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Implementation
Kinds of Implementation Terms modified by Implementation Selected AbstractsNEXT STEPS FOR UKRAINE ABOLITION OF HIV REGISTRIES, IMPLEMENTATION OF ROUTINE HUMAN IMMUNODEFICIENCY VIRUS TESTING AND EXPANSION OF SERVICESADDICTION, Issue 3 2010JACOB M. IZENBERG No abstract is available for this article. [source] CALLING TIME FOR IMPLEMENTATION OF THE ENGLISH ALCOHOL HARM REDUCTION STRATEGYADDICTION, Issue 12 2004IAN T. GILMORE No abstract is available for this article. [source] OBSTACLES TO IMPLEMENTATION OF NEW PUBLIC MANAGEMENT IN AN IRISH HOSPITALFINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 1 2007Geraldine Robbins First page of article [source] SOME PRACTICAL GUIDANCE FOR THE IMPLEMENTATION OF PROPENSITY SCORE MATCHINGJOURNAL OF ECONOMIC SURVEYS, Issue 1 2008Marco Caliendo Abstract Propensity score matching (PSM) has become a popular approach to estimate causal treatment effects. It is widely applied when evaluating labour market policies, but empirical examples can be found in very diverse fields of study. Once the researcher has decided to use PSM, he is confronted with a lot of questions regarding its implementation. To begin with, a first decision has to be made concerning the estimation of the propensity score. Following that one has to decide which matching algorithm to choose and determine the region of common support. Subsequently, the matching quality has to be assessed and treatment effects and their standard errors have to be estimated. Furthermore, questions like ,what to do if there is choice-based sampling?' or ,when to measure effects?' can be important in empirical studies. Finally, one might also want to test the sensitivity of estimated treatment effects with respect to unobserved heterogeneity or failure of the common support condition. Each implementation step involves a lot of decisions and different approaches can be thought of. The aim of this paper is to discuss these implementation issues and give some guidance to researchers who want to use PSM for evaluation purposes. [source] THE EFFECTS OF ITQ IMPLEMENTATION: A DYNAMIC APPROACHNATURAL RESOURCE MODELING, Issue 4 2000LEE G. ANDERSON ABSTRACT. This paper investigates the intertemporal effects of introducing Individual Transferable Quota, ITQ, fishery management programs on stock size, fleet size and composition, and returns to quota holders and to vessel operators. Theoretical analysis is conducted using a specific version of a general dynamic model of a regulated fishery. It is demonstrated that the effects will differ depending upon the prevailing regulation program, current stock size, and existing fleet size, composition and mobility and upon how the stock and fleet change over time after the switch to ITQs. The paper expands upon previous works by modeling the dynamics of change in fleet and stock size and by allowing for changes in the TAC as stock size changes, by comparing ITQs to different regulations, and by allowing the status quo before ITQ implementation to be something other than a bioeconomic equilibrium. Specific cases are analyzed using a simulation model. The analysis shows that the annual return per unit harvest to quota owners can increase or decrease over the transition period due to counteracting effects of changes in stock and fleet size. With ITQs denominated as a percentage of the TAC, the current annual value of a quota share depends upon the annual return per unit of harvest and the annual amount of harvest rights. Because the per unit value can increase or decrease over time, it is also possible that the total value can do the same. Distribution effects are also studied and it is shown that while the gains from quota share received are the present value of a potentially infinite stream of returns, potential losses are the present value of a finite stream, the length of which depends upon the remaining life of the vessel and the expected time it will continue to operate. [source] POLICY IMPLEMENTATION IN AN AFRICAN STATE: AN EXTENSION OF KINGDON'S MULTIPLE-STREAMS APPROACHPUBLIC ADMINISTRATION, Issue 4 2009VALÉRY RIDDE Kingdon's multiple-streams framework, which emerged in the mid-1980s, today forms one of the indispensable analytical frameworks for understanding public policy agenda-setting. However, it is only in the context of wealthy countries that this approach has been validated for setting the agenda of national and international policies. This article reports the results of empirical research in an African state studying the transferability of a threefold theoretical innovation. The question under consideration is whether the multiple-streams framework is useful for examining public policy implementation at the local level and in the context of a low income country. The research findings confirm the premise that the multiple-streams framework can be extended and can lead to the formulation of several theoretical propositions. [source] A MAS IMPLEMENTATION FOR SYSTEM IDENTIFICATION AND PROCESS CONTROLASIAN JOURNAL OF CONTROL, Issue 4 2006E. J. González ABSTRACT In this paper, a MAS for system identification and process control is presented. In particular, this MAS implements a self-tuning regulator (STR) scheme. It has adopted FIPA specifications because they have become a stronger standard in MAS development and they involve not only agent language specifications but also agent management and conversations. In this work, an Ontology Agent (OA) is included, using DAML + OIL as ontology language. The obtained results validate this approach in the implementation of well-known algorithms for control process. [source] SEMANTICS-ASSISTED PROBLEM SOLVING ON THE SEMANTIC GRIDCOMPUTATIONAL INTELLIGENCE, Issue 2 2005Liming Chen In this paper we propose a distributed knowledge management framework for semantics and knowledge creation, population, and reuse on the grid. Its objective is to evolve the Grid toward the Semantic Grid with the ultimate purpose of facilitating problem solving in e-Science. The framework uses ontology as the conceptual backbone and adopts the service-oriented computing paradigm for information- and knowledge-level computation. We further present a semantics-based approach to problem solving, which exploits the rich semantic information of grid resource descriptions for resource discovery, instantiation, and composition. The framework and approach has been applied to a UK e-Science project,Grid Enabled Engineering Design Search and Optimisation in Engineering (GEODISE). An ontology-enabled problem solving environment (PSE) has been developed in GEODISE to leverage the semantic content of GEODISE resources and the Semantic Grid infrastructure for engineering design. Implementation and initial experimental results are reported. [source] Animated instructional software for mechanics of materials: Implementation and assessmentCOMPUTER APPLICATIONS IN ENGINEERING EDUCATION, Issue 1 2006Timothy A. Philpot Abstract During the past 3 years, the Basic Engineering Department at the University of Missouri, Rolla has been developing a second-generation suite of instructional software called MecMovies for the Mechanics of Materials course. The MecMovies suite consists of over 110 animated example problems, drill-and-practice games, and interactive exercises. Students generally respond favorably to software of this type; however, much of the data that has been gathered to assess the effectiveness of similar software has been anecdotal. The method by which instructional software is incorporated into the engineering class is partly responsible for this lack of systematic evaluation. Often, software packages have been implemented in the classroom as supplemental material,recommended but not required. In the Fall 2003 semester, MecMovies was integrated thoroughly into the course assignments for one of the six UMR Mechanics of Materials sections. Four professors were involved in the study, and student performance in the experimental MecMovies section was compared to performance in the five control sections through a common final exam. At the end of the semester, students who used the MecMovies software also completed a survey questionnaire consisting of a number of subjective rating items. This paper presents a comparison of student performance in the experimental and control sections along with discussion of student qualitative ratings and comments. © 2006 Wiley Periodicals, Inc. Comput Appl Eng Educ 14: 31,43, 2006; Published online in Wiley InterScience (www.interscience.wiley.com); DOI 10.1002/cae.20065 [source] Using GIS, Genetic Algorithms, and Visualization in Highway DevelopmentCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 6 2001Manoj K. Jha A model for highway development is presented, which uses geographic information systems (GIS), genetic algorithms (GA), and computer visualization (CV). GIS serves as a repository of geographic information and enables spatial manipulations and database management. GAs are used to optimize highway alignments in a complex search space. CV is a technique used to convey the characteristics of alternative solutions, which can be the basis of decisions. The proposed model implements GIS and GA to find an optimized alignment based on the minimization of highway costs. CV is implemented to investigate the effects of intangible parameters, such as unusual land and environmental characteristics not considered in optimization. Constrained optimization using GAs may be performed at subsequent stages if necessary using feedback received from CVs. Implementation of the model in a real highway project from Maryland indicates that integration of GIS, GAs, and CV greatly enhances the highway development process. [source] An MPI Parallel Implementation of Newmark's MethodCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 3 2000Ali Namazifard The standard message-passing interface (MPI) is used to parallelize Newmark's method. The linear matrix equation encountered at each time step is solved using a preconditioned conjugate gradient algorithm. Data are distributed over the processors of a given parallel computer on a degree-of-freedom basis; this produces effective load balance between the processors and leads to a highly parallelized code. The portability of the implementation of this scheme is tested by solving some simple problems on two different machines: an SGI Origin2000 and an IBM SP2. The measured times demonstrate the efficiency of the approach and highlight the maintenance advantages that arise from using a standard parallel library such as MPI. [source] Implementation, performance, and science results from a 30.7 TFLOPS IBM BladeCenter clusterCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 2 2010Craig A. Stewart Abstract This paper describes Indiana University's implementation, performance testing, and use of a large high performance computing system. IU's Big Red, a 20.48 TFLOPS IBM e1350 BladeCenter cluster, appeared in the 27th Top500 list as the 23rd fastest supercomputer in the world in June 2006. In spring 2007, this computer was upgraded to 30.72 TFLOPS. The e1350 BladeCenter architecture, including two internal networks accessible to users and user applications and two networks used exclusively for system management, has enabled the system to provide good scalability on many important applications while being well manageable. Implementing a system based on the JS21 Blade and PowerPC 970MP processor within the US TeraGrid presented certain challenges, given that Intel-compatible processors dominate the TeraGrid. However, the particular characteristics of the PowerPC have enabled it to be highly popular among certain application communities, particularly users of molecular dynamics and weather forecasting codes. A critical aspect of Big Red's implementation has been a focus on Science Gateways, which provide graphical interfaces to systems supporting end-to-end scientific workflows. Several Science Gateways have been implemented that access Big Red as a computational resource,some via the TeraGrid, some not affiliated with the TeraGrid. In summary, Big Red has been successfully integrated with the TeraGrid, and is used by many researchers locally at IU via grids and Science Gateways. It has been a success in terms of enabling scientific discoveries at IU and, via the TeraGrid, across the US. Copyright © 2009 John Wiley & Sons, Ltd. [source] Obstacles to Bottom-Up Implementation of Marine Ecosystem ManagementCONSERVATION BIOLOGY, Issue 5 2008KIRSTEN E. EVANS manejo de ecosistemas; manejo marino basado en ecosistemas; participación de partes interesadas; planificación de la conservación Abstract:,Ecosystem management (EM) offers a means to address multiple threats to marine resources. Despite recognition of the importance of stakeholder involvement, most efforts to implement EM in marine systems are the product of top-down regulatory control. We describe a rare, stakeholder-driven attempt to implement EM from the bottom up in San Juan County, Washington (U.S.A.). A citizens advisory group led a 2-year, highly participatory effort to develop an ecosystem-based management plan, guided by a preexisting conservation-planning framework. A key innovation was to incorporate social dimensions by designating both sociocultural and biodiversity targets in the planning process. Multiple obstacles hindered implementation of EM in this setting. Despite using a surrogate scheme, the information-related transaction costs of planning were substantial: information deficits prevented assessment of some biodiversity targets and insufficient resources combined with information deficits prevented scientific assessment of the sociocultural targets. Substantial uncertainty, practical constraints to stakeholder involvement, and the existence of multiple, potentially conflicting, objectives increased negotiation-related costs. Although information deficits and uncertainty, coupled with underinvestment in the transaction costs of planning, could reduce the long-term effectiveness of the plan itself, the social capital and momentum developed through the planning process could yield unforeseeable future gains in protection of marine resources. The obstacles we identified here will require early and sustained attention in efforts to implement ecosystem management in other grassroots settings. Resumen:,El manejo de ecosistemas es un medio para abordar múltiples amenazas a los recursos marinos. No obstante el reconocimiento de la importancia de la participación de las partes interesadas, la mayoría de los esfuerzos para implementar el manejo de ecosistemas en sistemas marinos son producto del control normativo de arriba hacia abajo. Describimos un intento raro, conducido por las partes interesadas, por implementar el manejo del ecosistema de abajo hacia arriba en el Condado San Juan, Washington (E.U.A.). Un grupo consultivo de ciudadanos dirigió un esfuerzo altamente participativo para desarrollar un plan de manejo basado en el ecosistema, guiados por un marco de planificación de la conservación preexistente. Una innovación clave fue la incorporación de dimensiones sociales al incluir objetivos tanto socioculturales como de biodiversidad en el proceso de planificación. Múltiples obstáculos dificultaron la implementación del manejo del ecosistema en este escenario. No obstante que se utilizó un plan sustituto, los costos de transacción de la planificación relacionados con la información fueron mayores de lo que el grupo pudo superar: los déficits de información impidieron la evaluación de algunos objetivos de biodiversidad y la insuficiencia de recursos combinada con los déficits de información impidieron la evaluación científica de los objetivos socioculturales. Los costos relacionados con la negociación incrementaron por la incertidumbre, por limitaciones prácticas en la participación de partes interesadas y la existencia de objetivos múltiples, potencialmente conflictivos. Aunque los déficits de información y la incertidumbre, aunados con la baja inversión en los costos de transacción de la planificación, pudieran reducir la efectividad a largo plazo del plan mismo, el capital social y el ímpetu desarrollados durante el proceso de planificación podrían producir ganancias futuras imprevisibles para la protección de recursos marinos. Los obstáculos que identificamos aquí requerirán de atención temprana y sostenida en los esfuerzos para implementar el manejo de ecosistemas en otros escenarios de base popular. [source] Implementation of the EMC3-EIRENE code on TEXTOR-DED: accuracy and convergence studyCONTRIBUTIONS TO PLASMA PHYSICS, Issue 1-3 2004M. Kobayash First page of article [source] CI Implementation: An Empirical Test of the CI Maturity ModelCREATIVITY AND INNOVATION MANAGEMENT, Issue 4 2006Frances Jørgensen There are a number of tools available for organizations wishing to measure and subsequently develop Continuous Improvement (CI). In this article, we review and evaluate a well-accepted CI development model, namely the CI Maturity Model (Bessant and Caffyn, 1997), against data collected from the 2nd Continuous Improvement Network Survey and a number of empirical cases described in the literature. While the CI Maturity Model suggests that CI maturation ought to be a linear process, the findings in this article suggest that there are feasible alternatives for companies to develop CI capability. [source] Planning Environmental Sanitation Programmes in EmergenciesDISASTERS, Issue 2 2005Peter A. Harvey Environmental sanitation programmes are vital for tackling environmental-related disease and ensuring human dignity in emergency situations. If they are to have maximum impact they must be planned in a rapid but systematic manner. An appropriate planning process comprises five key stages: rapid assessment and priority setting; outline programme design; immediate action; detailed programme design; and implementation. The assessment should be based on carefully selected data, which are analysed via comparison with suitable minimum objectives. How the intervention should be prioritised is determined through objective ranking of different environmental sanitation sector needs. Next, a programme design outline is produced to identify immediate and longer-term intervention activities and to guarantee that apposite resources are made available. Immediate action is taken to meet acute emergency needs while the detailed programme design takes shape. This entails in-depth consultation with the affected community and comprehensive planning of activities and resource requirements. Implementation can then begin, which should involve pertinent management and monitoring strategies. [source] Implementation of brief alcohol intervention in primary health care: do nurses' and general practitioners' attitudes, skills and knowledge change?DRUG AND ALCOHOL REVIEW, Issue 6 2005MAURI AALTO Abstract Brief alcohol intervention reduces heavy drinking, but its implementation has been challenging. The purpose was to evaluate self-reported changes in attitudes, skills and knowledge regarding brief intervention among nurses and general practitioners (GPs) during an implementation project. A questionnaire survey was used before and after the implementation to all nurses and GPs working at the time in the seven primary health-care centres of the city of Tampere, Finland. Several positive changes indicate an increased amount of knowledge regarding brief intervention among the professionals during the implementation. This was found especially among the nurses. The success in increasing the knowledge can also be seen in a decrease of training needs. Instead, attitudes and skills among the professionals did not seem to develop positively. Increasing motivational skills especially seems to be the future challenge. [source] Implementation of the ,Fresh Start' smoking cessation programme to 23 antenatal clinics: a randomized controlled trial investigating two methods of disseminationDRUG AND ALCOHOL REVIEW, Issue 1 2001MARGARET COOKE Abstract The aim of the research was to investigate the effect of two methods of dissemination on the implementation of a smoking cessation programme and use of smoking cessation interventions in antenatal clinics. A repeated-measures randomized design was used. Hospital antenatal clinics (n = 23) were randomized to simple or intensive dissemination groups. All clinics in NSW with > 500 births were asked to participate. A survey of all clinical staff (n = 323) in 23 antenatal clinics was carried out prior to programme dissemination and 18 months after dissemination (n = 283). The response rate was 63% at baseline and 64% at follow-up. Smoking cessation intervention significantly increased after dissemination. (F (18,1) = 49.26, p < 0.001). The average number of smoking cessation interventions provided by clinics after programme dissemination increased from 4.5 to 7. 48 (mean difference 2.98, t(19) 7.08, n < 0.001, 95% CI (2.1,3.86). Type of dissemination did not influence the number of programme components used or the number of smoking cessation interventions offered. Also, the estimated proportion of clients offered intervention by clinicians did not vary due to type of dissemination. A simple mail-out of a smoking cessation programme to antenatal clinics for use during pregnancy can increase clinician intervention for smoking. When more intensive methods of dissemination are used, the quality of the interventions implemented by clinicians improves. More research on dissemination methods are required as both methods of dissemination did not produce systematic or sustained use of the programme. [source] Alcohol policy in South Africa: a review of policy development processes between 1994 and 2009ADDICTION, Issue 8 2010Charles D. H. Parry ABSTRACT Background Implementation of effective policies to reduce harmful alcohol consumption requires both a good understanding of the policy development process and which strategies are likely to work. Aims To contribute to this understanding by reviewing four specific policy development initiatives that have taken place in South Africa between 1994 and 2009: restrictions on alcohol advertising and counter-advertising, regulation of retail sales of alcohol, alcohol taxation and controls on alcohol packaging. Methods Material was drawn from a record of meetings and conferences held between 1994 and 2009 and a database of reports, newspaper clippings and policy documentation. Findings When the policy process resulted in a concrete outcome there was always a clear recognition of the problem and policy alternatives, but success was more likely if there was an alignment of ,political' forces and/or when there was a determined bureaucracy. The impact of the other factors such as the media, community mobilization, non-governmental organizations (NGOs), the liquor industry and research are also discussed. Future avenues for policy research are identified, including the need for more systematic studies that give greater consideration to economic factors. Conclusions Alcohol policy development in South Africa takes place in a piecemeal fashion and is the product of various competing influences. Having a comprehensive national alcohol strategy cutting across different sectors may be a better way for other developing countries to proceed. [source] The Limits of ex post ImplementationECONOMETRICA, Issue 3 2006Philippe Jehiel The sensitivity of Bayesian implementation to agents' beliefs about others suggests the use of more robust notions of implementation such as ex post implementation, which requires that each agent's strategy be optimal for every possible realization of the types of other agents. We show that the only deterministic social choice functions that are ex post implementable in generic mechanism design frameworks with multidimensional signals, interdependent valuations, and transferable utilities are constant functions. In other words, deterministic ex post implementation requires that the same alternative must be chosen irrespective of agents' signals. The proof shows that ex post implementability of a nontrivial deterministic social choice function implies that certain rates of information substitution coincide for all agents. This condition amounts to a system of differential equations that are not satisfied by generic valuation functions. [source] Implementation of chemometric methodology in ACE: Predictive investigation of protein,ligand bindingELECTROPHORESIS, Issue 16 2007Grady Hanrahan Abstract An ACE predictive investigation of protein,ligand binding using a highly effective chemometric response surface design technique is presented. Here, Kd was estimated using one noninteracting standard which relates to changes in the electrophoretic mobility of carbonic anhydrase B (CAB, EC 4.2.1.1) on complexation with the ligand 4-carboxybenzenesulfonamide (CBSA) present in the electrophoresis buffer. Experimental factors including injection time, capillary length, and applied voltage were selected and tested at three levels in a Box,Behnken design. Statistical analysis results were used to create a mathematical model for response surface prediction via contour and surface plots at a given target response (Kd,=,1.19×10,6,M). As expected, there were a number of predicted solutions that reached our target response based on the significance of each factor at appropriate levels. The adequacy of the model was validated by experimental runs with the predicted model solution (capillary length,=,47,cm, voltage,=,11,kV, injection time,=,0.01,min) presented in detail as an example. [source] Comparison of costs and utilization among buprenorphine and methadone patientsADDICTION, Issue 6 2009Paul G. Barnett ABSTRACT Aims Buprenorphine is an effective alternative to methadone for treatment of opioid dependence, but economic concerns represent a barrier to implementation. The economic impacts of buprenorphine adoption by the US Veterans Health Administration (VHA) were examined. Design Prescriptions of buprenorphine, methadone treatment visits, health-care utilization and cost, and diagnostic data were obtained for 2005. Findings VHA dispensed buprenorphine to 606 patients and methadone to 8191 other patients during the study year. An analysis that controlled for age and diagnosis found that the mean cost of care for the 6 months after treatment initiation was $11 597 for buprenorphine and $14 921 for methadone (P < 0.001). Cost was not significantly different in subsequent months. The first 6 months of buprenorphine treatment included an average of 66 ambulatory care visits, significantly fewer than the 137 visits in methadone treatment (P < 0.001). In subsequent months, buprenorphine patients had 8.4 visits, significantly fewer than the 21.0 visits of methadone patients (P < 0.001). Compared to new methadone episodes, new buprenorphine episodes had 0.634 times the risk of ending [95% confidence interval 0.547,0.736]. Implementation of buprenorphine treatment was not associated with an influx of new opioid-dependent patients. Conclusion Despite the higher cost of medication, buprenorphine treatment was no more expensive than methadone treatment. VHA methadone treatment costs were higher than reported by other providers. Although new buprenorphine treatment episodes lasted longer than new methadone episodes, buprenorphine is recommended for more adherent patients. [source] Increasing hospital-wide delivery of smoking cessation care for nicotine-dependent in-patients: a multi-strategic intervention trialADDICTION, Issue 5 2009Megan Freund ABSTRACT Aims, design and intervention Smoking care provision to in-patients is important in assisting smoking cessation and for management of nicotine withdrawal. Limited studies have reported the effectiveness of interventions designed to increase the hospital-wide provision of such care. A quasi-experimental matched-pair trial, involving two intervention and two control hospitals in NSW, Australia, investigated whether a multi-strategic intervention increased hospital-wide smoking care provision. Participants and measurements Patient surveys (n = 274,347 per experimental condition), medical notes audits (n = 181,228) and health professional surveys (n = 229,302) were used to collect outcome data at baseline and follow-up. Findings Significantly greater increases in intervention hospitals compared to control hospitals were found for patient-reported offer of nicotine replacement therapy (NRT) (intervention 34% versus control 12%), provision of NRT (16% versus 4%) and provision of written resources (11% versus 2%), and for the recording in medical notes of smoking management discussion (13% versus 3%), offer of NRT (24% versus 3%) and provision of NRT (21% versus 5%). Intervention group health professionals reported significantly greater increases in the mean estimate of patients who: had their smoking management discussed (30% versus 17%); were offered or provided with NRT (30% versus 18%); were asked their intention to smoke post-discharge (22% versus 10%); and were provided with discharge NRT (21% versus 4%). Conclusions Implementation of a multi-strategic intervention is effective in increasing hospital smoking care delivery, particularly the provision of NRT. Research is required to identify methods to increase further the delivery of this and other forms of smoking care. [source] Optimizing triage consistency in Australian emergency departments: The Emergency Triage Education KitEMERGENCY MEDICINE AUSTRALASIA, Issue 3 2008Marie Frances Gerdtz Abstract Objective: The Emergency Triage Education Kit was designed to optimize consistency of triage using the Australasian Triage Scale. The present study was conducted to determine the interrater reliability of a set of scenarios for inclusion in the programme. Methods: A postal survey of 237 paper-based triage scenarios was utilized. A quota sample of triage nurses (n = 42) rated each scenario using the Australasian Triage Scale. The scenarios were analysed for concordance and agreement. The criterion for inclusion of the scenarios in the programme was , , 0.6. Results: Data were collected during 2 April to 14 May 2007. Agreement for the set was , = 0.412 (95% CI 0.410,0.415). Of the initial set: 92/237 (38.8%, 95% CI 32.6,45.3) showed concordance ,70% to the modal triage category (, = 0.632, 95% CI 0.629,0.636) and 155/237 (65.4%, 95% CI 59.3,71.5) showed concordance ,60% to the modal triage category (, = 0.507, 95% CI 0.504,0.510). Scenarios involving mental health and pregnancy presentations showed lower levels of agreement (, = 0.243, 95% CI 0.237,0.249; , = 0.319, 95% CI 0.310,0.328). Conclusion: All scenarios that showed good levels of agreement have been included in the Emergency Triage Education Kit and are recommended for testing purposes; those that showed moderate agreement have been incorporated for teaching purposes. Both scenario sets are accompanied by explanatory notes that link the decision outcome to the Australasian College for Emergency Medicine Guidelines on the Implementation of the Australasian Triage Scale. Future analysis of the scenarios is required to identify how task-related factors influence consistency of triage. [source] Implementation of the IPPC Directive and its economic impacts: evidence from the EU steel and glass industryENVIRONMENTAL POLICY AND GOVERNANCE, Issue 3 2008Tilmann Rave Abstract This paper aims at assessing the likely economic impacts of different approaches to implementation of Directive 96/61/EC on integrated pollution prevention and control (IPPC) by establishing a conceptual framework and by providing empirical evidence from case studies in the EU electric steel and domestic glass industry. The potential economic implications of the IPPC permitting process are analysed from the point of view of individual plants. Both plant- and sector-specific factors and the institutional and regulatory context of IPPC implementation in different member states are taken into account. The paper finds only limited evidence of any adverse competitiveness impacts arising from IPPC implementation. Copyright © 2008 John Wiley & Sons, Ltd and ERP Environment. [source] ,Objective-led' SEA in a Scottish local authorityENVIRONMENTAL POLICY AND GOVERNANCE, Issue 3 2004Graham Esson Scottish planners have expanded environmental effect assessment of development plans into the policy appraisal of their sustainability impacts. The application of this methodology is demonstrated in our review of the appraisal of the Perth and Kinross structure plan, which demonstrates the strengths and limitations of this objective-led approach to strategic environmental assessment when compared with a baseline-led one. Scottish Executive interim planning guidance for the European Union directive on strategic environmental assessment integrates the two approaches. This requires the local baseline to be clearly established and plan-induced movements in it to be predicted, monitored and evaluated. It also requires the use of techniques capable of assessing all forms of impact, and better engagement with the public and environmental authorities. Implementation of the directive will tax the capacity of Scottish planning authorities to meet these requirements whilst retaining their preference for an objective-led policy-based approach to assessment. Copyright © 2004 John Wiley & Sons, Ltd and ERP Environment. [source] Emergency Department Information System Implementation and Process Redesign Result in Rapid and Sustained Financial Enhancement at a Large Academic CenterACADEMIC EMERGENCY MEDICINE, Issue 5 2010Jason S. Shapiro MD Abstract Objectives:, The objectives were to measure the financial impact of implementing a fully integrated emergency department information system (EDIS) and determine the length of time to "break even" on the initial investment. Methods:, A before-and-after study design was performed using a framework of analysis consisting of four 15-month phases: 1) preimplementation, 2) peri-implementation, 3) postimplementation, and 4) sustained effects. Registration and financial data were reviewed. Costs and rates of professional and facility charges and receipts were calculated for the phases in question and compared against monthly averages for covariates such as volume, collections rates, acuity, age, admission rate, and insurance status with an autoregressive time series analysis using a segmented model. The break-even point was calculated by measuring cumulative monthly receipts for the last three study phases in excess of the average monthly receipts from the preimplementation phase, corrected for change in volume, and then plotting this against cumulative overall cost. Results:, Time to break even on the initial EDIS investment was less than 8 months. Total revenue enhancement at the end of the 5-year study period was $16,138,953 with an increase of 69.40% in charges and 70.06% in receipts. This corresponds to an increase in receipts per patient from $50 to $90 for professional services and $131 to $183 for facilities charges. Other than volume, there were no significant changes in trends for covariates between the preimplementation and sustained-effects periods. Conclusions:, A comprehensive EDIS implementation with process redesign resulted in sustained increases in professional and facility revenues and a rapid initial break-even point. ACADEMIC EMERGENCY MEDICINE 2010; 17:527,535 © 2010 by the Society for Academic Emergency Medicine [source] Development and Implementation of a Relative Value Scale for Teaching in Emergency Medicine: The Teaching Value UnitACADEMIC EMERGENCY MEDICINE, Issue 8 2003Naghma S. Khan MD Abstract Relative value units exist for measuring clinical productivity. Limited objective measures exist, however, for nonclinical activities, specifically teaching. Objective: To develop an objective measure of teaching productivity linked to a performance-based incentive plan. Methods: Teaching goals and objectives were identified before the 1998,1999 academic year. Teaching value units (TVUs), objective measures for quantifying teaching activities, were developed and assigned based on an estimation of time needed to complete each activity and weighted for importance to the teaching mission. Each physician was allocated teaching time based on past performance and future goals. Targeted TVUs necessary to meet expectations were proportionate to allocated teaching time. Teaching productivity was defined as a percentage of targeted TVUs achieved. Incentive dollars for teaching were distributed based on percentage of targeted TVUs achieved, weighted individually for teaching load. Results: Teaching productivity was evaluated over a three-year period. In year 1, mean TVUs allocated/physician were 181 units (range 25 to 449). Four of 18 physicians (22%) met expectations. The mean individual TVUs achieved were 54% of expected (range 0% to 114%). By year 3, mean TVUs allocated/physician were 179 (range 45 to 629). Twelve of 22 physicians (55%) met expectations. The mean individual TVUs achieved were 82% of expected (range 11% to 146%). Between year 1 and year 3, group productivity increased from 73% to 88%, and mean individual productivity increased from 54% to 82% (p = 0.01). Conclusions: The development of a TVU-based system enabled objective quantification and monitoring of a broad range of teaching activities. The TVU-based system linked to an incentive plan helped to increase individual and group teaching productivity. [source] Endocrine responses of Fundulus heteroclitus to effluent from a bleached-kraft pulp mill before and after installation of reverse osmosis treatment of a waste streamENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 11 2000Monique G. Dubé Abstract Implementation of process changes on the nonbleaching side of bleached kraft pulp mill (BKPM) operations has increased in recent years to maximize resource use and to minimize residual environmental effects of discharged effluents. The objective of this study was to determine if reverse osmosis (RO) treatment of evaporator and digester clean condensates reduced or removed the effects of a BKPM effluent on reproductive endocrine function of the estuarine killifish, Fundulus heteroclitus (mummichog). Comparison of data collected before (1997) and after (1998), the years of the process change, showed that the potential of the combined mill effluent to depress plasma testosterone levels after 30 and 57 d of exposure to an environmentally relevant effluent concentration (1%) was reduced after RO treatment of condensates. However, in vitro production of some sex steroids was depressed with a 1% effluent exposure after the process change. In addition, in 1998, depression of plasma testosterone levels in effluent-exposed fish was present at higher effluent concentrations (5%). These results are significant because they suggest that condensates may be a source of endocrine-disrupting compounds in BKPM effluents and RO may reduce their discharge. [source] Implementation and evaluation of existing guidelines on the use of neurophysiological tests in non-acute migraine patients: a questionnaire survey of neurologists and primary care physiciansEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2009P. Rossi Background and purpose:, The main aims of this study were to evaluate: the diffusion, use and perception of the usefulness of the 2004 EFNS guidelines on neurophysiological testing in non-acute headache patients; the frequency with which the different neurophysiological tests were recommended in non-acute migraine patients by physicians aware or unaware of the guidelines; and the appropriateness of the reasons given for recommending neurophysiological tests. Methods:, One hundred and fifty physicians selected amongst the members of the Italian societies of general practitioner (GPs), neurologists and headache specialists were contacted via e-mail and invited to fill in a questionnaire specially created for the study. Results:, Ninety-two percent of the headache specialists, 8.6% of the neurologists and 0% of the GPs were already aware of the EFNS guidelines. A significantly higher proportion of headache specialists had not recommended any neurophysiological tests to the migraine patients they had seen in the previous 3 months, whereas these tests had frequently been prescribed by the GPs and neurologists. Overall, 80%, 42% and 42.6% of the reasons given by headache specialists, neurologists and GPs, respectively, for recommending neurophysiological testing in their migraine patients were appropriate (P < 0.01). Conclusions:, The diffusion of the EFNS guidelines on neurophysiological tests and neuroimaging procedures was found to be very limited amongst neurologists and GPs. The physicians aware of the EFNS guidelines recommended neurophysiological tests to migraine patients less frequently and more appropriately than physicians who were not aware of them. The most frequent misconceptions regarding neurophysiological tests concerned their perceived capacity to discriminate between migraine and secondary headaches or between migraine and other primary headaches. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||