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You can manage construction risks.

A construction project is about the riskiest thing any company does in the normal course of business. Hundreds of things can go wrong, dozens will. But officers who analyze and manage every other sort of risk often ignore construction risk as if it were uncontrollable. The truth is, it can't be eliminated, but it can be controlled. Construction is not a product but a confusing and often exasperating service. A group of experts--architects, bankers, consultants, contractors, engineers, users, city officials--coordinate the activities of an army of suppliers, laborers, designers, subcontractors, and inspectors. The job of the company officers is to coordinate the coordinators; to make prompt, informed decisions as the work progresses; to take and retain project responsibility at the highest level; and to analyze and manage the entire process in the following seven stages: 1. Study the types and phases of construction risk. 2. Assess the risks of the company's particular project. 3. Match these risks with the in-house capabilities. 4. Define a building strategy. 5. Pick the right kind of contract. 6. Choose a contractor. 7. Monitor construction. Analyzing risk is largely a matter of assessing the complexity of the building, the site, the financing, the schedule, and the special uses and problems of the project. This analysis then drives the choice of contract and contractor. The range runs from low-cost providers, lump sum contracts and very little teamwork at one end of the spectrum to highly differentiated construction companies, guaranteed-maximum-prince contracts, and consultative coordination at the other.

Contract Services↗

Discontinuation of approval of modifications in notes, guaranteed under Title VI or VII of the Public Health Service Act, proposed to permit use of the notes as collateral for tax-exempt financings--PHS. Final rule.

The Department of Health and Human Services (HHS) adds a new section to regulations for making and guaranteeing loans for construction and modernization of hospitals and medical facilities and to regulations for guaranteeing loans for the construction of teaching facilities for health professions personnel. Under these regulations HHS will not approve the modification of the terms of an existing loan guaranteed under Title VI or Title VII of the Public Health Service (PHS) Act if the modification would permit use of the guarantee (or guaranteed loan) as collateral for tax-exempt financing.

Financial Management↗

MDS Cognitive Performance Scale.

BACKGROUND: Chronic cognitive impairment is a major problem in U.S. nursing homes, yet traditional assessment systems in most facilities included only limited information on cognitive status. Following the Congressional mandate in the Omnibus Reconciliation Act of 1987 (OBRA '87), U.S. nursing homes now complete the Minimum Data Set (MDS), a standardized, comprehensive assessment of each resident's functional, medical, psychosocial, and cognitive status. We designed a Cognitive Performance Scale (CPS) that uses MDS data to assign residents into easily understood cognitive performance categories. METHODS: Information was drawn from three data sets, including two multistate data sets constructed for the Health Care Financing Administration. The prevalence and reliability of the MDS cognitive performance variables were established when assessed by trained nursing personnel. Five selected MDS items were combined to create the single, functionally meaningful seven-category hierarchical Cognitive Performance Scale. RESULTS: The CPS scale corresponded closely with scores generated by the Mini-Mental State Examination and the Test for Severe Impairment, nursing judgments of disorientation, and neurological diagnoses of Alzheimer's disease and other dementias. CONCLUSIONS: The new CPS provides a functional view of cognitive performance, using readily available MDS data. It should prove useful to clinicians and investigators using the MDS to determine a resident's cognitive assets.

Activities of Daily Living↗

Hill-Burton health facilities; review--HRSA. Notice of review.

This notice announces a review of institutions and organizations which have received grants under the Hill-Burton Program (Title VI of the Public Health Service Act, 42 U.S.C. 291 et seq.) for the construction or modernization of hospitals or other health facilities.

Financing, Government↗

Situation of integrative medicine in China: results from a national survey in 2004.

Integrative medicine (IM), usually called integrated traditional and Western medicine in China, which came into being in the 1950s as a new form of medicine, although is now developing quickly, little is known about its status and existing problems. So a national survey in China was conducted through questionnaire in 2004 by Chinese Association of Integrative Medicine with the support of State Administration of Traditional Chinese Medicine (SATCM). The results show that, of all the medical professionals investigated in this survey, 91.21% and 93.52% respondents respectively favored IM as the best diagnostic and therapeutic method. Of all the patients who once went through TCM, Western medicine (WM) and IM therapies, 68.85%, 65.45% and 71.2% respondents respectively most appreciated IM, IM hospitals and IM therapeutic treatments. Most of the 6 595 respondents held that the optimal scientific research strategy in TCM should be integrating modern medical research method (n = 2 380) or modern scientific method (n = 2 920). However, many hospitals exposed the problems in the aspects of governmental supports and funding supports, human resources, and domestic or international academic activities. These results indicated that IM is the patients' social needs and doctors' aspiration in China. For further development of IM, the enhancement of scientific research construction and assistance by policies and finance from the government and other institutions are urgently needed in China.

Attitude of Health Personnel↗

Implementation of new legislative measures on industrial risks prevention and control in urban areas.

Incompatible at first sight, but vital to each other, the industry and the city have been developing a complex relationship for decades. From 1810 on in France, risk prevention and control in and around major industrial sites evolves step-by-step, learning from accidents. Land-use planning in the vicinity of SEVESO establishments becomes one of the key policies in the prevention of major industrial accident hazard on European level in 1996, focussing on historical situation of concern [M.D. Christou, S. Porter, Guidance on Land-use Planning as required by the council Directive 96/82/EC. Joint Research Centre, European Commission, 1999]. The Toulouse (F) accidents, on 21 September 2001 evidenced the need for new tools to reinforce protective action and ease the situation of clusters of factories engulfed in the urban setting. In France, new legislative measures adopted on 30 July 2003 deeply modified the approach to land-use planning around the main dangerous facilities (622 establishments). The implementation of technological risk prevention plans [Fr. "PPRT"] will limit the exposition of the population to the consequences of accidents. These plans, derived from the risk assessment (safety reports) produced by the operators of the hazardous facilities, will delineate areas within which requirements can be imposed on existing and future buildings and within which future building rights may be restricted. On the grounds of extremely serious danger that threatens human life, pre-existing constructions may be progressively expropriated. The financing of the corresponding measures, estimated a rough 2-4 billions euro, will be defined by agreements among the Central Government, the industrial company and the local and regional bodies.

Accidents, Occupational↗

The economics of the disposal of sewage and trade effluents.

In this review of the economics of the disposal of sewage and trade wastes, the author touches on all aspects of the subject, from the annual costs of sewerage and sewage-disposal services in England and Wales, and what he terms the "uneconomics" of pollution of natural waters, to the financing of capital expenditure on the construction of new sewage works and equipment and on alterations to existing works. He discusses the purposes and relative costs of the various processes in the treatment of domestic sewage and outlines the special problems involved in the disposal of trade wastes.

England↗