Monitoring the degree of implementation of an integrated delivery system

INTRODUCTION: The aim of the study was to develop a method to measure the implementation of specific components of an Integrated Service Delivery system for the frail elderly. The system includes six mechanisms and tools: (1) coordination of all organizations involved in delivering health and social services, (2) a single entry point, (3) case management, (4) a single assessment tool with a case-mix classification system, (5) an individualized service plan, and (6) a computerized clinical chart. METHOD: Focus groups of researchers, clinicians, managers and policy-makers identified quantitative indicators for each component. The six components were weighted according to their relative importance in order to generate a total score. Data were collected every six months over 30 months to establish the implementation degree in the three experimental areas: Sherbrooke, Granit and Coaticook in the Province of Quebec, Canada. RESULTS: After 30 months, coordination is the most developed component in the three experimental areas. Overall, in July 2003, the Integrated Service Delivery system was implemented at the rate of 73%, 71% and 70% in Sherbrooke, Granit and Coaticook, respectively. DISCUSSION: This type of quantitative assessment provides data for managers and researchers to monitor the implementation. Moreover, when there is an outcome study, the results of the outcome study can be correlated with the degree of implementation, thus allowing for dose-response analyzes and helping to decrease the “black box” effect

Update on onshore disposal of offshore drilling wastes

The US Environmental Protection Agency (EPA) is developing effluent limitations guidelines to govern discharges of cuttings from wells drilled using synthetic-based muds. To support this rulemaking, Argonne National Laboratory was asked by EPA and the US Department of Energy (DOE) to collect current information about those onshore commercial disposal facilities that are permitted to receive offshore drilling wastes. Argonne contacted state officials in Louisiana, Texas, California and Alaska to obtain this information. The findings, collected during October and November 1999, are presented by state

Putting 'international' back in IPEC.

During the previous six annual sessions of the International Petroleum Environmental Conference (IPEC), little attention has been given to international issues. Although the US is clearly a leader in oil field research and regulatory development information is available on interesting projects throughout the world Many participants in IPEC have little exposure to international oil and gas environmental problems and solutions. Beginning with the 7th IPEC, a stronger effort is being made to include international issues in the confidence. This paper describes some of the author's experiences in working with international oil and gas environmental issues in North America, Latin America, Europe, and Asia. Among the topics to be discussed are the issues that developing oil and gas-producing nations face and the need for sensitivity to other nation's cultures and legal systems

Update on cavern disposal of NORM-contaminated oil field wastes.

Some types of oil and gas production and processing wastes contain naturally occurring radioactive material (NORM). If NORM is present at concentrations above regulatory levels in oil field waste, the waste requires special disposal practices. The existing disposal options for wastes containing NORM are limited and costly. Argonne National Laboratory has previously evaluated the feasibility, legality, risk and economics of disposing of nonhazardous oil field wastes, other than NORM waste, in salt caverns. Cavern disposal of nonhazardous oil field waste, other than NORM waste, is occurring at four Texas facilities, in several Canadian facilities, and reportedly in Europe. This paper evaluates the legality, technical feasibility, economics, and human health risk of disposing of NORM-contaminated oil field wastes in salt caverns as well. Cavern disposal of NORM waste is technically feasible and poses a very low human health risk. From a legal perspective, a review of federal regulations and regulations from several states indicated that there are no outright prohibitions against NORM disposal in salt caverns or other Class II wells, except for Louisiana which prohibits disposal of radioactive wastes or other radioactive materials in salt domes. Currently, however, only Texas and New Mexico are working on disposal cavern regulations, and no states have issued permits to allow cavern disposal of NORM waste. On the basis of the costs currently charged for cavern disposal of nonhazardous oil field waste (NOW), NORM waste disposal in caverns is likely to be cost competitive with existing NORM waste disposal methods when regulatory agencies approve the practice

Downhole oil/water separators - What's new?

The US Department of Energy's (DOE's) National Petroleum Technology Office is interested in new technologies that can bring oil to the surface at a lower cost or with less environment impact. DOE is particularly interested in technologies that can accomplish both of these goals, and downhole oil/water separators (DOWS) seem to achieve that. They have the potential to reduce operating costs while providing a greater degree of environmental protection. DOE learned of the innovative DOWS technology and funded a team from Argonne National Laboratory, CH2M Hill (a private-sector consulting firm), and the Nebraska Oil and Gas Conservation Commission (a state agency) to conduct an independent evaluation of the technical feasibility, economic viability, and regulatory applicability of the DOWS technology. The results of that investigation were published in January 1999 and represent the most complete publicly available reference material on DOWs technology (the full text of the report can be downloaded from Argonne's website at www.ead.anl.gov). Other abbreviated versions of this information have been published during the past year. Last January, in the 1999 Produced Water Seminar, the author provided an overview of the DOWS technology. For the 2000 Produced Water Seminar, the author is providing updated information on DOWS and related technologies. To set the stage for the new information, the next few sections provided a review of previously reported information

Management of water extracted from carbon sequestration projects

Throughout the past decade, frequent discussions and debates have centered on the geological sequestration of carbon dioxide (CO{sub 2}). For sequestration to have a reasonably positive impact on atmospheric carbon levels, the anticipated volume of CO{sub 2} that would need to be injected is very large (many millions of tons per year). Many stakeholders have expressed concern about elevated formation pressure following the extended injection of CO{sub 2}. The injected CO{sub 2} plume could potentially extend for many kilometers from the injection well. If not properly managed and monitored, the increased formation pressure could stimulate new fractures or enlarge existing natural cracks or faults, so the CO{sub 2} or the brine pushed ahead of the plume could migrate vertically. One possible tool for management of formation pressure would be to extract water already residing in the formation where CO{sub 2} is being stored. The concept is that by removing water from the receiving formations (referred to as 'extracted water' to distinguish it from 'oil and gas produced water'), the pressure gradients caused by injection could be reduced, and additional pore space could be freed up to sequester CO{sub 2}. Such water extraction would occur away from the CO{sub 2} plume to avoid extracting a portion of the sequestered CO{sub 2} along with the formation water. While water extraction would not be a mandatory component of large-scale carbon storage programs, it could provide many benefits, such as reduction of pressure, increased space for CO{sub 2} storage, and potentially, 'plume steering.' Argonne National Laboratory is developing information for the U.S. Department of Energy's (DOE's) National Energy Technology Laboratory (NETL) to evaluate management of extracted water. If water is extracted from geological formations designated to receive injected CO{sub 2} for sequestration, the project operator will need to identify methods for managing very large volumes of water most of which will contain large quantities of salt and other dissolved minerals. Produced water from oil and gas production also typically contains large quantities of dissolved solids. Therefore, many of the same practices that are established and used for managing produced water also may be applicable for extracted water. This report describes the probable composition of the extracted water that is removed from the formations, options for managing the extracted water, the pros and cons of those options, and some opportunities for beneficial use of the water. Following the introductory material in Chapter 1, the report is divided into chapters covering the following topics: (Chapter 2) examines the formations that are likely candidates for CO{sub 2} sequestration and provides a general evaluation of the geochemical characteristics of the formations; (Chapter 3) makes some preliminary estimates of the volume of water that could be extracted; (Chapter 4) provides a qualitative review of many potential technologies and practices for managing extracted water and for each technology or management practice, pros and cons are provided; (Chapter 5) explores the potential costs of water management; and (Chapter 6) presents the conclusions

A Holistic Look at Minimizing Adverse Environmental Impact Under Section 316(b) of the Clean Water Act

Section 316(b) of the Clean Water Act (CWA) requires that “the location, design, construction, and capacity of cooling water intake structures reflect the best technology available for minimizing adverse environmental impact.” As the U.S. Environmental Protection Agency (EPA) develops new regulations to implement Section 316(b), much of the debate has centered on adverse impingement and entrainment impacts of cooling-water intake structures. Depending on the specific location and intake layout, once-through cooling systems withdrawing many millions of gallons of water per day can, to a varying degree, harm fish and other aquatic organisms in the water bodies from which the cooling water is withdrawn. Therefore, opponents of once-through cooling systems have encouraged the EPA to require wet or dry cooling tower systems as the best technology available (BTA), without considering site-specific conditions

Public Perception of Desalinated Produced Water From Oil and Gas Field Operations: A Replication

This study is a replication of Theodori et al.’s (2009) research on public perception of desalinated produced water from oil and gas field operations. The data used in this paper were collected in twelve Texas counties. Overall, the findings of this investigation paralleled those uncovered in Theodori et al.’s original exploration. Our data reveal that small percentages of respondents are extremely familiar with the process of desalination and extremely confident that desalinated water could meet human drinking water quality and purity standards. Our data also indicate that respondents are more favorably disposed toward the use of desalinated water for purposes where the probability of human or animal ingestion is lessened. Lastly, our data show that individuals with higher levels of familiarity with the process of desalination were more likely than those with lower levels of familiarity to agree that desalinated water from oil and gas field operations could safely be used for each of nine proposed purposes. Possible implications of these findings are advanced

Mathematical modeling and simulation of thyroid homeostasis: Implications for the Allan-Herndon-Dudley syndrome

Introduction: A mathematical model of the pituitary-thyroid feedback loop is extended to deepen the understanding of the Allan-Herndon-Dudley syndrome (AHDS). The AHDS is characterized by unusual thyroid hormone concentrations and a mutation in the SLC16A2 gene encoding for the monocarboxylate transporter 8 (MCT8). This mutation leads to a loss of thyroid hormone transport activity. One hypothesis to explain the unusual hormone concentrations of AHDS patients is that due to the loss of thyroid hormone transport activity, thyroxine (T4) is partially retained in thyroid cells. Methods: This hypothesis is investigated by extending a mathematical model of the pituitary-thyroid feedback loop to include a model of the net effects of membrane transporters such that the thyroid hormone transport activity can be considered. A nonlinear modeling approach based on the Michaelis-Menten kinetics and its linear approximation are employed to consider the membrane transporters. The unknown parameters are estimated through a constrained parameter optimization. Results: In dynamic simulations, damaged membrane transporters result in a retention of T4 in thyroid cells and ultimately in the unusual hormone concentrations of AHDS patients. The Michaelis-Menten modeling approach and its linear approximation lead to similar results. Discussion: The results support the hypothesis that a partial retention of T4 in thyroid cells represents one mechanism responsible for the unusual hormone concentrations of AHDS patients. Moreover, our results suggest that the retention of T4 in thyroid cells could be the main reason for the unusual hormone concentrations of AHDS patients