Define institutional options for a regional development authority.

This review identified 10 universal principles of successfully integrated healthcare systems that may be used by decision-makers to assist with integration efforts. These principles define key areas for restructuring and allow organizational flexibility and adaptation to local context. The literature does not contain a one-size-fits-all model or process for successful integration, nor is there a firm empirical foundation for specific integration strategies and processes.

Intraregional Migration- Historical Precedents


(Regional Strategy and Project Proposals).

The main components of the regional system are a physical subsystem composed of natural resources and infrastructural components; an activity subsystem composed of social and economic components; and a regulating subsystem composed of institutions and technological components.

Regional development, programs, and projects.

In most of the models, point-source parameter estimates were both highly significant in accounting for the spatial pattern in water quality and close to expected values based on the functional form of the model. In most cases, the statistical significance levels (i.e., “p-values”) for point sources were ≤0.004, which indicates the strong statistical relationship between estimates of point-source nutrient contributions and downstream loads. Theoretically, point-source coefficient estimates should approximate the value 1, because point sources (quantified as mass per time) discharge directly to streams without the potential for land-based attenuation (). The regional model point-source coefficient estimates range approximately from 0.67 to 1.9, with only 3 of the 12 models (1 TN and 2 TP) indicating a mean value that is statistically different from the expected value of 1 (based on a two-tailed t-test for α = 0.05). Point-source coefficient estimates that are higher or lower than expected likely result from inaccurately estimated point-source contributions, which are empirically adjusted by the model to best match the observed stream loads. The available point-source data derived from the U.S. Environmental Protection Agency (USEPA) Permit Compliance System (PCS) database must often be estimated due to lack of reporting, thus potentially causing lower accuracy and precision in the SPARROW prediction of point-source contributions to the stream nutrient load (). Models with coefficient values

Develop a regional water-management plan for INERHI.An extra-regional goal was also defined.
It also wanted to spur the creation of a regional development authority.


Comparison of simulation results from 12 independently calibrated SPARROW models of stream nutrient loads in major river basins across the U.S. reveals some national consistencies and some regional specificity of nutrient sources and delivery factors. All of the models provided similar levels of prediction accuracy as defined by statistical diagnostics (i.e., RMSE, R2). The models were generally consistent in identifying major sources although refined measures of those sources were better predictors of stream nutrient loads in some regions. Urban and agricultural sources of nutrients were the largest contributors to stream loads in most of the regions. The more diffuse of these sources (e.g., urban runoff) tended to affect water quality in more streams, whereas the more focused sources (e.g., point sources) commonly contributed the largest mass of nutrients regionally, which implies that they could have greater effects than do diffuse sources on downstream water quality. Agricultural sources were consistently identified as significant sources of nutrients throughout the country, but the relative importance of crops and animal waste to stream nutrient loads varied somewhat by region. Climatic factors were identified by most of the models as being important regional delivery factors for nutrients, but many other delivery factors appeared to be regionally specific. Spatial patterns in the source contributions and delivery rates were generally consistent, but some differences were apparent at regional boundaries. Finally, in all cases the accuracy and precision of the models are limited by the data available to build them. Thus, there is an ongoing need to expand monitoring efforts in order to better identify the factors that control stream nutrient loading and to improve the resolution of geospatial datasets to provide better explanatory power for all models used to support water-quality management decisions.

One year after the plan was published, the regional authority had not yet been created.

Introduction: Regional Geography

An important learning of this review is that there is a wide spectrum of models for health systems integration. Based on the literature from a diverse group of healthcare and business organizations and a range of jurisdictions, 10 relatively universal principles of successfully integrated healthcare systems have been identified. The 10 principles define the key areas for restructuring while at the same time allowing for organizational flexibility and adaptation to local context (Marriott et al. 2000). These principles may be used by decision-makers to assist with focusing and guiding integration efforts, but much more needs to be learned about specific structures and mechanisms for success. It is important to emphasize that the literature does not contain a one-size-fits-all model or process for successful integration, nor is there a firm empirical foundation for specific integration strategies and processes.

Progress to DateIt is too early to tell whether the regional plan will be implemented.

01/12/2017 · “The Logic of Regional Systems, ..

Thus, attempts to attribute observed trends to regional emissions changes require consideration of internal climate variability, particularly for short record lengths and small forced trends.