Current Utilization Rate Research Articles

Current utilization and influencing factors of complementary and alternative medicine among children with neuropsychiatric disease: a cross-sectional survey in Korea.

BackgroundComplementary and alternative medicine (CAM) is widespread but has various utilization rates according to country and the condition of patients. Generally, CAM is more frequently used in diseases that have no clear treatment method in conventional medicine. Therefore, a high utilization rate of CAM can be assumed in pediatric neurological diseases, but few studies have investigated the utilization of CAM in children with neuropsychiatric diseases. In particular, studies regarding the current use of CAM are scarce.MethodsWe conducted a survey of the parents or caregivers of patients who visited the pediatric rehabilitation clinic, pediatric neurology clinic, or pediatric psychiatry clinic at one university hospital from April to July 2011. We analyzed the factors that affect the utilization of CAM and other rehabilitation therapies.ResultsAmong the 578 patients recruited, 258 patients have ever received CAM (51.5 %), and the current CAM utilization rate was 19.0 % (110 patients). Two hundred patients (34.6 %) were currently receiving only other rehabilitation therapies, and 268 patients (46.4 %) were currently receiving no type of therapy. The rate of current CAM usage was significantly high in epilepsy patients.The ORs of 1–6-year-old and 7–12-year-old children compared with 13–19-year-old children were 3.14 (95 % CI 1.31–7.53) and 3.34 (95 % CI 1.64–6.79), respectively, and the OR of the group with longer disease duration (≥48 months) compared with the group with shorter disease duration was 3.36 (95 % CI 1.71–6.59). Only the age and disease duration showed statistically significant differences between the patients who were administered CAM and those who received other rehabilitation therapies (p < 0.0001).ConclusionsCAM is preferred by patients under 13 years of age compared with patients aged 13–19 years, whereas other rehabilitation therapies are preferred by patients aged 1–6 years, followed by those aged 6–12 years and then by those aged 13–19 years. The patient’s age and disease duration are the major factors influencing CAM use. Future studies should specify particular diseases, rather than combining all types of neuropsychiatric diseases, and include the socio-economic status of the parents.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-016-1066-4) contains supplementary material, which is available to authorized users.

Exceeding the Ontario Building Code for low-rise residential buildings: Economic and environmental implications

The residential sector accounts for approximately one fifth of Canada's secondary energy use and greenhouse gas emissions. Thus, addressing the energy efficiency of residential buildings has a significant role to play in reducing the nation's overall greenhouse gas emissions. The Ontario Building Code has recently been updated to reflect a more stringent energy performance standard. A home built to the prescribed minimum requirements will perform at a relatively high standard with respect to energy use when compared to homes built less than a decade ago. This paper explores three energy efficiency upgrade options which improve upon the energy efficiency of the 2012 Ontario Building Code. The “controlled ventilation” upgrade involved tightening up the building envelope and adding heat recovery to waste air streams, and two additional upgrade options were developed to meet the high performance targets of the R-2000 standard. While the upgrades explored did not show financial benefit for individual homeowners at current utility rates, if the benefits to society are considered, the upgrades are an economically efficient method of reducing greenhouse gas emissions owed to energy consumption. In addition to highlighting the need for a broader approach to the cost-benefit analyses associated with these types of upgrades, this finding also warrants a discussion about how to transform the current housing market so that energy efficient homes are more appropriately valued.

Environmental and ecological water requirements of a river system : a case study of the Haihe-Luanhe River system

In order to reduce the environmental and ecological problems induced by water resources management and use, this paper proposes a concept of environmenta water requirement. It is defined as the minimum water amount to be consumed by the natural water bodies to conserve its environmental and ecological functions. Based on the definition, the methods for calculating the amount of environmental and ecological water requirement are determined. In the case study on Haihe-Luanhe river system, the water requirement is divided into three parts, i.e., the basic instream flow, water requirement for sediment transfer and water consumption by evaporation of the lakes or everglades. The results of the calculation show that the environmental and ecological water requirement in the river system is about 124x108 m3, including 57x108 m3 for basic in-stream flow, 63x108 m3 for sediment transfer and 4x108 m3 for net evaporation loss of lakes. The total amount of environmental and ecological water requirement accounts for 54% of the amount of runoff (228x108 m3). However, it should be realized that the amount of environmental and ecological water requirement must be more than that we have calculated. According to this result, we consider that the rational utilization rate of the runoff in the river systems must not be more than 40%. Since the current utilization rate of the river system, which is over 80%, has been far beyond the limitation, the problems of environment and ecology are quite serious. It is imperative to control and adjust water development and utilization to eliminate the existing problems and to avoid the potential ecological or environmental crisis.

Minimally invasive surgery: national trends in adoption and future directions for hospital strategy

Surgeons have rapidly adopted minimally invasive surgical (MIS) techniques for a wide range of applications since the first laparoscopic appendectomy was performed in 1983. At the helm of this MIS shift has been laparoscopy, with robotic surgery also gaining ground in a number of areas. Researchers estimated national volumes, growth forecasts, and MIS adoption rates for the following procedures: cholecystectomy, appendectomy, gastric bypass, ventral hernia repair, colectomy, prostatectomy, tubal ligation, hysterectomy, and myomectomy. MIS adoption rates are based on secondary research, interviews with clinicians and administrators involved in MIS, and a review of clinical literature, where available. Overall volume estimates and growth forecasts are sourced from The Advisory Board Company's national demand model which provides current and future utilization rate projections for inpatient and outpatient services. The model takes into account demographics (growth and aging of the population) as well as non demographic factors such as inpatient to outpatient shift, increase in disease prevalence, technological advancements, coverage expansion, and changing payment models. Surgeons perform cholecystectomy, a relatively simple procedure, laparoscopically in 96 % of the cases. Use of the robot as a tool in laparoscopy is gaining traction in general surgery and seeing particular growth within colorectal surgery. Surgeons use robotic surgery in 15 % of colectomy cases, far behind that of prostatectomy but similar to that of hysterectomy, which have robotic adoption rates of 90 and 20 %, respectively. Surgeons are using minimally invasive surgical techniques, primarily laparoscopy and robotic surgery, to perform procedures that were previously done as open surgery. As risk-based pressures mount, hospital executives will increasingly scrutinize the cost of new technology and the impact it has on patient outcomes. These changing market dynamics may thwart the expansion of new surgical techniques and heighten emphasis on competency standards.

Access to cochlear implantation

This Supplement to Cochlear Implants International brings together the experiences and perspectives of cochlear implant (CI) clinicians, educators, and advocates from around the globe. Each of the authors has examined the issue of access in his or her country in an effort to explain why a great number of children and adults who could benefit from CIs are not receiving the intervention. While there is a good bit of diversity relative to CI availability in the five countries reviewed (Belgium, China, Japan, the UK, and the USA), there are also some important commonalities. There is considerable variation in CI utilization by appropriate children and adults in the countries represented. In the Flanders area of Belgium, pediatric utilization rates are estimated at 93% of eligible children, with the UK and some European countries also reaching over 90% if the age at the time of implant is extended into the mid-teen years. In stark contrast, about 50% of US children who could benefit are receiving CI and the utilization rate is lower still in Japan. In China, where cochlear implantation was later to begin on a large scale, the country's huge population and dramatic income disparities combine to keep China's current utilization rate relatively low though this could change in the future with current CI growth at 25% per year. Adding adults into the mix changes the utilization dynamic dramatically. None of the countries represented in our interesting (though unscientific) sample of five are reaching anywhere close to the number of adults who theoretically could benefit from cochlear implantation. Although adult recipient numbers are growing, it has been estimated that no more than 5% of candidate adults in the USA receive CI and the rate is likely to be even lower in the European and Asian countries represented in this issue. The reasons for this underutilization include: (1) low awareness of the benefits of CIs among the general population and among health care professionals; (2) the lack of specific referral pathways; (3) political issues relating to the deaf community, particularly in the USA; (4) financial issues related to provision of CI whether from private insurers (USA) or from government entities; and (5) relatively stringent candidacy requirements (especially in Japan). In many instances, the above problems could be mitigated to some degree if there were clearly articulated and adopted clinical practice guidelines to provide guidance to all the individuals and governmental entities that influence access to cochlear implantation. In the USA some of these issues could be improved by national agreement for best clinical practice in respect of CI access, the general acknowledgement of cost-effectiveness data, and the presence of an organization dedicated to the subject of cochlear implantation. Such an organization, the American Cochlear Implant Alliance, is described in the paper by Niparko et al. in this Supplement. It is our hope that the thoughtful articles that comprise this supplement will help advance discussions and encourage solutions so that as many eligible children and adults as possible may have full access to the life-changing benefits provided by cochlear implantation.

ANALISIS SUMBER DAYA PERIKANAN LEMURU (Sardinella lemuru Bleeker 1853) DI SELAT BALI (Analysis of the Sardine Oil (Sardinella lemuru Bleeker 1853) Resources in Bali Strait)

&lt;p&gt;Sardine oil (Sardinella lemuru Bleeker 1853) is the one of fish target of fishermen from Banyuwangi and Jembrana who fish in Bali strait. An in-depth study on current utilization rates and over 6 year period is required to obtain information on utilization of the sardine oil. . This study can be used as a guideline in formulating a policy in fishery management to promote sustainable sardine oil resources in Bali Strait. The purposes of this research were to calculate catch per unit effort (CPUE) of fishing gears, determine the standard fishing gears, determine of the production function, and determine feeding habits of sardine oil by analysing the stomach contents. Compared to other fishing gears, CPUE of purse seine has the highest average which made up 332.2032 metric ton per unit. Based on the calculation of the production function, the value of Cmsy was 88,358.71 metric ton per years, and the value of Emsy was 414.601 units. The analysis of the stomach contents showed that sardine oil’s food was plankton which consisted of phytoplankton and zooplankton. During the 6 year period, utilization of sardine oil resources was still allowed, because the highest catch did not exceed Cmsy. However, to sustain the resources, management and regulation in the use of fishing gears, especially purse seine was still needed. It can be done by renewing the joint decree between Governor of East Java and Bali in 1992.&lt;/p&gt;&lt;p&gt;&lt;br /&gt;&lt;strong&gt;Key words:&lt;/strong&gt; resources analysis, sardine oil fisheries, Bali Strait&lt;/p&gt;

Solar thermal market in Taiwan

The long-duration of national programs has been the driving force behind the expansion of the local market of solar water heaters (SWHs) in Taiwan in the last two decades. This study examines the potential market for SWHs using the statistical data from end users and the 2010 Population and Housing Census. The current effective utilization rate of residential SWHs in terms of potential number of systems installed is estimated to be 11.8%. The analyses also show that the current national subsidy program has recently lost its momentum in expanding the market. Therefore, regional subsidy programs should become the main force in influencing the growth in sales. In addition, SWHs of larger scale would be particularly effective in industries. To promote such applications, a combination of performance-based and direct subsidy schemes or tax deductions can be offered to end users to promote the applications of SWHs in the commercial sector. Solar-assisted cooling systems are considered to be another potential application of solar energy, which is associated with energy saving and power consumption in commercial and residential buildings. A short review of the R&D activities is also given in this paper.

An Overview of Utilization of Steel Slag

Abstract The current utilization rate of steel slag is only 22% in china, far behind the developed countries. At present, the amount of slag deposited in storage yard adds up to 30Mt, leading to the occupation of farm land and serious pollution to the environment. Improving the slag utilization is an important way to resolve these problems. The physical and chemical characteristics of steel slag were analyzed and then the research progress of steel slag utilization at home and abroad as recycled raw material in steel enterprise interior, aggregate of road and hydraulic construction, cement additive and concrete admixture, materials for waste water or gas treatment, construction materials and fertilizer in agriculture production were introduced respectively. At last, the important routes and critical problems for large-scale utilization of steel slag were proposed.

Location, Location, Location: Reassessing Erythropoiesis Stimulating Agents (ESAs) in the United States (US), Canada, and Europe (2007−2011)

Abstract 4753 Background:Erythropoiesis stimulating agents (ESAs) are approved for preventing transfusions (United States (US)) or treating symptomatic anemia (Canada/Europe) among chemotherapy or chronic kidney disease (CKD) patients. Extensive reassessments of safety, efficacy, dosing, and target hemoglobin levels have occurred. Methods:Regulatory agencies', ESA manufacturer notifications, clinical guidelines, phase III trials and meta-analyses cited in clinical guidelines were reviewed (2007 to 2011). Results:CKD and Cancer: Quality of life benefits are reported in Europe and Canada. In the US, product labels report exercise capacity improvements for CKD patients. CKD: Clinical trials reported cardiovascular, cerebrovascular, and mortality risks with ESAs targeting high versus low hemoglobin levels or cardiovascular and mortality risks with ESAs versus placebo. 2011 US' advisories recommend ESA doses sufficient to prevent transfusions among dialysis patients and caution with ESA administration to non-dialysis patients. Canadian and European recommendations target hemoglobin levels between 10 and 12 g/dl and 11 to 12 g/dl, respectively. Following these recommendations among non-dialysis US patients, ESA use decreased 16%. Most US dialysis CKD patients receive ESAs, with lower achieved hemoglobin levels, and 30% decreased ESA usage since 2008. In Europe and Canada, which initially had substantially lower ESA use, there has been a gradual increase. Cancer: Trials identified mortality, tumor progression, and venous thromboembolism risks with ESAs targeting higher versus lower hemoglobin levels. US labels warn against administering ESAs with potentially curative chemotherapy. European guidelines recommend ESAs for symptomatic patients at hemoglobin levels of 9 to 11 g/dL and consider for asymptomatic patients at levels of 11 to 11.9 g/dL. Canadian advisories report cost-utility ratios exceeding accepted standards. ESA use decreased by 70% in the US. Current ESA utilization rates for cancer are higher in Europe and lower in Canada. Conclusions:International differences in interpreting efficacy and safety data and ESA utilization exist. The changes have been most apparent in the US. Disclosures:No relevant conflicts of interest to declare.

Survey of Practices Regarding Utilization of Inhaled Steroids in 223 German Neonatal Units

Background: No survey has been published in recent years which primarily focuses on the prescription of inhaled corticosteroids in neonatal practice. Thus, the utilization rate of inhaled corticosteroids is unknown. Objectives: To elucidate the current utilization rate of inhaled corticosteroids in the prevention and therapy of bronchopulmonary dysplasia (BPD). Methods: We developed an 18-item questionnaire that was distributed in March 2009, via electronic mail, to the pediatricians-in-chief of all the 343 German pediatric hospitals with a neonatal unit (all levels of neonatal care). We sent electronic reminders after 4 and 8 weeks. Results: 223 hospitals (65%) returned the questionnaire. Of these, 102 (46%) administered inhaled corticosteroids to premature infants either as prophylaxis or treatment for BPD. Predominantly, treatment with inhaled steroids was seen as a ‘rescue therapy’ and used only if other therapeutic approaches had failed. Of the hospitals not administering inhaled steroids, the most frequently stated reason was ‘insufficient robust evidence to support benefit of therapy’ (57%). In the majority of hospitals (81%), the active substance of choice was budesonide. Conclusions: Of the responders, approximately 50% administer inhaled corticosteroids to premature infants either as a prophylaxis or treatment for BPD. Lack of beneficial evidence was the main reason for not administering inhaled steroids in about half of the units which took this approach. Future trials should address this discrepancy by aiming to establish a clear benefit-risk ratio of inhaled corticosteroids.

The Future of Radiation Oncology in the United States From 2010 to 2020: Will Supply Keep Pace With Demand?

Prior studies forecasted an incipient shortage of medical oncologists as a result of the aging US population, but the radiation oncology workforce has not been studied. Accordingly, we projected demand for radiation therapy and supply of radiation oncologists in 2010 and 2020 to determine whether a similar shortage may exist for this specialty. Demand for radiation therapy in 2010 and 2020 was estimated by multiplying current radiation utilization rates (as calculated with Surveillance, Epidemiology, and End Results data) by population projections from the Census Bureau. Supply of radiation oncologists was projected using data from the American Board of Radiology inclusive of current radiation oncologists and active residents, accounting for variation in full-time equivalent status and expected survival by age and sex. Between 2010 and 2020, the total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 22%, from 470,000 per year to 575,000 per year. In contrast, assuming that the current graduation rate of 140 residents per year remains constant, the number of full-time equivalent radiation oncologists is expected to increase by only 2%, from 3,943 to 4,022. The size of residency training classes for the years 2014 to 2019 would have to double to 280 residents per year in order for growth in supply of radiation oncologists to equal expected growth in demand. Demand for radiation therapy is expected to grow 10 times faster than supply between 2010 and 2020. Research is needed to explore strategies to enhance capacity to deliver quality radiation therapy despite increased patient loads.

Evolution of the Transition to a World Driven by Renewable Energy

The world’s energy supplies will continue to be pressured as the population grows and the standard of living rises in the developing world. A move by the rest of the world toward energy consumption rates on par with the United States is most probably unsustainable. An examination of population trends, current energy utilization rates, and estimated reserves shows that a major worldwide transition to renewable resources is necessary in the next 100 years. This paper examines one possible scenario of how energy usage and renewable power generation must evolve during this time period. As the global standard of living increases, energy consumption in developing nations will begin to approach that of the developed world. A combination of energy conservation and efficiency improvements in developed nations will be needed to push the worldwide energy consumption to approximately 200 million Btu per person per year. Fossil fuel resources will be exhausted or become prohibitively expensive, necessitating the development of renewable energy resources. At this projected steady state population and energy consumption, the required contribution of each type of renewable resource can be calculated. Comparing these numbers to the current renewable capacities illustrates the enormous effort that must be made in the next century.

Acute stroke therapy with tissue plasminogen activator (tPA) since it was approved by the U.S. Food and Drug Administration (FDA)

Tissue plasminogen activator (tPA) for acute ischemic stroke was approved by the U.S. Food and Drug Administration (FDA) in 1996. Since then it has been severely underutilized. At the time when most practitioners were first being exposed to the literature concerning tPA, there were many concerns about safety and the restrictions on use were quite onerous. Since then a good deal of further work has been done to loosen the restrictions and allay concerns about the risks. The true risk to benefit ratio is far better than is generally realized. Now it is mostly economic problems related to the costs of constantly supplying emergency care that is limiting access. Furthermore, in the current litigious environment, failure to treat is likely to be a more hazardous course of action than legal exposure due to poor outcomes. It must be emphasized that the drug is quite safe and highly effective, and current utilization rates are unacceptably low. Ann Neurol 2009;66:6-10.

Successful placement of postpyloric enteral tubes using electromagnetic guidance in critically ill children*

Initiation of postpyloric feeding is often delayed by difficulties in placement of enteral tubes. We evaluated the effectiveness of bedside postpyloric enteral tube (PET) placement using an electromagnetic (EM)-guided device. We hypothesized that: 1) EM-guided placement of PETs would be successful more often than standard blind placement with a shorter total time to successful placement and 2) the EM-guided technique would have similar overall costs to the standard technique. Prospective cohort trial with serial control groups in a pediatric intensive care unit at a tertiary care children's hospital. We collected data on a cohort of consecutive pediatric intensive care unit patients who underwent PET placement by standard blind technique followed by a cohort who underwent EM-guided placement. The primary outcome measure was successful placement determined by abdominal radiography. One hundred seven patients were evaluated in the trial: 57 in the standard group and 50 in the EM-guided group. Demographic data, percent intubated, and admission diagnosis were similar in both groups. Forty-one of 50 patients (82%) in the EM-guided group had successful placement compared with 22 of 57 in the standard group (38%) (p < 0.0001). The average time to successful placement was 1.7 vs. 21 hours in the EM-guided group and standard group, respectively (p < 0.0001). Children in the EM-guided group received fewer radiographs (p = 0.007) and were given more prokinetic drugs (p = 0.045). There were no episodes of pneumothorax in either group. After controlling for prokinetic drug use, EM-guided placement was more likely to result in successful placement than the standard blind technique (odds ratio 6.4, 95% confidence interval 2.5-16.3). An annual placement rate of 250 PETs by EM guidance, based on our institution's current utilization rates, is associated with a cost savings of $55.46 per PET placed. EM guidance is an efficient and cost-effective method of bedside PET placement.

Priorities Among Effective Clinical Preventive Services: Results of a Systematic Review and Analysis

Decision makers at multiple levels need information about which clinical preventive services matter the most so that they can prioritize their actions. This study was designed to produce comparable estimates of relative health impact and cost effectiveness for services considered effective by the U.S. Preventive Services Task Force and Advisory Committee on Immunization Practices. The National Commission on Prevention Priorities (NCPP) guided this update to a 2001 ranking of clinical preventive services. The NCPP used new preventive service recommendations up to December 2004, improved methods, and more complete and recent data and evidence. Each service received 1 to 5 points on each of two measures--clinically preventable burden and cost effectiveness--for a total score ranging from 2 to 10. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally. The three highest-ranking services each with a total score of 10 are discussing aspirin use with high-risk adults, immunizing children, and tobacco-use screening and brief intervention. High-ranking services (scores of 6 and above) with data indicating low current utilization rates (around 50% or lower) include: tobacco-use screening and brief intervention, screening adults aged 50 and older for colorectal cancer, immunizing adults aged 65 and older against pneumococcal disease, and screening young women for Chlamydia. This study identifies the most valuable clinical preventive services that can be offered in medical practice and should help decision-makers select which services to emphasize.

Manure's allure: Variation of the financial, environmental, and economic benefits from combined heat and power systems integrated with anaerobic digesters at hog farms across geographic and economic regions

Several studies have shown that anaerobic digesters integrated with combined heat and power systems (CHP/AD) are a financially attractive way to generate electricity, reduce odor, and improve nutrient management on hog farms; yet only very few systems have been installed to date. Employing published financial, economic, and environmental indicators, this study tests whether the benefits from CHP/AD identified in these studies can be replicated across all major hog-farming regions in the US. The study finds that a modest support of 1 cent per kWh is needed to assure that CHP/AD generated electricity is competitive with current utility rates in many hog-farming states. However, the study also shows that once CHP/AD systems are promoted hog-farming states stand to reap large benefits from CHP/AD, particularly environmental benefits (such as odor control and emissions reductions), economic benefits (in form of job creation), and added generating capacity.

Modelling the effectiveness of financing policies to address underutilization of children's health services in Nepal.

To estimate the price responsiveness of utilization of formal children's health-care services in Nepal and to use this information to model the impact on utilization of subsidies or increases in user fees. A total of 8112 individual observations (of children aged < 15 years) from 2847 households in 274 communities were obtained from the 1996 Nepal Living Standards Survey. A logit model was applied to determine the net impact of price on a parent or caregiver's decision to seek care for a given instance of illness. The model's coefficients were used to calculate the price responsiveness of utilization decisions. Parents or caregivers reported that 9.7% of children (788/8112) had been ill or injured in the previous month. Parents reported that they had sought care in 566 (71.8%) of these cases; care was most frequently sought from public providers. The price elasticity of demand for children's health-care services in the formal sector was estimated at -0.16. As prices rise, the demand curve exhibits continuous and declining price elasticity. Overall, a 100% subsidy of user fees would increase current utilization rates by 56%, while a 100% increase in fees would lead to a drop in utilization of only 12%. The differential in utilization across income groups was substantial after changes in fees were implemented. While the effect of price on the utilization of children's health-care services in Nepal is statistically significant, the size of the impact is modest. Policies to subsidize fees could increase utilization substantially, while fee increases would lead to modest declines in utilization and generate increased revenue.

Nationwide Trends in Rates of Utilization of Noninvasive Diagnostic Imaging among the Medicare Population between 1993 and 1999

To determine current utilization rates and recent nationwide trends for noninvasive diagnostic imaging (NDI) among the Medicare population. Medicare Part B claims data files from 1993, 1996, and 1999 were analyzed for all procedure codes related to NDI. NDI codes were grouped into 22 imaging categories, as well as seven imaging modality groups. The data were analyzed to determine the overall nationwide utilization and relative value unit (RVU) volume and rates and changes in utilization rates and RVU rates between 1993 and 1999 for the Medicare fee-for-service population, which included approximately 33 million enrollees per year. The overall utilization rate for all NDI in 1999 was 324,974 examinations per 100,000 enrollees. Conventional radiography was the most utilized imaging technology (55.5%), followed by ultrasonography (US) (20.5%), computed tomography (CT) (8.8%), mammography (6.0%), nuclear imaging (5.2%), magnetic resonance (MR) imaging (2.6%), and bone densitometry (1.5%) (percentages do not add up to 100% due to rounding). In the 6-year interval from 1993 to 1999, the rate of NDI utilization increased 3.8%. The utilization rate for conventional radiography decreased 13.7%, while that of all other modalities increased a combined total of 39.1%. During this 6-year period, RVU rates per 100,000 increased 14.6%, with RVUs for MR imaging increasing 76.6%; those for nuclear imaging, 38.7%; those for CT, 28.3%; and those for US, 24.2%. A 3.8% increase in the rate of NDI utilization occurred during the 6-year period between 1993 and 1999. A considerably larger increase in RVU rates (14.6%) occurred during the same time period.

Environmental and ecological water requirement of river system: a case study of Haihe-Luanhe river system

In order to reduce the environmental and ecological problems induced by water resources development and utilization, this paper proposes a concept of environmental and ecological water requirement. It is defined as the minimum water amount to be consumed by the natural water bodies to conserve its environmental and ecological functions. Based on the definition, the methods on calculating the amount of environmental and ecological water requirement are determined. In the case study on Haihe-Luanhe river system, the water requirement is divided into three parts, i.e., the basic in-stream flow, water requirement for sediment transfer and water consumption by evaporation of the lakes or everglades. The results of the calculation show that the environmental and ecological water requirement in the river system is about 124×108 m3, including 57×108 m3 for basic in-stream flow, 63×108 m3 for sediment transfer and 4×108 m3 for net evaporation loss of lakes. The total amount of environmental and ecological water requirement accounts for 54% of the amount of runoff (228×108 m3). However, it should be realized that the amount of environmental and ecological water requirement must be more than that we have calculated. According to this result, we consider that the rational utilization rate of the runoff in the river systems must not be more than 40%. Since the current utilization rate of the river system, which is over 80%, has been far beyond the limitation, the problems of environment and ecology are quite serious. It is imperative to control and adjust water development and utilization to eliminate the existing problems and to avoid the potential ecological or environmental crisis.

U.S. DEPARTMENT OF ENERGY PROJECTS INVOLVING THE USE OF COAL COMBUSTION BYPRODUCTS IN MINING APPLICATIONS

The onset of utility deregulation now makes it apparent that coal combustion by-product (CCB) utilization is one key area that may help utilities better manage their available resources. Because current utilization rates of CCB's are relatively low, the US Department of Energy is actively co-sponsoring a variety of CCB utilization projects, along with projects that seek to characterize the by-products resulting from newly-developed technologies for coal combustion, gasification, or flue gas cleanup. Mining applications represent a potential high-volume market for CCB's, with beneficial uses that include the prevention or control of acid mine drainage, surface subsidence over underground mines, and reclamation of acidic surface mine spoils. Future applications may include the development of CCB-based construction materials for use in mining and the selective backfilling of CCB's to increase underground coal mine extraction rates. The goal of these projects is to demonstrate that CCB's are of significant value when used in mining applications, and that CCB utilization in mines represents more than just a cheaper alternative to landfill disposal.