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

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

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

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

Impact of drought on U.S. steam electric power plant cooling water intakes and related water resource management issues.

This report was funded by the U.S. Department of Energy's (DOE's) National Energy Technology Laboratory (NETL) Existing Plants Research Program, which has an energy-water research effort that focuses on water use at power plants. This study complements their overall research effort by evaluating water availability at power plants under drought conditions. While there are a number of competing demands on water uses, particularly during drought conditions, this report focuses solely on impacts to the U.S. steam electric power plant fleet. Included are both fossil-fuel and nuclear power plants. One plant examined also uses biomass as a fuel. The purpose of this project is to estimate the impact on generation capacity of a drop in water level at U.S. steam electric power plants due to climatic or other conditions. While, as indicated above, the temperature of the water can impact decisions to halt or curtail power plant operations, this report specifically examines impacts as a result of a drop in water levels below power plant submerged cooling water intakes. Impacts due to the combined effects of excessive temperatures of the returned cooling water and elevated temperatures of receiving waters (due to high ambient temperatures associated with drought) may be examined in a subsequent study. For this study, the sources of cooling water used by the U.S. steam electric power plant fleet were examined. This effort entailed development of a database of power plants and cooling water intake locations and depths for those plants that use surface water as a source of cooling water. Development of the database and its general characteristics are described in Chapter 2 of this report. Examination of the database gives an indication of how low water levels can drop before cooling water intakes cease to function. Water level drops are evaluated against a number of different power plant characteristics, such as the nature of the water source (river vs. lake or reservoir) and type of plant (nuclear vs. fossil fuel). This is accomplished in Chapter 3. In Chapter 4, the nature of any compacts or agreements that give priority to users (i.e., which users must stop withdrawing water first) is examined. This is examined on a regional or watershed basis, specifically for western water rights, and also as a function of federal and state water management programs. Chapter 5 presents the findings and conclusions of this study. In addition to the above, a related intent of this study is to conduct preliminary modeling of how lowered surface water levels could affect generating capacity and other factors at different regional power plants. If utility managers are forced to take some units out of service or reduce plant outputs, the fuel mix at the remaining plants and the resulting carbon dioxide emissions may change. Electricity costs and other factors may also be impacted. Argonne has conducted some modeling based on the information presented in the database described in Chapter 2 of this report. A separate report of the modeling effort has been prepared (Poch et al. 2009). In addition to the U.S. steam electric power plant fleet, this modeling also includes an evaluation of power production of hydroelectric facilities. The focus of this modeling is on those power plants located in the western United States