Health outcomes, quality improvement and cost-effectiveness of the Community Diabetes Education (CoDE) program: Results of a randomized controlled trial

The objectives of this dissertation were to evaluate health outcomes, quality improvement measures, and the long-term cost-effectiveness and impact on diabetes-related microvascular and macrovascular complications of a community health worker-led culturally tailored diabetes education and management intervention provided to uninsured Mexican Americans in an urban faith-based clinic. A prospective, randomized controlled repeated measures design was employed to compare the intervention effects between: (1) an intervention group (n=90) that participated in the Community Diabetes Education (CoDE) program along with usual medical care; and (2) a wait-listed comparison group (n=90) that received only usual medical care. Changes in hemoglobin A1c (HbA1c) and secondary outcomes (lipid status, blood pressure and body mass index) were assessed using linear mixed-models and an intention-to-treat approach. The CoDE group experienced greater reduction in HbA1c (-1.6%, p<.001) than the control group (-.9%, p<.001) over the 12 month study period. After adjusting for group-by-time interaction, antidiabetic medication use at baseline, changes made to the antidiabetic regime over the study period, duration of diabetes and baseline HbA1c, a statistically significant intervention effect on HbA1c (-.7%, p=.02) was observed for CoDE participants. Process and outcome quality measures were evaluated using multiple mixed-effects logistic regression models. Assessment of quality indicators revealed that the CoDE intervention group was significantly more likely to have received a dilated retinal examination than the control group, and 53% achieved a HbA1c below 7% compared with 38% of control group subjects. Long-term cost-effectiveness and impact on diabetes-related health outcomes were estimated through simulation modeling using the rigorously validated Archimedes Model. Over a 20 year time horizon, CoDE participants were forecasted to have less proliferative diabetic retinopathy, fewer foot ulcers, and reduced numbers of foot amputations than control group subjects who received usual medical care. An incremental cost-effectiveness ratio of $355 per quality-adjusted life-year gained was estimated for CoDE intervention participants over the same time period. The results from the three areas of program evaluation: impact on short-term health outcomes, quantification of improvement in quality of diabetes care, and projection of long-term cost-effectiveness and impact on diabetes-related health outcomes provide evidence that a community health worker can be a valuable resource to reduce diabetes disparities for uninsured Mexican Americans. This evidence supports formal integration of community health workers as members of the diabetes care team.^

State rate -setting in conjunction with Medicare prospective payment: The effects of the Maine program

Maine implemented a hospital rate-setting program in 1984 at approximately the same time as Medicare started the Prospective Payment System (PPS). This study examines the effectiveness of the program in controlling cost over the period 1984-1989. Hospital costs in Maine are compared to costs in 36 non rate-setting states and 11 other rate-setting states. Changes in cost per equivalent admission, adjusted patient day, per capita, admissions, and length of stay are described and analyzed using multivariate techniques. A number of supply and demand variables which were expected to influence costs independently of rate-setting were controlled for in the study. Results indicate the program was effective in containing costs measured in terms of cost per adjusted patient day. However, this was not true for the other two cost variables. The average length of stay increased during the period in Maine hospitals indicating an association with rate-setting. Several supply variables, especially the number of beds per 1,000 population were strongly associated with the cost and use of hospitals. ^

Abundance of mesozooplankton in the western part of the Black Sea in 1995 during the Cooperative Marine Science Program for the Black Sea (CoMSBlack)

The "CoMSBlack-95" dataset is based on samples collected in the summer of 1995. The whole dataset is composed of 81 samples (28 stations) with data of zooplankton species composition, abundance and biomass. Samples were collected in discrete layers 0-10, 0-20, 0-50, 10-25, 25-50, 50-100 and from bottom up to the surface at depths depending on water column stratification and the thermocline depth. Zooplankton samples were collected with vertical closing Juday net,diameter - 36 cm, mesh size 150 µm. Tows were performed from surface down to bottom meters depths in discrete layers. Samples were preserved by a 4% formaldehyde sea water buffered solution. Sampling volume was estimated by multiplying the mouth area with the wire length. Mesozooplankton abundance: The collected material was analysed using the method of Domov (1959). Samples were brought to volume of 25-30 ml depending upon zooplankton density and mixed intensively until all organisms were distributed randomly in the sample volume. After that 5 ml of sample was taken and poured in the counting chamber which is a rectangle form for taxomomic identification and count. Large (> 1 mm body length) and not abundant species were calculated in whole sample. Counting and measuring of organisms were made in the Dimov chamber under the stereomicroscope to the lowest taxon possible. Taxonomic identification was done at the Institute of Oceanology by Asen Konsulov and Lyudmila Kamburska using the relevant taxonomic literature (Mordukhay-Boltovskoy, F.D. (Ed.). 1968, 1969,1972). Taxon-specific abundance: The collected material was analysed using the method of Domov (1959). Samples were brought to volume of 25-30 ml depending upon zooplankton density and mixed intensively until all organisms were distributed randomly in the sample volume. After that 5 ml of sample was taken and poured in the counting chamber which is a rectangle form for taxomomic identification and count. Copepods and Cladoceras were identified and enumerated; the other mesozooplankters were identified and enumerated at higher taxonomic level (commonly named as mesozooplankton groups). Large (> 1 mm body length) and not abundant species were calculated in whole sample. Counting and measuring of organisms were made in the Dimov chamber under the stereomicroscope to the lowest taxon possible. Taxonomic identification was done at the Institute of Oceanology by Asen Konsulov and Lyudmila Kamburska using the relevant taxonomic literature (Mordukhay-Boltovskoy, F.D. (Ed.). 1968, 1969,1972).

Accident Management Actions In An Upper-Head Small-Break Loss-Of-Coolant Accident With High-Pressure Safety Injection Failed

Since the Three Mile Island accident, an important focus of pressurized water reactor (PWR) transient analyses has been a small-break loss-of-coolant accident (SBLOCA). In 2002, the discovery of thinning of the vessel head wall at the Davis Besse nuclear power plant reactor indicated the possibility of an SBLOCA in the upper head of the reactor vessel as a result of circumferential cracking of a control rod drive mechanism penetration nozzle - which has cast even greater importance on the study of SBLOCAs. Several experimental tests have been performed at the Large Scale Test Facility to simulate the behavior of a PWR during an upper-head SBLOCA. The last of these tests, Organisation for Economic Co-operation and Development Nuclear Energy Agency Rig of Safety Assessment (OECD/NEA ROSA) Test 6.1, was performed in 2005. This test was simulated with the TRACE 5.0 code, and good agreement with the experimental results was obtained. Additionally, a broad analysis of an upper-head SBLOCA with high-pressure safety injection failed in a Westinghouse PWR was performed taking into account different accident management actions and conditions in order to check their suitability. This issue has been analyzed also in the framework of the OECD/NEA ROSA project and the Code Applications and Maintenance Program (CAMP). The main conclusion is that the current emergency operating procedures for Westinghouse reactor design are adequate for these kinds of sequences, and they do not need to be modified.

Training project management complexity in postgraduate and continuing education programs: a learning strategy in the eshe (European Space of Higher Education) framework

The objective of this paper is to address the methodological process of a teaching strategy for training project management complexity in postgraduate programs. The proposal is made up of different methods —intuitive, comparative, deductive, case study, problem-solving Project-Based Learning— and different activities inside and outside the classroom. This integration of methods motivated the current use of the concept of “learning strategy”. The strategy has two phases: firstly, the integration of the competences —technical, behavioral and contextual—in real projects; and secondly, the learning activity was oriented in upper level of knowledge, the evaluating the complexity for projects management in real situations. Both the competences in the learning strategy and the Project Complexity Evaluation are based on the ICB of IPMA. The learning strategy is applied in an international Postgraduate Program —Erasmus Mundus Master of Science— with the participation of five Universities of the European Union. This master program is fruit of a cooperative experience from one Educative Innovation Group of the UPM -GIE-Project-, two Research Groups of the UPM and the collaboration with other external agents to the university. Some reflections on the experience and the main success factors in the learning strategy were presented in the paper

Training project management complexity in postgraduate and continuing education programs: a learning strategy in the eshe (European Space of Higher Education) framework

The objective of this paper is to address the methodological process of a teaching strategy for training project management complexity in postgraduate programs. The proposal is made up of different methods —intuitive, comparative, deductive, case study, problem-solving Project-Based Learning— and different activities inside and outside the classroom. This integration of methods motivated the current use of the concept of ―learning strategy‖. The strategy has two phases: firstly, the integration of the competences —technical, behavioral and contextual—in real projects; and secondly, the learning activity was oriented in upper level of knowledge, the evaluating the complexity for projects management in real situations. Both the competences in the learning strategy and the Project Complexity Evaluation are based on the ICB of IPMA. The learning strategy is applied in an international Postgraduate Program —Erasmus Mundus Master of Science— with the participation of five Universities of the European Union. This master program is fruit of a cooperative experience from one Educative Innovation Group of the UPM -GIE-Project-, two Research Groups of the UPM and the collaboration with other external agents to the university. Some reflections on the experience and the main success factors in the learning strategy were presented in the paper.

Reaching the unreached: An initiative to bridge the gap between the gap by active role of management institutes/schools

There are large numbers of business communities in India which neither had any formal education nor they took any professional training but still they contribute in successful business formation. Their presence can be felt in all areas of business. Still there is a big professional gap between the educational institutes, specially the B-Schools and this independent business community. With the help of this paper an effort is made to develop a Two-Way learning relationship for the mutual benefit of both entities. It will also highlight the role of an educational institute beyond academics for the well being of society. This may lead to derive and develop the exchange of innovative business ideas and framing the suitable policies for long term sustainability in today´s competitive arena. The study conducted by researcher with a sample size of 100 which includes a mix of well known academic professionals, MBA students and non academic business professionals has revealed that there is a need of an exchange program for the mutual benefits. There exists a big professional gap in this area which can be filled with the active and effective initiative by management institutes. An effort is made in this paper to highlight this gap and to suggest some framework to bridge the gap

Sustainable Air Traffic Management System Development Methodology

As it is defined in ATM 2000+ Strategy (Eurocontrol 2001), the mission of the Air Traffic Management (ATM) System is: “For all the phases of a flight, the ATM system should facilitate a safe, efficient, and expedite traffic flow, through the provision of adaptable ATM services that can be dimensioned in relation to the requirements of all the users and areas of the European air space. The ATM services should comply with the demand, be compatible, operate under uniform principles, respect the environment and satisfy the national security requirements.” The objective of this paper is to present a methodology designed to evaluate the status of the ATM system in terms of the relationship between the offered capacity and traffic demand, identifying weakness areas and proposing solutions. The first part of the methodology relates to the characterization and evaluation of the current system, while a second part proposes an approach to analyze the possible development limit. As part of the work, general criteria are established to define the framework in which the analysis and diagnostic methodology presented is placed. They are: the use of Air Traffic Control (ATC) sectors as analysis unit, the presence of network effects, the tactical focus, the relative character of the analysis, objectivity and a high level assessment that allows assumptions on the human and Communications, Navigation and Surveillance (CNS) elements, considered as the typical high density air traffic resources. The steps followed by the methodology start with the definition of indicators and metrics, like the nominal criticality or the nominal efficiency of a sector; scenario characterization where the necessary data is collected; network effects analysis to study the relations among the constitutive elements of the ATC system; diagnostic by means of the “System Status Diagram”; analytical study of the ATC system development limit; and finally, formulation of conclusions and proposal for improvement. This methodology was employed by Aena (Spanish Airports Manager and Air Navigation Service Provider) and INECO (Spanish Transport Engineering Company) in the analysis of the Spanish ATM System in the frame of the Spanish airspace capacity sustainability program, although it could be applied elsewhere.

Determining practices achievement in the requirement management process using a two-stage questionnaire

This paper aims to obtain a baseline snapshot of the requirement management process using a two-stage questionnaire to identify both performed and non-performed CMMI practices. The questionnaire proposed in this paper may help with the assessment of the requirement management process, provide useful information related to the current state of the process, and indicate those practices that require immediate attention with the aim of begin a Software Process Improvement program.

Configuration management and product lines to enhance the replication process in software engineering

This research is concerned with the experimental software engineering area, specifically experiment replication. Replication has traditionally been viewed as a complex task in software engineering. This is possibly due to the present immaturity of the experimental paradigm applied to software development. Researchers usually use replication packages to replicate an experiment. However, replication packages are not the solution to all the information management problems that crop up when successive replications of an experiment accumulate. This research borrows ideas from the software configuration management and software product line paradigms to support the replication process. We believe that configuration management can help to manage and administer information from one replication to another: hypotheses, designs, data analysis, etc. The software product line paradigm can help to organize and manage any changes introduced into the experiment by each replication. We expect the union of the two paradigms in replication to improve the planning, design and execution of further replications and their alignment with existing replications. Additionally, this research work will contribute a web support environment for archiving information related to different experiment replications. Additionally, it will provide flexible enough information management support for running replications with different numbers and types of changes. Finally, it will afford massive storage of data from different replications. Experimenters working collaboratively on the same experiment must all have access to the different experiments.

A Three-Dimensional B.I.E.M. Program

The program PECET (Boundary Element Program in Three-Dimensional Elasticity) is presented in this paper. This program, written in FORTRAN V and implemen ted on a UNIVAC 1100,has more than 10,000 sentences and 96 routines and has a lot of capabilities which will be explained in more detail. The object of the program is the analysis of 3-D piecewise heterogeneous elastic domains, using a subregionalization process and 3-D parabolic isopara, metric boundary elements. The program uses special data base management which will be described below, and the modularity followed to write it gives a great flexibility to the package. The Method of Analysis includes an adaptive integration process, an original treatment of boundary conditions, a complete treatment of body forces, the utilization of a Modified Conjugate Gradient Method of solution and an original process of storage which makes it possible to save a lot of memory.

PREPARATION AND MANAGEMENT OF THE MSc PROGRAME IN ENVIRONMENTAL SECURITY

Authors proposed an MSc Program related to Environmental Security and Management. This program endeavors to prepare students for the regional and global postgraduate job market.

Agent-based modeling and simulation for the design of the future european Air Traffic Management system: the experience of CASSIOPEIA

The SESAR (Single European Sky ATM Research) program is an ambitious re-search and development initiative to design the future European air traffic man-agement (ATM) system. The study of the behavior of ATM systems using agent-based modeling and simulation tools can help the development of new methods to improve their performance. This paper presents an overview of existing agent-based approaches in air transportation (paying special attention to the challenges that exist for the design of future ATM systems) and, subsequently, describes a new agent-based approach that we proposed in the CASSIOPEIA project, which was developed according to the goals of the SESAR program. In our approach, we use agent models for different ATM stakeholders, and, in contrast to previous work, our solution models new collaborative decision processes for flow traffic management, it uses an intermediate level of abstraction (useful for simulations at larger scales), and was designed to be a practical tool (open and reusable) for the development of different ATM studies. It was successfully applied in three stud-ies related to the design of future ATM systems in Europe.

Project Management : Gestión de la remedición mediambiental de las plantas de gas manufacturado

Para hacerse cargo del legado de las Plantas de Gas Manufacturado (MGP) en el Estado de Nueva York, la División de Remediación Medioambiental del Departamento de Conservación Medioambiental, creo las Investigaciones de las áreas afectadas y el Programa de Remediación Medioambiental. Con el paso de los años, la conciencia y entendimiento de la importancia y complejidad de estos proyectos fue creciendo, ya que las investigaciones realizadas daban fe del tamaño y extensión de la contaminación asociada a las plantas de gas manufacturado, propiedad ahora de las diversas compañías de gas que operan a lo largo y ancho del Estado de Nueva York. Tras varios años dentro del Programa de Remediación Medioambiental, muchas de estas compañías han intentado manejar estos vastos y complejos proyectos como han podido, dejándose llevar un poco, subestimando y pasando por alto muchos detalles, ya que al fin y al cabo son proyecto regulados por el estado y que, por tanto, son financiados enteramente por este. Esto ha ido causando en los últimos años grandes problemas a algunas Compañías que a la hora de reportar estos proyectos se han encontrado con una falta total de control y grandes lagunas que resolver. Una técnica para resolver estos problemas es hacer uso de grandes técnicas de gestión empresarial como es el Project Management. En este proyecto se exponen y desarrollan las técnicas que han de utilizarse para integrar la Gestión de Proyectos con el fin de poder gestionar y coordinar las competentes demandas de alcance, tiempo, costes, calidad, recursos, y riesgos con el fin de alcanzar los requerimientos y objetivos del proyecto y de la Compañía. ABSTRACT To address the Manufactured Gas Plant (MGP) legacy in New York State, the Department of Environmental Conservation’s Division of Environmental Remediation has established the MGP Site Investigation and Remediation Programs. With the passage of time the Department’s understanding of the complexity of these sites grew, as investigations identified the extend of the contamination problem associated with many MGPs, property of the Operating Companies in the State. Through many years under the Remediation Programs, some Operating Companies have tried to manage these large and complex projects as they could, underestimating and overlooking them, as they were, in fact, regulated and financed by the Department. This has cause a lot of controlling issues and gaps to solve to the companies. Now the companies are trying to solve this kind of problems using the more innovative management techniques, as Project Management. This project expose and explains how to integrate the project management processes into the MGP Projects under the Remediation Program, to manage and balance the competing demands of scope, time ,cost, quality, resources, and risk to meet the project and company’s requirements and objectives.

Understanding the main drivers of value creation in an open innovation program

Innovation has been identified as the single most relevant element in fuelling corporations’ competitive advantage and ultimate value creation. Corporations no longer rely on a single, linear structure of innovation; the new paradigm of open innovation opens up new possibilities of organizing innovation within the ecosystem, thus giving rise to new drivers for value creation. These value drivers have an impact on the strategic position of the firm and have the ability to create superior financial performance. In this paper we explore the close relationship between open innovation and value creation and propose a framework to analyze this process as well as the most critical elements involved.