Do Context-Sensitive Solutions Really Work?

2008 ◽  
Vol 2060 (1) ◽  
pp. 107-115 ◽  
Author(s):  
Lisa Olszak ◽  
Robert Goldbach ◽  
James Long
Keyword(s):  
Information Exchange ◽  
Cost Savings ◽  
Interdisciplinary Approach ◽  
Cost Effective ◽  
Lessons Learned ◽  
Future Research ◽  
Project Schedule ◽  
Context Sensitive ◽  
Community Stakeholders ◽  
Underlying Principle

Most state transportation agencies tout context-sensitive solutions (CSS) as an underlying principle in their approach to transportation project development. FHWA defines CSS as “a collaborative, interdisciplinary approach that involves all stakeholders to develop a transportation facility that fits its physical setting and preserves scenic, aesthetic, historic and environmental resources while maintaining safety and mobility.” The purpose of this research was to apply TRB CSS measurement criteria to test whether a well-planned CSS strategy contributes to a safe, cost-effective transportation project that is integrated within the fabric of the community. Olszak Management Consulting, Inc.—with support from FHWA and the Pennsylvania Turnpike Commission (PTC)—evaluated a CSS approach to an FHWA major highway project, The Mon/Fayette Expressway. PTC empowered five design advisory teams (DATs) made up of technical and community members to make decisions about critical design issues. Olszak's evaluation efforts focused on DAT stakeholder and multidisciplinary team performance activities that spanned 24 months of preliminary design. Surveys of designers, meeting facilitators, community stakeholders, and project leaders yielded strong evidence of satisfaction with both processes and outcomes. Cost savings were indicated and the project schedule was maintained. This paper details the DAT structure and functions, methods for documentation and information exchange, reliability of metrics, research findings, lessons learned, and suggestions for future research.

Abstract 53: Results Of The Nashville Barber-pharmacist Hypertension Management Pilot Study

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Jarod Parrish ◽  
Ciantel A Blyler ◽  
Henry E Okafor ◽  
L. Cindy Chang ◽  
Devika Nair ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pilot Study ◽  
Los Angeles ◽  
Care Delivery ◽  
Medication Management ◽  
Lessons Learned ◽  
Future Research ◽  
Hypertension Management ◽  
Male Clients ◽  
Community Stakeholders

Background: The Los Angeles Barbershop Blood Pressure Study (LABBPS) demonstrated that collaboration between barbers and pharmacists delivering hypertension management could significantly improve blood pressure as well as access to care. It is unknown if this model can be translated to other locations. This single-arm, proof-of-concept pilot study tested the development and implementation of a similar protocol in Nashville, TN (NCT04232124). Methods: Between 2019 and 2021, community stakeholders, clinicians, investigators, and the LABBPS team convened to adapt the study design and protocol. Established barbershops with barbers willing to be trained on study procedures were recruited as study sites. Non-Hispanic Black male clients, aged 35-79 years with systolic blood pressure (SBP) > 140 mmHg on two screening days were eligible for participation. Enrolled participants met with a pharmacist for lifestyle and medication management at least once monthly for a six-month period. Barbers measured blood pressure during haircuts for additional monitoring. Results: Eight barbershops in business for an average of 20 (± 5) years participated in the trial. Barbers from each shop (range: 1-4) were trained. A total of 419 clients completed screening visit 1, 82 were eligible and 52 (12%) completed visit 2. We enrolled 36, with 30 completing the initial clinical visit and 27 had complete data at 6-months. Participants were on average age 50 (± 10) years, had a body mass index 33 (± 6), 44% were currently smoking, 52% with high school or less education, and 56% reported current primary care. Baseline BP 157.7±17.1/ 95.1±13.9 mmHg improved to 125.7±11.9/75.6±9.5, a change of -32.1±21.6/ -19.5±14.1, respectively. At 6-months 85% of the group had a BP<140/90, 74% BP<135/85, and 67% BP<130/80. At baseline 15% of participants reported health as excellent/very good and this increased to 56% at 6-months (p=0.002). Adverse reactions reported were minimal. Conclusion: Implementation of the barber-pharmacist model of hypertension management and care delivery improved BP control among hypertensive Black men in Nashville. Lessons learned regarding adaptation overcoming unforeseen barriers will inform expansion into additional naïve locations for future research.

Pushing the Operational Envelope of a Cap-Rock Restoration Campaign Utilizing Perforate Wash Cement Technology and a Hydraulic Work Over Unit Offshore Malaysia

2021 ◽  
Author(s):  
Mohamad Anas Abdul Razak ◽  
Ahmad Zawawi Abdul Rajab ◽  
Jay Sern Chew ◽  
John Brian Chesson ◽  
Susin Lim
Keyword(s):  
Risk Mitigation ◽  
Cost Savings ◽  
Cost Effective ◽  
Lessons Learned ◽  
Strict Adherence ◽  
Washing Process ◽  
Challenges And Opportunities ◽  
Sustained Casing Pressure ◽  
Cap Rock ◽  
Operational Envelope

Abstract Malaysia's government recognizes the high risk that aging idle wells pose to its health, safety and environment and has developed some of the most stringent plug and abandonment, P&A, regulations to protect its future. Corroded casing strings and sustained casing pressure are common issues on its multi-decade old platforms and a risk-based design philosophy has been adopted to balance risk mitigation and operational costs, while still ensuring an eternal barrier. Both conventional rigs as well as rigless hydraulic workover units, HWU, are being used for P&A operations. This study considers the barrier element rationale applied in four offshore wells that were plug and abandoned by cap-rock restoration Perforate, Wash, Cement, PWC, barrier plugs. It also considers the operating window of a jet-based PWC technology to understand the challenges and opportunities for further optimization during HWU operations. Cap rock restoration utilizing both cup-based and jet-based PWC technology is being widely applied throughout Malaysia as a cost-effective alternative to casing section milled barrier plugs. Malaysia's P&A regulation allows isolation at the cap rock level, whereby "Contractor shall adhere to the Cap-Rock Abandonment Applicability Flowchart to identify technically and commercially acceptable candidates for this well abandonment method." The PWC method enables cap rock restoration in a single trip process; whereby the casing annulus is accessed by TCP guns to allow for annular debris to be effectively washed prior to cement plug placement. The process is not limited only to TCP guns; as a mechanical casing perforator was utilized in a shallow cased hole section of one of the wells to avoid damaging the outer casing. A custom BHA was developed and tested to match the cuts from the mechanical perforator. Specially oriented, rotating, wash jets were configured to maximize the annular access during the washing process. The washing effectiveness of this new BHA was confirmed by the massive amount of annular debris that was observed over the surface shakers. Operations were conducted offshore with a HWU with limited infrastructure and operating capability compared to a conventional rig. A PWC candidate screening matrix was applied early during the planning phase to manage rig limitation, well condition and operational risk to ensure successful barrier placement. All cap rock barriers were successfully installed and tested, and no sustained annular pressure remained in any of the wells. Fewer PWC plugs were required than originally planned, due to strict adherence to the Caprock Restoration Plan Decision Tree, resulting in significant cost savings for the project. The detailed time breakdown of the HWU operations provides useful insight into the operational efficiencies and unplanned events during the HWU campaign and lessons learned are shared from the project.

Drilling with Glass and Air: Using Hollow Glass Spheres to Address a Wide Ranging Drilling Challenge in a Safe, Efficient and Cost-Effective Manner

2021 ◽  
Author(s):  
M.. Rylance ◽  
Y.. Tuzov ◽  
V.. Sherishorin
Keyword(s):  
Scale Up ◽  
Cost Savings ◽  
Cost Effective ◽  
Lessons Learned ◽  
Successful Outcome ◽  
Drilling Fluids ◽  
Eastern Siberia ◽  
Hollow Glass ◽  
Glass Spheres ◽  
Effective Manner

Abstract A major development with multiple rigs delivering extensive multi-laterals encountered a pervasive mud-window issue within the reservoir. The resulting severe mud losses, extensive NPT and formation-damage was also deteriorating with time due to depletion. Conventional approaches to stem losses had failed and adoption of an energized mud-system with acceptable Effective Circulating Density (ECD) was not considered cost effective, pragmatic nor safe. Instead a novel application using Hollow-Glass-Spheres (HGS) was trialled, that demonstrated an effective and highly successful outcome. With 10 rigs drilling 60-70 wells per-year, each with 5,500 to 6,750m in the reservoir, quick resolution of the issue was required. For these reasons the Team at bp Russia looked carefully at alternatives that might fit the mud-window, but that offered a realistic approach for the environment and conditions in Eastern Siberia. The Team identified HGS as an approach to lighten the mud, often used for cementing ECD, application for drilling has been limited. For this approach we required an option with broad capabilities that could be scaled-up and exported to other development areas where such issues existed. This paper will report on the planning, delivery, and execution of a pilot on the Sb. field at TYNGD, in Eastern Siberia. Initially deployed on three wells, including multi-laterals, the paper will walk through the engineering considerations, during the planning and execution phases. Reporting comprehensively on the data gathered and the many lessons learned during the incremental and stepwise deployment. Data will be provided that demonstrated loss-free drilling was achieved where this had not occurred before, with a dramatic reduction in NPT, FLA needs and costs. The paper will also report on the post drilling productivity and comparison with offset wells drilled with conventional mud systems and suffering severe losses. The results of this pilot have beaten all expectations, there have been many insights and the Team are now looking to set a timetable to scale-up across the NOJV. Much has been learned, waste HGS material has been demonstrated to be an effective FLA pill in other sections of the well and centralisation of mud process may offer additional cost savings and improvements. Further efficiencies are expected to be achieved and potential across the Company portfolio could be a major game changer. HGS for cementing is well documented, application for drilling fluids has been less reported and almost exclusively applied to one-off sections/wells. The TYNGD application is novel as this is a major new development with 10 drilling rigs. Application is on multi-laterals and prior offset wells are available for direct comparison. The results of the approach demonstrate a new way of performing well construction in an effective manner for major Field Developments where losses are prevalent.

scholarly journals Supporting Expectant and Parenting Teens: New Evidence to Inform Future Programming and Research

2020 ◽  
Vol 24 (S2) ◽  
pp. 67-75
Author(s):  
Jessica F. Harding ◽  
Susan Zief ◽  
Amy Farb ◽  
Amy Margolis
Keyword(s):  
Quantitative Methods ◽  
Cost Effective ◽  
Lessons Learned ◽  
Future Research ◽  
Federal Programs ◽  
Qualitative And Quantitative Methods ◽  
Teen Parents ◽  
Health Journal ◽  
The Right ◽  
New Evidence

Abstract Until recently, federal programs had not explicitly focused on improving the outcomes of highly vulnerable teen parents. Established in 2010, the Pregnancy Assistance Fund (PAF) aims to improve the health, social, educational, and economic outcomes for expectant and parenting teens and young adults, their children, and their families, through providing grants to states and tribes. This article introduces the Maternal and Child Health Journal supplement “Supporting Expectant and Parenting Teens: The Pregnancy Assistance Fund,” which draws together the perspectives of researchers and practitioners to provide insights into serving expectant and parenting teens through the PAF program. The articles in the supplement include examples of programs that use different intervention strategies to support teen parents, with programs based in high school, college, and community settings in both urban and rural locations. Some of the articles provide rigorous evidence of what works to support teen parents. In addition, the articles demonstrate key lessons learned from implementation, including allowing some flexibility in implementation while clearly outlining core programmatic components, using partnerships to meet the multifaceted needs of young parents, hiring the right staff and providing extensive training, using strategies for engaging and recruiting teen parents, and planning for sustainability early. The studies use a range of qualitative and quantitative methods to evaluate programs to support teen parents, and three articles describe how to implement innovative and cost effective methods to evaluate these kinds of programs. By summarizing findings across the supplement, we increase understanding of what is known about serving expectant and parenting teens and point to next steps for future research.

Web-Based Risk and Hazard Identification and Screening

2000 ◽  
Author(s):  
John L. Steele ◽  
Evaristo J. Bonano
Keyword(s):  
Management System ◽  
Safety Management ◽  
Cost Savings ◽  
Cost Effective ◽  
Lessons Learned ◽  
Hazard Identification ◽  
Department Of Energy ◽  
Assessment Process ◽  
Safety Management System ◽  
Effective Manner

Abstract Organizations, both in the private and public sector, need to avoid to the extent practicable, workplace hazards and minimize the associated risks in order to comply with regulations. However, they have also recognized that this is a sound business practice that could result in significant cost savings by avoiding fines and penalties due to non-compliance and enhanced productivity. Consequently, many organizations have instituted safe work practices into their operations and those practices have become a major criterion in evaluating managers’ performance. This new philosophy is now commonly referred to as “Integrated Safety Management.” Per the direction of the Secretary of Energy, all U. S. Department of Energy (“DOE”) facilities across the country have been instructed to implement an Integrated Safety Management System. Different DOE facilities have taken various approaches to the implementation of the system. This paper describes the approach instituted at Sandia National Laboratories and a tool that was developed from lessons learned during that effort. The tool is the cornerstone for implementing an Integrated Safety Management System in a time and cost-effective manner. The tool is now commercially available and can be readily rendered applicable to any type of systematic assessment process.

Health Information Exchange for Improving the Efficiency and Quality of Healthcare Delivery

2011 ◽  
pp. 352-374 ◽  
Author(s):  
Jing Shi ◽  
Sudhindra Upadhyaya ◽  
Ergin Erdem
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Critical Role ◽  
Healthcare Delivery ◽  
Cost Effective ◽  
Quality Of Healthcare ◽  
Future Research ◽  
The Right

In healthcare industry, providers, patients, and all other stakeholders must have the right information at the right time for achieving efficient and cost effective services. Exchange of information between the heterogeneous system entities plays a critical role. Health information exchange (HIE) is not only a process of transmitting data, but also a platform for streamlining operations to improve healthcare delivery in a secure manner. In this chapter, we present a comprehensive view of electronic health record (EHR) systems and HIE by presenting their architecture, benefits, challenges, and other related issues. While providing information on the current state of EHR/HIE applications, we also discuss advanced issues and secondary uses of HIE implementations, and shed some light on the future research in this area by highlighting the challenges and potentials.

scholarly journals A Direct Reporting Platform for Financial Exploitation: From Banks to APS

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 696-696
Author(s):  
Jason Burnett ◽  
Sally Reisch ◽  
Geoffrey Rogers
Keyword(s):  
Financial Services ◽  
Information Exchange ◽  
Lessons Learned ◽  
Future Research ◽  
Protective Services ◽  
Adult Protective Services ◽  
Major Barrier ◽  
Financial Exploitation ◽  
Platform Development ◽  
Victims Of Crime

Abstract Despite encouraging changes in regulations and practices, opportunities remain to strengthen the collaboration between Financial Services Institutions (FSI) and Financial Exploitation (FE) investigative agencies such as Adult Protective Services (APS). A major barrier to these collaborations is timely and effective information exchange, between the agencies, for maximizing client protection. Often times, the need for more information from the agencies involved delays or mitigates the provision of financial protection to the client/victim. Through the U.S. Office for Victims of Crime, funding has been provided to develop a single reporting platform for enhancing communication and collaboration between FSI and APS. The helpful platform provides an innovative conduit for providing timely and effective information exchange between FSI and APS agencies to better serve and protect older adults against FE. This presentation will discuss the platform development, the lessons learned, preliminary data and future research. Part of a symposium sponsored by Abuse, Neglect and Exploitation of Elderly People Interest Group.

Health Information Exchange for Improving the Efficiency and Quality of Healthcare Delivery

2012 ◽  
pp. 714-736 ◽  
Author(s):  
Jing Shi ◽  
Sudhindra Upadhyaya ◽  
Ergin Erdem
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Critical Role ◽  
Healthcare Delivery ◽  
Cost Effective ◽  
Quality Of Healthcare ◽  
Future Research ◽  
The Right

In healthcare industry, providers, patients, and all other stakeholders must have the right information at the right time for achieving efficient and cost effective services. Exchange of information between the heterogeneous system entities plays a critical role. Health information exchange (HIE) is not only a process of transmitting data, but also a platform for streamlining operations to improve healthcare delivery in a secure manner. In this chapter, we present a comprehensive view of electronic health record (EHR) systems and HIE by presenting their architecture, benefits, challenges, and other related issues. While providing information on the current state of EHR/HIE applications, we also discuss advanced issues and secondary uses of HIE implementations, and shed some light on the future research in this area by highlighting the challenges and potentials.

scholarly journals The Air Force Visiting Surgeon Program: Development, Outcomes, and Future Application

2021 ◽  
Author(s):  
Justin P Fox ◽  
Kerry P Latham
Keyword(s):  
Plastic Surgery ◽  
Air Force ◽  
Surgical Care ◽  
Cost Savings ◽  
Cost Effective ◽  
Senior Author ◽  
Lessons Learned ◽  
Future Application ◽  
Military Health ◽  
Effective Manner

ABSTRACT Introduction Active duty service members and their families have limited access to subspecialty surgical care when assigned OCONUS. To address this issue, the Air Force Visiting Surgeon Program (VSP) was created to push subspecialty care to these locations. Visiting Surgeon Program was accomplished using temporary duty (TDY) orders. We conducted this 12-year review, 2009-2021, of the program to assess objective measures of impact, identify key lessons learned, and consider the program’s future. Materials and Methods In 2009, the senior author, Col Latham, performed a cost analysis of plastic surgery care provided at OCONUS installations and found that TRICARE Overseas often paid rates substantially higher than a TDY assignment for a single procedure. To improve beneficiaries’ access to care while providing a cost savings to the health care system, 2-week plastic surgery missions were proposed to interested OCONUS military treatment facilities (MTFs). Ultimately, four sites selected to host the program in Alaska, Italy, England, and Japan. These sites were selected based on patient volumes, operating room capacity, and local command and surgeon support. By 2015, the Air Force formalized the program via Air Force Instruction 44-102 which outlined roles and responsibilities of MTF Commanders; established points of contact; and instituted key safety measures. Results To date, 58 missions have been completed by 21 surgeons through the VSP at Aviano Air Base (Italy; 24.1%), Joint Base Elmendorf-Richardson (Alaska; 31.0%), Royal Air Force Lakenheath (England; 27.6%), and Yokota Air Base (Japan; 17.2%). While primarily an Air Force program, 17% (10/58) of missions were supported Army or Navy surgeons. Overall, 2,000 patient consultations and 865 surgical cases were performed avoiding $6.7 million in cost. In addition to direct beneficiary care, the VSP also contributed to the participating surgeon and host surgical teams mission readiness. Conclusions The VSP provides a template to make select subspecialty surgical care available in a cost-effective manner across the military health system, while also providing a model for the forward deployment of military plastic surgeons and triservice collaboration.

A Cost-Effective Interdisciplinary Approach to Microbiologic Send-Out Test Use

2014 ◽  
Vol 139 (2) ◽  
pp. 194-198 ◽  
Author(s):  
Scott W. Aesif ◽  
David M. Parenti ◽  
Linda Lesky ◽  
John F. Keiser
Keyword(s):  
Clinical Laboratory ◽  
Cost Savings ◽  
Clinical Pathology ◽  
Interdisciplinary Approach ◽  
Cost Effective ◽  
The United States ◽  
House Staff ◽  
University Hospital ◽  
Clinical Indication ◽  
Face To Face

Context Use of reference laboratories for selected laboratory testing (send-out tests) represents a significant source of laboratory costs. As the use of more complex molecular analyses becomes common in the United States, strategies to reduce costs in the clinical laboratory must evolve in order to provide high-value, cost-effective medicine. Objective To report a strategy that employs clinical pathology house staff and key hospital clinicians in the effective use of microbiologic send-out testing. Design The George Washington University Hospital is a 370-bed academic hospital in Washington, DC. In 2012 all requisitions for microbiologic send-out tests were screened by the clinical pathology house staff prior to final dispensation. Tests with questionable utility were brought to the attention of ordering clinicians through the use of interdisciplinary rounds and direct face-to-face consultation. Results Screening resulted in a cancellation rate of 38% of send-out tests, with proportional cost savings. Nucleic acid tests represented most of the tests screened and the largest percentage of cost saved through screening. Following consultation, requested send-out tests were most often canceled because of a lack of clinical indication. Conclusions Direct face-to-face consultation with ordering physicians is an effective, interdisciplinary approach to managing the use of send-out testing in the microbiology laboratory.

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