Large Demonstration Project Research Articles

Batteries for Large-Scale Stationary Electrical Energy Storage

Large-scale stationary battery energy storage has been under development for several decades. Several large battery demonstration projects have been built and tested under a variety of electric utility grid applications, and in conjunction with renewable energy sources such as wind and photovoltaics that require energy storage systems. Applications fall into two broad categories: Energy applications and power applications. Energy applications involve storage system discharge over periods of hours (typically one discharge cycle per day) with correspondingly long charging periods. Power applications involve comparatively short periods of discharge (seconds to minutes), short recharging periods, and often require many cycles per day. While many battery technologies have been proposed and developed, only a handful have actually been commercially employed. These include lead- acid, nickel/cadmium, sodium/sulfur, and vanadium-redox flow batteries. Other battery technologies, such as lithium-ion batteries, are less mature and not yet well-developed for these applications.

Vanadium redox battery: Positive half-cell electrolyte studies

The vanadium redox battery (VRB) employs two “electrolyte tanks” that store energy in the form of the two vanadium redox couples and a cell “stack” where the charge/discharge reactions occur. To date, 2 M vanadium electrolyte have been successfully used in large demonstration projects for stationary applications. For mobile applications however, higher vanadium concentrations are required to reduce the size and weight of the battery. The main limitation for the vanadium electrolyte concentration and subsequently its energy density in the VRB is the thermal precipitation of the V(V) ion at elevated temperatures. In this paper optimization study of vanadium V(V) supersaturated solutions in terms of concentrations, temperature, and precipitation behavior are reported along with properties such as density and viscosity. It appears that 3.0–3.5 M V(V) solutions in 6 M total sulfate are sufficiently stable at temperatures up to 30 °C, although 2 M solutions are still required for operation at higher temperatures of about 40 °C.

The Role of Staff Turnover in the Implementation of Evidence-Based Practices in Mental Health Care

This study examined turnover rates of teams implementing psychosocial evidence-based practices in public-sector mental health settings. It also explored the relationship between turnover and implementation outcomes in an effort to understand whether practitioner perspectives on turnover are related to implementation outcomes. Team turnover was measured for 42 implementing teams participating in a national demonstration project examining implementation of five evidence-based practices between 2002 and 2005. Regression techniques were used to analyze the effects of team turnover on penetration and fidelity. Qualitative data collected throughout the project were blended with the quantitative data to examine the significance of team turnover to those attempting to implement the practices. High team turnover was common (M+/-SD=81%+/-46%) and did not vary by practice. The 24-month turnover rate was inversely related to fidelity scores at 24 months (N=40, beta=-.005, p=.01). A negative trend was observed for penetration. Further analysis indicated that 71% of teams noted that turnover was a relevant factor in implementation. The behavioral health workforce remains in flux. High turnover most often had a negative impact on implementation, although some teams were able to use strategies to improve implementation through turnover. Implementation models must consider turbulent behavioral health workforce conditions.

English

Brownfield reclamation in some ways is similar to surface mine reclamation. The similarities are that in both cases there is a large area of once productive ground that was severely impacted as part of a no-longer active resource extraction or augmentation industry. The differences include possible toxic soils or substrate and generally a lack of nearby quality soil for the brownfields given their typically urban settings. In contrast, reclamation is now part of a surface mining permit, soils are stockpiled to be replaced after mining, or topsoil substitutes are located and approved to serve as a final cover at a mine site. Brownfields, however, are usually located in urban areas where topsoils are difficult to obtain and transport. We conducted a large field demonstration project involving a brownfield in Chicago that was reclaimed with dredged spoils from the Illinois River. Disposal of dredged spoil often presents a problem in and of itself, and utilization as a topsoil substitute presents several advantages. In the case of the Peoria River sediments, the chemical and physical attributes are generally favorable as a topsoil substitute. These sediments tend to be fine textured, Silty Clay Loams and Silty Clays with about 3-5% organic matter content. Metal content is typically elevated above reference soils, but is generally not a problem. This paper presents our experience with this reclamation approach.

Cost of Care at End of Life Varies Widely by Region

Cost of Care at End of Life Varies Widely by Region

Women Empowerment through Participation in Aquaculture: Experience of a Large-scale Technology Demonstration Project in Bangladesh

The paper investigated rural women’s empowerment through participation in aquaculture activities within a large scale demonstration project in Bangladesh. The paper is based on farm level data collected from 200 women in two districts of Bangladesh. A questionnaire was used for the purpose of data collection and data gathering spanned a period of four months, (September to December) in 2004. The findings show that women in the study area gained a significant level of empowerment during the course of their participation in the aquaculture program. The extent of their empowerment was positively and significantly correlated with their education, extension media contact and exposure to training, as well as their knowledge and participation in aquaculture. Other factors, such as age, family size, family farm size, area under aquaculture, and annual family income did not show any significant relationship with the extent of a woman’s empowerment through participation in aquaculture.

Use of the Pre-Post Method to Measure Cost Savings in Disease Management

The US disease management (DM) industry continues to endorse the use of the methodologically flawed pre-post design to evaluate financial outcomes, which regularly reports returns on investment of up to 8:1. This is in sharp contrast to the peer-reviewed literature and large Medicare demonstration projects that generally report little, if any, cost savings from DM. The industry defends the practice of using the pre-post evaluation design by suggesting that measuring total healthcare costs at the diseased-population level eliminates regression to the mean and accounts for indirect changes in physician behavior. The industry further argues that equivalent and concurrent control groups are not available and that instead, a cost trend of the non-diseased population should be used to provide equivalence. This article illustrates the fallacies of these arguments and demonstrates how the pre-post technique elicits financial results generally favoring the DM program. Given that the continued use and support of this methodology serves only to propagate the concerns over the financial value of DM, it is time that a collective decision be made as to whether maximizing short-term profits is worth jeopardizing the long-term viability of the entire industry. Additionally as important, other healthcare systems around the world are looking to the US DM industry for guidance as they ponder the introduction of DM in their own countries. The inability of DM to accurately measure and achieve financial savings may be inhibiting the widespread initiation of future DM programs.

Overview of the European and North American studies on HPV testing in primary cervical cancer screening

Several studies suggest that HPV testing is more sensitive than cytology in primary cervical screening. These studies had different designs and were reported in different ways. Individual patient data were collected for all European and North American studies in which cytology was routinely performed and HPV testing was included as an additional parallel test. More than 60,000 women were included. The sensitivity and specificity of HPV testing were compared with routine cytology, both overall and for ages <35, 35-49 and 50+. The age-specific prevalence of high risk HPV (hr-HPV) was also analysed. HPV testing was substantially more sensitive in detecting CIN2+ than cytology (96.1% vs. 53.0%) but less specific (90.7% vs. 96.3%). The sensitivity of HPV testing was similar in all studies carried out in different areas of Europe and North America, whereas the sensitivity of cytology was highly variable. HPV sensitivity was uniformly high at all ages, whereas the sensitivity of cytology was substantially better in women over the age of 50 than in younger women (79.3% vs. 59.6%). The specificity of both tests increased with age. Positivity rates for HPV testing in women without high-grade CIN were region dependent. These results support the use of HPV testing as the sole primary screening test, with cytology reserved for women who test HPV positive. Large demonstration projects are needed to fully evaluate this strategy.

Access to Quality Care: Psychosomatic Medicine

Back to table of contents Previous article Next article From the PresidentFull AccessAccess to Quality Care: Psychosomatic MedicineMichelle Riba, M.D., M.S.Michelle RibaSearch for more papers by this author, M.D., M.S.Published Online:15 Oct 2004https://doi.org/10.1176/pn.39.20.0390003 Recently I had the opportunity to participate in a critical discussion aimed at addressing a key priority: access to quality psychosomatic medicine for our patients. The Center for Mental Health Services (CMHS) and Treatment Effectiveness Now (TEN), a policy action consortium focusing on access to care for patients for co-occurring psychiatric and other types of medical disorders, sponsored a daylong meeting of psychiatric thought leaders from APA and the Academy of Psychosomatic Medicine to discuss the work of the New Freedom Commission and more specifically its Subcommittee on Mental Health Interface with General Medicine. The subcommittee helped shape several specific goals and recommendations that were included in the commission's final report. (The subcommittee's report can be accessed at the New Freedom Commission's Web site at<www.mentalhealthcommission.gov/subcommittee/MHInterface_010803.doc>.)The purpose of the retreat was to review the commission's findings and recommendations and begin to develop an action plan to address barriers to patients' receiving integrated care.Through the leadership of Mel Haas, M.D., of CMHS, Anita Everett, M.D., of the Substance Abuse and Mental Health Services Administration (SAMHSA), and Carol Alter, M.D., of TEN, the group focused on the report recommendations that further research be conducted in psychosomatic medicine; that support be continued for demonstrations of effective models of care; that collaborative care models be reimbursed; and that the federal government address ways that Medicare, Medicaid, and other federal programs and private insurers can better coordinate and provide care for patients with psychiatric and other medical needs.Jurgen Unutzer, M.D., the author of the subcommittee's report, discussed evidence supporting the use of collaborative care models in primary care settings. Dr. Alter, a member of APA's Council on Psychosomatic Medicine and executive director of TEN, reviewed the complex nature of reimbursement for psychiatric care of medically ill patients, noting that current reimbursement practices resulted from the carveout of mental health care from insurance benefits and the inadequacies inherent in segregating mental health from physical health.Others in attendance included Drs. Constantine Lyketsos, Philip Muskin, and Steven Epstein, members of APA's Council on Psychosomatic Medicine. They discussed the role that APA can play in addressing barriers to integrated care. It was helpful to have the viewpoints of two residents from the George Washington University department of psychiatry, Drs. Kimberly Humann and Niku Sing. From my perspective, a critical issue that needs to be addressed is psychiatry residency training in psychosomatic medicine and its funding.It was clear the group felt that the New Freedom Commission's recommendations provide an important opportunity to support the work that those of us in psychosomatic medicine have already begun and need to build on. The group felt strongly that we need to support current efforts to build a research agenda with the National Institutes of Health, Centers for Medicare and Medicaid Services, and other federal agencies. This will drive the field to answer critical questions about the relationship of psychiatric illness to other medical illnesses and to support additional inquiries of large demonstration projects focusing on chronic medical illness. Drs. Haas and Everett felt strongly that CMHS and its parent organization, SAMHSA, will continue to play a role in helping with this process.Finally, the group felt that there was a critical need to focus on the issues of cost of care for co-occurring psychiatric and other medical disorders, training, and the need to build an advocacy base within the larger medical community.While there was a great appreciation of the complexity of the reimbursement landscape, there was also an understanding that we need to use APA's resources and power to ensure that answers to questions about reimbursement and access are identified quickly. APA's Council on Psychosomatic Medicine, under the leadership of Dr. Muskin, will begin to prioritize those projects, and Sam Muszynski and Becky Yowell of APA's Office of Healthcare Systems and Financing will address the reimbursement issues.We have long struggled with the issues of access to and reimbursement for psychiatric care for medically ill patients, but the current confluence of factors including burgeoning clinical, economic, and research evidence regarding the impact, causes, and interventions for psychiatric symptoms occurring in chronically ill people creates an important opportunity for us to address barriers to receiving integrated care.I commend Dr. Alter for her continued efforts to focus our attention on addressing barriers to access and the leadership and support of Drs. Haas and Everett. ▪ ISSUES NewArchived

A Low-Cost, Post Hoc Method to Rate Overall Site Quality in a Multi-Site Demonstration

Demonstration programs and social experiments are often subject to sophisticated, controlled evaluations. An important factor that is not subject to control, and sometimes even goes unobserved, is overall program site quality. Site quality can be observed in process evaluations, but these tend to be expensive. This paper describes an alternative approach to site quality measurement. With observations elicited from national program staff of a large demonstration project, we developed an approach that uses Concept Mapping to identify dimensions for rating program site quality and compared our results with ratings based on site visits developed during program implementation. The site quality ratings and rankings resulting from our approach are plausible, have desirable psychometric properties, and are developed at much lower cost than is possible for even relatively modest process analyses.

A Low-Cost, Post Hoc Method to Rate Overall Site Quality in a Multi-Site Demonstration

Demonstration programs and social experiments are often subject to sophisticated, controlled evaluations. An important factor that is not subject to control, and sometimes even goes unobserved, is overall program site quality. Site quality can be observed in process evaluations, but these tend to be expensive. This paper describes an alternative approach to site quality measurement. With observations elicited from national program staff of a large demonstration project, we developed an approach that uses Concept Mapping to identify dimensions for rating program site quality and compared our results with ratings based on site visits developed during program implementation. The site quality ratings and rankings resulting from our approach are plausible, have desirable psychometric properties, and are developed at much lower cost than is possible for even relatively modest process analyses.

Hot rocks and hydrogen

Iceland is beginning a national experiment to develop a hydrogen energy system. The authors outline the plans. The joint venture company Icelandic New Energy plans include: an experiment with hydrogen buses; the construction of a hydrogen production, compression and storage site; a fishing vessel that runs on hydrogen; and the exchange of batteries and diesel generators with fuel cells. The first large hydrogen demonstration project, the Ecological City Transport System (ECTOS), was announced in March 2001. For two years three fuel cell buses will operate within Reykjavik's public transport system. This means 4% of the of the city's public bus fleet will be powered by hydrogen. The aim is to test performance of a completely new technology in difficult seasonal conditions. INE intends to use the outcomes of the ECTOS project to form the basis for the further hydrogenisation of the Icelandic economy. The cost of hydrogen will undoubtedly play a major role in the acceptance and speed of adoption.

Assessing the performance of joinery coatings

In 1994 a large scale demonstration project was started in the Netherlands, with the aim of studying the performance of (less polluting) coating systems. In the project 66 paint systems (water-borne acrylics, high solids and traditional solvent-based alkyds) were applied to wooden window components of 66 housing complexes. Also the project contains field exposure and laboratory tests. The variables considered were the type of wood, details of the element, pre-treatment, colour, application conditions and environmental location. Important aspects for evaluation were durability and VOC content of the paint system. The practical performance was assessed each year, and each time on hundreds of window frames, gloss, moisture content, chalking, cracking, flaking, blistering and defects of the elements were measured.

Integrating the Traffic Management Applications of ITS: An Overview of the UTMC Programme in the UK

Launched in 1997, the Urban Traffic Management and Control (UTMC) research programme is the UK DETR's main initiative for the development of a more open approach to intelligent transport systems (ITS) in urban areas. This five-year programme supports the research and development of open standards and new applications for urban traffic management with the aim of seeing the market develop for the supply and use of UTMC systems. UTMC systems are defined by their Technical Specifications and associated documents. The research projects to date have focused on key areas of the Technical Specification and much of that research is, or is close to being, complete. The results provide the basis for conclusions about UTMC standards in key areas, notably communications. These are presented here. The results are also being drawn together in the current Call 4 for large demonstration projects. We summarise the aims and approach to Call 4 below.

Hydrogen: The future cryofuel in internal combustion engines

The characteristics of cryogenic hydrogen, such as high density and considerable cooling effect, favor the fuel injection, the mixing process and thus the combustion process. In addition to the preferred use of liquid hydrogen due to its range per tank filling and low amount of mass for storage in the vehicle, the cryogenic characteristics of hydrogen provide significant advantages. In addition to engine operation with external mixture formation, considerable success was achieved with internal mixture formation with injection of cryogenic high pressure hydrogen. Only pressurization of cryogenic hydrogen can be accomplished without investing a considerable amount of engine power. Hybrid mixture formation, a proper combination of external and internal mixture formation with suitably pressurized cryogenic hydrogen, is very attractive with respect to power and torque as well as other positive characteristics under steady and intermittent operating conditions. The state of the art technology of liquid hydrogen represents a suitable base for large scale demonstration projects now. Additional aims of more intense R&D work relate to internal mixture formation and improved engine drivability, as well as utility vehicle application including trucks and buses. With respect to fuel costs there will be an increased demand in developing hydrogen production free from CO 2 emissions even from fossil sources such as crude oil or natural gas.

Specialty differences and the ordering of screening mammography by primary care physicians.

Careful attention to factors that affect women and their physicians is necessary to achieve the national goal that, by the year 2000, 60 percent of women should have had a screening mammogram in the previous 2 years. This report evaluates factors that differentiate primary care physicians who regularly order mammograms from those who do not. The study was conducted as part of a large demonstration project in Washington State and includes a survey of women served by the physicians. We conducted a survey of primary care physicians and women in four counties to assess factors that influenced self-reported ordering of screening mammography. Among the 73 percent of family physicians, general practitioners, internists, and obstetrician-gynecologists who returned the questionnaire, there were more obstetrician-gynecologists (76 percent) who reported ordering screening mammograms in 90 percent or more of women aged 50 to 75 years, but they cared for only 15 percent of women in the sample. Women's survey results confirmed the physicians' reported differences and also revealed demographic characteristics that distinguished populations associated with particular primary care specialists. These specialists differed in their perceptions of their colleague's mammography practices, the adequacy of insurance coverage, and how often they had spent an unreasonable time explaining mammography results. In a multivariate model of factors expected to influence behavior, performance of clinical breast examination rather than specialty was the salient factor associated with ordering screening mammography. These results suggest that the context of practice, rather than specialty type or beliefs about mammography, has the major influence upon behavior. To achieve national screening mammography goals in the Northwest, we must influence the context of family physicians' preventive care practices because they care for 47 percent of women aged 50 years or older.

Benzodiazepine use in older, community-dwelling southern Californians: prevalence and clinical correlates.

To determine the use of benzodiazepines (BZDs) in an older, community-dwelling sample and to examine the sociodemographic and clinical correlates of BZD use. A cross-sectional study of 1752 elderly people (aged > or = 65 y) who completed a mailed medication survey and a telephone health status survey. Participants were invited to participate in a large Medicare demonstration project on prevention by their private physicians, who were also enrolled in the larger study. Participants had to be English-speaking, could not have dementia or a terminal illness, and had to give informed consent to participate in the study. Sociodemographic and health status variables that predicted BZD use were examined. Sociodemographic variables included age, gender, ethnicity, education, and income. Health status variables included functional status, with measures of mental, social, and physical health. Influenza immunization status was used as an indicator for preventive health services use and self-reported chronic illness was used as a measure of comorbidity. Twenty percent of the participants used BZDs at least twice in the past year. We found that those who used BZDs were more than twice as likely to take ten or more drugs, two-and-a-half times more likely to have difficulty falling asleep, and over twice as likely to be depressed. BZD users were also more likely to be white, to have a college education, and to have received a recent influenza shot, but were not more likely to be women when controlled for health status. Further clinical research should explore the relationship between BZD use among older patients and the BZD-associated adverse clinical factors we observed, as well as the association between multiple drug use and potential adverse outcomes in older BZD users.

The work and role of the Commission of the European Communities

Abstract In order to evaluate the potential for remote sensing techniques as a support to sectorial policies, an exploratory research programme was initiated in 1973. The availability of second generation Earth observation satellites has permitted the implementation of pilot projects on selected applications. Large area demonstration projects are now in progress and advanced research activities are preparing for the use of future satellites.

Vehicle detection video through image processing: the Autoscope system

Recent worldwide developments concerning the use of vehicle detection for wireless large-scale data collection and implementation of advanced traffic control and management schemes such as vehicle guidance/navigation are briefly discussed, and the system developed in the US, Autoscope, is described. Early work on Autoscope, leading to its present advantages over other emerging devices, and recent progress, such as preproduction line prototype development, field testing, and plans for extensive field validation and verification, are examined. The aforementioned plans include two large demonstration projects recently initiated in Minneapolis. In the first project, Autoscope will be used for incident detection over a section of Interstate 394. The second project involves implementation of the machine vision system at a signalized intersection. >

AIDS Education in the Jail Setting

This article describes some of the obstacles to and advantages of providing effective human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) education programs in jails. The description is based on a six-module, multisession program directed to injection drug users in the Maricopa County (Phoenix, AZ) jail as part of a large research and demonstration project funded by the National Institute on Drug Abuse. Some preliminary analyses of longitudinal data from Phoenix are presented. The results suggest that an evaluation of jail-based education focusing on safer needle usage and sex practices must be very thoughtfully designed and implemented.