embraced the value-based agenda to transform acute care facilities, mental health providers have been slow to consider the benefits of this approach. This article gives a broad overview of implementing a value-based model in mental health care, the significant development resources needed, organizational issues, and finally concludes with the benefits and a vision of value-based mental health care for the future.
Thompson, Ruthanne; Coe, Alice; Klaver, Irene; Dickson, Kenneth
Informed by the results of a baseline research study of regional citizen knowledge and understanding concerning watershed issues, a team of university faculty and classroom teachers designed and implemented a water conservation education program to address lacking areas of watershed knowledge. The authors developed age-appropriate, hands-on…
The vulnerability of surface water in the Niger-Delta Region of Nigeria to frequent oil spills and has other pollutants have had negative effects on the fragile mangrove ecosystem, wildlife, aquatic resources and most importantly on man. It is in this regard that the intervention of adult education came into being to see that the ...
Jackson-Smith, Douglas B.; McEvoy, Jamie P.
We assess the long-term effectiveness of outreach and education efforts associated with a water quality improvement project in a watershed located in northern Utah, USA. Conducted 15 years after the original project began, our research examines the lasting impacts of different extension activities on landowners' motivations to participate and…
This article investigates the representation of water scarcity in Jordanian textbooks to understand its role on improving education on environmental sustainability. People's understanding of an issue guides their actions toward finding and implementing appropriate solutions to what they perceive as a problem. Discourses are key in constructing…
Itthipuripat, Sirawaj; Cha, Kexin; Rangsipat, Napat; Serences, John T
Normative theories posit that value-based decision-making is context independent. However, decisions between two high-value options can be suboptimally biased by the introduction of a third low-value option. This context-dependent modulation is consistent with the divisive normalization of the value of each stimulus by the total value of all stimuli. In addition, an independent line of research demonstrates that pairing a stimulus with a high-value outcome can lead to attentional capture that can mediate the efficiency of visual information processing. Here we tested the hypothesis that value-based attentional capture interacts with value-based normalization to influence the optimality of decision-making. We used a binary-choice paradigm in which observers selected between two targets and the color of each target indicated the magnitude of their reward potential. Observers also had to simultaneously ignore a task-irrelevant distractor rendered in a color that was previously associated with a specific reward magnitude. When the color of the task-irrelevant distractor was previously associated with a high reward, observers responded more slowly and less optimally. Moreover, as the learned value of the distractor increased, electrophysiological data revealed an attenuation of the lateralized N1 and N2Pc responses evoked by the relevant choice stimuli and an attenuation of the late positive deflection (LPD). Collectively, these behavioral and electrophysiological data suggest that value-based attentional capture and value-based normalization jointly mediate the influence of context on free-choice decision-making. Copyright © 2015 the American Physiological Society.
Cha, Kexin; Rangsipat, Napat; Serences, John T.
Normative theories posit that value-based decision-making is context independent. However, decisions between two high-value options can be suboptimally biased by the introduction of a third low-value option. This context-dependent modulation is consistent with the divisive normalization of the value of each stimulus by the total value of all stimuli. In addition, an independent line of research demonstrates that pairing a stimulus with a high-value outcome can lead to attentional capture that can mediate the efficiency of visual information processing. Here we tested the hypothesis that value-based attentional capture interacts with value-based normalization to influence the optimality of decision-making. We used a binary-choice paradigm in which observers selected between two targets and the color of each target indicated the magnitude of their reward potential. Observers also had to simultaneously ignore a task-irrelevant distractor rendered in a color that was previously associated with a specific reward magnitude. When the color of the task-irrelevant distractor was previously associated with a high reward, observers responded more slowly and less optimally. Moreover, as the learned value of the distractor increased, electrophysiological data revealed an attenuation of the lateralized N1 and N2Pc responses evoked by the relevant choice stimuli and an attenuation of the late positive deflection (LPD). Collectively, these behavioral and electrophysiological data suggest that value-based attentional capture and value-based normalization jointly mediate the influence of context on free-choice decision-making. PMID:25995350
This study draws upon the definition of water sustainability from the National Water Research Institute as the continual supply of clean water for human uses and for other living beings without compromising the water welfare of future generations. Currently, the greatest consumer of water resources worldwide is irrigation. The move from small-scale, family farms towards corporately owned and market driven, mass scale operations have drastically increased corn production and large-scale factory hog farming in the American Midwest—and the water quality related costs associated with this shift are well-documented. In the heart of the corn belt, the state of Iowa has dealt with issues over the past two decades ranging from flooding of historic proportions, to yield destroying droughts. Most recently, the state's water quality is intensely scrutinized due to nutrient levels higher than almost anywhere else in the world. While the changed agricultural landscape is ultimately responsible for these environmental costs, they can be mitigated if the farmers adopt practices that support water sustainability. However, many Iowa farmers have yet to embrace these necessary practices because of a lack of proper education in this context. Thus, the purpose of this paper is to explore how water sustainability is being conceptualized within the agricultural realm, and ultimately, how the issues are being communicated and understood within various subgroups in Iowa, such as the farmers, the college students, and the general public.
While more women are participating in training and decision-making in the local-level drinking water and sanitation sectors, this is not occurring at higher levels because of the gender imbalance that remains in higher-level sector education and professional training programs. This imbalance is characterized by gender-biased science curricula and by a lack of female role models. Even in developing countries where female enrollment outstrips that of men in higher education, women commonly prepare for careers in areas that are less valued than sanitary engineering. This imbalance ignores the fact that women can perform technical and managerial skills as competently as men. A similar male-dominated pattern emerges in professional training courses offered by development agencies, especially courses that focus on management issues. Low female school attendance begins when girls must forego primary school attendance to help their mothers in domestic chores, such as fetching water. Inadequate sanitation facilities for girls at schools also pose impediments. Efforts to improve this situation include 1) a promotional brochure developed by the Botswana Ministry of Education to raise awareness of the importance of men's and women's work as technicians and engineers in the water and sanitation sector among secondary school students; 2) creation of free schools and universities in Oman, where the numbers of women in previously male-dominated jobs are increasing; and 3) promotion of female education at the Asian Institute of Technology.
Garau, Martina; Towse, Adrian; Garrison, Louis; Housman, Laura; Ossa, Diego
Current pricing and reimbursement systems for diagnostics are not efficient. Prices for diagnostics are often driven by administrative practices and expected production cost. The purpose of the paper is to discuss how a value-based pricing framework being used to ensure efficient use and price of medicines could also be applied to diagnostics. Diagnostics not only facilitates health gain and cost savings, but also information to guide patients' decisions on interventions and their future 'behaviors'. For value assessment processes we recommend a two-part approach. Companion diagnostics introduced at the launch of the drug should be assessed through new drug assessment processes considering a broad range of value elements and a balanced analysis of diagnostic impacts. A separate diagnostic-dedicated committee using value-based pricing principles should review other diagnostics lying outside the companion diagnostics-and-drug 'at-launch' situation.
Piccoli, Andrezza de Souza; Kligerman, Débora Cynamon; Cohen, Simone Cynamon; Assumpção, Rafaela Facchetti
Article 225 of the Brazilian Constitution establishes that all citizens have the right to an ecologically balanced environment, as a common good that is essential for a healthy life, and that the government and society have the duty to protect and preserve the environment for present and future generations. This article outlines a methodology for promoting social mobilization to address water scarcity developed under the National Environmental Education and Social Mobilization for Sanitation Program (PEAMSS, acronym in Portuguese). The main aim of this article is to show the importance of education as a driving force for empowerment for water resources management. It outlines the main concepts of emancipatory environmental education and then goes on to describe the elaboration of a PEAMMS action plan. It concludes that the universalization of the right to safe and clean drinking water and access to sanitation is only possible through democratic and participatory water resources management. Actions are necessary to evaluate the reach of the PEAMSS and define the way ahead for the program.
The?real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a??value-based health care delivery?. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges.?In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of?a better healthcare for all, with real bene...
Zénon, Alexandre; Klein, Pierre-Alexandre; Alamia, Andrea; Boursoit, François; Wilhelm, Emmanuelle; Duque, Julie
During motor decision making, the neural activity in primary motor cortex (M1) encodes dynamically the competition occurring between potential action plans. A common view is that M1 represents the unfolding of the outcome of a decision process taking place upstream. Yet, M1 could also be directly involved in the decision process. Here we tested this hypothesis by assessing the effect of M1 disruption on a motor decision-making task. We applied continuous theta burst stimulation (cTBS) to inhibit either left or right M1 in different groups of subjects and included a third control group with no stimulation. Following cTBS, participants performed a task that required them to choose between two finger key-presses with the right hand according to both perceptual and value-based information. Effects were assessed by means of generalized linear mixed models and computational simulations. In all three groups, subjects relied both on perceptual (P < 0.0001) and value-based information (P = 0.003) to reach a decision. Yet, left M1 disruption led to an increased reliance on value-based information (P = 0.03). This result was confirmed by a computational model showing an increased weight of the valued-based process on the right hand finger choices following left M1 cTBS (P < 0.01). These results indicate that M1 is involved in motor decision making, possibly by weighting the final integration of multiple sources of evidence driving motor behaviors. Copyright © 2015 Elsevier Inc. All rights reserved.
VALENTIN MUNTEANU; DOINA DANAIATA; LUMINITA HURBEAN; ALICE BERGLER
The ongoing discussion about the adequate management form and the purpose of organizations in the contemporary postmodern society have once again gained in importance and interest after the financial crises of 2008. Different management concepts have been developed throughout the time, which propose objectives for organizations and thus managerial goals, activities and decision making. Considering the value based management approach and the stakeholder theory, we propose a shift in the value ...
Fausti, Scott W.; Diersen, Matthew A.; Qasmi, Bashir A.; Li, Jing
Pricing and technological innovation are discussed within the context of the beef industryâ€™s value-based marketing initiative. Cash and contract marketing practices for fed cattle are addressed with respect to slaughter volume and pricing methods (live, dressed, and grid). A methodology for estimating grid market share of weekly slaughter volume, based on USDA market reports (2004â€“2009), is introduced. Weekly grid market shares for the cash and contract markets are derived. Summary statis...
Balog, Joseph E.
In an era of value-based care, the practice of medicine and other health professions have been drawn to subjective, comprehensive and multidimensional views of health such as the World Health Organization(WHO) concept that defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. This paper, through a philosophical analysis, demonstrates that health is not multidimensional and is a natural phenomenon. A philosophical disc...
The importance of capital planning is increasing as the healthcare industry moves toward value-based care. Replacing unwieldy and inflexible traditional capital planning processes with a rolling capital planning approach can result in: Greater standardization, facilitating better strategic planning across the whole system. Reduced labor intensity in the planning and budgeting process. Reduced costs through being able to plan better for replacement purchases and take advantage of group purchasing and bundling opportunities. Increased transparency in the decision-making process.
Spaulding, Aaron; Zhao, Mei; Haley, D Rob
To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators. This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases. Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables. The secondary data sources were merged into a single database using Stata 10. Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions. Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Berkman, Elliot T
Traditional models of health behaviour focus on the roles of cognitive, personality and social-cognitive constructs (e.g. executive function, grit, self-efficacy), and give less attention to the process by which these constructs interact in the moment that a health-relevant choice is made. Health psychology needs a process-focused account of how various factors are integrated to produce the decisions that determine health behaviour. I present an integrative value-based choice model of health behaviour, which characterises the mechanism by which a variety of factors come together to determine behaviour. This model imports knowledge from research on behavioural economics and neuroscience about how choices are made to the study of health behaviour, and uses that knowledge to generate novel predictions about how to change health behaviour. I describe anomalies in value-based choice that can be exploited for health promotion, and review neuroimaging evidence about the involvement of midline dopamine structures in tracking and integrating value-related information during choice. I highlight how this knowledge can bring insights to health psychology using illustrative case of healthy eating. Value-based choice is a viable model for health behaviour and opens new avenues for mechanism-focused intervention.
Ersek, Jennifer L; Nadler, Eric; Freeman-Daily, Janet; Mazharuddin, Samir; Kim, Edward S
The art of practicing oncology has evolved substantially in the past 5 years. As more and more diagnostic tests, biomarker-directed therapies, and immunotherapies make their way to the oncology marketplace, oncologists will find it increasingly difficult to keep up with the many therapeutic options. Additionally, the cost of cancer care seems to be increasing. Clinical pathways are a systematic way to organize and display detailed, evidence-based treatment options and assist the practitioner with best practice. When selecting which treatment regimens to include on a clinical pathway, considerations must include the efficacy and safety, as well as costs, of the therapy. Pathway treatment regimens must be continually assessed and modified to ensure that the most up-to-date, high-quality options are incorporated. Value-based models, such as the ASCO Value Framework, can assist providers in presenting economic evaluations of clinical pathway treatment options to patients, thus allowing the patient to decide the overall value of each treatment regimen. Although oncologists and pathway developers can decide which treatment regimens to include on a clinical pathway based on the efficacy of the treatment, assessment of the value of that treatment regimen ultimately lies with the patient. Patient definitions of value will be an important component to enhancing current value-based oncology care models and incorporating new, high-quality, value-based therapeutics into oncology clinical pathways.
Graber, David R; Kilpatrick, Anne Osborne
The importance of values in organizations is often discussed in management literature. Possessing strong or inspiring values is increasingly considered to be a key quality of successful leaders. Another common theme is that organizational values contribute to the culture and ultimate success of organizations. These conceptions or expectations are clearly applicable to healthcare organizations in the United States. However, healthcare organizations have unique structures and are subject to societal expectations that must be accommodated within an organizational values system. This article describes theoretical literature on organizational values. Cultural and religious influences on Americans and how they may influence expectations from healthcare providers are discussed. Organizational cultures and the training and socialization of the numerous professional groups in healthcare also add to the considerable heterogeneity of value systems within healthcare organizations. These contribute to another challenge confronting healthcare managers--competing or conflicting values within a unit or the entire organization. Organizations often fail to reward members who uphold or enact the organization's values, which can lead to lack of motivation and commitment to the organization. Four key elements of values-based leadership are presented for healthcare managers who seek to develop as values-based leaders. 1) Recognize your personal and professional values, 2) Determine what you expect from the larger organization and what you can implement within your sphere of influence, 3) Understand and incorporate the values of internal stakeholders, and 4) Commit to values-based leadership.
Blöschl, Günter; Bucher, Christian; Carr, Gemma; Farnleitner, Andreas; Rechberger, Helmut; Wagner, Wolfgang; Zessner, Matthias
An interdisciplinary approach is often described as a valuable strategy to assist in overcoming the existing and emerging challenges to water resource management. The development of educational approaches to instil a culture of interdisciplinarity in the future generation of water resource professionals will help to meet this strategic need. The Vienna Doctoral Programme on Water Resource Systems demonstrates how the adoption of an interdisciplinary education framework has been applied to a graduate programme in the water sciences. The interdisciplinary approach aims to provide doctoral research students with an understanding of the wide spectrum of processes relevant to water resource systems. This will enable them to bring together a range of ideas, strategies and methods to their current research and future careers. The education programme also aims to teach the softer skills required for successful interdisciplinary work such as the ability to communicate clearly with non-specialist professionals and the capacity to listen to and accommodate suggestions from experts in different disciplines, which have often not traditionally been grouped together. The Vienna Doctoral Programme achieves these aims through teaching an appreciation for a wide variety of approaches including laboratory analysis, field studies and numerical methods across the fields of hydrology, remote sensing, hydrogeology, structural mechanics, microbiology, water quality and resource management. Teaching takes the form of a detailed study programme on topics such as socio-economic concepts, resource and river basin management, modelling and simulation methods, health related water quality targets, urban water management, spatial data from remote sensing and basics for stochastic mechanics. Courses are also held by internationally recognised top scientists, and a guest scientist seminar series allows doctoral researchers to profit from the expertise of senior researchers from around the world
Zahari, M.; Dol, S. S.
The hydrodynamic behaviour of immersed body is essential in fluid dynamics study. Water tunnel is an example of facility required to provide a controlled condition for fluid flow research. The operational principle of water tunnel is quite similar to the wind tunnel but with different working fluid and higher flow-pumping capacity. Flow visualization in wind tunnel is more difficult to conduct as turbulent flows in wind dissipate quickly whilst water tunnel is more suitable for such purpose due to higher fluid viscosity and wide variety of visualization techniques can be employed. The present work focusses on the design and development of open flow water tunnel for the purpose of studying vortex-induced vibration from turbulent vortex shedding phenomenon. The water tunnel is designed to provide a steady and uniform flow speed within the test section area. Construction details are discussed for development of low-cost water tunnel for quantitative and qualitative fluid flow measurements. The water tunnel can also be used for educational purpose such as fluid dynamics class activity to provide quick access to visualization medium for better understanding of various turbulence motion learnt in class.
Amelia Beata Staszowska
Full Text Available Legionella are known as one of the dangerous water-borne pathogens, causing severe respiratory tract infections. The aim of this study was to assess the installation water quality in an educational building located in Lublin on the basis of Legionella sp. concentration and physicochemical parameters of cold and hot installation water. Samples (n=60 of cold and hot water were collected for testing from the 10 tapping points during three surveys over a period of five months. The test samples were analyzed for the basic physicochemical parameters of the water quality such as pH, electrical conductivity, temperature, hardness, alkalinity, the total carbon content, the concentration of nitrates, chlorides and sulphates. Additionally, the concentration of calcium, magnesium, iron, manganese and zinc were examined. The presence of Legionella in water samples was measured according the standard methods. The quality of the analyzed water did not raise objections and met the criteria of the Ordinance of the Polish Ministry of Health (2015, pos.1989. The only parameter which did not comply with applicable regulations was the temperature of the supply water and return hot water - it was lower than required. Bacteria of the genus Legionella were detected only in the hot water samples from series 1 when the rate of colonization reached the level of 80%. Among the positive samples, 2 contained less than 1000 CFU/100 ml, 4 samples contained 1x103 to 1x104 CFU/100 ml, and 2 samples contained more than 1x104 CFU/100 ml. The maximum number of CFU in a sample was 1.8x104/100 ml. The most dangerous serogroup L. pneumophila sg 1 was not detected in any of the positive isolated samples. All Legionella - positive samples belonged to L. pneumophila sg 2-14. These findings necessitated a corrective action in the form of thermal disinfection system and its maintenance. Its effectiveness was confirmed by the results of the survey of 2 and 3.
J. M. Kaspersma
Full Text Available The water sector is dependent on effective institutions and organisations, and, therefore, on strong competences at the individual level. In this paper we describe competence formation and competence needs in a case study of the Directorate General of Water Resources (DGWR in the Ministry of Public Works in Indonesia. A framework is introduced for the water sector comprising three aggregate competences for technical issues, management, and governance, and a meta-competence for continuous learning and innovation. The four competences are further organised in a T-shaped competence profile. Though DGWR professionals have a firmly "technical" orientation, both surveys and interviews reveal a strong perceived requirement for other competences: in particular the learning meta-competence, as well as the aggregate competence for management. The aggregate competence for governance systematically scores lower. Further, a discrepancy appears to exist between the competences that staff perceive as needed in daily work, and those that can be acquired during post-graduate water education.
In both locally-based and international post-graduate water education, the aggregate competences for management as well as governance are reportedly addressed modestly, if at all. With low competence in these fields, it is difficult for professionals to communicate and collaborate effectively in a multidisciplinary way. As a result, the horizontal bar of the T-shaped profile remains weakly developed. In international post-graduate education, this is partially compensated by the attention to continuous learning and innovation. The exposure to a different culture and learning format is experienced as fundamentally formative.
Kaspersma, J. M.; Alaerts, G. J.; Slinger, J. H.
The water sector is dependent on effective institutions and organisations, and, therefore, on strong competences at the individual level. In this paper we describe competence formation and competence needs in a case study of the Directorate General of Water Resources (DGWR) in the Ministry of Public Works in Indonesia. A framework is introduced for the water sector comprising three aggregate competences for technical issues, management, and governance, and a meta-competence for continuous learning and innovation. The four competences are further organised in a T-shaped competence profile. Though DGWR professionals have a firmly "technical" orientation, both surveys and interviews reveal a strong perceived requirement for other competences: in particular the learning meta-competence, as well as the aggregate competence for management. The aggregate competence for governance systematically scores lower. Further, a discrepancy appears to exist between the competences that staff perceive as needed in daily work, and those that can be acquired during post-graduate water education. In both locally-based and international post-graduate water education, the aggregate competences for management as well as governance are reportedly addressed modestly, if at all. With low competence in these fields, it is difficult for professionals to communicate and collaborate effectively in a multidisciplinary way. As a result, the horizontal bar of the T-shaped profile remains weakly developed. In international post-graduate education, this is partially compensated by the attention to continuous learning and innovation. The exposure to a different culture and learning format is experienced as fundamentally formative.
... www.girlshealth.gov/ Home Nutrition Nutrition basics Water Water Did you know that water makes up more ... to drink more water Other drinks How much water do you need? top Water is very important, ...
Groothuizen, Johanna Elise; Callwood, Alison; Gallagher, Ann
Values-based recruitment is used in England to select healthcare staff, trainees and students on the basis that their values align with those stated in the Constitution of the UK National Health Service (NHS). However, it is unclear whether the extensive body of existing literature within the field of moral philosophy was taken into account when developing these values. Although most values have a long historical tradition, a tendency to assume that they have just been invented, and to approach them uncritically, exists within the healthcare sector. Reflection is necessary. We are of the opinion that selected virtue ethics writings, which are underpinned by historical literature as well as practical analysis of the healthcare professions, provide a helpful framework for evaluation of the NHS Constitution values, to determine whether gaps exist and improvements can be made. Based on this evaluation, we argue that the definitions of certain NHS Constitution values are ambiguous. In addition to this, we argue that 'integrity' and 'practical wisdom', two important concepts in the virtue ethics literature, are not sufficiently represented within the NHS Constitution values. We believe that the NHS Constitution values could be strengthened by providing clearer definitions, and by integrating 'integrity' and 'practical wisdom'. This will benefit values-based recruitment strategies. Should healthcare policy-makers in other countries wish to develop a similar values-based recruitment framework, we advise that they proceed reflectively, and take previously published virtue ethics literature into consideration. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Brown, Gary C; Brown, Melissa M; Brown, Heidi C; Kindermann, Sylvia; Sharma, Sanjay
To perform a value-based medicine analysis of clinical trials that evaluate the interventions of laser photocoagulation, intravitreal pegaptanib therapy, and photodynamic therapy (PDT) with verteporfin for the treatment of classic subfoveal choroidal neovascularization. Reference case cost-utility analysis using value-based medicine principles, which use patient-based utility values and standardized, input variable criteria. Data from participants in the Macular Photocoagulation Study, Pegaptanib for Neovascular Age-Related Macular Degeneration Study, and the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study. Visual data were converted to a value-based format using time tradeoff utility analysis values from patients with macular degeneration. Costs were obtained from 2005 Medicare data. Outcomes (quality-adjusted life-years [QALYs]) and costs were discounted at a 3% annual rate. Interventional QALYs gained, percent improvement in quality of life, and dollars spent per QALY gained. Laser photocoagulation confers a 4.4% (P = 0.03 versus pegaptanib therapy) improvement in quality of life for the reference case, whereas pegaptanib therapy confers a 5.9% improvement and PDT confers an 8.1% (P = 0.0002 versus pegaptanib therapy) improvement. The cost-utility associated with laser photocoagulation is $8179, that for pegaptanib therapy is $66978, and that for PDT is $31544. All sensitivity analyses remain within the conventional standards of cost-effectiveness. Photodynamic therapy confers greater patient value than intravitreal pegaptanib therapy and laser photocoagulation for the treatment of classic subfoveal choroidal neovascularization. Despite the fact that laser photocoagulation is the most cost-effective intervention, both PDT and pegaptanib therapy deliver greater value, and thus are both preferred over laser photocoagulation. Using an economic measure, photodynamic therapy is the preferred treatment among these 3 interventions.
Eikemo, Marie; Biele, Guido; Willoch, Frode; Thomsen, Lotte; Leknes, Siri
Modifying behavior to maximize reward is integral to adaptive decision-making. In rodents, the μ-opioid receptor (MOR) system encodes motivation and preference for high-value rewards. Yet it remains unclear whether and how human MORs contribute to value-based decision-making. We reasoned that if the human MOR system modulates value-based choice, this would be reflected by opposite effects of agonist and antagonist drugs. In a double-blind pharmacological cross-over study, 30 healthy men received morphine (10 mg), placebo, and the opioid antagonist naltrexone (50 mg). They completed a two-alternative decision-making task known to induce a considerable bias towards the most frequently rewarded response option. To quantify MOR involvement in this bias, we fitted accuracy and reaction time data with the drift-diffusion model (DDM) of decision-making. The DDM analysis revealed the expected bidirectional drug effects for two decision subprocesses. MOR stimulation with morphine increased the preference for the stimulus with high-reward probability (shift in starting point). Compared to placebo, morphine also increased, and naltrexone reduced, the efficiency of evidence accumulation. Since neither drug affected motor-coordination, speed-accuracy trade-off, or subjective state (indeed participants were still blinded after the third session), we interpret the MOR effects on evidence accumulation efficiency as a consequence of changes in effort exerted in the task. Together, these findings support a role for the human MOR system in value-based choice by tuning decision-making towards high-value rewards across stimulus domains.
Valentijn, Pim P; Biermann, Claus; Bruijnzeels, Marc A
Integrated care services are considered a vital strategy for improving the Triple Aim values for people with chronic kidney disease. However, a solid scholarly explanation of how to develop, implement and evaluate such value-based integrated renal care services is limited. The aim of this study was to develop a framework to identify the strategies and outcomes for the implementation of value-based integrated renal care. First, the theoretical foundations of the Rainbow Model of Integrated Care and the Triple Aim were united into one overarching framework through an iterative process of key-informant consultations. Second, a rapid review approach was conducted to identify the published research on integrated renal care, and the Cochrane Library, Medline, Scopus, and Business Source Premier databases were searched for pertinent articles published between 2000 and 2015. Based on the framework, a coding schema was developed to synthesis the included articles. The overarching framework distinguishes the integrated care domains: 1) type of integration, 2) enablers of integration and the interrelated outcome domains, 3) experience of care, 4) population health and 5) costs. The literature synthesis indicated that integrated renal care implementation strategies have particularly focused on micro clinical processes and physical outcomes, while little emphasis has been placed on meso organisational as well as macro system integration processes. In addition, evidence regarding patients' perceived outcomes and economic outcomes has been weak. These results underscore that the future challenge for researchers is to explore which integrated care implementation strategies achieve better health and improved experience of care at a lower cost within a specific context. For this purpose, this study's framework and evidence synthesis have set a developmental agenda for both integrated renal care practice and research. Accordingly, we plan further work to develop an implementation
Kenley, C. Robert; Collins, John W.; Beck, John M.; Heydt, Harold J.; Garcia, Chad B.
This paper describes a method for performing multiattribute decision analysis to prioritize ap-proaches to handling risks during the development and operation of complex socio-technical systems. The method combines risk categorization based on enterprise views, risk prioritization of the categories based on the Analytic Hierarchy Process (AHP), and more standard probability-consequence ratings schemes. We also apply value-based testing me-thods used in software development to prioritize risk-handling approaches. We describe a tool that synthesizes the methods and performs a multiattribute analysis of the technical and pro-grammatic risks on the Next Generation Nuclear Plant (NGNP) enterprise.
The development of value-based distribution reliability assessment (VBDRA) at Scarborough Public Utilities was described. Load point reliability indices, customer interruption costs (CIC), continuity and service reliability, accuracy of CIC, and the aspects of application of VBDRA were addressed. The application of VBDRA to a long-term rebuild plan for 4.16 kV distribution system was described. The importance of a cost-benefit analysis for implementation of VBDRA was emphasized. In the case of the Scarborough Public Utilities Commission the enhanced feeder reliability assessment was found to influence the allocation of funding to where it provided the most value to customers. 14 refs., 3 tabs., 3 figs
Tourki, Kamel; Qaraqe, Khalid A.; Alouini, Mohamed-Slim
In this paper, we consider a spectrum sharing cognitive radio system with ratio selection using a mean value-based power allocation strategy. We first provide the exact statistics in terms of probability density function and cumulative density function of the secondary channel gain as well as of the interference channel gain. These statistics are then used to derive exact closed form expression of the secondary outage probability. Furthermore, asymptotical analysis is derived and generalized diversity gain is deduced. We validate our analysis with simulation results in a Rayleigh fading environment. © 2013 IEEE.
Johansen, Søren Glud; Thorstenson, Anders
replenishment order is issued, if the expected cost of ordering immediately according to the (s, S) policy is less than the expected cost of deferring the order until the next demand or until the level Q is reached. We use simulation to evaluate our policy. Applying the value-based Q(s, S) policy to a standard...... set of 12-item numerical examples from the literature, the long-run average cost of the best known solution is reduced by approximately 1%. Further examples are also investigated and in some cases for which the cost structure implies a high service level, the cost reduction exceeds 10% of the cost...
Gupta, Dipti; Karst, Ingolf; Mendelson, Ellen B
In this article, we define value in the context of reimbursement and explore the effect of shifting reimbursement paradigms on the decision-making autonomy of a women's imaging radiologist. The current metrics used for value-based reimbursement such as report turnaround time are surrogate measures that do not measure value directly. The true measure of a physician's value in medicine is accomplishment of better health outcomes, which, in breast imaging, are best achieved with a physician-patient relationship. Complying with evidence-based medicine, which includes data-driven best clinical practices, a physician's clinical expertise, and the patient's values, will improve our science and preserve the art of medicine.
In this paper, we consider a spectrum sharing cognitive radio system with ratio selection using a mean value-based power allocation strategy. We first provide the exact statistics in terms of probability density function and cumulative density function of the secondary channel gain as well as of the interference channel gain. These statistics are then used to derive exact closed form expression of the secondary outage probability. Furthermore, asymptotical analysis is derived and generalized diversity gain is deduced. We validate our analysis with simulation results in a Rayleigh fading environment. © 2013 IEEE.
Ruiz-Díaz, María Stephany; Mora-García, Gustavo José; Salguedo-Madrid, Germán Israel; Alario, Ángelo; Gómez-Camargo, Doris Esther
Water-related diseases are closely linked with drinking water, sanitation, and hygiene (WASH) indicators, socioeconomic status, education level, or dwelling's conditions. Developing countries exhibit a particular vulnerability to these diseases, especially rural areas and urban slums. This study assessed socioeconomic features, WASH indicators, and water-related diseases in two rural areas of the Colombian Caribbean coast. Most of this population did not finish basic education (72.3%, N = 159). Only one of the communities had a water supply (aqueduct), whereas the other received water via an adapted tanker ship. No respondents reported sewage services; 92.7% ( N = 204) had garbage service. Reported cases of diarrhea were associated with low education levels ( P = 2.37 × 10 -9 ) and an unimproved drinking water supply ( P = 0.035). At least one fever episode was reported in 20% ( N = 44) of dwellings, but the cases were not related to any indicator. The Aedes/ House index (percentage of houses that tested positive for Aedes larvae and/or pupae) was 69%, the container index (percentage of water-holding containers positive for Aedes larvae or pupae) 29.4%, and the Breteau index (number of positive containers per 100 houses in a specific location) was three positive containers per 100 inspected houses. The presence of positive containers was associated with the absence of a drinking water supply ( P = 0.04). The community with poorer health indicators showed greater health vulnerability conditions for acquisition of water-related diseases. In summary, water supply and educational level were the main factors associated with the presence of water-related diseases in both communities.
Brown, Gary C; Brown, Melissa M; Sharma, Sanjay; Brown, Heidi; Smithen, Lindsay; Leeser, David B; Beauchamp, George
ABSTRACT Purpose To ascertain the extent to which ophthalmologic interventions have been evaluated in value-based medicine format. Methods Retrospective literature review. Papers in the healthcare literature utilizing cost-utility analysis were reviewed by researchers at the Center for Value-Based Medicine, Flourtown, Pennsylvania. A literature review of papers addressing the cost-utility analysis of ophthalmologic procedures in the United States over a 12-year period from 1992 to 2003 was undertaken using the National Library of Medicine and EMBASE databases. The cost-utility of ophthalmologic interventions in inflation-adjusted (real) year 2003 US dollars expended per quality-adjusted life-year ($/QALY) was ascertained in all instances. Results A total of 19 papers were found, including a total of 25 interventions. The median cost-utility of ophthalmologic interventions was $5,219/QALY, with a range from $746/QALY to $6.5 million/QALY. Conclusions The majority of ophthalmologic interventions are especially cost-effective by conventional standards. This is because of the substantial value that ophthalmologic interventions confer to patients with eye diseases for the resources expended. PMID:15747756
Mitamura, Chelsea; Erickson, Lynnsey; Devine, Patricia G
People often disagree about what constitutes sexism, and these disagreements can be both socially and legally consequential. It is unclear, however, why or how people come to different conclusions about whether something or someone is sexist. Previous research on judgments about sexism has focused on the perceiver's gender and attitudes, but neither of these variables identifies comparative standards that people use to determine whether any given behavior (or person) is sexist. Extending Devine and colleagues' values framework (Devine, Monteith, Zuwerink, & Elliot, 1991; Plant & Devine, 1998), we argue that, when evaluating others' behavior, perceivers rely on the morally-prescriptive values that guide their own behavior toward women. In a series of 3 studies we demonstrate that (1) people's personal standards for sexism in their own and others' behavior are each related to their values regarding sexism, (2) these values predict how much behavioral evidence people need to infer sexism, and (3) people with stringent, but not lenient, value-based standards get angry and try to regulate a sexist perpetrator's behavior to reduce sexism. Furthermore, these personal values are related to all outcomes in the present work above and beyond other person characteristics previously used to predict sexism inferences. We discuss the implications of differing value-based standards for explaining and reconciling disputes over what constitutes sexist behavior.
Boerema, Simone T; van Velsen, Lex; Vollenbroek-Hutten, Miriam M R; Hermens, Hermie J
In the aging society, the need for the elderly to remain mobile and independent is higher than ever. However, many aids supporting mobility often fail to target real needs and lack acceptance. The aim of this study is to demonstrate how value-based design can contribute to the design of mobility aids that address real needs and thus, lead to high acceptance. We elicited values, facilitators, and barriers of mobility of older adults via ten in-depth interviews. Next, we held co-creation sessions, resulting in several designs of innovative mobility aids, which were evaluated for acceptance via nine in-depth interviews. The interviews resulted in a myriad of key values, such as "independence from family" and "doing their own groceries." Design sessions resulted in three designs for a wheeled walker. Their acceptance was rather low. Current mobility device users were more eager to accept the designs than non-users. The value-based approach offers designers a close look into the lives of the elderly, thereby opening up a wide range of innovation possibilities that better fit their actual needs. Product service systems seem to be a promising focus for targeting human needs in mobility device design.
Wich, Michael; Auhuber, Thomas; Scholtysik, Dirk; Ekkernkamp, Axel
In the mid-1920s Porter and others developed a reform approach for existing health care systems, aiming at a patient-focused, value-based orientation. Improving patient outcomes by attaining, preserving and restoring good health is inherently less costly than dealing with poor health. The authors of the present article will outline that the German statutory accident insurance system, which was already introduced in1884 and is of an evolving nature, reflects key elements of Porter's efficient value-based health care system. The German accident insurance system with its statutory mandate limited to the prevention and rehabilitation of work-related damage to one's health can also serve as a model for other larger health care insurance systems. Prevention and rehabilitation is pursued using all appropriate means to achieve the set goals of protecting and restoring individual health. In line with these objectives, the statutory health insurance controls the process in terms of the required care quality. The components of a complex health care system, usually managed by a variety of different institutions, are consolidated. Thus it can be ensured that in both prevention and rehabilitation all services that are necessary to keep focussing the value "individual health" rather than indemnities are applied. Copyright © 2018. Published by Elsevier GmbH.
Ocana, Alberto; Amir, Eitan; Tannock, Ian F
The high market price of new anticancer agents has stimulated debate about the long-term sustainability of healthcare systems and whether these new agents can continue to be supported by public healthcare or by private insurers. In addition, some drugs have been approved with limited clinical benefit, raising concerns about setting a minimum requirement for medical benefit. Options to resolve these problems include raising the bar for approval of new drugs and/or pricing of new agents based on the medical benefit that they offer to patients. In this commentary, we suggest that new agents should be marketed in a two-step process that would include first the approval of the new drug by the regulatory agencies and second the introduction of a market price based on the medical benefit that the new intervention offers to patients. Introduction of value-based pricing would maintain the sustainability of health care systems and would improve drug development, as it would pressure pharmaceutical companies to become more innovative and avoid the development of compounds with limited benefit. Value-based pricing could also stimulate the funding of research directed to development of new anticancer drugs with novel mechanisms of action. Cancer Res; 76(11); 3127-9. ©2016 AACR. ©2016 American Association for Cancer Research.
Faith, Karen E
At the heart of healthcare are fundamental values like caring and compassion as well as the duty shared by healthcare organizations to address the care needs of those in their communities who are vulnerable, injured, or ill. A concern being raised by some political analysts in Canada is that fundamental values are being challenged by current economic and political influences that are reshaping the landscape of healthcare in this country. Influences from industry, technology, and business have significantly shifted healthcare from its moral foundations. A culture of caring is also challenged by the values and behaviours of individuals that negatively impact staff morale and inter-professional collaboration in many work settings. If a "culture of caring" is to survive the canons of cost containment, the impact of recurrent political wrangling, and other substantive influences, then healthcare must be guided by committed values-based leadership. Using case illustrations, this article attempts to explain the characteristics and role of values-based leaders in promoting those values that inspire a culture of caring.
Mandal, Aloke K; Tagomori, Gene K; Felix, Randell V; Howell, Scott C
In Medicare Advantage (MA) with its CMS Hierarchical Condition Categories (CMS-HCC) payment model, CMS reimburses private plans (Medicare Advantage Organizations [MAOs]) with prospective, monthly, health-based or risk-adjusted, capitated payments. The effect of this payment methodology on healthcare delivery remains debatable. How value-based contracting generates cost efficiencies and improves clinical outcomes in MA is studied. A difference in contracting arrangements between an MAO and 2 provider groups facilitated an intervention-control, preintervention-postintervention, difference-in-differences approach among statistically similar, elderly, community-dwelling MA enrollees within one metropolitan statistical area. Starting in 2009, for intervention-group MA enrollees, the MAO and a provider group agreed to full-risk capitation combined with a revenue gainshare. The gainshare was based on increases in the Risk Adjustment Factor (RAF), which modified the CMS-HCC payments. For the control group, the MAO continued to reimburse another provider group through fee-for-service. RAF, utilization, and survival were followed until December 31, 2012. The intervention group's mean RAF increased significantly (P based visits (P based care for these MA enrollees with multiple comorbidities, a 6% survival benefit with a 32.8% lower hazard of death (P Value-based contracting can drive utilization patterns and improve clinical outcomes among chronically ill, elderly MA members.
Garrison, Louis P; Towse, Adrian
'Value-based' outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: "What kinds of pricing and reimbursement models should be applied in personalized healthcare?" The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that-to meet this social objective of optimal innovation in personalized healthcare-payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption.
Spaulding, Aaron; Edwardson, Nick; Zhao, Mei
The hospital value-based purchasing (HVBP) program of the Centers for Medicare & Medicaid Services challenges hospitals to deliver high-quality care or face a reduction in Medicare payments. How do different organizational structures and market characteristics enable or inhibit successful transition to this new model of value-based care? To address that question, this study employs an institutional theory lens to test whether certain organizational structures and market characteristics mediate hospitals' ability to perform across HVBP domains.Data from the 2014 American Hospital Association Annual Survey Database, Area Health Resource File, the Medicare Hospital Compare Database, and the association between external environment and hospital performance are assessed through multiple regression analysis. Results indicate that hospitals that belong to a system are more likely than independent hospitals to score highly on the domains associated with the HVBP incentive arrangement. However, varying and sometimes counterintuitive market influences bring different dimensions to the HVBP program. A hospital's ability to score well in this new value arrangement may be heavily based on the organization's ability to learn from others, implement change, and apply the appropriate amount of control in various markets.
Goldstein, Daniel A; Chen, Qiushi; Ayer, Turgay; Howard, David H; Lipscomb, Joseph; Ramalingam, Suresh S; Khuri, Fadlo R; Flowers, Christopher R
The SQUIRE trial demonstrated that adding necitumumab to chemotherapy for patients with metastatic squamous cell lung cancer (mSqCLC) increased median overall survival by 1.6 months (hazard ratio, 0.84). However, the costs and value associated with this intervention remains unclear. Value-based pricing links the price of a drug to the benefit that it provides and is a novel method to establish prices for new treatments. To evaluate the range of drug costs for which adding necitumumab to chemotherapy could be considered cost-effective. We developed a Markov model using data from multiple sources, including the SQUIRE trial, which compared standard chemotherapy with and without necitumumab as first-line treatment of mSqCLC, to evaluate the costs and patient life expectancies associated with each regimen. In the analysis, patients were modeled to receive gemcitabine and cisplatin for 6 cycles or gemcitabine, cisplatin, and necitumumab for 6 cycles followed by maintenance necitumumab. Our model's clinical inputs were the survival estimates and frequency of adverse events (AEs) described in the SQUIRE trial. Log-logistic models were fitted to the survival distributions in the SQUIRE trial. The cost inputs included drug costs, based on the Medicare average sale prices, and costs for drug administration and management of AEs, based on Medicare reimbursement rates (all in 2014 US dollars). We evaluated incremental cost-effectiveness ratios (ICERs) for the use of necitumumab across a range of values for its cost. Model robustness was assessed by probabilistic sensitivity analyses, based on 10 000 Monte Carlo simulations, sampling values from the distributions of all model parameters. In the base case analysis, the addition of necitumumab to the treatment regimen produced an incremental survival benefit of 0.15 life-years and 0.11 quality-adjusted life-years (QALYs). The probabilistic sensitivity analyses established that when necitumumab cost less than $563 and less than
Farovik, Anja; Place, Ryan J.; McKenzie, Sam; Porter, Blake; Munro, Catherine E.
There are a substantial number of studies showing that the orbitofrontal cortex links events to reward values, whereas the hippocampus links events to the context in which they occur. Here we asked how the orbitofrontal cortex contributes to memory where context determines the reward values associated with events. After rats learned object–reward associations that differed depending on the spatial context in which the objects were presented, neuronal ensembles in orbitofrontal cortex represented distinct value-based schemas, each composed of a systematic organization of the representations of objects in the contexts and positions where they were associated with reward or nonreward. Orbitofrontal ensembles also represent the different spatial contexts that define the mappings of stimuli to actions that lead to reward or nonreward. These findings, combined with observations on complementary memory representation within the hippocampus, suggest mechanisms through which prefrontal cortex and the hippocampus interact in support of context-guided memory. PMID:26019346
Jensen, Per Anker; Maslesa, Esmir
Research on the barriers for building renovation in Denmark has revealed that an important obstacle is a lack of simple and holistic tools that can assist stakeholders in prioritisation and decision-making during the early stages of building renovation projects. The purpose of this article...... is to present a tool - RENO-EVALUE, which can be used as decision support for sustainable renovation projects, and for evaluation, during and after building renovations. The tool is a result from the European Eracobuild project ACES - "A concept for promotion of sustainable retrofitting and renovation in early...... stages". This article presents the main result of a work package concerning benefits of renovation. RENO-EVALUE has been developed from four case studies on renovation projects in Denmark, tested and validated on the cases and in a Delphi study. The tool is value based by focusing on the different...
Garrison, Louis P; Bresnahan, Brian W; Higashi, Mitchell K; Hollingworth, William; Jarvik, Jeffrey G
Innovation in the field of diagnostic imaging is based primarily on the availability of new and improved equipment that opens the door for new clinical applications. Payments for these imaging procedures are subject to complex Medicare price control schemes, affecting incentives for appropriate use and innovation. Achieving a "dynamically efficient" health care system-one that elicits a socially optimal amount of innovation-requires that innovators be rewarded in relation to the value they add and can demonstrate with evidence. The authors examine how and whether value-based reimbursement for diagnostic imaging services might better reward innovation explicitly for expected improvements in health and economic outcomes. Copyright © 2011 AUR. Published by Elsevier Inc. All rights reserved.
Song, H Francis; Yang, Guangyu R; Wang, Xiao-Jing
Trained neural network models, which exhibit features of neural activity recorded from behaving animals, may provide insights into the circuit mechanisms of cognitive functions through systematic analysis of network activity and connectivity. However, in contrast to the graded error signals commonly used to train networks through supervised learning, animals learn from reward feedback on definite actions through reinforcement learning. Reward maximization is particularly relevant when optimal behavior depends on an animal's internal judgment of confidence or subjective preferences. Here, we implement reward-based training of recurrent neural networks in which a value network guides learning by using the activity of the decision network to predict future reward. We show that such models capture behavioral and electrophysiological findings from well-known experimental paradigms. Our work provides a unified framework for investigating diverse cognitive and value-based computations, and predicts a role for value representation that is essential for learning, but not executing, a task.
Flume, Mathias; Bardou, Marc; Capri, Stefano; Sola-Morales, Oriol; Cunningham, David; Levin, Lars-Ake; Touchot, Nicolas
Indication value-based pricing (IBP) has been proposed in the United States as a tool to capture the differential value of drugs across indications or patient groups and is in the early phases of implementation. In Europe, no major country has experimented with IBP or is seriously discussing its use. We assessed how the reimbursement and pricing environment allows for IBP in seven European countries, evaluating both incentives and hurdles. In price setting countries such as France and Germany, the Health Technology Assessment and pricing process already accounts for differences of value across indications. In countries where differential value drives coverage decisions such as the United Kingdom and Sweden, IBP is likely to be used, at least partially, but not in the short-term. Italy is already achieving some form of differential value through managed entry agreements, whereas in Spain the electronic prescription system provides the infrastructure necessary for IBP but other hurdles exist.
Fendrick, A Mark; Zank, Daniel C
When consumers are required to pay the same out-of-pocket amount for pulmonary services for which clinical benefits depend on patient characteristics, clinical indication, and provider choice, there is an enormous potential for both underutilization and overutilization. Unlike most current one-size-fits-all health plan designs, value-based insurance design (V-BID) explicitly acknowledges clinical heterogeneity across the continuum of care. By adding clinical nuance to benefit design, V-BID seeks to align consumer and provider incentives with value, encouraging the use of high-value services and discouraging the use of low-value interventions. This article describes the concept of V-BID; creates a framework for its development in pulmonary medicine; and outlines how this concept aligns with research, care delivery, and payment reform initiatives.
Koerber, Florian; Rolauffs, Bernd; Rogowski, Wolf
Since the first pioneering scientists explored the potential of using human cells for therapeutic purposes the branch of regenerative medicine has evolved to become a mature industry. The focus has switched from 'what can be done' to 'what can be commercialized'. Timely health economic evaluation supports successful marketing by establishing the value of a product from a healthcare system perspective. This article reports results from a research project on early health economic evaluation in collaboration with developers, clinicians and manufacturers. We present an approach to determine an early value-based price for a new treatment of cartilage defects of the knee from the area of regenerative medicine. Examples of using evaluation results for the purpose of business planning, market entry, preparing the coverage decision and managed entry are discussed.
Given the high costs of innovative new drugs, most European countries have introduced policies for price control, in particular value-based pricing (VBP) and international reference pricing. The purpose of this study is to describe how profit-maximizing manufacturers would optimally adjust their launch sequence to these policies and how VBP countries may best respond. To decide about the launching sequence, a manufacturer must consider a tradeoff between price and sales volume in any given country as well as the effect of price in a VBP country on the price in international reference pricing countries. Based on the manufacturer's rationale, it is best for VBP countries in Europe to implicitly collude in the long term and set cost-effectiveness thresholds at the level of the lowest acceptable VBP country. This way, international reference pricing countries would also converge towards the lowest acceptable threshold in Europe.
The immune system contributes to the maintenance of health by preventing and limiting the clinical consequences of infections by pathogenic microorganisms. During the evolution of Homo sapiens, those with the fittest immune system survived. The immune system of Homo sapiens was further improved and adapted by admixture with Neanderthal genes. Nowadays, the human immune system provides adequate protection against the majority of infections. For some 20 infectious diseases, the immune system needs to be improved by vaccination. Vaccination is the number one value-based healthcare intervention and has resulted in global eradication of smallpox. Eradication of poliomyelitis and measles is within reach. A continuous effort will be required for recently emerged pathogens, such as Ebola and HIV, as well as the most difficult - malaria and tuberculosis.
Despite assertions to the contrary, KWM Fulford's values-based practice is implicitly committed to subjectivism when it comes to reasoning about values. This renders the approach unworkable. The act of merely uncovering underlying values is not enough to effect change and, therefore, resolve problems if we have no way, even in principle, of determining which values are right and which are wrong. Fulford's only departure from subjectivism about value is his commitment to 'framework values', which seems grounded in a version of ethical relativism. I argue that we need to reject both subjectivism and relativism if progress within ethical discussions about practice is to be meaningful and a real possibility. © 2013 John Wiley & Sons Ltd.
Full Text Available Measurements of response time (RT have long been used to infer neural processes underlying various cognitive functions such as working memory, attention, and decision making. However, it is currently unknown if RT is also informative about various stages of value-based choice, particularly how reward values are constructed. To investigate these questions, we analyzed the pattern of RT during a set of multi-dimensional learning and decision-making tasks that can prompt subjects to adopt different learning strategies. In our experiments, subjects could use reward feedback to directly learn reward values associated with possible choice options (object-based learning. Alternatively, they could learn reward values of options' features (e.g. color, shape and combine these values to estimate reward values for individual options (feature-based learning. We found that RT was slower when the difference between subjects' estimates of reward probabilities for the two alternative objects on a given trial was smaller. Moreover, RT was overall faster when the preceding trial was rewarded or when the previously selected object was present. These effects, however, were mediated by an interaction between these factors such that subjects were faster when the previously selected object was present rather than absent but only after unrewarded trials. Finally, RT reflected the learning strategy (i.e. object-based or feature-based approach adopted by the subject on a trial-by-trial basis, indicating an overall faster construction of reward value and/or value comparison during object-based learning. Altogether, these results demonstrate that the pattern of RT can be informative about how reward values are learned and constructed during complex value-based learning and decision making.
Colas, Jaron T
In principle, formal dynamical models of decision making hold the potential to represent fundamental computations underpinning value-based (i.e., preferential) decisions in addition to perceptual decisions. Sequential-sampling models such as the race model and the drift-diffusion model that are grounded in simplicity, analytical tractability, and optimality remain popular, but some of their more recent counterparts have instead been designed with an aim for more feasibility as architectures to be implemented by actual neural systems. Connectionist models are proposed herein at an intermediate level of analysis that bridges mental phenomena and underlying neurophysiological mechanisms. Several such models drawing elements from the established race, drift-diffusion, feedforward-inhibition, divisive-normalization, and competing-accumulator models were tested with respect to fitting empirical data from human participants making choices between foods on the basis of hedonic value rather than a traditional perceptual attribute. Even when considering performance at emulating behavior alone, more neurally plausible models were set apart from more normative race or drift-diffusion models both quantitatively and qualitatively despite remaining parsimonious. To best capture the paradigm, a novel six-parameter computational model was formulated with features including hierarchical levels of competition via mutual inhibition as well as a static approximation of attentional modulation, which promotes "winner-take-all" processing. Moreover, a meta-analysis encompassing several related experiments validated the robustness of model-predicted trends in humans' value-based choices and concomitant reaction times. These findings have yet further implications for analysis of neurophysiological data in accordance with computational modeling, which is also discussed in this new light.
Jaron T Colas
Full Text Available In principle, formal dynamical models of decision making hold the potential to represent fundamental computations underpinning value-based (i.e., preferential decisions in addition to perceptual decisions. Sequential-sampling models such as the race model and the drift-diffusion model that are grounded in simplicity, analytical tractability, and optimality remain popular, but some of their more recent counterparts have instead been designed with an aim for more feasibility as architectures to be implemented by actual neural systems. Connectionist models are proposed herein at an intermediate level of analysis that bridges mental phenomena and underlying neurophysiological mechanisms. Several such models drawing elements from the established race, drift-diffusion, feedforward-inhibition, divisive-normalization, and competing-accumulator models were tested with respect to fitting empirical data from human participants making choices between foods on the basis of hedonic value rather than a traditional perceptual attribute. Even when considering performance at emulating behavior alone, more neurally plausible models were set apart from more normative race or drift-diffusion models both quantitatively and qualitatively despite remaining parsimonious. To best capture the paradigm, a novel six-parameter computational model was formulated with features including hierarchical levels of competition via mutual inhibition as well as a static approximation of attentional modulation, which promotes "winner-take-all" processing. Moreover, a meta-analysis encompassing several related experiments validated the robustness of model-predicted trends in humans' value-based choices and concomitant reaction times. These findings have yet further implications for analysis of neurophysiological data in accordance with computational modeling, which is also discussed in this new light.
In principle, formal dynamical models of decision making hold the potential to represent fundamental computations underpinning value-based (i.e., preferential) decisions in addition to perceptual decisions. Sequential-sampling models such as the race model and the drift-diffusion model that are grounded in simplicity, analytical tractability, and optimality remain popular, but some of their more recent counterparts have instead been designed with an aim for more feasibility as architectures to be implemented by actual neural systems. Connectionist models are proposed herein at an intermediate level of analysis that bridges mental phenomena and underlying neurophysiological mechanisms. Several such models drawing elements from the established race, drift-diffusion, feedforward-inhibition, divisive-normalization, and competing-accumulator models were tested with respect to fitting empirical data from human participants making choices between foods on the basis of hedonic value rather than a traditional perceptual attribute. Even when considering performance at emulating behavior alone, more neurally plausible models were set apart from more normative race or drift-diffusion models both quantitatively and qualitatively despite remaining parsimonious. To best capture the paradigm, a novel six-parameter computational model was formulated with features including hierarchical levels of competition via mutual inhibition as well as a static approximation of attentional modulation, which promotes “winner-take-all” processing. Moreover, a meta-analysis encompassing several related experiments validated the robustness of model-predicted trends in humans’ value-based choices and concomitant reaction times. These findings have yet further implications for analysis of neurophysiological data in accordance with computational modeling, which is also discussed in this new light. PMID:29077746
Abdulla, Amer G; Ituarte, Philip H G; Wiggins, Randi; Teisberg, Elizabeth O; Harari, Avital; Yeh, Michael W
Experts advocate restructuring health care in the United States into a value-based system that maximizes positive health outcomes achieved per dollar spent. We describe how a value-based system implemented by the University of California, Los Angeles UCLA Section of Endocrine Surgery (SES) has optimized both quality and costs while increasing patient volume. Two SES clinical pathways were studied, one allocating patients to the most appropriate surgical care setting based on clinical complexity, and another standardizing initial management of papillary thyroid carcinoma (PTC). The mean cost per endocrine case performed from 2005 to 2010 was determined at each of three care settings: A tertiary care inpatient facility, a community inpatient facility, and an ambulatory facility. Blood tumor marker levels (thyroglobulin, Tg) and reoperation rates were compared between PTC patients who underwent routine central neck dissection (CND) and those who did not. Surgical patient volume and regional market share were analyzed over time. The cost of care was substantially lower in both the community inpatient facility (14% cost savings) and the ambulatory facility (58% cost savings) in comparison with the tertiary care inpatient facility. Patients who underwent CND had lower Tg levels (6.6 vs 15.0 ng/mL; P = 0.024) and a reduced need for re-operation (1.5 vs 6.1%; P = 0.004) compared with those who did not undergo CND. UCLA maintained its position as the market leader in endocrine procedures while expanding its market share by 151% from 4.9% in 2003 to 7.4% in 2010. A value-driven health care delivery system can deliver improved clinical outcomes while reducing costs within a subspecialty surgical service. Broader application of these principles may contribute to resolving current dilemmas in the provision of care nationally.
Asadullah, A.; Nisa, K.; Khan, S.I.
in order to investigate the physic-chemical quality, 780 water samples were collected from 490 educational institutes located in various areas of Karachi, during the period of May to September 2005. The parameters include pH, turbidity, total dissolve solids (TDS), hardness and conductivity that were varied from 3.2 to 8.7, 0.2 to 3.1 NTU (nephelometric turbidity unit), 79 to 1066 ppm, 69 to 558ppm and 96 to 1775 mu S/cm, respectively. On the basis of pH 6%, taste 2.1%, turbidity 0%, TDS 2.5% and hardness 1.3%, of the samples were found out of acceptable limits of World Health Organisation (WHO) guidelines. Moreover, the conductivity of the studied waters was found to be the multiple of 0.6001 to that of TDS (R/sup 2/ = 0.987) when regression model was established. (author)
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Sussex, Jon; Towse, Adrian; Devlin, Nancy
The UK Government is proposing a novel form of price regulation for branded medicines, which it has dubbed 'value-based pricing' (VBP). The specifics of how VBP will work are unclear. We provide an account of the possible means by which VBP of medicines might be operationalized, and a taxonomy to describe and categorize the various approaches. We begin with a brief discussion of the UK Government's proposal for VBP and proceed to define a taxonomy of approaches to VBP. The taxonomy has five main dimensions: (1) what is identified as being of value, (2) how each element is measured, (3) how it is valued, (4) how the different elements of value are aggregated, and (5) how the result is then used to determine the price of a medicine. We take as our starting point that VBP will include a measure of health gain and that, as proposed by the UK Government, this will be built on the QALY. Our principal interest is in the way criteria other than QALYs are taken into account, including severity of illness, the extent of unmet need, and wider societal considerations such as impacts on carers. We set out to: (1) identify and describe the full range of alternative means by which 'value' might be measured and valued, (2) identify and describe the options available for aggregating the different components of value to establish a maximum price, and (3) note the challenges and relative advantages associated with these approaches. We review the means by which aspects of VBP are currently operationalized in a selection of countries and place these, and proposals for the UK, in the context of our taxonomy. Finally, we give an initial assessment of the challenges, pros and cons of each approach. We conclude that identifying where VBP should lie on each of the five dimensions entails value judgements: there are no simple 'right or wrong' solutions. If a wider definition of value than incremental QALYs gained is adopted, as is desirable, then a pragmatic way to aggregate the different
Lehr, Christian; Rauneker, Philipp; Fahle, Marcus; Hohenbrink, Tobias; Böttcher, Steven; Natkhin, Marco; Thomas, Björn; Dannowski, Ralf; Schwien, Bernd; Lischeid, Gunnar
We used an aquarium to construct a physical model of the water cycle. The model can be used to visualize the movement of the water through the landscape from precipitation and infiltration via surface and subsurface flow to discharge into the sea. The model consists of two aquifers that are divided by a loamy aquitard. The 'geological' setting enables us to establish confining groundwater conditions and to demonstrate the functioning of artesian wells. Furthermore, small experiments with colored water as tracer can be performed to identify flow paths below the ground, simulate water supply problems like pollution of drinking water wells from inflowing contaminated groundwater or changes in subsurface flow direction due to changes in the predominant pressure gradients. Hydrological basics such as the connectivity of streams, lakes and the surrounding groundwater or the dependency of groundwater flow velocity from different substrates can directly be visualized. We used the model as an instructive tool in education and for public relations. We presented the model to different audiences from primary school pupils to laymen, students of hydrology up to university professors. The model was presented to the scientific community as part of the "Face of the Earth" exhibition at the EGU general assembly 2014. Independent of the antecedent knowledge of the audience, the predominant reactions were very positive. The model often acted as icebreaker to get a conversation on hydrological topics started. Because of the great interest, we prepared video material and a photo documentation on 1) the construction of the model and 2) the visualization of steady and dynamic hydrological situations. The videos will be published soon under creative common license and the collected material will be made accessible online. Accompanying documents will address professionals in hydrology as well as non-experts. In the PICO session, we will present details about the construction of the model
Callwood, Alison; Cooke, Debbie; Allan, Helen T.
Aim: To discuss theoretical conceptualisation and definition of values and values-based recruitment in the context of women’s views about what they would like from their midwife. \\ud \\ud Background: Values-based recruitment received headline status in the UK government’s response to pervasive deficiencies in compassionate care identified in the health service. Core values which aim to inform service user’s experience are defined in the National Health Service Constitution but clarity about wh...
Full Text Available Value plays a central role in practically every aspect of human life that requires a decision: whether we choose between different consumer goods, whether we decide which person we marry or which political candidate gets our vote, we choose the option that has more value to us. Over the last decade, neuroeconomic research has mapped the neural substrates of economic value, revealing that activation in brain regions such as ventromedial prefrontal cortex (VMPFC, ventral striatum or posterior cingulate cortex reflects how much an individual values an option and which of several options he/she will choose. However, while great progress has been made exploring the mechanisms underlying concrete decisions, neuroeconomic research has been less concerned with the questions of why people value what they value, and why different people value different things. Social psychologists and sociologists have long been interested in core values, motivational constructs that are intrinsically linked to the self-schema and are used to guide actions and decisions across different situations and different time points. Core value may thus be an important determinant of individual differences in economic value computation and decision-making. Based on a review of recent neuroimaging studies investigating the neural representation of core values and their interactions with neural systems representing economic value, we outline a common framework that integrates the core value concept and neuroeconomic research on value-based decision-making.
Brosch, Tobias; Sander, David
VALUE PLAYS A CENTRAL ROLE IN PRACTICALLY EVERY ASPECT OF HUMAN LIFE THAT REQUIRES A DECISION: whether we choose between different consumer goods, whether we decide which person we marry or which political candidate gets our vote, we choose the option that has more value to us. Over the last decade, neuroeconomic research has mapped the neural substrates of economic value, revealing that activation in brain regions such as ventromedial prefrontal cortex (VMPFC), ventral striatum or posterior cingulate cortex reflects how much an individual values an option and which of several options he/she will choose. However, while great progress has been made exploring the mechanisms underlying concrete decisions, neuroeconomic research has been less concerned with the questions of why people value what they value, and why different people value different things. Social psychologists and sociologists have long been interested in core values, motivational constructs that are intrinsically linked to the self-schema and are used to guide actions and decisions across different situations and different time points. Core value may thus be an important determinant of individual differences in economic value computation and decision-making. Based on a review of recent neuroimaging studies investigating the neural representation of core values and their interactions with neural systems representing economic value, we outline a common framework that integrates the core value concept and neuroeconomic research on value-based decision-making.
Ward, Lawrence; Powell, Rhea E; Scharf, Michael L; Chapman, Andrew; Kavuru, Mani
Health care is at a crossroads and under pressure to add value by improving patient experience and health outcomes and reducing costs to the system. Efforts to improve the care model in primary care, such as the patient-centered medical home, have enjoyed some success. However, primary care accounts for only a small portion of total health-care spending, and there is a need for policies and frameworks to support high-quality, cost-efficient care in specialty practices of the medical neighborhood. The Patient-Centered Specialty Practice (PCSP) model offers ambulatory-based specialty practices one such framework, supported by a formal recognition program through the National Committee for Quality Assurance. The key elements of the PCSP model include processes to support timely access to referral requests, improved communication and coordination with patients and referring clinicians, reduced unnecessary and duplicative testing, and an emphasis on continuous measurement of quality, safety, and performance improvement for a population of patients. Evidence to support the model remains limited, and estimates of net costs and value to practices are not fully understood. The PCSP model holds promise for promoting value-based health care in specialty practices. The continued development of appropriate incentives is required to ensure widespread adoption. Copyright © 2017. Published by Elsevier Inc.
Çelik Şimşek, N.; Uzun, B.
According to the Turkish condominium ownership system, 3D physical buildings and its condominium units are registered to the condominium ownership books via 2D survey plans. Currently, 2D representations of the 3D physical objects, causes inaccurate and deficient implementations for the determination of the land shares. Condominium ownership and easement right are established with a clear indication of land shares (condominium ownership law, article no. 3). So, the land share of each condominium unit have to be determined including the value differences among the condominium units. However the main problem is that, land share has often been determined with area based over the project before construction of the building. The objective of this study is proposing a new approach in terms of value-based land share calculations of the condominium units that subject to condominium ownership. So, the current approaches and its failure that have taken into account in determining the land shares are examined. And factors that affect the values of the condominium units are determined according to the legal decisions. This study shows that 3D BIM models can provide important approaches for the valuation problems in the determination of the land shares.
Shore, Neal D; Jacoby, Dana
Changes involving the health care economic landscape have affected physicians' workflow, productivity, compensation structures, and culture. Ongoing Federal legislation regarding regulatory documentation and imminent payment-changing methodologies have encouraged physician consolidation into larger practices, creating affiliations with hospitals, multidisciplinary medical specialties, and integrated delivery networks. As subspecialization and evolution of care models have accelerated, independent medical groups have broadened ancillary service lines by investing in enterprises that compete with hospital-based (academic and nonacademic) entities, as well as non-physician- owned multispecialty enterprises, for both outpatient and inpatient services. The looming and dramatic shift from volume- to value-based health care compensation will assuredly affect urology group compensation arrangements and productivity formulae. For groups that can implement change rapidly, efficiently, and harmoniously, there will be opportunities to achieve the Triple Aim goals of the Patient Protection and Affordable Care Act, while maintaining a successful medical-financial practice. In summary, implementing new payment algorithms alongside comprehensive care coordination will assist urology groups in addressing the health economic cost and quality challenges that have been historically encountered with fee-for-service systems. Urology group leadership and stakeholders will need to adjust internal processes, methods of care coordination, cultural dependency, and organizational structures in order to create better systems of care and management. In response, ancillary services and patient throughput will need to evolve in order to adequately align quality measurement and reporting systems across provider footprints and patient populations.
Louis P. Garrison
Full Text Available ‘Value-based’ outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: “What kinds of pricing and reimbursement models should be applied in personalized healthcare?” The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that—to meet this social objective of optimal innovation in personalized healthcare—payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption.
Heller, Richard E. [Radiology Partners, El Segundo, CA (United States); Coley, Brian D. [University of Cincinnati, Department of Radiology and Medical Imaging, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Simoneaux, Stephen F. [Emory University School of Medicine, Department of Radiology, Children' s Healthcare of Atlanta, Atlanta, GA (United States); Podberesky, Daniel J. [Nemours Children' s Hospital, Department of Radiology, Nemours Children' s Health System, Orlando, FL (United States); Hernanz-Schulman, Marta [Vanderbilt University School of Medicine, Department of Radiology, Monroe Carell Jr. Children' s Hospital at Vanderbilt, Nashville, TN (United States); Robertson, Richard L. [Harvard Medical School, Department of Radiology, Boston Children' s Hospital, Boston, MA (United States); Donnelly, Lane F. [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States)
Recent political and economic factors have contributed to a meaningful change in the way that quality in health care, and by extension value, are viewed. While quality is often evaluated on the basis of subjective criteria, pay-for-performance programs that link reimbursement to various measures of quality require use of objective and quantifiable measures. This evolution to value-based payment was accelerated by the 2015 passage of the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA). While many of the drivers of these changes are rooted in federal policy and programs such as Medicare and aimed at adult patients, the practice of pediatrics and pediatric radiology will be increasingly impacted. This article addresses issues related to the use of quantitative measures to evaluate the quality of services provided by the pediatric radiology department or sub-specialty section, particularly as seen from the viewpoint of a payer that may be considering ways to link payment to performance. The paper concludes by suggesting a metric categorization strategy to frame future work on the subject. (orig.)
Dranitsaris, George; Truter, Ilse; Lubbe, Martie S; Sriramanakoppa, Nitin N; Mendonca, Vivian M; Mahagaonkar, Sangameshwar B
Decision analysis (DA) is commonly used to perform economic evaluations of new pharmaceuticals. Using multiples of Malaysia's per capita 2010 gross domestic product (GDP) as the threshold for economic value as suggested by the World Health Organization (WHO), DA was used to estimate a price per dose for bevacizumab, a drug that provides a 1.4-month survival benefit in patients with metastatic colorectal cancer (mCRC). A decision model was developed to simulate progression-free and overall survival in mCRC patients receiving chemotherapy with and without bevacizumab. Costs for chemotherapy and management of side effects were obtained from public and private hospitals in Malaysia. Utility estimates, measured as quality-adjusted life years (QALYs), were determined by interviewing 24 oncology nurses using the time trade-off technique. The price per dose was then estimated using a target threshold of US$44 400 per QALY gained, which is 3 times the Malaysian per capita GDP. A cost-effective price for bevacizumab could not be determined because the survival benefit provided was insufficient According to the WHO criteria, if the drug was able to improve survival from 1.4 to 3 or 6 months, the price per dose would be $567 and $1258, respectively. The use of decision modelling for estimating drug pricing is a powerful technique to ensure value for money. Such information is of value to drug manufacturers and formulary committees because it facilitates negotiations for value-based pricing in a given jurisdiction.
Breeze, Penny; Brennan, Alan
Our aim was to adapt the traditional framework for expected net benefit of sampling (ENBS) to be more compatible with drug development trials from the pharmaceutical perspective. We modify the traditional framework for conducting ENBS and assume that the price of the drug is conditional on the trial outcomes. We use a value-based pricing (VBP) criterion to determine price conditional on trial data using Bayesian updating of cost-effectiveness (CE) model parameters. We assume that there is a threshold price below which the company would not market the new intervention. We present a case study in which a phase III trial sample size and trial duration are varied. For each trial design, we sampled 10,000 trial outcomes and estimated VBP using a CE model. The expected commercial net benefit is calculated as the expected profits minus the trial costs. A clinical trial with shorter follow-up, and larger sample size, generated the greatest expected commercial net benefit. Increasing the duration of follow-up had a modest impact on profit forecasts. Expected net benefit of sampling can be adapted to value clinical trials in the pharmaceutical industry to optimise the expected commercial net benefit. However, the analyses can be very time consuming for complex CE models. © 2014 The Authors. Health Economics published by John Wiley & Sons Ltd.
Danzon, Patricia; Towse, Adrian; Mestre-Ferrandiz, Jorge
This paper analyzes pharmaceutical pricing between and within countries to achieve second-best static and dynamic efficiency. We distinguish countries with and without universal insurance, because insurance undermines patients' price sensitivity, potentially leading to prices above second-best efficient levels. In countries with universal insurance, if each payer unilaterally sets an incremental cost-effectiveness ratio (ICER) threshold based on its citizens' willingness-to-pay for health; manufacturers price to that ICER threshold; and payers limit reimbursement to patients for whom a drug is cost-effective at that price and ICER, then the resulting price levels and use within each country and price differentials across countries are roughly consistent with second-best static and dynamic efficiency. These value-based prices are expected to differ cross-nationally with per capita income and be broadly consistent with Ramsey optimal prices. Countries without comprehensive insurance avoid its distorting effects on prices but also lack financial protection and affordability for the poor. Improving pricing efficiency in these self-pay countries includes improving regulation and consumer information about product quality and enabling firms to price discriminate within and between countries. © 2013 The Authors. Health Economics published by John Wiley & Sons Ltd.
St John, A; Edwards, G; Fisher, S; Badrick, T; Callahan, J; Crothers, J
All areas of healthcare, including pathology, are being challenged by the reality that the days of ever increasing budgets are over and the key debate is about how to provide value for money. As originally described by Porter and Tiesberg, value-based healthcare is defined as maximising outcomes over cost by moving away from fee for service models to ones that reward providers on the basis of outcomes (1). While production efficiencies will continue to evolve, the opportunities for future stepwise improvements in production costs are likely to have diminished. The focus now is on delivering improved testing outcomes in a relatively cost neutral or at least cost effective way. This brings pathology into line with other health services that focus on value for money for payers, and maximising health outcomes for consumers. This would signal a break from the existing pathology funding model, which does not directly recognise or reward the contribution of pathology towards improved health outcomes, or seek to decommission tests that offer little clinical value. Pathology has a direct impact on clinical and economic outcomes that extend from testing and it is important to garner support for a new approach to funding that incentivises improvements of the overall quality and contribution of the pathology service. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
Hirth, Richard A; Cliff, Elizabeth Q; Gibson, Teresa B; McKellar, M Richard; Fendrick, A Mark
In 2011 Connecticut implemented the Health Enhancement Program for state employees. This voluntary program followed the principles of value-based insurance design (VBID) by lowering patient costs for certain high-value primary and chronic disease preventive services, coupled with requirements that enrollees receive these services. Nonparticipants in the program, including those removed for noncompliance with its requirements, were assessed a premium surcharge. The program was intended to curb cost growth and improve health through adherence to evidence-based preventive care. To evaluate its efficacy in doing so, we compared changes in service use and spending after implementation of the program to trends among employees of six other states. Compared to employees of other states, Connecticut employees were similar in age and sex but had a slightly higher percentage of enrollees with chronic conditions and substantially higher spending at baseline. During the program's first two years, the use of targeted services and adherence to medications for chronic conditions increased, while emergency department use decreased, relative to the situation in the comparison states. The program's impact on costs was inconclusive and requires a longer follow-up period. This novel combination of VBID principles and participation requirements may be a tool that can help plan sponsors increase the use of evidence-based preventive services. Project HOPE—The People-to-People Health Foundation, Inc.
Hamid, Kamran S; Nwachukwu, Benedict U; Ellis, Scott J
The US health care system is transitioning to a value-based model of health care in which providers will be rewarded for delivering services that achieve excellent clinical outcomes with efficient cost utilization. The concept of "value" in health care (defined as health outcomes achieved per dollar spent) is rapidly spreading as physicians and health systems brace for the paradigm shift from "fee-for-volume" to "fee-for-value" reimbursement. What constitutes good value versus poor value in health care remains nebulous at this time. Various specialties across medicine and within orthopaedics are seeking to better demonstrate value delivered to patients, payers, and policy makers. The objective of this article is to develop a framework for defining and measuring value in foot and ankle surgery. In this new era of health care, we believe that a working knowledge of value and its determinants will be imperative for foot and ankle surgeons to unify research and quality improvement efforts so as to demonstrate the value of services rendered within the subspecialty. Level V, expert opinion.
Full Text Available The concept of “pay for performance” (P4P applied to the practice of medicine has become a major foundation in current public and private payer reimbursement strategies for both institutional and individual physician providers. “Pay for performance” programs represent a substantial shift from traditional service-based reimbursement to a system of performance-based provider payment using financial incentives to drive improvements in the quality of care. P4P strategies currently embody rudimentary structure and process (as opposed to outcomes metrics which set relatively low-performance thresholds. P4P strategies that align reimbursement allocation with “free market” type shifts in cognitive and procedural care using evidence-based data and positive reinforcement are more likely to produce large-scale improvements in quality and cost efficiency with respect to clinical urologic care. This paper reviews current paradigms and, using BPH procedural therapy outcomes, cost, and reimbursement data, makes the case for a fundamental change in perspective to value-based pay for performance as a reimbursement system with the potential to align the interests of patients, physicians, and payers and to improve global clinical outcomes while preserving free choice of clinically efficacious treatments.
Brosch, Tobias; Sander, David
Value plays a central role in practically every aspect of human life that requires a decision: whether we choose between different consumer goods, whether we decide which person we marry or which political candidate gets our vote, we choose the option that has more value to us. Over the last decade, neuroeconomic research has mapped the neural substrates of economic value, revealing that activation in brain regions such as ventromedial prefrontal cortex (VMPFC), ventral striatum or posterior cingulate cortex reflects how much an individual values an option and which of several options he/she will choose. However, while great progress has been made exploring the mechanisms underlying concrete decisions, neuroeconomic research has been less concerned with the questions of why people value what they value, and why different people value different things. Social psychologists and sociologists have long been interested in core values, motivational constructs that are intrinsically linked to the self-schema and are used to guide actions and decisions across different situations and different time points. Core value may thus be an important determinant of individual differences in economic value computation and decision-making. Based on a review of recent neuroimaging studies investigating the neural representation of core values and their interactions with neural systems representing economic value, we outline a common framework that integrates the core value concept and neuroeconomic research on value-based decision-making. PMID:23898252
Tseng, Eric K; Hicks, Lisa K
Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care.
Heller, Richard E.; Coley, Brian D.; Simoneaux, Stephen F.; Podberesky, Daniel J.; Hernanz-Schulman, Marta; Robertson, Richard L.; Donnelly, Lane F.
Recent political and economic factors have contributed to a meaningful change in the way that quality in health care, and by extension value, are viewed. While quality is often evaluated on the basis of subjective criteria, pay-for-performance programs that link reimbursement to various measures of quality require use of objective and quantifiable measures. This evolution to value-based payment was accelerated by the 2015 passage of the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA). While many of the drivers of these changes are rooted in federal policy and programs such as Medicare and aimed at adult patients, the practice of pediatrics and pediatric radiology will be increasingly impacted. This article addresses issues related to the use of quantitative measures to evaluate the quality of services provided by the pediatric radiology department or sub-specialty section, particularly as seen from the viewpoint of a payer that may be considering ways to link payment to performance. The paper concludes by suggesting a metric categorization strategy to frame future work on the subject. (orig.)
Garrison, Louis P.; Towse, Adrian
‘Value-based’ outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: “What kinds of pricing and reimbursement models should be applied in personalized healthcare?” The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that—to meet this social objective of optimal innovation in personalized healthcare—payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption. PMID:28869571
Utomo, C.; Rahmawati, Y.; Pararta, D. L.; Ariesta, A.
Readiness of infrastructure establishment is needed in the early phase of real estate development. To meet the needs of retail property in the form of traditional markets, the Government prepares to build a new 1300 units. Traditional market development requires infrastructure development. One of it is the preparation of sand material embankment as much as ± 200,000 m3. With a distance of 30 km, sand material can be delivered to the project site by dump trucks that can only be operated by 2 trip per day. The material is managed by using stockpile method. Decision of stockpile location requires multi person and multi criteria in a collaborative environment. The highest and the best use (HBU) criteria was used to construct a value-based decision hierarchy. Decision makers from five stakeholders analyzed the best of three locations by giving their own preference of development cost and HBU function. Analytical Hierarchy Process (AHP) based on satisfying options and cooperative game was applied for agreement options and coalition formation on collaborative decision. The result indicates that not all solutions become a possible location for the stockpile material. It shows the ‘best fit’ options process for all decision makers.
This article clarifies how the freedom of thought as a human right can be understood and promoted as a right of mental health service users, especially people with psychotic disorder, by using Martha Nussbaum's capabilities approach and Fulford's and Fulford et al 's values-based practice. According to Nussbaum, freedom of thought seems to primarily protect the capability to think, believe and feel. This capability can be promoted in the context of mental health services by values-based practice. The article points out that both Nussbaum's approach and values-based practice recognise that people's values differ. The idea of involving different actors and service users in mental healthcare is also common in both Nussbaum's approach and values-based practice. However, there are also differences in that values-based practice relies on a 'good process' in decision-making, whereas the capabilities approach is oriented towards a 'right outcome'. However, since process and outcome are linked with each other, these two approaches do not necessarily conflict despite this difference. The article suggests that absolute rights are possible within the two approaches. It also recognises that the capabilities approach, values-based practice and human rights approach lean on liberal values and thus can be combined at least in liberal societies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
McFarland, Daniel C; Ornstein, Katherine A; Holcombe, Randall F
Hospital Value-Based Purchasing (HVBP) incentivizes quality performance-based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population-dense areas and could bias Centers for Medicare & Medicaid Services (CMS) reimbursement. Assess nonrandom variation in patient satisfaction as determined by HCAHPS. Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized 4 highly predictive variables, and hospitals were reranked accordingly. A total of 3907 HVBP-participating hospitals. There were 934,800 patient surveys by the most conservative estimate. A total of 3144 county demographics (US Census) and HCAHPS surveys. Hospital size and primary language (non-English speaking) most strongly predicted unfavorable HCAHPS scores, whereas education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals' locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. Demographic and structural factors (eg, hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct. © 2015 Society of Hospital Medicine.
Mills, Anne E; Spencer, Edward M
The recognition that the success of the healthcare organization depends on its achievement of two interrelated goals is a relatively recent phenomenon. In its mid-history the healthcare organization was largely able to ignore cost issues. In its latter history, many would argue that it ignored its quality goals as it pursued its cost goals (15). Either approach, given declining revenues and a competitive landscape, is incompatible with continued responsible operation. If this is true, then tools that were appropriate when the healthcare organization was focused on the achievement of one or another of these goals are not adequate as the healthcare organization seeks to achieve both goals together. Thus, new perspectives and new tools must be found that help the organization address two intimately related but sometimes conflicting goals. Values based decision-making can be the perspective needed, and organization ethics is one tool that can be of use in supporting it within the institution. But there are caveats. In order for values based decision-making to be effective, leadership must take an active role in promoting its use. It must relinquish a degree of control and it must begin to trust its stakeholders to make decisions within the context of the organization's values and goals. This can be extremely difficult, as control by senior management is often seen as the only effective means of ensuring that correct decisions are made. There are additional difficulties in the healthcare organization. Control rests within two groups and the healthcare organization is operating in an environment in which variance elimination is emphasized as a means of controlling costs. This may be an appealing notion for revenue strapped healthcare organization leaders, but it implies greater control exerted by managers, not less. Relinquishing any degree of control is a frightening prospect, but it has been done successfully. An excellent example of leadership encouraging decisions
Lustig, Adam; Ogden, Michael; Brenner, Robert W; Penso, Jerry; Westrich, Kimberly D; Dubois, Robert W
has achieved 72% hypertension control for at-risk patients and continues work towards the 80% campaign goal. The implementation of the Measure Up/Pressure Down campaign by CHC and SMG provides some valuable lessons. To further explore important aspects of successfully implementing the Measure Up/Pressure Down campaign in real-world settings, 6 key themes were identified that drove quality improvement and may be helpful to other organizations that implement similar quality improvement initiatives: (1) transitioning to value-based payments, (2) creating an environment for success, (3) leveraging program champions, (4) sharing quality data, (5) promoting care team collaboration, and (6) leveraging health information technology. The strategies employed by SMG and CHC, such as leveraging data analysis to identify at-risk patients and comparing physician performance, as well as identifying leaders to institute change, can be replicated by an ACO or a managed care organization (MCO). An MCO can provide data analysis services, sparing the provider groups the analytic burden and helping the MCO build a more meaningful relationship with their providers. No outside funding supported this project. The authors declare no conflicts of interest. The authors are members of the Working Group on Optimizing Medication Therapy in Value-Based Healthcare. Odgen is employed by Cornerstone Health Care; Brenner is employed by Summit Medical Group; and Penso is employed by American Medical Group Association. Lustig, Westrich, and Dubois are employed by the National Pharmaceutical Council, an industry-funded health policy research organization that is not involved in lobbying or advocacy. Study concept and design were contributed by Lustig, Penso, Westrich, and Dubois. Lustig, Ogden, Brenner, and Penso collected the data, and data interpretation was performed by all authors. The manuscript was written primarily by Lustig, along with the other authors, and revised by Lustig, Penso, Westrich, and
Fulford has argued that (1) the medical concepts illness, disease and dysfunction are inescapably evaluative terms, (2) illness is conceptually prior to disease, and (3) a model conforming to (2) has greater explanatory power and practical utility than the conventional value-free medical model. This 'reverse' model employs Hare's distinction between description and evaluation, and the sliding relationship between descriptive and evaluative meaning. Fulford's derivative 'Values Based Medicine' (VBM) readjusts the imbalance between the predominance of facts over values in medicine. VBM allegedly responds to the increased choices made available by, inter alia, the progress of medical science itself. VBM attributes appropriate status to evaluative meaning, where strong consensus about descriptive meaning is lacking. According to Fulford, quasi-legal bioethics, while it can be retained as a kind of deliberative framework, is outcome-based and pursues 'the right answer', while VBM approximates a democratic, process-oriented method for dealing with diverse values, in partnership with necessary contributions from evidence-based medicine (EBM). I support the non-cognitivist underpinnings of VBM, and its emphasis on the importance of values in medicine. But VBM overstates the complexity and diversity of values, misrepresents EBM and VBM as responses to scientific and evaluative complexity, and mistakenly depicts 'quasi-legal bioethics' as a space of settled descriptive meaning. Bioethical reasoning can expose strategies that attempt to reduce authentic values to scientific facts, illustrating that VBM provides no advantage over bioethics in delineating the connections between facts and values in medicine. © 2011 Blackwell Publishing Ltd.
Grill, Kalle; Dawson, Angus
A number of ethical frameworks have been proposed to support decision-making in public health and the evaluation of public health policy and practice. This is encouraging, since ethical considerations are of paramount importance in health policy. However, these frameworks have various deficiencies, in part because they incorporate substantial ethical positions. In this article, we discuss and criticise a framework developed by James Childress and Ruth Bernheim, which we consider to be the state of the art in the field. Their framework distinguishes aims, such as the promotion of public health, from constraints on the pursuit of those aims, such as the requirement to avoid limitations to liberty, or the requirement to be impartial. We show how this structure creates both theoretical and practical problems. We then go on to present and defend a more practical framework, one that is neutral in avoiding precommitment to particular values and how they ought to be weighted. We believe ethics is at the very heart of such weightings and our framework is developed to reflect this belief. It is therefore both pluralist and value-based. We compare our new framework to Childress and Bernheim's and outline its advantages. It is justified by its impetus to consider a wide range of alternatives and its tendency to direct decisions towards the best alternatives, as well as by the information provided by the ranking of alternatives and transparent explication of the judgements that motivate this ranking. The new framework presented should be useful to decision-makers in public health, as well as being a means to stimulate further reflection on the role of ethics in public health.
The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a ‘value-based health care delivery’. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup. And maybe, therefore, the assumptions underpinning personalized medicine have largely escaped questioning. The use of personalized medicine and the use of digital technologies is reshaping our health care system and how we think of health interventions and our individual responsibility. However, encouraging individuals to engage in preventive health activities possibly avoids one form of medicalization (clinical), but on the other hand, it takes up another form (preventive medicine and ‘self-care’) that moves medical and health concerns into every corner of everyday life. This ought to be of little value to the individual patient and public health. We ought to instead demand proof of these value ideas and the lacking research. Before this is in place critical appraisal and cynicism are requisite skills for the future. Otherwise, we are just listening to visionaries when we put our future health into their hands and let personalized solutions reach into people's everyday life regardless of patient safety and integrity. PMID:28409064
Morita, Kenji; Jitsev, Jenia; Morrison, Abigail
Value-based action selection has been suggested to be realized in the corticostriatal local circuits through competition among neural populations. In this article, we review theoretical and experimental studies that have constructed and verified this notion, and provide new perspectives on how the local-circuit selection mechanisms implement reinforcement learning (RL) algorithms and computations beyond them. The striatal neurons are mostly inhibitory, and lateral inhibition among them has been classically proposed to realize "Winner-Take-All (WTA)" selection of the maximum-valued action (i.e., 'max' operation). Although this view has been challenged by the revealed weakness, sparseness, and asymmetry of lateral inhibition, which suggest more complex dynamics, WTA-like competition could still occur on short time scales. Unlike the striatal circuit, the cortical circuit contains recurrent excitation, which may enable retention or temporal integration of information and probabilistic "soft-max" selection. The striatal "max" circuit and the cortical "soft-max" circuit might co-implement an RL algorithm called Q-learning; the cortical circuit might also similarly serve for other algorithms such as SARSA. In these implementations, the cortical circuit presumably sustains activity representing the executed action, which negatively impacts dopamine neurons so that they can calculate reward-prediction-error. Regarding the suggested more complex dynamics of striatal, as well as cortical, circuits on long time scales, which could be viewed as a sequence of short WTA fragments, computational roles remain open: such a sequence might represent (1) sequential state-action-state transitions, constituting replay or simulation of the internal model, (2) a single state/action by the whole trajectory, or (3) probabilistic sampling of state/action. Copyright © 2016. Published by Elsevier B.V.
Dranitsaris, George; Truter, Ilse; Lubbe, Martie S
Worldwide, prices for cancer drugs have been under downward pressure where several governments have mandated price cuts of branded products. A better alternative to government mandated price cuts would be to estimate a final price based on drug performance, cost effectiveness and a country's ability to pay. We developed a global pricing index for new cancer drugs in patients with metastatic colorectal cancer (mCRC) that encompasses all of these attributes. A pharmacoeconomic model was developed to simulate mCRC patients receiving chemotherapy plus a 'new drug' that improves survival by 1.4, 3 and 6months, respectively. Cost and utility data were obtained from cancer centres and oncology nurses (n=112) in Canada, Spain, India, South Africa and Malaysia. Multivariable analysis was then used to develop the pricing index, which considers survival benefit, per capita GDP and income dispersion (as measured by the Gini coefficient) as predictor variables. Higher survival benefits were associated with elevated drug prices, especially in higher income countries such as Canada. For Argentina with a per capita GDP of $15,000 and a Gini coefficient of 51, the index estimated that for a drug which provides a 4month survival benefit in mCRC, the value based price would be $US 630 per dose. In contrast, the same drug in a wealthier country like Norway (per capita GDP=$50,000) could command a price of $US 2,775 per dose. The application of this index to estimate a price based on cost effectiveness and the wealth of a nation would be important for opening dialogue between the key stakeholders and a better alternative to government mandated price cuts. Copyright © 2011 Elsevier Ltd. All rights reserved.
Danzon, Patricia M
To analyze how value-based pricing (VBP), which grounds the price paid for pharmaceuticals in their value, can manage "affordability" challenges, defined as drugs that meet cost-effectiveness thresholds but are "unaffordable" within the short-run budget. Three specific contexts are examined, drawing on recent experience. First, an effective new treatment for a chronic, progressive disease, such as hepatitis C, creates a budget spike that is transitory because initial prevalence is high, relative to current incidence. Second, "cures" that potentially provide lifetime benefits may claim abnormally high VBP prices, with high immediate budget impact potentially/partially offset by deferred cost savings. Third, although orphan drugs in principle target rare diseases, in aggregate they pose affordability concerns because of the growing number of orphan indications and increasingly high prices. For mass diseases, the transitory budget impact of treating the accumulated patient stock can be managed by stratified rollout that delays treatment of stable patients and prioritizes patients at high risk of deterioration. Delay spreads the budget impact and permits potential savings from launch of competing treatments. For cures, installment payments contingent on outcomes could align payment flows and appropriately shift risk to producers. This approach, however, entails high administrative and incentive costs, especially if applied across multiple payers in the United States. For orphan drugs, the available evidence on research and development trends and returns argues against the need for a higher VBP threshold to incentivize research and development in orphan drugs, given existing statutory benefits under orphan drug legislation. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Carbone, Marco; Cristoferi, Laura; Cortesi, Paolo Angelo; Rota, Matteo; Ciaccio, Antonio; Okolicsanyi, Stefano; Gemma, Marta; Scalone, Luciana; Cesana, Giancarlo; Fabris, Luca; Colledan, Michele; Fagiuoli, Stefano; Ideo, Gaetano; Belli, Luca Saverio; Munari, Luca Maria; Mantovani, Lorenzo; Strazzabosco, Mario
Autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis represent the three major autoimmune liver diseases (AILDs). Their management is highly specialized, requires a multidisciplinary approach and often relies on expensive, orphan drugs. Unfortunately, their treatment is often unsatisfactory, and the care pathway heterogeneous across different centers. Disease-specific clinical outcome indicators (COIs) able to evaluate the whole cycle of care are needed to assist both clinicians and administrators in improving quality and value of care. Aim of our study was to generate a set of COIs for the three AILDs. We then prospectively validated these indicators based on a series of consecutive patients recruited at three tertiary clinical centers in Lombardy, Italy. In phase I using a Delphi method and a RAND 9-point appropriateness scale a set of COIs was generated. In phase II the indicators were applied in a real-life dataset. Two-hundred fourteen patients were enrolled and followed-up for a median time of 54months and the above COIs were recorded using a web-based electronic medical record program. The COIs were easy to collect in the clinical practice environment and their values compared well with the available natural history studies. We have generated a comprehensive set of COIs which sequentially capture different clinical outcome of the three AILDs explored. These indicators represent a critical tool to implement a value-based approach to patients with these conditions, to monitor, compare and improve quality through benchmarking of clinical performance and to assess the significance of novel drugs and technologies. This article is part of a Special Issue entitled: Cholangiocytes in Health and Diseaseedited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen. Copyright © 2017. Published by Elsevier B.V.
Nilsson, Kerstin; Bååthe, Fredrik; Andersson, Annette Erichsen; Wikström, Ewa; Sandoff, Mette
Implementing the value-based healthcare concept (VBHC) is a growing management trend in Swedish healthcare organizations. The aim of this study is to explore how representatives of four pilot project teams experienced implementing VBHC in a large Swedish University Hospital over a period of 2 years. The project teams started their work in October 2013. An explorative and qualitative design was used, with interviews as the data collection method. All the participants in the four pilot project teams were individually interviewed three times, with interviews starting in March 2014 and ending in November 2015. All the interviews were transcribed and analyzed using qualitative analysis. Value for the patients was experienced as the fundamental drive for implementing VBHC. However, multiple understandings of what value for patients' means existed in parallel. The teams received guidance from consultants during the first 3 months. There were pros and cons to the consultant's guidance. This period included intensive work identifying outcome measurements based on patients' and professionals' perspectives, with less interest devoted to measuring costs. The implementation process, which both gave and took energy, developed over time and included interventions. In due course it provided insights to the teams about the complexity of healthcare. The necessity of coordination, cooperation and working together inter-departmentally was critical. Healthcare organizations implementing VBHC will benefit from emphasizing value for patients, in line with the intrinsic drive in healthcare, as well as managing the process of implementation on the basis of understanding the complexities of healthcare. Paying attention to the patients' voice is a most important concern and is also a key towards increased engagement from physicians and care providers for improvement work.
The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a 'value-based health care delivery'. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup. And maybe, therefore, the assumptions underpinning personalized medicine have largely escaped questioning. The use of personalized medicine and the use of digital technologies is reshaping our health care system and how we think of health interventions and our individual responsibility. However, encouraging individuals to engage in preventive health activities possibly avoids one form of medicalization (clinical), but on the other hand, it takes up another form (preventive medicine and 'self-care') that moves medical and health concerns into every corner of everyday life. This ought to be of little value to the individual patient and public health. We ought to instead demand proof of these value ideas and the lacking research. Before this is in place critical appraisal and cynicism are requisite skills for the future. Otherwise, we are just listening to visionaries when we put our future health into their hands and let personalized solutions reach into people's everyday life regardless of patient safety and integrity.
Full Text Available This study used system dynamics method to investigate the factors affecting elementary school students’ BMI values. The construction of the dynamic model is divided into the qualitative causal loop and the quantitative system dynamics modeling. According to the system dynamics modeling, this study consisted of research on the four dimensions: student’s personal life style, diet-relevant parenting behaviors, advocacy and implementation of school nutrition education, and students’ peer interaction. The results of this study showed that students with more adequate health concepts usually have better eating behaviors and consequently have less chance of becoming obese. In addition, this study also verified that educational attainment and socioeconomic status of parents have a positive correlation with students’ amounts of physical activity, and nutrition education has a prominent influence on changing students’ high-calorie diets.
Lan, Tian-Syung; Chen, Kai-Ling; Chen, Pin-Chang; Ku, Chao-Tai; Chiu, Pei-Hsuan; Wang, Meng-Hsiang
This study used system dynamics method to investigate the factors affecting elementary school students' BMI values. The construction of the dynamic model is divided into the qualitative causal loop and the quantitative system dynamics modeling. According to the system dynamics modeling, this study consisted of research on the four dimensions: student's personal life style, diet-relevant parenting behaviors, advocacy and implementation of school nutrition education, and students' peer interaction. The results of this study showed that students with more adequate health concepts usually have better eating behaviors and consequently have less chance of becoming obese. In addition, this study also verified that educational attainment and socioeconomic status of parents have a positive correlation with students' amounts of physical activity, and nutrition education has a prominent influence on changing students' high-calorie diets.
Philippines Univ., Quezon City. Inst. for Science and Mathematics Education Development.
Information about the relationship between water and health is provided in this module. Topics considered include: (1) the various uses of water; (2) water demand of individuals in certain communities; (3) water sources; (4) water cycle; (5) pure water; (6) water pollution, focusing on pollution resulting from heat, chemicals, radioactive…
Bohra, Tasneem; Benmarhnia, Tarik; McKinnon, Britt; Kaufman, Jay S.
Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortalit...
Martin, F.D.; Bretz, R.E.; Bowman, R.S.; Kieft, T.L.; Cadena, F.
The Hobbs Oil and Water Experimental (HOWE) Facility came on-line as a research component of the Waste-Management Education and Research Consortium (WERC) when funding for the Consortium became official in late February 1990. As a support facility for WERC, which was established to expand the ability of this nation to manage hazardous, radioactive, and solid wastes through a multidisciplinary approach, HOWE can tap into the expertise that resides at three major New Mexico universities, on Native American community college, and two national laboratories. The intention of the HOWE is to provide education, as well as research and development programs, that reflect concerns of the petroleum industry in the United States. Personnel work to solve environmental problems and assess the impact to the industry of regulatory actions pertaining to those problems. Leadership for the program is provided from the New Mexico Institute of Mining and Technology at Socorro, NM, by Technical Leaders F.D. Martin, Director of the Petroleum Recovery Research Center, and Dr. R.E. Bretz of the petroleum engineering faculty. The HOWE site is administered by Mike DeMarco, Director of the Petroleum Technology Program at the New Mexico Junior College in Hobbs, NM. Currently, the HOWE laboratory is being provided with state-of-the-art equipment to support research projects or field demonstration activities. Programs include research pertaining to groundwater pollution transport processes, slurry-phase bioremediation of oilfield production pit sludges, and treatment of produced brines or contaminated waters. This paper introduces the HOWE and discusses the research programs relevant to the petroleum industry that are presently underway or planned. Future collaborative efforts with industry that are presently underway or planned. Future collaborative efforts with industry groups are being encouraged
Bohra, Tasneem; Benmarhnia, Tarik; McKinnon, Britt; Kaufman, Jay S
Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortality. The analysis combines a concentration index created along a cumulative distribution of the Demographic and Health Surveys sample ranked according to maternal education, and decomposition measures the contribution of water and sanitation to educational inequalities in child mortality. We observed a large education-related inequality in child mortality and access to water and sanitation. There is a need for programs and policies in child health to focus on ensuring equity and to consider the educational stratification of the population to target the most disadvantaged segments of the population. © The American Society of Tropical Medicine and Hygiene.
Full Text Available A group decision support system is required on a value-based decision because there are different concern caused by differing preferences, experiences, and background. It is to enable each decision-maker to evaluate and rank the solution alternatives before engaging into negotiation with other decision-makers. Stakeholder of multi-criteria decision making problems usually evaluates the alternative solution from different perspective, making it possible to have a dominant solution among the alternatives. Each stakeholder needs to identify the goals that can be optimized and those that can be compromised in order to reach an agreement with other stakeholders. This paper presents group decision model involving three decision-makers on the selection of suitable system for a building’s roof. The objective of the research is to find an agreement options model and coalition algorithms for multi person decision with two main preferences of value which are function and cost. The methodology combines value analysis method using Function Analysis System Technique (FAST; Life Cycle Cost analysis, group decision analysis method based on Analytical Hierarchy Process (AHP in a satisfying options, and Game theory-based agent system to develop agreement option and coalition formation for the support system. The support system bridges theoretical gap between automated design in construction domain and automated negotiation in information technology domain by providing a structured methodology which can lead to systematic support system and automated negotiation. It will contribute to value management body of knowledge as an advanced method for creativity and analysis phase, since the practice of this knowledge is teamwork based. In the case of roof system selection, it reveals the start of the first negotiation round. Some of the solutions are not an option because no individual stakeholder or coalition of stakeholders desires to select it. The result indicates
Sikkandar Basha, Nazareen
The design and the development of Large-Scale Complex Engineered Systems (LSCES) requires the involvement of multiple teams and numerous levels of the organization and interactions with large numbers of people and interdisciplinary departments. Traditionally, requirements-driven Systems Engineering (SE) is used in the design and development of these LSCES. The requirements are used to capture the preferences of the stakeholder for the LSCES. Due to the complexity of the system, multiple levels of interactions are required to elicit the requirements of the system within the organization. Since LSCES involves people and interactions between the teams and interdisciplinary departments, it should be socio-technical in nature. The elicitation of the requirements of most large-scale system projects are subjected to creep in time and cost due to the uncertainty and ambiguity of requirements during the design and development. In an organization structure, the cost and time overrun can occur at any level and iterate back and forth thus increasing the cost and time. To avoid such creep past researches have shown that rigorous approaches such as value based designing can be used to control it. But before the rigorous approaches can be used, the decision maker should have a proper understanding of requirements creep and the state of the system when the creep occurs. Sensemaking is used to understand the state of system when the creep occurs and provide a guidance to decision maker. This research proposes the use of the Cynefin framework, sensemaking framework which can be used in the design and development of LSCES. It can aide in understanding the system and decision making to minimize the value gap due to requirements creep by eliminating ambiguity which occurs during design and development. A sample hierarchical organization is used to demonstrate the state of the system at the occurrence of requirements creep in terms of cost and time using the Cynefin framework. These
Reid, Kimberly J; Aguilar, Kathleen M; Thompson, Eric; Miller, Ross M
Through reduced out-of-pocket costs and wellness offerings, value-based benefit design (VBBD) is a promising strategy to improve medication adherence and other health-related outcomes across populations. There is limited evidence, however, of the effectiveness of these policy-level changes among individuals with anxiety or depression. To assess the impact of a multifaceted VBBD policy that incorporates waived copayments, wellness offerings, and on-site services on medication adherence among plan members with anxiety or depression, and to explore how this intervention and its resulting improved adherence affects other health-related outcomes. A retrospective longitudinal pre/post design was utilized to measure outcomes before and after the VBBD policy change. Repeated measures statistical regression models with correlated error terms were utilized to evaluate outcomes among employees of a self-insured global health company and their spouses (N = 529) who had anxiety or depression after the VBBD policy change. A multivariable linear regression model was chosen as the best fit to evaluate a change in medication possession ratio (MPR) after comparing parameters for several distributions. The repeated measures multivariable regression models were adjusted for baseline MPR and potential confounders, including continuous age, sex, continuous modified Charlson Comorbidity Index, and the continuous number of prescriptions filled that year. The outcomes were assessed for the 1 year before the policy change (January 1, 2011, through December 31, 2011) and for 2 years after the change (January 1, 2012, through December 31, 2013). The primary outcome was a change in MPR. The secondary outcomes included healthcare utilization, medical or pharmacy costs, the initiation of medication, generic medication use, and employee absenteeism (the total number of sick days). The implementation of the VBBD strategy was associated with a significant increase in average MPR (0.65 vs 0.61 in
Parkinson, Bonny; Sermet, Catherine; Clement, Fiona; Crausaz, Steffan; Godman, Brian; Garner, Sarah; Choudhury, Moni; Pearson, Sallie-Anne; Viney, Rosalie; Lopert, Ruth; Elshaug, Adam G
Pharmaceutical expenditure has increased rapidly across many Organisation for Economic Cooperation and Development (OECD) countries over the past three decades. This growth is an increasing concern for governments and other third-party payers seeking to provide equitable and comprehensive healthcare within sustainable budgets. In order to create headroom for increasing utilisation, and to fund new high-cost therapies, there is an active push to 'disinvest' from low-value drugs. The aim of this article is to review how reimbursement policy decision makers have sought to partially or completely disinvest from drugs in a range of OECD countries (UK, France, Canada, Australia and New Zealand) where they are publicly funded or subsidised. We employed a systematic literature search strategy and the incorporation of grey literature known to the authorship team. We canvass key policy instruments from each country to outline key approaches to the identification of candidate drugs for disinvestment assessment (passive approaches vs. more active approaches); methods of disinvestment and value-based purchasing (de-listing, restricting treatment, price or reimbursement rate reductions, encouraging generic prescribing); lessons learnt from the various approaches; the potential role of coverage with evidence development; and the need for careful stakeholder management. Dedicated sections are provided with detailed coverage of policy approaches (with drug examples) from each country. Historically, countries have relied on 'passive disinvestment'; however, due to (1) the availability of new cost-effectiveness evidence, or (2) 'leakage' in drug utilisation, or (3) market failure in terms of price competition, there is an increasing focus towards 'active disinvestment'. Isolating low-value drugs that would create headroom for innovative new products to enter the market is also motivating disinvestment efforts by multiple parties, including industry. Historically, disinvestment has
... drink and water in food (like fruits and vegetables). 6. Of all the earthâs water, how much is ocean or seas? 97 percent of the earthâs water is ocean or seas. 7. How much of the worldâs water is frozen? Of all the water on earth, about 2 percent is frozen. 8. How much ...
Koppen, Ilan J. N.; Yacob, Desale; Di Lorenzo, Carlo; Saps, Miguel; Benninga, Marc A.; Cooper, Jennifer N.; Minneci, Peter C.; Deans, Katherine J.; Bates, D. Gregory; Thompson, Benjamin P.
Contrast enemas with barium or water-soluble contrast agents are sometimes performed in children with severe intractable constipation to identify anatomical abnormalities. However there are no clear definitions for normal colonic size or abnormalities such as colonic dilation or sigmoid redundancy
Luu, Tuan; Rowley, Chris; Siengthai, Sununta; Thanh Thao, Vo
Purpose Notwithstanding the rising magnitude of system factors in patient safety improvement, "human factors" such as idiosyncratic deals (i-deals) which also contribute to the adjustment of system deficiencies should not be neglected. The purpose of this paper is to investigate the role of value-based HR practices in catalyzing i-deals, which then influence clinical error control. The research further examines the moderating role of corporate social responsibility (CSR) on the effect of value-based HR practices on i-deals. Design/methodology/approach The data were collected from middle-level clinicians from hospitals in the Vietnam context. Findings The research results confirmed the effect chain from value-based HR practices through i-deals to clinical error control with CSR as a moderator. Originality/value The HRM literature is expanded through enlisting i-deals and clinical error control as the outcomes of HR practices.
Callwood, Alison; Cooke, Debbie; Allan, Helen
The aim of this study was to discuss theoretical conceptualization and definition of values and value-based recruitment in the context of women's views about what they would like from their midwife. Value-based recruitment received headline status in the UK government's response to pervasive deficiencies in compassionate care identified in the health service. Core values which aim to inform service user's experience are defined in the National Health Service Constitution but clarity about whether these encompass all that women say is important to them is needed. Discussion paper. A literature search included published papers written in English relating to values, VBR and women's views of a 'good' midwife with no date limiters. Definitions of values and value-based recruitment are examined. Congruence is explored between what women say is important to them and key government and professional regulatory documentation. The importance of a 'sustainable emotional' dimension in the midwife-mother relationship is suggested. Inconsistencies are identified between women's views, government, professional documentation and what women say they want. An omission of any reference to emotions or emotionality in value-based recruitment policy, professional recruitment and selection guidance documentation is identified. A review of key professional documentation, in relation to selection for 'values', is proposed. We argue for clarity and revision so that values embedded in value-based recruitment are consistent with health service users' views. An enhancement of the 'values' in the value-based recruitment framework is recommended to include the emotionality that women state is a fundamental part of their relationship with their midwife. © 2016 John Wiley & Sons Ltd.
Badash, Ido; Kleinman, Nicole P; Barr, Stephanie; Jang, Julie; Rahman, Suraiya; Wu, Brian W
The current healthcare system in the United States (US) is characterized by high costs and poor patient outcomes. A value-based healthcare system, centered on providing the highest quality of care for the lowest cost, is the country?s chosen solution for its healthcare crisis. As the US?transitions to a value-based model, a new definition of health is necessary to clearly define what constitutes a healthy state. However, such a definition is impossible to develop without a proper understandin...
Chovanec, A.; Grath, J.; Kralik, M.; Vogel, W.
An up-date overview of the situation of the Austrian waters is given by analyzing the status of the water quality (groundwater, surface waters) and water protection measures. Maps containing information of nitrate and atrazine in groundwaters (analyses at monitoring stations), nitrate contents and biological water quality of running waters are included. Finally, pollutants (nitrate, orthophosphate, ammonium, nitrite, atrazine etc.) trends in annual mean values and median values for the whole country for the years 1992-1999 are presented in tables. Figs. 5. (nevyjel)
A Pedagogical Dimension to the Technocratic Problem of Water Management: Preschool Teacher Beliefs and Attitudes Towards Teaching Water Science and Sustainable Management of Water in the Context of Environmental Education
Full Text Available Future generations are necessary to become conscious of water environmental problems, since preschool age, as they will be forced to manage them in the future. Experiential Environmental Education is a tool for sustainable management of water resources, but the key to this process is teachers and the factors that shape their readiness to fulfill their role. In this research their beliefs and attitudes are being investigated, as they influence the quality of teaching and environmental awareness of children. Specifically, 128 preschool teachers from North Greece were interviewed on how they perceive a their Willingness to improve their skills and knowledge on the scientific subject of water and its sustainable management, b their Comfort in teaching these subjects and c their Familiarity with the content knowledge, pedagogical teaching methods of preschool and environmental education and developmentally appropriate activities for teaching these subjects according to Psychology. In addition, it explores preschool teacher’s beliefs and attitudes d about whether water science and sustainable management of water could keep Child’s Interest and e if it contributes to Child Benefit, raising children’s awareness of environmental issues and developing his/her language, art, math, technological and social skills. Correlation Analysis showed that preschool teacher’s beliefs and attitudes towards teaching the subject of water were positive but under certain preconditions (they do not have the Willingness to spend time creating materials, they do not need more scientific knowledge, they do not consider children’s experimentation as the best way of learning, the ‘creative clutter’ caused by experimentation annoys them, they are not willing to engage in children’s experimentation with water, watching what children do, what they say or ask and they do not consider more activities with water necessary. However, these items of the Scale may
Brown, Gary C; Brown, Melissa M; Lieske, Heidi B; Lieske, Philip A; Brown, Kathryn S
There is a dearth of patient, preference-based cost-effectiveness analyses evaluating genetic testing for neovascular age-related macular degeneration (NVAMD). A Value-Based Medicine, 12-year, combined-eye model, cost-utility analysis evaluated genetic testing of Category 3 AMD patients at age 65 for progression to NVAMD. The benefit of genetic testing was predicated upon the fact that early-treatment ranibizumab therapy (baseline vision 20/40-20/80) for NVAMD confers greater patient value than late-treatment (baseline vision ≤20/160). Published genetic data and MARINA Study ranibizumab therapy data were utilized in the analysis. Patient value (quality-of-life gain) and financial value (2012 US real dollar) outcomes were discounted at 3 % annually. Genetic testing-enabled, early-treatment ranibizumab therapy per patient conferred mean 20/40 -1 vision, a 0.845 QALY gain and 14.1 % quality-of-life gain over sham therapy. Late-treatment ranibizumab therapy conferred mean 20/160 +2 vision, a 0.250 QALY gain and 4.2 % quality-of-life gain over sham therapy. The gain from early-treatment over late-treatment was 0.595 QALY (10.0 % quality-of-life gain). The per-patient cost for genetic testing/closer monitoring was $2205 per screened person, $2.082 billion for the 944,000 estimated new Category 3 AMD patients annually. Genetic testing/monitoring costs per early-treatment patient totaled $66,180. Costs per early-treatment patient included: genetic testing costs: $66,180 + direct non-ophthalmic medical costs: -$40,914 + caregiver costs: -$172,443 + employment costs: -$14,098 = a net societal cost saving of $160,582 per early treatment patient. When genetic screening facilitated an incremental 12,965 (8.0 %) of the 161,754, new annual NVAMD patients aged ≥65 in the US to undergo early-treatment ranibizumab therapy, each additional patient treated accrued an overall, net financial gain for society of $160,582. Genetic screening was cost-effective, using World
... can be found in some metal water taps, interior water pipes, or pipes connecting a house to ... reduce or eliminate lead. See resources below. 5. Children and pregnant women are especially vulnerable to the ...
Jennifer L. Steiner
Full Text Available Fibromyalgia Syndrome (FMS is a chronic pain condition characterized by pain, fatigue, and nonrestorative sleep. The disruptive symptoms of FMS are associated with reductions in quality of life related to family, intimate relationships, and work. The present study was part of a randomized pilot study of an 8-week Acceptance and Commitment Therapy (ACT intervention compared to education in a sample of 28 women with FMS. The Chronic Pain Values Inventory was administered at baseline, postintervention, and 12 week follow-up. Both groups showed significant improvements in family success, which were maintained at follow-up. Groups showed a differential pattern of success in work. The ACT group demonstrated significant, maintained improvements in success in intimate relationships, while the education group reported no changes over time. Findings suggest that both interventions may lead to improvements in valued living; however different interventions may be best suited for certain valued domains. The results of this study indicate that FMS patients are able to improve their success in family and intimate relationships and losses in these areas are not necessarily permanent.
Lestano, L; Jacobs, Jan P. A. M.
Generally a currency crisis is defined to occur if an index of currency pressure exceeds a threshold. This paper compares currency crisis dating methods. For two definitions of currency pressure we contrast ad hoc and extreme value-based thresholds. We illustrate the methods with data of six East
Kolarczyk, Lavinia M; Arora, Harendra; Manning, Michael W; Zvara, David A; Isaak, Robert S
Health care reimbursement models are transitioning from volume-based to value-based models. Value-based models focus on patient outcomes both during the hospital admission and postdischarge. These models place emphasis on cost, quality of care, and coordination of multidisciplinary services. Perioperative physicians are challenged to evaluate traditional practices to ensure coordinated, cost-effective, and evidence-based care. With the Centers for Medicare and Medicaid Services planned introduction of bundled payments for coronary artery bypass graft surgery, cardiovascular anesthesiologists are financially responsible for postdischarge outcomes. In order to meet these patient outcomes, multidisciplinary care pathways must be designed, implemented, and sustained, a process that is challenging at best. This review (1) provides a historical perspective of health care reimbursement; (2) defines value as it pertains to quality, service, and cost; (3) reviews the history of value-based care for cardiac surgery; (4) describes the drive toward optimization for vascular surgery patients; and (5) discusses how programs like Enhanced Recovery After Surgery assist with the delivery of value-based care. Copyright © 2018 Elsevier Inc. All rights reserved.
Knekta, Eva; Eklöf, Hanna
The aim of this study was to evaluate the psychometric properties of an expectancy-value-based questionnaire measuring five aspects of test-taking motivation (effort, expectancies, importance, interest, and test anxiety). The questionnaire was distributed to a sample of Swedish Grade 9 students taking a low-stakes (n = 1,047) or a high-stakes (n =…
Full Text Available The Vienna Doctoral Programme on Water Resource Systems (DK-WRS is a programme that aims to educate students in interdisciplinary water science through cutting edge research at an international level. It is funded by the Austrian Science Fund and designed to run over a period of 12 yr during which 80 doctoral students are anticipated to graduate. This paper reports on our experiences of setting up and implementing the Programme. We identify three challenges: integrating the disciplines, maintaining depth in an interdisciplinary programme, and teaching subjects remote to each student's core expertise. To address these challenges we adopt a number of approaches. We use three levels of instruments to foster integration across the disciplines: joint groups (e.g. a joint study programme, joint science questions (e.g. developed in annual symposia, and joint study sites. To maintain depth we apply a system of quality control including regular feedback sessions, theses by journal publications and international study exchange. For simultaneously teaching students from civil and environmental engineering, biology, geology, chemistry, mathematics we use visually explicit teaching, learning by doing, extra mentoring and by cross relating associated subjects. Our initial assessment of the Programme shows some very positive outcomes. Joint science questions formed between students from various disciplines indicate integration is being achieved. The number of successful publications in top journals suggests that depth is maintained. Positive feedback from the students on the variety and clarity of the courses indicates the teaching strategy is working well. Our experiences have shown that implementing and running an interdisciplinary doctoral programme has its challenges and is demanding in terms of time and human resources but seeing interactions progress and watching people grow and develop their way of thinking in an interdisciplinary environment is a
Blöschl, G.; Carr, G.; Bucher, C.; Farnleitner, A. H.; Rechberger, H.; Wagner, W.; Zessner, M.
The Vienna Doctoral Programme on Water Resource Systems (DK-WRS) is a programme that aims to educate students in interdisciplinary water science through cutting edge research at an international level. It is funded by the Austrian Science Fund and designed to run over a period of 12 yr during which 80 doctoral students are anticipated to graduate. This paper reports on our experiences of setting up and implementing the Programme. We identify three challenges: integrating the disciplines, maintaining depth in an interdisciplinary programme, and teaching subjects remote to each student's core expertise. To address these challenges we adopt a number of approaches. We use three levels of instruments to foster integration across the disciplines: joint groups (e.g. a joint study programme), joint science questions (e.g. developed in annual symposia), and joint study sites. To maintain depth we apply a system of quality control including regular feedback sessions, theses by journal publications and international study exchange. For simultaneously teaching students from civil and environmental engineering, biology, geology, chemistry, mathematics we use visually explicit teaching, learning by doing, extra mentoring and by cross relating associated subjects. Our initial assessment of the Programme shows some very positive outcomes. Joint science questions formed between students from various disciplines indicate integration is being achieved. The number of successful publications in top journals suggests that depth is maintained. Positive feedback from the students on the variety and clarity of the courses indicates the teaching strategy is working well. Our experiences have shown that implementing and running an interdisciplinary doctoral programme has its challenges and is demanding in terms of time and human resources but seeing interactions progress and watching people grow and develop their way of thinking in an interdisciplinary environment is a valuable reward.
Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam
In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers
Victoria von Groddeck
Full Text Available The aim of this paper is to reflect the epistemological and methodological aspects of an empirical research study which analyzes the phenomenon of increased value communication within business organizations from a system theoretical perspective in the tradition of Niklas LUHMANN. Drawing on the theoretical term of observation it shows how a research perspective can be developed which opens up the scope for an empirical analysis of communication practices. This analysis focuses on the reconstruction of these practices by first understanding how these practices stabilize themselves and second by contrasting different practices to educe an understanding of different forms of observation of the relevant phenomenon and of the functions of these forms. Thus, this approach combines system theoretical epistemology, analytical research strategies, such as form and functional analysis, and qualitative research methods, such as narrative interviews, participant observation and document analysis. URN: urn:nbn:de:0114-fqs1003177
Sharma, Lata; Janardhanan, S.; Krishnamurthi, T.N.
Derived Air Concentration (DAC) limits for plutonium isotopic mixtures, as obtained from reprocessing of spent fuel heavy water reactors, are presented in this paper. DAC for the mixtures is expressed in terms of alpha activity of plutonium. Growth of 241 Am in the product is taken into consideration. Current recommedations on DAC limits for individual Pu isotopes, as laid down in ICRP-30 report, are used for estimating DAC for the mixture. DACsub(α) for high exposure plutonium is found to be less by a factor of 2-3, when compared with the limit for 239 Pu. As a result, detection and alarm limits for air monitoring instruments should be scaled down while handling high exposure plutonium. (author)
Sharma, L.; Janardhanan, S.; Krishnamurthi, T.N. (Bhabha Atomic Research Centre, Bombay (India). Health Physics Div.)
Derived Air Concentration (DAC) limits for plutonium isotopic mixtures, as obtained from reprocessing of spent fuel heavy water reactors, are presented in this paper. DAC for the mixtures is expressed in terms of alpha activity of plutonium. Growth of /sup 241/Am in the product is taken into consideration. Current recommedations on DAC limits for individual Pu isotopes, as laid down in ICRP-30 report, are used for estimating DAC for the mixture. DACsub(..cap alpha..) for high exposure plutonium is found to be less by a factor of 2-3, when compared with the limit for /sup 239/Pu. As a result, detection and alarm limits for air monitoring instruments should be scaled down while handling high exposure plutonium.
Brinker, R.; Allen, L.; Cole, P.; Rho, C.
International Coastal Cleanup Day, held each September, is an effective campaign to bring volunteers together to clean trash from beaches and waterways and document results. Over 500,000 participants cleared over 9 million pounds of trash in 2015. To build on the enthusiasm for this event, the city of Livermore, California's Water Resource Department, the Livermore Valley Joint Unified School District, Livermore Area Recreation and Parks Department created a water education program to embed within the city's Coastal Cleanup Day events. Goals of the education program are to increase awareness of the local watershed and its geographic reach, impacts of climate change and drought on local water supplies, pollution sources and impacts of local pollution on the ocean, positive impacts of a recent plastic bag ban, water quality assessment, and action steps citizens can take to support a healthy watershed. Volunteers collect and test water samples (when water is in the creek) using modified GLOBE and World Water Monitoring Day protocols. Test results are uploaded to the World Water Monitoring Day site and documented on the program web site. Volunteers report that they did not know about watersheds, impacts of local pollution, and water quality components before the education program. Volunteers are encouraged to adopt a creek spot for one year, and continue to collect and document trash. High school and middle school science classes added the water quality testing into curriculum, and regularly visit creek sites to clean the spots and monitor habitats. Each year for the past five years, about 300 volunteers have worked on creek clean-up events, 20 have adopted creek sites, and collected over 4,000 gallons of trash annually. As a result of these efforts, sites have been downgraded from a trash hot spot of concern. Strategies will be shared to expand an established (or start a new) Coastal Cleanup Day event into a successful watershed and climate awareness citizen science
Full Text Available This research has aimed to create a new observation tool that lets the assessment of water psychomotor skills as well as the knowledge of its current state of development through its administration. In order to that, 8 experts (Physical Education teachers and swimming monitors all of them, have analyzed the Observation Tool for Assessing Water Psychomotor skills, composed by 5 factors (familiarization with the context, balance, displacement, handling and social relationships reporting satisfactory results. Furthermore, the water psychomotor development of 58 children aged between 3 and 6 years old was studied. Displacement and handling factors got the highest values meanwhile social relationships got the lowest value. Likewise, 5-6 years old group showed significant higher levels of water psychomotor development than 3-4 years old group.
Cramer, J S; Ramalingam, S; Rosenthal, T C; Fox, C H
The authors describe the implementation and first three years (1997-1999) of a department-wide incentive plan of the Department of Family Medicine at the State University of New York at Buffalo School of Medicine and Biomedical Sciences. By using a consensus approach, a representative elected committee designed a clinical relative value unit (explained in detail) that could be translated to equally value and reward faculty efforts in patient care, education, and research and which allowed the department to avoid the imposition of a model that could have undervalued scholarship and teaching. By 1999, the plan's goal of eight patient-care-equivalent points per four-hour session had been exceeded for pure clinical care. Clearly, only a small financial incentive was necessary (in 1999, an incentive pool of 4% of providers' gross salary) to motivate the faculty to be more productive and to self-report their efforts. Long-term productivity for pure clinical care rose from 9.8 points per session in 1997 to 10.4 in 1999. Of the mean total of 3,980 points for the year 1999, the contribution from teaching was 1,146, or 29%, compared with 25% in 1997. For scholarship, the number of points was 775, or 20%, in 1999, compared with 11% in 1997. The authors describe modifications to the original plan (e.g., integration of quality measures) that the department's experience has fostered. Problems encountered included the lack of accurate and timely billing information from the associated teaching hospitals, the inherent problems of self-reported information, difficulties of gaining buy-in from the faculty, and inherent risks of a pay-for-performance approach. But the authors conclude that the plan is fulfilling its goal of effectively and fairly quantifying all areas of faculty effort, and is also helping the department to more effectively demonstrate clinical productivity in negotiations with teaching hospitals.
Van Wyk, Llewellyn V
Full Text Available Water scarcity is without a doubt on of the greatest threats to the human species and has all the potential to destabilise world peace. Falling water tables are a new phenomenon. Up until the development of steam and electric motors, deep groudwater...
Hertie School of Governance
All human life depends on water and air. The sustainable management of both is a major challenge for today's public policy makers. This issue of Schlossplatz³ taps the streams and flows of the current debate on the right water governance.
Full Text Available The attention of this paper is drawn to analyze the economic potential of involvement of farmers into the small-medium sized value-based food chain (VBFC. The survey represents a solid dana basis from which econometric modelling approach was further developed. Empirical results reveal the positive economic viability on a general level; this means more stable purchase price of raw milk for dairy farms, which are the part of value-based food chain. Results point at inelastic demand for milk and milk related products. Furthermore, there are some accompanying and underlying indirect social benefits, such as production of high-quality food products, more stable and constant demand for raw milk, steady payments and better social situation. The last one is especially important for the farms operating in less-favored mountain areas where the survey was actually conducted.
Value-based insurance designs frequently lower consumers' cost sharing to motivate healthy behavior, such as adhering to medication regimens. Few health care purchasers have followed the more controversial approach of using increased cost sharing to temper demand for high-cost, low-value medical care. Yet there is evidence that when health care's affordability is at stake, the public may be willing to compromise on coverage of certain medical problems and less effective treatments. Businesses should engage employees in discussions about if and how this type of value-based insurance design should apply to their own insurance coverage. A similar process could also be used for Medicare and other public-sector programs.
Full Text Available Previous theoretical studies of animal and human behavioral learning have focused on the dichotomy of the value-based strategy using action value functions to predict rewards and the model-based strategy using internal models to predict environmental states. However, animals and humans often take simple procedural behaviors, such as the "win-stay, lose-switch" strategy without explicit prediction of rewards or states. Here we consider another strategy, the finite state-based strategy, in which a subject selects an action depending on its discrete internal state and updates the state depending on the action chosen and the reward outcome. By analyzing choice behavior of rats in a free-choice task, we found that the finite state-based strategy fitted their behavioral choices more accurately than value-based and model-based strategies did. When fitted models were run autonomously with the same task, only the finite state-based strategy could reproduce the key feature of choice sequences. Analyses of neural activity recorded from the dorsolateral striatum (DLS, the dorsomedial striatum (DMS, and the ventral striatum (VS identified significant fractions of neurons in all three subareas for which activities were correlated with individual states of the finite state-based strategy. The signal of internal states at the time of choice was found in DMS, and for clusters of states was found in VS. In addition, action values and state values of the value-based strategy were encoded in DMS and VS, respectively. These results suggest that both the value-based strategy and the finite state-based strategy are implemented in the striatum.
The proposed values-based negotiation model (VBM) agrees with and extends principled negotiation’s recognition of personal values and emotions as important negotiation elements. First, building upon Martin Buber’s existentialist treatment of religion and secularism, VBM centers on religion as one of many possible sources of personal values that informs respectful and mutually beneficial interactions without needing one to necessarily be religious. Just as one need not be a Buddhist or a Hindu...
Ito, Makoto; Doya, Kenji
Previous theoretical studies of animal and human behavioral learning have focused on the dichotomy of the value-based strategy using action value functions to predict rewards and the model-based strategy using internal models to predict environmental states. However, animals and humans often take simple procedural behaviors, such as the "win-stay, lose-switch" strategy without explicit prediction of rewards or states. Here we consider another strategy, the finite state-based strategy, in which a subject selects an action depending on its discrete internal state and updates the state depending on the action chosen and the reward outcome. By analyzing choice behavior of rats in a free-choice task, we found that the finite state-based strategy fitted their behavioral choices more accurately than value-based and model-based strategies did. When fitted models were run autonomously with the same task, only the finite state-based strategy could reproduce the key feature of choice sequences. Analyses of neural activity recorded from the dorsolateral striatum (DLS), the dorsomedial striatum (DMS), and the ventral striatum (VS) identified significant fractions of neurons in all three subareas for which activities were correlated with individual states of the finite state-based strategy. The signal of internal states at the time of choice was found in DMS, and for clusters of states was found in VS. In addition, action values and state values of the value-based strategy were encoded in DMS and VS, respectively. These results suggest that both the value-based strategy and the finite state-based strategy are implemented in the striatum.
... Staying Safe Videos for Educators Search English Español Water Safety KidsHealth / For Parents / Water Safety What's in ... remains your best measure of protection. Making Kids Water Wise It's important to teach your kids proper ...
Badash, Ido; Kleinman, Nicole P; Barr, Stephanie; Jang, Julie; Rahman, Suraiya; Wu, Brian W
The current healthcare system in the United States (US) is characterized by high costs and poor patient outcomes. A value-based healthcare system, centered on providing the highest quality of care for the lowest cost, is the country's chosen solution for its healthcare crisis. As the US transitions to a value-based model, a new definition of health is necessary to clearly define what constitutes a healthy state. However, such a definition is impossible to develop without a proper understanding of what "health" actually means. To truly understand its meaning, one must have a thorough historical understanding of the changes in the concept of health and how it has evolved to reflect the beliefs and scientific understanding of each time period. Thus, this review summarizes the changes in the definition of health over time in order to provide a context for the definition needed today. We then propose a new definition of health that is specifically tailored to providers working in the era of value-based care.
Ramírez Toro Graciela I
Full Text Available Abstract Background Waterborne disease is a major risk for small water supplies in rural settings. This study was done to assess the impact of an educational intervention designed to improve water quality and estimate the contribution of water to the incidence of diarrhoeal disease in poor rural communities in Puerto Rico a two-part study was undertaken. Methods An educational intervention was delivered to communities relying on community water supplies. This intervention consisted of student operators and administrators supervising and assisting community members who voluntarily "operate" these systems. These voluntary operators had no previous training and were principally concerned with seeing that some water was delivered. The quality of that water was not something they either understood or addressed. The impact of this intervention was measured through water sampling for standard bacteriological indicators and a frank pathogen. In addition, face-to-face epidemiological studies designed to determine the base-line occurrence of diarrhoeal disease in the communities were conducted. Some 15 months after the intervention a further epidemiological study was conducted in both the intervention communities and in control communities that had not received any intervention. Results Diarrhoeal illness rates over a four week period prior to the intervention were 3.5%. Salmonella was isolated from all of 5 distributed samples prior to intervention and from only 2 of 12 samples after the intervention. In the 15 months follow-up study, illness rates were lower in the intervention compared to control communities (2.5% vs 3.6%% (RR = 0.70, 95%CI 0.43, 1.15, though this was not statistically significant. However, in the final Poisson regression model living in an intervention system (RR = 0.318; 95%CI 0.137 - 0.739 and owning a dog (RR = 0.597, 95%CI 0.145 - 0.962 was negatively associated with illness. Whilst size of system (RR = 1.006, 95%CI 1.001 - 1
E. Sanmuga Priya
Full Text Available Phytoremediation through aquatic macrophytes treatment system (AMATS for the removal of pollutants and contaminants from various natural sources is a well established environmental protection technique. Water hyacinth (Eichhornia crassipes, a worst invasive aquatic weed has been utilised for various research activities over the last few decades. The biosorption capacity of the water hyacinth in minimising various contaminants present in the industrial wastewater is well studied. The present review quotes the literatures related to the biosorption capacity of the water hyacinth in reducing the concentration of dyestuffs, heavy metals and minimising certain other physiochemical parameters like TSS (total suspended solids, TDS (total dissolved solids, COD (chemical oxygen demand and BOD (biological oxygen demand in textile wastewater. Sorption kinetics through various models, factors influencing the biosorption capacity, and role of physical and chemical modifications in the water hyacinth are also discussed.
Hansen, Lexine Tallis
International community development is a fertile area of research for environmental education scholars and practitioners. Although the community development field is well established, there is relatively little focus on education and learning in community development literature, especially in developing country settings. Particularly,…
Gentry, Sarah; Badrinath, Padmanabhan
The demand for healthcare is rising due to aging populations, rising chronic disease prevalence, and technological innovations. There are currently more effective and cost-effective interventions available than can be afforded within limited budgets. A new way of thinking about the optimal use of resources is needed. Ensuring that available resources are used for interventions that provide outcomes that patient's most value, rather than a focus just on effectiveness and cost-effectiveness, may help to ensure that resources are used optimally. Value-based healthcare puts what patients value at the center of healthcare. It helps ensure that they receive the care that can provide them with outcomes they think are important and that limited resources are focused on high-value interventions. In order to do this, we need flexible definitions of 'health', personalized and tailored to patient values. We review the current status of value-based health care in England and identify lessons applicable to a variety of health systems. For this, we draw upon the work of the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS), Right Care Initiative, and our local experience in promoting value-based health care for specific conditions in our region. Combining the best available evidence with open and honest dialogue between patients, clinicians, and others, whilst requiring considerable time and resources are essential to building a consensus around the value that allows the best use of limited budgets. Values have been present in healthcare since its beginnings. Placing value and values at the center of healthcare could help to ensure available resources are used to provide the greatest possible benefit to patients.
Dranitsaris, George; Ortega, Ana; Lubbe, Martie S; Truter, Ilse
Several European governments have recently mandated price cuts in drugs to reduce health care spending. However, such measures without supportive evidence may compromise patient care because manufacturers may withdraw current products or not launch new agents. A value-based pricing scheme may be a better approach for determining a fair drug price and may be a medium for negotiations between the key stakeholders. To demonstrate this approach, pharmacoeconomic (PE) modeling was used from the Spanish health care system perspective to estimate a value-based price for bevacizumab, a drug that provides a 1.4-month survival benefit to patients with metastatic colorectal cancer (mCRC). The threshold used for economic value was three times the Spanish per capita GDP, as recommended by the World Health Organization (WHO). A PE model was developed to simulate outcomes in mCRC patients receiving chemotherapy ± bevacizumab. Clinical data were obtained from randomized trials and costs from a Spanish hospital. Utility estimates were determined by interviewing 24 Spanish oncology nurses and pharmacists. A price per dose of bevacizumab was then estimated using a target threshold of € 78,300 per quality-adjusted life year gained, which is three times the Spanish per capita GDP. For a 1.4-month survival benefit, a price of € 342 per dose would be considered cost effective from the Spanish public health care perspective. The price may be increased to € 733 or € 843 per dose if the drug were able to improve patient quality of life or enhance survival from 1.4 to 3 months. This study demonstrated that a value-based pricing approach using PE modeling and the WHO criteria for economic value is feasible and perhaps a better alternative to government mandated price cuts. The former approach would be a good starting point for opening dialog between European government payers and the pharmaceutical industry.
Sutrisno; Widowati; Sunarsih; Kartono
In this paper, a mathematical model in quadratic programming with fuzzy parameter is proposed to determine the optimal strategy for integrated inventory control and supplier selection problem with fuzzy demand. To solve the corresponding optimization problem, we use the expected value based fuzzy programming. Numerical examples are performed to evaluate the model. From the results, the optimal amount of each product that have to be purchased from each supplier for each time period and the optimal amount of each product that have to be stored in the inventory for each time period were determined with minimum total cost and the inventory level was sufficiently closed to the reference level.
.... Unequal access to quality education leaves millions ill equipped for today's workplace. The "No Child Left Behind Act" is an effective point of departure, yet it too fails to adequately address the myriad issues affecting quality education...
Full Text Available Heritage management and monument conservation play a significant role in the preservation of archaeological heritage. Anastylosis, a process with a long history in the Mediterranean region, is discussed with relevance to current debates concentrating on concepts of value-based approaches. Examination of the diverse values that may be attributed to monuments provides an insight into the evolution of ideas in heritage management, conservation and restoration practices. In the current theoretical framework the concept of values, as attributed by all stakeholders, and its application when preserving archaeological heritage, are constantly debated. The participation of stakeholders in the process of value identification is considered fundamental by heritage management experts. This paper presents the findings of a survey conducted to collect the opinions of anastylosis and restoration professionals, with reference to case studies on a number of monuments subjected to anastylosis in Greece and Turkey, highlighting the importance of assessing values in order to establish the appropriate type and extent of intervention. The paper concludes that a value-based approach to decision-making and planning for anastylosis, or any other form of architectural conservation, is crucial for preserving monuments in a way that satisfies those who want to experience and benefit from heritage.
1 EDUCATION ABSTRACT United States schools are better than ever, but they are not assuring competitive advantage . Unequal access to quality...Development Network, Washington, DC Defense Logistics Agency, Corporate Planning (J-1), Ft Belvoir, VA International : Department for Education and...influencing all aspects of the US education system in an effort to improve student achievement, enhance national competitive advantage , and promote
Full Text Available The modern scientific and technological development has shown the vulnerability of nature, unsuspected before the damage is recognizable should do. And it is this ability to damage to nature which does consider the importance of prior knowledge, as the precautionary principle against the actions of man This work aims to deepen the features which characterize education for risk perception pollution water resources and the situation in this respect has in the municipality of Mella in the province Santiago de Cuba, all of which serve as a basis to substantiate the need to create a communication strategy that influences positively on the quality of life population.
Apr 2, 2003 ... microbiological quality of container-stored water in households. NP Nala1*, P .... nity calendar as well as availability and accessibility of meeting venues. .... at the 95th percentile, still higher than the WHO (1997) risk limit,.
Full Text Available A study in three countries (Bangladesh, Ethiopia and Uganda assessed progress against the Paris Principles for Aid Effectiveness (AE in three sectors – water, health and education – to test the assumption that the water sector is lagging behind. The findings show that it is too simplistic to say that the water sector is lagging, although this may well be the case in some countries. The study found that wider governance issues are more important for AE than having in place sector-specific mechanics such as Sector-Wide Approaches alone. National political leadership and governance are central drivers of sector AE, while national financial and procurement systems and the behaviour of actors who have not signed up to the Paris Principles – at both national and global levels – have implications for progress that cut across sectors. Sectors and sub-sectors do nonetheless have distinct features that must be considered in attempting to improve sector-level AE. In light of these findings, using political economy approaches to better understand and address governance and strengthening sector-level monitoring is recommended as part of efforts to improve AE and development results in the water sector.
The Centers for Medicare and Medicaid Services (CMS) promulgated a new Medicare program called the Value-Based Purchasing Program (VBPP) as part of the 2010 Affordable Care Act (ACA). Like many other regulatory agencies, CMS used the Notice-and-Comment process to issue proposed rules, solicit public comments, and then publish final rules. Conventional literature suggests that CMS should disproportionately favor business interests during the Notice-and-Comment process, mainly due to the business interests' greater resources and capacity to draft well-reasoned comments. However, this article argues against this presumption and contends instead that CMS listens equally well to both business interest comments and private citizen comments during the formation of the VBPP. With regard to the VBPP and the ACA, CMS appears to be resisting disproportionate sway by business interests and is instead privileging the ACA's goal of improving healthcare quality.
Because of their involvement with the Affordable Care exchanges, the national insurance companies have reported significant financial losses. As a result, there will soon be significant payer pressure to reduce medical expenses. To succeed in future negotiations with the payers, medical practices must understand the needs of the payers and then play to those needs. The author is a former managed care executive with more than 25 years of experience managing provider networks and implementing payer strategies for some of the largest payers in the United States. In this article, he outlines important things medical practices should be doing to prepare for the new world of value-based contracting. Medical practices that embrace this change and work hard to evolve with the future are the ones that are going to survive and succeed.
Full Text Available Microarray technology allows simultaneous measurement of the expression levels of thousands of genes within a biological tissue sample. The fundamental power of microarrays lies within the ability to conduct parallel surveys of gene expression using microarray data. The classification of tissue samples based on gene expression data is an important problem in medical diagnosis of diseases such as cancer. In gene expression data, the number of genes is usually very high compared to the number of data samples. Thus the difficulty that lies with data are of high dimensionality and the sample size is small. This research work addresses the problem by classifying resultant dataset using the existing algorithms such as Support Vector Machine (SVM, K-nearest neighbor (KNN, Interval Valued Classification (IVC and the improvised Interval Value based Particle Swarm Optimization (IVPSO algorithm. Thus the results show that the IVPSO algorithm outperformed compared with other algorithms under several performance evaluation functions.
Ramyachitra, D; Sofia, M; Manikandan, P
Microarray technology allows simultaneous measurement of the expression levels of thousands of genes within a biological tissue sample. The fundamental power of microarrays lies within the ability to conduct parallel surveys of gene expression using microarray data. The classification of tissue samples based on gene expression data is an important problem in medical diagnosis of diseases such as cancer. In gene expression data, the number of genes is usually very high compared to the number of data samples. Thus the difficulty that lies with data are of high dimensionality and the sample size is small. This research work addresses the problem by classifying resultant dataset using the existing algorithms such as Support Vector Machine (SVM), K-nearest neighbor (KNN), Interval Valued Classification (IVC) and the improvised Interval Value based Particle Swarm Optimization (IVPSO) algorithm. Thus the results show that the IVPSO algorithm outperformed compared with other algorithms under several performance evaluation functions.
Corben, D.; Stevenson, R.; Wolstenholme, E.F.
System dynamics has been seen primarily as a strategic tool, most effectively used at the highest level of strategy to identify robust policy interventions under a wide range of scenarios. However, an alternative, complementary and powerful role is emerging. This is at an 'intermediate level' in organisations to coordinate and integrate policies across the value chain. It is at this level where business value, as defined by the discounted value of future free cash flow, is both created and destroyed. This paper introduces the need for 'intermediate-level' and 'value-based' modelling and emphasises the natural role of system dynamics in supporting a methodology to fulfil the need. It describes the development of an approach and its application in the oil industry to coordinate the response of people and tools within operational, financial and commercial functions across the value chain to address a variety of problems and issues. (author)
Choudhry, Niteesh K; Fischer, Michael A; Smith, Benjamin F; Brill, Gregory; Girdish, Charmaine; Matlin, Olga S; Brennan, Troyen A; Avorn, Jerry; Shrank, William H
Value-based insurance design (VBID) plans selectively lower cost sharing to increase medication adherence. Existing plans have been structured in a variety of ways, and these variations could influence the effectiveness of VBID plans. We evaluated seventy-six plans introduced by a large pharmacy benefit manager during 2007-10. We found that after we adjusted for the other features and baseline trends, VBID plans that were more generous, targeted high-risk patients, offered wellness programs, did not offer disease management programs, and made the benefit available only for medication ordered by mail had a significantly greater impact on adherence than plans without these features. The effects were as large as 4-5 percentage points. These findings can provide guidance for the structure of future VBID plans.
Brown, Joshua W; Alexander, William H
Recent work on the role of the ACC in cognition has focused on choice difficulty, action value, risk avoidance, conflict resolution, and the value of exerting control among other factors. A main underlying question is what are the output signals of ACC, and relatedly, what is their effect on downstream cognitive processes? Here we propose a model of how ACC influences cognitive processing in other brain regions that choose actions. The model builds on the earlier Predicted Response Outcome model and suggests that ACC learns to represent specifically the states in which the potential costs or risks of an action are high, on both short and long timescales. It then uses those cost signals as a basis to bias decisions to minimize losses while maximizing gains. The model simulates both proactive and reactive control signals and accounts for a variety of empirical findings regarding value-based decision-making.
Nita Setiawati Wibisono
Full Text Available This research is done to determine landscape elements that affect property value based on housing residents’ perception in Surabaya residential areas. The landscape elements that used in this research are natural elements such as vegetation and soil; and man-made element such as garden statue, road pattern, road width and hierarchy, park and plant, artificial lake, and road equipment. Purposive sampling technique is used to represent respondents in the residential areas that provide landscape elements in East and West Surabaya. Data analysis technique uses validity and reliability test, analysis factor, binary logistic regression, and the average of variable test. The result shows that majority of the residents of East Surabaya and West Surabaya residential areas approved that landscape consist of park and plant, road width and hierarchies, and road pattern affect their residential property values. The residents are also willing to contribute about 7.4% of their house price to improve the appearance of the residential landscape.
program) steadily declined from 15% in 1970 to 10.7% in 2001.16 Data from the National Center for Education Statistics show that the number of...academic institutions, and corporate education and training institutions. By size, it’s defined in terms of distribution of funds, facilities , and...of students entering four-year colleges and universities require some remedial education .”9 Given statistics such as these, concerns for the US
Powell, Neil; Larsen, Rasmus Kløcker
Higher education institutions in Sweden are increasingly exposed to international market conditions and rising competition from a more mobile student body. This increases the need for universities to adapt to their social and economic environment and to their clients, including the political trends and financial opportunities in Sweden and EU, if…
Pathirana, A.; Koster, J. H.; de Jong, E.; Uhlenbrook, S.
Solving today's complex hydrological problems requires originality, creative thinking and trans-disciplinary approaches. Hydrological education that was traditionally teacher centred, where the students look up to the teacher for expertise and information, should change to better prepare hydrologists to develop new knowledge and apply it in new contexts. An important first step towards this goal is to change the concept of education in the educators' minds. The results of an investigation to find out whether didactic training influences the beliefs of hydrology educators about their teaching styles is presented. Faculty of UNESCO-IHE has been offered a didactic certification program named university teaching qualification (UTQ). The hypothesis that UTQ training will significantly alter the teaching style of faculty at UNESCO-IHE from expert/formal authority traits towards facilitator/delegator traits was tested. A first survey was conducted among the entire teaching staff (total 101, response rate 58%). The results indicated that there are significantly higher traits of facilitator and delegator teaching styles among UTQ graduates compared to faculty who were not significantly trained in didactics. The second survey which was conducted among UTQ graduates (total 20, response rate 70%), enquiring after their teaching styles before and after UTQ, corroborated these findings.
Rine, P. Jesse; Guthrie, David S.
Leaders of evangelical Christian colleges must navigate a challenging environment shaped by public concern about college costs and educational quality, federal inclinations toward increased regulation, and lingering fallout from the Great Recession. Proceeding from the premise that empirical analysis empowers institutional actors to lead well in…
which should be taken into account in the planning and ... not make people adopt different values or lifestyles. It ... result in truly effective learning. ... a psychological, as well as an educational perspective .... wire coathangers and old stockings were used to collect .... occurring and to reconcile existing prejudices to the.
Globally, Physical Education (PE) carries the stamp of neoliberalism and as a field we are keen, it seems, to accrue more of the vestiges of this ideology. While neoliberal positions and practices are not necessarily harmful to the long-term interests of the field or the students we teach, indeed it may be strategic to take them up, the field…
Bennett, Dean B.; Zaitlin, Samuel
This guide is designed for both independent study and class use. It provides the basis for a unit in a science class for the secondary school level. At the undergraduate college level, it provides an outline of activities for a contract as part of an education or science course. The lessons in the guide concentrate on the application of science…
... What is NIEHS Doing? Further Reading For Educators Introduction Water pollution is any contamination of water with ... NIEHS Newsletter) Karletta Chief Featured in Science Friday Film (April 2018) Chlorine Levels Help Detect Risk for ...
Swistock, Brian; Clark, James
The increase in shale gas drilling in Pennsylvania has resulted in thousands of landowners receiving predrilling testing of their drinking water. Landowners often have difficulty understanding test reports resulting in low awareness of pre-existing problems. Extension and several partners developed a program to improve understanding of…
Lee, Ronald T., Ed.
This resource guide is intended to aid practitioners in the design of new curriculum units or the enrichment of existing units by suggesting activities and resources in the topic areas of earth, air, fire, and water. Special projects and trips relating to these topic areas are proposed. A sample arts networking system used to integrate various…
Wolf, L. W.; Lee, M.; Stone, K.
Youth, as future citizens, play an important role in obtaining and maintaining water resources. Water EducaTion for Alabama's Black Belt (WET Alabama) provides off-campus environmental and water-education activities designed to increase the appreciation, knowledge, conservation, and protection of water resources by middle-school teachers and children from predominantly African-American families in some of Alabama's poorest counties. The project is structured around a variety of indoor and outdoor activities held at two field sites, Auburn University's E. V. Smith Center in Macon County and the Robert G. Wehle Nature Center in Bullock County located in Alabama's "Black Belt" region, a region in which the prosperity of local communities is low. The educational activities provide an engaging laboratory and field experience for children from rural schools that lack scientific facilities and equipment. Both hosting centers have easy access to surface water (ponds, wetlands, streams) and offer facilities for basic hydrologic experiments (e.g., aquifer models, permeameter, water quality). The E.V. Smith site has access to groundwater through pairs of nested wells. Educational activities are designed to help students and teachers visualize groundwater flow and its interaction with surface water in an aquifer tank model; compare the hydrologic properties (porosity and permeability) of different aquifer materials (sands, gravels, and clays); learn about groundwater purging and sampling; and assess water quality and flow direction in the field. Simple exercises demonstrate (1) the balance of recharge and discharge, (2) the effects of flooding, drought and pumping, and (3) movement of contaminants through aquifers. A set of ready-to-teach laboratory exercises and tutorials address goals specified by the State of Alabama science curriculum for grades 6 to 8. The ultimate goal of Project WET Alabama is to help students and teachers from resource-poor schools become knowledgeable
Stolder, Mary Ellen; Hydo, Sharon K; Zorn, Cecelia R; Bottoms, Marjorie S
The ancient Greeks, as well as current writers, prompt us to examine the self as teacher. Seeing the self as a border crosser is used to reveal both the light-side and shadow-side of self, as metaphorically suggested by fire, wind, earth, and water. Only through teacher self-awareness can respect be used to expand our lives as teachers and enrich students' learning and growth.
Pedersen, John Storm
Can value-based management in the public sector lead to improvements in efficiency in the daily operations and improvements in the quality of the pubic services? This is discussed in the article. And the answer is yes!...
Over the past century, the US education system facilitated the development of history's greatest economic and military power, and that same system continues to provide adequate human resources for our national security...
The Article deals with issues of improving methods of planning and carrying out internal audit in conditions of risk-oriented approach to audit according to the indices of value-based management system - VBM (Value Based Management) using the risk card (risk matrix). A risk card (risk matrix) method has been disclosed taking into account risk level of each of the key factors influencing joint-stock company value rates. Recommendations have been given and abstract of working document has been ...
Calderon, Lindsay E; Kavanagh, Kevin T; Rice, Mara K
Catheter-associated urinary tract infections (CAUTIs) occur in 290,000 US hospital patients annually, with an estimated cost of $290 million. Two different measurement systems are being used to track the US health care system's performance in lowering the rate of CAUTIs. Since 2010, the Agency for Healthcare Research and Quality (AHRQ) metric has shown a 28.2% decrease in CAUTI, whereas the Centers for Disease Control and Prevention metric has shown a 3%-6% increase in CAUTI since 2009. Differences in data acquisition and the definition of the denominator may explain this discrepancy. The AHRQ metric analyzes chart-audited data and reflects both catheter use and care. The Centers for Disease Control and Prevention metric analyzes self-reported data and primarily reflects catheter care. Because analysis of the AHRQ metric showed a progressive change in performance over time and the scientific literature supports the importance of catheter use in the prevention of CAUTI, it is suggested that risk-adjusted catheter-use data be incorporated into metrics that are used for determining facility performance and for value-based purchasing initiatives. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
The issue of the sources of normativity has been a very hot topic in contem-porary Anglo-American ethics. Some scholars believe that the normativity should be interpre-ted as a reason-implying concept and it can be analyzed further as moral reasons. So,to better understand the sources of normativity,we have to explore the sources of the reasons further. Generally,there are two competing views on the sources of reasons:subjectivism and objectiv-ism. Subjectivism argues that the reasons for action are ultimately based on desires or facts a-bout desires. Objectivism argues that the reasons are given by the objects,determined by the value of the relevant facts about desired objects. Parfit proposed an objectivist theory of reasons for action,and he tried to prove that reasons are external,objective,and value-based,through his three arguments,i. e. ,the agony argument,the all or none argument,and the incoherence argument. He finally demonstrated that what can determine reasons for action are facts rather than desires.
Zhang, Hui; Cowling, David W; Facer, Matthew
Various health insurance benefit designs based on value-based purchasing have been promoted to steer patients to high-value providers, but little is known about the designs' relative effectiveness and underlying mechanisms. We compared the impact of two designs implemented by the California Public Employees' Retirement System on inpatient hospital total hip or knee replacement: a reference-based pricing design for preferred provider organizations (PPOs) and a centers-of-excellence design for health maintenance organizations (HMOs). Payment and utilization data for the procedures in the period 2008-13 were evaluated using pre-post and quasi-experimental designs at the system and health plan levels, adjusting for demographic characteristics, case-mix, and other confounders. We found that both designs prompted higher use of designated low-price high-quality facilities and reduced average replacement expenses per member at the plan and system levels. However, the designs used different routes: The reference-based pricing design reduced average replacement payments per case in PPOs by 26.7 percent in the first year, compared to HMOs, but did not lower PPO members' utilization rates. In contrast, the centers-of-excellence design lowered HMO members' utilization rates by 29.2 percent in the first year, compared to PPOs, but did not reduce HMO average replacement payments per case. The reference-based pricing design appears more suitable for reducing price variation, and the centers-of-excellence design for addressing variation in use.
Full Text Available Thirty years ago, starting from a new awareness of the limits of biomedical power and healthcare services to solve all population’ health problems, the Ottawa Conference coined a New Public Health by defining Health Promotion (HP as “the process of enabling people to increase control over and to improve their health and well-being”. Since then and over the next 30 years, several programs have been developed all over the world to translate HP concepts into practical actions and many health successes have been achieved as well. Nowadays, even if the global health context has strongly changed, the original principles of HP still provide a solid ground for action, being the community engagement and empowerment of women and men still at the heart of any health strategy, in a shared responsibility of all society’s sectors approach. However, since now HP promotion efforts have been directed toward priority health problems in a issue- settings-based approach, but in a sustainable and ethical prospective this will be not enough now: a deeper attention on effectiveness is request and an evidence- and value-based HP approach is needed to support the Public Health community and the policy-making, including the new challenges related to Public Health Genomics.
Full Text Available Talking about Big Data in healthcare we usually refer to how to use data collected from current electronic medical records, either structured or unstructured, to answer clinically relevant questions. This operation is typically carried out by means of analytics tools (e.g. machine learning or by extracting relevant data from patient summaries through natural language processing techniques. From other perspective of research in medical informatics, powerful initiatives have emerged to help physicians taking decisions, in both diagnostics and therapeutics, built from the existing medical evidence (i.e. knowledge-based decision support systems. Much of the problems these tools have shown, when used in real clinical settings, are related to their implementation and deployment, more than failing in its support, but, technology is slowly overcoming interoperability and integration issues. Beyond the point-of-care decision support these tools can provide, the data generated when using them, even in controlled trials, could be used to further analyze facts that are traditionally ignored in the current clinical practice. In this paper, we reflect on the technologies available to make the leap and how they could help driving healthcare organizations shifting to a value-based healthcare philosophy.
McCay, D.; Fiorenza, P.; Lautz, L.
More than half of Ph.D. scientists and engineers find employment in non-academic sectors. Recognizing the range of career options for graduate degree holders and the need to align graduate education with the expectations of prospective employers, the National Science Foundation (NSF) created the NSF Research Traineeship (NRT) program. To date, over 100 NRT programs have been funded. As these programs are implemented, it is important to assess their progress, successes, and challenges. This presentation describes the ongoing evaluation of one NRT program, "Education Model Program on Water-Energy Research" (or EMPOWER) at Syracuse University. Through seminars, mini-grants, professional development activities, field courses, internship opportunities, and coursework, EMPOWER's goal is to equip students with the skills needed for the range of career options in water and energy. In collaboration with an external evaluator, EMPOWER is examining the fidelity of the program to proposed goals, providing feedback to inform project improvement (formative assessment) and assessing the effectiveness of achieving program goals (summative assessment). Using a convergent parallel mixed method design, qualitative and quantitative data were collected to develop a full assessment of the first year of the program. Evaluation findings have resulted in several positive changes to the program. For example, EMPOWER students perceive themselves to have high technical skills, but the data show that the students do not believe that they have a strong professional network. Based on those findings, EMPOWER offered several professional development events focused on building one's professional network. Preliminary findings have enabled the EMPOWER leadership team to make informed decisions about the ways the program elements can be redesigned to better meet student needs, about how to the make the program more effective, and determine the program elements that may be sustained beyond the funding
Full Text Available The proposed values-based negotiation model (VBM agrees with and extends principled negotiation’s recognition of personal values and emotions as important negotiation elements. First, building upon Martin Buber’s existentialist treatment of religion and secularism, VBM centers on religion as one of many possible sources of personal values that informs respectful and mutually beneficial interactions without needing one to necessarily be religious. Just as one need not be a Buddhist or a Hindu to practice yoga, negotiators of any theological outlook can profit from a model grounded in broad, common tenets drawn from a range of organized religions. Second, VBM distinguishes feelings from emotions because the long-lasting and intrinsically stimulated effects of feelings have greater implications on the perception of negotiated outcomes. VBM negotiators view negotiations as a constitutive prosocial process whereby parties consider the outcome important enough to invest time and energy. Negotiators who use VBM appeal to the goodness of their counterparts by doing good first so that both parties avoid a win-lose outcome. This counterintuitive move contradicts the self-centered but understandably normal human behavior of prioritizing one’s own interests before others’ interests. However, when one appeals to the goodness of one’s Buberian Thou counterparts, he or she stimulates positive emotions that promote understanding. Third, VBM provides a framework that draws upon an individual’s personal values (religious or otherwise and reconfigures the distributive-bargaining-and-integrative-negotiation distinction so that negotiators can freely apply distributive tactics to claim maximum intangible and tangible outcomes without compromising on their personal values or valuable relationships.
Turner, Jason S; Broom, Kevin D; Counte, Michael A
Recent US legislation is attempting to transition inpatient Medicare payments to a value-based purchasing (VBP) program. The VBP program is a pay-for-performance (P4P) system that incentivizes hospitals to improve patient satisfaction, health outcomes, and adherence to clinical protocols while simultaneously holding down costs. Our study evaluates (1) the impact of financial performance on the VBP adjustments and (2) whether there is a correlation between the VBP adjustment and the financial performance of Missouri hospitals that opted into the program. While upward and downward adjustments to the inpatient base rate may be related to hospital financial performance, prior financial performance may also be related to the adjustments. Financial health may allow facilities to invest and position the hospital for favorable future P4P adjustments. The results of our analysis indicate the VBP adjustment to the inpatient base rate is very small (±0.18%), clustered around zero, and is not correlated with financial performance. We also find that financial performance and improvement in the years prior to the adjustment are not related to the VBP adjustment or its respective components. This suggests that CMS is avoiding penalizing less profitable facilities, but the adjustment is also so small and tightly clustered around zero that it is failing to provide an adequate incentive to hospitals. The costs of improving patient satisfaction, clinical process adherence, health care outcomes, and efficiency above that of peers coupled with the growing number of metrics being used to calculate the VBP adjustments call into question the financial incentives of the hospital VBP program.
The National Health Service (NHS) should reward innovation it values. This will enable the NHS and the United Kingdom (UK) economy to benefit and impact positively on the Research and Development (R&D) decision making of companies. The National Institute for Health and Clinical Excellence (NICE) currently seeks to do this on behalf of the NHS. Yet the Office of Fair Trading proposals for Value Based Pricing add price setting powers--initially for the Department of Health (DH) and then for NICE. This introduces an additional substantial uncertainty that will impact on R&D and, conditional on R&D proceeding, on launch (or not) in the UK. Instead of adding to uncertainty the institutional arrangements for assessing value should seek to be predictable and science based, building on NICE's current arrangements. The real challenge is to increase understanding of the underlying cost-effectiveness of the technology itself by collecting evidence alongside use. The 2009 Pharmaceutical Price Regulation Scheme sought to help do this with Flexible Pricing (FP) and Patient Access Schemes (PASs). The PASs to date have increased access to medicines, but no schemes proposed to date have yet helped to tackle outcomes uncertainty. The 2010 Innovation Pass can also be seen as a form of 'coverage with evidence development.' The NHS is understandably concerned about the costs of running such evidence collection schemes. Enabling the NHS to deliver on such schemes will impact favourably on R&D decisions. Increasing the uncertainty in the UK NHS market through government price setting will reduce incentives for R&D and for early UK launch.
Richard-Devantoy, Stéphane; Olié, Emilie; Guillaume, Sébastien; Bechara, Antoine; Courtet, Philippe; Jollant, Fabrice
The literature suggests that many suicide attempters show impairment in both decision-making and cognitive control. However, it is not clear if these deficits are linked to each other, and if they may be related to more basic alterations in attention. This is a relevant question in the perspective of future interventions targeting cognitive deficits to prevent suicidal acts. Two different populations of patients with histories of suicide attempts were assessed (N=142 and 119). The Iowa Gambling Task (IGT) was used to measure decision-making in both populations. We used a D2 cancellation task and a verbal working memory task in population 1; the Stroop test, the N-Back task, the Trail Making Test, and the Hayling Sentence Completion test in population 2. Regarding decision-making, we only found a small negative correlation between the Hayling test error score (r=-0.24; p=0.01), and the net score from the second half of the IGT. In contrast, working memory, cognitive flexibility and cognitive inhibition measures were largely inter-correlated. Most patients were medicated. Only patients with mood disorders. These results add to previous findings suggesting that the neurocognitive vulnerability to suicidal behavior may rely on impairments in two distinct anatomical systems, one processing value-based decision-making (associated with ventral prefrontal cortex, among others) and one underlying cognitive control (associated with more dorsal prefrontal regions). This distinction may result in tailored-made cognitive interventions. Copyright © 2013 Elsevier B.V. All rights reserved.
Full Text Available n a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. Methods The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs at decision-making points in primary healthcare (PHC based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. Results The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. Conclusion This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability.
... for Educators Search English Español Why Do Eyes Water? KidsHealth / For Kids / Why Do Eyes Water? What's ... coming out of your nose. Why Do Eyes Water? Eyes water for lots of different reasons besides ...
McCully, Kristin M.
To protect and conserve the Earth's biodiversity and ecosystem services, it is important not only to understand and conserve species and ecosystems, but also to instill an understanding and appreciation for biodiversity and ecosystem services in the next generations of both scientists and citizens. Thus, this dissertation combines research into the ecology and identity of large bivalves at Midway Atoll in the Northwestern Hawaiian Islands (NWHI) with research on pedagogical strategies for integrating mathematics into undergraduate biology education. The NWHI is one of the few remaining large, mainly intact, predator-dominated coral reef ecosystems and one of the world's largest marine protected areas. Previous bivalve studies focused on the black-lipped pearl oyster, Pinctada margaritifera, which was heavily harvested in the late 1920s, has not recovered, and is now a candidate species for restoration. First, I combined remote sensing, geographic information systems, SCUBA, and mathematical modeling to quantify the abundance, spatial distributions, and filtration capacity of large epifaunal bivalves at Midway Atoll. These bivalves are most abundant on the forereef outside the atoll, but densities are much lower than reported on other reefs, and Midway's bivalves are unlikely to affect plankton abundance and productivity inside the lagoon. Second, I used molecular techniques and phylogenetic reconstructions to identify pearl oysters (Pinctada) from Midway Atoll as P. maculata , a species not previously reported in Hawaii. As a small morphologically cryptic species, P. maculata may be a native species that has not been collected previously, a native species that has been identified incorrectly as the morphologically similar P. radiata, or it may be a recent introduction or natural range extension from the western Pacific. Finally, I review science education literature integrating mathematics into undergraduate biology curricula, and then present and evaluate a
One of the major problems facing countries with nuclear power and nuclear waste management programs is that of promoting public confidence in the waste management system. This paper discusses the need for education in the field of radioactive waste management as a means for speaking the same language and as the gateway to the solution, no matter what the ultimate solution may be
The Education Program aims to develop human resources through scientific training programs and to provide and disseminate scientific information in nuclear and correlated areas. IPEN is responsible for the graduate program in the nuclear area at University of Sao Paulo, the Nuclear Technology Program IPEN/USP
The Education Program aims to develop human resources through scientific training programs and to provide and disseminate scientific information in nuclear and correlated areas. IPEN is responsible for the graduate program in the nuclear area at University of Sao Paulo, the Nuclear Technology Program IPEN/USP, Brazil
Literacy facilitators across the archipelago are currently faced with the challenge to integrate local values in functional literacy education programs, because its integration is a new aspect. This makes localized literacy content a hard thing to implement. Yet, if properly conducted, it can lead to improved learner's basic competencies. In an…
Ryan, Andrew M; Damberg, Cheryl L
The Medicare program has implemented pay-for-performance (P4P), or Value-Based Purchasing, for inpatient care and for Medicare Advantage plans, and plans to implement a program for physicians in 2015. In this paper, we review evidence on the effectiveness of P4P and identify design criteria deemed to be best practice in P4P. We then assess the extent to which Medicare's existing and planned Value-Based Purchasing programs align with these best practices. Of the seven identified best practices in P4P program design, the Hospital Value-Based Purchasing program is strongly aligned with two of the best practices, moderately aligned with three, weakly aligned with one, and has unclear alignment with one best practice. The Physician Value-Based Purchasing Modifier is strongly aligned with two of the best practices, moderately aligned with one, weakly aligned with three, and has unclear alignment with one of the best practices. The Medicare Advantage Quality Bonus Program is strongly aligned with four of the best practices, moderately aligned with two, and weakly aligned with one of the best practices. We identify enduring gaps in P4P literature as it relates to Medicare's plans for Value-Based Purchasing and discuss important issues in the future of these implementations in Medicare. Copyright © 2013 Elsevier Inc. All rights reserved.
United Nations Children's Fund, New York, NY.
This report summarizes the latest available statistics on international achievements in child survival, health, nutrition, education, water and sanitation, and the plight of women. Each section contains a commentary, related statistics, and a discussion on progress and disparity in the section's particular area. Following a foreword by United…
Theiler, Julio; Isla, Miguel; Arrillaga, Hugo; Ceirano, Eduardo; Lozeco, Cristobal
This paper explains the educational changes in the Water Resources Engineering program offered by the Universidad Nacional del Litoral in Santa Fe, Argentina, for the last 20 years at the undergraduate level. The need for modernizing the engineering teaching program occurred due to changes in the social system in which the concepts of development…
Inhulsen, Maj-Britt Mr; Mérelle, Saskia Ym; Renders, Carry M
To examine the associations between parental feeding styles and children's dietary intakes and the modifying effect of maternal education and children's ethnicity on these associations. Cross-sectional study of parental feeding styles, assessed by the Parental Feeding Style Questionnaire, and children's dietary intakes. Multiple regression analyses were carried out to assess the associations between the parental feeding styles studied ('control', 'emotional feeding', 'encouragement to eat' and 'instrumental feeding') and children's dietary intakes (consumption of fruit, vegetables, water and sugar-sweetened beverages (SSB)). The modifying effect of maternal education and children's ethnicity on these associations was explored. North-western part of the Netherlands. Children aged 3-7 years (n 5926). Both 'encouragement' and 'control' were associated with higher consumption of vegetables and lower consumption of SSB, but only 'encouragement' was positively associated with fruit and water intakes. 'Instrumental feeding' showed a positive association with SSB and negative associations with fruit, vegetable and water consumption. No significant associations were found for 'emotional feeding'. Maternal educational level and children's ethnicity moderated some associations; for example, 'control' was beneficial for vegetable intake in all subgroups, whereas the association with SSB was beneficial only in highly educated mothers. The study shows that both encouraging and controlling feeding styles may improve children's dietary behaviour, while 'instrumental feeding' may have a detrimental effect. Furthermore, maternal educational level and children's ethnicity influence these associations. The study's findings could provide a basis for development of interventions to improve parental feeding styles.
Kohler, Graeme; Sampalli, Tara; Ryer, Ashley; Porter, Judy; Wood, Les; Bedford, Lisa; Higgins-Bowser, Irene; Edwards, Lynn; Christian, Erin; Dunn, Susan; Gibson, Rick; Ryan Carson, Shannon; Vallis, Michael; Zed, Joanna; Tugwell, Barna; Van Zoost, Colin; Canfield, Carolyn; Rivoire, Eleanor
include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Persson, Ulf; Willis, Michael; Odegaard, Knut
Value-based pricing (VBP) is a method of setting prices for products based on perceived benefits to the consumer. When information is symmetric and freely available and agency is perfect, VBP is efficient and desirable. Because of substantial information asymmetries, medical insurance distortions, and the prescribing monopoly of physicians, VBP is rare for prescription drugs, though a number of countries have recently moved in this direction. Because the potential benefits can be sizable, it is high time for a review of actual VBP-based decision-making in practice. Sweden, with its pharmaceutical benefits board (TLV), was an early adopter of VBP decision-making. We illustrate actual decision-making, thus, using the case of Acomplia for the treatment of obesity in Sweden, with and without the presence of co-morbid conditions. This example has a number of features that will be useful in illustrating the strengths and weaknesses of VBP in actual practice, including multiple indications, a need for not just one but two economic simulation models, considerable sub-group analysis, and requirements for additional evidence development. TLV concluded, in 2006, that Acomplia was cost-effective for patients with a body mass index (BMI) exceeding 35 kg/m2 and patients with a BMI exceeding 28 kg/m2 and either dyslipidemia or type 2 diabetes. Because of uncertainty in some of the underlying assumptions, reimbursement was granted only until 31 December 2008, at which time the manufacturer would be required to submit additional documentation of the long-term effects and cost-effectiveness in order to obtain continued reimbursement. Deciding on reimbursement coverage for pharmaceutical products is difficult. Ex ante VBP assessment is a form of risk sharing, which has been used by TLV to speed up reimbursement and dispersion of effective new drugs despite uncertainty in their true cost-effectiveness. Manufacturers are often asked in return to generate additional health economic
Burridge, Nina; Payne, Anne Maree; Rahmani, Nasima
Progress in education in Afghanistan since the fall of the Taliban has been described as "fragile, limited in reach, depth and uncertainty of sustainability" [UNICEF. 2013. "Basic Education and Gender Equality: Afghanistan." United Nations International Children's Emergency Fund.…
Full Text Available Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in SpainThe editorial addresses the current use of economic evaluation in the assessment and potential funding and reimbursement of health technologies. Cost-effectiveness ratio and the acceptability thresholds are analyzed, pointing out the limitations that the current approach has for capturing the value of new technologies. A potential shift from National Health Systems to value-based prices is discussed, with a focus on health economics outcomes where multi-criteria analyses can be a complementary tool to traditional cost-effectiveness approaches.
Petrou, Panagiotis; Talias, Michael A
The continuing increase of pharmaceutical expenditure calls for new approaches to pricing and reimbursement of pharmaceuticals. Value based pricing of pharmaceuticals is emerging as a useful tool and possess theoretical attributes to help health system cope with rising pharmaceutical expenditure. To assess the feasibility of introducing a value-based pricing scheme of pharmaceuticals in Cyprus and explore the integrative framework. A probabilistic Markov chain Monte Carlo model was created to simulate progression of advanced renal cell cancer for comparison of sorafenib to standard best supportive care. Literature review was performed and efficacy data were transferred from a published landmark trial, while official pricelists and clinical guidelines from Cyprus Ministry of Health were utilised for cost calculation. Based on proposed willingness to pay threshold the maximum price of sorafenib for the indication of second line renal cell cancer was assessed. Sorafenib value based price was found to be significantly lower compared to its current reference price. Feasibility of Value Based Pricing is documented and pharmacoeconomic modelling can lead to robust results. Integration of value and affordability in the price are its main advantages which have to be weighed against lack of documentation for several theoretical parameters that influence outcome. Smaller countries such as Cyprus may experience adversities in establishing and sustaining essential structures for this scheme.
Tokumitsu, Seika; Hasegawa, Makoto
Investigations were conducted for the purposes of understanding coloring phenomena to be caused by optical rotation of polarized light beams in sugared water and realizing their applications as educational tools. By allowing polarized laser beams in red, blue or green to travel in sugared water of certain concentrations, changes in their intensities were measured while changing a distance between a pair of polarizing plates in the sugared water. An equation was established for a theoretical value for the angle of rotation for light of any colors (wavelengths) travelling in sugared water of any concentrations. The predicted results exhibited satisfactory matching with the measured values. In addition, the intensities of transmitted laser beams, as well as colors to be observable when a white-color LED torch was employed as a light source, were also become predictable, and the predicted results were well-matched with the observation results.
Bean, Melanie K; Mazzeo, Suzanne E; Stern, Marilyn; Bowen, Deborah; Ingersoll, Karen
To reduce pediatric obesity in clinical settings, multidisciplinary behaviorally-based treatment programs are recommended. High attrition and poor compliance are two difficulties frequently encountered in such programs. A brief, empathic and directive clinical intervention, Motivational Interviewing (MI), might help address these motivational and behavioral issues, ultimately resulting in more positive health outcomes. The efficacy of MI as an adjunct in the treatment of pediatric obesity remains relatively understudied. MI Values was developed to implement within an existing multidisciplinary treatment program for obese, ethnically diverse adolescents, the T.E.E.N.S. Program (Teaching, Encouragement, Exercise, Nutrition, Support). T.E.E.N.S. participants who consent to MI Values are randomized to either MI or an education control condition. At weeks 1 and 10 of T.E.E.N.S. participation, the subset of participants assigned to the MI condition engages in individual MI sessions and control participants view health education videos. All MI sessions are audiotaped and coded to monitor treatment fidelity, which has been satisfactory thus far. Participants complete comprehensive assessments at baseline, 3- and 6-month follow-ups. We hypothesize that MI participants will demonstrate greater reductions in Body Mass Index (BMI) percentile, improved diet and physical activity behaviors, better compliance with T.E.E.N.S., and lower attrition than participants in the control group. We present study design and methods for MI Values as well as data on feasibility of recruitment methods and treatment integrity. At study completion, findings will contribute to the emerging literature examining the efficacy of MI in the treatment of pediatric obesity. Copyright © 2011 Elsevier Inc. All rights reserved.
George, Christine Marie; Inauen, Jennifer; Perin, Jamie; Tighe, Jennifer; Hasan, Khaled; Zheng, Yan
More than 100 million people globally are estimated to be exposed to arsenic in drinking water that exceeds the World Health Organization guideline of 10 µg/L. In an effort to develop and test a low-cost sustainable approach for water arsenic testing in Bangladesh, we conducted a randomized controlled trial which found arsenic educational…
Identifies major value bases which have been used to teach values in the classroom and outlines a values education program which stresses teaching about values without indoctrination. Based upon the hierarchy of human needs developed by psychologist Abraham Maslow, the program is based upon universal values, basic human needs, and recognition of…
The Education Program of IPEN aims to develop human resources through scientific training programs and to provide and disseminate scientific information in nuclear and correlated areas. IPEN is responsible for the graduate program in the nuclear area at University of Sao Paulo: the Nuclear Technology Program IPEN/USP. Since its creation, in 1976, the Program was evaluated with grade A by the Federal Government Evaluation (CAPES), the highest in this classification. In 2003 CAPES changed the evaluation criteria; since then, it has been considered a program of Excellence, with grade 6. Levels 6 and 7 are granted only to those programs having internationally recognized expertise. Level 6 was maintained in the last evaluation considering the period 2010-2012. Along its 37 years the Nuclear Technology Program awarded 2,217 titles: 1,511 masters and 706 doctoral degrees. The institution is also responsible for the Professional Master Degree - Lasers in Dentistry, in partnership with the School of Dentistry from University of Sao Paulo. IPEN has a Scientific Initiation Program for undergraduate students aiming to stimulate young people to enter the scientific research career. This program allows the student to have the opportunity to develop a specially assigned study under the guidance of a supervisor. CNEN and CNPq are the main funding agencies supporting this Program. The institute also offers, since 2000, undergraduate disciplines for students of University of Sao Paulo. A total of 33 disciplines have been approved by the University. In the period considered over 1,000 students attended the courses. There is also a Scholarship Program for graduate students, funded by CNPq, CAPES and IPEN. Scholarships funded by FAPESP and CNEN are also available on demand, according to the conditions set forth in the respective notices. Concerning scientific information support, there is available a central specialized library, which offers, beyond traditional collections and services
The Education Program of IPEN aims to develop human resources through scientific training programs and to provide and disseminate scientific information in nuclear and correlated areas. IPEN is responsible for the graduate program in the nuclear area at University of Sao Paulo: the Nuclear Technology Program IPEN/USP. Since its creation, in 1976, the Program was evaluated with grade A by the Federal Government Evaluation (CAPES), the highest in this classification. In 2003 CAPES changed the evaluation criteria; since then, it has been considered a program of Excellence, with grade 6. Levels 6 and 7 are granted only to those programs having internationally recognized expertise. Level 6 was maintained in the last evaluation considering the period 2010-2012. Along its 37 years the Nuclear Technology Program awarded 2,217 titles: 1,511 masters and 706 doctoral degrees. The institution is also responsible for the Professional Master Degree - Lasers in Dentistry, in partnership with the School of Dentistry from University of Sao Paulo. IPEN has a Scientific Initiation Program for undergraduate students aiming to stimulate young people to enter the scientific research career. This program allows the student to have the opportunity to develop a specially assigned study under the guidance of a supervisor. CNEN and CNPq are the main funding agencies supporting this Program. The institute also offers, since 2000, undergraduate disciplines for students of University of Sao Paulo. A total of 33 disciplines have been approved by the University. In the period considered over 1,000 students attended the courses. There is also a Scholarship Program for graduate students, funded by CNPq, CAPES and IPEN. Scholarships funded by FAPESP and CNEN are also available on demand, according to the conditions set forth in the respective notices. Concerning scientific information support, there is available a central specialized library, which offers, beyond traditional collections and services
Kim, Jong In; Kim, Gukbin
The remaining years of healthy life expectancy (RYH) at age 65 years can be calculated as RYH (65) = healthy life expectancy-aged 65 years. This study confirms the associations between socioeconomic indicators and the RYH (65) in 148 countries. The RYH data were obtained from the World Health Organization. Significant positive correlations between RYH (65) in men and women and the socioeconomic indicators national income, education level, and improved drinking water were found. Finally, the predictors of RYH (65) in men and women were used to build a model of the RYH using higher socioeconomic indicators (R(2 )= 0.744, p educational attainment, national income level, and improved water quality influenced the RYH at 65 years. Therefore, policymaking to improve these country-level socioeconomic factors is expected to have latent effects on RYH in older age. © The Author(s) 2016.
Savings Septic Unsafe Disposable Wipe Woes FacebookLogo FOCUS AREAS Drinking Water Wastewater Training Security Conservation & Water Efficiency Water We Drink Source Water Protection SORA/COI EPA MOU CartIcon Links Listserv Educators Homeowners Operators Small Systems Drinking Water Read On Tap Latest
Bloeschl, G.; Carr, G.; Loucks, D. P.
Greater understanding of how interdisciplinary research and education evolves is critical for identifying and implementing appropriate programme management strategies. We propose a program evaluation framework that is based on social learning processes (individual learning, interdisciplinary research practices, and interaction between researchers with different backgrounds); social capital outcomes (ability to interact, interpersonal connectivity, and shared understanding); and knowledge and human capital outcomes (new knowledge that integrates multiple research fields). The framework is tested on established case study doctoral program: the Vienna Doctoral Program on Water Resource Systems. Data are collected via mixed qualitative/quantitative methods that include semi-structured interviews, publication co-author analysis, analysis of research proposals, categorisation of the interdisciplinarity of publications and graduate analysis. Through the evaluation and analysis, several interesting findings about how interdisciplinary research evolves and can be supported are identified. Firstly, different aspects of individual learning seem to contribute to a researcher's ability to interact with researchers from other research fields and work collaboratively. These include learning new material from different research fields, learning how to learn new material and learning how to integrate different material. Secondly, shared interdisciplinary research practices can be identified that may be common to other programs and support interaction and shared understanding between different researchers. They include clarification and questioning, harnessing differences and setting defensible research boundaries. Thirdly, intensive interaction between researchers from different backgrounds support connectivity between the researchers, further enabling cross-disciplinary collaborative work. The case study data suggest that social learning processes and social capital outcomes
van Haarst, Ernst P; Bosch, J L H Ruud
We sought criteria for nocturnal polyuria in asymptomatic, nonurological adults of all ages by reporting reference values of the ratio of daytime and nighttime urine volumes, and finding nocturia predictors. Data from a database of frequency-volume charts from a reference population of 894 nonurological, asymptomatic volunteers of all age groups were analyzed. The nocturnal polyuria index and the nocturia index were calculated and factors influencing these values were determined by multivariate analysis. The nocturnal polyuria index had wide variation but a normal distribution with a mean ± SD of 30% ± 12%. The 95th percentile of the values was 53%. Above this cutoff a patient had nocturnal polyuria. This value contrasts with the International Continence Society definition of 33% but agrees with several other reports. On multivariate regression analysis with the nocturnal polyuria index as the dependent variable sleeping time, maximum voided volume and age were the covariates. However, the increase in the nocturnal polyuria index by age was small. Excluding polyuria and nocturia from analysis did not alter the results in a relevant way. The nocturnal voiding frequency depended on sleeping time and maximum voided volume but most of all on the nocturia index. The prevalence of nocturnal polyuria is overestimated. We suggest a new cutoff value for the nocturnal polyuria index, that is nocturnal polyuria exists when the nocturnal polyuria index exceeds 53%. The nocturia index is the best predictor of nocturia. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
NSGIC Education | GIS Inventory — A Water Resource is a DEP primary facility type related to the Water Use Planning Program. The sub-facility types related to Water Resources that are included are:...
Koppen, Ilan J N; Yacob, Desale; Di Lorenzo, Carlo; Saps, Miguel; Benninga, Marc A; Cooper, Jennifer N; Minneci, Peter C; Deans, Katherine J; Bates, D Gregory; Thompson, Benjamin P
Contrast enemas with barium or water-soluble contrast agents are sometimes performed in children with severe intractable constipation to identify anatomical abnormalities. However there are no clear definitions for normal colonic size or abnormalities such as colonic dilation or sigmoid redundancy in children. To describe characteristics of colonic anatomy on air contrast enemas in children without constipation to provide normal values for colonic size ratios in children. We performed a retrospective chart review of children aged 0-5 years who had undergone air contrast enemas for intussusception. The primary outcome measures were the ratios of the diameters and lengths of predetermined colonic segments (lengths of rectosigmoid and descending colon; diameters of rectum, sigmoid, descending colon, transverse colon and ascending colon) in relation to the L2 vertebral body width. We included 119 children (median age 2.0 years, range 0-5 years, 68% boys). Colonic segment length ratios did not change significantly with age, although the differences for the rectosigmoid/L2 ratio were borderline significant (P = 0.05). The ratios that involved the rectal and ascending colon diameters increased significantly with age, while diameter ratios involving the other colonic segments did not. Differences by gender and race were not significant. These data can be used for reference purposes in young children undergoing contrast studies of the colon.
Hidayati, A.; Rahmi, A.; Yohandri; Ratnawulan
The importance of teaching materials in accordance with the characteristics of students became the main reason for the development of basic electronics I module integrated character values based on conceptual change teaching model. The module development in this research follows the development procedure of Plomp which includes preliminary research, prototyping phase and assessment phase. In the first year of this research, the module is validated. Content validity is seen from the conformity of the module with the development theory in accordance with the demands of learning model characteristics. The validity of the construct is seen from the linkage and consistency of each module component developed with the characteristic of the integrated learning model of character values obtained through validator assessment. The average validation value assessed by the validator belongs to a very valid category. Based on the validator assessment then revised the basic electronics I module integrated character values based on conceptual change teaching model.
Hogue, T. S.; Blaine, A. C.; Martin, A. C.
The ConocoPhillips Center for a Sustainable WE2ST (Water-Energy Education, Science, and Technology) is a testament to the power of collaboration and innovation. WE2ST began as a partnership between ConocoPhillips (foundation gift) and the Colorado School of Mines (CSM) with the goal of fostering solutions to water-energy challenges via education, research and outreach. The WE2ST center is a training ground for the next generation of water-energy-social scientists and engineers and is a natural fit for CSM, which is known for its expertise in water resources, water treatment technologies, petroleum engineering, geosciences, and hydrology. WE2ST has nine contributing faculty researchers that combine to create a web of expertise on sustainable energy and water resources. This research benefits unconventional energy producers, water-reliant stakeholders and the general public. Areas of focus for research include water sources (quality and quantity), integrated water-energy solution viability and risk, and social-corporate responsibility. The WE2ST Center currently provides annual support for 8-9 Graduate Fellows and 13 Undergraduate Scholars. Top-tier graduate students are recruited nationally and funded similar to an NSF Graduate Research Fellowship (GRF). Undergraduate Scholars are also recruited from across the CSM campus to gain experience in faculty laboratories and on research teams. All WE2ST students receive extensive professional skills training, leadership development, communication skills training, networking opportunities in the water-energy industries, and outreach opportunities in the community. The corner stone of the WE2ST Center is a focus on communication with the public. Both in social science research teams and in general interactions with the public, WE2ST seeks to be "an honest broker" amidst a very passionate and complex topic. WE2ST research is communicated by presentations at technical conferences, talking with people at public gatherings
Terho Harri; Haas Alexander; Eggert Andreas; Ulaga Wolfgang
While the creation of superior customer value is regarded as fundamental to a firm's long term survival and growth little is known about the effective implementation of a firm's value orientation at sales force level. As the sales force plays a pivotal role in implementing marketing strategies this study adopts a discovery oriented approach and conceptualizes value based selling as an effective sales approach in business markets. Based on in depth interviews with sales managers in a variety o...
Full Text Available The focus of this research is to known the influence of Problem Based Learning (PBL model application, that intergrated with Islamic values based on ICT, toward the ability of higher-order thinkingskill and the strenghtening of students’ characters. This research is quasy experiment type with group design pretest-postest. The research was conducted in SMA.Sampling by means of random sampling, to determine the control class and experimentalclass.Data analysis technique used is the t-test, based on the value of significance, as well as test-effect size. The research data shows that the model of problem based learning integrates Islamic values based on ICThas positive influence towards the increasing of higher-order thinking skill and the strenghtening of students’ characters compared to the students that use conventional method.The result of effect size test on experimental class in on medium category. It means that the learning which use problem based learning (PBL model, integrated with Islamic values based on ICT, can be said effective on increasing higher order thinking skillof students.
Full Text Available We approach marketization and commodification of adult education from multiple lenses including our personal narratives and neoliberalism juxtaposed against the educational philosophy of the Progressive Period. We argue that adult education occurs in many arenas including the public spaces found in social movements, community-based organizations, and government sponsored programs designed to engage and give voice to all citizens toward building a stronger civil society. We conclude that only when adult education is viewed from the university lens, where it focuses on the individual and not the public good, does it succumb to neoliberal forces.
the forecast expected number of dengue cases. The results have shown significantly high coefficient of determination if applied only for the rainy season using empirical relation-2 (ER-2. These results have shown further improvement once a concept of time lag of one month was applied using the ER-3 empirical relation. ER-3 model is most suitable for the Sukhothai province in predicting possible dengue incidence with 0.81 coefficient of determination. The spatial statistical relationship of various land use/land cover classes with dengue-affected areas was quantified in the form of information value received from GIS analysis. The highest information value was obtained for the Built-up area. This indicated that Built-up area has the maximum influence on the incidence of dengue. The other classes showing negative values indicate lesser influence on dengue epidemics. Agricultural areas have yielded moderate risk areas based on their medium high information values. Water bodies have shown significant information value for DF/ DHF only in one district. Interestingly, forest had shown no influence on DF/DHF. Conclusion This paper explores the potential of remotely sensed data and GIS technology to analyze the spatial factors affecting DF/DHF epidemic. Three empirical models were evaluated. It was found that Empirical Relatrion-3 (ER-3 has yielded very high coefficient of determination to forecast the number of DF/DHF incidence. An analysis of physio-environmental factors such as land use/ land cover types with dengue incidence was carried out. Influence of these factors was obtained in quantitative terms using Information Value method in the GIS environment. It was found that built-up areas have highest influence and constitute the highest risk zones. Forest areas have no influence on DF/DHF epidemic. Agricultural areas have moderate risk in DF/DHF incidences. Finally the dengue risk map of the Sukhothai province was developed using Information Value method. Dengue risk map
Ngwenya, B. N.; Thakadu, O. T.; Phaladze, N. A.; Bolaane, B.
In developing countries, the sanitation and hygiene provision often receives limited resources compared to the water supply. However, water supply benefits tend to diminish if improved sanitation and hygiene are neglected. This paper presents findings of a situational analysis of water supply, sanitation and hygiene infrastructure and their utilization in three primary schools in north-western Botswana. The overall objective of the paper is to determine access and functionality of water supply, sanitation and hygiene infrastructure in three primary schools. The specific objectives are: a) Learners' perspective of their water and sanitation facilities and b) gendered utilization of sanitation and hygiene facilities. Data were collected through a face-to-face administered social survey tool to 286 learners selected through proportionate stratified random sampling from three purposively selected villages in the middle and lower Okavango Delta. Findings indicate that standpipes provide 96% of potable water supply. However, the majority (65% of leaners) indicated that they 'sometimes' experienced water shortage due to dry/nonfunctioning taps/pumps and leaks/wastage. Overall, schools have relatively sufficient sanitation facilities consisting of both water borne toilets and VIP latrines. The major sanitation gap identified was that 80% flush toilets hardly work, while 77% of VIP toilets were in disrepair. Furthermore, poor water supply compromised hand washing with 65.7% learners "always" washing their hands if school standpipes had water, while the majority did not wash hands if standpipes were dry. The study concluded that availability of sanitation infrastructure does not necessarily translate into utilization in the study area due to multiple problems, such as lack of personal hygiene supplies (regular toilet paper and hand washing detergents), privacy issues and recurring water problems. The chronicity of inadequate water, sanitation and hygiene infrastructure in
Operators Small Systems Small Community Training & Education education, training and professional implement the 1996 Amendments to the Safe Drinking Water Act (SDWA). Â EPA Environmental Education Center
Minnesota Univ., Duluth. Minnesota Sea Grant Program.
Water on the Web (WOW) curriculum materials help students understand data taken from several water sampling robots called Remote Underwater Sampling Station (RUSS) units located in Ice Lake, Lake Independence, Lake Minnetonka, and Grindstone Lake in Minnesota. WOW allows high school and college students to monitor Minnesota lakes over the…
Toth, Peter P; Danese, Mark; Villa, Guillermo; Qian, Yi; Beaubrun, Anne; Lira, Armando; Jansen, Jeroen P
To estimate real-world cardiovascular disease (CVD) burden and value-based price range of evolocumab for a US-context, high-risk, secondary-prevention population. Burden of CVD was assessed using the UK-based Clinical Practice Research Datalink (CPRD) in order to capture complete CV burden including CV mortality. Patients on standard of care (SOC; high-intensity statins) in CPRD were selected based on eligibility criteria of FOURIER, a phase 3 CV outcomes trial of evolocumab, and categorized into four cohorts: high-risk prevalent atherosclerotic CVD (ASCVD) cohort (n = 1448), acute coronary syndrome (ACS) (n = 602), ischemic stroke (IS) (n = 151), and heart failure (HF) (n = 291) incident cohorts. The value-based price range for evolocumab was assessed using a previously published economic model. The model incorporated CPRD CV event rates and considered CV event reduction rate ratios per 1 mmol/L reduction in low-density lipoprotein-cholesterol (LDL-C) from a meta-analysis of statin trials by the Cholesterol Treatment Trialists Collaboration (CTTC), i.e. CTTC relationship. Multiple-event rates of composite CV events (ACS, IS, or coronary revascularization) per 100 patient-years were 12.3 for the high-risk prevalent ASCVD cohort, and 25.7, 13.3, and 23.3, respectively, for incident ACS, IS, and HF cohorts. Approximately one-half (42%) of the high-risk ASCVD patients with a new CV event during follow-up had a subsequent CV event. Combining these real-world event rates and the CTTC relationship in the economic model, the value-based price range (credible interval) under a willingness-to-pay threshold of $150,000/quality-adjusted life-year gained for evolocumab was $11,990 ($9,341-$14,833) to $16,856 ($12,903-$20,678) in ASCVD patients with baseline LDL-C levels ≥70 mg/dL and ≥100 mg/dL, respectively. Real-world CVD burden is substantial. Using the observed CVD burden in CPRD and the CTTC relationship, the cost-effectiveness analysis showed
Dr. Ulrich Scholz
The developement of a "general theory" of relationship marketing must be considered as distant vision rather than as imminent reality.We now use the existing stock of knowledge to identify some largely unexplored,yet relevant, aspects of relationship marketing and call for these issues to be
Bramwell, Kate; Richardson, Thomas
Acceptance and commitment therapy (ACT) has been found to be effective for various mental health disorders but the processes through which it affects change remain unclear. Much process research in the area is on physical rather than mental health, and focuses on the broad concept of psychological flexibility with little research on specific mechanisms identified in theory such as fusion and values. This study explored whether there was a relationship between two of the main ACT processes (cognitive defusion and values) and levels of depression and distress. Thirty-three participants completed questionnaires at the start and end of their treatment measuring general mental health and distress, depression, levels of cognitive fusion and how much they were living in line with their values and how important their values were to them. Results showed reductions in levels of fusion and increases in values-based action were significantly related to reductions in distress and depression. There was no correlation between changes in values importance and changes in distress or depression. This study therefore suggests decreased defusion and increased values-based action is an important mechanism in the efficacy of ACT in those with depression and mental health problems. The study is however limited by a small sample size and future research with a sample large enough for mediation analysis would be beneficial.
Halima Boubacar Maïnassara
Full Text Available Objective. To assess the effect on health of the following measures in schools in Maradi (Niger: clean water supply, construction of latrines, establishment of hand washing stations, and health education. Methodology. It was a “before and after” intervention study on a sample of school children aged 7 to 12 years in the Maradi region. The interventions included building of latrines, supplying clean water, setting up hand washing stations, and teaching health education lessons. An individual questionnaire, analysis of stool samples, and a group questionnaire were administered to children and teachers, respectively. The threshold for significance was set at P<0.05. Results. A statistically significant reduction in cases of diarrhoea and abdominal pains was noted after the project. Overall, carriage of at least one parasite increased from 7.5% before the project to 10.2% after it (P=0.04. In the programme group schools, there was a statistically significant increase in the prevalence of Hymenolepis nana, from 0 to 1.9 (P=0.02. Pinworm prevalence remained stable in this group but increased significantly in the control group. Conclusions. Putting health infrastructure in place in schools obviously had an impact on hygiene-related habits in the beneficiary schools and communities.
Allen, James E., Jr.
In this address, James E. Allen, Jr., Assistant Secretary for Education and U.S. Commissioner of Education, discusses the relationship of education to the problem of ecological destruction. He states that the solutions to the problems of air, water, and soil pollution may be found in redirected education. This "education for survival" can serve to…
I advance some novel arguments for the use of historical experiments in science education. After distinguishing three different types of historical experiments and their general purposes, I define "complementary experiments", which can recover lost scientific knowledge and extend what has been recovered. Complementary experiments can help science…
Full Text Available Katie Owens,1 Jim Eggers,2 Stephanie Keller,1 Audrey McDonald1 1HealthStream Engagement Institute, Pensacola, FL, 2Analytics, HealthStream, Laurel, MD, USA Abstract: Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach’s alpha = 0.88 on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and
Full Text Available The ‘Agriculture of the Middle’ (AotM development paradigm emphasises that in order to survive, family farms must transition from a supply chain approach to a values-based supply chain (VBSC approach, involving amendments to both product type and actor dynamics within the chain. This paper presents a qualitative case study of a beef co-operative integrated to a VBSC. We use an analytical framework of viability, sustainability and resilience to analyse impacts at farm-level. Our analysis highlights a number of positive effects on farm-level viability, sustainability and resilience. These benefits stemmed largely from improvements to market orientation, price stability, and members’ capacities in responding to problems. However, the autonomy of the co-operative was challenged by VBSC chain members, which impacted negatively on the stability of the co-operative.
Vanounou, Tsafrir; Garfinkle, Richard
Peritoneal spread from colorectal cancer is second only to the liver as a site for metastasis. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a well-established treatment option for patients with peritoneal carcinomatosis (PC) of colorectal origin. However, due to concerns regarding both its clinical benefit and high cost, its universal adoption as the standard of care for patients with limited peritoneal dissemination has been slow. The purpose of this review was to clarify the clinical utility and cost effectiveness of CRS-HIPEC in the treatment of colorectal PC using the framework of value-based medicine, which attempts to combine both benefit and cost into a single quantifiable metric. Our comprehensive review of the clinical outcomes and cost effectiveness of CRS-HIPEC demonstrate that it is a highly valuable oncologic therapy and a good use of healthcare resources.
Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey
Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach's alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that
Andersen, Tonny Elmose; Ravn, Sophie Lykkegaard; Roessler, Kirsten Kaya
Whiplash injury is the most common traffic-related injury affecting thousands of people every year. Conservative treatments have not proven effective in preventing persistent symptoms and disability after whiplash injury. Early established maladaptive pain behaviours within the first weeks after the injury may explain part of the transition from acute to chronic whiplash associated disorder (WAD). Hence, early targeting of psychological risk factors such as pain catastrophizing, fear-avoidance-beliefs, depression, and symptoms of posttraumatic stress disorder (PTSD) may be important in preventing the development of chronic WAD. Some evidence exists that targeting fear-avoidance beliefs and PTSD with exposure strategies and value-based actions may prevent development of persistent disability after whiplash injury. Yet, the results have to be tested in a randomized controlled trial (RCT). The primary objective of the present study is to test whether a specifically tailored value-based cognitive-behavioural therapy program (V-CBT) is able to prevent the development of persistent disability, pain, and psychological distress if delivered within the first three months after a whiplash injury. The current study is a two-armed randomized controlled study with a crossover design. Group A is scheduled for V-CBT within one week of randomization and group B with a delayed onset 3 months after randomization. If the study detects significant effects of V-CBT as a preventive intervention, the study will provide new insights of preventive treatment for patients with WAD and thereby serve as an important step towards preventing the chronic condition. Current Controlled Trials Registration September 19, 2014: NCT02251028.
Kyu Sik Jung
Full Text Available Preoperative liver stiffness (LS measurement using transient elastography (TE is useful for predicting late recurrence after curative resection of hepatocellular carcinoma (HCC. We developed and validated a novel LS value-based predictive model for late recurrence of HCC.Patients who were due to undergo curative resection of HCC between August 2006 and January 2010 were prospectively enrolled and TE was performed prior to operations by study protocol. The predictive model of late recurrence was constructed based on a multiple logistic regression model. Discrimination and calibration were used to validate the model.Among a total of 139 patients who were finally analyzed, late recurrence occurred in 44 patients, with a median follow-up of 24.5 months (range, 12.4-68.1. We developed a predictive model for late recurrence of HCC using LS value, activity grade II-III, presence of multiple tumors, and indocyanine green retention rate at 15 min (ICG R15, which showed fairly good discrimination capability with an area under the receiver operating characteristic curve (AUROC of 0.724 (95% confidence intervals [CIs], 0.632-0.816. In the validation, using a bootstrap method to assess discrimination, the AUROC remained largely unchanged between iterations, with an average AUROC of 0.722 (95% CIs, 0.718-0.724. When we plotted a calibration chart for predicted and observed risk of late recurrence, the predicted risk of late recurrence correlated well with observed risk, with a correlation coefficient of 0.873 (P<0.001.A simple LS value-based predictive model could estimate the risk of late recurrence in patients who underwent curative resection of HCC.
Squitieri, Lee; Chung, Kevin C
In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.
Several cases of expensive drugs designed for large patient populations (e.g. sofosbuvir) have raised a complex question in terms of drug pricing. Even assuming value-based pricing, the treatment with these drugs of all eligible patients would have an immense budgetary impact, which is unsustainable also for the richest countries. This raises the need to reduce the prices of these agents in comparison with those suggested by the value-based approach and to devise new pricing methods that can achieve this goal. The present study discusses in detail the following two methods: (i) The approach based on setting nation-wide budget thresholds for individual innovative agents in which a fixed proportion of the historical pharmaceutical expenditure represents the maximum budget attributable to an innovative treatment; (ii) The approach based on nation-wide price-volume agreements in which drug prices are progressively reduced as more patients receive the treatment. The first approach has been developed in the USA by the Institute for Clinical and Economic Review and has been applied to PCSK9 inhibitors (alirocumab and evolocumab). The second approach has been designed for the Italian market and has found a systematic application to manage the price of ranibizumab, sofosbuvir, and PCSK9 inhibitors. While, in the past, price-volume agreements have been applied only on an empirical basis (i.e. in the absence of any quantitative theoretical rule), more recently some explicit mathematical models have been described. The performance of these models is now being evaluated on the basis of the real-world experiences conducted in some European countries, especially Italy.
Brown, Melissa M; Brown, Gary C; Brown, Heidi C; Peet, Jonathan; Roth, Zachary
To assess the comparative effectiveness and cost-effectiveness (cost-utility) of a 0.05% emulsion of topical cyclosporine (Restasis; Allergan Inc, Irvine, California) for the treatment of moderate to severe dry eye syndrome that is unresponsive to conventional therapy. Data from 2 multicenter, randomized, clinical trials and Food and Drug Administration files for topical cyclosporine, 0.05%, emulsion were used in Center for Value-Based Medicine analyses. Analyses included value-based medicine as a comparative effectiveness analysis and average cost-utility analysis using societal and third-party insurer cost perspectives. Outcome measures of comparative effectiveness were quality-adjusted life-year (QALY) gain and percentage of improvement in quality of life, and for cost-effectiveness were cost-utility ratio (CUR) using dollars per QALY. Topical cyclosporine, 0.05%, confers a value gain (comparative effectiveness) of 0.0319 QALY per year compared with topical lubricant therapy, a 4.3% improvement in quality of life for the average patient with moderate to severe dry eye syndrome that is unresponsive to conventional lubricant therapy. The societal perspective incremental CUR for cyclosporine over vehicle therapy is $34,953 per QALY and the societal perspective average CUR is $11,199 per QALY. The third-party-insurer incremental CUR is $37,179 per QALY, while the third-party-insurer perspective average CUR is $34,343 per QALY. Topical cyclosporine emulsion, 0.05%, confers considerable patient value and is a cost-effective therapy for moderate to severe dry eye syndrome that is unresponsive to conventional therapy.
Schaffer, Dannah Lynn
The main goal of this research study was to develop and validate a three-tier diagnostic test to determine pre-service teachers' (PSTs) conceptual knowledge of the water cycle. For a three-tier diagnostic test, the first tier assesses content knowledge; in the second tier, a reason is selected for the content answer; and the third tier allows test-takers to select how confident they are in their answers for the first two tiers. The second goal of this study was to diagnose any alternative conceptions PSTs might have about the water cycle. The Water Cycle Diagnostic Test (WCDT) was developed using the theoretical framework by Treagust (1986, 1988, and 1995), and in similar studies that developed diagnostic tests (e.g., Calean & Subramaniam, 2010a; Odom & Barrow, 2007; Pesman & Eryilmaz, 2010). The final instrument consisted of 15 items along with a demographic survey that examined PSTs' weather-related experiences that may or may not have affected the PSTs' understanding of the water cycle. The WCDT was administered to 77 PSTs enrolled in science methods courses during the fall of 2012. Among the 77 participants, 37 of the PSTs were enrolled in elementary education (EPST) and 40 in secondary science (SPST). Using exploratory factor analysis, five categories were factored out for the WCDT: Phase Change of Water; Condensation and Storage; Clouds; Global Climate Change; and Movement through the Water Cycle. Analysis of the PSTs' responses demonstrated acceptable reliability (alpha = 0.62) for the instrument, and acceptable difficulty indices and discrimination indices for 12 of the items. Analysis indicated that the majority of the PSTs had a limited understanding of the water cycle. Of the PSTs sampled, SPSTs were significantly more confident in their answers' on the WCDT than the EPSTs. Completion of an undergraduate atmospheric science and/or meteorology course, as well as a higher interest in listening and/or viewing weather-related programs, resulted in PSTs
NSGIC Education | GIS Inventory — A Water Pollution Control Facility is a DEP primary facility type related to the Water Pollution Control Program. The sub-facility types related to Water Pollution...
Barrett, Angeline M.
A good quality education is inclusive, relevant and democratic. Of these three characteristics, the author contends that democratic is the most fundamental and underpins the other two. Education can only truly be inclusive and relevant if its goals are continuously the subject of open democratic debate, since education is a value-based,…
Cline, Jane E.; Smith, Brandy A.
The inclusion of activities to develop sensory awareness, spatial thinking, and physical dexterity, operationalized through hands-on science lessons such as water play, have long been part of early childhood education. This practical article addresses Next Generation Science Standards K-2 ETS1-3 and K-2 ETS1-2 by having four-year-old…
Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey
Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach’s alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that
Andreza Fortini da Silva
Full Text Available This article examines how a primary teacher establishes links between students' initial contributions on the theme ‘water’ and the elements that will make up the teaching approach of this subject in the science classroom. For this purpose, we examine discursive interactions in the first lessons of a teaching sequence, looking for links between events that are being elicited and developed by the teacher with intense participation of the students. We shall also examine the teaching strategies conducted by the teacher, emphasizing the presence of visual resources in text production activities, understanding them as literacy practices in the context of science lessons. To examine the effectiveness of these strategies and mediational resources, we shall analyze some exemplars of the students' productions (texts and drawings. We will use as criteria of analysis: speech marks of the opening activity and of the preliminary discussions in the texts produced by the pupils; evidence of changes in the pupils’ initial repertoires about the theme; evidence of connections between the “water in our lives” and “water as a science subject”. The context of the research is a third year grade classroom in a public elementary school in Contagem / MG - Brazil.
Mason, Fred J.; Houdart, Joseph F.
This manual is designed for students involved in environmental education programs dealing with water pollution problems. By establishing a network of Environmental Monitoring Stations within the educational system, four steps toward the prevention, control, and abatement of water pollution are proposed. (1) Train students to recognize, monitor,…
This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.
This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).
Linley, Warren G; Hughes, Dyfrig A
The criteria used by the National Institute for Health and Clinical Excellence (NICE) for accepting higher incremental cost-effectiveness ratios for some medicines over others, and the recent introduction of the Cancer Drugs Fund (CDF) in England, are assumed to reflect societal preferences for National Health Service resource allocation. Robust empirical evidence to this effect is lacking. To explore societal preferences for these and other criteria, including those proposed for rewarding new medicines under the future value-based pricing (VBP) system, we conducted a choice-based experiment in 4118 UK adults via web-based surveys. Preferences were determined by asking respondents to allocate fixed funds between different patient and disease types reflecting nine specific prioritisation criteria. Respondents supported the criteria proposed under the VBP system (for severe diseases, address unmet needs, are innovative--provided they offered substantial health benefits, and have wider societal benefits) but did not support the end-of-life premium or the prioritisation of children or disadvantaged populations as specified by NICE, nor the special funding status for treatments of rare diseases, nor the CDF. Policies introduced on the basis of perceived--and not actual--societal values may lead to inappropriate resource allocation decisions with the potential for significant population health and economic consequences. Copyright © 2012 John Wiley & Sons, Ltd.
Full Text Available The research aims to determine how the social design of policy formulation in recovery after disasters and social conflicts. The method used in the study is a qualitative research design, data collection techniques through documentation and interviews with key informants. The recovery of the public life after reconstruction due to natural disasters and social conflicts demanding greater government attention to solve bersoalan arising through the formulation of programs oriented to local values. The importance of such a policy given that the public is the target to be met interests, and basically in their social life with values that serve as a guide in achieving a common goal. The Formulations recovery program based value is essentially a process of public policy formulation design also is social design process that relies on the dimension; (1 a value appreciation of relevant actors; (2 an orientation toward conflict resolution, problem solving, and change. The first dimension concerns an administrator's to listen to other voices, share in others experiences, and gain new knowledge. The second describes the administrator's orientation toward conflict resolution, problem solving, and change; the administrator's actions can range from proactive to reactive. Research indicates that, the experience of local government in the province of East Nusa Tenggara post-disaster and conflict should be a lesson for having successfully implemented local values-based formulation design in formulating regional development programs.
Wesson, Donald E; Kitzman, Heather E
Improving population health may require health systems to proactively engage patient populations as partners in the implementation of healthy behaviors as a shared value using strategies that incentivize healthy outcomes for the population as a whole. The current reactive health care model, which focuses on restoring the health of individuals after it has been lost, will not achieve the goal of improved population health. To achieve this goal, health systems must proactively engage in partnerships with the populations they serve. Health systems will need the help of community entities and individuals who have the trust of the population being served to act on behalf of the health system if they are to achieve this effective working partnership. The need for these trusted agents is particularly pertinent for vulnerable and historically underserved segments of the population. In this Invited Commentary, the authors discuss ways by which health systems might identify, engage, and leverage trusted agents to improve the health of the population through value-based care.
Thakar, Sumit; Dadlani, Ravi; Sivaraju, Laxminadh; Aryan, Saritha; Mohan, Dilip; Sai Kiran, Narayanam Anantha; Rajarathnam, Ravikiran; Shyam, Maya; Sadanand, Venkatraman; Hegde, Alangar S
It is well-accepted that the current healthcare scenario worldwide is due for a radical change, given that it is fraught with mounting costs and varying quality. Various modifications in health policies have been instituted toward this end. An alternative model, the low-cost, value-based health model, focuses on maximizing value for patients by moving away from a physician-centered, supply-driven system to a patient-centered system. The authors discuss the successful inception, functioning, sustainability, and replicability of a novel health model in neurosurgery built and sustained by inspired humanitarianism and that provides all treatment at no cost to the patients irrespective of their socioeconomic strata, color or creed. The Sri Sathya Sai Institute of Higher Medical Sciences (SSSIHMS) at Whitefield, Bengaluru, India, a private charitable hospital established in 2001, functions on the ideals of providing free state-of-the-art healthcare to all in a compassionate and holistic manner. With modern equipment and respectable outcome benchmarks, its neurosurgery unit has operated on around 18,000 patients since its inception, and as such, has contributed INR 5310 million (USD 88.5 million) to society from an economic standpoint. The inception and sustainability of the SSSIHMS model are based on self-perpetuating philanthropy, a cost-conscious culture and the dissemination of human values. Replicated worldwide, at least in the developing nations, this unique healthcare model may well change the face of healthcare economics.
Evidence-Based Medicine (EBM), Values-Based Practice (VBP) and Person-Centered Healthcare (PCH) are all concerned with the values in play in the clinical encounter. However, these recent movements are not in agreement about how to discover these relevant values. In some parts of EBM textbooks, the prescribed method for discovering values is through social science research on the average values in a particular population. VBP by contrast always investigates the individually held values of the different stakeholders in the particular clinical encounter, although the account has some other difficulties. I argue that although average values for populations might be very useful in informing questions of resource distribution and policy making, their use cannot replace the individual solicitation of patient (and other stakeholder) values in the clinical encounter. Because of the inconsistency of the EBM stance on values, the incompatibility of some versions of the EBM treatment of values with PCH, and EBM's attempt to transplant research methods from science into the realm of values, I must recommend the use of the VBP account of values discovery. © 2015 John Wiley & Sons, Ltd.
Palazzo, Salvatore; Filice, Aldo; Mastroianni, Candida; Biamonte, Rosalbino; Conforti, Serafino; Liguori, Virginia; Turano, Salvatore; De Simone, Rosanna; Rovito, Antonio; Manfredi, Caterina; Minardi, Stefano; Vilardo, Emmanuelle; Loizzo, Monica; Oriolo, Carmela
Clinical decision making in oncology is based so far on the evidence of efficacy from high-quality clinical research. Data collection and analysis from experimental studies provide valuable insight into response rates and progression-free or overall survival. Data processing generates valuable information for medical professionals involved in cancer patient care, enabling them to make objective and unbiased choices. The increased attention of many scientific associations toward a more rational resource consumption in clinical decision making is mirrored in the Choosing Wisely campaign against the overuse or misuse of exams and procedures of little or no benefit for the patient. This cultural movement has been actively promoting care solutions based on the concept of "value". As a result, the value-based decision-making process for cancer care should not be dissociated from economic sustainability and from ethics of the affordability, also given the growing average cost of the most recent cancer drugs. In support of this orientation, the National Comprehensive Cancer Network (NCCN) has developed innovative and "complex" guidelines based on values, defined as "evidence blocks", with the aim of assisting the medical community in making overall sustainable choices.
Value-Based Assessment of New Medical Technologies: Towards a Robust Methodological Framework for the Application of Multiple Criteria Decision Analysis in the Context of Health Technology Assessment.
Angelis, Aris; Kanavos, Panos
In recent years, multiple criteria decision analysis (MCDA) has emerged as a likely alternative to address shortcomings in health technology assessment (HTA) by offering a more holistic perspective to value assessment and acting as an alternative priority setting tool. In this paper, we argue that MCDA needs to subscribe to robust methodological processes related to the selection of objectives, criteria and attributes in order to be meaningful in the context of healthcare decision making and fulfil its role in value-based assessment (VBA). We propose a methodological process, based on multi-attribute value theory (MAVT) methods comprising five distinct phases, outline the stages involved in each phase and discuss their relevance in the HTA process. Importantly, criteria and attributes need to satisfy a set of desired properties, otherwise the outcome of the analysis can produce spurious results and misleading recommendations. Assuming the methodological process we propose is adhered to, the application of MCDA presents three very distinct advantages to decision makers in the context of HTA and VBA: first, it acts as an instrument for eliciting preferences on the performance of alternative options across a wider set of explicit criteria, leading to a more complete assessment of value; second, it allows the elicitation of preferences across the criteria themselves to reflect differences in their relative importance; and, third, the entire process of preference elicitation can be informed by direct stakeholder engagement, and can therefore reflect their own preferences. All features are fully transparent and facilitate decision making.
Naessens, James M; Van Such, Monica B; Nesse, Robert E; Dilling, James A; Swensen, Stephen J; Thompson, Kristine M; Orlowski, Janis M; Santrach, Paula J
The majority of quality measures used to assess providers and hospitals are based on easily obtained data, focused on a few dimensions of quality, and developed mainly for primary/community care and population health. While this approach supports efforts focused on addressing the triple aim of health care, many current quality report cards and assessments do not reflect the breadth or complexity of many referral center practices.In this article, the authors highlight the differences between population health efforts and referral care and address issues related to value measurement and performance assessment. They discuss why measures may need to differ across the three levels of care (primary/community care, secondary care, complex care) and illustrate the need for further risk adjustment to eliminate referral bias.With continued movement toward value-based purchasing, performance measures and reimbursement schemes need to reflect the increased level of intensity required to provide complex care. The authors propose a framework to operationalize value measurement and payment for specialty care, and they make specific recommendations to improve performance measurement for complex patients. Implementing such a framework to differentiate performance measures by level of care involves coordinated efforts to change both policy and operational platforms. An essential component of this framework is a new model that defines the characteristics of patients who require complex care and standardizes metrics that incorporate those definitions.
Nash, David B.; Harris, Dennis
Abstract Chronic instability in the health care environment has raised concerns among providers and patients, especially those who treat and cope with chronic conditions. Changes to existing health care laws are unlikely to alter what have become the primary goals of the US health care system: cost-effectiveness and patient-centricity. To that end, it is vital that patient and physician voices be incorporated in policy decisions and, importantly, that access to care and patient-reported outcomes are considered when calculating “value.” Following a discussion of perceived pressures on patient access to information and appropriate treatment for diabetes, a panel of engaged stakeholders in the diabetes community outlined and committed to a collaborative effort aimed at effecting necessary policy changes and ensuring that a patient-centered, value-based system of diabetes care is achieved. The overarching themes that emerged included: (1) patients and physicians must have a stronger voice and a place at the table; (2) a collaborative of multiple organizations is necessary to seize improvement opportunities; and (3) the diabetes community must advocate for population health initiatives around diabetes. PMID:28795910
Nash, David B; Skoufalos, Alexis; Harris, Dennis
Chronic instability in the health care environment has raised concerns among providers and patients, especially those who treat and cope with chronic conditions. Changes to existing health care laws are unlikely to alter what have become the primary goals of the US health care system: cost-effectiveness and patient-centricity. To that end, it is vital that patient and physician voices be incorporated in policy decisions and, importantly, that access to care and patient-reported outcomes are considered when calculating "value." Following a discussion of perceived pressures on patient access to information and appropriate treatment for diabetes, a panel of engaged stakeholders in the diabetes community outlined and committed to a collaborative effort aimed at effecting necessary policy changes and ensuring that a patient-centered, value-based system of diabetes care is achieved. The overarching themes that emerged included: (1) patients and physicians must have a stronger voice and a place at the table; (2) a collaborative of multiple organizations is necessary to seize improvement opportunities; and (3) the diabetes community must advocate for population health initiatives around diabetes.
Shaikh, Faiq; Hendrata, Kenneth; Kolowitz, Brian; Awan, Omer; Shrestha, Rasu; Deible, Christopher
In the era of value-based healthcare, many aspects of medical care are being measured and assessed to improve quality and reduce costs. Radiology adds enormously to health care costs and is under pressure to adopt a more efficient system that incorporates essential metrics to assess its value and impact on outcomes. Most current systems tie radiologists' incentives and evaluations to RVU-based productivity metrics and peer-review-based quality metrics. In a new potential model, a radiologist's performance will have to increasingly depend on a number of parameters that define "value," beginning with peer review metrics that include referrer satisfaction and feedback from radiologists to the referring physician that evaluates the potency and validity of clinical information provided for a given study. These new dimensions of value measurement will directly impact the cascade of further medical management. We share our continued experience with this project that had two components: RESP (Referrer Evaluation System Pilot) and FRACI (Feedback from Radiologist Addressing Confounding Issues), which were introduced to the clinical radiology workflow in order to capture referrer-based and radiologist-based feedback on radiology reporting. We also share our insight into the principles of design thinking as applied in its planning and execution.
Chen, Lena M; Epstein, Arnold M; Orav, E John; Filice, Clara E; Samson, Lok Wong; Joynt Maddox, Karen E
Medicare recently launched the Physician Value-Based Payment Modifier (PVBM) Program, a mandatory pay-for-performance program for physician practices. Little is known about performance by practices that serve socially or medically high-risk patients. To compare performance in the PVBM Program by practice characteristics. Cross-sectional observational study using PVBM Program data for payments made in 2015 based on performance of large US physician practices caring for fee-for-service Medicare beneficiaries in 2013. High social risk (defined as practices in the top quartile of proportion of patients dually eligible for Medicare and Medicaid) and high medical risk (defined as practices in the top quartile of mean Hierarchical Condition Category risk score among fee-for-service beneficiaries). Quality and cost z scores based on a composite of individual measures. Higher z scores reflect better performance on quality; lower scores, better performance on costs. Among 899 physician practices with 5 189 880 beneficiaries, 547 practices were categorized as low risk (neither high social nor high medical risk) (mean, 7909 beneficiaries; mean, 320 clinicians), 128 were high medical risk only (mean, 3675 beneficiaries; mean, 370 clinicians), 102 were high social risk only (mean, 1635 beneficiaries; mean, 284 clinicians), and 122 were high medical and social risk (mean, 1858 beneficiaries; mean, 269 clinicians). Practices categorized as low risk performed the best on the composite quality score (z score, 0.18 [95% CI, 0.09 to 0.28]) compared with each of the practices categorized as high risk (high medical risk only: z score, -0.55 [95% CI, -0.77 to -0.32]; high social risk only: z score, -0.86 [95% CI, -1.17 to -0.54]; and high medical and social risk: -0.78 [95% CI, -1.04 to -0.51]) (P risk only performed the best on the composite cost score (z score, -0.52 [95% CI, -0.71 to -0.33]), low risk had the next best cost score (z score, -0.18 [95% CI, -0.25 to -0.10]), then
scientific background that the human recovery process for those suffering from mental disease involves the combined support of work, school, marriage, and childrearing stems from this fact. Humans develop their own mental capital over their life-courses and utilize it in an effort to realize their well-beings. Humans utilize mental function self-regulation based on the emotional and interpersonal functions developed during childhood in order to formulate an image of themselves (the ego) as well as the type of person they want to become (values/needs). This is indeed the true essence of adolescence. The values that drive an individual's behavior by their very nature exist in the outside world and are shared by others as well as society. These are internalized as individual characteristics through the self-regulation process of adolescence. Regardless of life stage or type of mental illness, individual reflection, verbalization, and reorganization of adolescent ego and values formation are essential to the recovery process. Humans are born with both bodies and brains, and throughout the courses of their lives, they formulate and develop values. Based on an understanding of the tripartite relationship between the brain, real-world, and life courses, it can be argued that the supporting of individual values is the scientific basis for the so-called "patient-centered care" and "needs-based support" that serve as a psychiatrist's essential capabilities. Along with the patient's recovery, which is based on this values-based psychiatry, professional growth is the privilege enjoyed by those in the psychiatric field. Beginning with a foundation based on assisted recovery at the individual level, the psychiatrist can produce mental health changes at the regional level. The psychiatrist consequently possesses the national-level vision necessary to implement a community design model that combines mental health and preventive medicine.
Dunbar-Rees, Rupert; Panch, Trishan; Dancy, Mark
The last year has seen the publication of two papers which will radically shape the future organisation of healthcare in general, and cardiovascular disease in particular: Cardiovascular Outcomes Strategy (Department of Health) and The Strategy That Will Fix Healthcare (Harvard Business Review). Both publications set out a health delivery mechanism based around improvement of outcomes for groups of patients with similar needs. Instead of organising care around disease categories, it is proposed that the cardiovascular diseases are treated as a single family of diseases. We are reaching the limits of what an activity-based system organised around existing provider structures can sustainably deliver. Unless we find delivery systems which reduce costs while at the same time improving outcomes that are meaningful to patients, then we will be faced with a future of healthcare rationing. The increasing burden of chronic disease and ongoing quality concerns in delivery systems has created a 'burning platform', which must be addressed if we are to maintain a system which offers high-quality care free at the point of delivery. This paper explores what an outcomes and value-based system could look like when applied to cardiovascular disease. It explores what it means for providers and patients if we start to think about outcomes by patients with similar needs, rather than by intervention, or by clinical specialty. As a specific example, the paper explores the features of an Integrated Circulation Service, what the challenges and implications might be, and whether there is any evidence that this would deliver improved outcomes, at a lower cost to the system.
Chen, Hsueh-Fen; Karim, Saleema; Wan, Fei; Nevola, Adrienne; Morris, Michael E; Bird, T Mac; Tilford, J Mick
Previous studies showed that the Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-based Purchasing Program (HVBP) disproportionately penalized hospitals caring for the poor. The Mississippi Delta Region (Delta Region) is among the most socioeconomically disadvantaged areas in the United States. The financial performance of hospitals in the Delta Region under both HRRP and HVBP remains unclear. To compare the differences in financial performance under both HRRP and HVBP between hospitals in the Delta Region (Delta hospitals) and others in the nation (non-Delta hospitals). We used a 7-year panel dataset and applied difference-in-difference models to examine operating and total margin between Delta and non-Delta hospitals in 3 time periods: preperiod (2008-2010); postperiod 1 (2011-2012); and postperiod 2 (2013-2014). The Delta hospitals had a 0.89% and 4.24% reduction in operating margin in postperiods 1 and 2, respectively, whereas the non-Delta hospitals had 1.13% and 1% increases in operating margin in postperiods 1 and 2, respectively. The disparity in total margins also widened as Delta hospitals had a 1.98% increase in postperiod 1, but a 0.30% reduction in postperiod 2, whereas non-Delta hospitals had 1.27% and 2.28% increases in postperiods 1 and 2, respectively. The gap in financial performance between Delta and non-Delta hospitals widened following the implementation of HRRP and HVBP. Policy makers should modify these 2 programs to ensure that resources are not moved from the communities that need them most.
Tan, Ryan Y C; Met-Domestici, Marie; Zhou, Ke; Guzman, Alexis B; Lim, Soon Thye; Soo, Khee Chee; Feeley, Thomas W; Ngeow, Joanne
To meet increasing demand for cancer genetic testing and improve value-based cancer care delivery, National Cancer Centre Singapore restructured the Cancer Genetics Service in 2014. Care delivery processes were redesigned. We sought to improve access by increasing the clinic capacity of the Cancer Genetics Service by 100% within 1 year without increasing direct personnel costs. Process mapping and plan-do-study-act (PDSA) cycles were used in a quality improvement project for the Cancer Genetics Service clinic. The impact of interventions was evaluated by tracking the weekly number of patient consultations and access times for appointments between April 2014 and May 2015. The cost impact of implemented process changes was calculated using the time-driven activity-based costing method. Our study completed two PDSA cycles. An important outcome was achieved after the first cycle: The inclusion of a genetic counselor increased clinic capacity by 350%. The number of patients seen per week increased from two in April 2014 (range, zero to four patients) to seven in November 2014 (range, four to 10 patients). Our second PDSA cycle showed that manual preappointment reminder calls reduced the variation in the nonattendance rate and contributed to a further increase in patients seen per week to 10 in May 2015 (range, seven to 13 patients). There was a concomitant decrease in costs of the patient care cycle by 18% after both PDSA cycles. This study shows how quality improvement methods can be combined with time-driven activity-based costing to increase value. In this paper, we demonstrate how we improved access while reducing costs of care delivery. Copyright © 2016 by American Society of Clinical Oncology.
Brown, Melissa M; Brown, Gary C; Lieske, Heidi B; Lieske, P Alexander
This analysis discusses the comparative effectiveness and cost-effectiveness of vitreoretinal interventions, measured in quality-adjusted life years (QALYs) and percentage patient value (PPV gain, or improvement in quality of life and/or length of life). The material is relevant since the Patient Protection and Affordable Care Act enacted by Congress with the support of the President has emphasized the critical importance of patient-based preferences. The majority of preference-based, comparative effectiveness and cost-effectiveness vitreoretinal interventions assessed in the US healthcare literature are Value-Based Medicine analyses, thus comparable. These interventions confer a mean patient (human) value gain (improvement in quality of life) of 8.3% [SD 6.3%, 95% confidence interval (CI) + 2.6%]. The average cost-utility of these vitreoretinal interventions is US$23 026/QALY (SD US$24 508, 95% CI + US$8770). Most vitreoretinal interventions are very cost effective using a conventional US standard of US$50 000/QALY as the upper anchor for a very cost-effective intervention, and the World Health Organization of approximately US$142 200/QALY as the upper anchor for a cost-effective intervention. Most vitreoretinal interventions confer considerable patient value and are very cost effective. Further standardization across healthcare is needed in the preference-based, comparative and cost-utility (cost-effectiveness) arena. The metrics of PPV (percentage patient value) gain and US$/PPV (dollars expended per percentage patient value gain) or financial value gain may be more user-friendly than the QALY.
Introduces networking projects for studying rivers and water quality. Describes two projects in South Africa (Project W.A.T.E.R and SWAP) associated with the international network, Global Rivers Environmental Education Network. Discusses water test kits and educational material developed through Project W.A.T.E.R. (Water Awareness through…
Callwood, Alison; Cooke, Debbie; Bolger, Sarah; Lemanska, Agnieszka; Allan, Helen
Universities in the United Kingdom (UK) are required to incorporate values based recruitment (VBR) into their healthcare student selection processes. This reflects an international drive to strengthen the quality of healthcare service provision. This paper presents novel findings in relation to the reliability and predictive validity of multiple mini interviews (MMIs); one approach to VBR widely being employed by universities. To examine the reliability (internal consistency) and predictive validity of MMIs using end of Year One practice outcomes of under-graduate pre-registration adult, child, mental health nursing, midwifery and paramedic practice students. Cross-discipline evaluation study. One university in the United Kingdom. Data were collected in two streams: applicants to A) The September 2014 and 2015 Midwifery Studies programmes; B) September 2015 adult; Child and Mental Health Nursing and Paramedic Practice programmes. Fifty-seven midwifery students commenced their programme in 2014 and 69 in 2015; 47 and 54 agreed to participate and completed Year One respectively. 333 healthcare students commenced their programmes in September 2015. Of these, 281 agreed to participate and completed their first year (180 adult, 33 child and 34 mental health nursing and 34 paramedic practice students). Stream A featured a seven station four-minute model with one interviewer at each station and in Stream B a six station model was employed. Cronbach's alpha was used to assess MMI station internal consistency and Pearson's moment correlation co-efficient to explore associations between participants' admission MMI score and end of Year one clinical practice outcomes (OSCE and mentor grading). Stream A: Significant correlations are reported between midwifery applicant's MMI scores and end of Year One practice outcomes. A multivariate linear regression model demonstrated that MMI score significantly predicted end of Year One practice outcomes controlling for age and academic
Ansmann, Lena; Hillen, Hendrik Ansgar; Kuntz, Ludwig; Stock, Stephanie; Vennedey, Vera; Hower, Kira Isabelle
Health and social care systems are under pressure to organise care around patients' needs with constrained resources. Several studies reveal that care is constantly challenged by balancing economic requirements against individual patients' preferences and needs. Therefore, value-based health and social care aims to facilitate patient-centredness while taking the resources spent into consideration. The OrgValue project examines the implementation of patient-centredness while considering the health and social care organisations' resource orientation in the model region of the city of Cologne, Germany. First, the implementation status of patient-centredness as well as its facilitators and barriers-also in terms of resource orientation-will be assessed through face-to-face interviews with decision-makers (at least n=18) from health and social care organisations (HSCOs) in Cologne. Second, patients' understanding of patient-centredness and their preferences and needs will be revealed by conducting face-to-face interviews (at least n=15). Third, the qualitative results will provide the basis for a quantitative survey of decision-makers from all HSCOs in Cologne, which will include questions on patient-centredness, resource orientation and determinants of implementation. Fourth, qualitative interviews with decision-makers from different types of HSCOs will be conducted to develop a uniform measurement instrument on the cost and service structure of HSCOs. For all collected data, the relevant data protection regulations will be adhered to. Consultation and a positive vote from the ethics committee of the Medical Faculty of the University of Cologne have been obtained. All personal identifiers (eg, name, date of birth) will be pseudonymised. Dissemination strategies include a feedback report as well as research and development workshops for the organisations with the aim of initiating organisational learning and organisational development, presenting results in publications
R Scott Braithwaite
Full Text Available BACKGROUND: Evidence suggests that cost sharing (i.e.,copayments and deductibles decreases health expenditures but also reduces essential care. Value-based insurance design (VBID has been proposed to encourage essential care while controlling health expenditures. Our objective was to estimate the impact of broader diffusion of VBID on US health care benefits and costs. METHODS AND FINDINGS: We used a published computer simulation of costs and life expectancy gains from US health care to estimate the impact of broader diffusion of VBID. Two scenarios were analyzed: (1 applying VBID solely to pharmacy benefits and (2 applying VBID to both pharmacy benefits and other health care services (e.g., devices. We assumed that cost sharing would be eliminated for high-value services ($300,000 per life-year. All costs are provided in 2003 US dollars. Our simulation estimated that approximately 60% of health expenditures in the US are spent on low-value services, 20% are spent on intermediate-value services, and 20% are spent on high-value services. Correspondingly, the vast majority (80% of health expenditures would have cost sharing that is impacted by VBID. With prevailing patterns of cost sharing, health care conferred 4.70 life-years at a per-capita annual expenditure of US$5,688. Broader diffusion of VBID to pharmaceuticals increased the benefit conferred by health care by 0.03 to 0.05 additional life-years, without increasing costs and without increasing out-of-pocket payments. Broader diffusion of VBID to other health care services could increase the benefit conferred by health care by 0.24 to 0.44 additional life-years, also without increasing costs and without increasing overall out-of-pocket payments. Among those without health insurance, using cost saving from VBID to subsidize insurance coverage would increase the benefit conferred by health care by 1.21 life-years, a 31% increase. CONCLUSION: Broader diffusion of VBID may amplify benefits from
Braithwaite, R Scott; Omokaro, Cynthia; Justice, Amy C; Nucifora, Kimberly; Roberts, Mark S
Evidence suggests that cost sharing (i.e.,copayments and deductibles) decreases health expenditures but also reduces essential care. Value-based insurance design (VBID) has been proposed to encourage essential care while controlling health expenditures. Our objective was to estimate the impact of broader diffusion of VBID on US health care benefits and costs. We used a published computer simulation of costs and life expectancy gains from US health care to estimate the impact of broader diffusion of VBID. Two scenarios were analyzed: (1) applying VBID solely to pharmacy benefits and (2) applying VBID to both pharmacy benefits and other health care services (e.g., devices). We assumed that cost sharing would be eliminated for high-value services (value services ($100,000-$300,000 per life-year or unknown), and would be increased for low-value services (>$300,000 per life-year). All costs are provided in 2003 US dollars. Our simulation estimated that approximately 60% of health expenditures in the US are spent on low-value services, 20% are spent on intermediate-value services, and 20% are spent on high-value services. Correspondingly, the vast majority (80%) of health expenditures would have cost sharing that is impacted by VBID. With prevailing patterns of cost sharing, health care conferred 4.70 life-years at a per-capita annual expenditure of US$5,688. Broader diffusion of VBID to pharmaceuticals increased the benefit conferred by health care by 0.03 to 0.05 additional life-years, without increasing costs and without increasing out-of-pocket payments. Broader diffusion of VBID to other health care services could increase the benefit conferred by health care by 0.24 to 0.44 additional life-years, also without increasing costs and without increasing overall out-of-pocket payments. Among those without health insurance, using cost saving from VBID to subsidize insurance coverage would increase the benefit conferred by health care by 1.21 life-years, a 31% increase
Everybody knows that children love water and how great water play is for children. The author discusses ways to add water to one's playscape that fully comply with health and safety regulations and are still fun for children. He stresses the importance of creating water play that provides children with the opportunity to interact with water.
Willis, Michael; Persson, Ulf; Zoellner, York; Gradl, Birgit
Value-based pricing (VBP), whereby prices are set according to the perceived benefits offered to the consumer at a time when costs and benefits are characterized by considerable uncertainty and are then reviewed ex post, is a much discussed topic in pharmaceutical reimbursement. It is usually combined with coverage with evidence development (CED), a tool in which manufacturers are granted temporary reimbursement but are required to collect and submit additional health economic data at review. Many countries, including the UK, are signalling shifts in this direction. Several countries, including Sweden, have already adopted this approach and offer good insight into the benefits and pitfalls in actual practice. To describe VBP reimbursement decision making using CED in actual practice in Sweden. Decision making by The Dental and Pharmaceutical Benefits Agency (TLV) in Sweden was reviewed using a case study of continuous intraduodenal infusion of levodopa/carbidopa (Duodopa®) in the treatment of advanced Parkinson's disease (PD) with severe motor fluctuations. The manufacturer of Duodopa® applied for reimbursement in late 2003. While the proper economic data were not included in the submission, TLV granted reimbursement until early 2005 to provide time for the manufacturer to submit a formal economic evaluation. The re-submission with economic data was considered inadequate to judge cost effectiveness, so TLV granted an additional extension of reimbursement until August 2007, at which time conclusive data were expected. The manufacturer initiated a 3-year, prospective health economic study and a formal economic model. Data from a pre-planned interim analysis of the data were loaded into the model and the cost-effectiveness ratio was the basis of the next re-submission. TLV concluded that the data were suitable for making a definite decision and that the drug was not cost effective, deciding to discontinue reimbursement for any new patients (current patients were
Clark, Bobby; DuChane, Janeen; Hou, John; Rubinstein, Elan; McMurray, Jennifer; Duncan, Ian
.001). Similar results were found among users of antihyperlipidemics. The mean adherence rate was sustained over time for participants (77.7% vs. 78.3%) but declined over time for nonparticipants (77.6% vs. 70.8%). The difference in mean change over time was statistically significant between participants and nonparticipants (0.6% vs. -6,8%, P less than 0.001). Average prescription costs PMPY increased for participants of the ZCP program during the post-implementation period; however, the increase was not larger than the cost increase among nonparticipants ($581 vs. $584, P = 0.95). Furthermore, among antihyperlipidemics the cost increase post-implementation was actually significantly less for participants than nonparticipants ($51 vs. $143, P less than 0.001). Plan sponsors are increasingly evaluating the use of value-based benefit design (VBBD) to change member behavior. This ZCP program used a reduction in cost sharing to incentivize members to use more generic drugs and to enroll in a care management coaching program. The study also demonstrated that a VBBD program can have a positive impact on adherence and cost outcomes among those who participate compared with nonparticipants.
NSGIC Education | GIS Inventory — Boundaries of current public water supplier's (PWS) service areas. This data set contains the present service area boundary of the water system and does not contain...
The Water Almanac 1992 - a yearbook for the entire water field - presents contributions on current topics in water engineering and in water law and environmental law and information on FRG public authorities or institutions responsible for water resources management or water research, as well as on educational facilities in this field in the FRG, Austria and Switzerland, including independent scientific institutions. The contribution on the consequences of the Chernobyl reactor accident for the environment in western Europe has been analysed as a separate document for retrieval from the database. (BBR) [de
Education is a recurring theme of our 60th anniversary year, as I was reminded last week when we had a visit from the winners of the Spanish schools competition launched with the Prince of Asturias Award prize money (see here). Young people are always remarkable in their curiosity and inventiveness, and this was very clear in all the submissions for the competition. I was most impressed with the six winners, but have to give a special mention to the youngest, Sofía Isabella Villamizar Villegas, who at just seven years of age made a lovely video explaining the Higgs mechanism by analogy to moving a balloon with and without static charge through a field of suspended strips of paper. It was not only charming, but also very effective as analogies go. The Spanish visit came in the middle of judging to find a winner of the Beamline for Schools competition, which closed at the end of March having received almost 300 proposals for experiments from schools all over the world. These vary ...
Ross-Harrington, Melinda; Kincaid, G. David
One of twelve water treatment technology units, this student manual on filtration provides instructional materials for six competencies. (The twelve units are designed for a continuing education training course for public water supply operators.) The competencies focus on the following areas: purposes of sedimentation basins and flocculation…
Ross-Harrington, Melinda; Kincaid, G. David
One of twelve water treatment technology units, this student manual on wells provides instructional materials for five competencies. (The twelve units are designed for a continuing education training course for public water supply operators.) The competencies focus on the following areas: dug, driven, and chilled wells, aquifer types, deep well…
Ross-Harrington, Melinda; Kincaid, G. David
One of twelve water treatment technology units, this student manual on hydraulics provides instructional materials for three competencies. (The twelve units are designed for a continuing education training course for public water supply operators.) The competencies focus on the following areas: head loss in pipes in series, function loss in…
Petróczi, Andrea; Norman, Paul; Brueckner, Sebastian
In sport, a wide array of substances with established or putative performance-enhancing properties is used. Most substances are fully acceptable, whilst a defined set, revised annually, is prohibited; thus, using any of these prohibited substances is declared as cheating. In the increasingly tolerant culture of pharmacological and technical human enhancements, the traditional normative approach to anti-doping, which involves telling athletes what they cannot do to improve their athletic ability and performance, diverges from the otherwise positive values attached to human improvement and enhancement in society. Today, doping is the epitome of conflicting normative expectations about the goal (performance enhancement) and the means by which the goal is achieved (use of drugs). Owing to this moral-functional duality, addressing motivations for doping avoidance at the community level is necessary, but not sufficient, for effective doping prevention. Relevant and meaningful anti-doping must also recognise and respect the values of those affected, and consolidate them with the values underpinning structural, community level anti-doping. Effective anti-doping efforts are pragmatic, positive, preventive, and proactive. They acknowledge the progressive nature of how a "performance mindset" forms in parallel with the career transition to elite level, encompasses all levels and abilities, and directly addresses the reasons behind doping use with tangible solutions. For genuine integration into sport and society, anti-doping should consistently engage athletes and other stakeholders in developing positive preventive strategies to ensure that anti-doping education not only focuses on the intrinsic values associated with the spirit of sport but also recognises the values attached to performance enhancement, addresses the pressures athletes are under, and meets their needs for practical solutions to avoid doping. Organisations involved in anti- doping should avoid the image of
The City of Cape Town's Water Demand Management (WDM) department has been involved in school projects for several years, although these have generally been restricted to educational activities during Water Week and school competitions, due mainly to limited resources. Cape Town is a water scarce area, and ...
The effectiveness of a value-based EMOtion-cognition-Focused educatIonal programme to reduce diabetes-related distress in Malay adults with Type 2 diabetes (VEMOFIT) : Study protocol for a cluster randomised controlled trial
Chew, BH; Vos, Rimke C.; Shariff Ghazali, Sazlina; Shamsuddin, Nurainul Hana; Fernandez, Aaron; Mukhtar, Firdaus; Ismail, Mastura; Mohd Ahad, Azainorsuzila; Sundram, Narayanan N.; Ali, Siti Zubaidah Mohd; Rutten, Guy E H M
Background: Type 2 diabetes mellitus (T2DM) patients experience many psychosocial problems related to their diabetes. These often lead to emotional disorders such as distress, stress, anxiety and depression, resulting in decreased self-care, quality of life and disease control. The purpose of the
Yang, Byeong Ju
This book shows US the distribution diagram of water and waste water processing with device of water processing, and device of waste water processing, property of water quality like measurement of pollution of waste water, theoretical Oxygen demand, and chemical Oxygen demand, processing speed like zero-order reactions and enzyme reactions, physical processing of water and waste water, chemical processing of water and waste water like neutralization and buffering effect, biological processing of waste water, ammonia removal, and sludges processing.
Theoretical predictions of the changes in the irradiance and color of light beams traveling in sugared water caused by optical rotation phenomena, and their possible applications for educational purposes
Tokumitsu, S.; Hasegawa, M.
The coloring phenomena caused by optical rotation of polarized light beams in sugared water can be an appropriate subject for use as an educational tool. In this paper, such coloring phenomena are studied in terms of theory, and the results are compared with experimental results. First, polarized laser beams in red, blue, or green were allowed to travel in sugared water of certain concentrations, and changes in the irradiance of the beams were measured while changing the distance between a pair of polarizing plates arranged in the sugared water. The angle of rotation was then determined for each color. An equation was established for predicting a theoretical value of the angle of rotation for laser beams of specific colors (wavelengths) traveling in sugared water of specific concentrations. The predicted results from the equation exhibited satisfactory agreement with the experimental values obtained from the measurements. In addition, changes in the irradiance of traveling laser beams, as well as the changes in colors observable for white light beams, were also predicted, resulting in good agreement with the observed results.
The project "Water Saving for Development (WaS4D)" is financed by European Territorial Cooperational Programme, Greece-Italy 2007-2013, and aims at developing issues on water saving related to improvement of individual behaviors and implementing innovative actions and facilities in order to harmonize policies and start concrete actions for a sustainable water management, making also people and stakeholders awake to water as a vital resource, strategic for quality of life and territory competitiveness. Drinkable water saving culture & behavior, limited water resources, water supply optimization, water resources and demand management, water e-service & educational e-tools are the key words of WaS4D. In this frame the project objectives are: • Definition of water need for domestic and other than domestic purposes: regional and territorial hydro-balance; • promotion of locally available resources not currently being used - water recycling or reuse and rainwater harvesting; • scientific data implementation into Informative Territorial System and publication of geo-referred maps into the institutional web sites, to share information for water protection; • participated review of the regulatory framework for the promotion of water-efficient devices and practices by means of the definition of Action Plans, with defined targets up to brief (2015) and medium (2020) term; • building up water e-services, front-office for all the water issues in building agricultural, industrial and touristic sectors, to share information, procedures and instruments for the water management; • creation and publication of a user friendly software, a game, to promote sustainability for houses also addressed to young people; • creation of water info point into physical spaces called "Water House" to promote education, training, events and new advisory services to assist professionals involved in water uses and consumers; • implementation of participatory approach & networking for a
Pedro Arrojo Agudo
Full Text Available The economic term of water is seen from the perspective of an ecological economy, an Aristotelian sense that integrates social values, environmental considerations and financial issues. Water should thus be conceptualized as an “ecosocial” good and not merely as a simple factor of production. Therefore, the focus of water management should not limit itself to managing a scarce resource. Rather the focus should be to articulate an institutional framework that would allow for the use of management tools based on the financial value of water (pricing policies, fiscal incentives, economic penalties for inefficiency... fixed to a somewhat interventionist market, or which answers to administration mechanisms, with constraints setting the conditions of sustainablity that the sound management of water requires in each territory. This approach brings to the table a profoundly territorial andcontextualized view of water management within the paradigm of Sustainable Development. Having said this does not imply disregarding the classical economic science tools of cost/benefit analysis, though. Quite the contrary: today, economic science can provide highly useful, multiple concepts and traditional techniques to the creation of a new model of the economic management of water. At bottom, the challenge is to take advantage of the previous conceptual and methodological body of work, refining the work in some cases,contextualizing it in others, and above all, complementing the previous work with other value-based perspectives to develop a multi-criteria decision-making model for the management and financial assessment of water policies.
Water is a major component in many consumer products. Azeotropic distillation of products such as detergents and foodstuffs to form a two-phase distillate is a simple experimental method to determine the percentage of water in the product. (Author/GA)
Although there is an abundance of water in Lesotho, it is argued that future development of the Lesotho Highlands water project is not yet required. Lesotho exports water to arid regions in South Africa. However, some South Africans believe that further development of the scheme is unnecessary and they argue that Gauteng Province has enough water for the immediate future provided the demand is managed effectively - this being the case, there would be no urgency for completing what is termed phase 1B. It is argued that if 1B is completed before the water is required, then costs to the consumer would increase. It was also argued that proceeding with 1B would give South Africa greater flexibility in augmenting supply to the Vaal river system. Some disadvantages to Lesotho if 1B does not proceed would be loss of royalties and job opportunities and a curb on development of its infrastructure
New Yorgis Blouini fondi konverentsil esinenud Eesti välisminister Urmas Paet leidis, et tulemusliku arengukoostöö eeldused on korruptsiooni vähendamine ja heade valitsemistavade juurutamine arengukoostöö sihtriikides. Blouini sihtasutuse eesmärk on tõsta teadlikkust globaliseerumise väljakutsete ja võimaluste kohta
Egyed, Alexander; Grünbacher, Paul; Heindl, Matthias; Biffl, Stefan
Traceability from requirements to code is mandated by numerous software development standards. These standards, however, are not explicit about the appropriate level of quality of trace links. From a technical perspective, trace quality should meet the needs of the intended trace utilizations. Unfortunately, long-term trace utilizations are typically unknown at the time of trace acquisition which represents a dilemma for many companies. This chapter suggests ways to balance the cost and benefits of requirements traceability. We present data from three case studies demonstrating that trace acquisition requires broad coverage but can tolerate imprecision. With this trade-off our lessons learned suggest a traceability strategy that (1) provides trace links more quickly, (2) refines trace links according to user-defined value considerations, and (3) supports the later refinement of trace links in case the initial value consideration has changed over time. The scope of our work considers the entire life cycle of traceability instead of just the creation of trace links.
Petersen, Marianne Graves; Rasmussen, Majken Kirkegaard
Stereotypic presumptions about gender affect the design process, both in relation to how users are understood and how products are designed. As a way to decrease the influence of stereotypic presumptions in design process, we propose not to disregard the aspect of gender in the design process......, as the perspective brings valuable insights on different approaches to technology, but instead to view gender through a value lens. Contributing to this perspective, we have developed Value Representations as a design-oriented instrument for staging a reflective dialogue with users. Value Representations...
Malte Thran; Lukas Boehnke
In the fall of 2014, the new German grassroots political protest movement “Pegida” emerged. The movement’s targets of criticism include the pronounced ‘failures’ of German asylum and immigration policy, refugees, and a so-called “Islamization.” This contribution is an analysis of Pegida's programmatic publications. Pegida claims to promote national values and already has a positive image of Germany in particular and the nation state in general. Germany is seen as an agency of ‘humanity’ that ...
Full Text Available The article presents the idea of gaining a position of competitive advantage by companies operating in the knowledge-based economy and in the age of modern technology. The rate of change in companies’ environments forces organizations to react quickly to clients’ needs. In recent years, there has been an observed systematic increase in the importance of communicating customer value in Poland. This paper shows changes (trends in the system of market communication in the age of modern technology and changes in the economy. The author presents the mechanisms and effects of communication in age new technology in Poland. Modern technologies enable the collection, storage and transmission of information. Reflections contained in the paper do not have definite characteristics and should be treated as an opinion in the discussion.
van der Voordt, Theo; van der Voordt, DJM; Dijkstra, K
The healthcare sector in the Netherlands is shifting from a governmentally steered domain towards regulated market forces and performance-based financing. Organizational changes, new ideas about care and cure, demographical developments and technological innovations play
Inhulsen, Maj-Britt Mr; Mérelle, Saskia Ym; Renders, Carry M
OBJECTIVE: To examine the associations between parental feeding styles and children's dietary intakes and the modifying effect of maternal education and children's ethnicity on these associations. DESIGN: Cross-sectional study of parental feeding styles, assessed by the Parental Feeding Style
Hasok Chang ("Sci Educ" 20:317-341, 2011) shows how the recovery of past experimental knowledge, the physical replication of historical experiments, and the extension of recovered knowledge can increase scientific understanding. These activities can also play an important role in both science and history and philosophy of science…
Intercultural Center for Research in Education, Arlington, MA.
The Sunflower/Girasol program is a Spanish/English bilingual science discovery program for Hispanic children in grades 2-6, designed to improve science instruction and educational opportunity for this group. The report describes the program's proposed activities and products, progress to date, and results of an evaluation of the first two units of…
In this article I review lessons to be learned from five commercial rafting participant fatalities in Northern Queensland between 2007 and 2009, and examine some implications of the coroner's recommendations from an outdoor education perspective. I aim both to help prevent future fatalities and to contribute to discussion about how best to achieve…
Schuster, Mark A.
A senior researcher and hospital Chief of General Pediatrics, testifies about his work with a California school district to prevent obesity by developing a middle school program to promote healthy eating and physical activity. A two-year study has found that students have limited access to drinking water, especially at meals. In the schools being…
Schaffer, Dannah Lynn
The main goal of this research study was to develop and validate a three-tier diagnostic test to determine pre-service teachers' (PSTs) conceptual knowledge of the water cycle. For a three-tier diagnostic test, the first tier assesses content knowledge; in the second tier, a reason is selected for the content answer; and the third tier allows…
The overall NRC program for the resolution of the water hammer issue is divided into four tasks: water hammer summary reports; revision of CP and OL review procedures; water hammer positions for operating reactors; and water hammer safety studies
& Development (LDRD) National Security Education Center (NSEC) Office of Science Programs Richard P Databases National Security Education Center (NSEC) Center for Nonlinear Studies Engineering Institute Scholarships STEM Education Programs Teachers (K-12) Students (K-12) Higher Education Regional Education
& Development (LDRD) National Security Education Center (NSEC) Office of Science Programs Richard P Databases National Security Education Center (NSEC) Center for Nonlinear Studies Engineering Institute Scholarships STEM Education Programs Teachers (K-12) Students (K-12) Higher Education Regional Education
Giulio Querini; Salvo Creaco
Water sustainability needs a balance between demand and availability: 1) Water demand management: demand may be managed by suppliers and regulations responsible persons, using measures like invoicing, consumptions measurement and users education in water conservation measures; 2) Augmentation of water supply: availibility may be augmented by infrastructural measures, waste water reuse, non-conventional resources and losses reduction. Water Demand Management is about achieving a reduction in t...
Dolnicar, Sara; Hurlimann, Anna; Grün, Bettina
Branding is a key strategy widely used in commercial marketing to make products more attractive to consumers. With the exception of bottled water, branding has largely not been adopted in the water context although public acceptance is critical to the implementation of water augmentation projects. Based on responses from 6247 study participants collected between 2009 and 2012, this study shows that (1) different kinds of water – specifically recycled water, desalinated water, tap water and ra...
吉冨, 健一; 網本, 貴一; 梅田, 貴士; 富川, 光
We are studying on the development of teaching/learning materials in Science. This article focuses on a contextual science learning of the Earth’s origin and the hydrological circulation from the perspective of “water”. Some storylines about the origin of water, the gravity of planet, formation of the atmosphere and seas, and the creation of life are proposed in connection with the knowledge and concepts of physics, chemistry, and biology as well as earth science. And an example of lesson pra...
Paerregaard, Karsten; Stensrud, Astrid Bredholt; Andersen, Astrid Oberborbeck
This article examines the implementation of Peru’s new water law and discusses how it produces new forms of water citizenship. Inspired by the global paradigm of “integrated water resources management,” the law aims to include all citizens in the management of the country’s water resources...... by embracing a “new water culture.” We ask what forms of water citizenship emerge from the new water law and how they engage with local water practices and affect existing relations of inequality. We answer these questions ethnographically by comparing previous water legislation and how the new law currently...... is negotiated and contested in three localities in Peru’s southern highlands. We argue that the law creates a new water culture that views water as a substance that is measurable, quantifiable, and taxable, but that it neglects other ways of valuing water. We conclude that water citizenship emerges from...
Agriculture consumes about 70 per cent of the world's available water but experts say that where there are competing demands for water use, and groundwater sources have been depleted, small farmers are the first to lose their supply. As a consequence farmers are displaced from their land and the landless, who help them, are made jobless. Environmental damage to wetlands and estuaries from upstream depletion, as well as an increase of water-borne disease, also occurs.There must be more emphasis towards increasing the efficiency of water management systems and increasing water productivity, getting more crops per drop, says the Food and Agriculture Organization (FAO). Water stress leaves women the most vulnerable. Without a ready source of water they may have to walk for several hours every day to find it, or send their children to fetch it. Child nurturing and education suffer and the water available maybe unfit for human use. The U.N. estimates that 1.2 billion people lack access to safe water and about 2.5 billion are without access to proper sanitation. The absence of safe water translates into a tremendous burden of disease, linked to gastro-intestinal infection, making it a key water associated development issue, the World Health Organization (WHO) says. 'Access to sanitation facilities is a basic human right that safeguards health and human dignity,' said Sir Richard Jolly, Chair of the Geneva-based Water Supply and Sanitation Collaborative Council (WSCC). 'We know from experience that clean water alone leads only to minor health improvements. Sound hygiene behaviour must be recognized as a separate issue in its own right, with adequate sanitation and clean water as supporting components.' This year, water pollution, poor sanitation and water shortages will kill over 12 million people, said Klaus Toepfer, Executive Director of the United Nations Environment Programme (UNEP). Millions more are in bad health and trapped in poverty, said Mr. Toepfer, much of
Lindquist, Erik D.; George, C. M.; Perin, Jamie; Neiswender de Calani, Karen J.; Norman, W. Ray; Davis, Thomas P.; Perry, Henry
Safe domestic potable water supplies are urgently needed to reduce childhood diarrheal disease. In periurban neighborhoods in Cochabamba, Bolivia, we conducted a cluster randomized controlled trial to evaluate the efficacy of a household-level hollow fiber filter and/or behavior change communication (BCC) on water, sanitation, and hygiene (WASH) to reduce the diarrheal disease in children less than 5 years of age. In total, 952 households were followed for a period of 12 weeks post-distribution of the study interventions. Households using Sawyer PointONE filters had significantly less diarrheal disease compared with the control arm during the intervention period, which was shown by diarrheal prevalence ratios of 0.21 (95% confidence interval [95% CI] = 0.15–0.30) for the filter arm and 0.27 (95% CI = 0.22–0.34) for the filter and WASH BCC arm. A non-significant reduction in diarrhea prevalence was reported in the WASH BCC study arm households (0.71, 95% CI = 0.59–0.86). PMID:24865680
课程改革是教育教学改革的核心，也是难点。本文就高等职业教育《工程水文与水利计算》课程设计，从课程教学目标、课程的设计理念、设计思路、设计的主要内容与原则几个方面进行了论述，提出课程设计要形成基于岗位工作要求的课程目标、基于职业能力培养的课程内容、基于教学规律的课程组织和适应学生自主学习的课程资源。%Curriculum reform is the core of reform in education and teaching and also the difficult point. The curriculum design of Engineering Hydrology and Water Conservancy Computation in higher vocational education is discussed from such aspects as the teaching objective, the design concept~ the design idea, the main content and pricinple. It is proposed that the objective should be set based on the requirements of the working position, the content should be designed for the cultivation of students＂ profesional ability, curriculum organization should be based on teaching rules and curriculum resources should be adaptable to students＂ autonomous learning.
Bloom, Jennifer L.; Hutson, Bryant L.; He, Ye; Konkle, Erin
Appreciative education is presented as a framework for leading higher education institutions, delivering truly student-centered services, and guiding higher education professionals' interactions with students.
... water because the immature coconuts are green in color. Coconut water is different than coconut milk. Coconut milk is produced from an emulsion of the grated meat of a mature coconut. Coconut water is commonly ...
Students will learn about what causes water pollution and how to be environmentally aware. *Note: Students should understand the concept of the water cycle before moving onto water pollution (see Lesson Plan “Oceans all Around Us”).
Water is essential for life and ecological sustenance; its availability is essential component of national welfare and productivity.The country's socio-economic activities are largely dependent on the natural endowment of water resources. Kenya's water resources comprises of surface waters (rivers, lakes and wetlands) and ground water. Surface water forms 86% of total water resources while the rest is ground water Geological, topographical and climatic factors influence the natural availability and distribution of water with the rainfall distribution having the major influence. Water resources in Kenya are continuously under threat of depletion and quality degradation owing to rising population, industrialization, changing land use and settlement activities as well as natural changes. However, the anticipated climate change is likely to exacerbate the situation resulting in increased conflict over water use rights in particular, and, natural resource utilisation in general. The impacts of climate change on the water resources would lead to other impacts on environmental and socio-economic systems
... Genetics Services Directory Cancer Prevention Overview Research Fluoridated Water On This Page What is fluoride, and where is it found? What is water fluoridation? When did water fluoridation begin in the ...
... Consultations, and General Public. Contact Us Parasites Home Water Language: English Español (Spanish) Recommend on Facebook Tweet Share Compartir Parasites can live in natural water sources. When outdoors, treat your water before drinking ...
Ross-Harrington, Melinda; Kincaid, G. David
One of twelve water treatment technology units, this student manual on distribution systems provides instructional materials for six competencies. (The twelve units are designed for a continuing education training course for public water supply operators.) The competencies focus on the following areas: types of pipe for distribution systems, types…
Conservation education, outdoor education, and environmental education all have as a common goal the understanding and appreciation of the natural world. Outdoor education is a method of teaching wherein established disciplines, topics, and concepts which can best be taught outdoors are taught outdoors. Conservation education is the study of man's…
Swistock, Bryan R; Clemens, Stephanie; Sharpe, William E; Rummel, Shawn
Pennsylvania has over three million rural residents using private water wells for drinking water supplies but is one of the few states that lack statewide water well construction or management standards. The study described in this article aimed to determine the prevalence and causes of common health-based pollutants in water wells and evaluate the need for regulatory management along with voluntary educational programs. Water samples were collected throughout Pennsylvania by Master Well Owner Network volunteers trained by Penn State Extension. Approximately 40% of the 701 water wells sampled failed at least one health-based drinking water standard. The prevalence of most water quality problems was similar to past studies although both lead and nitrate-N were reduced over the last 20 years. The authors' study suggests that statewide water well construction standards along with routine water testing and educational programs to assist water well owners would result in improved drinking water quality for private well owners in Pennsylvania.
The subject matter of this diploma thesis "Sexual Education" is sexual education in the Czech Republic, specifically dedicated to the study of the integration of sexual education into the educational process in schools and families.
Full Text Available Perceptions of water and water related issues still render many under-researched topics. This study aims to further our knowledge regarding people’s perceptions of water and our understanding about the different ways individuals use water. The authors asked the question: Does the way an individual perceives water (i.e., as a commodity, a human right, private resource, public resource and/or natural resource influence consumption and conservation of water, and sentiments towards control and allocation of water? An exploratory online questionnaire was designed to generate qualitative and quantitative data of survey participants’ perceptions, beliefs and actions towards water issues, such as overconsumption and scarcity. Data analysis included comparison of the quantitative data regarding the non-statistical association between how an individual perceives water and the individual’s beliefs, as well as qualitative analysis of the comments using an iterative pattern coding technique. One hundred and sixty four individuals participated in the survey (75% completion rate and over 430 comments were made. Themes that emerged from the comments included: responsibility, scarcity, the value of water, knowledge gained and education needed. Comparison of the different perceptions of water revealed that different perceptions of what water is resulted in different beliefs about what the cost of water should be. These findings have implications for future water use, including what needs to change in order to increase appreciation for water issues.
Goals Recycling Green Purchasing Pollution Prevention Reusing Water Resources Environmental Management System Environmental Outreach Feature Stories Individual Permit for Storm Water Public Reading Room Sustainability Â» Reusing Water Reusing Water Millions of gallons of industrial wastewater is recycled at LANL by
Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.
This final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. This rule also: Updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the third year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between calendar year (CY) 2012 and CY 2014; and discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CY 2014 through CY 2017. In addition, this rule finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model and to the Home Health Quality Reporting Program (HH QRP). We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule.
Hassanzadeh, Elmira; Elshorbagy, Amin; Wheater, Howard
The Saskatchewan River is the key water resource for the 3 prairie provinces of Alberta, Saskatchewan and Manitoba in Western Canada, and thus it is necessary to pursue long-term regional and watershed-based planning for the river basin. The water resources system is complex because it includes multiple components, representing various demand sectors, including the environment, which impose conflicting objectives, and multiple jurisdictions. The biophysical complexity is exacerbated by the socioeconomic dimensions associated for example with impacts of land and water management, value systems including environmental flows, and policy and governance dimensions.. We focus on the South Saskatchewan River Basin (SSRB) in Alberta and Saskatchewan, which is already fully allocated in southern Alberta and is subject to increasing demand due to rapid economic development and a growing population. Multiple sectors and water uses include agricultural, municipal, industrial, mining, hydropower, and environmental flow requirements. The significant spatial variability in the level of development and future needs for water places different values on water across the basin. Water resources planning and decision making must take these complexities into consideration, yet also deal with a new dimension—climate change and its possible future impacts on water resources systems. There is a pressing need to deal with water in terms of its value, rather than a mere commodity subject to traditional quantitative optimization. In this research, a value-based water resources system (VWRS) model is proposed to couple the hydrological and the societal aspects of water resources in one integrated modeling tool for the SSRB. The objective of this work is to develop the VWRS model as a negotiation, planning, and management tool that allows for the assessment of the availability, as well as the allocation scenarios, of water resources for competing users under varying conditions. The proposed
Sinha, S.K.; Madia, J.; Dixon, S.
The Consolidated Edison Company of New York, Inc. (Con Edison) has constructed a first-of-a-kind water hammer events simulator for use at its training center. The Learning Center, Con Edison's central training facility, intends to use the simulator as an educational tool to demonstrate the various mechanisms of the water hammer phenomenon to power plant designers, engineers and operators. The water hammer phenomenon has been studied extensively for the past 15 years for the nuclear industry. However, the acknowledge of the various water hammer mechanisms and the measures to prevent or mitigate water hammer have not been widely disseminated among the operators of fossil-fueled power plants. Con Edison personnel who operate the various generation stations and the New York City steam distribution systems are expected to benefit from the new simulator. Knowledge gained from interacting with the simulator will be very important in helping the Con Edison prevent, mitigate, or accommodate water hammer at its facilities. The water hammer simulator was fabricated in Con Edison's central machine shop. Details of the design and construction of the simulator were finalized in consultation with Creare, Inc., an engineering research firm, located in Hanover, New Hampshire. The simulator seeks to recreate the essential features of water hammer in steam mines following the buildup of cold (subcooled) water by condensation and steam-water interaction. This paper describes the fabrication, design, testing, and operation of the Con Edison water hammer simulator. A discussion of how Con Edison plans to use the facility at The Learning Center is included
Hjorth, Mikkel; Smith, Rachel Charlotte; Iversen, Ole Sejer
, (2) managing digital and analogue design materials and (3) balancing different modes of teaching. This paper demonstrates how a combination of design theory, in-school practice and peer-to-peer learning created a framework towards educating design educators – a framework that allowed us......Design thinking and digital technologies are increasingly introduced in education to develop children’s design literacy. This shift demands a change in teachers’ mindsets, capabilities and approaches to design and technology as well as new teaching practices. This paper reports on a research......-based master's course developed to address and study the challenges that educators experience when teaching design in K-12 classes. We investigate three aspects that we argue are crucial when developing teachers' capability to teach design literacy to children: (1) ability to navigate a complex design process...
Haering, Kathryn; Evanylo, Gregory K.; Benham, Brian Leslie, 1960-; Goatley, Michael
Describes water reuse and reclaimed water, explains how reclaimed water is produced, options for water reuse, water reuse regulations, and agronomic concerns with water reuse, and provides several case studies of water reuse.
Many cities worldwide have gone beyond the limits of their water supply. Growing urban populations increase their demand for water, thereby straining local water supplies and requiring engineers to seek our even more distant water sources. It is costly to build and maintain reservoirs, canals, pumping stations, pipes, sewers, and treatment plants. Water supply activities require much energy and chemicals, thereby contributing to environmental pollution. Many cities are beginning to manage the water supply rather than trying to keep up with demand. Pumping ground water for Mexico City's 18 million residents (500,000 people added/year) surpasses natural replenishment by 50% to 80%, resulting in falling water tables and compressed aquifers. Mexico City now ambitiously promotes replacement of conventional toilets with 1.6 gallon toilets (by late 1991, this had saved almost 7.4 billion gallons of water/year). Continued high rural-urban migration and high birth rates could negate any savings, however. Waterloo, Ontario, has also used conservation efforts to manage water demand. These efforts include retrofit kits to make plumbing fixtures more efficient, efficiency standards for plumbing fixtures, and reduction of water use outdoors. San Jose, California, has distributed water savings devices to about 220,000 households with a 90% cooperation rate. Boston, Massachusetts, not only promoted water saving devices but also repaired leaks and had an information campaign. Increasing water rates to actually reflect true costs also leads to water conservation, but not all cities in developing countries use water meters. All households in Edmonton, Alberta, are metered and its water use is 1/2 of that of Calgary, where only some households are metered. Tucson, Arizona, reduced per capita water use 16% by raising water rates and curbing water use on hot days. Bogor, Indonesia, reduced water use almost 30% by increasing water rates. In the US, more and more states are mandating use
Smieja, Joanne A.
Household water treatments (HWT) can help provide clean water to millions of people worldwide who do not have access to safe water. This article describes four common HWT used in developing countries and the pertinent chemistry involved. The intent of this article is to inform both high school and college chemical educators and chemistry students…
Welcome The Mississippi Water Resources Research Institute provides a statewide center of expertise in water and associated land-use and serves as a repository of knowledge for use in education private interests in the conservation, development, and use of water resources; to provide training
Dolnicar, Sara; Hurlimann, Anna; Grün, Bettina
Branding is a key strategy widely used in commercial marketing to make products more attractive to consumers. With the exception of bottled water, branding has largely not been adopted in the water context although public acceptance is critical to the implementation of water augmentation projects. Based on responses from 6247 study participants collected between 2009 and 2012, this study shows that (1) different kinds of water - specifically recycled water, desalinated water, tap water and rainwater from personal rainwater tanks - are each perceived very differently by the public, (2) external events out of the control of water managers, such as serious droughts or floods, had a minimal effect on people's perceptions of water, (3) perceptions of water were stable over time, and (4) certain water attributes are anticipated to be more effective to use in public communication campaigns aiming at increasing public acceptance for drinking purposes. The results from this study can be used by a diverse range of water stakeholders to increase public acceptance and adoption of water from alternative sources. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.
Dolnicar, Sara; Hurlimann, Anna; Grün, Bettina
Branding is a key strategy widely used in commercial marketing to make products more attractive to consumers. With the exception of bottled water, branding has largely not been adopted in the water context although public acceptance is critical to the implementation of water augmentation projects. Based on responses from 6247 study participants collected between 2009 and 2012, this study shows that (1) different kinds of water – specifically recycled water, desalinated water, tap water and rainwater from personal rainwater tanks – are each perceived very differently by the public, (2) external events out of the control of water managers, such as serious droughts or floods, had a minimal effect on people's perceptions of water, (3) perceptions of water were stable over time, and (4) certain water attributes are anticipated to be more effective to use in public communication campaigns aiming at increasing public acceptance for drinking purposes. The results from this study can be used by a diverse range of water stakeholders to increase public acceptance and adoption of water from alternative sources. PMID:24742528
Soil Conservation Society of America, Ankeny, IA.
The Soil Conservation Society of America's (SCSA) aim is to advance the science and art of good land and water use. Conservation education has a significant role in achieving the wise use of these resources. In this report, perspectives are offered on: (1) the requirements for effective conservation education programs; (2) rationale for…
Bowen, H. J. M.
Deals with water pollution in the following categories: a global view, self purification, local pollution, difficulties in chemical analysis, and remedies for water pollution. Emphasizes the extent to which man's activities have modified the cycles of certain elements. (GS)
The Drinking Water and Wastewater Resiliency site provides tools and resources for drinking water and wastewater utilities in the full spectrum of emergency management which includes prevention, mitigation, preparedness, response and recovery.
Krause, Franz; Salverda, Tijo; Hollington , Andrea; Tappe, Oliver; Kloß, Sinah; Schneider, Nina
We encounter water every day. It is a vital substance biologically as much as socially. We may notice this in art exhibitions and university courses communicating submersed and subversive facts about water; the rhythms of floods and tides resonating with fishing techniques and conflict patterns; inundations carrying moral and political weight as much as water and pollution; and particular mixtures of water and land generating wealth, anxieties and memories. In short, wherever people deal with...
In global times, university education policy that holds the greatest promise for social responsibility is the focus here; the argument made is that such policy ought to be conceptualised using a normative human development and capabilities approach, drawing on the work of Amartya Sen and Martha Nussbaum. Their ideas offer a values-based way of…
Chan, Lap Ki; Cheng, Maurice M. W.
Although high-fidelity digital models of human anatomy based on actual cross-sectional images of the human body have been developed, reports on the use of physical models in anatomy teaching continue to appear. This article aims to examine the common features shared by these physical models and analyze their educational value based on the…
Boelens, R.A.; Perreault, T.; Vos, J.M.C.
Water justice is becoming an ever-more pressing issue in times of increasing water-based inequalities and discrimination. Megacities, mining, forestry, industry and agribusiness claim an increasingly large share of available surface and groundwater reserves. Water grabbing and pollution generate
This work is about the water pollution. The air and the water interaction cycles is the main idea of the geochemical pollution conception. In the water surface as well as in the deep aquifers we can found cough metals or minerals from the athmosferic air. The activities of mercury fluor and nitrates are important to the pollution study
Aquatic animals are healthiest and grow best when environmental conditions are within certain ranges that define, for a particular species, “good” water quality. From the outset, successful aquaculture requires a high-quality water supply. Water quality in aquaculture systems also deteriorates as an...
Zolnikov, Tara Rava
Water is essential in providing nutrients, but contaminated water contributes to poor population health. Water quality and availability can change in unstructured situations, such as war. To develop a practical strategy to address poor water quality resulting from intermittent wars in Iraq, I reviewed information from academic sources regarding waterborne diseases, conflict and war, water quality treatment, and malnutrition. The prevalence of disease was high in impoverished, malnourished populations exposed to contaminated water sources. The data aided in developing a strategy to improve water quality in Iraq, which encompasses remineralized water from desalination plants, health care reform, monitoring and evaluation systems, and educational public health interventions.
Discusses development education as an educational process aimed at preparing people for participation in change and examines the implications for disarmament education. Development education is interpreted to include adult literacy education as well as a system of spreading basic concepts and encouraging and developing local initiatives. (DB)
Kashiwai, Shin-ichi; Yokomizo, Osamu; Orii, Akihito.
In a reactor core of a BWR type reactor, the area of a flow channel in a lower portion of a downcoming pipe for downwardly releasing steams present at the top portion in a water rod is increased. Further, a third coolant flow channel (an inner water rod) is disposed in an uprising having an exit opened near the inlet of the water rod and an inlet opened at the outside near the top portion of the water and having an increase flow channel area in the upper portion. The downcoming pipe in the water rod is filled with steams, and the void ratio is increased by so much as the flow channel area of the downcoming pipe is increased. Since the pressure difference between the inlet and the exit of the inner water rod is greater than the pressure difference between the inlet and the exit of the water rod, most of water flown into the inner water rod is discharged out of the exit in the form of water as it is. Since the area of the flow channel is increased in the portion of the inner water rod, void efficiency in the upper portion of the reactor core is decreased by so much. Since the void ratio is thus increased in the lower portion and the void efficiency is decreased in the upper portion of the reactor core, axial void distribution can be flattened. (N.H.)
... Water Quality? [1.7MB PDF] Past featured science... Water Quality Data Today's Water Conditions Get continuous real- ... list of USGS water-quality data resources . USGS Water Science Areas Water Resources Groundwater Surface Water Water ...
This is a report about a meeting of the international Radiation Education Forum in Budapest on August 20-25, 2002. The Forum, with an international membership, has been active since 1999 in dealing, among other things, with problems connected with the way in which the topic of radioactivity is handled by the media and the public. (orig.)
Guo, Biying; Huang, Xiaorong; Ma, Kai; Gao, Linyun; Wang, Yanqiu
The exploration of the compilation of natural resources balance sheet has been proposed since 2013. Several elements of water resources balance sheet have been discussed positively in China, including basic concept, framework and accounting methods, which focused on calculating the amount of water resources with statistical methods but lacked the analysis of the interrelationship between physical volume and magnitude of value. Based on the study of physical accounting of water resources balance sheet, the connotation of water resources value is analyzed in combination with research on the value of water resources in the world. What's more, the theoretical framework, form of measurement and research methods of water resources value accounting are further explored. Taking Chengdu, China as an example, the index system of water resources balance sheet in Chengdu which includes both physical and valuable volume is established to account the depletion of water resources, environmental damage and ecological water occupation caused by economic and social water use. Moreover, the water resources balance sheet in this region which reflects the negative impact of the economy on the environment is established. It provides a reference for advancing water resources management, improving government and social investment, realizing scientific and rational allocation of water resources.
Jones, Tammie R; Coke, Lola
This study, implemented on 2 medical-surgical units, evaluated the impact of a standardized, evidence-based new medication education program. Outcomes evaluated included patient postdischarge knowledge of new medication purpose and side effects, patient satisfaction with new medication, and Medicare reimbursement earn-back potential. As a result, knowledge scores for new medication purpose and side effects were high post intervention. Patient satisfaction with new medication education increased. Value-based purchasing reimbursement earn-back potential improved.
This paper does not present an advocacy of a passive education as opposed to an active education nor does it propose that passive education is in any way 'better' or more important than active education. Through readings of Maurice Blanchot, Jacques Derrida and B.S. Johnson, and gentle critiques of Jacques Rancière and John Dewey, passive…
Kutepov, A.I.; Fedotov, I.N.; Prokopov, O.I.
The patented water curtain is used to eliminate gas-oil gushers and is distinguished by the fact that in order to simplify operation, the water-line collector is made out of two symmetrical parts installed with the possibility of relative rotation. The collector is equipped with at least one pipe arranged in the zone of the collector and has openings for the supply of water.
de Graaf, Inge
The world's largest assessable source of freshwater is hidden underground, but we do not know what is happening to it yet. In many places of the world groundwater is abstracted at unsustainable rates: more water is used than being recharged, leading to decreasing river discharges and declining groundwater levels. It is predicted that for many regions of the world unsustainable water use will increase, due to increasing human water use under changing climate. It would not be long before shortage causes widespread droughts and the first water war begins. Improving our knowledge about our hidden water is the first step to stop this. The world largest aquifers are mapped, but these maps do not mention how much water they contain or how fast water levels decline. If we can add a third dimension to the aquifer maps, so a thickness, and add geohydrological information we can estimate how much water is stored. Also data on groundwater age and how fast it is refilled is needed to predict the impact of human water use and climate change on the groundwater resource.
The present paper describes the coolant chemistry and its consequences for 1300 MWsub(e) KWU PWR plants. Some selected systems, i.e. primary heat transport system, steam water cycle and cooling water arrangements, are chosen for this description. Various aspects of coolant chemistry regarding general corrosion, selective types of corrosion and deposits on heat transfer surfaces have been discussed. The water supply systems necessary to fulfill the requirements of the coolant chemistry are discussed as well. It has been concluded that a good operating performance can only be achieved when - beside other factors - the water chemistry has been given sufficient consideration. (orig./RW)
The present paper describes the coolant chemistry and its consequences for 1300 MWsub(e) KWU PWR plants. Some selected systems, i.e. primary heat transport system, steam water cycle and cooling water arrangements, are chosen for this description. Various aspects of coolant chemistry regarding general corrosion, selective types of corrosion and deposits on heat transfer surface have been discussed. The water supply systems necessary to fulfill the requirements of the coolant chemistry are discussed as well. It has been concluded that a good operating performance can only be achieved when - beside other factors - the water chemistry has been given sufficient consideration. (orig./RW)
analysis of the Soil and water samples shows traces of heavy metals when compared ... The research thus point out the need for environmental Education and proper ..... Macro invertebrate community pattems and diversity in relation to water ...
Urban water issues in developing countries are complex and increasingly urgent. ... is helping countries in the parched Middle East and North Africa share lessons ... can protect water quality by organizing garbage collection and educating the ...
@@ In England, many children go to nursery school from the age of about three, but these schools are not compulsory. Compulsory education begins at the age of five, when children go to primary school. Primary education takes six years, then pupils go to secondary education. After six years of secondary education, pupils take the General Certificate of Secondary Education (GCSE) examination. Most pupils take about eight subjects in this exam.