scholarly journals The Air Force Visiting Surgeon Program: Development, Outcomes, and Future Application

2021 ◽  
Author(s):  
Justin P Fox ◽  
Kerry P Latham
Keyword(s):  
Plastic Surgery ◽  
Air Force ◽  
Surgical Care ◽  
Cost Savings ◽  
Cost Effective ◽  
Senior Author ◽  
Lessons Learned ◽  
Future Application ◽  
Military Health ◽  
Effective Manner

ABSTRACT Introduction Active duty service members and their families have limited access to subspecialty surgical care when assigned OCONUS. To address this issue, the Air Force Visiting Surgeon Program (VSP) was created to push subspecialty care to these locations. Visiting Surgeon Program was accomplished using temporary duty (TDY) orders. We conducted this 12-year review, 2009-2021, of the program to assess objective measures of impact, identify key lessons learned, and consider the program’s future. Materials and Methods In 2009, the senior author, Col Latham, performed a cost analysis of plastic surgery care provided at OCONUS installations and found that TRICARE Overseas often paid rates substantially higher than a TDY assignment for a single procedure. To improve beneficiaries’ access to care while providing a cost savings to the health care system, 2-week plastic surgery missions were proposed to interested OCONUS military treatment facilities (MTFs). Ultimately, four sites selected to host the program in Alaska, Italy, England, and Japan. These sites were selected based on patient volumes, operating room capacity, and local command and surgeon support. By 2015, the Air Force formalized the program via Air Force Instruction 44-102 which outlined roles and responsibilities of MTF Commanders; established points of contact; and instituted key safety measures. Results To date, 58 missions have been completed by 21 surgeons through the VSP at Aviano Air Base (Italy; 24.1%), Joint Base Elmendorf-Richardson (Alaska; 31.0%), Royal Air Force Lakenheath (England; 27.6%), and Yokota Air Base (Japan; 17.2%). While primarily an Air Force program, 17% (10/58) of missions were supported Army or Navy surgeons. Overall, 2,000 patient consultations and 865 surgical cases were performed avoiding $6.7 million in cost. In addition to direct beneficiary care, the VSP also contributed to the participating surgeon and host surgical teams mission readiness. Conclusions The VSP provides a template to make select subspecialty surgical care available in a cost-effective manner across the military health system, while also providing a model for the forward deployment of military plastic surgeons and triservice collaboration.

Drilling with Glass and Air: Using Hollow Glass Spheres to Address a Wide Ranging Drilling Challenge in a Safe, Efficient and Cost-Effective Manner

2021 ◽  
Author(s):  
M.. Rylance ◽  
Y.. Tuzov ◽  
V.. Sherishorin
Keyword(s):  
Scale Up ◽  
Cost Savings ◽  
Cost Effective ◽  
Lessons Learned ◽  
Successful Outcome ◽  
Drilling Fluids ◽  
Eastern Siberia ◽  
Hollow Glass ◽  
Glass Spheres ◽  
Effective Manner

Abstract A major development with multiple rigs delivering extensive multi-laterals encountered a pervasive mud-window issue within the reservoir. The resulting severe mud losses, extensive NPT and formation-damage was also deteriorating with time due to depletion. Conventional approaches to stem losses had failed and adoption of an energized mud-system with acceptable Effective Circulating Density (ECD) was not considered cost effective, pragmatic nor safe. Instead a novel application using Hollow-Glass-Spheres (HGS) was trialled, that demonstrated an effective and highly successful outcome. With 10 rigs drilling 60-70 wells per-year, each with 5,500 to 6,750m in the reservoir, quick resolution of the issue was required. For these reasons the Team at bp Russia looked carefully at alternatives that might fit the mud-window, but that offered a realistic approach for the environment and conditions in Eastern Siberia. The Team identified HGS as an approach to lighten the mud, often used for cementing ECD, application for drilling has been limited. For this approach we required an option with broad capabilities that could be scaled-up and exported to other development areas where such issues existed. This paper will report on the planning, delivery, and execution of a pilot on the Sb. field at TYNGD, in Eastern Siberia. Initially deployed on three wells, including multi-laterals, the paper will walk through the engineering considerations, during the planning and execution phases. Reporting comprehensively on the data gathered and the many lessons learned during the incremental and stepwise deployment. Data will be provided that demonstrated loss-free drilling was achieved where this had not occurred before, with a dramatic reduction in NPT, FLA needs and costs. The paper will also report on the post drilling productivity and comparison with offset wells drilled with conventional mud systems and suffering severe losses. The results of this pilot have beaten all expectations, there have been many insights and the Team are now looking to set a timetable to scale-up across the NOJV. Much has been learned, waste HGS material has been demonstrated to be an effective FLA pill in other sections of the well and centralisation of mud process may offer additional cost savings and improvements. Further efficiencies are expected to be achieved and potential across the Company portfolio could be a major game changer. HGS for cementing is well documented, application for drilling fluids has been less reported and almost exclusively applied to one-off sections/wells. The TYNGD application is novel as this is a major new development with 10 drilling rigs. Application is on multi-laterals and prior offset wells are available for direct comparison. The results of the approach demonstrate a new way of performing well construction in an effective manner for major Field Developments where losses are prevalent.

Web-Based Risk and Hazard Identification and Screening

2000 ◽  
Author(s):  
John L. Steele ◽  
Evaristo J. Bonano
Keyword(s):  
Management System ◽  
Safety Management ◽  
Cost Savings ◽  
Cost Effective ◽  
Lessons Learned ◽  
Hazard Identification ◽  
Department Of Energy ◽  
Assessment Process ◽  
Safety Management System ◽  
Effective Manner

Abstract Organizations, both in the private and public sector, need to avoid to the extent practicable, workplace hazards and minimize the associated risks in order to comply with regulations. However, they have also recognized that this is a sound business practice that could result in significant cost savings by avoiding fines and penalties due to non-compliance and enhanced productivity. Consequently, many organizations have instituted safe work practices into their operations and those practices have become a major criterion in evaluating managers’ performance. This new philosophy is now commonly referred to as “Integrated Safety Management.” Per the direction of the Secretary of Energy, all U. S. Department of Energy (“DOE”) facilities across the country have been instructed to implement an Integrated Safety Management System. Different DOE facilities have taken various approaches to the implementation of the system. This paper describes the approach instituted at Sandia National Laboratories and a tool that was developed from lessons learned during that effort. The tool is the cornerstone for implementing an Integrated Safety Management System in a time and cost-effective manner. The tool is now commercially available and can be readily rendered applicable to any type of systematic assessment process.

scholarly journals The Optimization of Building Deconstruction for Department of Defense Facilities: Ft. McClellan Deconstruction Project

2006 ◽  
Vol 1 (1) ◽  
pp. 102-122 ◽  
Author(s):  
Bradley Guy
Keyword(s):  
Economic Efficiency ◽  
Department Of Defense ◽  
Cost Effective ◽  
Economic Benefits ◽  
Maximum Amount ◽  
Lessons Learned ◽  
Building Structures ◽  
Additional Time ◽  
Effective Manner ◽  
Total Labor

Deconstruction is the selective dismantling of building structures to recover the maximum amount of primarily reusable and secondarily recyclable materials in a safe and cost-effective manner. Deconstruction is a labor intensive process and can be difficult to achieve in a time-efficient and economical manner for light wood-framed buildings. Deconstruction techniques that balance hand and mechanical labor must be developed to maintain the integrity of materials for reuse and obtain maximum salvage value per unit of cost and time-on-site. This project entailed the removal of three identical WWII-era two-story wood-framed barracks buildings at Ft. McClellan Army Base, Anniston, AL, using hand deconstruction, combined mechanical and hand deconstruction techniques, and a traditional demolition method, i.e., mechanical reduction and disposal, in order to determine “optimal” deconstruction techniques based on salvage value per unit of cost. The maximum practical materials salvage from the study buildings using 100% hand deconstruction techniques was 39% of the mass by weight. A combination of hand and mechanical techniques was discovered to have approximately the same economic efficiency as 100% hand deconstruction, measured as a ratio of gross cost per salvage value, with a 44.6% reduction in total labor-hours, and a reduction of only 7% of salvage materials by weight. These findings indicate the potential for greatly increasing wood-framed building deconstruction practice relative to the additional time-on-site and labor that is required, compared to demolition, while optimizing economic benefits. This paper describes the research methods and deconstruction techniques employed, and lessons learned to advance the practice of deconstruction to be more economically competitive and time-efficient.

Lessons Learned From the Application and Refinement of Risk-Informed Inservice Inspection Programs

2008 ◽  
Author(s):  
Alan D. Chockie ◽  
M. Robin Graybeal ◽  
Scott D. Kulat
Keyword(s):  
Cost Effective ◽  
Nuclear Regulatory Commission ◽  
Lessons Learned ◽  
Nuclear Industry ◽  
Plant Safety ◽  
Nuclear Plants ◽  
New Information ◽  
Effective Manner ◽  
Regulatory Commission ◽  
Available Information

The risk-informed inservice inspection (RI-ISI) process provides a structured and systematic framework for allocating inspection resources in a cost-effective manner while improving plant safety. It helps focus inspections where failure mechanisms are likely to be and where enhanced inspections are warranted. To date, over eighty-five percent of US nuclear plants and a number of non-US plants have implemented, or are in the process of implementing, RI-ISI programs. Many are already involved in the periodic update of their RI-ISI program. The development of RI-ISI methodologies in the US has been a long and involved process. The risk-informed procedures and rules were developed to take full advantage of PRA data, industry and plant experiences, information on specific damage mechanisms, and other available information. An important feature of the risk-informed methodologies is the requirement to make modifications and improvements to the plant’s RI-ISI application as new information and insights become available. The nuclear industry, ASME Section XI, and the Nuclear Regulatory Commission have all worked together to take advantage of the lessons learned over the years to refine and expand the use of risk-informed methodologies. This paper examines the lessons learned and the benefits received from the application and refinement of risk-informed inservice inspection programs. Also included in the paper is a review of how the information and insights have been used to improve the risk-informed methodologies.

Do Context-Sensitive Solutions Really Work?

2008 ◽  
Vol 2060 (1) ◽  
pp. 107-115 ◽  
Author(s):  
Lisa Olszak ◽  
Robert Goldbach ◽  
James Long
Keyword(s):  
Information Exchange ◽  
Cost Savings ◽  
Interdisciplinary Approach ◽  
Cost Effective ◽  
Lessons Learned ◽  
Future Research ◽  
Project Schedule ◽  
Context Sensitive ◽  
Community Stakeholders ◽  
Underlying Principle

Most state transportation agencies tout context-sensitive solutions (CSS) as an underlying principle in their approach to transportation project development. FHWA defines CSS as “a collaborative, interdisciplinary approach that involves all stakeholders to develop a transportation facility that fits its physical setting and preserves scenic, aesthetic, historic and environmental resources while maintaining safety and mobility.” The purpose of this research was to apply TRB CSS measurement criteria to test whether a well-planned CSS strategy contributes to a safe, cost-effective transportation project that is integrated within the fabric of the community. Olszak Management Consulting, Inc.—with support from FHWA and the Pennsylvania Turnpike Commission (PTC)—evaluated a CSS approach to an FHWA major highway project, The Mon/Fayette Expressway. PTC empowered five design advisory teams (DATs) made up of technical and community members to make decisions about critical design issues. Olszak's evaluation efforts focused on DAT stakeholder and multidisciplinary team performance activities that spanned 24 months of preliminary design. Surveys of designers, meeting facilitators, community stakeholders, and project leaders yielded strong evidence of satisfaction with both processes and outcomes. Cost savings were indicated and the project schedule was maintained. This paper details the DAT structure and functions, methods for documentation and information exchange, reliability of metrics, research findings, lessons learned, and suggestions for future research.

Pushing the Operational Envelope of a Cap-Rock Restoration Campaign Utilizing Perforate Wash Cement Technology and a Hydraulic Work Over Unit Offshore Malaysia

2021 ◽  
Author(s):  
Mohamad Anas Abdul Razak ◽  
Ahmad Zawawi Abdul Rajab ◽  
Jay Sern Chew ◽  
John Brian Chesson ◽  
Susin Lim
Keyword(s):  
Risk Mitigation ◽  
Cost Savings ◽  
Cost Effective ◽  
Lessons Learned ◽  
Strict Adherence ◽  
Washing Process ◽  
Challenges And Opportunities ◽  
Sustained Casing Pressure ◽  
Cap Rock ◽  
Operational Envelope

Abstract Malaysia's government recognizes the high risk that aging idle wells pose to its health, safety and environment and has developed some of the most stringent plug and abandonment, P&A, regulations to protect its future. Corroded casing strings and sustained casing pressure are common issues on its multi-decade old platforms and a risk-based design philosophy has been adopted to balance risk mitigation and operational costs, while still ensuring an eternal barrier. Both conventional rigs as well as rigless hydraulic workover units, HWU, are being used for P&A operations. This study considers the barrier element rationale applied in four offshore wells that were plug and abandoned by cap-rock restoration Perforate, Wash, Cement, PWC, barrier plugs. It also considers the operating window of a jet-based PWC technology to understand the challenges and opportunities for further optimization during HWU operations. Cap rock restoration utilizing both cup-based and jet-based PWC technology is being widely applied throughout Malaysia as a cost-effective alternative to casing section milled barrier plugs. Malaysia's P&A regulation allows isolation at the cap rock level, whereby "Contractor shall adhere to the Cap-Rock Abandonment Applicability Flowchart to identify technically and commercially acceptable candidates for this well abandonment method." The PWC method enables cap rock restoration in a single trip process; whereby the casing annulus is accessed by TCP guns to allow for annular debris to be effectively washed prior to cement plug placement. The process is not limited only to TCP guns; as a mechanical casing perforator was utilized in a shallow cased hole section of one of the wells to avoid damaging the outer casing. A custom BHA was developed and tested to match the cuts from the mechanical perforator. Specially oriented, rotating, wash jets were configured to maximize the annular access during the washing process. The washing effectiveness of this new BHA was confirmed by the massive amount of annular debris that was observed over the surface shakers. Operations were conducted offshore with a HWU with limited infrastructure and operating capability compared to a conventional rig. A PWC candidate screening matrix was applied early during the planning phase to manage rig limitation, well condition and operational risk to ensure successful barrier placement. All cap rock barriers were successfully installed and tested, and no sustained annular pressure remained in any of the wells. Fewer PWC plugs were required than originally planned, due to strict adherence to the Caprock Restoration Plan Decision Tree, resulting in significant cost savings for the project. The detailed time breakdown of the HWU operations provides useful insight into the operational efficiencies and unplanned events during the HWU campaign and lessons learned are shared from the project.

Hollow Glass Spheres HGS in Drilling Fluid: Case Study of Preventing and Mitigating Total Losses

2021 ◽  
Author(s):  
Vitaly Sherishorin ◽  
Martin Rylance ◽  
Yevgeniy Tuzov ◽  
Olga Krokhaleva ◽  
Evgeny Tikhonov ◽  
...  
Keyword(s):  
Drilling Fluid ◽  
Scale Up ◽  
Cost Savings ◽  
Field Application ◽  
Lessons Learned ◽  
Drilling Fluids ◽  
Lost Circulation ◽  
Initial Application ◽  
General Plan ◽  
Effective Manner

Abstract The paper describes the first deployment of HGS in Eastern Siberia as a mud additive. The technology was utilized for reducing drilling fluid density for prevention and mitigation of losses; while drilling through a producing reservoir section with low pore pressure, unconsolidated and fractured sands. The engineering considerations, fundamentals of the approach and major risks involved were reviewed with application to the Sredneboutobinskoye Oilfield as a pilot field application for broader future plans. Key planning, delivery and execution principles of the initial application will be reported in the paper. Initially deployed on three wells, including multi-laterals (Rylance et al., 2021), the paper will walk through the engineering considerations during the planning and execution phases. Key sections include the data gathered and the many lessons learned during the incremental and stepwise deployment. The paper will also report on post drilling productivity and comparisons with the offset wells drilled with conventional mud systems, which suffered severe losses. The results of this pilot have exceeded expectations. There have been many insights and the Team are now looking to set a timetable to scale-up across the Taas-Yuryakh Neftegazodobycha (TYNGD). After many hours of laboratories study and preparation works, the general plan was to reduce the static density and ECD to mitigate fluid losses. However, the applied results showed additional effects from HGS. Data will be provided that demonstrated loss-free drilling was achieved where this had not been the case before, with a material reduction in NPT, lost circulation material (LCM) needs and costs. Much has been learned, recovered HGS material has been demonstrated to be an effective LCM pill and centralization of mud processing may offer additional cost savings and improvements. Further efficiencies are also expected to be achieved and future potential is considerable. HGS for cementing is well documented, yet application for drilling fluids has been less well reported and almost exclusively related to single wells. The TYNGD application is innovative as this is a major development with 10 active drilling rigs. The application is on multi-laterals and offset wells are available for direct comparison. The results of the approach demonstrate a new way of performing well construction in an effective manner for major field developments where losses are prevalent.

15K Multistage Fracturing Completion System Addresses Operational Challenges, Improves Production Performance and Cost Savings in Openhole Environments

2021 ◽  
Author(s):  
Rasim Serdar Rodoplu ◽  
Adegbenga O. Sobowale ◽  
Jon E. Hanson ◽  
Beau R. Wright
Keyword(s):  
New Technology ◽  
Cost Savings ◽  
Cost Effective ◽  
Production Performance ◽  
High Rate ◽  
Field Development ◽  
Additional Equipment ◽  
Effective Manner ◽  
Open Hole ◽  
The Right

Abstract Multistage fracturing (MSF) ball drop completion systems have been utilized around the globe for effectively treating formations completed as open hole and cemented. Multiple, high-rate hydraulic fracturing stages are pumped through these completions while gaining efficiency during pumping operations. A challenge within the industry was developing systems that are capable of higher pressures (greater than 10k psi) while still being able to be deployed in challenging openhole environments with minimum equipment and intervention requirements. This paper will discuss the planning, deployment and fracturing execution operations of an improved version of one of these systems. To be able to effectively utilize any MSF completion system; formation properties, deployment environment, lateral length, openhole size, liner size, and tubing movements during fracturing should be thoroughly analyzed and equally considered. To create a reliable system, another important consideration is how the system will be deployed; a long string to surface, or will it be deployed as part of a liner hanger system? In the case of the latter, it should be compatible with the liner hanger system by accommodating multiple balls to set and release the hanger system and actuate the openhole packers. In tight formation environments, where treating pressure differentials reaches as high as 15,000 psi during fracturing operations, openhole packers that are capable of holding these pressures in challenging openhole conditions are needed. Not only the packers but also the remaining completion system components need to be capable of withstanding, including burst, collapse, and ball-to-ball seat differential while simultaneously accommodating the pressure with cooling and ballooning induced tubing movement caused by these high pressure treatments. Improving such a robust design with innovative solutions, such as dissolvable frac balls that can handle 15,000 psi differential, optimizes the overall process. The completion design, deployment, and subsequent fracturing operations on a well showcases how effective consideration of components operates as a system can create a reliable MSF system. It also demonstrates how close collaboration between reservoir management, production engineering, completion experts, and vendor results in a coordination of efforts that eliminates operational hazards, thus ensuring smooth operations. The successful deployment of an openhole MSF completion system that can handle 15,000 psi with dissolving frac balls and eliminating openhole anchors helped pave the way to deal with tighter formations in an efficient and cost-effective manner. With the help of this new technology, the well planners were able to address operational challenges that would have otherwise required additional equipment or would have limited deployment capabilities. The engineering approach and design to develop this completion system and utilization in the right candidate confirmed the benefit of the novel completion for field development options.

Results of a pilot study to examine the effective integration of apprentices into the industrial construction sector

2003 ◽  
Vol 30 (2) ◽  
pp. 391-405 ◽  
Author(s):  
Aminah Robinson Fayek ◽  
Ahmed Shaheen ◽  
Ayo Oduba
Keyword(s):  
Pilot Study ◽  
Best Practice ◽  
Labour Force ◽  
Cost Effective ◽  
Lessons Learned ◽  
Construction Sector ◽  
Skilled Workers ◽  
Industrial Construction ◽  
Effective Manner ◽  
The Impact

The industrial construction sector in Alberta has recently undergone a period of rapid growth, resulting in a shortage of skilled workers in almost all of the major industrial sector trades. To meet these shortages, a need has arisen to increase the utilization of apprentices on industrial construction projects. In an effort to address this issue, the Construction Owners Association of Alberta has established a goal of developing an industry Best Practice on how to improve the on-the-job portion of apprenticeship training and identify means by which the industry can more effectively use apprentices. The challenge is to increase their usage in a cost-effective manner that also provides apprentices with adequate training opportunities. Before this can be done, the impacts and benefits to the various parties involved in industrial construction must be quantified and assessed. This paper describes the findings of a pilot study that was conducted on a major industrial project to help in quantifying the impact of the use of apprentices in the industrial construction sector and to identify methods of effectively increasing their use while simultaneously enhancing their on-the-job learning experience. The main conclusion of this paper is that apprentices can be effectively incorporated in industrial construction, and they can be both productive and cost-effective, provided they are given adequate instruction and supervision. The lessons learned from the study are discussed to provide insight into conducting future studies. Recommendations for an industry Best Practice on the effective utilization of apprentices are presented.Key words: apprentice, electrician, industrial construction, journeyman, labour force, pipefitter, productivity, training, work sampling.

scholarly journals Celebrating the World Breastfeeding Week in the Era of COVID-19 Pandemic in Southern Nigeria: Lessons Learned

2020 ◽  
pp. 46-57
Author(s):  
A. R. Nte ◽  
G. K. Eke
Keyword(s):  
Prevention And Control ◽  
Cost Effective ◽  
Professional Associations ◽  
Lessons Learned ◽  
Infection Prevention And Control ◽  
Religious Activities ◽  
Good Opportunity ◽  
Effective Manner ◽  
Virtual Meetings ◽  
And Control

Background: The annual World Breastfeeding Week (WBW) celebration has been a period of massive interaction with stakeholders through various means and sharing of information related to the promotion, protection and support of breastfeeding since its inception in 1992. However, with the advent of the novel coronavirus disease 2019 (COVID-19) pandemic and subsequent uncertainties about the fate of breastfeeding on one hand, and the imposed measures for COVID-19 infection prevention and control on the other, there was need to modify the traditional way of celebrating the Week to ensure that knowledge about the COVID-19-breastfeeding dyad is communicated to relevant stakeholders while complying with the COVID-19 preventive protocols. Aims: To share experiences and document lessons learned from the celebration of the 2020 WBW which can be reflected upon and used for improving on strategies to protect, promote and support breastfeeding even amidst the restrictions imposed by the protocols for the prevention and control of COVID-19 infection. Place of Study: University of Port Harcourt Teaching Hospital (UPTH), Nigeria. Methodology: The Baby Friendly Hospital Initiative (BFHI) Committee of the UPTH has celebrated the annual WBW every 1st to 7th August for the past 22 years (1997-2019). The reports of events of previous WBW Celebrations were retrieved and the format of the various activities was compared with that of activities for the 2020 WBW Celebration, which took place in the era of COVID-19 pandemic. The findings are presented in tables. Results: Activities for the celebration of WBW in the pre-COVID-19 era usually included physical meetings for the sensitisation of the hospital communities/stakeholders, radio/television sessions, information sharing in various places of religious activities and a rally to interact with the community people. During the COVID-19 pandemic, new strategies for celebration of the WBW were adopted, including among others, virtual meetings, decentralisation of sensitisation of the hospital’s clientele and a physical meeting for the sensitisation of the Hospital Management Committee. Positive outcomes of the 2020 Celebration included the management’s commitment to the promotion, protection and support of breastfeeding, participation in the webinars by stakeholders from within and outside the hospital/Rivers State and establishment of collaborations with several partners. Lesson learned included among others, the celebration of the Week by many stakeholders, the reduced cost of celebration due to the absence of physical meetings and their attendant costs. The personalised invitation of all departments, units and professional associations secured their commitments to breastfeeding. Decentralising the celebration facilitated the adaptation of the messages to the needs of different clienteles and strengthening of members from different departments to promote, protect and support breastfeeding in their work environment. However, the poor participation of the hospital community in the virtual meetings attributable to lack of experience and the cost of participation were setbacks to the targets of the Committee. Conclusion: The era of the COVID-19 pandemic provided a good opportunity to engage stakeholders from within and outside the hospital for the support of breastfeeding as a safe infant feeding option in the midst of COVID-19 and introduced a new normal, the use of virtual meetings to promote, protect and support breastfeeding in a cost effective manner. The celebration of the Week reiterated the role of breastfeeding for ensuring planetary health which was being challenged by the COVID-19 pandemic.

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