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Friday, July 23, 2010

EU SHOULD PROTECT ITS TERRITORIAL BORDERS and ENVIROMENTAL INTERESTS,TOGETHER WITH NEIGHBOURING COUNTRIES

Eastern Mediterranean ready to reveal its sub-salt secrets


With industry interest reawakened by recent deepwater, sub-salt gas finds offshore Israel, the eastern Mediterranean and Levantine Basin today loom large on the frontier exploration agenda. Here, Øystein Lie, Thore Sortemos and Per Helge Semb of Petroleum Geo-Services explain why they think a new hydrocarbon province could open up offshore Cyprus and Lebanon in the next few years.

Offshore Cyprus and Lebanon are huge unexplored areas in the eastern Mediterranean. This deepwater area is close to proven offshore hydrocarbon provinces in the Nile Delta and Israel. Until recently, shallow post-salt targets have been the main focus in these areas; however, with recent advances in seismic technology sub-salt plays have been revealed. The recent deepwater, sub-salt gas discoveries offshore Israel have significantly increased industry interest in the eastern Mediterranean and particularly the Levantine Basin. High quality Lower Miocene reservoir sands were discovered in both the Tamar and Dalit wells (Figure 1). Analogues to the drilled structures offshore Israel can be found both offshore Cyprus and Lebanon which may prove to be a new province for oil and gas in the next few years.


Figure 1: Eastern Mediterranean map illustrating the
seismic data coverage in Cyprus and Lebanon and location of major oil and gas fields.

When the Republic of Cyprus arranged its first licensing round in 2007, Noble Energy was awarded block 12. The second licence round, scheduled to open this year, will include all the remaining open exploration blocks covering a huge unexplored area.


Petroleum Geo-Services (PGS) has provided the Cyprus commerce, industry & tourism ministry with a dense 2D coverage over the exploration blocks, and one 3D survey. The data covers an offshore area of more than 50,000km2 and forms the basis for a geological report, with interpretation and assessment of the variety of plays in the Herodotus Basin, the Eratosthenes Continental Block, the Cyprus Arc Basin and the Levantine Basin.


The Republic of Lebanon is preparing for its first offshore licensing round and anticipates an announcement this year. It is offering oil and gas companies more than 25,000km2 of highly prospective acreage located north of the oil and gas producing areas of Gaza and Israel. The offshore area is covered by extensive 2D – an extension of the recent 2D dual-sensor (GeoStreamer) survey offshore Cyprus – as well as by 3D seismic data. The data reveals several attractive hydrocarbon plays where the primary focus would be in the Miocene sub-salt plays, the Jurassic/Cretaceous horst blocks and Miocene stratigraphic pinch-outs.


Seismic technology
The recent 2D seismic data was acquired with the GeoStreamer which differs from a conventional streamer in that it has two recording sensors.


A pressure sensor in a conventional towed streamer always records two wavefields that interfere with each other. The two wavefields are the up-going pressure wavefield propagating directly to the pressure sensor from the earth below and the down-going pressure wavefield reflected downwards from the free (sea) surface immediately above the streamer. Thus, every recorded reflection wavelet from conventional marine streamers is accompanied by a ghost reflection from the ocean’s surface.


The PGS dual-sensor streamer (GeoStreamer) measures both the pressure wave field using hydrophones, and the vertical component of the particle velocity using motion sensors. By combining the data from the two sensors the energy can be separated into up- and down-going parts (Carlson et al, 2007). By considering only the up-going wavefield, the effect of the ghost reflections from the sea surface is removed. When the ghost reflections are removed, the resulting spectrum is flat and broadband thus enabling the user to optimize the data quality, not just for one target depth, but for all depths shallow to deep (Figure 2).



Figure 2: A comparison between 2D conventional seismic (left)
and 2D dual-sensor seismic (right) from offshore Cyprus.

The dual-sensor streamer was towed deep to increase the energy level on the low frequencies and still keep the desired content of high frequencies. The deep tow ensured a quiet environment which, combined with the enhanced low frequency signal, significantly increased the signal-to-noise ratio of the seismic data. Based on experience of the operations in the eastern Mediterranean, the dual-sensor streamer benefits have been seen in three key areas: enhanced resolution of the seismic image both shallow and deep, due to a broader frequency spectrum; better signal penetration revealing sub-salt and deeper targets, which have been valuable for the interpretation; and improved seismic operational efficiency due to less weather down-time.


Eastern Mediterranean MegaProject
The continuous seismic coverage from Cyprus to Lebanon (Figure 3) provides an excellent starting point to understand the geological development of this prospective region. Matching and balancing of the entire PGS 2D and 3D seismic database and including third party data in the offshore regions, has been undertaken. A total of 18,000km GeoStreamer 2D data, 18,000km conventional 2D data, in addition to 2900km2 3D seismic data, has allowed interpretation of regional reflectors, with no restriction across country borders. The data has provided an improved understanding of the nature of the hydrocarbon systems, improved interpretation of plays and prospects, and clearer understanding of the hydrocarbon potential of the different basins in the area.




Figure 3: The interpreted seabed horizon
of the eastern Mediterranean MegaProject.

Six key regional horizons have been interpreted across the data set. The horizons for interpretation were chosen based on reflector continuity and regional character, in order to enable us to delineate the different tectonic elements in the area such as the Levantine Basin, the Cyprus Arc, the Eratosthenes Seamount and the Herodotus Basin. The interpretation has also outlined several prospects and leads at the potential reservoir horizons.


While no wells have been drilled within the study area, the hydrocarbon charge system is interpreted to have potential source intervals in possible Middle Jurassic and Upper Cretaceous- Lower Tertiary and Lower Miocene. The isolated structural setting of the Levantine Basin favours the deposition of source rocks, and it is considered highly unlikely that no source rocks are present in such a thick sedimentary succession. Nearby discoveries in the NEMED block in Egypt, the recent deepwater Lower Miocene Tamar and Dalit discoveries and exploration wells drilled in the shallow water and onshore areas of Israel and Gaza have already proved the presence of a working hydrocarbon system in both the Herodotus and the Levantine Basin. Proven reservoir facies, in the Cenozoic of the eastern Mediterranean, occur in a variety of depositional settings and frequently display god reservoir quality and we believe that there is a strong likelihood that clastic and/or carbonate reservoirs will be present in the current area of interest. Preliminary regional interpretation indicates, among other possibilities, the presence of basin floor fan systems, channel systems and carbonate build ups.


The sedimentary basins of the eastern Mediterranean contain a wide range of trapping styles.


A 2D GeoStreamer line through the Levantine Basin from south to north.

The most prospective trap types in the deepwater Levantine Basin are currently considered to be sub-salt NE-SW trending folds and NNE-SSW trending faulted anticlinal Syrian Arc traps. But other trap types such as tilted fault blocks, horst blocks and stratigraphic traps have also been identified and the interpretation has already revealed several large structural analogues to the Tamar discovery in the Levantine Basin. The thick, extensive Messinian Evaporite succession that characterizes the geology of the eastern Mediterranean should constitute an effective regional top seal.


As with its larger counterparts in the North Sea and West Africa, the EMMP is planned to expand, using a phased approach, to include data from neighbouring countries offshore. But today it is already supplying interested parties with an invaluable head start prior to the upcoming licensing rounds in both Cyprus and Lebanon.


Conclusions
Offshore Cyprus and Lebanon are offering highly attractive acreage for exploration. A recent regional GeoStreamer 2D seismic data grid has improved the data coverage and quality to reveal new subsalt plays. The Eastern Mediterranean MegaProject is providing seamless seismic data coverage across country borders to increase the understanding of the hydrocarbon systems and potential of the eastern Mediterranean. OE

By: Øystein Lie, Thore Sortemos and Per Helge Semb
Issue: March 2010

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Monday, July 12, 2010

E-GOVERNMENT -SERVICE ORIENTED ARCHITECTURE (c)

3 . Afternoon session

(CONTINUED FROM  25/05/10,clicking on the title you are redirected)

The afternoon session presentations related to SOA in eGovernment practice

and consisted of six presentations.

3.1 Service-Oriented e-Processing and Case Management of  Law Violation

Mr Oliver Ziehm, CSC presented the service-oriented eProcessing and case

management of law violations. The use of SOA in the eJustice system for law

violations processing in the German federal state of Hessen shows how

current modernisation goals of public administration can be reached by

applying SOA-based information technology principles.

The solution significantly accelerates a multi-agency process; reduces the

corresponding cost and sets up the preconditions for IT-driven administrative

modernisation. The approach is process-driven, combining service orientation,

legacy service integration, business process management and enterprise

content management. The solution is distributed and completely paperless.

eJustice SOA is not restricted to law violations; the solution blueprint is

applicable to a wide range of multi-organisational integration problems.

eJustice SOA is a recipient of the 2009 CSC Chairman’s Award.

The objectives of eJustice SOA were to introduce electronic legal relations for

law violations in the German state of Hessen, to introduce multi-department,

multi-agency, electronic collaboration, and to modernise judicial processing by  introducing fundamental techniques. Such techniques include Enterprise


content management (ECM), Business Process management (BPM), and

Application systems integration.

In addition, the system accelerates the process avoiding transport of paper

files between and within agencies and data re-entry, reduces cost by the

abolishment of paperwork and reduces revenue loss as a result of expired

cases.

It is important to note that the system crosses the hierarchical structure of

administrative organisations and at the same time complying with some of the

strongest legal principles of the German constitution, i.e., the autonomy of

involved agencies and the independence of the judges who can veto the

process.

The eJustice SOA has been in production since March 2007. It has been used

in 3 Hessian agencies and the ECM client is used by 44 assistants,

prosecutors, and judges in their daily work. About 3,000 user operations on

electronic case files, each and all aspects of prosecuting traffic offenses are

fully digitised, while there is digital signature of court decisions. The plans for

2010 increase the number of involved agencies to 56, and the number of

processed cases to more than 50,000 per year.

Mr Ziehm concluded stressing the strong project political sponsorship that

allowed changes in legislation when necessary and the activation of a multistakeholder

management process that was necessary. The use of standards

contributed to the project success, as well as the excellent understanding of

the relevant processes by the project team.

Finally, Mr Ziehm underlined that SOA is not to be considered as a primarily

technical approach, but a management one.
 
In reply to a question by Mr Sobolewski, Mr Ziehm clarified that a set of twenty


services were created and one public service registry.

3.2 Practical application of SOA in the Public Procurement  processes of the European Commission

Mr João Rodrigues Frade (PricewaterhouseCoopers, Performance

Improvement Consulting) discussed the practical application of SOA in the

public procurement processes of the European Commission.

According to Mr Rodrigues Frade, EU public procurement plays an important

part on the single market and is governed by rules intended to remove

barriers and open up markets in a non-discriminatory and competitive way.

Total public procurement in the EU – i.e. the purchases of goods, services and

public works by governments and public utilities – is estimated at about 1 per

cent of the Union’s GDP or € 1,500 billion in 2002.

Based on the i2010 eGovernment Action Plan, the high level take-up of

electronic procurement is highly desirable for Europe. Its widespread usage  could result in savings in total procurement costs of around 5 per cent and


reductions in transaction costs of 10 per cent or more. Consequently, this

could lead to savings of tens of billions of euro annually and easier access to

public procurement markets for SMEs. As a result, this action plan points out

to eProcurement, and in particular cross-border eProcurement, as the area on

which to focus in the application of key electronic services.

The e-PRIOR platform

To support these objectives, the IDABC electronic invoicing and electronic

ordering project started in the summer of 2007 as a joint IDABC action of the

Directorate General for Internal Market and Services and the Directorate

General for Informatics of the European Commission.

Based on the experience of this project, the presentation explored how SOA

and platform-based development were used to satisfy a wide variety of

business and technical requirements, which were the foundation of the service

oriented platform named e-PRIOR (electronic Procurement Invoicing and

Ordering).

e-PRIOR is an e-Procurement system, exposing a number of web services

linked to particular steps in the procurement process of the European

Commission. Broadly, it helps public authorities manage their procurement

processes electronically. They can use it to receive catalogues digitally, they

can submit their orders on-line and they can manage their invoices, simply by

exchanging standardised electronic business documents.

The goal

Among others, the   Among others, the goal is to actively foster dialogue, interaction and


discussion, but also to address the strategic, as well as implementation

aspects of using SOA to bridge the legacy systems used by public

administrations and the systems of their suppliers. All this is to be set in the

context of achieving interoperable eServices, which are cross-border and help

making procurement faster, more transparent, greener and more secure.

Mr Rodrigues Frade concluded that the EC is paving the way for

eProcurement and the adoption of standards and SOA, promoting

interoperability in reliable eCollaboration between suppliers and customers. e-

PRIOR is a strong example of an “Enterprise Service Bus” platform

independent of the back office systems that can be reused in different

document exchange contexts.

Ms Lahti asked about the schedule of bringing the e-PRIOR services online.

Mr Rodrigues Frade explained that after the eInvoicing related services

(invoice, credit note, document attachment) which are already online, the rest

of the eProcurement services are scheduled for the end of the year 2010. The

project is working on ordering and catalogue services now and in the mean

time it is working to expand the list of involved suppliers.

Following a question from the audience on the need for e-PRIOR specific

infrastructure, Mr Rodrigues Frade explained that the project currently

operates in a point-to-point architecture, since it is at its pilot phase. However,e-PRIOR is already connected to the PEPPOL large scale pilot eProcurement


project, where cloud architecture is employed and it is e-PRIOR’s plans to

render point to point connectivity deprecated when the necessary critical mass

is achieved.

Mr. Sobolewski inquired about the number of services employed in e-PRIOR.

Mr. Rodrigues Frade explained that there are different services for each

document type, but in general there are fifteen services currently provided. He

added that the e-PRIOR platform exists in two versions, one using the BEA

Weblogic proprietary platform and one using open source infrastructure to

facilitate its reuse by public administrations, which includes implementations

of the Spring framework, JBPM and EJB3.
 
3.3 Time for a SOA reference framework for the European  Commission

Mr Koert Declercq (Deloitte Consulting) presented the SOA reference

framework for public services.

SOA in government is rising. Public administrations evolve in a complex

environment, involving many actors at different levels. For that reason,

governments have traditionally developed systems that do not integrate with

one another. Today, public administrations face obstacles because their

applications are outdated: they do not meet business needs adequately, they

are costly to maintain, and at the same time not flexible enough to handle

policy and regulation changes efficiently.

In this context, the SOA paradigm seems particularly suited to help

government agencies. SOA should be seen as a design philosophy that

informs how the solution should be built. SOA uses a set of common

applications or services that extend across all systems and perform common

types of functions and business processes, without having to modify all core

underlying systems.

SOA should organise existing IT solutions in such a way that the

heterogeneous array of distributed, complex systems and applications can be

transformed into a network of integrated, simplified and highly flexible

systems. Therefore, the adoption of SOA principles across public

administrations is getting stronger by the day.

Examples of successful SOA implementations can be found: the Overheids

Service Bus in the Netherlands, the e-Health Platform in Belgium, Health and

Human Services in US, and Inspire geo-portal at the Commission. These

examples provide a simple basic infrastructure with a set of services, which

are accessible via portal or service bus.
The advantages SOA offers by its distributed nature and loose coupling also


lead to its main challenges. With SOA, the complexity is in the area of

choosing the right services, orchestrating and composing them. It is thus

essential to define the type of services that the administration would deliver  through SOA and create a SOA roadmap. This can be supported by the  following elements:

● Reference list of services. These services are clearly understood by the

business and imply a clear communication within the organisation.

● Logical order in the implementation of the infrastructure services. The

order is based on a SOA maturity assessment. When the SOA experience

and maturity increase, the type of services change.

● Clear split between business and infrastructure services.

● Good SOA governance that aims to increase overall quality of SOA and

enable control in a complex environment.

If these elements are considered, it seems clear that guidance is essential

when starting a SOA initiative. In that sense, a key success factor to a

successful SOA transition is a reference architecture.

Necessity for reference architecture

Architectural guidelines are essential in order to organise a successful SOA

transition, with appropriate governance and roadmap. At the European level,

reference architecture can provide a helpful framework to progressively

implement the services needed. European SOA reference architecture will

provide a blueprint for creating or evaluating architecture and depict how to

leverage on existing systems, providing systems’ integration and reusable

services across public administrations.
Mr Malotaux asked about the relation of the proposed reference model to the


EIF of the European Commission. Mr Declercq replied that the proposed

reference model fits in the EIF provisions and the EIF sets the landscape, but

we should start filling it up.

Mr Sobolewski commented that the reference architecture is not SOA as it

only proposes a list of services with no workflow or service orchestration.

According to Mr Sobolewski, citizens should be in the position to decide what

services to get in line with their needs. Mr Declercq commented that the

customer in the proposed reference architecture is not the citizen, but a

specific user relevant to a business case.

Ms Donovang-Kuhlisch commented that she considers the proposed

reference architecture positively as it approaches the definition,

categorisation, and implementation of services in different levels. The lowlevel

infrastructure and the business processes define a matrix that forms the

eGovernment services landscape.
 
(TO BE CONTINUED)


SOURCE EU ICT

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Saturday, July 03, 2010

AGEING IN EU

EUROPEAN UNION IS  INVESTING  FOR THE LAST YEARS, THROUGH A LOTS OF RESEARCH PROJECTS  IN AGING WELL,EITHER ON E-HEALTH OR HEALTH  PROGRAMS.
THE MOST IMPORTANT  ONE ,IS THE AAL  ,WHERE ARE GOING TO BE INVESTED 600 MILLION EURO'S FROM 2008-2013 .
AS AGEING LIMITS ARE  AUGMENTING ,IN THE NEXT YEARS  UP TO 2050 THE POPULATION OVER 80 WILL BE TRIPLE ,COMPARING WITH TODAY,TELECARE,TELEMEDICINE,TELEHEALTH PRACTICES  WILL  WORK FOR THE BENEFIT OF OUR CONTINENT'S AGEING POPULATION,MAKING THEIR LIVES HEALTHIER AND JOYFUL,EITHER AT HOUSE OR AT THE COMMUNITY .

"There is no reason for older people in Europe to miss out on the benefits of new technologies. The solutions and services resulting from this programme will help them to remain active in society as well as staying socially connected and independent for a longer time," said Viviane Reding, EU Commissioner for the Information Society and Media. 


infodesk epaphos advisors 



clicking on the title you are redirected to the AAL   programme



Preparing More Care of Elderly
With a nudge from the new health care law and pressure from Medicare, hospitals, doctors and nurses are struggling to prepare for explosive growth in the numbers of high-risk elderly patients.

More than 40 percent of adult patients in acute care hospital beds are 65 or older. Seventy million Americans will have turned 65 by 2030. They include the 85-and-older cohort, the nation’s fastest-growing age group.

Elderly people often have multiple chronic illnesses, expensive to treat, and they are apt to require costly hospital readmissions, sometimes as often as 10 times in a single year.

The Obama administration is spending $500 million from last year’s stimulus package to support the training of doctors and nurses and other health care providers at all levels, “from college teachers through work force professionals on the front lines of patient care,” said Kathleen Sebelius, the secretary of health and human services.

But the administration and Congress seem to be paying less attention to geriatric health issues. For example, only 11 percent of research funding at the National Institutes of Health went to aging research last year.

“In every area of aging — education, clinical care, research — people just don’t realize how dire the situation is,” said Dr. David B. Reuben, chief of the geriatrics division of the David Geffen School of Medicine at the University of California, Los Angeles.

Dr. Judith Salerno, a geriatrician who is executive officer of the Institute of Medicine in Washington, agreed. “All the most common causes of death and illness and functional impairment in the general population are diseases of aging,” she said.

At N.I.H., the director, Dr. Francis S. Collins, sees the picture in different terms. He says N.I.H. budgets are tight across the board, not just for aging research, after a $10 billion spike from stimulus funds.

“The opportunities in aging research are compelling,” Dr. Collins said in a telephone interview. He mentioned a study last year on mice that lived significantly longer after being given rapamycin, a cancer and immunosuppressive drug.

“That is turning out to be the most exciting new pathway for extending normal life span that has ever been discovered,” Dr. Collins said. But he said the opportunities were also compelling in cancer, diabetes, mental illness and autism.

“It is frustrating to have such great opportunities and limited budget resources,” Dr. Collins said. They all need more funds, he added.

In hospitals and doctors’ offices, where explaining to elderly patients how to deal with their often-complicated problems can be time-consuming, payments from Medicare, Medicaid and most private insurers are not sufficient, said Dr. J. Fred Ralston Jr., president of the 129,000-member American College of Physicians.

“The payment system doesn’t finance the kind of resources we need to take care of the 20 percent of Medicare patients who use 80 percent of resources,” he said.

Dr. Mark R. Chassin, a former New York State health commissioner, said, “The biggest challenge that we face with the increasing numbers of very elderly folks is how to preserve as much independence in their lives as possible.” Dr. Chassin heads the Joint Commission, which accredits thousands of hospitals and other health care providers.

To stay independent, the elderly will need to stay healthy.

“Many of these people could be back on the golf course and enjoying their grandchildren if we did the right thing for them,” said Mary D. Naylor, a longtime geriatric care researcher and professor of gerontology in the School of Nursing at the University of Pennsylvania.

Her research showed that even fragile older people could avoid a quick return to the hospital if they are managed by teams of nurses, social workers, physicians and therapists, together with their own family members. Hospital readmissions, which cost $17 billion a year, could be reduced by 20 percent — $3.5 billion — or more, she said.

Hospitals will be penalized by cuts in their Medicare payments, starting in 2012, if too many patients are readmitted within 30 days after being discharged.

Dr. Reuben at U.C.L.A. said research showed that “vulnerable elderly people who are at risk of becoming frail often do not get appropriate care. For dementia, falls, bladder incontinence, depression, they get about a third of the care they need.”

He added: “If somebody is falling, it makes sense to examine their gait and their balance. If someone has bladder incontinence, you might want to have them do exercises, but their doctors commonly reach for the next drug they can give them.”

Hospitals are training their staffs to make special assessments of patients who may be at risk of falling, a major threat for the elderly. A fall-prevention program is a requirement for Joint Commission accreditation.

Many internists, family physicians and other primary care doctors are lobbying for payments for a team approach based in the physician’s office. The concept, which they call a patient-centered medical home, will be tried out under the new health care law by Medicare, Medicaid and some private insurers. Secretary Sebelius has called the medical home idea “one of our most promising models for improving the quality of care and bringing down health care costs.”

Geraldine Goldsmith, a patient at New York University’s Langone Medical Center, said a team of N.Y.U. geriatric care specialists “taught me how to survive” during her long fight against sickle cell anemia, a genetic blood disorder.

To stave off a painful sickle cell crisis, which may put her in the hospital as often as every six weeks, Ms. Goldsmith, who is 73, gets continuous support from Marilyn Lopez, a geriatric nurse practitioner.

Caring for the elderly is “a profession of the heart,” Ms. Lopez said.

Ms. Goldsmith said the geriatric team “makes sure that I eat proper food, take my medications, keep my appointments — as you get older, you forget.”

She added that Ms. Lopez “calls and says: ‘Geraldine, look at your calendar. I’m going to see you tomorrow.’ ”

At the N.Y.U. medical center, an electronic screening system tracks patients who may be at risk for problems with cognition, falls, nutrition, pain, skin conditions like pressure ulcers, and taking multiple medications, Ms. Lopez said. Similarly, at the University of Alabama Hospital at Birmingham, Susan B. Powell, a nurse practitioner, sees to it that medications prescribed for older patients are checked by a pharmacist against a list of drugs found to be unsafe for the elderly. So many of these patients are seeing six or eight doctors and end up with many prescriptions, Ms. Powell said.

After elderly patients are sent home, she telephones to remind them to contact a physician and to follow orders from their nurses and doctors.

Both hospitals use a precise set of methods and principles for geriatric care called Niche (for Nurses Improving Care for Healthsystem Elders). With support from the John A. Hartford Foundation and the Atlantic Philanthropies, the Niche program has spread to 300 hospitals around the country.

Although the recession has made finding jobs difficult for recent nursing graduates in places like New York and California, the Labor Department has said that 600,000 new nurses would be needed within 10 years to replace those who retire and to meet growing demand.

Currently, 11,000 of the nation’s 3.1 million registered nurses are certified as geriatric nurses or nurse practitioners. But tens of thousands of student nurses are now learning about the special needs of the elderly as part of their regular studies, said Geraldine Bednash, chief executive of the American Association of Colleges of Nursing.

Every student nurse at N.Y.U. spends time working with elderly patients. “Before long, 90 percent of American nurses will have to provide care for older adults,” said Terry Fulmer, dean of the N.Y.U. College of Nursing. Ms. Fulmer helped create and develop the Niche approach.

This year, the National Health Service Corps, a unit of the Department of Health and Human Services, is doubling its program that repays student loans for caregivers who work in rural and underserved urban neighborhoods. Family practice doctors, nurse practitioners, dentists and others who care for the elderly are among those eligible. The administration has allocated $300 million in stimulus funds to support about 7,800 graduates.

With stimulus money and $34 million more under the new health care law, the administration is also expanding training for geriatric specialists who commit to teaching student physicians and nurses.

“As we talk about needing more health care providers of all kinds,” Ms. Sebelius said in a telephone interview, “we are also retraining current providers” to become better at geriatric care.

But doctors are generally not paid extra for the time they spend in lengthy meetings listening to elderly patients with multiple problems. “Geriatricians work in one of the few fields where the more you know, the less you are paid,” said Dr. Salerno of the Institute of Medicine.

Not surprisingly, specialists in geriatric care are in short supply. There are only about 7,000 geriatricians to deal with the aging boomer generation over the next 10 years, Dr. Reuben said. More than 20,000 will be needed, according to the American Geriatrics Society, a professional and advocacy group. To help fill that gap, all first-year interns in internal medicine at the Birmingham medical school are spending four weeks with geriatric patients this year. They are part of a $200 million national effort to promote geriatric education principally financed by the Donald W. Reynolds Foundation, based in Las Vegas.

Dr. Kellie Flood, a geriatrician who directs the Birmingham program, discusses newly admitted elderly patients at 10 a.m. daily with Ms. Powell and other nurses and doctors, as well as therapists, dietitians and social workers.

“We start planning for their departure from Day 1,” Dr. Flood said. By some counts, her geriatrics unit outperforms comparable general medical units in the hospital. “We have a lower average length of stay — four days — and a lower 30-day return rate — 16 percent,” she said. The national average is close to 20 percent for Medicare patients discharged from a hospital and readmitted within a month.

Dr. Flood, Ms. Powell and their team have a fan in William Mullins, 88, a retired pharmacist who lives in nearby Pelham, Ala. Mr. Mullins, who had a small stroke in April, praised the “great care” at Birmingham. “They treated me,” he said, “like they was my daddy or my mother.”

By MILT FREUDENHEIM

SOURCE  NYT  29/06/10

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