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Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches - Workshop Summaryby Institute of Medicine J. Michael Mcginnis Leighanne Olsen Roundtable On Value Science-Driven Health Care
Recent scientific and technological advances have accelerated our understanding of the causes of disease development and progression,and resulted in innovative treatments and therapies. Ongoing work to elucidate the effects of individual genetic variation on patient outcomes suggests the rapid pace of discovery in the biomedical sciences will only accelerate. However,these advances belie an important and increasing shortfall between the expansion in therapy and treatment options and knowledge about how these interventions might be applied appropriately to individual patients. The impressive gains made in Americans' health over the past decades provide only a preview of what might be possible when data on treatment effects and patient outcomes are systematically captured and used to evaluate their effectiveness. Needed for progress are advances as dramatic as those experienced in biomedicine in our approach to assessing clinical effectiveness. In the emerging era of tailored treatments and rapidly evolving practice,ensuring the translation of scientific discovery into improved health outcomes requires a new approach to clinical evaluation. A paradigm that supports a continual learning process about what works best for individual patients will not only take advantage of the rigor of trials,but also incorporate other methods that might bring insights relevant to clinical care and endeavor to match the right method to the question at hand. The Institute of Medicine Roundtable on Value & Science-Driven Health Care's vision for a learning healthcare system,in which evidence is applied and generated as a natural course of care,is premised on the development of a research capacity that is structured to provide timely and accurate evidence relevant to the clinical decisions faced by patients and providers. As part of the Roundtable's Learning Healthcare System series of workshops,clinical researchers,academics,and policy makers gathered for the workshop Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches. Participants explored cutting-edge research designs and methods and discussed strategies for development of a research paradigm to better accommodate the diverse array of emerging data resources,study designs,tools,and techniques. Presentations and discussions are summarized in this volume.
Preliminary Observations on Information Technology Needs and Priorities at the Centers for Medicare and Medicaid Services: An Interim Reportby National Research Council of the National Academies
Increasingly, the core mission of the Centers for Medicare and Medicaid Services (CMS), an agency of the Department of Health and Human Services, is expanding from one of focusing on prompt claims payment to one of becoming more broadly involved in improving health care quality and efficiency. The requirements for the information technology (IT) systems of CMS are changing as its mission changes, and the efforts to evolve its systems from those designed to support the agency's historical mission come in the midst of a push to modernize the nation's health care IT more broadly. These new challenges arise even as CMS must meet challenging day-to-day operational requirements and make frequent adjustments to its business processes, code, databases, and systems in response to changing statutory, regulatory, and policy requirements. In light of these and other emerging challenges, CMS asked the National Research Council to conduct a study that would lay out a forward-looking vision for the Centers for Medicare and Medicaid Services, taking account of CMS's mission, business processes, and information technology requirements. The study is being conducted in two phases. The first, resulting in the present volume, draws on a series of teleconferences, briefings, and an information-gathering workshop held in Washington, D.C., on September 27-28, 2010. The second phase, drawing on that workshop and on additional briefings, site visits, and committee deliberations, will result in a final report with recommendations, to be issued at the end of the project in 2011.
The electric vehicle offers many promises--increasing U.S. energy security by reducing petroleum dependence, contributing to climate-change initiatives by decreasing greenhouse gas (GHG) emissions, stimulating long-term economic growth through the development of new technologies and industries, and improving public health by improving local air quality. There are, however, substantial technical, social, and economic barriers to widespread adoption of electric vehicles, including vehicle cost, small driving range, long charging times, and the need for a charging infrastructure. In addition, people are unfamiliar with electric vehicles, are uncertain about their costs and benefits, and have diverse needs that current electric vehicles might not meet. Although a person might derive some personal benefits from ownership, the costs of achieving the social benefits, such as reduced GHG emissions, are borne largely by the people who purchase the vehicles. Given the recognized barriers to electric-vehicle adoption, Congress asked the Department of Energy (DOE) to commission a study by the National Academies to address market barriers that are slowing the purchase of electric vehicles and hindering the deployment of supporting infrastructure. As a result of the request, the National Research Council (NRC)--a part of the National Academies--appointed the Committee on Overcoming Barriers to Electric-Vehicle Deployment. This committee documented their findings in two reports--a short interim report focused on near-term options, and a final comprehensive report. Overcoming Barriers to Electric-Vehicle Deployment fulfills the request for the short interim report that addresses specifically the following issues: infrastructure needs for electric vehicles, barriers to deploying the infrastructure, and possible roles of the federal government in overcoming the barriers. This report also includes an initial discussion of the pros and cons of the possible roles. This interim report does not address the committee's full statement of task and does not offer any recommendations because the committee is still in its early stages of data-gathering. The committee will continue to gather and review information and conduct analyses through late spring 2014 and will issue its final report in late summer 2014. Overcoming Barriers to Electric-Vehicle Deployment focuses on the light-duty vehicle sector in the United States and restricts its discussion of electric vehicles to plug-in electric vehicles (PEVs), which include battery electric vehicles (BEVs) and plug-in hybrid electric vehicles (PHEVs). The common feature of these vehicles is that their batteries are charged by being plugged into the electric grid. BEVs differ from PHEVs because they operate solely on electricity stored in a battery (that is, there is no other power source); PHEVs have internal combustion engines that can supplement the electric power train. Although this report considers PEVs generally, the committee recognizes that there are fundamental differences between PHEVs and BEVs.
The rapid evolution of information technology (IT) is transforming our society and its institutions. For the most knowledge-intensive entities of all, research universities, profound IT-related challenges and opportunities will emerge in the next decade or so. Yet, there is a sense that some of the most significant issues are not well understood by academic administrators, faculty, and those who support or depend on the institution’s activities. This study identifies those information technologies likely to evolve in the near term (a decade or less) that could ultimately have a major impact on the research university. It also examines the possible implications of these technologies for the research university—its activities (learning, research, outreach) and its organization, management, and financing—and for the broader higher education enterprise. The authoring committee urges research universities and their constituents to develop new strategies to ensure that they survive and thrive in the digital age.
Rates of organ donation lag far behind the increasing need. At the start of 2006, more than 90,000 people were waiting to receive a solid organ (kidney, liver, lung, pancreas, heart, or intestine). Organ Donation examines a wide range of proposals to increase organ donation, including policies that presume consent for donation as well as the use of financial incentives such as direct payments, coverage of funeral expenses, and charitable contributions. This book urges federal agencies, nonprofit groups, and others to boost opportunities for people to record their decisions to donate, strengthen efforts to educate the public about the benefits of organ donation, and continue to improve donation systems. Organ Donation also supports initiatives to increase donations from people whose deaths are the result of irreversible cardiac failure. This book emphasizes that all members of society have a stake in an adequate supply of organs for patients in need, because each individual is a potential recipient as well as a potential donor.
The Department of Defense (DOD) spends over $300 billion each year to develop, produce, field and sustain weapons systems (the U.S. Air Force over $100 billion per year). DOD and Air Force acquisitions programs often experience large cost overruns and schedule delays leading to a loss in confidence in the defense acquisition system and the people who work in it. Part of the DOD and Air Force response to these problems has been to increase the number of program and technical reviews that acquisition programs must undergo. This book looks specifically at the reviews that U.S. Air Force acquisition programs are required to undergo and poses a key question: Can changes in the number, content, or sequence of reviews help Air Force program managers more successfully execute their programs? This book concludes that, unless they do it better than they are now, Air Force and DOD attempts to address poor acquisition program performance with additional reviews will fail. This book makes five recommendations that together form a gold standard for conduct of reviews and if implemented and rigorously managed by Air Force and DOD acquisition executives can increase review effectiveness and efficiency. The bottom line is to help program managers successfully execute their programs.
Study focuses narrowly on the risks of oil spills from lightering, which was defined as the transfer at sea of crude oil or petroleum products from one vessel to another. Paper.
South of the Big Four is a gracefully told, arresting look at an America in which the center no longer holds, where a new kind of forgiveness and understanding must be found. In the tradition of A Thousand Acres and A Map of the World, the novel's sudden truths and lasting images transcend the daily lives of its Midwestern characters to create a penetrating, resonant story, made all the more remarkable because it is the author's debut.
Savor a year of outstanding cheese-centric dishes with The Cheesemonger's Seasons. In this beautifully photographed volume, Chester Hastings offers his favorite recipes for cooking with cheese. As a chef, he knows how to transform raw ingredients, and as a cheesemonger, he's a cheese genius. With his skills, he shares how to match peak-season produce with fine cheeses to create inspired takes on classics as well as imaginative new flavor combinations. Ninety recipes are organized by season, and include appetizers, sides, mains, and desserts. The Cheesemonger's Seasons is a go-to cookbook that will bring a bounty of fruits and vegetables to the table in delicious new ways.
The serious leisure aficionado knows that it doesn't take much to transform a ho-hum afternoon into a truly memorable one--just a few balls, some mallets, maybe a horseshoe or two. The transformative nature of lawn sports takes center stage in Balls on the Lawn, an ode to classic outdoor activities, from the common (bocce) to the obscure (Kan-Jam). Including the history and complete rules of 10 iconic games, plus appropriate accompanying cocktails (serious leisure requires serious sustenance), Balls on the Lawn will revolutionize Saturday afternoons through the long-held traditions, robust competition, and abundant camaraderie of lawn sports.
The best (and most fun) way to learn about chocolate is by eating it, and this guide provides curious gourmands and budding chocoholics with all the tips they need to become cacao experts. The booklet includes information on buying and tasting chocolate plus how to hosting a tasting party. Let the tasting begin!
Many people see the enjoyment of wine as an intimidating and complicated matter, requiring a mastery of arcane rules and rituals. In fact, there's no more to it than putting each wine to the ultimate test: Does it taste good? Wine writer Brian St. Pierre's book begins by introducing the basic flavors of the several grape varieties used in making wines around the world. Once those are understood, all the rest flows smoothly--what distinguishes the colors and types, how to match wine with food, how to store and serve it, and even how much to spend on a bottle. St. Pierre's sensible approach combined with stunning photographs and elegant maps of the world's great wine-growing regions make this the perfect no-nonsense guide or lovely gift for anyone who wants to learn to understand, appreciate, and, above all, fully enjoy the fruit of the vine.
The Canon EOS 6D is the latest of Canon's full-frame DSLR cameras. Its impressive array of advanced capabilities allows the photographer more influence over the final image. This book's exploration of the EOS 6D goes beyond that of the user's manual. It provides illustrations, step-by-step setting adjustments, helpful suggestions for setup, and detailed explanations for each of the camera's many features and menu configurations. The text is illustrated with easy-to-follow screenshots and example images. This book will also introduce intermediate-level camera users to DSLR model-differentiating features: built-in GPS and Wi-Fi. The content covers effective use of the camera's hardware (and some software) as well as certain related accessories, with little emphasis on general photography. Author James Johnson covers everything from basic camera features to advanced photographic options. With this book as your guide, you'll learn to successfully use this powerful camera.
Despite recent advances in our understanding of the genetic basis of human behavior, little of this work has penetrated into formal demography. Very few demographers worry about how biological processes might affect voluntary behavior choices that have demographic consequences even though behavioral geneticists have documented genetics effects on variables such as parenting and divorce. Offspring: Human Fertility Behavior in Demographic Perspective brings together leading researchers from a wide variety of disciplines to review the state of research in this emerging field and to identify promising research directions for the future.
A report on the Observations on the President's Fiscal Year 2001 Federal Science and Technology Budget
Nutrient Control Actions for Improving Water Quality in the Mississippi River Basin and Northern Gulf of Mexicoby National Research Council of the National Academies
A large area of coastal waters in the northern Gulf of Mexico experiences seasonal conditions of low levels of dissolved oxygen, a condition known as hypoxia. Excess discharge of nutrients into the Gulf of Mexico from the Mississippi and Atchafalaya rivers causes nutrient overenrichment in the gulf's coastal waters and stimulates the growth of large algae blooms. When these algae die, the process of decomposition depletes dissolved oxygen from the water column and creates hypoxic conditions. In considering how to implement provisions of the Clean Water Act to strengthen nutrient reduction objectives across the Mississippi River basin, the U.S. Environmental Protection Agency (EPA) requested advice from the National Research Council. This book represents the results of the committee's investigations and deliberations, and recommends that the EPA and U.S. Department of Agriculture should jointly establish a Nutrient Control Implementation Initiative to learn more about the effectiveness of actions meant to improve water quality throughout the Mississippi River basin and into the northern Gulf of Mexico. Other recommendations include how to move forward on the larger process of allocating nutrient loading caps -- which entails delegating responsibilities for reducing nutrient pollutants such as nitrogen and phosphorus -- across the basin.
The 21st century is witnessing a rapid increase in the pace of knowledge creation in the sciences and engineering. Competing in this global economy requires a science and engineering workforce that is consistently at the technological forefront. Dr. Charles Vest, President of the National Academy of Engineering, in a speech at the University of Michigan on October 15, 2007, put it simply: prospering in the knowledge age requires people with knowledge. The purpose of the Lifelong Learning Imperative Workshop, summarized in this volume, was to consider learning opportunities for the engineering professional. The participants in the workshop addressed the necessity of lifelong learning, the history of continuing education, possible delivery systems, systems used by other professions, and the current state of learning when viewed in the light of the rapid rate of technological change.
Dino Martini Mysteries, #1 Working for his ex and his boyfriend, Dino's past and present cross. Dino is caught off guard when his ex shows up out of the blue asking for help. His current lover, Seth, is pushing him to find dirt on his sister's boyfriend. Juggling between two cases - and his boyfriend and ex - isn't easy, but what choice does he have?Working with his ex takes Dino on a trip down memory lane, raising a few doubts and stirring up Seth's jealousLike Pizza and Beer by Elle Parkery. Now he must save his ex's restaurant and his relationship with Seth before it's too late WARNING: Explicit sexual situations, M/M sex and mild violence. 72,777 Words
The Wolf Within, #3 As Stanzie discovers her wolf, she learns being herself is more dangerous than ever. Where is Bethany Dillon? The seventeen year-old girl is missing from the Maplefair pack and Constance Newcastle--Stanzie--and Liam Murphy must find her. Fast. A serial killer still has not been caught. Bethany could have run away, or killed herself. But no one in her pack seems to know the truth. Or, they're just not telling. Constanceís knack for uncovering secrets leads her into peril, and to save Bethany, she must break every rule. She risks losing everything, including Liam...and her life. 90,135 Words
The dead have no respect for anyone trying to have a life. Portia Mahaffey always liked that she was the only woman in her family without a psychic 'gift'. But a concussion awakens her latent ability to see ghosts. And one of those ghosts is prepared to haunt her until Portia agrees to convince the police her death was no accident. With no choice but to help Corinne, Portia reluctantly uses her new gift and some good old-fashioned detection to track down the truth. Seeing the dead is just the beginning. Portia's world becomes filled with hungry demons, mercenary shadow beings, vengeful poltergeists...and one very alive murderer willing rank her among the dead. Who knew hanging with the dead could be so hazardous to the living? WARNING: Contains mild sexual escapades, ghosts, demons, and flatulent pugs. 76,991 Words
The Wolf Within, #1 If you could shift into a wolf, what would you discover about yourself? Two years after the deaths of her bond mates, Constance Newcastle is ready to start over. The problem? The rest of the Great Pack, gathered in Paris to shift into wolves together, is not so sure she deserves the chance. Although the Great Council ruled the car crash an accident, even Constance blames herself. She was driving, after all. Treated like a pariah by those she longs to rejoin, Constance reunites with an old lover. Everything looks promising until he mysteriously dies. Accused of his murder and desperate to clear her name, Constance joins forces with handsome, confident Liam Murphy, a former Alpha pack leader with a past as tragic and troubled as her own. Guided by the mysterious Councilor Jason Allerton, Constance and Liam discover they are not alone-- throughout the Great Pack, people are dying. Can all the deaths be accidents, or is something more sinister going on?
To understand Iraq, Charles Tripp's history is the book to read. Since its first appearance in 2000, it has become a classic in the field of Middle East studies, read and admired by students, soldiers, policymakers and journalists. The book is now updated to include the recent American invasion, the fall and capture of Saddam Hussein and the subsequent descent into civil strife. What is clear is that much that has happened since 2003 was foreshadowed in the account found in this book. Tripp's thesis is that the history of Iraq throughout the twentieth-century has made it what it is today, but also provides alternative futures. Unless this is properly understood, many of the themes explored in this book - patron-client relations, organized violence, sectarian, ethnic and tribal difference - will continue to exert a hold over the future of Iraq as they did over its past.
This book offers a comprehensive thousand-year history of the land, people, society, culture and economy of Hungary, from its nebulous origins in the Ural Mountains to the 1988 elections. It tells above all the thrilling story of a people who became a great power in the region and then fought against--and were invaded by--Ottomans, Germans and Soviets. The Hungarian people preserved nevertheless a continuous individuality through their Ural-born language and a specifically Hungaro-European culture.
A report from the International Monetary Fund.
Perspectivas de la Economía Mundial, Octubre de 2012: Hacer Frente a los Altos Niveles de Deuda y al Lento Crecimientoby International Monetary Fund
A report from the International Monetary Fund.