State of Alaska Election Security Project Phase 2 Report

A laska’s election system is among the most secure in the country, and it has a number of safeguards other states are now adopting. But the technology Alaska uses to record and count votes could be improved— and the state’s huge size, limited road system, and scattered communities also create special challenges for insuring the integrity of the vote. In this second phase of an ongoing study of Alaska’s election security, we recommend ways of strengthening the system—not only the technology but also the election procedures. The lieutenant governor and the Division of Elections asked the University of Alaska Anchorage to do this evaluation, which began in September 2007.Lieutenant Governor Sean Parnell. State of Alaska Division of Elections.List of Appendices / Glossary / Study Team / Acknowledgments / Introduction / Summary of Recommendations / Part 1 Defense in Depth / Part 2 Fortification of Systems / Part 3 Confidence in Outcomes / Conclusions / Proposed Statement of Work for Phase 3: Implementation / Reference

Multidisciplinary Functional MR Imaging for Prostate Cancer

Various functional magnetic resonance (MR) imaging techniques are used for evaluating prostate cancer including diffusion-weighted imaging, dynamic contrast-enhanced MR imaging, and MR spectroscopy. These techniques provide unique information that is helpful to differentiate prostate cancer from non-cancerous tissue and have been proven to improve the diagnostic performance of MRI not only for cancer detection, but also for staging, post-treatment monitoring, and guiding prostate biopsies. However, each functional MR imaging technique also has inherent challenges. Therefore, in order to make accurate diagnoses, it is important to comprehensively understand their advantages and limitations, histologic background related with image findings, and their clinical relevance for evaluating prostate cancer. This article will review the basic principles and clinical significance of functional MR imaging for evaluating prostate cancer

Advanced Launch System propulsion focused technology liquid methane turbopump technical implementation plan

This program will focus on the integration of all functional disciplines of the design, manufacturing, materials, fabrication and producibility to define and demonstrate a highly reliable, easily maintained, low cost liquid methane turbopump as a component for the STBE (Space Transportation Booster Engine) using the STME (main engine) oxygen turbopump. A cost model is to be developed to predict the recurring cost of production hardware and operations. A prime objective of the program is to design the liquid methane turbopump to be used in common with a LH2 turbopump optimized for the STME. Time phasing of the effort is presented and interrelationship of the tasks is defined. Major subcontractors are identified and their roles in the program are described

Performance-Based Financing: Report on Feasibility and Implementation Options Final September 2007

This study examines the feasibility of introducing a performance-related bonus scheme in the health sector. After describing the Tanzania health context, we define “Performance-Based Financing”, examine its rationale and review the evidence on its effectiveness. The following sections systematically assess the potential for applying the scheme in Tanzania. On the basis of risks and concerns identified, detailed design options and recommendations are set out. The report concludes with a (preliminary) indication of the costs of such a scheme and recommends a way forward for implementation. We prefer the name “Payment for Performance” or “P4P”. This is because what is envisaged is a bonus payment that is earned by meeting performance targets1. The dominant financing for health care delivery would remain grant-based as at present. There is a strong case for introducing P4P. Its main purpose will be to motivate front-line health workers to improve service delivery performance. In recent years, funding for council health services has increased dramatically, without a commensurate increase in health service output. The need to tighten focus on results is widely acknowledged. So too is the need to hold health providers more accountable for performance at all levels, form the local to the national. P4P is expected to encourage CHMTs and health facilities to “manage by results”; to identify and address local constraints, and to find innovative ways to raise productivity and reach under-served groups. As well as leveraging more effective use of all resources, P4P will provide a powerful incentive at all levels to make sure that HMIS information is complete, accurate and timely. It is expected to enhance accountability between health facilities and their managers / governing committees as well as between the Council Health Department and the Local Government Authority. Better performance-monitoring will enable the national level to track aggregate progress against goals and will assist in identifying under-performers requiring remedial action. We recommend a P4P scheme that provides a monetary team bonus, dependent on a whole facility reaching facility-specific service delivery targets. The bonus would be paid quarterly and shared equally among health staff. It should target all government health facilities at the council level, and should also reward the CHMT for “whole council” performance. All participating facilities/councils are therefore rewarded for improvement rather than absolute levels of performance. Performance indicators should not number more than 10, should represent a “balanced score card” of basic health service delivery, should present no risk of “perverse incentive” and should be readily measurable. The same set of indicators should be used by all. CHMTs would assist facilities in setting targets and monitoring performance. RHMTs would play a similar role with respect to CHMTs. The Council Health Administration would provide a “check and balance” to avoid target manipulation and verify bonus payments due. The major constraint on feasibility is the poor state of health information. Our study confirmed the findings of previous ones, observing substantial omission and error in reports from facilities to CHMTs. We endorse the conclusion of previous reviewers that the main problem lies not with HMIS design, but with its functioning. We advocate a particular focus on empowering and enabling the use of information for management by facilities and CHMTs. We anticipate that P4P, combined with a major effort in HMIS capacity building – at the facility and council level – will deliver dramatic improvements in data quality and completeness. We recommend that the first wave of participating councils are selected on the basis that they can first demonstrate robust and accurate data. We anticipate that P4P for facilities will not deliver the desired benefits unless they have a greater degree of control to solve their own problems. We therefore propose - as a prior and essential condition – the introduction of petty cash imprests for all health facilities. We believe that such a measure would bring major benefits even to facilities that have not yet started P4P. It should also empower Health Facility Committees to play a more meaningful role in health service governance at the local level. We recommend to Government that P4P bonuses, as described here, are implemented across Mainland Tanzania on a phased basis. The main constraint on the pace of roll-out is the time required to bring information systems up to standard. Councils that are not yet ready to institute P4P should get an equivalent amount of money – to be used as general revenue to finance their comprehensive council health plans. We also recommend that up-to-date reporting on performance against service delivery indicators is made a mandatory requirement for all councils and is also agreed as a standard requirement for the Joint Annual Health Sector Review. P4P can also be applied on the “demand-side” – for example to encourage women to present in case of obstetric emergencies. There is a strong empirical evidence base from other countries to demonstrate that such incentives can work. We recommend a separate policy decision on whether or not to introduce demand-side incentives. In our view, they are sufficiently promising to be tried out on an experimental basis. When taken to national scale (all councils, excepting higher level hospitals), the scheme would require annual budgetary provision of about 6 billion shillings for bonus payments. This is equivalent to 1% of the national health budget, or about 3% of budgetary resources for health at the council level. We anticipate that design and implementation costs would amount to about 5 billion shillings over 5 years – the majority of this being devoted to HMIS strengthening at the facility level across the whole country

Federal incentives for industrial modernization: Historical review and future opportunities

Concerns over the aging of the U.S. aerospace industrial base led DOD to introduce first its Technology Modernization (Tech Mod) Program, and more recently the Industrial Modernization Incentive Program (IMIP). These incentives include productivity shared savings rewards, contractor investment protection to allow for amortization of plant and equipment, and subcontractor/vendor participation. The purpose here is to review DOD IMIP and to evaluate whether a similar program is feasible for NASA and other non-DOD agencies. The IMIP methodology is of interest to industrial engineers because it provides a structured, disciplined approach to identifying productivity improvement opportunities and documenting their expected benefit. However, it is shown that more research on predicting and validating cost avoidance is needed

Cross-layer system reliability assessment framework for hardware faults

System reliability estimation during early design phases facilitates informed decisions for the integration of effective protection mechanisms against different classes of hardware faults. When not all system abstraction layers (technology, circuit, microarchitecture, software) are factored in such an estimation model, the delivered reliability reports must be excessively pessimistic and thus lead to unacceptably expensive, over-designed systems. We propose a scalable, cross-layer methodology and supporting suite of tools for accurate but fast estimations of computing systems reliability. The backbone of the methodology is a component-based Bayesian model, which effectively calculates system reliability based on the masking probabilities of individual hardware and software components considering their complex interactions. Our detailed experimental evaluation for different technologies, microarchitectures, and benchmarks demonstrates that the proposed model delivers very accurate reliability estimations (FIT rates) compared to statistically significant but slow fault injection campaigns at the microarchitecture level.Peer ReviewedPostprint (author's final draft

Measuring persistence of implementation: QUERI Series

As more quality improvement programs are implemented to achieve gains in performance, the need to evaluate their lasting effects has become increasingly evident. However, such long-term follow-up evaluations are scarce in healthcare implementation science, being largely relegated to the "need for further research" section of most project write-ups. This article explores the variety of conceptualizations of implementation sustainability, as well as behavioral and organizational factors that influence the maintenance of gains. It highlights the finer points of design considerations and draws on our own experiences with measuring sustainability, framed within the rich theoretical and empirical contributions of others. In addition, recommendations are made for designing sustainability analyses