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Sample records for emergency referrals safer

  1. Support and Assessment for Fall Emergency Referrals (SAFER 1) trial protocol. Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial

    PubMed Central

    2010-01-01

    Background Many emergency ambulance calls are for older people who have fallen. As half of them are left at home, a community-based response may often be more appropriate than hospital attendance. The SAFER 1 trial will assess the costs and benefits of a new healthcare technology - hand-held computers with computerised clinical decision support (CCDS) software - to help paramedics decide who needs hospital attendance, and who can be safely left at home with referral to community falls services. Methods/Design Pragmatic cluster randomised trial with a qualitative component. We shall allocate 72 paramedics ('clusters') at random between receiving the intervention and a control group delivering care as usual, of whom we expect 60 to complete the trial. Patients are eligible if they are aged 65 or older, live in the study area but not in residential care, and are attended by a study paramedic following an emergency call for a fall. Seven to 10 days after the index fall we shall offer patients the opportunity to opt out of further follow up. Continuing participants will receive questionnaires after one and 6 months, and we shall monitor their routine clinical data for 6 months. We shall interview 20 of these patients in depth. We shall conduct focus groups or semi-structured interviews with paramedics and other stakeholders. The primary outcome is the interval to the first subsequent reported fall (or death). We shall analyse this and other measures of outcome, process and cost by 'intention to treat'. We shall analyse qualitative data thematically. Discussion Since the SAFER 1 trial received funding in August 2006, implementation has come to terms with ambulance service reorganisation and a new national electronic patient record in England. In response to these hurdles the research team has adapted the research design, including aspects of the intervention, to meet the needs of the ambulance services. In conclusion this complex emergency care trial will provide

  2. SAFER - Services and Applications For the Emergency Response: en route for a safer world with the GMES operational services

    NASA Astrophysics Data System (ADS)

    Denis, G.; Hello, D.

    2009-04-01

    In the frame of GMES, SAFER prepares the implementation of operational versions of the Emergency Response Core Service. SAFER is a large integrated project which has been selected by the European Commission (FP7 call GMES). SAFER will reinforce European capacity to respond to emergency situations: fires, floods, earthquakes, volcanic eruptions, landslides, humanitarian crisis. The main goal of SAFER is the upgrade of the service and the validation of its performance with 2 priorities: - First priority is the improvement of response when crisis occurs, with the rapid mapping capacity after disastrous events, including the relevant preparatory services. For validation purposes, the project will deliver services at full scale for real events or during exercises. The main performance criterion is the response time. - The second priority is the extension to core service components before and after the crisis. It targets the longer term service evolution, through the provision of thematic products, to be added in the portfolio of services. The main performance criterion is the added-value of products with risk-specific information. Coordinated by Infoterra, the consortium is built around a core team of European service providers. A wide network of scientific partners and service providers will extend the European dimension. The presentation will highlight: - The heritage and foundations. - The expected contribution to the implementation of the operational Emergency Response Core Service. - The key challenges to move from the research and development and project-driven logic to the sustainable operations. - The possible synergies with other services.

  3. Consultation and referral patterns from a teaching hospital emergency department.

    PubMed

    Cortazzo, J M; Guertler, A T; Rice, M M

    1993-09-01

    The objective of this study was to describe consultation and referral patterns from a military emergency department (ED). The design of the study consisted of a prospective analysis of consultations and referrals from Madigan Army Medical Center ED during April 1990, an Army Medical Center with multiple residencies, including emergency medicine (EM). Patient population included active and retired military personnel, their families, and civilian emergency medical system-transported patients. ED visits averaged 60,000 per year. The overall rate of consultation and referral was 39.9%; 10.7% were consultations, whereas 29.2% were referrals. PGY-2 and -3 EM residents consultation rates were higher than average. Of all ED visits, 19.7% resulted in consultations or referrals to surgical services, 13.6% to medical services, and 2.8% to pediatrics. ED patients frequently are referred to or result in consultations with non-EM physicians. Differences in consultation by level of training and the impact of consultation on consulting services both deserve further investigation. Review of EM resident use of consultation and referral may focus evaluation of ED care in teaching hospitals. PMID:8395848

  4. Adherence to Referral Criteria for Burns in the Emergency Department

    PubMed Central

    Chipp, Elizabeth; Walton, Jules; Gorman, David; Moiemen, Naiem S

    2008-01-01

    Objective: To audit the referral patterns of burns in an emergency department compared with national referral guidelines. Methods: A retrospective case note audit of patients attending an emergency department with a diagnosis of “burn” in a 1-year period. Results: Only one quarter of the patients were managed according to the suggested national referral criteria for burns. Large and full thickness burns were managed appropriately but those at important anatomical sites and in patients at the extremes of age were managed less well. Conclusion: Increased awareness of the national referral guidelines, along with further education of staff within this department, may improve management of burn injuries. It is likely that referral patterns are similar in other emergency departments and may be improved by training staff in the assessment and management of burns. Increased adherence to the guidelines is likely to improve patient outcome at the expense of increased patient numbers and workloads in regional burns units that have implications for funding and service provision. PMID:18536778

  5. Understanding the Impact of Residents' Interpersonal Relationships During Emergency Department Referrals and Consultations

    PubMed Central

    Chan, Teresa; Sabir, Kameron; Sanhan, Sarila; Sherbino, Jonathan

    2013-01-01

    Background Communicating with colleagues is a key physician competency. Yet few studies have sought to uncover the complex nature of relationships between referring and consulting physicians, which may be affected by the inherent relationships between the participants. Objective Our study examines themes identified from discussions about communications and the role of relationships during the referral-consultation process. Methods From March to September 2010, 30 residents (10 emergency medicine, 10 general surgery, 10 internal medicine) were interviewed using a semistructured focus group protocol. Two investigators independently reviewed the transcripts using inductive methods and grounded theory to generate themes (using codes for ease of analysis) until saturation was reached. Disagreements were resolved by consensus, yielding an inventory of themes and subthemes. Measures for ensuring trustworthiness of the analysis included generating an audit trail and external auditing of the material by investigators not involved with the initial analysis. Results Two main relationship-related themes affected the referral-consultation process: familiarity and trust. Various subthemes were further delineated and studied in the context of pertinent literature. Conclusions Relationships between physicians have a powerful influence on the emergency department referral-consultation dynamic. The emergency department referral-consultation may be significantly altered by the familiarity and perceived trustworthiness of the referring and consulting physicians. Our proposed framework may further inform and improve instructional methods for teaching interpersonal communication. Most importantly, it may help junior learners understand inherent difficulties they may encounter during the referral process between emergency and consulting physicians. PMID:24455004

  6. Quality improvement in emergency obstetric referrals: qualitative study of provider perspectives in Assin North district, Ghana

    PubMed Central

    Afari, Henrietta; Hirschhorn, Lisa R; Michaelis, Annie; Barker, Pierre; Sodzi-Tettey, Sodzi

    2014-01-01

    Objective To describe healthcare worker (HCW)-identified system-based bottlenecks and the value of local engagement in designing strategies to improve referral processes related to emergency obstetric care in rural Ghana. Design Qualitative study using semistructured interviews of participants to obtain provider narratives. Setting Referral systems in obstetrics in Assin North Municipal Assembly, a rural district in Ghana. This included one district hospital, six health centres and four local health posts. This work was embedded in an ongoing quality improvement project in the district addressing barriers to existing referral protocols to lessen delays. Participants 18 HCWs (8 midwives, 4 community health officers, 3 medical assistants, 2 emergency room nurses, 1 doctor) at different facility levels within the district. Results We identified important gaps in referral processes in Assin North, with the most commonly noted including recognising danger signs, alerting receiving units, accompanying critically ill patients, documenting referral cases and giving and obtaining feedback on referred cases. Main root causes identified by providers were in four domains: (1) transportation, (2) communication, (3) clinical skills and management and (4) standards of care and monitoring, and suggested interventions that target these barriers. Mapping these challenges allowed for better understanding of next steps for developing comprehensive, evidence-based solutions to identified referral gaps within the district. Conclusions Providers are an important source of information on local referral delays and in the development of approaches to improvement responsive to these gaps. Better engagement of HCWs can help to identify and evaluate high-impact holistic interventions to address faulty referral systems which result in poor maternal outcomes in resource-poor settings. These perspectives need to be integrated with patient and community perspectives. PMID:24833695

  7. Referrals between Public Sector Health Institutions for Women with Obstetric High Risk, Complications, or Emergencies in India - A Systematic Review.

    PubMed

    Singh, Samiksha; Doyle, Pat; Campbell, Oona M; Mathew, Manu; Murthy, G V S

    2016-01-01

    Emergency obstetric care (EmOC) within primary health care systems requires a linked referral system to be effective in reducing maternal death. This systematic review aimed to summarize evidence on the proportion of referrals between institutions during pregnancy and delivery, and the factors affecting referrals, in India. We searched 6 electronic databases, reviewed four regional databases and repositories, and relevant program reports from India published between 1994 and 2013. All types of study or reports (except editorials, comments and letters) which reported on institution-referrals (out-referral or in-referral) for obstetric care were included. Results were synthesized on the proportion and the reasons for referral, and factors affecting referrals. Of the 11,346 articles identified by the search, we included 232 articles in the full text review and extracted data from 16 studies that met our inclusion criteria Of the 16, one was RCT, seven intervention cohort (without controls), six cross-sectional, and three qualitative studies. Bias and quality of studies were reported. Between 25% and 52% of all pregnancies were referred from Sub-centres for antenatal high-risk, 14% to 36% from nurse run delivery or basic EmOC centres for complications or emergencies, and 2 to 7% were referred from doctor run basic EmOC centres for specialist care at comprehensive EmOC centres. Problems identified with referrals from peripheral health centres included low skills and confidence of staff, reluctance to induce labour, confusion over the clinical criteria for referral, non-uniform standards of care at referral institutions, a tendency to by-pass middle level institutions, a lack of referral communication and supervision, and poor compliance. The high proportion of referrals from peripheral health centers reflects the lack of appropriate clinical guidelines, processes, and skills for obstetric care and referral in India. This, combined with inadequate referral communication

  8. It Takes Two to Tango: Improving Patient Referrals from the Emergency Department to Inpatient Clinicians

    PubMed Central

    Lawrence, Sean; Spencer, Lyndall M.; Sinnott, Michael; Eley, Robert

    2015-01-01

    Background The transfer of responsibility for patient care across clinical specialties is a complex process. Published and anecdotal data suggest that referrals often fail to meet the needs of one or both parties and that patient focus can be lost during the process. Little is known about the Australian situation. Methods To obtain a more complete understanding of the referral process, including the nature of communication in an Australian context, we conducted semistructured interviews in a convenience sample of 25 volunteers. Two established strategies for analyzing qualitative data were used. Results All respondents considered the following information essential components of a referral: an account of the patient's current condition, a working diagnosis or problem statement and history of the presenting concern, key test results or tests awaiting results, a potential management plan, and any special characteristics of the patient. Respondents acknowledged implied, if not literal, power to accept or reject an emergency department (ED) referral and said the imbalance of power was reinforced when the ED physician was junior to the inpatient clinician. Respondents also noted that in addition to the predominant organizational culture, an independent culture is associated with specific shifts. Foremost among the nonclinical aspects of a referral considered to be important was the timeliness of the contact made to achieve the transition. Respondents also said the success of a referral depended on the speaking and listening abilities of all parties. The individual's motivation to accept or reject a referral can also have an impact on communication. Conclusion Respondents attributed the difficulty of negotiating the transfer of a patient's care across the ED and inpatient interface to three distinct factors: variations in the clinical information required, the culture of the organization and of the clinical team in which the transaction takes place, and the

  9. The Effectiveness of Emergency Obstetric Referral Interventions in Developing Country Settings: A Systematic Review

    PubMed Central

    Hussein, Julia; Kanguru, Lovney; Astin, Margaret; Munjanja, Stephen

    2012-01-01

    Background Pregnancy complications can be unpredictable and many women in developing countries cannot access health facilities where life-saving care is available. This study assesses the effects of referral interventions that enable pregnant women to reach health facilities during an emergency, after the decision to seek care is made. Methods and findings Selected bibliographic databases were searched with no date or language restrictions. Randomised controlled trials and quasi experimental study designs with a comparison group were included. Outcomes of interest included maternal and neonatal mortality and other intermediate measures such as service utilisation. Two reviewers independently selected, appraised, and extracted articles using predefined fields. Forest plots, tables, and qualitative summaries of study quality, size, and direction of effect were used for analysis. Nineteen studies were included. In South Asian settings, four studies of organisational interventions in communities that generated funds for transport reduced neonatal deaths, with the largest effect seen in India (odds ratio 0·48 95% CI 0·34–0·68). Three quasi experimental studies from sub-Saharan Africa reported reductions in stillbirths with maternity waiting home interventions, with one statistically significant result (OR 0.56 95% CI 0.32–0.96). Effects of interventions on maternal mortality were unclear. Referral interventions usually improved utilisation of health services but the opposite effect was also documented. The effects of multiple interventions in the studies could not be disentangled. Explanatory mechanisms through which the interventions worked could not be ascertained. Conclusions Community mobilisation interventions may reduce neonatal mortality but the contribution of referral components cannot be ascertained. The reduction in stillbirth rates resulting from maternity waiting homes needs further study. Referral interventions can have unexpected adverse effects

  10. Emergency Department Referral Process and Subsequent Use of Safety-Net Clinics.

    PubMed

    Ruben, Kathleen; Mortensen, Karoline; Eldridge, Barbara

    2015-10-01

    We analyzed data on 10,761 low-income emergency department (ED) patients participating in the Emergency Department-Primary Care Connect program to identify successful methods of disseminating information on availability of primary care clinics. Data were obtained from all five hospitals in Montgomery County, Maryland, four participating county clinics, and from patient navigators. A two-part negative binomial model estimated factors associated with the probability of a clinic visit following a referral, and factors associated with the frequency of subsequent clinic visits. Twenty-one percent of patients had a subsequent clinic visit, and two-thirds of these patients returned for a second clinic visit. Patients were more likely to make the initial clinic visit if the referral was made by both the ED Provider and the patient navigator, relative to referral by the ED provider only. ED providers and patient navigators helped patients gain access to primary care services by referring them to safety-net clinics. PMID:25236770

  11. Gender Differences in Emergency Department Visits and Detox Referrals for Illicit and Nonmedical Use of Opioids

    PubMed Central

    Ryoo, Hyeon-Ju; Choo, Esther K.

    2016-01-01

    Introduction Visits to the emergency department (ED) for use of illicit drugs and opioids have increased in the past decade. In the ED, little is known about how gender may play a role in drug-related visits and referrals to treatment. This study performs gender-based comparison analyses of drug-related ED visits nationwide. Methods We performed a cross-sectional analysis with data collected from 2004 to 2011 by the Drug Abuse Warning Network (DAWN). All data were coded to capture major drug categories and opioids. We used logistic regression models to find associations between gender and odds of referral to treatment programs. A second set of models were controlled for patient “seeking detox,” or patient explicitly requesting for detox referral. Results Of the 27.9 million ED visits related to drug use in the DAWN database, visits by men were 2.69 times more likely to involve illicit drugs than visits by women (95% CI [2.56, 2.80]). Men were more likely than women to be referred to detox programs for any illicit drugs (OR 1.12, 95% CI [1.02–1.22]), for each of the major illicit drugs (e.g., cocaine: OR 1.27, 95% CI [1.15–1.40]), and for prescription opioids (OR 1.30, 95% CI [1.17–1.43]). This significant association prevailed after controlling for “seeking detox.” Conclusion Women are less likely to receive referrals to detox programs than men when presenting to the ED regardless of whether they are “seeking detox.” Future research may help determine the cause for this gender-based difference and its significance for healthcare costs and health outcomes. PMID:27330662

  12. Audit of Childbirth Emergency Referrals by Trained Traditional Birth Attendants in Enugu, Southeast, Nigeria

    PubMed Central

    Okafor, II; Arinze-Onyia, SU; Ohayi, SAR; Onyekpa, JI; Ugwu, EO

    2015-01-01

    Background: The essence of training traditional birth attendants (TBAs) is to attend to women in uncomplicated labor and to refer them immediately to hospitals when complications develop. Aim: The aim was to audit childbirth emergency referrals by trained TBAs to a specialist hospital in Enugu, Nigeria. Subjects and Methods: A retrospective study of 205 childbirth emergencies referred to Semino Hospital and Maternity (SHM), Enugu by trained TBAs from August 1, 2011 to January 31, 2014. Data analysis was descriptive and inferential at 95% confidence level. Results: Most of the patients (185/205, 90.2%) were married and (100/205, 48.8%) had earlier booked for antenatal care in formal health facilities. There were obstetric danger signs or previous bad obstetric histories (pregnancies with unfavorable outcome) in 110 (110/205, 53.7%) women on admission at SHM. One hundred and fifteen (115/205, 56.1%) women walked into the hospital by themselves while 50 (50/205, 24.39%) could not walk. The fetal heart sounds were normal in 94 (94/205, 45.6%), abnormal in 65 (65/205, 31.8%) and absent in 42 (42/205, 20.4%) of the women on admission. Five healthy babies were delivered by the TBAs before referring their mothers. Delays of more than 12 h had occurred in 155 (155/205, 76.6%) of the women before referrals. Prolonged labor (100/205, 48.8%), obstructed labor (40/205, 19.5%), attempted vaginal birth after previous cesarean delivery (40/205, 19.5%) and malpresentation (30/205, 14.6%) were the common indications for referrals. The maternal mortality and perinatal mortality ratios were 610/100,000 live births and 228/1000 total births respectively. Conclusion: Delays at TBA centers are common before referral and most patients are referred in poor clinical state. Further training and re-training of the TBAs with more emphasis on recognition of obstetric danger signs and bad obstetric histories may help in screening high-risk patients for prompt referral to hospitals before

  13. Barriers to knowledge sharing in Chinese healthcare referral services: an emergent theoretical model

    PubMed Central

    Nunes, Miguel Baptista

    2016-01-01

    Background This paper reports on a research study that aims to identify and explain barriers to knowledge sharing (KS) in the provision of healthcare referral services in Chinese healthcare organisations. Design An inductive case study approach was employed, in which 24 healthcare professionals and workers from four healthcare organisations in the province of Hubei, Central China, were interviewed using semi-structured scripts. Results Through data analysis, 14 KS barriers emerged in four main themes: interpersonal trust barriers, communication barriers, management and leadership barriers, and inter-institutional barriers. A cause–consequence analysis of the identified barriers revealed that three of them are at the core of the majority of problems, namely, the absence of national and local policies for inter-hospital KS, lack of a specific hospital KS requirement, and lack of mutual acquaintance. Conclusions To resolve KS problems, it is of great importance that healthcare governance agencies, both at the national and regional levels, take leadership in the process of KS implementation by establishing specific and strong policies for inter-institutional KS in the referral process. This paper raises important issues that exceed academic interests and are important to healthcare professionals, hospital managers, and Information communication technology (ICT) managers in hospitals, as well as healthcare politicians and policy makers. PMID:26895146

  14. The Basics of Alcohol Screening, Brief Intervention and Referral to Treatment in the Emergency Department

    PubMed Central

    Vaca, Federico E.; Winn, Diane

    2007-01-01

    Nearly eight million emergency department (ED) visits are attributed to alcohol every year in the United States. A substantial proportion is due to trauma. In 2005, 16,885 people were killed as a result of alcohol-related motor vehicle crashes. Patients with alcohol-use problems (AUPs) are not only more likely to drive after drinking but are also at greater risk for serious alcohol-related illness and injury. Emergency departments have an important and unique opportunity to identify these patients and intervene during the “teachable moment” of an ED visit. The American College of Emergency Physicians, Emergency Nurses Association, American College of Surgeons-Committee on Trauma, American Public Health Association, and the National Highway Traffic Safety Administration, have identified Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) as a pivotal injury- and illness-prevention strategy to improve the health and well-being of ED patients. We provide a general overview of the basis and need for integrating SBIRT into EDs. Models of SBIRT, as well as benefits and challenges to its implementation, are also discussed. PMID:19561690

  15. Referrals between Public Sector Health Institutions for Women with Obstetric High Risk, Complications, or Emergencies in India – A Systematic Review

    PubMed Central

    Singh, Samiksha; Doyle, Pat; Campbell, Oona M.; Mathew, Manu; Murthy, G. V. S.

    2016-01-01

    Emergency obstetric care (EmOC) within primary health care systems requires a linked referral system to be effective in reducing maternal death. This systematic review aimed to summarize evidence on the proportion of referrals between institutions during pregnancy and delivery, and the factors affecting referrals, in India. We searched 6 electronic databases, reviewed four regional databases and repositories, and relevant program reports from India published between 1994 and 2013. All types of study or reports (except editorials, comments and letters) which reported on institution-referrals (out-referral or in-referral) for obstetric care were included. Results were synthesized on the proportion and the reasons for referral, and factors affecting referrals. Of the 11,346 articles identified by the search, we included 232 articles in the full text review and extracted data from 16 studies that met our inclusion criteria Of the 16, one was RCT, seven intervention cohort (without controls), six cross-sectional, and three qualitative studies. Bias and quality of studies were reported. Between 25% and 52% of all pregnancies were referred from Sub-centres for antenatal high-risk, 14% to 36% from nurse run delivery or basic EmOC centres for complications or emergencies, and 2 to 7% were referred from doctor run basic EmOC centres for specialist care at comprehensive EmOC centres. Problems identified with referrals from peripheral health centres included low skills and confidence of staff, reluctance to induce labour, confusion over the clinical criteria for referral, non-uniform standards of care at referral institutions, a tendency to by-pass middle level institutions, a lack of referral communication and supervision, and poor compliance. The high proportion of referrals from peripheral health centers reflects the lack of appropriate clinical guidelines, processes, and skills for obstetric care and referral in India. This, combined with inadequate referral communication

  16. Conducting an audit to improve the facilitation of emergency maternal and newborn referral in northern Ghana.

    PubMed

    Awoonor-Williams, John Koku; Bailey, Patricia E; Yeji, Francis; Adongo, Ayire Emmanuel; Baffoe, Peter; Williams, Afua; Mercer, Sarah

    2015-10-01

    Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; district management addressed the costliness and lack of transport and increased midwives' ability to communicate with pregnant women and drivers; and that facility staff increasingly adhered to guidelines and facilitating mechanisms. By conducting an audit of maternal and newborn referrals, the Ghana Health Service identified areas for improvement that service providers and management at multiple levels addressed, demonstrating a platform for problem solving that could be a model elsewhere. PMID:25833654

  17. Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

    PubMed Central

    Raj, Sunil Saksena; Manthri, Suneedh; Sahoo, Pratap Kumar

    2015-01-01

    Background: An effective emergency referral transport system is the link between the home of the pregnant woman and a health facility providing basic or comprehensive emergency obstetric care. This study attempts to explore the role of emergency transport associated with maternal deaths in Unnao district, Uttar Pradesh (UP). Methods: A descriptive study was carried out to assess the causes of and factors leading to maternal deaths in Unnao district, UP, through community based Maternal Death Review (MDR) using verbal autopsy, in a sample of 57 maternal deaths conducted between June 1, 2009, and May 31, 2010. A facility review was also conducted in 15 of the 16 block level and district health facilities to collect information on preparedness of the facilities for treating obstetric complications including referral transportation. A descriptive analysis was carried out using ratios and percentages to analyze the availability of basic facilities which may lead to maternal deaths. Results: It was found that there were only 10 ambulances available at 15 facilities against 19 required as per Indian Public Health Standards (IPHS). About 47% of the deaths took place in a facility, 30% enroute to a health facility and 23% at home. Twenty five percent of women were taken to one facility, 32% were taken to two facilities, and 25% were taken to three facilities while 19% were not taken to any facility before their death. Sixteen percent of the pregnant women could not arrange transportation to reach any facility. The mean time to make arrangements for travel from home to facility-1 and facility-2 to facility-3 was 3.1 hours; whereas from facility-1 to facility-2 was 9.9 hours. The mean travel time from home to facility-1 was 1 hour, from facility-1 to facility-2 was 1.4 hours and facility-2 to facility-3 was 1.6 hours. Conclusion: The public health facility review and MDR, clearly indicates that the inter-facility transfers appropriateness and timeliness of referral are major

  18. Kaqchikel midwives, home births, and emergency obstetric referrals in Guatemala: contextualizing the choice to stay at home.

    PubMed

    Berry, Nicole S

    2006-04-01

    Maternal mortality is highest in those countries whose health budgets are restricted. Practical strategies employed in the International Safe Motherhood Initiative, therefore, must be both effective and economical. Investing in emergency obstetric care resources has been touted as one such strategy. This investment aims to insure significant improvements are made in regional health centers, and a chain of referral is put into place so that only problem cases are attended by the most skilled health workers. This article examines how this model of referral functions in Sololá, Guatemala, where most Kaqchikel Mayan women give birth at home with a traditional midwife, and no skilled biomedical attendant is available at the birth to make a referral. Ethnographic data is used to explore reasons why women do not go to the hospital at the first sign of difficulty. I argue that the problem frequently is not that Mayan midwives, their clients and families fail to understand the biomedical information about dangers in birth, but rather that this information fails to fit into an already existing social system of understanding birth and birth-related knowledge. PMID:16225975

  19. DESIGN OF NIDA CTN PROTOCOL 0047: SCREENING, MOTIVATIONAL ASSESSMENT, REFERRAL, AND TREATMENT IN EMERGENCY DEPARTMENTS (SMART-ED)

    PubMed Central

    Donovan, Dennis M.; Adinoff, Bryon; Crandall, Cameron; Forcehimes, Alyssa A.; Lindblad, Robert; Mandler, Raul N.; Oden, Neal; Perl, Harold I.; Walker, Robrina

    2011-01-01

    Background Medical settings such as emergency departments (EDs) present an opportunity to identify and provide services for individuals with substance use problems who might otherwise never receive any form of assessment, referral, or intervention. Although Screening, Brief Intervention, and Referral to Treatment (SBIRT) models have been extensively studied and are considered effective for individuals with alcohol problems presenting in emergency departments and other medical settings, the efficacy of such interventions has not been established for drug users presenting in EDs. Objectives This paper describes the design of a NIDA Clinical Trials Network protocol testing the efficacy of an SBIRT model in medical EDs, highlighting considerations that that are pertinent to the design of other studies targeting substance use behaviors in medical treatment settings. Methods The protocol is described, and critical design decisions are discussed. Results Design challenges included defining treatment conditions, study population, and site characteristics; developing the screening process; choosing the primary outcome; balancing brevity and comprehensiveness of assessment; and selecting the strategy for statistical analysis. Conclusion Many of the issues arising in the design of this study will be relevant to future studies of interventions for addictions in medical settings. Scientific Significance Optimal trial design is critical to determining how best to integrate substance abuse interventions into medical care. PMID:21854285

  20. Safer Bridges

    NASA Technical Reports Server (NTRS)

    1977-01-01

    Safer bridges are among a number of spinoff benefits from NASA procedures for testing 'cfracture toughness" of a structural part, meaning its ability to -siscracktsh at might cause failure. The New River Bridge in West Virginia, shown under construction, is the world's largest single span bridge. U.S. Steel fracture toughness requirements for such bridges include NASA-developed test procedures. Bridge materials and other metal structures may develop flaws during their service lifetimes. Such flaws can affect the structural integrity of the part. Thus, it is important to know the "fracture toughness" of a structural part, or its ability to resist cracks. NASA has long experience in developing fracture toughness tests for aerospace hardware. Since 1960, NASA-Lewis has worked closely with the American Society for Testing & Materials. Lewis and NASA-funded industrial contractors have made many important contributions to test procedures, now recommended by ASTM, for measuring fracture toughness.

  1. Oral surgery in Norwegian general dental practice--a survey. Extent, scope, referrals, emergencies, and medically compromised patients.

    PubMed

    Berge, T I

    1992-02-01

    A questionnaire containing 37 questions concerning oral surgery and oral medicine was mailed to a systematic random sample of 500 Norwegian general dental practitioners in October 1989. A 60% return rate was obtained. From the 20 questions included in this paper the following conclusions were drawn: Norwegian general practitioners perform a substantial number and diversity of procedures in the field of oral surgery and oral medicine. The predictor variables sex, age, geographic location, and type of practice (private/public) showed by multiple classification analysis only limited correlation with the amount and diversity of procedures. On average, 12.3 patients were referred per practitioner per year to specialists in oral surgery. The indicated need for orthognathic consultations was 0.75 patient per year per practitioner. Serious emergencies demanding referral seldom occurred. Each month 6.6 medically compromised patients were seen in general practice, among which cardiovascular disorders dominated. PMID:1533083

  2. Evaluation of Publicly Financed and Privately Delivered Model of Emergency Referral Services for Maternal and Child Health Care in India

    PubMed Central

    Prinja, Shankar; Bahuguna, Pankaj; Lakshmi, P. V. M.; Mokashi, Tushar; Aggarwal, Arun Kumar; Kaur, Manmeet; Reddy, K. Rahul; Kumar, Rajesh

    2014-01-01

    Background Emergency referral services (ERS) are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost. Methods Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS) standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective. Results On an average, an ambulance transported 3–4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7) per patient transported or INR 21 (USD 0.35) per km travelled. Conclusion Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR) should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system. PMID:25360798

  3. Determinants of out-of-hours service users' potentially inappropriate referral or non-referral to an emergency department: a retrospective cohort study in a local health authority, Veneto Region, Italy

    PubMed Central

    Toffanin, Roberto; Rigon, S; Sandonà, P; Carrara, T; Damiani, G; Baldo, V

    2016-01-01

    Background A growing presence of inappropriate patients has been recognised as one of the main factors influencing emergency department (ED) overcrowding, which is a very widespread problem all over the world. On the other hand, out-of-hours (OOH) physicians must avoid delaying the diagnostic and therapeutic course of patients with urgent medical conditions. The aim of this study was to analyse the appropriateness of patient management by OOH services, in terms of their potentially inappropriate referral or non-referral of non-emergency cases to the ED. Methods This was an observational retrospective cohort study based on data collected in 2011 by the local health authority No. 4 in the Veneto Region (Italy). After distinguishing between patients contacting the OOH service who were or were not referred to the ED, and checking for patients actually presenting to the ED within 24 hours thereafter, these patients’ medical management was judged as potentially appropriate or inappropriate. Results The analysis considered 22 662 OOH service contacts recorded in 2011. The cases of potentially inappropriate non-referral to the ED were 392 (1.7% of all contacts), as opposed to 1207 potentially inappropriate referrals (5.3% of all contacts). Age, nationality, type of disease and type of intervention by the OOH service were the main variables associated with the appropriateness of patient management. Conclusions These findings may be useful for pinpointing the factors associated with a potentially inappropriate patient management by OOH services and thus contribute to improving the deployment of healthcare and the quality of care delivered by OOH services. PMID:27503862

  4. Quality of emergency medical care in Gondar University Referral Hospital, Northwest Ethiopia: a survey of patients’ perspectives

    PubMed Central

    2014-01-01

    Background Ethiopia has fairly good coverage but very low utilization of health care services. Emergency medical care services require fast, correct and curious services to clients as they present with acute problems. In Ethiopia and Gondar in particular, the quality of emergency medical care has not been studied. The main aim of this study was to assess the disease profile and patients’ satisfaction in Gondar University Referral Hospital (GURH). Methods A facility based cross-sectional study was conducted among patients visiting GURH for emergency care. Ethical clearance was obtained from the Institutional Review Board of University of Gondar. Patients were selected by systematic random sampling, using patient flow list in the day and night emergency services. Data were collected using a standard Press Ganey questionnaire by BSc health science graduates. Data were entered in to Epi Info 3.5.3 software and exported to SPSS version 20.0 for windows for analysis. Results A total of 963 patients (response rate = 96.8%) were studied. The mean (+ s.d.) age of patients was 28.4 (+17.9) years. The overall satisfaction using the mean score indicates that 498 (51.7%) 95%CI: (48.4% - 54.9%) were satisfied with the service, the providers and the facility suitability whereas 465(48.3%) 95%CI: (45.1%- 51.6%) were not satisfied. Seven hundred and six (73.3%) 95%CI: 70.4%-76.1%, patients reported that they have been discriminated or treated badly during the service provision in the hospital. OPD site visited (p < 0.0001), visiting days of the week (P < 0.049), medical condition on arrival (P < 0.0001), degree of confidence in the hospital (AOR = 1.9, 95%CI: 1.1, 3.1), reported discrimination/bad treatment of patients with service (AOR = 0.4, 95%CI: 0.2, 0.7), were significantly associated determinants of patient satisfaction. Conclusions Non-communicable disease emergencies like injuries and cardiovascular diseases are common. There is a low level of

  5. The burden of bone, native joint and soft tissue infections on orthopaedic emergency referrals in a city hospital.

    PubMed

    Howell, A; Parker, S; Tsitskaris, K; Oddy, M J

    2016-01-01

    Introduction Bone, native joint and soft tissue infections are frequently referred to orthopaedic units although their volume as a proportion of the total emergency workload has not been reported previously. Geographic and socioeconomic variation may influence their presentation. The aim of this study was to quantify the burden of such infections on the orthopaedic department in an inner city hospital, determine patient demographics and associated risk factors, and review our current utilisation of specialist services. Methods All cases involving bone, native joint and soft tissue infections admitted under or referred to the orthopaedic team throughout 2012 were reviewed retrospectively. Prosthetic joint infections were excluded. Results Almost 15% of emergency admissions and referrals were associated with bone, native joint or soft tissue infection or suspected infection. The cohort consisted of 169 patients with a mean age of 43 years (range: 1-91 years). The most common diagnosis was cellulitis/other soft tissue infection and the mean length of stay was 13 days. Two-thirds of patients (n=112, 66%) underwent an operation. Fifteen per cent of patients were carrying at least one blood borne virus, eleven per cent were alcohol dependent, fifteen per cent were using or had been using intravenous drugs and nine per cent were homeless or vulnerably housed. Conclusions This study has shown that a significant number of patients are admitted for orthopaedic care as a result of infection. These patients are relatively young, with multiple complex medical and social co-morbidities, and a long length of stay. PMID:26688397

  6. The epidemiology and type of injuries seen at the accident and emergency unit of a Nigerian referral center

    PubMed Central

    Adoga, Adeyi A.; Ozoilo, Kenneth N.

    2014-01-01

    Background: A plethora of injuries present at any accident and emergency unit, but the pattern of the injuries varies from region to region especially in ours with the increased ethno-religious clashes and terrorist attacks. This study aims to determine the epidemiology and type of injuries presenting to our center with the possibility of developing injury surveillance initiatives in our center and Nigeria as a whole. Materials and Methods: Injured patients consecutively presenting to the accident and emergency department of the Jos University Teaching Hospital within the period February 2011 to January 2012 were prospectively recorded. Results: A total of 720 injured patients admitted with an age range of 8 months to 75 years (mean = 37.9; SD = ±52.4), which consists of 544 males and 176 females giving a male to female ratio of 3.1:1. Patients aged 20-29 years were in the majority (n = 220, 30.6%) with peak incidences in the period of communal clashes. Injuries sustained from motorcycles were the highest (n = 248, 34.4%). Others were 160 (22.2%) in other vehicular and pedestrian injuries, machete (n = 128), gunshots (n = 92), burns (n = 36), bomb blast injuries (n = 16), fall from heights (n = 32) and miscellaneous (n = 8). Injuries sustained in communal clashes and terrorist attacks accounted for 236 (32.8%) presentations. The most common site of injury was the head (n = 30 4, 42.2%). Relatives, passersby and law enforcement agencies brought patients to the hospital with times between injury and presentation ranging from 1 h to 3 weeks. 40 (5.6%) patients were brought in dead. Conclusion: A collective effort - on the part of the government and the citizenry is required to ensure better outcomes and a safer society for all. PMID:24812451

  7. Referral for psychological therapy of people with long term conditions improves adherence to antidepressants and reduces emergency department attendance: Controlled before and after study

    PubMed Central

    de Lusignan, Simon; Chan, Tom; Tejerina Arreal, Maria C.; Parry, Glenys; Dent-Brown, Kim; Kendrick, Tony

    2013-01-01

    Background Referral to psychological therapies is recommended for people with common mental health problems (CMHP) however its impact on healthcare utilisation in people with long term conditions (LTCs) is not known. Method Routinely collected primary care, psychological therapy clinic and hospital data were extracted for the registered population of 20 practices (N = 121199). These data were linked using the SAPREL (Secure and Private Record Linkage) method. We linked the 1118 people referred to psychological therapies with 6711 controls, matched for age, gender and practice. We compared utilisation of healthcare resources by people with LTCs, 6 months before and after referral, and conducted a controlled before and after study to compare health utilisation with controls. We made the assumption that collection of a greater number of repeat prescriptions for antidepressants was associated with greater adherence. Results Overall 21.8% of people with an LTC had CMHP vs. 18.8% without (p < 0.001). People with LTCs before referral were more likely to use health care resources (2-tailed t-test p < 0.001). Cases with LTCs showed referral to the psychological therapies clinic was associated with increased antidepressant medication prescribing (mean differences 0.62, p < 0.001) and less use of emergency department than controls (mean difference −0.21, p = 0.003). Conclusions Referral to improved access to psychological therapies (IAPT) services appears of value to people with LTC. It is associated with the issue of a greater number of prescriptions for anti-depressant medicines and less use of emergency services. Further studies are needed to explore bed occupancy and outpatient attendance. PMID:23639304

  8. Barriers to referral for elevated blood pressure in the emergency department and differences between provider-type

    PubMed Central

    Souffront, Kimberly; Chyun, Deborah; Kovner, Christine

    2015-01-01

    A multidisciplinary sample of ED providers across the United States (n = 450) were surveyed to identify barriers to referral for elevated blood pressure (BP) in the ED and differences between provider-type. RNs reported less knowledge of Stage I HTN (p = .043) and Pre-HTN (p<.01); were less aware of definitions for HTN (p<.001); reported more difficulty caring for patients who are asymptomatic (p = .007); required financial compensation to refer (p = .048); and perceived BP referrals are influenced by the medical director (p<.001). MDs reported more skills to refer (p = .008) and time as a barrier (p = .038); PAs were more likely to report patients are not aware of health benefits (p = .035) and doubted their concern for their BP (p = .023); and felt emotionally uncomfortable when referring (p = .025). Despite these differences, there was no significant difference between provider-type and referral. PMID:25582763

  9. Refusing to Be Excluded: Finding Ways of Integrating Psychotherapeutic Modalities to the Emerging Needs of a Pupil Referral Unit

    ERIC Educational Resources Information Center

    Malberg, Norka T.

    2008-01-01

    This paper describes the application of child psychotherapy, its theory and practice, in a Pupil Referral Unit (PRU). It examines the importance of a flexible approach to outreach work and the implementation of interventions that take into consideration both the internal and the external world of the adolescent. Furthermore, the process of…

  10. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy.

    PubMed

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  11. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy

    PubMed Central

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  12. Beware the Emergency Ankle Fracture Referral: An Unusual Case of Lateral Subtalar Joint Dislocation Secondary to Calcaneal Fracture with associated Lateral Malleolus Fracture

    PubMed Central

    Colegate-Stone, TJ; James, SE; Koka, SR

    2015-01-01

    Introduction: The referral of a lateral malleolus fracture is one of the commonest orthopaedic trauma presentations. Failure to fully assess the patient and radiography can lead to missing associated injuries in the hindfoot. Case Report: We describe an unusual hindfoot injury with an atypical combination of lateral subtalar dislocation and calcaneal fracture with associated lateral malleolus fracture that was initially not appreciated by the referring emergency department. This case is of particular interest as subtalar dislocation is a rare injury and lateral subtalar dislocation is even rarer. Conclusion: Failure to fully assess such injuries and manage non-operatively leads to early degenerative tibia-talar, hindfoot and midfoot changes and a difficult situation for the surgeon to salvage. We advocate early CT scan and open reduction with fixation for such cases. PMID:27299009

  13. SAFER Rescue System Tested

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Astronauts Carl J. Meade and Mark C. Lee (red strip on suit) test the new Simplified Aid for EVA Rescue (SAFER) system some 130 nautical miles above Earth. The pair was actually performing an in-space rehearsal or demonstration of a contingency rescue using never-before flown hardware. Meade, who here wears the small back-pack unit with its complementary chest-mounted control unit, and Lee anchored to the Space Shuttle Discovery's Remote Manipulator System (RMS) robot arm, took turns using the SAFER hardware during their shared space walk.

  14. Emergency room referral to internal medicine wards or to coronary care units of patients with first acute myocardial infarction. Israel Study Group on First Acute Myocardial Infarction.

    PubMed

    Drory, Y; Shapira, I; Goldbourt, U; Fisman, E Z; Villa, Y; Tenenbaum, A; Pines, A

    2000-01-01

    The objective of the study was to assess factors associated with ward assignment in the emergency room for patients < or = 65 years old with first acute myocardial infarction. We analysed uni- and multivariate predictors for ward assignment (coronary care unit versus internal ward). Eight major centrally located Israeli hospitals provided data during one year. The study population included 1252 patients, of whom 83% were men, 37% were hypertensives, 22% were diabetics, and 14% had previous anginal syndrome. Most patients (83%) were admitted to the coronary care unit. Internal medicine ward assignment was significantly associated with advanced age, history of hypertension or diabetes, a longer time from appearance of symptoms to arrival at the hospital, and myocardial infarction type (non-Q-wave or non-anterior). The likelihood of medical ward referral increased stepwise with the increasing number of a patient's predictive factors: those with > or = 4 factors had a > 30% chance of being assigned to a medical ward compared to a < 10% chance when there were 0-3 risk factors. Exclusion of patients with thrombolysis had no effect on the results. The shortage of cardiac care unit beds apparently leads to emergency room selection acting in detriment of patients with poorest prognoses. Clear guidelines for decision making in the emergency room are needed to resolve this paradoxical situation. PMID:10998758

  15. Safer Head Start Playgrounds.

    ERIC Educational Resources Information Center

    Cunningham, Gayle; Hendricks, Charlotte

    1996-01-01

    Argues that there are three areas to evaluate when creating safer playgrounds for children: environment, supervision, and education. Discusses the importance of safe and properly installed equipment, resilient surfacing, removal of hazards, proper maintenance, appropriate adult-to-child ratio, and enforcement of proper playground safety and injury…

  16. [Negotiating safer sex].

    PubMed

    Gordon, G; Charnock, D

    1991-01-01

    Women have generally assumed responsibility for contraception since the appearance of oral contraceptives and IUDs. But AIDS prevention programs are now asking women to assume responsibility for safer sex through use of condoms, a male method. Women are being asked to carry condoms, to negotiate their use each time they have sex, and to insist if the partner resists. The problem with this strategy is that frequently it is the male partner who makes sexual decisions, and women have less negotiating power. Women are considered feminine if they assume a passive role in sexual activity. This work suggests strategies to improve the negotiating power of women. Options and problems of speaking about safer sex vary in accordance with the nature of the relationship. A woman with a new partner can try to ascertain his sexual history, but may gain no information on his probable health even if he tells her the truth. It may be easier to convince him to use a condom at least in the beginning of the romance. Women working in the sex industry often have greater trouble convincing their friends and lovers to use a condom than their clients. Some family planning workers have begun to speak of safer sex with all their clients. Role playing and workshops or discussions with small groups of women having similar problems may help women overcome their reticence about discussing sexual topics. Some general suggestions to help women negotiate safer sex include choosing an opportune moment and planning in advance what to say; daring to speak directly without beating around the bush (the partner may also be gathering courage to speak); practicing placing condoms on objects and if necessary placing one on the partner without speaking; being honest with the partner about sex, love, and fidelity; and remembering that protection from condoms is mutual given that it is not possible to know who is infected. Until now, programs to help women practice safer sex have concentrated on sex industry

  17. Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication

    PubMed Central

    Vardy, J; Keliher, T; Fisher, J; Ritchie, F; Bell, C; Chekroud, M; Clarey, F; Blackwood, L; Barry, L; Paton, E; Clark, A; Connelly, R

    2016-01-01

    Objectives Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption. Setting ED of a UK tertiary referral hospital. Participants All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%). Primary outcome measures Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician. Secondary outcome measures Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria. Results 1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with ‘Severe’ or ‘Very Severe’ acute alcohol intoxication (p<0.001). Admissions due to alcohol differed to admissions not due to alcohol being on average younger (45 vs 56 years, p<0.001) more often male (73.4% vs 45.1% males, p<0.001) and more likely to have a diagnosis synonymous with alcohol or related to recreational drug use, pancreatitis, deliberate self-harm, head injury, gastritis, suicidal ideation, upper gastrointestinal bleeds or seizures (p<0.001). An increase in admissions due to alcohol on Saturdays reflects a surge in admissions with acute alcohol intoxication above the weekly average (p=0.003). Conclusions Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD. PMID:27324707

  18. Incidence, aetiology and mortality secondary to hypertensive emergencies in a large-scale referral centre in Israel (1991-2010).

    PubMed

    Leiba, A; Cohen-Arazi, O; Mendel, L; Holtzman, E J; Grossman, E

    2016-08-01

    Hypertensive emergency (HE) is a life-threatening condition that requires immediate blood pressure (BP) reduction. Although it has been on the decline, the incidence of HE has recently increased in a few countries. The aim of the present retrospective study was to evaluate the incidence, aetiology and 1-year mortality of HE in a large medical centre over a 20-year period (1991-2010). The electronic medical records of all patient files who were hospitalized in the Chaim Sheba Medical Center in Israel from 1991 to 2010 with a primary diagnosis (at admission or discharge) of Malignant Hypertension, Hypertensive Emergency or Accelerated Hypertension were retrieved and analysed. The study interval was divided into four periods of 5 years each. Among 306 files reviewed, only 142 patients had a true HE. Average age at presentation was 63.3±16.5 years. Men were younger than women (59±16 vs 68±16 years; P<0.001). At presentation, most patients (80.3%) had been diagnosed with essential hypertension previously and were undertreated. Average maximum mean arterial pressure (MAP) was higher in men (169±22 mm Hg) than in women (161±17 mm Hg; P=0.026). The rate of HE decreased over the course of the study, from 12.7/100 000 admissions during 1991-1995 to 6.2/100 000 admissions (2006-2010). Similarly, 1-year mortality decreased from 16.7 to 3.6%. The rate of HE has decreased and the prognosis has improved over the last two decades. Appropriate BP control of patients with essential hypertension may further decrease the risk of HE. PMID:26674757

  19. Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital?

    PubMed

    Sullivan, Clair; Staib, Andrew; Eley, Rob; Griffin, Bronwyn; Cattell, Rohan; Flores, Judy; Scott, Ian

    2016-04-01

    Objective The aim of the present study was to identify patient and non-patient factors associated with reduced mortality among patients admitted from the emergency department (ED) to in-patient wards in a major tertiary hospital that had previously reported a near halving in mortality in association with a doubling in National Emergency Access Target (NEAT) compliance over a 2-year period from 2012 to 2014. Methods We retrospectively analysed routinely collected data from the Emergency Department Information System (EDIS) and hospital discharge abstracts on all emergency admissions during calendar years 2011 (pre-NEAT interventions) and 2013 (post-NEAT interventions). Patients admitted to short-stay wards and then discharged home, as well as patients dying in the ED, were excluded. Patients included in the study were categorised according to age, time and day of arrival to the ED, mode of transport to the ED, emergency triage category, type of clinical presentation and major diagnostic codes. Results The in-patient mortality rate for emergency admissions decreased from 1.9% (320/17022) in 2011 to 1.2% (202/17162) in 2013 (P<0.001). There was no change from 2011 to 2013 in the percentage of deaths in the ED (0.19% vs 0.17%) or those coded as in-patient palliative care (17.9% vs 22.2%). Although deaths were not associated with age by itself, the mortality rate of older patients admitted to medical wards decreased significantly from 3.5% to 1.7% (P=0.011). A higher mortality rate was seen among patients presenting to ED triage between midnight and 12 noon than at other times in 2011 (2.5% vs 1.5%; P<0.001), but this difference disappeared by 2013 (1.3% vs 1.1%; P=0.150). A similar pattern was seen among patients presenting on weekends versus weekdays: 2.2% versus 1.7% (P=0.038) in 2011 and 1.3% versus 1.1% (P=0.150) in 2013. Fewer deaths were noted among patients with acute cardiovascular or respiratory disease in 2013 than in 2011 (1.7% vs 3.6% and 1.5% vs 3

  20. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Justice. 11.17 Section 11.17 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Referral to Department of Justice. When Department of Justice approval or consultation is required under § 11.16, the referral or request shall be transmitted to the Department of Justice by the Chief...

  1. Safer sex in tourist resorts.

    PubMed

    Ford, N; Inman, M

    1992-01-01

    A survey in Torbay, England, indicated substantial sexual interaction of an unsafe kind between young residents and tourists. A pilot programme is described which sought to promote safer sexual behaviour: the attention of both tourists and local people who frequented nightclubs was engaged by peer groups who conveyed educational messages. PMID:1637480

  2. How to sell safer sex.

    PubMed

    Overs, C

    1991-09-01

    Social and economic factors determine the extent of the sex industry in societies. Despite AIDS, the sex industry will continue to thrive. Accordingly, health promotion strategies aimed at sex workers and their clients should not stem from the belief that the industry should cease to exist. This paper offers advice in developing and implementing programs to promote safer sex among sex workers. The social context is 1 element to consider in planning successful campaigns. Interventions must be combined with well-planned prevention campaigns aimed at entire populations. The opinions and participation of those involved in the industry should also be sought, while worker discussion and action upon other community issues should not be discouraged. Care should be given to target the numerous and diverse sex worker audiences in addition to other persons related to and involved in the industry. Programs should address the main obstacles to practicing safer sex, and attention should be given to ensure the provision of an adequate and regular supply of cheap or free condoms through varied distribution channels. In the area of service provision, sex workers need easy access to social support and health care services from which they are often excluded. Activities conducted around the world include the marketing of safer sex, distributing printed information on HIV and AIDS to clients, training sex workers to pass designated constructive ideas to others involved in the sex industry, referring sex workers to sex businesses supportive of safer sex practices, and developing street theater and cabaret shows in bars. PMID:12284682

  3. Safer Aviation Materials Tested

    NASA Technical Reports Server (NTRS)

    Palaszewski, Bryan A.

    2001-01-01

    A series of thermally stable polymer samples were tested. These materials are called low heat release materials and are designed for aircraft interior decorative materials. The materials are designed to give off a minimum amount of noxious gases when heated, which increases the possibility that people can escape from a burning aircraft. New cabin materials have suitably low heat release so that fire does not spread, toxic chemicals are not given off, and the fire-emergency escape time for crew and passengers is lengthened. These low heat-release materials have a variety of advantages and applications: interiors for ground-based facilities, interiors of space vehicles, and many commercial fire-protection environments. A microscale combustion calorimeter at the Federal Aviation Administration's (FAA) Technical Center tested NASA Langley Research Center materials samples. The calorimeter is shown. A sharp, quantitative, and reproducible heat-release-rate peak is obtained in the microscale heat-release-rate test. The newly tested NASA materials significantly reduced the heat release capacity and total heat release. The thermal stability and flammability behavior of the samples was very good. The new materials demonstrated a factor of 4 reduction in total heat release over ULTEM (a currently used material). This information is provided in the following barchart. In other tests, the materials showed greater than a factor 9 reduction in heat-release capacity over ULTEM. The newly tested materials were developed for low dielectric constant, low color, and good solubility. A scale up of the material samples is needed to determine the repeatability of the performance in larger samples. Larger panels composed of the best candidate materials will be tested in a larger scale FAA Technical Center fire facility. The NASA Glenn Research Center, Langley (Jeff Hinkley), and the FAA Technical Center (Richard Lyon) cooperatively tested these materials for the Accident Mitigation

  4. Five Steps to Safer Health Care

    MedlinePlus

    ... to Safer Health Care Five Steps to Safer Health Care: Patient Fact Sheet This information is for reference ... safety is one of the Nation's most pressing health care challenges. A 1999 report by the Institute of ...

  5. Making motherhood safer in Bolivia.

    PubMed

    Blaney, C L

    1994-02-01

    The Bolivian government and other organizations aim to reduce maternal deaths and improve maternal health through a variety of initiatives. The goal is to reduce infant mortality by 1997 from 480 to 250 per 100,000 births. In a rural area of Inquisivi, maternal mortality in 1990 was 1400 per 100,000 births. Hospital and family planning service improvements are targeted, as well as increases in prenatal visits and training of birth attendants. The Protection a la Salud (PROSALUD) is concerned with improvements in technical, managerial, and interpersonal quality of care. The complaint has been difficulties with access and availability of services, and poor quality of services. PROSALUD centers have a referral system aimed at reducing maternal death. Training is provided in family planning counseling, because preventing unwanted pregnancies reduces complications from unsafe abortions that cause 27% of maternal mortality nationally. Lack of knowledge about contraception was reported by many women who were hospitalized for complications from unsafe abortion. Modern contraceptive usage is 12%, compared to 57% in Brazil and 55% in Colombia. Contraceptives only recently have become available in public facilities, but availability is still limited. Women avoid hospitals because of fears that their traditional practices will not be respected. Quechua and Aymara women deliver their children in upright positions, because of the ease of delivery. The placenta is delivered carefully, because it is viewed as a body combining the spirits of the mother and infant and deserving a proper burial. The traditional hospital delivery requires lying down in a cold room with unfamiliar attendants, and the patients complain of having to walk too early and leave the hospital too early. In rural areas, modern and traditional approaches that are put into action with the participation of the community work best. Mothercare and Save the Children/Bolivia have been successful in encouraging

  6. The business case for transitioning to safer chemicals.

    PubMed

    McFadden, Roger D

    2011-01-01

    Emerging domestic and international chemical regulations and a heightened consumer awareness of chemicals of concern in products is challenging American businesses to reevaluate and reconsider their approaches to supply chain management and product design. Some of these companies recognize business opportunities and are responding proactively with innovative strategies and tactics. This article describes steps that Staples Inc., the world's largest office products provider, is taking to meet demand for products that are safer and more sustainable. In trying to meet the demand for safer products, Staples faces significant barriers, including the complexity of supply chains, data gaps, and confidential business information. New collaborations between companies, government, and advocates, and improved tools and criteria for defining safer products enhance the ability of businesses, like Staples, to meet new consumer demands. PMID:22001038

  7. The Moorfields Safer Surgery System

    PubMed Central

    Dhingra, Sumit; Khaw, Peng T.

    2009-01-01

    This review presents the ‘Moorfields Safer Surgery System’, which is designed to improve the consistency and outcomes of trabeculectomy surgery. Evidence-based recommendations are made for each step of the surgery. This system requires a minimum of equipment and can be easily implemented by most surgeons. The system is ultimately designed to preserve the vision in our patients by minimising complications while maintaining a desired intraocular pressure. PMID:20142973

  8. HIV counselling and testing practices for children seen in an urban emergency department of a tertiary referral hospital in Dar es Salaam, Tanzania: a retrospective cross-sectional study

    PubMed Central

    Sawe, Hendry R; Mfinanga, Juma A; Ringo, Faith H; Mwafongo, Victor; Reynolds, Teri A; Runyon, Michael S

    2016-01-01

    Objectives To describe the HIV counselling and testing practices for children presenting to an emergency department (ED) in a low-income country. Setting The ED of a large east African national referral hospital. Participants This retrospective review of all paediatric (<18 years old) ED visits in 2012 enrolled patients who had an HIV test ordered and excluded those without testing. Files were available for 5540/5774 (96%) eligible patients and 1632 (30%) were tested for HIV, median age 1.3 years (IQR 9 months to 4 years), 58% <18 months old and 61% male. Primary and secondary outcome measures The primary outcome measure was documentation of pretest and post-test counselling, or deferral of counselling, for children tested for HIV in the ED. Secondary measures included the overall rate of HIV testing, rate of counselling documented in the inpatient record when deferred in the ED, rate of counselling documented when testing was initiated by the inpatient service, rate of counselling documented by test result (positive vs negative) and the rate of referral to follow-up HIV care among patients testing positive. Results Of 418 patients tested in the ED, counselling, or deferral of counselling, was documented for 70 (17%). When deferred to the ward, subsequent counselling was documented for 15/42 (36%). Counselling was documented in 33% of patients testing positive versus 1.1% patients testing negative (OR 43 (95% CI 23 to 83). Of 199 patients who tested positive and survived to hospital discharge, 76 (38%) were referred for follow-up at the HIV clinic on discharge. Conclusions Physicians documented the provision, or deferral, of counselling for <20% of children tested for HIV in the ED. Counselling was much more likely to be documented when the test result was positive. Less than 40% of those testing positive were referred for follow-up care. PMID:26880672

  9. Predictors of Safer Sex Intentions and Protected Sex Among Heterosexual HIV-Negative Methamphetamine Users

    PubMed Central

    Mausbach, Brent T.; Semple, Shirley J.; Strathdee, Steffanie A; Patterson, Thomas L.

    2009-01-01

    The purpose of this study was to test a version of the Theory of Planned Behavior (TPB) for predicting safe sex behavior in a sample of 228 HIV-negative heterosexual methamphetamine users. We hypothesized that, in addition to TPB constructs, participants’ amount of methamphetamine use and desire to stop unsafe sex behaviors would predict intentions to engage in safer sex behaviors. In turn, we predicted that safer sex intentions would be positively correlated with participants’ percentage of protected sex. Hierarchical linear regression indicated that 48% of the total variance in safer sex intentions was predicted by our model, with less negative attitudes toward safer sex, greater normative beliefs, greater control beliefs, less methamphetamine use, less intent to have sex, and greater desire to stop unsafe sex emerging as significant predictors of greater safer sex intentions. Safer sex intentions were positively associated with future percent protected sex (p<.05). These findings suggest that, among heterosexual methamphetamine users, the TPB is an excellent model for predicting safer sex practices in this population, as are some additional factors (e.g., methamphetamine use). Effective interventions for increasing safer sex practices in methamphetamine user will likely include constructs from this model with augmentations to help reduce methamphetamine use. PMID:19085216

  10. Referral expectations of radiology.

    PubMed

    Smith, W; Altmaier, E; Berberoglu, L; Morris, K; O'Halloran, C

    1992-08-01

    In summary, the data suggest that the traditional role of the radiologist as an expert consultant who provides an accurate written report is still the dominant perception. This study emphasizes the importance of development of communication skills and communication standards, with particular emphasis on written data as the single most important factor in keeping a strong clinician referral base. PMID:10121759

  11. Determinants and Outcomes of Emergency Caesarean Section following Failed Instrumental Delivery: 5-Year Observational Review at a Tertiary Referral Centre in London

    PubMed Central

    McDonnell, Sian; Chandraharan, Edwin

    2015-01-01

    Objectives. To review the determinants for a failed operative vaginal delivery and to examine associated fetal and maternal morbidity. Design. Retrospective observational study. Setting. Large London Teaching Hospital. Method. A retrospective review of case notes during a 5-year period was carried out. Results. Overall 119 women (0.44%) out of 26,856 births had a caesarean section following a failed instrumental delivery, which comprised 5.1% of all operative vaginal births. 73% had a spontaneous onset of labour and 63% required syntocinon at some time prior to delivery. 71.5% of deliveries were complicated by malposition. Only 20% of deliveries were attended by a consultant obstetrician. Almost 50% of women and 8.4% of neonates sustained trauma at the time of either their failed instrumental delivery or the caesarean section. Conclusions. Emergency caesarean section during the second stage of labour is associated with maternal and fetal complications. A ‘failed instrumental delivery score' (FIDS) may aid practitioners in predicting an increased likelihood of a failed operative vaginal birth and therefore to consider a trial of operative vaginal delivery in the theatre. Senior input should also be sought because a failed operative vaginal birth is associated with increased maternal and fetal morbidity. PMID:26078882

  12. Safer work clothing for fishermen.

    PubMed

    Geving, Ingunn Holmen; Reitan, Jarl; Sandsund, Mariann; Faerevik, Hilde; Reinertsen, Randi Eidsmo; Aasjord, Halvard

    2006-01-01

    The fisherman's work environment consists of many potential risks. A study of occupational accidents in the Norwegian fishing industry in the nine-year period from 1998 to 2006 shows that more than 3/4 of the deaths were caused by loss of fishing vessel or man-overboard accidents. Furthermore, the greatest risk of drowning is found in the smallest fleet. The aim of our project was to develop safer work clothing and through this contribute to a reduction in work accidents and injuries in the fishing fleet. We considered that it is possible to produce protective work clothing that satisfies a specification of requirements covering the fishermen's needs for protection and comfort during work. An end user-centred process including twenty-three personal interviews and a questionnaire was used to clarify the fishermen's needs and wishes before detailed design and product development. We identified an overview of all the fishermen's needs for protection during work, and produced a prioritised list of functional requirements for the clothing. The results show that the clothing previously preferred by fishermen does not satisfy all the users' demands for safety, functionality and comfort. These demands have been taken into consideration when designing improved work clothing for the fishing fleet. A selected number of prototypes were developed on the basis of the established specification of requirements. The prototypes were evaluated according to the users' requirements through tests in SINTEF's Work Physiology Laboratory and on board fishing vessels. The results demonstrate that the new protective clothing satisfies the fishermen's requirements. PMID:17312698

  13. Anger as a Moderator of Safer Sex Motivation among Low Income Urban Women

    PubMed Central

    Carey, Michael P.

    2005-01-01

    Theoretical models suggest that both HIV knowledge and HIV risk perception inform rational decision-making and, thus, predict safer sex motivation and behavior. However, the amount of variance explained by knowledge and risk perception is typically small. In this cross-sectional study, we investigated whether the predictive power of HIV knowledge and HIV risk perception on safer sex motivation is affected by trait anger. We hypothesized that anger may disrupt rational-decision making, distorting the effects of both HIV knowledge and risk perception on safer sex intentions. Data from 232 low-income, urban women at risk for HIV infection were used to test a path model with past sexual risk behavior, HIV knowledge, and HIV risk perception as predictors of safer sex intentions. Moderator effects of anger on safer sex intentions were tested by simultaneous group comparisons between high-anger and low-anger women (median-split). The theoretically expected “rational pattern” was found among low-anger women only, including (a) a positive effect of knowledge on safer sex intentions, and (b) buffer (inhibitor) effects of HIV knowledge and HIV risk perception on the negative path leading from past risk behavior to safer sex intentions. Among high-anger women, an “irrational pattern” emerged, with no effects of HIV knowledge and negative effects of both past risk behavior and HIV risk perception on safer sex intentions. In sum, the results suggest that rational knowledge and risk-based decisions regarding safer sex may be limited to low-anger women. PMID:16247592

  14. Astronauts Meade tests SAFER system during EVA

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Astronaut Carl J. Meade tests the new Simplified Aid for EVA Rescue (SAFER) system some 130 nautical miles above Earth. The end of the Remote Manipulator System's (RMS) robot arm, with an unoccupied foot restraint attached, is at frame's edge.

  15. Exploring referral systems for injured patients in low-income countries: a case study from Cambodia.

    PubMed

    Nakahara, Shinji; Saint, Saly; Sann, Sary; Ichikawa, Masao; Kimura, Akio; Eng, Lycheng; Yoshida, Katsumi

    2010-07-01

    Injury is a growing public health concern worldwide. Since severe injuries require urgent treatment, involving smooth, timely patient referral between facilities, strengthening of the referral system would reduce injury mortality. Smooth referral consists of identification of severe cases, organization of transportation, communication between facilities and prompt care at the receiving facility. This study examined these components of referral of injured patients in a representative sample of health centres (HCs) and referral hospitals (RHs) in Cambodia. We analysed data from a survey carried out in 80 HCs and 17 RHs by interview or mailed questionnaire from December 2006 to April 2007. Collected information on referral included the presence of referral guidelines for injured patients, distance of referral, commonly used transportation and its cost, communication with receiving facilities, and fast-tracking at receiving facilities. Formal referral systems were not functioning well in some areas (insufficient communication and underutilization of ambulances), and informal systems were frequently involved (patient transfer by taxi or referral by community volunteers, and treatment by traditional healers) but were not fully integrated into the referral network (traditional healers seldom referred patients to public facilities). The referral distance was long for most of the surveyed facilities and transportation costs were high when transferring from remote areas, even by ambulance. This study identified the weaknesses and strengths of the emergency referral system in Cambodia. Streamlining referral mechanisms will require organization of each component of the referral mechanism by strengthening the existing system and mobilizing local resources, which would allow Cambodia to develop an efficient system at reasonable cost, though it may differ from Western models. Guidelines including these components along with training and supervision, and expansion of the system to

  16. Greener is Cleaner, and Safer

    ERIC Educational Resources Information Center

    Science Scope, 2005

    2005-01-01

    One easy way to reduce the number of accidents in the lab is to go "green." Green chemistry, or sustainable chemistry, emerged about a decade ago, but the concept has been practiced for centuries by indigenous people of many continents. The basic principles of green chemistry are that you should use only what you need and recycle what you can.…

  17. Team training for safer birth.

    PubMed

    Cornthwaite, Katie; Alvarez, Mary; Siassakos, Dimitrios

    2015-11-01

    Effective and coordinated teamworking is key to achieving safe birth for mothers and babies. Confidential enquiries have repeatedly identified deficiencies in teamwork as factors contributing to poor maternal and neonatal outcomes. The ingredients of a successful multi-professional team are varied, but research has identified some fundamental teamwork behaviours, with good communication, proficient leadership and situational awareness at the heart. Simple, evidence-based methods in teamwork training can be seamlessly integrated into a core, mandatory obstetric emergency training. Training should be an enjoyable, inclusive and beneficial experience for members of staff. Training in teamwork can lead to improved clinical outcomes and better birth experience for women. PMID:25979351

  18. SAFER Tests by Meade and Lee

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Astronauts Carl J. Meade and Mark C. Lee (red stripe on suit) test the Simplified Aid for EVA Rescue (SAFER) system some 130 nautical miles from Earth. The pair were actually performing an in-space rehearsal or demonstration of a contingency rescue using the never- before flown hardware. Meade, who here wears the small back-pack unit with its complementary chest-mounted control unit, and Lee, anchored to Discovery's Remote Manipulator System (RMS) robot arm, took turns using the SAFER hardware during their shared space walk of September 16, 1994.

  19. Urban Middle Schools Become Safer, More Effective.

    ERIC Educational Resources Information Center

    Schools in the Middle, 1992

    1992-01-01

    Through the Safe Schools project, initiated by the Education Development Center, Inc., and funded by the Office of Juvenile Justice and Delinquency Prevention, two urban middle schools in the northeast became safer, more effective places of learning over three-year period. This article describes the process. (MLH)

  20. Using Technology to Create Safer Schools.

    ERIC Educational Resources Information Center

    Townley, Arthur J.; Martinez, Kenneth

    1995-01-01

    Although classes to create student self-esteem and antigang programs are gaining in popularity, most school districts have not used available technology to help create safer campuses. Increased availability of telephones and two-way radios would enhance school security, along with incorporation of newer technologies such as computers, digitized…

  1. Lost Opportunities to Reduce Periconception HIV Transmission: Safer Conception Counseling By South African Providers Addresses Perinatal but not Sexual HIV Transmission

    PubMed Central

    Milford, Cecilia; Kaida, Angela; Ehrlich, Matthew J.; Ng, Courtney; Greener, Ross; Mosery, F. N.; Harrison, Abigail; Psaros, Christina; Safren, Steven A.; Bajunirwe, Francis; Wilson, Ira B.; Bangsberg, David R.; Smit, Jennifer A.

    2014-01-01

    Introduction: Safer conception strategies create opportunities for HIV-serodiscordant couples to realize fertility goals and minimize periconception HIV transmission. Patient–provider communication about fertility goals is the first step in safer conception counseling. Methods: We explored provider practices of assessing fertility intentions among HIV-infected men and women, attitudes toward people living with HIV (PLWH) having children, and knowledge and provision of safer conception advice. We conducted in-depth interviews (9 counselors, 15 nurses, 5 doctors) and focus group discussions (6 counselors, 7 professional nurses) in eThekwini District, South Africa. Data were translated, transcribed, and analyzed using content analysis with NVivo10 software. Results: Among 42 participants, median age was 41 (range, 28–60) years, 93% (39) were women, and median years worked in the clinic was 7 (range, 1–27). Some providers assessed women's, not men's, plans for having children at antiretroviral therapy initiation, to avoid fetal exposure to efavirenz. When conducted, reproductive counseling included CD4 cell count and HIV viral load assessment, advising mutual HIV status disclosure, and referral to another provider. Barriers to safer conception counseling included provider assumptions of HIV seroconcordance, low knowledge of safer conception strategies, personal feelings toward PLWH having children, and challenges to tailoring safer sex messages. Conclusions: Providers need information about HIV serodiscordance and safer conception strategies to move beyond discussing only perinatal transmission and maternal health for PLWH who choose to conceive. Safer conception counseling may be more feasible if the message is distilled to delaying conception attempts until the infected partner is on antiretroviral therapy. Designated and motivated nurse providers may be required to provide comprehensive safer conception counseling. PMID:25436820

  2. Rural Hospitals Often Safer, Cheaper for Common Surgeries

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_158884.html Rural Hospitals Often Safer, Cheaper for Common Surgeries: Study Major ... may be safer when done in a rural hospital compared to a suburban or city hospital, a ...

  3. Under construction: building a safer industry.

    PubMed Central

    Tibbetts, John

    2002-01-01

    A revolution in the building industry over the past decade has spawned a new generation of safer materials and practices, decreasing some health risks for construction workers. Concerned consumers, builders, materials manufacturers, and government regulatory agencies have all contributed to a turn toward "green" building materials and practices, meaning that homeowners and office workers now are better able to live and work in healthier environments, and many construction workers are handling and installing less-toxic materials. PMID:11882489

  4. Gynaecological referrals to Baragwanath Hospital.

    PubMed

    Buchmann, E; Ephraim, G; Kathawaroo, S

    1994-04-01

    Three hundred and fifty-nine consecutive referral letters to Baragwanath Hospital's gynaecological outpatients' department were analysed. Letters from private doctors contained significantly less clinical information than those from clinics. Only 11% of referring private doctors mentioned what treatment they had given patients before sending them to hospital. Soweto clinic nurses tended to include more information in their letters than clinic doctors. There were no significant differences in the number of appropriate referrals and incorrect diagnoses from private doctors, clinic doctors and clinic nurses respectively. The poor communication, especially between general practitioners and the hospital, is probably the result of overwork and lack of time. Hospital doctors should reply to well-written referral letters, and liaison between clinics and the hospital ought to be improved and expanded. PMID:7974041

  5. Emerging technologies and challenges for better and safer drugs.

    PubMed

    Theodosiou, Maria; Amir-Aslani, Arsia; Mégarbane, Bruno

    2014-04-01

    Regardless of stringent safety regulations and increased compound selectivity by pharmaceutical companies, prediction of toxicity in humans is still far from perfect and adverse drug reactions are still detected after drug marketing. High costs of failures due to toxicity has led pharmaceutical companies to search for screening methods that would allow detection of toxicity issues at an early stage and improve their preclinical and clinical toxicology. Thanks to the last decade's biotechnology revolution, new technologies like toxicogenomics have demonstrated the capacity to improve toxicity assessment. However, our understanding of toxicological mechanisms is still incomplete and a wide range of approaches must be used to gain insight into toxicity issues. Consequently, an array of in silico, in vitro and in vivo methods is utilized to predict toxicity and its causative mechanisms, improving drug development processes and minimizing costs of failure. PMID:24243233

  6. Haemorrhage after home birth: audit of decision making and referral.

    PubMed

    Smit, Marrit; Dijkman, Anneke; Rijnders, Marlies; Bustraan, Jacqueline; van Dillen, Jeroen; Middeldorp, Johanna; Havenith, Barbara; van Roosmalen, Jos

    2013-11-01

    In the Netherlands, 20 per cent of women give birth at home. In 0.7 per cent, referral to secondary care because of postpartum haemorrhage (PPH) is indicated. Midwives are regularly trained in managing obstetric emergencies. A postgraduate training programme developed for Dutch community-based midwives called 'CAVE' (pre-hospital obstetric emergency course) focuses on the identification and management of obstetric emergencies, including timely and adequate referral to hospital. This descriptive study aims to identify substandard care (SSC) in PPH after home birth in the Netherlands. Sixty seven cases of PPH reported by community-based midwives were collected. After applying selection criteria, seven cases were submitted to audit. The audit panel consisted of 12 midwives (of which seven contributed a case), 10 obstetricians, an educational expert and an ambulance paramedic. First, an individual assessment was performed by all members. Subsequently, at a plenary audit meeting, SSC factors were determined and assigned incidental, minor and major substandard care. PMID:24371910

  7. Referral Handbook of Community Services.

    ERIC Educational Resources Information Center

    Myers, Renny J.; And Others

    This guide to community services is designed to assist financial counseling agencies in the development of community service handbooks with comprehensive listings of community resources and referral centers. The handbook is organized into sections according to problem areas and includes the following: (1) alcohol and drug treatment; (2) child…

  8. 38 CFR 1.950 - Prompt referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Prompt referral. 1.950 Section 1.950 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs § 1.950 Prompt referral. (a) VA shall promptly refer...

  9. 38 CFR 1.950 - Prompt referral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Prompt referral. 1.950 Section 1.950 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs § 1.950 Prompt referral. (a) VA shall promptly refer...

  10. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Referrals. 2001.34 Section 2001.34 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification § 2001.34 Referrals. (a) General. Referrals are...

  11. Understanding hospital referral rates: a user's guide.

    PubMed Central

    Roland, M O; Bartholomew, J; Morrell, D C; McDermott, A; Paul, E

    1990-01-01

    Detailed referral information from one practice was used to investigate the effect of calculating referral rates in several different ways. Referral rates for individual general practitioners should be related to the number of consultations carried out and not to the number of registered patients; for whole practices list size may be used as the denominator. Most doctors will not need to control for age and sex of patients when comparing referral rates but may need to control for case mix when comparing referral rates to individual specialties. In addition, a method is described for distinguishing systematic variation between the referral rates of individual doctors from the random variation that may arise from data based on fairly small numbers of referrals. The method indicates whether systematic variation is greater than would be expected by chance, and it can be extended to indicate whether variability in referral rates is greater in one specialty than another. Because of random variation with time a year's data may not be sufficient to allow reliable interpretation of referral rates to individual specialties, except for the largest. At present there is no known relation between high or low referral rates and quality of care. Nevertheless, if doctors are to interpret their own rates of referral they need those rates to be reliable and valid. Use of the 10 guidelines described in this paper will help to prevent unwarranted conclusions being drawn from information on general practitioners' rates of referral to hospital. PMID:2390594

  12. Safer Systems: A NextGen Aviation Safety Strategic Goal

    NASA Technical Reports Server (NTRS)

    Darr, Stephen T.; Ricks, Wendell R.; Lemos, Katherine A.

    2008-01-01

    The Joint Planning and Development Office (JPDO), is charged by Congress with developing the concepts and plans for the Next Generation Air Transportation System (NextGen). The National Aviation Safety Strategic Plan (NASSP), developed by the Safety Working Group of the JPDO, focuses on establishing the goals, objectives, and strategies needed to realize the safety objectives of the NextGen Integrated Plan. The three goal areas of the NASSP are Safer Practices, Safer Systems, and Safer Worldwide. Safer Practices emphasizes an integrated, systematic approach to safety risk management through implementation of formalized Safety Management Systems (SMS) that incorporate safety data analysis processes, and the enhancement of methods for ensuring safety is an inherent characteristic of NextGen. Safer Systems emphasizes implementation of safety-enhancing technologies, which will improve safety for human-centered interfaces and enhance the safety of airborne and ground-based systems. Safer Worldwide encourages coordinating the adoption of the safer practices and safer systems technologies, policies and procedures worldwide, such that the maximum level of safety is achieved across air transportation system boundaries. This paper introduces the NASSP and its development, and focuses on the Safer Systems elements of the NASSP, which incorporates three objectives for NextGen systems: 1) provide risk reducing system interfaces, 2) provide safety enhancements for airborne systems, and 3) provide safety enhancements for ground-based systems. The goal of this paper is to expose avionics and air traffic management system developers to NASSP objectives and Safer Systems strategies.

  13. Space Station Live: FLEX in Space for Safer Combustion

    NASA Video Gallery

    Flame Extinguishment Experiment (FLEX) Principal Investigator Mark Hickman, from Glenn Research Center, discusses why scientists study flames in space. One reason is to create a safer environment t...

  14. Referrals to a facial pain service.

    PubMed

    Lang, M; Selvadurai, T; Zakrzewska, J M

    2016-04-01

    Aim To assess the quality of referral letters to a facial pain service and highlight the key requirements of such letters.Method The source of all referral letters to the service for five years was established. For one year the information provided in 94 referrals was assessed. Using a predetermined checklist of essential information the referral letters were compared to these set criteria.Results The service received 7,001 referrals and, on average, general dental practitioners (GDPs) referred 303 more patients per year than general medical practitioners (GMPs). Seventy-one percent of all referrals were from primary care practitioners, the rest were from specialists. Over 70% of GMP and 52% of GDP letters included a past medical history, with GMPs more likely to suggest a possible diagnosis and include previous secondary care referrals. The mean score for GMP referrals compared to the standard proforma (maximum of 12) was 5.6 and for GDP referrals 5.0. A relevant drug history was included by 75.6% GMP compared to 38.7% of GDPs. GMPs were more likely to include any relevant mental health history.Conclusions The overall quality of referral letters is low which makes it difficult for the specialists to provide robust treatment plans. PMID:27056518

  15. Determinants of Safer Sex Behaviors among College Students

    ERIC Educational Resources Information Center

    Kanekar, Amar; Sharma, Manoj

    2010-01-01

    Safer sex behaviors (monogamy, sexual abstinence, correct and consistent condom usage) are important for prevention of sexually transmitted diseases and HIV/AIDS among college students. The purpose of this article was to review studies addressing determinants of safer sex behaviors among college students. In order to collect materials for this…

  16. Protecting children in research: Safer ways to research with children who may be experiencing violence or abuse.

    PubMed

    Randall, Duncan; Anderson, Anna; Taylor, Julie

    2016-09-01

    Children participating in research, like other children, may be being maltreated. There is also potential for exposure to abuse during research. Research training, practices and protocols to respond to disclosure and discovery of abuse to protect both researchers and children may not be sufficiently robust. Our aim was to compare and contrast research practices reported in the literature related to protecting children and to recommend safer ways to conduct research. The simultaneous increase in research with children, along with an increased willingness to listen to child victims of abuse, means that researchers must consider the protection of children in the research setting. Twenty-three papers were identified in a literature review. These studies reported a wide variation of ethical considerations, methods, methodology and came from different disciplines. From the 23 papers, two overarching themes were identified: social justice and research and safer research. To make research safer teams should consider training, safety protocols and support for child protection, which includes support to report safeguarding concerns to social care. Further work is required to ensure that training, protocols and support are effective in facilitating researchers to identify and make appropriate child abuse referrals. Ethics practices in abuse research need further debate. PMID:26105062

  17. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda J.

    1991-01-01

    In a critique of the existing literature, the author found that most studies simply calculate referral rates and count letters between referring physicians and specialists. Longitudinal studies that consider all participants' views and place referral in a broader context could reveal more about this complex process. This article is the first of a six-part series reporting on a longitudinal study of 50 referrals in Ontario and Manitoba. PMID:21229088

  18. 29 CFR 102.170 - Agency referral to IRS for tax referral effect; Agency responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 2 2011-07-01 2011-07-01 false Agency referral to IRS for tax referral effect; Agency responsibilities. 102.170 Section 102.170 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Debt Collection Procedures By Federal Income Tax Refund Offset § 102.170 Agency referral to IRS for tax...

  19. 29 CFR 102.170 - Agency referral to IRS for tax referral effect; Agency responsibilities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 2 2013-07-01 2013-07-01 false Agency referral to IRS for tax referral effect; Agency responsibilities. 102.170 Section 102.170 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Debt Collection Procedures By Federal Income Tax Refund Offset § 102.170 Agency referral to IRS for tax...

  20. 29 CFR 102.170 - Agency referral to IRS for tax referral effect; Agency responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Agency referral to IRS for tax referral effect; Agency responsibilities. 102.170 Section 102.170 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Debt Collection Procedures By Federal Income Tax Refund Offset § 102.170 Agency referral to IRS for tax...

  1. 29 CFR 102.170 - Agency referral to IRS for tax referral effect; Agency responsibilities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 2 2012-07-01 2012-07-01 false Agency referral to IRS for tax referral effect; Agency responsibilities. 102.170 Section 102.170 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Debt Collection Procedures By Federal Income Tax Refund Offset § 102.170 Agency referral to IRS for tax...

  2. Advancing safer alternatives through functional substitution.

    PubMed

    Tickner, Joel A; Schifano, Jessica N; Blake, Ann; Rudisill, Catherine; Mulvihill, Martin J

    2015-01-20

    To achieve the ultimate goal of sustainable chemicals management policy–the transition to safer chemicals, materials, products, and processes–current chemicals management approaches could benefit from a broader perspective. Starting with considerations of function, rather than characterizing and managing risks associated with a particular chemical, may provide a different, solutions-oriented lens to reduce risk associated with the uses of chemicals. It may also offer an efficient means, complementing existing tools, to reorient chemicals management approaches from time-intensive risk assessment and risk management based on single chemicals to comparative evaluation of the best options to fulfill a specific function. This article describes a functional approach to chemicals management we call “functional substitution” that encourages decision-makers to look beyond chemical by chemical substitution to find a range of alternatives to meet product performance. We define functional substitution, outline a rationale for greater use of this concept when considering risks posed by uses of chemicals, and provide examples of how functional approaches have been applied toward the identification of alternatives. We also discuss next steps for implementing functional substitution in chemical assessment and policy development. PMID:25517452

  3. Safer Electrolytes for Lithium-Ion Cells

    NASA Technical Reports Server (NTRS)

    Kejha, Joe; Smith, Novis; McCloseky, Joel

    2004-01-01

    A number of nonvolatile, low-flammability liquid oligomers and polymers based on aliphatic organic carbonate molecular structures have been found to be suitable to be blended with ethylene carbonate to make electrolytes for lithium-ion electrochemical cells. Heretofore, such electrolytes have often been made by blending ethylene carbonate with volatile, flammable organic carbonates. The present nonvolatile electrolytes have been found to have adequate conductivity (about 2 mS/cm) for lithium ions and to remain liquid at temperatures down to -5 C. At normal charge and discharge rates, lithiumion cells containing these nonvolatile electrolytes but otherwise of standard design have been found to operate at current and energy densities comparable to those of cells now in common use. They do not perform well at high charge and discharge rates -- an effect probably attributable to electrolyte viscosity. Cells containing the nonvolatile electrolytes have also been found to be, variously, nonflammable or at least self-extinguishing. Hence, there appears to be a basis for the development of safer high-performance lithium-ion cells.

  4. 49 CFR 1018.70 - Prompt referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... referral. (a) A claim which requires enforced collection is referred to GAO or DOJ for litigation. A... GAO for resolution and instruction prior to proceeding with collection actions and/or referral to DOJ for litigation. (c) The Board may refer a claim to GAO or DOJ even though the termination...

  5. 49 CFR 1018.70 - Prompt referral.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... referral. (a) A claim which requires enforced collection is referred to GAO or DOJ for litigation. A... GAO for resolution and instruction prior to proceeding with collection actions and/or referral to DOJ for litigation. (c) The Board may refer a claim to GAO or DOJ even though the termination...

  6. A Conceptualization of the Referral Process

    ERIC Educational Resources Information Center

    Corazzini, John G.; Shelton, John

    1974-01-01

    This article discussed the roles of the various participants in the referral process as well as several other of its dimensions including the holistic/atomistic, the horizontal/vertical, and the personal/institutional. It is suggested that referral be seen in human terms and as a "transfer of trust." (Author)

  7. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... violation of State or local criminal law, the institution shall notify the appropriate State or local law... SUSPECTED CRIMINAL VIOLATIONS Referral of Known or Suspected Criminal Violations § 612.2301 Referrals. (a..., appropriate investigation, and reporting of criminal activity. Within 30 calendar days of determining...

  8. Using Discipline Referrals To Make Decisions.

    ERIC Educational Resources Information Center

    Tobin, Tary; Sugai, George; Colvin, Geoff

    2000-01-01

    Computerized discipline referral data are a valuable resource in identifying at-risk students and staff development needs. Graphing referral data according to grade level, types of problem behavior, gender, or other features can facilitate decisions about applicable types of prevention programs and schoolwide strategies. (Contains 44 references.)…

  9. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral Procedures § 303.303 Referral procedures. (a) General. (1) The lead agency's child find system described...

  10. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral Procedures § 303.303 Referral procedures. (a) General. (1) The lead agency's child find system described...

  11. 48 CFR 919.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Referral. 919.602-1 Section 919.602-1 Federal Acquisition Regulations System DEPARTMENT OF ENERGY SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Eligibility 919.602-1 Referral....

  12. 48 CFR 619.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Referral. 619.602-1 Section 619.602-1 Federal Acquisition Regulations System DEPARTMENT OF STATE SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Eligibility 619.602-1 Referral....

  13. Inappropriate circumcision referrals by GPs.

    PubMed Central

    Griffiths, D; Frank, J D

    1992-01-01

    One hundred and twenty boys were referred by GPs over a 12-month period to a paediatric urologist for circumcision. The reasons for referral were: ballooning in 36, non-retraction in 28, balanoposthitis in 36 or a combination in 15. On examination 53% had a retractile, 21% a partially retractile and 21% a non-retractile foreskin. Six patients had obvious balanitis xerotica obliterans. Only one quarter of the patients required a circumcision. The penis was not examined by the referring doctor in 15 patients. The implications of this survey are that a large proportion of general practitioners have difficulty in discriminating between a true phimosis and a developmentally non-retractile foreskin. This diagnostic inaccuracy was greatest when the referring doctor did not examine the patient. PMID:1625262

  14. Graduated driver licensing and safer driving.

    PubMed

    McKnight, A James; Peck, Raymond C

    2003-01-01

    Graduated Driver Licensing (GDL) inserts between the leaner permit and full licensure an intermediate or "provisional" license that allows novices to drive unsupervised but subject to provisions intended to reduce the risks that accompany entry into highway traffic. Introduction of GDL has been followed by lowered accident rates, resulting from both limiting exposure of novices to unsafe situations and by helping them to deal with them more safely. Sources of safer driving include extended learning, early intervention, contingent advancement, and multistage instruction. To extend the learning process, most GDL systems lengthen the duration of the learner phase and require a specified level of adult-supervised driving. Results indicate that extended learning can reduce accidents substantially if well structured and highly controlled. Early intervention with novice traffic violators have shown both a general deterrent effect upon novice violators facing suspension and a specific effect upon those who have experienced it. Making advancement to full licensure contingent upon a violation-free record when driving on the provisional license has also evidenced a reduction in accidents and violations during that phase of licensure. Multistage instruction attempts development of advanced skills only after novices have had a chance to master more basic skills. Although this element of GDL has yet to be evaluated, research indicates crash reduction is possible in situations where it does not increase exposure to risk. While the various elements of GDL have demonstrated potential benefit in enhancing the safety of novice drivers, considerable improvement in the nature and enforcement of GDL requirements is needed to realize that potential. PMID:12535910

  15. Newer Epilepsy Drugs May Be Safer During Pregnancy

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_160751.html Newer Epilepsy Drugs May Be Safer During Pregnancy Small British ... 2016 (HealthDay News) -- Women who take the new epilepsy drugs levetiracetam and topiramate during pregnancy don't ...

  16. Salmonella Is a Sneaky Germ: Seven Tips for Safer Eating

    MedlinePlus

    ... our food safer to eat focuses on reducing contamination from Salmonella. Don't let Salmonella sneak up ... used to be a common cause of Salmonella contamination. To counter that, stringent procedures for cleaning and ...

  17. Safer Vehicles for People and the Planet

    SciTech Connect

    Wenzel, Thomas P; Wenzel, Thomas P; Ross, Marc

    2008-03-01

    those riding in them is flawed. For starters, all else is never equal; other aspects of vehicle design appear to control what really happens in a crash, as reflected in the safety record of different kinds of vehicles. What's more, the use of high-strength steel, light-weight metals such as aluminum and magnesium, and fiber-reinforced plastics now offers automotive engineers the means to fashion vehicles that are simultaneously safer and less massive than their predecessors, and such designs would, of course, enjoy the better fuel economy that shedding pounds brings.

  18. [Body packer: review and experience in a referral hospital].

    PubMed

    Madrazo, Zoilo; Silvio-Estaba, Leonardo; Secanella, Luis; García-Barrasa, Arantxa; Aranda, Humberto; Golda, Thomas; Biondo, Sebastiano; Rafecas, Antoni

    2007-09-01

    Smuggling of illicit drugs by concealing them within the human body (body packer) is a medical-legal issue that has increased in the last few decades. Physicians, especially those working in the emergency department, should be familiar with the diagnostic and therapeutic management -usually conservative management- of this type of patient and their possible complications. The present article reviews the general concepts and physiopathology associated with transport of packages in the digestive tract and describes the experience of a referral hospital with a protocol specifically designed for these patients. PMID:17916283

  19. Severe systolic hypertension and the search for safer motherhood.

    PubMed

    Martin, James N

    2016-03-01

    Timely and appropriate response to severe hypertension during gestation is an important component of quality, safe care for pregnant or puerperal mothers regardless of causation. The reduction of severe maternal morbidity and maternal mortality in the hypertensive mother is clearly enhanced by the addition of standard protocols for provider response to severe hypertension, particularly severe systolic hypertension. The program developed in New York State via the Safe Motherhood Initiative promotes the implementation of unit-specific safety bundles, especially one that is focused upon a standardized approach to handling the obstetric emergency of severe hypertension usually associated with preeclampsia/eclampsia. The comprehensive preeclampsia/eclampsia safety bundle as summarized by Drs. Moroz and colleagues is reviewed especially from the perspective of its focus on the timely and specific responses for health care providers to make when severe hypertension is detected in the pregnant patient. Evidence-based guidance to practice considerations and clinical care of patients with preeclampsia/eclampsia is embedded within the program outlined for New York State by Moroz and her District II ACOG colleagues. There is a central focus on timely and appropriate antepartum/postpartum management of severe hypertension, a core concept to lessen maternal risk for cerebral hemorrhage. Ten considerations for further integration into the New York program are suggested. Beyond blood pressure control, there is a need for systematic review of interventions and outcomes over time, attention to possible future variations of the protocol for racial/ethnic patient groups at highest risk for maternal morbidity and mortality, and the identification of biomarker(s) that further specify and quantify risk to the maternal brain and other organ systems when severe hypertension develops. Safer motherhood will happen when evidence for best practice is integrated into systems of care for all

  20. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., Training, and Referral § 382.605 Referral, evaluation, and treatment. The requirements for referral, evaluation, and treatment must be performed in accordance with 49 CFR part 40, Subpart O. ... 49 Transportation 5 2010-10-01 2010-10-01 false Referral, evaluation, and treatment....

  1. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., Training, and Referral § 382.605 Referral, evaluation, and treatment. The requirements for referral, evaluation, and treatment must be performed in accordance with 49 CFR part 40, Subpart O. ... 49 Transportation 5 2013-10-01 2013-10-01 false Referral, evaluation, and treatment....

  2. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., Training, and Referral § 382.605 Referral, evaluation, and treatment. The requirements for referral, evaluation, and treatment must be performed in accordance with 49 CFR part 40, Subpart O. ... 49 Transportation 5 2014-10-01 2014-10-01 false Referral, evaluation, and treatment....

  3. 32 CFR 701.9 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... DoD/DON FOIA referral policy is based upon the concept of the originator of a record making a release... outside the Executive Branch of Government (e.g., Congress, State and local government agencies,...

  4. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification § 2001.34... an NDC database system. (3) Notification of referral of records accessioned into NARA or in...

  5. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification § 2001.34... an NDC database system. (3) Notification of referral of records accessioned into NARA or in...

  6. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification § 2001.34... an NDC database system. (3) Notification of referral of records accessioned into NARA or in...

  7. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification § 2001.34... an NDC database system. (3) Notification of referral of records accessioned into NARA or in...

  8. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or mental health staff for evaluation and, when appropriate,...

  9. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or mental health staff for evaluation and, when appropriate,...

  10. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or mental health staff for evaluation and, when appropriate,...

  11. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or mental health staff for evaluation and, when appropriate,...

  12. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or mental health staff for evaluation and, when appropriate,...

  13. A proposed referral centre based on HL7/XML.

    PubMed

    Chen, T S; Liao, B S; Lee, C H; Gough, T G

    2002-01-01

    With the growth of the Inteernet, hospitals have also applied HL7 (Health Level Seven) to exchange data between them. The referral system is identified as an appropriate application system. The effect of referral is to transfer the patient to a suitable hospital in a timely fashion, and to arrange appropriate treatment for the patient. Taking advantage of the Internet to exchange referral data can, not only accelerate the process of patient referral, but also avoid the unnecessary repeat examinations to decrease the waste of medical resources. This article builds up a referral-related message according to the HL7 standard, and develops a referral centre using the Internet environment, making use of XML (eXtensible Markup Language) standard to transform the referral-related data to XML format and exchange referral data between platforms. This electronic referral mechanism is expected to offer other hospitals experience of improved referral practice. PMID:15460680

  14. The Nature of All "Inappropriate Referrals" Made to a Countywide Physical Activity Referral Scheme: Implications for Practice

    ERIC Educational Resources Information Center

    Johnston, Lynne Halley; Warwick, Jane; De Ste Croix, Mark; Crone, Diane; Sldford, Adrienne

    2005-01-01

    Objective: The aim of this study was to evaluate the impact of a centralised referral mechanism (CRM) upon the number and type of "inappropriate referrals" made to a countywide physical activity referral scheme. Design: Case study. Method: Phase 1: Hierarchical Content Analysis of 458 "inappropriate referrals" made to a countywide scheme over a…

  15. Safer Aircraft Possible With Nitrogen Generation

    NASA Technical Reports Server (NTRS)

    Palaszewski, Bryan A.

    2001-01-01

    A system named On-Board Inert Gas Generation System/On-Board Oxygen Generation System (OBIGGS/OBOGS) was studied with Boeing. The study established the requirements for nitrogen purge (for fuel tank inerting and cargo compartment fire suppression) and oxygen (for passengers and crew). The nitrogen would be used for suppressing fires and fuel tank explosions on the aircraft, and the oxygen would be used for breathing gas during high-altitude or emergency operations.

  16. Analysing general practitioners' referral decisions. II. Applying the analytical framework: do high and low referrers differ in factors influencing their referral decisions?

    PubMed

    Bailey, J; King, N; Newton, P

    1994-03-01

    An analytical framework of the referral decision was applied to the question of whether general practitioners (GPs) with relatively high and relatively low referral rates differed in the types of factors that influenced their referral decisions. Interview data from six high referring and six low referring GPs were compared at all levels of the framework, using both quantitative and qualitative content analysis. High referrers were found to mention significantly more negative factors than low referrers, i.e. they referred 'in spite of' reasons against referral. In particular, they referred patients in spite of having doubts about treatment effectiveness. Low referrers mentioned factors related to interpersonal processes significantly more often than high referrers, for example, GP-patient communication as an influence. Possible interpretations of these findings are discussed. PMID:8034159

  17. Precautionary policies in local government: green chemistry and safer alternatives.

    PubMed

    Raphael, Debbie O; Geiger, Chris A

    2011-01-01

    Local governments like the City and County of San Francisco have shouldered the burden of toxic chemicals released into the environment through the substantial costs of health care, environmental cleanup, and infrastructure to purify drinking water, manage wastewater, and manage solid waste. Cities can no longer afford to wait for federal regulation to prevent toxic chemicals from appearing in products used locally. San Francisco's Precautionary Principle Policy calls on the City to act on early warning signs of harm and to use the best available science to identify safer alternatives. Under its umbrella, a wide array of policy tools have been utilized including financial incentives through procurement contracts, certification and promotion of safer business practices, requirements for information disclosure, and bans and restrictions on the sale of products when safer alternatives are readily available. These policies can often become the models for regional, state, and national change. PMID:22001035

  18. Astronauts Carl Meade and Mark Lee test SAFER during EVA

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Astronauts Carl J. Meade and Mark C. Lee (red stripe on suit) test the Simplified Aid for EVA Rescue (SAFER) system some 130 nautical miles from Earth. The pair was actually performing an in-space rehearsal or demonstration of a contingency rescue using the never-before flown hardware. Meade, who here wears the small back-pack unit with its complementary chest-mounted control unit, and Lee, anchored to Discovery's Remote Manipulator System (RMS) robot arm, took turns using the SAFER hardware during their shared space walk of September 16, 1994.

  19. Astronauts Meade and Lee test SAFER system during EVA

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Astronauts Carl J. Meade and Mark C. Lee (red strip on suit) test the new Simplified Aid for EVA Rescue (SAFER) system some 130 nautical miles above Earth. The pair was actually performing an in-space rehearsal or demonstration of a contingency rescue using the never-before flown hardware. Meade, who here wears the small back-pack unit with its complementary chest-mounted control unit, and Lee (anchored to the Space Shuttle Discovery's Remote Manipulator System (RMS) robot arm) took turns using the SAFER hardware during their shared space walk.

  20. Astronauts Carl Meade and Mark Lee test SAFER during EVA

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Backdropped against the darkness of space some 130 nautical miles above Earth, astronaut Mark C. Lee (red stripe on EVA suit) tests the new Simplified Aid for EVA Rescue (SAFER) system. Astronaut Carl J. Meade, tethered to Discovery, at bottom center, got his turn later using the new SAFER hardware. The scen was captured with a 70mm handheld Hasselblad camera operated by a fellow crew member in the shirt-sleeve environment of the Space Shuttle Discovery's cabin. Part of the hardware for the Lidar-In-space Technology Experiment (LITE) is in left foreground.

  1. Challenges and approaches for the development of safer immunomodulatory biologics.

    PubMed

    Sathish, Jean G; Sethu, Swaminathan; Bielsky, Marie-Christine; de Haan, Lolke; French, Neil S; Govindappa, Karthik; Green, James; Griffiths, Christopher E M; Holgate, Stephen; Jones, David; Kimber, Ian; Moggs, Jonathan; Naisbitt, Dean J; Pirmohamed, Munir; Reichmann, Gabriele; Sims, Jennifer; Subramanyam, Meena; Todd, Marque D; Van Der Laan, Jan Willem; Weaver, Richard J; Park, B Kevin

    2013-04-01

    Immunomodulatory biologics, which render their therapeutic effects by modulating or harnessing immune responses, have proven their therapeutic utility in several complex conditions including cancer and autoimmune diseases. However, unwanted adverse reactions--including serious infections, malignancy, cytokine release syndrome, anaphylaxis and hypersensitivity as well as immunogenicity--pose a challenge to the development of new (and safer) immunomodulatory biologics. In this article, we assess the safety issues associated with immunomodulatory biologics and discuss the current approaches for predicting and mitigating adverse reactions associated with their use. We also outline how these approaches can inform the development of safer immunomodulatory biologics. PMID:23535934

  2. Referral Finder: Saving Time and Improving The Quality of In-hospital Referrals.

    PubMed

    Cathcart, Jennifer; Cowan, Neil; Tully, Vicki

    2016-01-01

    Making referrals to other hospital specialties is one of the key duties of the foundation doctor, which can be difficult and time consuming. In Ninewells hospital, Scotland, in our experience the effectiveness of referrals is limited by contact details not being readily accessible and foundation doctors not knowing what information is relevant to each specialty. We surveyed foundation doctors on their experience of the existing referral process to identify where we needed to focus to improve the process. The doctors reported significant delays in obtaining contact details from the operator, and found they did not know the specific information needed in each referral. To increase the information available to foundation doctors, we set up a page on the staff intranet called 'Referral Finder'. This page includes contact details, guidelines for referral, and links to relevant protocols for each specialty. By making this information readily accessible our objective was to increase the speed and quality of referrals. When surveyed two months after the web page was established, foundation doctors reported a reduction in calls to operator from baseline and reported achieving more effective referrals. When asked to comment, many doctors asked if the page could include details for other hospitals in our health board and provide more specialty specific information. This feedback prompted us to extend the scope of the page to include the district general hospital in our region, and update many of the existing details. Doctors were then surveyed after the updates, 100% agreed that the website saved time and there was a 49.3% reduction in doctors who reported not knowing the specific information needed for a referral. Having adequate information improved referrals and resulted in time saved. This would allow more time for patient care. The quality improvement project was praised among doctors as a useful, innovative and replicable project. PMID:27158494

  3. Referral Finder: Saving Time and Improving The Quality of In-hospital Referrals

    PubMed Central

    Cathcart, Jennifer; Cowan, Neil; Tully, Vicki

    2016-01-01

    Making referrals to other hospital specialties is one of the key duties of the foundation doctor, which can be difficult and time consuming. In Ninewells hospital, Scotland, in our experience the effectiveness of referrals is limited by contact details not being readily accessible and foundation doctors not knowing what information is relevant to each specialty. We surveyed foundation doctors on their experience of the existing referral process to identify where we needed to focus to improve the process. The doctors reported significant delays in obtaining contact details from the operator, and found they did not know the specific information needed in each referral. To increase the information available to foundation doctors, we set up a page on the staff intranet called ‘Referral Finder’. This page includes contact details, guidelines for referral, and links to relevant protocols for each specialty. By making this information readily accessible our objective was to increase the speed and quality of referrals. When surveyed two months after the web page was established, foundation doctors reported a reduction in calls to operator from baseline and reported achieving more effective referrals. When asked to comment, many doctors asked if the page could include details for other hospitals in our health board and provide more specialty specific information. This feedback prompted us to extend the scope of the page to include the district general hospital in our region, and update many of the existing details. Doctors were then surveyed after the updates, 100% agreed that the website saved time and there was a 49.3% reduction in doctors who reported not knowing the specific information needed for a referral. Having adequate information improved referrals and resulted in time saved. This would allow more time for patient care. The quality improvement project was praised among doctors as a useful, innovative and replicable project. PMID:27158494

  4. Paediatric Orbital Fractures: The Importance of Regular Thorough Eye Assessment and Appropriate Referral

    PubMed Central

    Kassam, Karim; Rahim, Ishrat; Mills, Caroline

    2013-01-01

    The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated “red flags”, and appropriate referral are discussed in this short paper. PMID:24349804

  5. Paediatric orbital fractures: the importance of regular thorough eye assessment and appropriate referral.

    PubMed

    Kassam, Karim; Rahim, Ishrat; Mills, Caroline

    2013-01-01

    The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated "red flags", and appropriate referral are discussed in this short paper. PMID:24349804

  6. Safety Assessment for Explosive Risk (SAFER) peer review report.

    SciTech Connect

    Heimdahl, Olaf E. R.; LaHoud, Paul; Chapman, Leon Darrel

    2004-08-01

    At the direction of the Department of Defense Explosives Safety Board (DDESB), a Peer Review Team was established to review the status of development of the risk-based explosives safety siting process and criteria as currently implemented in the software 'Safety Assessment for Explosive Risk (SAFER)' Version 2.1. The objective of the Peer Review Team was to provide an independent evaluation of the components of the SAFER model, the ongoing development of the model and the risk assessment process and criteria. This peer review report addressed procedures; protocols; physical and statistical science algorithms; related documents; and software quality assurance, validation and verification. Overall, the risk-based method in SAFER represents a major improvement in the Department of Defense (DoD) approach to explosives safety management. The DDESB and Risk Based Explosives Safety Criteria Team (RBESCT) have made major strides in developing a methodology, which over time may become a worldwide model. The current status of all key areas of the SAFER code has been logically developed and is defensible. Continued improvement and refinement can be expected as implementation proceeds. A consistent approach to addressing and refining uncertainty in each of the primary areas (probability of event, consequences of event and exposure) will be a very beneficial future activity.

  7. Identifying Subtypes of Spousal Assaulters Using the B-SAFER

    ERIC Educational Resources Information Center

    Thijssen, Jill; de Ruiter, Corine

    2011-01-01

    In the present study, a structured risk assessment instrument for intimate partner violence, the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER), was coded for 146 files of spousal assault cases from the Dutch probation service, dating from 2004 and 2005. The aim of the study was twofold: (a) to validate Holtzworth-Munroe and…

  8. Astronaut Mark Lee test SAFER system during EVA

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Backdropped against the blue and white Earth, 130 nautical miles below, astronaut Mark C. Lee test the new Simplified Aid for EVA Rescue (SAFER) system. The scen was captured with a 70mm handheld Hasselblad camera with a 30mm lens attached.

  9. Exercise in the 70s--Implications for Safer Practices.

    ERIC Educational Resources Information Center

    Morehouse, Chauncey A.

    1981-01-01

    Precautionary measures that should be taken by individuals to provide for safer participation in a vigorous exercise program are outlined, including the need for physical examinations, physical conditioning and warm-up, proper clothing and equipment, and awareness of environmental hazards. (JMF)

  10. Safer Schools in the UK--A Case Study

    ERIC Educational Resources Information Center

    Hayden, Carol; Holt, Amanda; Martin, Denise; Nee, Claire

    2011-01-01

    This article reports a research that is based on a European Safer Schools Partnership that included ten countries and specifically the UK case study which was located in London. The initiators of this partnership had been involved in early SSPs in the UK and the educationalists were very much focussed on work that would address problematic…

  11. Elevated levels of serum creatinine: recommendations for management and referral

    PubMed Central

    Mendelssohn, D C; Barrett, B J; Brownscombe, L M; Ethier, J; Greenberg, D E; Kanani, S D; Levin, A; Toffelmire, E B

    1999-01-01

    BACKGROUND: The potential benefits of earlier referral to a nephrologist of patients with elevated levels of serum creatinine include identifying and treating reversible causes of renal failure, slowing the rate of decline associated with progressive renal insufficiency, managing the coexisting conditions associated with chronic renal failure and facilitating efficient entry into dialysis programs for all patients who might benefit. METHODS: A subcommittee of the Canadian Society of Nephrology, which included representatives from family practice and internal medicine, conducted a MEDLINE search for the period 1966 to 1998 using the key words referral and consultation, dialysis, hemodialysis, peritoneal dialysis, renal replacement therapy and kidney diseases. Where published evidence was lacking, conclusions were reached by consensus. GUIDELINES: Earlier referral to nephrologists of patients with elevated creatinine levels is expected to lead to better health care outcomes and lower costs for both the patients and the health care system. All patients with newly discovered renal insufficiency (as evidenced by serum creatinine elevated to a level above the upper limit of the normal range of that laboratory, adjusted for age and height in children) must undergo investigations to determine the potential reversibility of disease, to evaluate the prognosis and to optimize planning of care. All patients with an established, progressive increase in serum creatinine level should be followed with a nephrologist. Adequate preparation for dialysis or transplantation (or both) requires at least 12 months of relatively frequent contact with a renal care team. Nephrologists should provide consultation in a timely manner for any patient with an elevated serum creatinine level. In addition, they should provide advice about what aspects of the condition require particularly urgent or emergency assessment. SPONSORS: This clinical practice guideline has been endorsed by the Canadian

  12. 49 CFR 655.62 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Referral, evaluation, and treatment. 655.62... OPERATIONS Consequences § 655.62 Referral, evaluation, and treatment. If a covered employee has a verified... and treatment programs....

  13. 49 CFR 655.62 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Referral, evaluation, and treatment. 655.62... OPERATIONS Consequences § 655.62 Referral, evaluation, and treatment. If a covered employee has a verified... and treatment programs....

  14. Sources of referral information: a marketing analysis of physician behavior.

    PubMed

    Powers, T L; Swan, J E; Taylor, J A; Bendall, D

    1998-01-01

    The referral process is an important means of obtaining patients and it is necessary to determine ways of influencing the referral process to increase the patient base. This article reports research based on a survey of the referral habits of 806 primary care physicians. The results are examined in the context of physician receptivity to marketer-controlled versus health services sources of referral information. PMID:9702564

  15. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda

    1991-01-01

    Fifty referrals from family physicians in Ontario were examined by interviewing the patients, referring physicians, consultants, and others involved at various points in the process. This, the second in a series of six articles, introduces the participants and describes how grounded theory methodology was used to analyze the approximately 3000 pages of field notes. PMID:21229052

  16. Behavior Analytic Consultation for Academic Referral Concerns

    ERIC Educational Resources Information Center

    Dufrene, Brad A.; Zoder-Martell, Kimberly A.; Dieringe, Shannon Titus; Labrot, Zachary

    2016-01-01

    Applied behavior analysis provides a technology of human behavior that demonstrates great potential for improving socially important outcomes for individuals. School-based consultation may provide a vehicle for delivering applied behavior analysis services in schools to address academic referral concerns. In this article, we propose that…

  17. Descriptive Analysis of Selected Data Referral Networks.

    ERIC Educational Resources Information Center

    MAXIMA Corp., Silver Spring, MD.

    The National Environmental Data Referral Service (NEDRES) is being developed in response to a national need to improve the awareness of and access to a broad range of environmental data files. Two studies were conducted in support of this effort: a survey of prospective users confirming the need for and willingness to pay fees for the service and…

  18. Information and Referral Service, District Office Training.

    ERIC Educational Resources Information Center

    Health and Welfare Council of Central Maryland, Inc., Baltimore.

    Within a standard format the details of instruction and training in various areas (units) of information and referral (I and R) services are given for Social Security Administration workers. Each unit is specified by the following categories: objective, special consideration, background, presentation, participation, review, and examples. There are…

  19. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda J.

    1991-01-01

    In a study of 50 referrals, family physicians were shown to choose consultants whom they trusted. They had previously worked with them or had indirect evidence, including patient reports, of their technical and communication skills and effectiveness with patients. By trial and error, “good” ones were retained and “bad” ones - including those not trusted by patients - were avoided. PMID:20469520

  20. Slowing the Flood of Special Education Referrals.

    ERIC Educational Resources Information Center

    Dauphinais, Paul

    2000-01-01

    Describes alternatives to the standard special education approach of assessment, referral, and placement. Provides three guiding principles that personalize the assessment process. Proposes solutions: meeting with parents to plan for student success, assembling a team of professionals to review and solve problems, and establishing formal…

  1. Gifted Girls: Gender Bias in Gifted Referrals

    ERIC Educational Resources Information Center

    Bianco, Margarita; Harris, Bryn; Garrison-Wade, Dorothy; Leech, Nancy

    2011-01-01

    The goal of this mixed-methods study was to explore the effect of gender on teachers' willingness to refer students to a gifted and talented program. Teachers (N = 28) were provided with one of two profiles (i.e., female or male) describing a gifted student. Results indicated that teachers' decisions for referral to gifted programs were…

  2. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 2 2013-07-01 2013-07-01 false Referral procedures. 303.303 Section 303.303 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES Child Find, Evaluations...

  3. 48 CFR 419.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Referral. 419.602-1 Section 419.602-1 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Responsibility...

  4. 48 CFR 2819.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Referral. 2819.602-1 Section 2819.602-1 Federal Acquisition Regulations System DEPARTMENT OF JUSTICE Socioeconomic Programs SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Eligibility 2819.602-1...

  5. 48 CFR 1419.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Referral. 1419.602-1 Section 1419.602-1 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Responsibility...

  6. 48 CFR 1319.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Referral. 1319.602-1 Section 1319.602-1 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determination of Responsibility...

  7. Alternative Education's Impact on Office Disciplinary Referrals

    ERIC Educational Resources Information Center

    Gut, Eva; McLaughlin, John M.

    2012-01-01

    Disruptive behaviors negatively impact learning by taking time away from classroom instruction (Gottlieb and Polirstok 2005) and may also produce unsafe school environments. This study examined changes in the number of office disciplinary referrals (ODRs) received in public schools prior to and following the schools partnering with one particular…

  8. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT... alone or together with an inmate's prior history, may warrant consideration for a control unit...

  9. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... part and 31 CFR parts 900 through 904, debts shall be referred to Justice as early as possible, and, in... Department of Justice of any payments credited by the Department to the debtor's account. Pursuant to 31 CFR... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Referrals to...

  10. PLEXUS--The Expert System for Referral.

    ERIC Educational Resources Information Center

    Vickery, A.; Brooks, H. M.

    1987-01-01

    Presents a description of PLEXUS, an expert system on gardening designed as a referral tool for public libraries by the University of London. Highlights include determining user characteristics, developing the problem statement, the use of semantic categories, and search strategies that modify the original problem statement using Boolean…

  11. Handedness, Birth Order, Reading Problems: Referrals to a School Psychologist.

    ERIC Educational Resources Information Center

    Altus, Grace T.; Altus, William D.

    To investigate the influence of handedness in the referral of elementary school students to a school psychologist, 120 left-handed referrals were matched with 120 right-handed referrals by sex, full-scale intelligence quotient, and chronological age. Comparison of the groups revealed that twins were more numerous among the left-handed students.…

  12. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... citations affecting § 412.96, see the List of CFR Sections Affected, which appears in the Finding Aids...: Referral centers. (a) Criteria for classification as a referral center: Basic rule. CMS classifies a hospital as a referral center only if the hospital is a Medicare participating acute care hospital...

  13. 34 CFR 303.206 - Referral policies for specific children.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Referral policies for specific children. 303.206... Referral policies for specific children. Each application must include the State's policies and procedures that require the referral for early intervention services under this part of specific children...

  14. 29 CFR 500.224 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 3 2011-07-01 2011-07-01 false Referral to Administrative Law Judge. 500.224 Section 500.224 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS MIGRANT AND SEASONAL AGRICULTURAL WORKER PROTECTION Administrative Proceedings Referral for Hearing § 500.224 Referral to Administrative...

  15. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Referral to Department of Justice. 1014.7 Section 1014.7... § 1014.7 Referral to Department of Justice. (a) When Department of Justice approval or consultation is required under § 1014.6, the referral or request shall be transmitted to the Department of Justice by...

  16. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to Department of Justice... Procedures § 17.9 Referral to Department of Justice. When Department of Justice approval or consultation is required under § 17.8, the referral or request shall be transmitted to the Department of Justice by...

  17. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Information and referral programs. (a) General provisions. The State plan must assure that— (1) The designated State agency will implement an information and referral system adequate to ensure that individuals with... 34 Education 2 2011-07-01 2010-07-01 true Information and referral programs. 361.37 Section...

  18. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Information and referral programs. (a) General provisions. The State plan must assure that— (1) The designated State agency will implement an information and referral system adequate to ensure that individuals with... 34 Education 2 2013-07-01 2013-07-01 false Information and referral programs. 361.37 Section...

  19. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Information and referral programs. (a) General provisions. The State plan must assure that— (1) The designated State agency will implement an information and referral system adequate to ensure that individuals with... 34 Education 2 2014-07-01 2013-07-01 true Information and referral programs. 361.37 Section...

  20. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Information and referral programs. (a) General provisions. The State plan must assure that— (1) The designated State agency will implement an information and referral system adequate to ensure that individuals with... 34 Education 2 2012-07-01 2012-07-01 false Information and referral programs. 361.37 Section...

  1. 34 CFR 361.37 - Information and referral programs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Information and referral programs. (a) General provisions. The State plan must assure that— (1) The designated State agency will implement an information and referral system adequate to ensure that individuals with... 34 Education 2 2010-07-01 2010-07-01 false Information and referral programs. 361.37 Section...

  2. Chicago's Safer Foundation: A Road Back for Ex-Offenders. Program Focus.

    ERIC Educational Resources Information Center

    Finn, Peter

    The Safer Foundation in Chicago, Illinois, is the largest community-based provider of employment services for ex-offenders in the United States. Established in 1972, Safer has a professional staff of nearly 200 in 6 locations. Safer runs a private school, called the PACE (Programmed Activities for Correctional Education) Institute, at the Cook…

  3. Identifying subtypes of spousal assaulters Using the B-SAFER.

    PubMed

    Thijssen, Jill; de Ruiter, Corine

    2011-05-01

    In the present study, a structured risk assessment instrument for intimate partner violence, the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER), was coded for 146 files of spousal assault cases from the Dutch probation service, dating from 2004 and 2005. The aim of the study was twofold: (a) to validate Holtzworth-Munroe and Stuart's typology using the risk factors of the B-SAFER and (b) to examine the relationship between the subtypes found and recidivism rates. Four subtypes of assaulters were identified: family only, generally violent/antisocial, low-level antisocial, and psychopathology. These subtypes were comparable to the subtypes found in previous studies. The generally violent/antisocial subtype had the highest recidivism rate, although not significantly different from the other three subtypes. PMID:20522890

  4. Integrating zebrafish toxicology and nanoscience for safer product development

    PubMed Central

    Kim, Ki-Tae; Tanguay, Robert L.

    2013-01-01

    The design, manufacture and application of safer products and manufacturing processes have been important goals over the last decade and will advance in the future under the umbrella of "Green Chemistry". In this review, we focus on the burgeoning diversity of new engineered nanomaterials (ENMs) and the prescient need for a nanotoxicology paradigm that quickly identifies potentially hazardous nanochemistries. Advances in predictive toxicological modeling in the developing zebrafish offer the most immediate translation to human hazard that is practically achievable with high throughput approaches. Translation in a vertebrate model that is also a low cost alternative to rodents for hazard prediction has been a desirable but elusive testing paradigm. The utility of zebrafish, if applied early in the ENM discovery pipeline, could greatly enhance efforts toward greener and more efficient nanoscience. Early pipeline detection of human and environmental health impacts will quickly inform decisions in the design and production of safer commercial ENMs. PMID:23772181

  5. Self-Assembly Protein Nanogels for Safer Cancer Immunotherapy.

    PubMed

    Purwada, Alberto; Tian, Ye F; Huang, Weishan; Rohrbach, Kathleen M; Deol, Simrita; August, Avery; Singh, Ankur

    2016-06-01

    Soluble antigen-based cancer vaccines have poor retention in tissues along with suboptimal antigen processing by dendritic cells. Multiple booster doses are often needed, leading to dose-limiting systemic toxicity. A versatile, immunomodulatory, self-assembly protein nanogel vaccine is reported that induces robust immune cell response at lower antigen doses than soluble antigens, an important step towards biomaterials-based safer immunotherapy approaches. PMID:27100566

  6. Characteristics of Successful and Unsuccessful Mental Health Referrals of Refugees.

    PubMed

    Shannon, Patricia J; Vinson, Gregory A; Cook, Tonya L; Lennon, Evelyn

    2016-07-01

    In this community based participatory research study, we explored key characteristics of mental health referrals of refugees using stories of providers collected through an on-line survey. Ten coders sorted 60 stories of successful referrals and 34 stories of unsuccessful referrals into domains using the critical incident technique. Principal components analysis yielded categories of successful referrals that included: active care coordination, establishing trust, proactive resolution of barriers, and culturally responsive care. Unsuccessful referrals were characterized by cultural barriers, lack of care coordination, refusal to see refugees, and system and language barriers. Recommendations for training and policy are discussed. PMID:25735618

  7. SAFER Inspection of Space Shuttle Thermal Protection System

    NASA Technical Reports Server (NTRS)

    Scoville, Zebulon C.; Rajula, Sudhakar

    2005-01-01

    In the aftermath of the space shuttle Columbia accident, it quickly became clear that new methods would need to be developed that would provide the capability to inspect and repair the shuttle's thermal protection system (TPS). A boom extension to the Remote Manipulator System (RMS) with a laser topography sensor package was identified as the primary means for measuring the damage depth in acreage tile as well as scanning Reinforced Carbon- Carbon (RCC) surfaces. However, concern over the system's fault tolerance made it prudent to investigate alternate means of acquiring close range photographs and contour depth measurements in the event of a failure. One method that was identified early was to use the Simplified Aid For EVA Rescue (SAFER) propulsion system to allow EVA access to damaged areas of concern. Several issues were identified as potential hazards to SAFER use for this operation. First, the ability of an astronaut to maintain controlled flight depends upon efficient technique and hardware reliability. If either of these is insufficient during flight operations, a safety tether must be used to rescue the crewmember. This operation can jeopardize the integrity of the Extra-vehicular Mobility Unit (EMU) or delicate TPS materials. Controls were developed to prevent the likelihood of requiring a tether rescue, and procedures were written to maximize the chances for success if it cannot be avoided. Crewmember ability to manage tether cable tension during nominal flight also had to be evaluated to ensure it would not negatively affect propellant consumption. Second, although propellant consumption, flight control, orbital dynamics, and flight complexity can all be accurately evaluated in Virtual Reality (VR) Laboratory at Johnson Space Center, there are some shortcomings. As a crewmember's hand is extended to simulate measurement of tile damage, it will pass through the vehicle without resistance. In reality, this force will push the crewmember away from the

  8. Assisting gay men to maintain safer sex: an evaluation of an AIDS service organization's safer sex maintenance program.

    PubMed

    Miller, R L

    1995-01-01

    As the second decade of the AIDS crisis unfolds, increasing concern has been raised that the widespread adoption of condom use that occurred among gay men in the 1980s is not being maintained. Most interventions to promote condom use among gay men are delivered by community-based organizations via programs that are virtually undocumented; little is known about their effectiveness, or the processes by which they may work. This study describes safer sex practices among self-identified gay men following their participation in an intervention developed and implemented by a community-based organization. The intervention was designed to enhance men's attitudes, beliefs, and self-efficacy expectations to maintain safer sex. Among 150 men with complete data at both assessments, self-reported condom use was low. Men reported using condoms more consistently for anal sexual behavior than oral sexual behavior, but there were men who reported consistent unprotected anal sexual intercourse. The intervention had little impact on patterns of behavior over time, although desired changes in attitudes, beliefs, and self-efficacy expectations were evidenced following the intervention. The results suggest the importance of assisting community-based organizations to document program models. Findings also suggest that community-based organizations can develop interventions to successfully enhance factors that theoretically support maintenance of safer sexual behaviors. PMID:8664098

  9. A mechanism of institutional isomorphism in referral networks among hospitals in Seoul, South Korea.

    PubMed

    Jung, Minsoo; Choi, Mankyu

    2010-01-01

    Hospitals engage in medical referral system relations voluntarily, by virtue of their own service capacities. These capacities include medical technology, equipment supply, and patient management, which are assessed individually by medical institutions in efforts to control costs and maintain efficiency in tertiary hospitals. This study assessed referral networks according to the institutional isomorphism theory of new economic sociology. As a result, the referral networks were shown to exhibit emergent structural hierarchy via cumulative clustering by established year and were not affected by attributive variables such as region, bed number, and year of establishment. In particular, the networks evidenced institutional isomorphism with certain central hospitals. As a consequence, personal indices were shown to decrease in accordance with its period, and only the structural index increased. Normative pressures cause organizations to become hierarchically homogenized, in accordance with the principle of organizational learning in specialized fields. Therefore, normative isomorphism on the basis of public domains should be considered an inherent factor in the development of referral networks. PMID:20436330

  10. Integrating MBSE into Ongoing Projects: Requirements Validation and Test Planning for the ISS SAFER

    NASA Technical Reports Server (NTRS)

    Anderson, Herbert A.; Williams, Antony; Pierce, Gregory

    2016-01-01

    The International Space Station (ISS) Simplified Aid for Extra Vehicular Activity (EVA) Rescue (SAFER) is the spacewalking astronaut's final safety measure against separating from the ISS and being unable to return safely. Since the late 1990s, the SAFER has been a standard element of the spacewalking astronaut's equipment. The ISS SAFER project was chartered to develop a new block of SAFER units using a highly similar design to the legacy SAFER (known as the USA SAFER). An on-orbit test module was also included in the project to enable periodic maintenance/propulsion system checkout on the ISS SAFER. On the ISS SAFER project, model-based systems engineering (MBSE) was not the initial systems engineering (SE) approach, given the volume of heritage systems engineering and integration (SE&I) products. The initial emphasis was ensuring traceability to ISS program standards as well as to legacy USA SAFER requirements. The requirements management capabilities of the Cradle systems engineering tool were to be utilized to that end. During development, however, MBSE approaches were applied selectively to address specific challenges in requirements validation and test and verification (T&V) planning, which provided measurable efficiencies to the project. From an MBSE perspective, ISS SAFER development presented a challenge and an opportunity. Addressing the challenge first, the project was tasked to use the original USA SAFER operational and design requirements baseline, with a number of additional ISS program requirements to address evolving certification expectations for systems operating on the ISS. Additionally, a need to redesign the ISS SAFER avionics architecture resulted in a set of changes to the design requirements baseline. Finally, the project added an entirely new functionality for on-orbit maintenance. After initial requirements integration, the system requirements count was approaching 1000, which represented a growth of 4x over the original USA SAFER system

  11. Artificial Intelligence For A Safer And More Efficient Car Driving

    NASA Astrophysics Data System (ADS)

    Adorni, Giovanni

    1989-03-01

    In this paper a project, PROMETHEUS, is described in which fourteen of Europe's leading car manufacturers are to join with approximately forty research institutes and governmental agencies to make the traffic of Europe safer, more efficient and more economical. PROMETHEUS project is divided into seven areas. In this paper one of the seven areas, PRO-ART, is described. PRO-ART is aimed at clarifying the need for and the principles of the artificial intelligence to be used in the next generation automobile. After a brief description of the overhall project, the description of the seven years PRO-ART Italian research programme will be given.

  12. Seismographs, sensors, and satellites: Better technology for safer communities

    USGS Publications Warehouse

    Groat, C.G.

    2004-01-01

    In the past 25 years, our ability to measure, monitor, and model the processes that lead to natural disasters has increased dramatically. Equally important has been the improvement in our technological capability to communicate information about hazards to those whose lives may be affected. These innovations in tracking and communicating the changes-floods, earthquakes, wildfires, volcanic eruptions-in our dynamic planet, supported by a deeper understanding of earth processes, enable us to expand our predictive capabilities and point the way to a safer future. ?? 2004 Elsevier Ltd. All rights reserved.

  13. Airport baggage scanning technology makes flying safer for Americans

    SciTech Connect

    Martz, Harry

    2013-08-28

    Each time you step on a commercial flight, you can feel safer because of a researcher you've probably never heard of. His name is Harry Martz. He's a veteran scientist at the Lawrence Livermore National Laboratory (LLNL) who wakes up every day thinking how his research can advance X-ray imaging technology to thwart the next terrorist attack. "My job is to improve national security," Martz said. "That's why my research team exists. We have to outsmart the terrorists. It's a constant battle."

  14. Paramedical risk framing during field referral of acute stroke and S-T elevation myocardial infarction patients.

    PubMed

    Campeau, Anthony Gerard

    2016-06-01

    Field referral of emergency ambulance patients by paramedics on a widespread basis is a relatively new aspect of paramedicine. Its implementation involves a significant revision to paramedics' clinical responsibilities and level of interaction with medical specialists. Using grounded theory methodology, this qualitative study uses interviews with paramedics from Ontario, Canada, to explore the framing of risk associated with these referrals in the context of caring for patients with two high-stakes medical conditions: acute stroke and S-T elevation myocardial infarction. The results outline how paramedics have incorporated risk framing into their practice. PMID:26819329

  15. Neurotology symptoms at referral to vestibular evaluation

    PubMed Central

    2013-01-01

    Background Dizziness-vertigo is common in adults, but clinical providers may rarely diagnose vestibular impairment and referral could be delayed. To assess neurotology symptoms (including triggers) reported by patients with peripheral vestibular disease, during the year just before their referral to vestibular evaluation. Methods 282 patients with peripheral vestibular disease and 282 control subjects accepted to participate. They had no middle ear, retinal, neurological, psychiatric, autoimmune or autonomic disorders. They reported their symptoms by a standardized questionnaire along with their anxiety/depression symptoms. Results Patients were referred after months or years from the onset of their symptoms, 24% of them reported frequent falls with a long clinical evolution; 10% of them reported no vertigo but instability related to specific triggers; 86% patients and 12% control subjects reported instability when moving the head rapidly and 79% patients and 6% control subjects reported instability when changing posture. Seven out of the 9 symptoms explored by the questionnaire allowed the correct classification of circa 95% of the participants (Discriminant function analysis, p < 0.001). High blood pressure, dyslipidemia and anxiety/depression symptoms showed a mild correlation with the total score of symptoms (multiple R2 =0.18, p < 0.001). Conclusions Late referral to vestibular evaluation may underlie a history of frequent falls; some patients may not report vertigo, but instability related to specific triggers, which could be useful to prompt vestibular evaluation. High blood pressure, dyslipidemia and anxiety/depression symptoms may have a mild influence on the report of symptoms of vestibular disease in both, patients and control subjects. PMID:24279682

  16. Development of Methods to Evaluate Safer Flight Characteristics

    NASA Technical Reports Server (NTRS)

    Basciano, Thomas E., Jr.; Erickson, Jon D.

    1997-01-01

    The goal of the proposed research is to begin development of a simulation that models the flight characteristics of the Simplified Aid For EVA Rescue (SAFER) pack. Development of such a simulation was initiated to ultimately study the effect an Orbital Replacement Unit (ORU) has on SAFER dynamics. A major function of this program will be to calculate fuel consumption for many ORUs with different masses and locations. This will ultimately determine the maximum ORU mass an astronaut can carry and still perform a self-rescue without jettisoning the unit. A second primary goal is to eventually simulate relative motion (vibration) between the ORU and astronaut. After relative motion is accurately modeled it will be possible to evaluate the robustness of the control system and optimize performance as needed. The first stage in developing the simulation is the ability to model a standardized, total, self-rescue scenario, making it possible to accurately compare different program runs. In orbit an astronaut has only limited data and will not be able to follow the most fuel efficient trajectory; therefore, it is important to correctly model the procedures an astronaut would use in orbit so that good fuel consumption data can be obtained. Once this part of the program is well tested and verified, the vibration (relative motion) of the ORU with respect to the astronaut can be studied.

  17. SAFER vehicle inspection: a multimodal robotic sensing platform

    NASA Astrophysics Data System (ADS)

    Page, David L.; Fougerolle, Yohan; Koschan, Andreas F.; Gribok, Andrei; Abidi, Mongi A.; Gorsich, David J.; Gerhart, Grant R.

    2004-09-01

    The current threats to U.S. security both military and civilian have led to an increased interest in the development of technologies to safeguard national facilities such as military bases, federal buildings, nuclear power plants, and national laboratories. As a result, the Imaging, Robotics, and Intelligent Systems (IRIS) Laboratory at The University of Tennessee (UT) has established a research consortium, known as SAFER (Security Automation and Future Electromotive Robotics), to develop, test, and deploy sensing and imaging systems for unmanned ground vehicles (UGV). The targeted missions for these UGV systems include -- but are not limited to --under vehicle threat assessment, stand-off check-point inspections, scout surveillance, intruder detection, obstacle-breach situations, and render-safe scenarios. This paper presents a general overview of the SAFER project. Beyond this general overview, we further focus on a specific problem where we collect 3D range scans of under vehicle carriages. These scans require appropriate segmentation and representation algorithms to facilitate the vehicle inspection process. We discuss the theory for these algorithms and present results from applying them to actual vehicle scans.

  18. Screening, Brief Intervention, and Referral to Treatment.

    PubMed

    Borus, Joshua; Parhami, Iman; Levy, Sharon

    2016-10-01

    Screening, Brief Intervention, and Referral to Treatment is a quick, effective technique with which to manage substance use in adolescents and young adults. Use of a validated measure for detecting substance use and abuse is significantly more effective than unvalidated tools or provider intuition. There are a variety of validated tools available to use in the adolescent/young adult population, and there are opportunities to increase the efficiency and scalability of screening by using computerized questionnaires. This area continues to evolve rapidly. PMID:27613340

  19. Understanding the referral services safe harbor.

    PubMed

    Tomes, J

    1994-02-01

    In today's competitive healthcare environment, healthcare facilities and individual providers must form new relationships to safeguard their market positions and compete efficiently. But while such relationships are necessary and serve legitimate goals, those entering into such arrangements must be concerned that in so doing they do not run afoul of the Medicare and Medicaid fraud and abuse statute. This article examines the potential dangers of remuneration for referrals, and explains how one of the many so-called "safe harbor" provisions of the fraud and abuse statute applies to this practice. PMID:10145951

  20. Developmental Screening Referrals: Child and Family Factors that Predict Referral Completion

    ERIC Educational Resources Information Center

    Jennings, Danielle J.; Hanline, Mary Frances

    2013-01-01

    This study researched the predictive impact of developmental screening results and the effects of child and family characteristics on completion of referrals given for evaluation. Logistical and hierarchical logistic regression analyses were used to determine the significance of 10 independent variables on the predictor variable. The number of…

  1. Verification in Referral-Based Crowdsourcing

    PubMed Central

    Naroditskiy, Victor; Rahwan, Iyad; Cebrian, Manuel; Jennings, Nicholas R.

    2012-01-01

    Online social networks offer unprecedented potential for rallying a large number of people to accomplish a given task. Here we focus on information gathering tasks where rare information is sought through “referral-based crowdsourcing”: the information request is propagated recursively through invitations among members of a social network. Whereas previous work analyzed incentives for the referral process in a setting with only correct reports, misreporting is known to be both pervasive in crowdsourcing applications, and difficult/costly to filter out. A motivating example for our work is the DARPA Red Balloon Challenge where the level of misreporting was very high. In order to undertake a formal study of verification, we introduce a model where agents can exert costly effort to perform verification and false reports can be penalized. This is the first model of verification and it provides many directions for future research, which we point out. Our main theoretical result is the compensation scheme that minimizes the cost of retrieving the correct answer. Notably, this optimal compensation scheme coincides with the winning strategy of the Red Balloon Challenge. PMID:23071530

  2. Verification in referral-based crowdsourcing.

    PubMed

    Naroditskiy, Victor; Rahwan, Iyad; Cebrian, Manuel; Jennings, Nicholas R

    2012-01-01

    Online social networks offer unprecedented potential for rallying a large number of people to accomplish a given task. Here we focus on information gathering tasks where rare information is sought through "referral-based crowdsourcing": the information request is propagated recursively through invitations among members of a social network. Whereas previous work analyzed incentives for the referral process in a setting with only correct reports, misreporting is known to be both pervasive in crowdsourcing applications, and difficult/costly to filter out. A motivating example for our work is the DARPA Red Balloon Challenge where the level of misreporting was very high. In order to undertake a formal study of verification, we introduce a model where agents can exert costly effort to perform verification and false reports can be penalized. This is the first model of verification and it provides many directions for future research, which we point out. Our main theoretical result is the compensation scheme that minimizes the cost of retrieving the correct answer. Notably, this optimal compensation scheme coincides with the winning strategy of the Red Balloon Challenge. PMID:23071530

  3. A Safer Formulation Concept for Flame-Generated Engineered Nanomaterials

    PubMed Central

    Gass, Samuel; Cohen, Joel M.; Pyrgiotakis, Georgios; Sotiriou, Georgios A.; Pratsinis, Sotiris E.; Demokritou, Philip

    2013-01-01

    The likely success or failure of the nanotechnology industry depends on the environmental health and safety of engineered nanomaterials (ENMs). While efforts toward engineering safer ENMs are sparse, such efforts are considered crucial to the sustainability of the nanotech industry. A promising approach in this regard is to coat potentially toxic nanomaterials with a biologically inert layer of amorphous SiO2. Core-shell particles exhibit the surface properties of their amorphous SiO2 shell while maintaining specific functional properties of their core material. A major challenge in the development of functional core-shell particles is the design of scalable high-yield processes that can meet large-scale industrial demand. Here, we present a safer formulation concept for flame-generated ENMs based on a one-step, in flight SiO2 encapsulation process, which was recently introduced by the authors as a means for a scalable manufacturing of SiO2 coated ENMs. Firstly, the versatility of the SiO2-coating process is demonstrated by applying it to four ENMs (CeO2, ZnO, Fe2O3, Ag) marked by their prevalence in consumer products as well as their range in toxicity. The ENM-dependent coating fundamentals are assessed and process parameters are optimized for each ENM investigated. The effects of the SiO2-coating on core material structure, composition and morphology, as well as the coating efficiency on each nanostructured material, are evaluated using state-of-the-art analytical methods (XRD, N2 adsorption, TEM, XPS, isopropanol chemisorption). Finally, the biological interactions of SiO2-coated vs. uncoated ENMs are evaluated using cellular bioassays, providing valuable evidence for reduced toxicity for the SiO2-coated ENMs. Results indicate that the proposed ‘safer by design’ concept bears great promise for scaled-up application in industry in order to reduce the toxicological profile of ENMs for certain applications. PMID:23961338

  4. Safer lithium ion batteries based on nonflammable electrolyte

    NASA Astrophysics Data System (ADS)

    Zeng, Ziqi; Wu, Bingbin; Xiao, Lifen; Jiang, Xiaoyu; Chen, Yao; Ai, Xinping; Yang, Hanxi; Cao, Yuliang

    2015-04-01

    The safety of lithium ion batteries has long been a critical obstacle for their high-power and large-scale applications because of the flammable nature of their carbon anode and organic carbonate electrolytes. To eliminate the potential safety hazards, lithium ion batteries should be built up with thermal-stable electrodes and nonflammable electrolytes. Here we report safer lithium ion batteries using nonflammable phosphonate electrolyte, thermal-stable LiFePO4 cathode and alloy anodes. Benefiting from the electrochemical compatibility and strong fire-retardancy of the phosphonate electrolyte, the cathode and anode materials in the nonflammable phosphonate electrolyte demonstrate similar charge-discharge performances with those in the conventional carbonate electrolyte, showing a great prospect for large-scale applications in electric vehicles and grid-scale electric energy storage.

  5. 25 CFR 217.3 - Referral of questions by superintendent.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Referral of questions by superintendent. 217.3 Section... DISTRIBUTION CORP. § 217.3 Referral of questions by superintendent. The superintendent shall refer all questions and problems related to the management of the assets as they come to his attention, together...

  6. 25 CFR 217.3 - Referral of questions by superintendent.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Referral of questions by superintendent. 217.3 Section... DISTRIBUTION CORP. § 217.3 Referral of questions by superintendent. The superintendent shall refer all questions and problems related to the management of the assets as they come to his attention, together...

  7. 45 CFR 31.4 - Certification and referral of debt.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Certification and referral of debt. 31.4 Section 31.4 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION TAX REFUND OFFSET § 31.4 Certification and referral of debt. (a) Certification. The Secretary shall certify to FMS...

  8. Accuracy of referrals for visual assessment in a stroke population

    PubMed Central

    Rowe, F J

    2011-01-01

    Purpose To evaluate accuracy of referrals from multidisciplinary stroke teams requesting visual assessments. Patients and methods Multicentre prospective study undertaken in 20 acute Trust hospitals. Stroke survivors referred with suspected visual difficulty were recruited. Standardised screening/referral and investigation forms were used to document data on referral signs and symptoms, plus type and extent of visual impairment. Results Referrals for 799 patients were reviewed: 60% men, 40% women. Mean age at onset of stroke was 69 years (SD 14: range 1–94 years). Signs recorded by referring staff were nil in 58% and positive in the remainder. Symptoms were recorded in 87%. Diagnosis of visual impairment was nil in 8% and positive in the remainder. Sensitivity of referrals (on the basis of signs detected) was calculated as 0.42 with specificity of 0.52. Kappa statistical evaluation of agreement between referral and diagnosis of visual impairment was 0.428 (SE 0.017: 95% confidence interval of −0.048, 0.019). Conclusion More than half of patient referrals were made despite no signs of visual difficulty being recorded by the referring staff. Visual impairment of varying severity was diagnosed in 92% of stroke survivors referred for visual assessment. Referrals were made based predominantly on visual symptoms and because of formal orthoptic liaison in Trusts involved. PMID:21127506

  9. 14 CFR 385.6 - Referral to the Reviewing Official.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Referral to the Reviewing Official. 385.6... Referral to the Reviewing Official. When the staff member finds that the public interest so requires, or... shall, in lieu of exercising the authority, submit the matter to the Reviewing Official for decision....

  10. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  11. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  12. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  13. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  14. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  15. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Referral to Dispute Resolution Committee. 902.3 Section 902.3 Judicial Administration NATIONAL CRIME PREVENTION AND PRIVACY COMPACT COUNCIL DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five...

  16. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Referral to Dispute Resolution Committee. 902.3 Section 902.3 Judicial Administration NATIONAL CRIME PREVENTION AND PRIVACY COMPACT COUNCIL DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five...

  17. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Referral to Dispute Resolution Committee. 902.3 Section 902.3 Judicial Administration NATIONAL CRIME PREVENTION AND PRIVACY COMPACT COUNCIL DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five...

  18. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 3 2011-01-01 2011-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  19. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  20. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Referral to Dispute Resolution Committee... DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five person Dispute Resolution Committee membership shall be determined according to Compact Article VI (g). Should...

  1. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Referral to Dispute Resolution Committee... DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five person Dispute Resolution Committee membership shall be determined according to Compact Article VI (g). Should...

  2. 49 CFR 209.133 - Referral for prosecution.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Referral for prosecution. 209.133 Section 209.133... Penalties § 209.133 Referral for prosecution. If an inspector, including a certified state inspector under... case, and if it appears that assessment of a civil penalty would not be an adequate deterrent to...

  3. 49 CFR 1503.703 - Civil penalty letter; referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... civil penalty action and that the matter is closed. (e) Referral for prosecution and collection. If the... 49 Transportation 9 2010-10-01 2010-10-01 false Civil penalty letter; referral. 1503.703 Section... AND ENFORCEMENT PROCEDURES Judicial Assessment of Civil Penalties § 1503.703 Civil penalty...

  4. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 3 2012-01-01 2012-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  5. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 3 2014-01-01 2014-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for exemption under this subpart shall be transmitted...

  6. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 3 2013-01-01 2013-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  7. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false Referral, evaluation, and treatment. 199.243... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a) Each... abuse professionals and counseling and treatment programs. (b) Each covered employee who engages...

  8. NETWORK. A History of the Scottish Telephone Referral Service.

    ERIC Educational Resources Information Center

    Smith, Vernon

    Since its beginnings in 1974 as an outgrowth of the BBC Adult Literacy project, NETWORK SCOTLAND LTD (formerly the Scottish Telephone Referral Service) has grown to play a key role in the provision of broadcast support and educational information services in the United Kingdom. The referral service was originally established to provide a mechanism…

  9. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Referral by court. 10.60 Section 10.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE PRACTICES AND PROCEDURES General Administrative Procedures § 10.60 Referral by court. (a) This...

  10. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Referral by court. 10.60 Section 10.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE PRACTICES AND PROCEDURES General Administrative Procedures § 10.60 Referral by court. (a) This...

  11. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Referral by court. 10.60 Section 10.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE PRACTICES AND PROCEDURES General Administrative Procedures § 10.60 Referral by court. (a) This...

  12. Decreasing Discipline Referrals for African American Males in Middle School

    ERIC Educational Resources Information Center

    Moore, Earl, Jr.; Ratchford, Vicky F.

    2007-01-01

    Brogden Middle School (BMS) is located approximately 15 miles south of Goldsboro, North Carolina, a city of approximately 40,000 citizens and the home of a military base. To decrease the number of discipline referrals of African American males, 10 students who had the most frequent discipline referrals during their seventh-grade year were…

  13. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... (31 CFR 901.5). (b) The Commission will use private collection agencies where it determines that their... RELATING TO DEBT COLLECTION Miscellaneous: Credit Bureau Reporting, Collection Services § 204.77 Referrals... 17 Commodity and Securities Exchanges 2 2013-04-01 2013-04-01 false Referrals to...

  14. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... (31 CFR 901.5). (b) The Commission will use private collection agencies where it determines that their... RELATING TO DEBT COLLECTION Miscellaneous: Credit Bureau Reporting, Collection Services § 204.77 Referrals... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false Referrals to...

  15. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... (31 CFR 901.5). (b) The Commission will use private collection agencies where it determines that their... RELATING TO DEBT COLLECTION Miscellaneous: Credit Bureau Reporting, Collection Services § 204.77 Referrals... 17 Commodity and Securities Exchanges 2 2012-04-01 2012-04-01 false Referrals to...

  16. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... (31 CFR 901.5). (b) The Commission will use private collection agencies where it determines that their... RELATING TO DEBT COLLECTION Miscellaneous: Credit Bureau Reporting, Collection Services § 204.77 Referrals... 17 Commodity and Securities Exchanges 3 2014-04-01 2014-04-01 false Referrals to...

  17. 17 CFR 204.77 - Referrals to collection agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (31 CFR 901.5). (b) The Commission will use private collection agencies where it determines that their... RELATING TO DEBT COLLECTION Miscellaneous: Credit Bureau Reporting, Collection Services § 204.77 Referrals... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Referrals to...

  18. National Environmental Data Referral Service (NEDRES) User Survey. Final Report.

    ERIC Educational Resources Information Center

    MAXIMA Corp., Silver Spring, MD.

    A survey was conducted to assess environmental data users' interest in a referral system such as the National Environmental Data Referral Service (NEDRES) and to gauge user willingness to participate in a proposed NEDRES network and to comply with a system of NEDRES user fees. Twenty-one organizations were identified and 3,200 individuals were…

  19. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Referral to Department of Justice. 177... ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.108 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  20. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  1. 49 CFR 1503.703 - Civil penalty letter; referral.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 9 2013-10-01 2013-10-01 false Civil penalty letter; referral. 1503.703 Section... AND ENFORCEMENT PROCEDURES Judicial Assessment of Civil Penalties § 1503.703 Civil penalty letter; referral. (a) Issuance. In a civil penalty action in which the amount in controversy exceeds the...

  2. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... for drugs, as directed by the substance abuse professional, to be performed in accordance with 49 CFR... 49 Transportation 3 2011-10-01 2011-10-01 false Referral, evaluation, and treatment. 199.243... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a)...

  3. 49 CFR 1018.71 - Referral of a compromise offer.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Referral of a compromise offer. 1018.71 Section... § 1018.71 Referral of a compromise offer. The Board may refer a debtor's firm written offer of compromise which is substantial in amount to GAO or to DOJ if the Board is uncertain whether the offer should...

  4. Building Safer Communities: The Integrated Community Safety Approach

    SciTech Connect

    Fawcett, Ricky Lee; Kerr, Thomas A; Jordan, Steven Albert

    2001-03-01

    This paper discusses an integrated community safety approach to creating safer communities. It defines community broadly to include two categories of community members: “industry” and “neighbors.” Potential community members within the “industry” category include facilities, government/regulators, customers, stockholders, and suppliers. Within the “neighbors” category are towns, cities, counties, states; people/commodity flow systems; news media and special interest groups; environment; and families of employees. Each of these potential community members and its characteristics are discussed. The integrated community safety approach consists of three major activities: (1) define the boundaries of the community; (2) facilitate the sense of community; and (3) address the needs of the community. Defining the boundaries of the community includes determining the geographical and social boundaries; this is accomplished through conducting a hazard analysis and community involvement to identify all of the community members. Facilitating the sense of community includes conducting a capability/needs assessment and continuing community involvement to identify the issues and concerns of community members. Addressing the needs of the community involves master planning to consider safety issues in all community development actions and continuing community education and involvement. The integrated community safety approach is a workable approach for existing industries and their neighbors as well as new projects that industries and their neighbors might be considering. By using this socio-technical approach to integrating industry and all of its neighbors into a safer community, the integrated community safety approach will better assure the viability and safety of industry and its neighbors while maintaining or improving the overall quality of life.

  5. Recommendations for safer radiotherapy: what’s the message?

    PubMed Central

    Dunscombe, Peter

    2012-01-01

    Radiotherapy, with close to a million courses delivered per year in North America, is a very safe and effective intervention for a devastating disease. However, although rare, several deeply regrettable incidents have occurred in radiotherapy and have rightly been the subject of considerable public interest. Partly in response to reports of these incidents a variety of authoritative organizations across the globe has harnessed the expertise amongst their members in attempts to identify the measures that will make radiotherapy safer. While the intentions of all these organizations are clearly good it is challenging for the health care providers in the clinic to know where to start with so much advice coming from so many directions. Through a mapping exercise we have identified commonalities between recommendations made in seven authoritative documents and identified those issues most frequently cited. The documents reviewed contain a total of 117 recommendations. Using the 37 recommendations in “Towards Safer Radiotherapy” as the initial base layer, recommendations in the other documents were mapped, adding to the base layer to accommodate all the recommendations from the additional six documents as necessary. This mapping exercise resulted in the distillation of the original 117 recommendations down to 61 unique recommendations. Twelve topics were identified in three or more of the documents as being pertinent to the improvement of patient safety in radiotherapy. They are, in order of most to least cited: training, staffing, documentation, incident learning, communication, check lists, quality control and preventive maintenance, dosimetric audit, accreditation, minimizing interruptions, prospective risk assessment, and safety culture. This analysis provides guidance for the selection of those activities most likely to enhance safety and quality in radiotherapy based on the frequency of citation in selected recent authoritative literature. PMID:23061045

  6. Referral and Timing of Referral to Hospice Care in Nursing Homes: The Significant Role of Staff Members

    ERIC Educational Resources Information Center

    Welch, Lisa C.; Miller, Susan C.; Martin, Edward W.; Nanda, Aman

    2008-01-01

    Purpose: Given concerns about end-of-life care for many nursing home (NH) residents, this study sought to understand factors influencing hospice referral or nonreferral as well as timing of referral. Design and Methods: We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors…

  7. The SAFER Latinos Project: Addressing a Community Ecology Underlying Latino Youth Violence

    ERIC Educational Resources Information Center

    Edberg, Mark; Cleary, Sean D.; Collins, Elizabeth; Klevens, Joanne; Leiva, Rodrigo; Bazurto, Martha; Rivera, Ivonne; del Cid, Alex Taylor; Montero, Luisa; Calderon, Melba

    2010-01-01

    This paper describes the intervention model, early implementation experience, and challenges for the "Seguridad, Apoyo, Familia, Educacion, y Recursos" (SAFER) Latinos project. The SAFER Latinos project is an attempt to build the evidence for a multilevel participatory youth violence prevention model tailored to the specific circumstances of…

  8. 75 FR 71123 - Agency Information Collection Activities; Proposed Collection; Comment Request; Safer Detergent...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-22

    ... organizations engaged in formulating, producing, purchasing, or distributing surfactants or products containing surfactants. Title: Safer Detergent Stewardship Initiative (SDSI) Program. ICR numbers: EPA ICR No. 2261.02... involved in the transition to safer surfactants. Surfactants are a major ingredient in cleaning...

  9. Keeping afloat: student nurses' experiences following assignment referral.

    PubMed

    Robshaw, Maxine; Smith, Joanna

    2004-10-01

    The retention of nursing students is an ongoing problem, both within the United Kingdom (UK) and internationally. While there is a plethora of literature relating to student attrition, there is an absence of evidence in relation to the experiences of those students who are struggling to meet the demands of nursing programmes. Using an inductive sociological enquiry based approach, this study sought to examine the experiences of student nurses after referral on the first attempt of a summative assessment. Nursing students who had failed an assignment (n=20) were invited to participate. Data was collected using focus groups, with the emergent themes collapsed into a concise format using thematic content analysis. Four key themes were identified: desire to succeed; acceptance of personal failure; recognition of personal attributes required for success; and responsibility for personal success and failure. Students remained on the programme, despite struggling with financial and personal difficulties, because the desire to become a qualified nurse outweighed transient hardships. This paper will illustrate the benefits of understanding the students' experiences, in order to ensure the support students receive is appropriate to their needs. Understanding the support strategies as perceived by the students may prevent further wastage from nursing programmes. PMID:15465166

  10. A Randomized Clinical Trial of the Health Evaluation and Referral Assistant (HERA): Research Methods

    PubMed Central

    Boudreaux, Edwin D.; Abar, Beau; Baumann, Brigitte M.; Grissom, Grant

    2013-01-01

    The Health Evaluation and Referral Assistant (HERA) is a web-based program designed to facilitate screening, brief intervention, and referral to treatment (SBIRT) for tobacco, alcohol, and drug abuse. After the patient completes a computerized substance abuse assessment, the HERA produces a summary report with evidence-based recommended clinical actions for the healthcare provider (the Healthcare Provider Report) and a report for the patient (the Patient Feedback Report) that provides education regarding the consequences of use, personally tailored motivational messages, and a tailored substance abuse treatment referral list. For those who provide authorization, the HERA faxes the individual’s contact information to a substance abuse treatment provider matched to the individual’s substance use severity and personal characteristics, like insurance and location of residence (dynamic referral). This paper summarizes the methods used for a randomized controlled trial to evaluate the HERA’s efficacy in leading to increased treatment initiation and reduced substance use. The study was performed in four emergency departments. Individual patients were randomized into one of two conditions: the HERA or assessment only. A total of 4,269 patients were screened and 1,006 participants enrolled. The sample was comprised of 427 tobacco users, 212 risky alcohol users, and 367 illicit drug users. Fourty-two percent used more than one substance class. The enrolled sample was similar to the eligible patient population. The study should enhance understanding of whether computer-facilitated SBIRT can impact process of care variables, such as promoting substance abuse treatment initiation, as well as its effect on subsequent substance abuse and related outcomes. PMID:23665335

  11. Impact of referral transport system on institutional deliveries in Haryana, India

    PubMed Central

    Prinja, Shankar; Jeet, Gursimer; Kaur, Manmeet; Aggarwal, Arun Kumar; Manchanda, Neha; Kumar, Rajesh

    2014-01-01

    Background & objectives: Creation of a strong referral transport network across the country is necessary for improving physical access to public sector health facilities. In this study we evaluated the referral transport services in Haryana, i.e. Haryana Swasthya Vaahan Sewa (HSVS), now known as National Ambulance Service (NAS), to assess the extent and pattern of utilization, and to ascertain its effect on public sector institutional deliveries. Methods: Secondary data on 116,562 patients transported during April to July 2011 in Haryana state were analysed to assess extent and pattern of NAS utilization. Exit interviews were conducted with 270 consecutively selected users and non- users of referral services respectively in Ambala (High NAS utilization), Hisar (medium utilization) and Narnaul (low utilization) districts. Month-wise data on institutional deliveries in public facilities during 2005-2012 were collected in these three districts, and analysed using interrupted time series analysis to assess the impact of NAS on institutional deliveries. Results: Female gender (OR = 77.7), rural place of residence (OR = 5.96) and poor socio-economic status (poorest wealth quintile OR = 2.64) were significantly associated with NAS ambulance service usage. Institutional deliveries in Haryana rose significantly after the introduction of NAS service in Ambala (OR=137.4, 95% CI=22.4-252.4) and Hisar (OR=215, 95% CI=88.5-341.3) districts. No significant increase was observed in Narnaul (OR=4.5, 95% CI= -137.4 to 146.4) district. Interpretation & conclusions: The findings of the present study showed a positive effect of referral transport service on increasing institutional deliveries. However, this needs to be backed up with adequate supply of basic and emergency obstetric care at hospitals and health centres. PMID:25109723

  12. Nuclear safety: In case of emergency

    SciTech Connect

    Clamp, A.

    1995-12-31

    With a land from their american colleagues, Russian and Ukranian member professionals are developing emergency procedures to make their plants safer. This report discusses how the United States are assisting their colleagues with computer generated simulation of reactor accident situations and with financial assistance.

  13. Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning.

    PubMed

    Pintye, Jillian; Ngure, Kenneth; Curran, Kathryn; Vusha, Sophie; Mugo, Nelly; Celum, Connie; Baeten, Jared M; Heffron, Renee

    2015-09-01

    HIV-serodiscordant couples often choose to attempt pregnancy despite their HIV transmission risk. Optimizing delivery of HIV risk reduction strategies during peri-conception periods (i.e., safer conception) requires understanding how HIV-serodiscordant couples approach fertility decisions. We conducted 36 in-depth individual interviews with male and female partners of Kenyan heterosexual HIV-serodiscordant couples who recently conceived. Transcripts were analyzed by gender and HIV serostatus using open coding. Matrices were used to identify patterns and emerging themes. Most participants expressed acceptance of being in an HIV-serodiscordant couple and affirmed their resilience to live with serodiscordance and achieve their fertility goals. Overall, while the goal for childbearing was unchanged, conception became an urgent desire so that both partners could experience childrearing together while the HIV-infected partner was still healthy. Children also add value to the relationship, and multiple children were a commonly expressed desire. Couples' desires dominated those of individual partners in fertility decision-making, but male preferences were more influential when the individual desires differed. Values and preferences of the couple as a unit may mediate fertility decision-making in HIV-discordant couples. Thus, it is important that safer conception programs include both partners when appropriate and consider the relationship context during risk reduction counseling and when recommending risk reduction interventions. PMID:26301703

  14. Can we select health professionals who provide safer care.

    PubMed

    Firth-Cozens, J; Cording, H; Ginsburg, R

    2003-12-01

    In order to improve patient safety, health services are looking to other industries' experiences and as a result are adopting a systems approach to learning from error, rather than simply focusing the blame on the individual. However, in health care the individual will remain an important contributor to safety and this paper looks at other literatures besides health to consider a number of individual characteristics and the role they might play in terms of work practices that affect patient safety. It considers the effects of a variety of personality profiles including sensation seeking, Type A, and those with high self esteem; looks at our ability to select for psychological wellbeing; and discusses the ways that psychometrics have been used in medicine to predict performance. It concludes that although rarely used, psychometrics has been shown to be useful in predicting some aspects of performance in medicine and suggests that this is an area well worth further study for the benefit of patient care. Nevertheless, we are a long way away from being able to select safer staff and should instead be developing this knowledge to enable us to recognise and address potential difficulties. PMID:14645743

  15. New "safer sex initiative" stresses "it takes two".

    PubMed

    1994-11-01

    Until very recently, no major manufacturer of oral contraceptives was willing to provide concrete education about STDs. Wyeth-Ayerst Laboratories recently launched its Nordette Safer Sex Initiative: a pouch containing a pack of Nordette pills, illustrated educational materials about oral contraceptives including health benefits and use instructions, instructions for protection against sexually transmitted diseases (STD), a sample Ramses condom from Schmid Laboratories, and a discount coupon toward future condom purchases. Ortho subsequently released a patient education program/package including a Lifestyles condom. This latter kit includes self-assessment questionnaires designed to help women rate their risk for STDs, and videotapes for both the patient and the provider. The kit is a box containing the sample condom, a pack of pills, a reference card to explain start dates, a question and answer booklet, and an audiocassette describing how the pill works. These collaborative programs between oral contraceptive manufacturers and condom manufacturers is welcomed as a real breakthrough by numerous reproductive health organizations and providers. The Wyeth program is actually a pilot program offered to 16,000 office-based obstetrician/gynecologists, but it is being considered for distribution to federally-funded clinics. For its part, the entire Ortho kit is available only to physicians, but the company is offering some of the material free to federally-funded clinics. PMID:12289956

  16. World Health Day is a day for safer motherhood.

    PubMed

    1998-01-01

    Every year, April 7 is kept as World Health Day. This year [1998] marks the 50th anniversary of the foundation of WHO. However, the day has a double significance because the theme of this year's World Health Day is safe motherhood. All around the world people will mark this day and remind communities and leaders that there is still much work to be done to make pregnancy and childbirth safer. World leaders in Washington will be doing their part on this day, for without high-level political commitment it is hard to get things done. However, this effort is not just for a day. The whole year is dedicated to the theme of safe motherhood. Please let us know about the initiatives taking place in your country, and do send photographs] We can all do something this year to make things better for women and their newborns. Please send your stories and photos to the Editor, Safe Motherhood (address on back page). As well as the 10 action messages that were developed at the technical consultation to mark the 10th anniversary of the Safe Motherhood Initiative, fact sheets and slides are also available either by writing to WHO or on the Internet. PMID:12293570

  17. The Nuclear Posture Review (NPR) : are we safer?

    SciTech Connect

    Brune, Nancy E.

    2010-07-01

    Nuclear Posture Review (NPR) is designed to make world safer by reducing the role of U.S. nuclear weapons and reducing the salience of nuclear weapons. U.S. also seeks to maintain a credible nuclear deterrent and reinforce regional security architectures with missile defenses and other conventional military capabilities. But recent studies suggest that nuclear proliferation is a direct response to the perceived threat of U.S. conventional capabilities not U.S. nuclear stockpile. If this is true, then the intent of the NPR to reduce the role and numbers of nuclear weapons and strengthen conventional military capabilities may actually make the world less safe. First stated objective of NPR is to reduce the role and numbers of U.S. nuclear weapons, reduce the salience of nuclear weapons and move step by step toward eliminating them. Second stated objective is a reaffirmation of U.S. commitment to maintaining a strong deterrent which forms the basis of U.S. assurances to allies and partners. The pathway - made explicit throughout the NPR - for reducing the role and numbers of nuclear weapons while maintaining a credible nuclear deterrent and reinforcing regional security architectures is to give conventional forces and capabilities and missile defenses (e.g. non-nuclear elements) a greater share of the deterrence burden.

  18. How Can We Make PV Modules Safer?: Preprint

    SciTech Connect

    Wohlgemuth, J. H.; Kurtz, S. R.

    2012-06-01

    Safety is a prime concern for the photovoltaics (PV) industry. As a technology deployed on residential and commercial buildings, it is critical that PV not cause damage to the buildings nor harm the occupants. Many of the PV systems on buildings are of sufficiently high voltage (300 to 600 Volts dc) that they may present potential hazards. These PV systems must be safe in terms of mechanical damage (nothing falls on someone), shock hazard (no risk of electrical shock when touching an exposed circuit element), and fire (the modules neither cause nor promote a fire). The present safety standards (IEC 61730 and UL 1703) do a good job of providing for design rules and test requirements for mechanical, shock, and spread of flame dangers. However, neither standard addresses the issue of electrical arcing within a module that can cause a fire. To make PV modules, they must be designed, built, and installed with an emphasis on minimizing the potential for open circuits and ground faults. This paper provides recommendations on redundant connection designs, robust mounting methods, and changes to the safety standards to yield safer PV modules.

  19. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 1 2012-07-01 2012-07-01 false Referrals to the Department of Justice. 13.33 Section 13.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral....

  20. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Referrals to the Department of Justice. 13.33 Section 13.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral....

  1. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Referrals to the Department of Justice. 13.33 Section 13.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral....

  2. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Referrals to the Department of Justice. 13.33 Section 13.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral....

  3. How do obstetric providers discuss referrals for prenatal genetic counseling?

    PubMed

    Bernhardt, Barbara A; Haunstetter, Carrie Mastromarino; Roter, Debra; Geller, Gail

    2005-04-01

    To investigate referrals of pregnant women to genetic counseling, we analysed transcripts from audiotaped first prenatal visits of 104 patients (72 actual patient visits and 32 simulated patient visits) with 32 providers (obstetricians and nurse-midwives). All patients had at least one indication for referral. Only 10% of visits with actual patients included a genetic counseling referral. When genetic counseling was discussed, it was only briefly described, primarily as an information session. This study shows that the majority of pregnant women with an indication for referral for genetic counseling are not referred. In addition, obstetric providers' inadequate descriptions of prenatal genetic counseling may result in women being poorly prepared for genetic counseling sessions. PMID:15959642

  4. Effect of hospital referral networks on patient readmissions.

    PubMed

    Mascia, Daniele; Angeli, Federica; Di Vincenzo, Fausto

    2015-05-01

    Previous studies have shown that referral networks encompass important mechanisms of coordination and integration among hospitals, which enhance numerous organizational-level benefits, such as productivity, efficiency, and quality of care. The present study advances previous research by demonstrating how hospital referral networks influence patient readmissions. Data include 360,697 hospitalization events within a regional community of hospitals in the Italian National Health Service. Multilevel hierarchical regression analysis tests the impacts of referral networks' structural characteristics on patient hospital readmissions. The results demonstrate that organizational centrality in the overall referral network and ego-network density have opposing effects on the likelihood of readmission events within hospitals; greater centrality is negatively associated with readmissions, whereas greater ego-network density increases the likelihood of readmission events. Our findings support the (re)organization of healthcare systems and provide important indications for policymakers and practitioners. PMID:25795994

  5. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  6. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  7. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  8. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  9. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  10. Treatment of hypertension in the emergency department.

    PubMed

    Baumann, Brigitte M; Cline, David M; Pimenta, Eduardo

    2011-01-01

    This review updates concepts of hypertension evaluation and management in patients presenting to the emergency department. It outlines the current challenges faced by emergency physicians in the identification and management of hypertensive patients: In spite of published emergency care guidelines, identification and referral rates remain low in patients presenting to the emergency department with moderate blood pressure (BP) elevations. In patients with severely elevated BP, the evaluation for acute end organ damage remains inconsistent and is symptom-based. Using current consensus guidelines, this review provides an algorithm for the management of the hypertensive emergency department patient. The final section of this review outlines management strategies for specific hypertensive emergencies. PMID:21719370

  11. Antibiotic Stewardship Challenges in a Referral Neonatal Intensive Care Unit.

    PubMed

    Shipp, Kimberly D; Chiang, Tracy; Karasick, Stephanie; Quick, Kayla; Nguyen, Sean T; Cantey, Joseph B

    2016-04-01

    Background Antibiotic overuse in neonates is associated with adverse outcomes. Data are limited to guide antibiotic stewardship in the neonatal intensive care unit (NICU). Our objective was to identify areas for antibiotic stewardship improvement in a referral NICU. Methods Retrospective review of antibiotic use administered to infants admitted to a referral NICU compared with an inborn NICU. Antibiotic use was quantified by days of therapy (DOT) per 1,000 patient-days (PD). Results A total of 78% of referral NICU infants received ≥ 1 course of antibiotics. Infants in the referral NICU received more antibiotic DOT/1,000 PD than in the inborn NICU (558.9 vs. 343.2, p < 0.001), with a higher proportion of broad-spectrum therapy. For infants in the referral NICU, 39% of antibiotic courses were started at the transferring hospital; these were broader in spectrum (28 vs. 20%, p < 0.001) and less likely to be de-escalated or discontinued at 48 to 72 hours (58 vs. 87%, p < 0.001) than courses started after transfer. Conclusions Compared with the inborn NICU, suspected sepsis in the referral NICU accounted for more antibiotic utilization, which was broad-spectrum and less likely to be de-escalated. Stewardship interventions should include reserving broad-spectrum therapy for infants with risk factors and de-escalating promptly once culture results become available. PMID:26683603

  12. Referral patterns to a specialist eating disorder service: the impact of the referrer's gender.

    PubMed

    Feeney, Eileen; Noble, Helen; Waller, Glenn

    2007-01-01

    There is some evidence that the characteristics of general practitioners (GPs) and of the services that they operate influence the likelihood of referring patients to specialist eating disorder services. The aim of this study was to determine whether the gender of the GP is associated with referral rates for different eating disorders. The sample was a retrospective case series of 93 patients, referred to a specialist eating disorder service by local GPs. Associations between GP gender and clinical characteristics of the patients were determined using chi-squared tests and t-tests. Patients with binge eating disorder were substantially more likely to be referred by female GPs, while other atypical cases were more likely to be referred by male GPs. There was no evidence that the patients referred by male GPs differed in clinical presentation from those referred by female GPs. Clinical hypotheses are advanced to explain these biases in the referral practices of male and female clinicians. There is a need for greater education of GPs about the importance of identifying atypical eating disorders and treating them appropriately. PMID:17676672

  13. CDC Vital Signs: Making Health Care Safer -- Stop Infections from Lethal CRE Germs Now

    MedlinePlus

    ... 62 MB] Read the MMWR Science Clips Making Health Care Safer Stop Infections from Lethal CRE Germs Now ... to otherwise healthy people outside of medical facilities. Health Care Providers can Know if patients in your facility ...

  14. CDC Vital Signs: Making Health Care Safer -- Think Sepsis. Time Matters.

    MedlinePlus

    ... Press Kit Read the MMWR Science Clips Making Health Care Safer Think sepsis. Time matters. Language: English Español ( ... the antibiotic type, dose, and duration are correct. Health care facility CEOs/administrators can Make infection control a ...

  15. CDC Vital Signs: Making Health Care Safer -- Antibiotic Rx in Hospitals

    MedlinePlus

    ... Press Kit Read the MMWR Science Clips Making Health Care Safer Antibiotic Rx in Hospitals: Proceed with Caution ... resistance and improving prescribing practices. Work with other health care facilities to prevent infections, transmission, and resistance. Problem ...

  16. Chemical-Free Cosmetics May Be Safer for Teen Girls, Study Suggests

    MedlinePlus

    ... Chemical-Free Cosmetics May Be Safer for Teen Girls, Study Suggests Lower levels of hormone-disrupting chemicals ... hormone-disrupting chemicals in the bodies of teen girls, a new study reports. Chemicals widely used in ...

  17. Assessing the Need for Referral in Automatic Diabetic Retinopathy Detection.

    PubMed

    Pires, Ramon; Jelinek, Herbert F; Wainer, Jacques; Goldenstein, Siome; Valle, Eduardo; Rocha, Anderson

    2013-12-01

    Emerging technologies in health care aim at reducing unnecessary visits to medical specialists, minimizing overall cost of treatment and optimizing the number of patients seen by each doctor. This paper explores image recognition for the screening of diabetic retinopathy, a complication of diabetes that can lead to blindness if not discovered in its initial stages. Many previous reports on DR imaging focus on the segmentation of the retinal image, on quality assessment, and on the analysis of presence of DR-related lesions. Although this study has advanced the detection of individual DR lesions from retinal images, the simple presence of any lesion is not enough to decide on the need for referral of a patient. Deciding if a patient should be referred to a doctor is an essential requirement for the deployment of an automated screening tool for rural and remote communities. We introduce an algorithm to make that decision based on the fusion of results by metaclassification. The input of the metaclassifier is the output of several lesion detectors, creating a powerful high-level feature representation for the retinal images. We explore alternatives for the bag-of-visual-words (BoVW)-based lesion detectors, which critically depends on the choices of coding and pooling the low-level local descriptors. The final classification approach achieved an area under the curve of 93.4% using SOFT-MAX BoVW (soft-assignment coding/max pooling), without the need of normalizing the high-level feature vector of scores. PMID:23963192

  18. Potential use of safer injecting facilities among injection drug users in Vancouver's Downtown Eastside

    PubMed Central

    Kerr, Thomas; Wood, Evan; Small, Dan; Palepu, Anita; Tyndall, Mark W.

    2003-01-01

    Background The Vancouver Coastal Health Authority will initiate North America's first sanctioned safer injecting facility, as a pilot project, on Sept. 15, 2003. The analyses presented here were conducted to estimate the potential use of safer injecting facilities by local illicit injection drug users (IDUs) and to evaluate the potential impact of newly established Health Canada restrictions and current police activities on the use of the proposed facility. Methods During April and May 2003, we recruited active IDUs in Vancouver's Downtown Eastside to participate in a feasibility study. We used descriptive and univariate statistics to determine potential use of a safer injecting facility and to explore factors associated with willingness to use such a facility with and without federal restrictions and police presence. Results Overall, 458 street-recruited IDUs completed an interviewer-administered survey, of whom 422 (92%) reported a willingness to use a safer injecting facility. Those expressing willingness were more likely to inject in public (odds ratio [OR] 3.9, 95% confidence interval [CI] 1.9–8.0). When the restrictions in the Health Canada guidelines were considered, only 144 (31%) participants were willing to use a safer injecting facility. IDUs who inject alone were more likely (OR 1.8, 95% CI 1.0–3.1) and women were less likely (OR 0.6, 95% CI 0.4–0.9) to be willing to use a safer injecting facility operating under these restrictions. Only 103 (22%) of the participants said they would be willing to use a safer injecting facility if police were stationed near the entrance. Interpretation Most IDUs participating in this study expressed a willingness to use a safer injecting facility. However, willingness declined substantially when the IDUs were asked about using a facility operating under selected Health Canada restrictions and in the event that police were stationed near the entrance. PMID:14557313

  19. “I Always Worry about What Might Happen Ahead”: Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda

    PubMed Central

    Bajunirwe, Francis; Kastner, Jasmine; Sanyu, Naomi; Akatukwasa, Cecilia; Ng, Courtney; Rifkin, Rachel; Milford, Cecilia; Moore, Lizzie; Wilson, Ira B.; Bangsberg, David R.; Smit, Jennifer A.; Kaida, Angela

    2016-01-01

    Background. We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients. Methods. We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis. Results. Of 38 providers, 76% were women with median age 34 years (range 24–57). First, we discuss providers' reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on “family planning” and maternal and child health; (3) empathize with the importance of having children for HIV-affected clients; and (4) describe opportunities to counsel HIV-serodiscordant couples. Second, we discuss provider-level challenges that impede safer conception counseling. Emergent themes included the following: (1) providers struggle to translate reproductive rights language into individualized risk reduction given concerns about maternal health and HIV transmission and (2) providers lack safer conception training and support needed to provide counseling. Discussion. Tailored guidelines and training are required for providers to implement safer conception counseling. Such support must respond to provider experiences with adverse HIV-related maternal and child outcomes and a national emphasis on pregnancy prevention. PMID:27051664

  20. Psychological Factors Explaining the Referral Behavior of Iranian Family Physicians

    PubMed Central

    Mohaghegh, Bahram; Seyedin, Hesam; Rashidian, Arash; Ravaghi, Hamid; Khalesi, Nader; Kazemeini, Hossein

    2014-01-01

    Background: The recently developed policy of the family practice program in rural regions of Iran faced some challenges such as inefficient referral system. The health insurance organizations (purchaser) and health policy makers are concerned about the high rate of patient referrals from family physicians to specialists due to imposing unnecessary services and costs. Objectives: This study examined utility of the theory of planned behavior to explain intention of Iranian family physicians to reduce referral rate of patients with respiratory diseases to medical specialist. Patients and Methods: An exploratory cross-sectional study, employing a correlational design directed by the theory of planned behavior was conducted. A questionnaire was developed based on an eliciting study and review of literature. One hundred and seventy-four family physicians working at primary care centers in two provinces of Iran completed the questionnaire (response rate of 86%). Results: The finding revealed that intention of family physicians to reduce referral rate of patients to specialists was significantly related to two theory-based variables of subjective norms (r = 0.38, P < 0.001) and perceived behavioral control (r = 0.43, P < 0.001), and not to attitudes. A stepwise regression entering direct measures of the theory variables explained 35% of the variance on the intention, with perceived behavioral control being the strongest predictor. Adding background variables to the model achieved further 5% by variables of practice size and past referral rate behavior. Conclusions: The results indicated that psychological variables of the theory of planned behavior could explain a noticeable proportion of variance in family physician's intention to decrease the rate of referring patients with respiratory diseases to medical specialists. The intention is primarily influenced by normative and control considerations. These findings contribute to a better understanding of referral decisions by

  1. Safer Wards: reducing violence on older people's mental health wards.

    PubMed

    Brown, Juliette; Fawzi, Waleed; McCarthy, Cathy; Stevenson, Carmel; Kwesi, Solomon; Joyce, Maggie; Dusoye, Jenny; Mohamudbucus, Yasin; Shah, Amar

    2015-01-01

    Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people's mental health wards. This was done using quality improvement methods and supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust. We established a multi-disciplinary group who led on the project on each ward and used a Pareto diagram to establish the focus of our work. We established a dashboard of measures based on our incident reporting system Datix, including number of incidents of violence, days between incidents, days of staff sickness, days between staff injury, use of restraint, and use of rapid tranquilisation (the last two being balancing measures in the reduction of violence). Each team identified factors driving physical violence on the wards, under headings of unmet patient needs, staff needs and staff awareness, which included lack of activity and a safe and therapeutic environment. Using driver diagrams, we identified change ideas that included hourly rounding (proactive checks on patient well-being), the addition of sensory rooms, flexible leave for patients, and a structured activity programme. We also introduced exercise to music, therapeutic groups led by patients, and focused on discharge planning and pet therapy, each of which starting sequentially over the course of a one year period from late 2013 and subject to a cycle of iterative learning using PDSA methods. The specific aim was a 20% decrease in violent incidents on three wards in City and Hackney, and Newham. Following our interventions, days between violent incidents increased from an average of three to an average of six. Days between staff injury due to physical violence rose from an average of

  2. Safer Wards: reducing violence on older people's mental health wards

    PubMed Central

    Brown, Juliette; Fawzi, Waleed; McCarthy, Cathy; Stevenson, Carmel; Kwesi, Solomon; Joyce, Maggie; Dusoye, Jenny; Mohamudbucus, Yasin; Shah, Amar

    2015-01-01

    Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people's mental health wards. This was done using quality improvement methods and supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust. We established a multi-disciplinary group who led on the project on each ward and used a Pareto diagram to establish the focus of our work. We established a dashboard of measures based on our incident reporting system Datix, including number of incidents of violence, days between incidents, days of staff sickness, days between staff injury, use of restraint, and use of rapid tranquilisation (the last two being balancing measures in the reduction of violence). Each team identified factors driving physical violence on the wards, under headings of unmet patient needs, staff needs and staff awareness, which included lack of activity and a safe and therapeutic environment. Using driver diagrams, we identified change ideas that included hourly rounding (proactive checks on patient well-being), the addition of sensory rooms, flexible leave for patients, and a structured activity programme. We also introduced exercise to music, therapeutic groups led by patients, and focused on discharge planning and pet therapy, each of which starting sequentially over the course of a one year period from late 2013 and subject to a cycle of iterative learning using PDSA methods. The specific aim was a 20% decrease in violent incidents on three wards in City and Hackney, and Newham. Following our interventions, days between violent incidents increased from an average of three to an average of six. Days between staff injury due to physical violence rose from an average of

  3. Referral patterns between primary care and genitourinary medicine.

    PubMed

    Champion, J K; Ross, J D

    1999-02-01

    Many patients attending genitourinary medicine (GUM) clinics are self referred, but some patients initially present to their general practitioner (GP). The aim of this study was to describe the referral pattern of GPs in the Lothian region of Scotland to the local GUM clinic. A questionnaire was completed by all patients referred by their GP and a case note review supplied further diagnostic and demographic information. Of 1140 (23%) patients, 965 were available for study and were referred by their GP. There was a wide variability in referral rates from different practices and from different partners within a practice. The median referral rate per 100,000 practice population was 22.4/year (range 0-586). A referral letter accompanied the patient in 797/965 (83%) cases. The detection of cases of chlamydia and gonorrhoea in patients in primary care subsequently referred to the GUM clinic was low and poor diagnostic acumen for herpes simplex virus (HSV) was notable. No consistent practice for investigation or treatment prior to referral was found and there was marked failure of the investigations initiated in primary care to achieve diagnosis. Despite this, 24% of patients were already on treatment at the time of their GUM consultation. Few STDs were diagnosed in primary care and subsequently referred to the GUM clinic suggesting either failure to diagnose infections or reluctance to refer on for confirmation, treatment, test of cure and health education. PMID:10215118

  4. Negative Biopsy after Referral for Biopsy-Proven Gastric Cancer

    PubMed Central

    Tae, Chung Hyun; Lee, Jun Haeng; Min, Byung-Hoon; Kim, Kyoung-Mee; Rhee, Poong-Lyul; Kim, Jae J.

    2016-01-01

    Background/Aims Repeat endoscopy with biopsy is often performed in patients with previously diagnosed gastric cancer to determine further treatment plans. However, biopsy results may differ from the original pathologic report. We reviewed patients who had a negative biopsy after referral for gastric cancer. Methods A total of 116 patients with negative biopsy results after referral for biopsy-proven gastric cancer were enrolled. Outside pathology slides were reviewed. Images of the first and second endoscopic examinations were reviewed. We reviewed the clinical history from referral to the final treatment. Results Eighty-eight patients (76%) arrived with information about the lesion from the referring physician. Among 96 patients with available outside slides, the rate of interobserver variation was 24%. Endoscopy was repeated at our institution; 85 patients (73%) were found to have definite lesions, whereas 31 patients (27%) had indeterminate lesions. In the group with definite lesions, 71% of the lesions were depressed in shape. The most common cause of a negative biopsy was mistargeting. In the group with indeterminate lesions, 94% had insufficient information. All patients with adequate follow-up were successfully treated based on the findings in the follow-up endoscopy. Conclusions A negative biopsy after referral for biopsy-proven gastric cancer is mainly caused by mistargeting and insufficient information during the referral. PMID:25963084

  5. Urgent cancer referral guidelines: a retrospective cohort study of referrals for upper gastrointestinal adenocarcinoma.

    PubMed

    Panter, Simon J; Bramble, Mike G; O'Flanagan, Hilda; Hungin, A Pali S

    2004-08-01

    Dyspepsia in primary care is common and guidelines indicate that patients with alarm symptoms, as defined by the urgent cancer referral guidelines, should be investigated by gastroscopy. The specificity and sensitivity of alarm symptoms is poor and only a small percentage of patients will turn out to have malignant disease. This primary care study shows that employing current guidelines will identify only 72% of patients at their initial visit to a general practitioner, but this figure could be increased to 86% if the guidelines included patients with weight loss or anaemia in the absence of dyspepsia. Past performance indicates that the majority of patients with the commonest symptom complex were not referred quickly and less than half were seen within 4 weeks. PMID:15296562

  6. Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda.

    PubMed

    Livingston, Patricia; Evans, Faye; Nsereko, Etienne; Nyirigira, Gaston; Ruhato, Paulin; Sargeant, Joan; Chipp, Megan; Enright, Angela

    2014-11-01

    High rates of maternal mortality remain a widespread problem in the developing world. Skilled anesthesia providers are required for the safe conduct of Cesarean delivery and resuscitation during obstetrical crises. Few anesthesia providers in low-resource settings have access to continuing education. In Rwanda, anesthesia technicians with only three years of post-secondary training must manage complex maternal emergencies in geographically isolated areas. The purpose of this special article is to describe implementation of the SAFE (Safer Anesthesia From Education) Obstetric Anesthesia course in Rwanda, a three-day refresher course designed to improve obstetrical anesthesia knowledge and skills for practitioners in low-resource areas. In addition, we describe how the course facilitated the knowledge-to-action (KTA) cycle whereby a series of steps are followed to promote the uptake of new knowledge into clinical practice. The KTA cycle requires locally relevant teaching interventions and continuation of knowledge post intervention. In Rwanda, this meant carefully considering educational needs, revising curricula to suit the local context, employing active experiential learning during the SAFE Obstetric Anesthesia course, encouraging supportive relationships with peers and mentors, and using participant action plans for change, post-course logbooks, and follow-up interviews with participants six months after the course. During those interviews, participants reported improvements in clinical practice and greater confidence in coordinating team activities. Anesthesia safety remains challenged by resource limitations and resistance to change by health care providers who did not attend the course. Future teaching interventions will address the need for team training. PMID:25145938

  7. Application of an ecological framework to examine barriers to the adoption of safer conception strategies by HIV-affected couples.

    PubMed

    Saleem, Haneefa T; Surkan, Pamela J; Kerrigan, Deanna; Kennedy, Caitlin E

    2016-01-01

    Safer conception interventions can significantly reduce the risk of horizontal HIV transmission between HIV-serodiscordant partners. However, prior to implementing safer conception interventions, it is essential to understand potential barriers to their adoption so that strategies can be developed to overcome these barriers. This paper examines potential barriers to the adoption of safer conception strategies by HIV-affected couples in Iringa, Tanzania using an ecological framework. We interviewed 30 HIV-positive women, 30 HIV-positive men and 30 health providers engaged in delivering HIV-related services. We also conducted direct observations at five health facilities. Findings suggest that there are multiple barriers to safer conception that operate at the individual, relational, environmental, structural, and super-structural levels. The barriers to safer conception identified are complex and interact across these levels. Barriers at the individual level included antiretroviral adherence, knowledge of HIV status, knowledge and acceptability of safer conception strategies, and poor nutrition. At the relational level, unplanned pregnancies, non-disclosure of status, gendered power dynamics within relationships, and patient-provider interactions posed a threat to safer conception. HIV stigma and distance to health facilities were environmental barriers to safer conception. At the structural level there were multiple barriers to safer conception, including limited safer conception policy guidelines for people living with HIV (PLHIV), lack of health provider training in safer conception strategies and preconception counseling for PLHIV, limited resources, and lack of integration of HIV and sexual and reproductive health services. Poverty and gender norms were super-structural factors that influenced and reinforced barriers to safer conception, which influenced and operated across different levels of the framework. Multi-level interventions are needed to ensure

  8. Safer-drinking Strategies Used by Chronically Homeless Individuals with Alcohol Dependence

    PubMed Central

    Grazioli, Véronique S.; Hicks, Jennifer; Kaese, Greta; Lenert, James; Collins, Susan E.

    2015-01-01

    Chronically homeless individuals with alcohol dependence experience severe alcohol-related consequences. It is therefore important to identify factors that might be associated with reduced alcohol-related harm, such as the use of safer-drinking strategies. Whereas effectiveness of safer-drinking strategies has been well-documented among young adults, no studies have explored this topic among more severely affected populations, such as chronically homeless individuals with alcohol dependence. The aims of this study were thus to qualitatively and quantitatively document safer-drinking strategies used in this population. Participants (N=31) were currently or formerly chronically homeless individuals with alcohol dependence participating in a pilot study of extended-release naltrexone and harm-reduction counseling. At weeks 0 and 8, research staff provided a list of safer-drinking strategies for participants to endorse. Implementation of endorsed safer-drinking strategies was recorded at the next appointment. At both time points, strategies to buffer the effects of alcohol on the body (e.g., eating prior to and during drinking) were most highly endorsed, followed by changing the manner in which one drinks (e.g., spacing drinks), and reducing alcohol consumption. Quantitative analyses indicated that all participants endorsed safer-drinking strategies, and nearly all strategies were implemented (80–90% at weeks 0 and 8, respectively). These preliminary findings indicate that chronically homeless people with alcohol dependence use strategies to reduce harm associated with their drinking. Larger randomized controlled trials are needed to test whether interventions that teach safer-drinking strategies may reduce overall alcohol-related harm in this population. PMID:25690515

  9. Safer-drinking strategies used by chronically homeless individuals with alcohol dependence.

    PubMed

    Grazioli, Véronique S; Hicks, Jennifer; Kaese, Greta; Lenert, James; Collins, Susan E

    2015-07-01

    Chronically homeless individuals with alcohol dependence experience severe alcohol-related consequences. It is therefore important to identify factors that might be associated with reduced alcohol-related harm, such as the use of safer-drinking strategies. Whereas effectiveness of safer-drinking strategies has been well-documented among young adults, no studies have explored this topic among more severely affected populations, such as chronically homeless individuals with alcohol dependence. The aims of this study were thus to qualitatively and quantitatively document safer-drinking strategies used in this population. Participants (N=31) were currently or formerly chronically homeless individuals with alcohol dependence participating in a pilot study of extended-release naltrexone and harm-reduction counseling. At weeks 0 and 8, research staff provided a list of safer-drinking strategies for participants to endorse. Implementation of endorsed safer-drinking strategies was recorded at the next appointment. At both time points, strategies to buffer the effects of alcohol on the body (e.g., eating prior to and during drinking) were most highly endorsed, followed by changing the manner in which one drinks (e.g., spacing drinks), and reducing alcohol consumption. Quantitative analyses indicated that all participants endorsed safer-drinking strategies, and nearly all strategies were implemented (80-90% at weeks 0 and 8, respectively). These preliminary findings indicate that chronically homeless people with alcohol dependence use strategies to reduce harm associated with their drinking. Larger randomized controlled trials are needed to test whether interventions that teach safer-drinking strategies may reduce overall alcohol-related harm in this population. PMID:25690515

  10. Piroxicam-β-Cyclodextrin: A GI Safer Piroxicam

    PubMed Central

    Scarpignato, C

    2013-01-01

    to a more rapid onset of action after oral administration and improved GI tolerability because of minimization of the drug gastric effects. One such drug, piroxicam-β-cyclodextrin (PBC), has been used in Europe for 25 years. Preclinical and clinical pharmacology of PBC do show that the β-cyclodextrin inclusion complex of piroxicam is better tolerated from the upper GI tract than free piroxicam, while retaining all the analgesic and anti-inflammatory properties of the parent compound. In addition, the drug is endowed with a quick absorption rate, which translates into a faster onset of analgesic activity, an effect confirmed in several clinical studies. An analysis of the available trials show that PBC has a GI safety profile, which is better than that displayed by uncomplexed piroxicam. Being an inclusion complex of piroxicam, whose CV safety has been pointed out by several observational studies, PBC should be viewed as a CV safe anti-inflmmatory compound and a GI safer alternative to piroxicam. As a consequence, it should be considered as a useful addition to our therapeutic armamentarium. PMID:23394552

  11. Piroxicam-β-cyclodextrin: a GI safer piroxicam.

    PubMed

    Scarpignato, C

    2013-01-01

    more rapid onset of action after oral administration and improved GI tolerability because of minimization of the drug gastric effects. One such drug, piroxicam-β-cyclodextrin (PBC), has been used in Europe for 25 years. Preclinical and clinical pharmacology of PBC do show that the β-cyclodextrin inclusion complex of piroxicam is better tolerated from the upper GI tract than free piroxicam, while retaining all the analgesic and anti-inflammatory properties of the parent compound. In addition, the drug is endowed with a quick absorption rate, which translates into a faster onset of analgesic activity, an effect confirmed in several clinical studies. An analysis of the available trials show that PBC has a GI safety profile, which is better than that displayed by uncomplexed piroxicam. Being an inclusion complex of piroxicam, whose CV safety has been pointed out by several observational studies, PBC should be viewed as a CV safe anti-inflmmatory compound and a GI safer alternative to piroxicam. As a consequence, it should be considered as a useful addition to our therapeutic armamentarium. PMID:23394552

  12. 29 CFR 2700.24 - Emergency response plan dispute proceedings.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Emergency response plan dispute proceedings. 2700.24 Section 2700.24 Labor Regulations Relating to Labor (Continued) FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION PROCEDURAL RULES Contests of Citations and Orders § 2700.24 Emergency response plan dispute proceedings. (a) Referral by the Secretary....

  13. Referral pattern for epilepsy surgery after evidence-based recommendations

    PubMed Central

    Haneef, Zulfi; Stern, John; Dewar, Sandra; Engel, Jerome

    2010-01-01

    Background: Class I evidence for surgical effectiveness in refractory temporal lobe epilepsy (TLE) in 2001 led to an American Academy of Neurology practice parameter in 2003 recommending “referral to a surgical epilepsy center on failing appropriate trials of first-line antiepileptic drugs.” We examined whether this led to a change in referral patterns to our epilepsy center. Methods: We compared referral data for patients with TLE at our center for 1995 to 1998 (group 1, n = 83) and 2005 to 2008 (group 2, n = 102) to determine whether these recommendations resulted in a change in referral patterns for surgical evaluation. Patients with brain tumors, previous epilepsy surgery evaluations, or brain surgery (including epilepsy surgery) were excluded. Results: We did not find a difference between the groups in the duration from the diagnosis of habitual seizures to referral (17.1 ± 10.0 vs 18.6 ± 12.6 years, p = 0.39) or the age at the time of evaluation (34.1 ± 10.3 vs 37.0 ± 11.8 years, p = 0.08). However, there was a difference in the distributions of age at evaluation (p = 0.03) and the duration of pharmacotherapy (p = 0.03) between the groups, with a greater proportion of patients in group 2 with drug-resistant epilepsy both earlier and later in their treatment course. Nonepileptic seizures were referred significantly earlier than TLE in either group or when combined. Conclusions: Our analysis does not identify a significantly earlier referral for epilepsy surgery evaluation as recommended in the practice parameter, but suggests a hopeful trend in this direction. GLOSSARY AAN = American Academy of Neurology; AED = antiepileptic drug; ERSET = Early Randomized Surgical Epilepsy Trial; NES = nonepileptic seizures; RCT = randomized controlled trial; TLE = temporal lobe epilepsy; VNS = vagus nerve stimulator. PMID:20733145

  14. Hospital referrals for low back pain: more coherence needed.

    PubMed Central

    Silman, A J; Jayson, M I; Papageorgiou, A C; Croft, P R

    2000-01-01

    Low back pain is a common reason for hospital referral but little is known of the resulting workload in different specialties. All new outpatient attendances for conditions with low back pain were recorded over one month in a teaching hospital and a district general hospital. The patients were seen in at least ten specialties and two-fifths of them had been seen previously with the same symptom in another department. In the two hospitals, low back pain accounted for 15% and 12% of all new outpatient attendances. A more coherent referral policy is needed. PMID:10741313

  15. Community Influences on Married Women's Safer Sex Negotiation Attitudes in Bangladesh: A Multilevel Analysis.

    PubMed

    Jesmin, Syeda S; Cready, Cynthia M

    2016-02-01

    The influence of disadvantaged or deprived community on individuals' health risk-behaviors is increasingly being documented in a growing body of literature. However, little is known about the effects of community characteristics on women's sexual attitudes and behaviors. To examine community effects on married women's safer sex negotiation attitudes, we analyzed cross-sectional data from the 2011 Bangladesh Demographic and Health Surveys on a sample of 15,134 married women in 600 communities. We estimated two multilevel logistic regression models. Model 1, which included only individual-level variables, showed that women's autonomy/empowerment, age, and HIV knowledge had significant associations with their safer sex negotiation attitudes. We did not find any socioeconomic status gradient in safer sex negotiation attitudes at the individual level. Adding community-level variables in Model 2 significantly improved the fit of the model. Strikingly, we found that higher community-level poverty was associated with greater positive safer sex negotiation attitudes. Prevailing gender norms and overall women's empowerment in the community also had significant effects. While research on community influences calls for focusing on disadvantaged communities, our research highlights the importance of not underestimating the challenges that married women in economically privileged communities may face in negotiating safer sex. To have sufficient and equitable impact on married women's sexual and reproductive health, sexual and reproductive health promotion policies and programs need to be directed to women in wealthier communities as well. PMID:26162431

  16. Introduction of Electronic Referral from Community Associated with More Timely Review by Secondary Services

    PubMed Central

    Warren, J.; White, S.; Day, K.J.; Gu, Y.; Pollock, M.

    2011-01-01

    Background Electronic referral (eReferral) from community into public secondary healthcare services was introduced to 30 referring general medical practices and 28 hospital based services in late 2007. Objectives To measure the extent of uptake of eReferral and its association with changes in referral processing. Methods Analysis of transactional data from the eReferral message service and the patient information management system of the affected hospital; interview of clinical, operational and management stakeholders. Results eReferral use rose steadily to 1000 transactions per month in 2008, thereafter showing moderate growth to 1200 per month in 2010. Rate of eReferral from the community in 2010 is estimated at 56% of total referrals to the hospital from general practice, and as 71% of referrals from those having done at least one referral electronically. Referral latency from letter date to hospital triage improves significantly from 2007 to 2009 (p<0.001), from a paper referral median of 8 days (inter-quartile range, IQR: 4–14) in 2007 to an eReferral median of 5 days (IQR: 2–9) and paper referral median of 6 days (IQR: 2–12) in 2009. Specialists upgrade the referrer-assigned eReferral priority in 19.2% of cases and downgrade it 18.6% of the time. Clinical users appreciate improvement of referral visibility (status and content access); however, both general practitioners and specialists point out system usability issues. Discussion With eReferrals, a referral’s status can be checked, and its content read, by any authorized user at any time. The period of eReferral uptake was associated with significant speed-up in referral processing without changes in staffing levels. The eReferral system provides a foundation for further innovation in the community-secondary interface, such as electronic decision support and shared care planning systems. Conclusions We observed substantial rapid voluntary uptake of eReferrals associated with faster, more reliable and

  17. Program- and service-level costs of seven screening, brief intervention, and referral to treatment programs

    PubMed Central

    Bray, Jeremy W; Mallonee, Erin; Dowd, William; Aldridge, Arnie; Cowell, Alexander J; Vendetti, Janice

    2014-01-01

    This paper examines the costs of delivering screening, brief intervention, and referral to treatment (SBIRT) services within the first seven demonstration programs funded by the US Substance Abuse and Mental Health Services Administration. Service-level costs were estimated and compared across implementation model (contracted specialist, inhouse specialist, inhouse generalist) and service delivery setting (emergency department, hospital inpatient, outpatient). Program-level costs were estimated and compared across grantee recipient programs. Service-level data were collected through timed observations of SBIRT service delivery. Program-level data were collected during key informant interviews using structured cost interview guides. At the service level, support activities that occur before or after engaging the patient comprise a considerable portion of the cost of delivering SBIRT services, especially short duration services. At the program level, average costs decreased as more patients were screened. Comparing across program and service levels, the average annual operating costs calculated at the program level often exceeded the cost of actual service delivery. Provider time spent in support of service provision may comprise a large share of the costs in some cases because of potentially substantial fixed and quasifixed costs associated with program operation. The cost structure of screening, brief intervention, and referral to treatment is complex and discontinuous of patient flow, causing annual operating costs to exceed the costs of actual service provision for some settings and implementation models. PMID:25114610

  18. 25 CFR 217.4 - Referral of questions by the joint managers.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... party's proposal, if any, for solution. Such referrals shall be in writing, addressed to the other joint... DISTRIBUTION CORP. § 217.4 Referral of questions by the joint managers. The business committee and the board...

  19. Graphene Based Ultra-Capacitors for Safer, More Efficient Energy Storage

    NASA Technical Reports Server (NTRS)

    Roberson, Luke B.; Mackey, Paul J.; Zide, Carson J.

    2016-01-01

    Current power storage methods must be continuously improved in order to keep up with the increasingly competitive electronics industry. This technological advancement is also essential for the continuation of deep space exploration. Today's energy storage industry relies heavily on the use of dangerous and corrosive chemicals such as lithium and phosphoric acid. These chemicals can prove hazardous to the user if the device is ruptured. Similarly they can damage the environment if they are disposed of improperly. A safer, more efficient alternative is needed across a wide range of NASA missions. One solution would a solid-state carbon based energy storage device. Carbon is a safer, less environmentally hazardous alternative to current energy storage materials. Using the amorphous carbon nanostructure, graphene, this idea of a safer portable energy is possible. Graphene was electrochemically produced in the lab and several coin cell devices were built this summer to create a working prototype of a solid-state graphene battery.

  20. Relapse from safer sex: the next challenge for AIDS prevention efforts.

    PubMed

    Stall, R; Ekstrand, M; Pollack, L; McKusick, L; Coates, T J

    1990-01-01

    Prevention campaigns to reduce sexual transmission of human immunodeficiency virus (HIV) typically emphasize the initial adoption of safer sex techniques. We present data from a 5-year prospective study to show that the vast majority of resident gay men in San Francisco have made these initial risk reductions. Rather, relapse from safer sex techniques is now the predominant predominant kind of high-risk sex, accounting for approximately two thirds of all prevalent high-risk sex in the 1988 wave of data collection. Predictors of relapse from safer sex are identified, and these are discussed in terms of their implications for preventing relapse from the exclusive practice of safe sex. In communities that have already manifested widespread behavioral risk reductions and in which HIV infection is highly prevalent, finding ways to prevent relapse of behavioral risk reductions will be the next important challenge in the fight against acquired immune deficiency syndrome. PMID:2243318

  1. Expediting Groundwater Sampling at Hanford and Making It Safer - 13158

    SciTech Connect

    Connell, Carl W. Jr.; Conley, S.F.; Carr, Jennifer S.; Schatz, Aaron L.; Brown, W.L.; Hildebrand, R. Douglas

    2013-07-01

    documents, the system saves three-to-four man days each month for the field personnel taking the measurements and the scientists and administrators managing the data and the documentation. After the information has received technical review, FLEDG automatically updates the database for water-level measurements and loads the document management system with the completed sampling report. Due to safety considerations, access to wells is conditional. A spreadsheet with appropriate data not only lists the wells that are cleared for work, but also the safety personnel who must be present before work can start. This spreadsheet is used in planning daily activities. Daily plans are structured to ensure that the wells to be sampled are cleared for work and the appropriate safety personnel have been assigned and are present before the work starts. Historically, the spreadsheets have been prepared manually, and as a result, are potentially subject to human error. However, a companion database application has been developed to work with FLEDG - making the entire sampling process more efficient and safer for personnel. The Well Access List - Electronic, WAL-E, is a database that contains much the same information that was previously manually loaded into the spread sheet. In addition, WAL-E contains a managed work-flow application that shows the access requirements and allows for appropriate reviews of the compiled well. Various CHPRC organizations, including Industrial Hygiene, RADCON, and Well Maintenance and Sample Administration are able to enter and review the wells added or deleted from the WAL-E database. The FLEDG system then accesses this database information to identify appropriate support personnel and provide safety requirements to field personnel. In addition, WAL-E offers the assurance that wells have appropriate locks and are correctly labeled and electrically grounded as required, before well activities begin. This feature is an extremely important aspect of the FLEDG

  2. SAFE(R): A Matlab/Octave Toolbox (and R Package) for Global Sensitivity Analysis

    NASA Astrophysics Data System (ADS)

    Pianosi, Francesca; Sarrazin, Fanny; Gollini, Isabella; Wagener, Thorsten

    2015-04-01

    Global Sensitivity Analysis (GSA) is increasingly used in the development and assessment of hydrological models, as well as for dominant control analysis and for scenario discovery to support water resource management under deep uncertainty. Here we present a toolbox for the application of GSA, called SAFE (Sensitivity Analysis For Everybody) that implements several established GSA methods, including method of Morris, Regional Sensitivity Analysis, variance-based sensitivity Analysis (Sobol') and FAST. It also includes new approaches and visualization tools to complement these established methods. The Toolbox is released in two versions, one running under Matlab/Octave (called SAFE) and one running in R (called SAFER). Thanks to its modular structure, SAFE(R) can be easily integrated with other toolbox and packages, and with models running in a different computing environment. Another interesting feature of SAFE(R) is that all the implemented methods include specific functions for assessing the robustness and convergence of the sensitivity estimates. Furthermore, SAFE(R) includes numerous visualisation tools for the effective investigation and communication of GSA results. The toolbox is designed to make GSA accessible to non-specialist users, and to provide a fully commented code for more experienced users to complement their own tools. The documentation includes a set of workflow scripts with practical guidelines on how to apply GSA and how to use the toolbox. SAFE(R) is open source and freely available from the following website: http://bristol.ac.uk/cabot/resources/safe-toolbox/ Ultimately, SAFE(R) aims at improving the diffusion and quality of GSA practice in the hydrological modelling community.

  3. First flight test results of the Simplified Aid For EVA Rescue (SAFER) propulsion unit

    NASA Technical Reports Server (NTRS)

    Meade, Carl J.

    1995-01-01

    The Simplified Aid for EVA Rescue (SAFER) is a small, self-contained, propulsive-backpack system that provides free-flying mobility for an astronaut engaged in a space walk, also known as extravehicular activity (EVA.) SAFER contains no redundant systems and is intended for contingency use only. In essence, it is a small, simplified version of the Manned Maneuvering Unit (MMU) last flown aboard the Space Shuttle in 1985. The operational SAFER unit will only be used to return an adrift EVA astronaut to the spacecraft. Currently, if an EVA crew member inadvertently becomes separated from the Space Shuttle, the Orbiter will maneuver to within the crew member's reach envelope, allowing the astronaut to regain contact with the Orbiter. However, with the advent of operations aboard the Russian MIR Space Station and the International Space Station, the Space Shuttle will not be available to effect a timely rescue. Under these conditions, a SAFER unit would be worn by each EVA crew member. Flight test of the pre-production model of SAFER occurred in September 1994. The crew of Space Shuttle Mission STS-64 flew a 6.9 hour test flight which included performance, flying qualities, systems, and operational utility evaluations. We found that the unit offers adequate propellant and control authority to stabilize and enable the return of a tumbling/separating crew member. With certain modifications, production model of SAFER can provide self-rescue capability to a separated crew member. This paper will present the program background, explain the flight test results and provide some insight into the complex operations of flight test in space.

  4. A Descriptive Study of Office Disciplinary Referrals in High Schools

    ERIC Educational Resources Information Center

    Flannery, K. Brigid; Fenning, Pamela; McGrath Kato, Mimi; Bohanon, Hank

    2013-01-01

    The purpose of this paper is to share descriptive data about Office Discipline Referrals (ODRs) in a sample of 112 high schools that used the School-wide Information System (SWIS) database to collect discipline data during the 2005-2006 academic year. The findings were that tardies, defiance/disrespect and skip/truancy were the most common types…

  5. 7 CFR 3.21 - Referrals of Debts to Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... Justice for litigation debts on which aggressive collection activity has been taken in accordance...

  6. Discipline Referral Outcomes: Meeting the Needs of Students

    ERIC Educational Resources Information Center

    Bergh, Bethney; Cowell, Joan

    2013-01-01

    In this study, school disciplinary procedures/programs used in response to disciplinary referrals and programs that schools have in place to prevent, intervene, and respond to behaviors that result in suspensions or expulsions from the classroom or school were investigated. The focus of this study was school leaders' concerns regarding the…

  7. 40 CFR 304.21 - Referral of claims.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Referral of claims. 304.21 Section 304... for arbitration may also be modified to add one or more additional parties, if such intervention is... description of the facility, the EPA response action taken at the facility, the EPA claim, and the...

  8. "An Evaluation of the Special Needs Referral Process." Practitioner Perspectives.

    ERIC Educational Resources Information Center

    Bryans, Amanda B.

    1999-01-01

    Notes that articulating existence and cause of referral biases is critical to more effective preschool services. Maintains that until high child poverty, exposure to violence, and shortage of safe and stimulating environments are addressed, escalating rates of serious child emotional/behavioral problems will continue. Asserts that we must question…

  9. Identification, Referral and Assessment of Handicapped Students: A Trainer's Manual.

    ERIC Educational Resources Information Center

    Spearman, Carolyn; Gaddis, Ruth

    The trainer's manual offers a sampling of workshop materials to assist the regular classroom teacher in the process of screening, identification, referral, and assessment of handicapped students. Following an introduction are sections with information, sample handouts, forms, and checklists on the following topics (sample subtopics in…

  10. 49 CFR 219.403 - Voluntary referral policy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Voluntary referral policy. 219.403 Section 219.403 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Identification of Troubled Employees §...

  11. Referral tracking system shows accurate bottom-line assessment.

    PubMed

    Henkel, J

    1990-12-01

    Rose Medical Center in Denver, Colo., needed a way to track referrals from its many offsite care centers to determine their impact on revenue. Programmers at Rose developed a microbased system, eventually bought by SMS, that measures profitability against investment to become a true decision support tool for hospital executives. PMID:10108212

  12. Early Childhood Developmental Screenings: Predictors of Screening Referral Completion

    ERIC Educational Resources Information Center

    Jennings, Danielle J.

    2012-01-01

    Developmental screening programs identify young children with delayed skill growth or challenging behaviors and refer them to community agencies for evaluation or other services. This research studied the predictive impact of developmental screening results and child and family characteristics on the completion of these referrals for evaluation. A…

  13. Prereferral Intervention Strategies to Reduce Referrals to Special Education

    ERIC Educational Resources Information Center

    Ajayi, Eniola D.

    2010-01-01

    The purpose of this quasi-experimental study was to determine the impact of specific prereferral intervention strategies on the reduction of referrals to special education among identified 39 second-grade students from an elementary school in one public school district in New Jersey. A mixed research methodology incorporating quantitative and…

  14. Evaluation and Referral for Child Maltreatment in Pediatric Poisoning Victims

    ERIC Educational Resources Information Center

    Wood, Joanne N.; Pecker, Lydia H.; Russo, Michael E.; Henretig, Fred; Christian, Cindy W.

    2012-01-01

    Objective: Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine…

  15. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 5 2014-04-01 2014-04-01 false Consumer complaint and information... HOUSING AND URBAN DEVELOPMENT MANUFACTURED HOME PROCEDURAL AND ENFORCEMENT REGULATIONS Consumer Complaint Handling and Remedial Actions § 3282.403 Consumer complaint and information referral. (a)...

  16. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 5 2013-04-01 2013-04-01 false Consumer complaint and information... HOUSING AND URBAN DEVELOPMENT MANUFACTURED HOME PROCEDURAL AND ENFORCEMENT REGULATIONS Consumer Complaint Handling and Remedial Actions § 3282.403 Consumer complaint and information referral. When a...

  17. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 5 2011-04-01 2011-04-01 false Consumer complaint and information... HOUSING AND URBAN DEVELOPMENT MANUFACTURED HOME PROCEDURAL AND ENFORCEMENT REGULATIONS Consumer Complaint Handling and Remedial Actions § 3282.403 Consumer complaint and information referral. When a...

  18. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 5 2012-04-01 2012-04-01 false Consumer complaint and information... HOUSING AND URBAN DEVELOPMENT MANUFACTURED HOME PROCEDURAL AND ENFORCEMENT REGULATIONS Consumer Complaint Handling and Remedial Actions § 3282.403 Consumer complaint and information referral. When a...

  19. 10 CFR 733.7 - Referral to the contracting officer.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.7 Referral to the contracting officer. If the DOE Office of the Inspector General declines to investigate an allegation of research misconduct, the DOE Element should forward the allegation to the contracting officer responsible...

  20. 10 CFR 733.7 - Referral to the contracting officer.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.7 Referral to the contracting officer. If the DOE Office of the Inspector General declines to investigate an allegation of research misconduct, the DOE Element should forward the allegation to the contracting officer responsible...

  1. 10 CFR 733.7 - Referral to the contracting officer.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.7 Referral to the contracting officer. If the DOE Office of the Inspector General declines to investigate an allegation of research misconduct, the DOE Element should forward the allegation to the contracting officer responsible...

  2. 10 CFR 733.7 - Referral to the contracting officer.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.7 Referral to the contracting officer. If the DOE Office of the Inspector General declines to investigate an allegation of research misconduct, the DOE Element should forward the allegation to the contracting officer responsible...

  3. 10 CFR 733.7 - Referral to the contracting officer.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.7 Referral to the contracting officer. If the DOE Office of the Inspector General declines to investigate an allegation of research misconduct, the DOE Element should forward the allegation to the contracting officer responsible...

  4. Midwifery workforce profile in Limpopo Province referral hospitals

    PubMed Central

    Ogunbanjo, Gboyega A.

    2014-01-01

    Background In sub-Saharan Africa including South Africa, maternal mortality rates remain unacceptably high due to a shortage of registered nurses with advanced midwifery diplomas. Objective To determine the profile of registered nurses (RNs) involved in maternity care in public referral hospitals of the Limpopo Province, South Africa. Method A cross-sectional descriptive study was conducted in all maternity units of Limpopo's public referral hospitals. The study population comprised of 210 registered nurses, who became the study sample. Data on their educational profile and work experience in midwifery was analysed using STATA version 9.0. Results The mean age of the 210 registered nurses was 44.5 ± 9.1 years (range 21 to 62). The majority (152/210; 70%) were 40 years and older, 56% (117/210) had been working for more than 10 years, and 63/210 (30%) were due to retire within 10 years. Only 22% (46/210) had advanced midwifery diplomas, i.e. after their basic undergraduate training. Only six (2.9%) of the RNs providing maternity care in these referral hospitals were studying for advanced midwifery diplomas at the time of the study. Conclusion This study demonstrated a shortage of registered nurses with advanced midwifery training/diplomas in referral hospitals of the Limpopo Province. This has a potentially negative effect in reducing the high maternal mortality rate in the province. PMID:26245396

  5. Patient Referrals: A Behavioral Outcome of Continuing Medical Education

    ERIC Educational Resources Information Center

    Mahan, J. Maurice; And Others

    1978-01-01

    One method for evaluating an aspect of physician practice behavior, patient referrals, resulting from continuing medical education programs on cancer at the University of Texas Medical Branch is described. Data presented provide strong support for the effectiveness of continuing education in modifying physician practice behavior. (LBH)

  6. Breaking the Cycle of Office Referrals and Suspensions: Defensive Management

    ERIC Educational Resources Information Center

    Fields, Barry

    2004-01-01

    This paper focuses on a strategy--Defensive Management--designed to assist teachers to better manage non-compliance and defiance in the classroom, with the ultimate goal of reducing disciplinary referrals and flow-on suspensions and exclusions from school. Non-compliance and defiance are behaviours that teachers find particularly challenging and,…

  7. Diagnostic Classification Decisions As a Function of Referral Information.

    ERIC Educational Resources Information Center

    Ysseldyke, James E.; Algozzine, Bob

    Educational decision makers (N=224) participated in a computer simulated decision making experience to ascertain the extent to which referral information on a child with a suspected handicapping condition biased classification decisions. Ss were randomly assigned to 16 conditions varying on the basis of the child's sex, socioeconomic status,…

  8. 40 CFR 1504.3 - Procedure for referrals and response.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    .... 1504.3 Section 1504.3 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY PREDECISION REFERRALS TO THE COUNCIL OF PROPOSED FEDERAL ACTIONS DETERMINED TO BE ENVIRONMENTALLY UNSATISFACTORY § 1504.3... information to permit an assessment of the matter's environmental acceptability. (3) Identify any...

  9. 40 CFR 1504.3 - Procedure for referrals and response.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    .... 1504.3 Section 1504.3 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY PREDECISION REFERRALS TO THE COUNCIL OF PROPOSED FEDERAL ACTIONS DETERMINED TO BE ENVIRONMENTALLY UNSATISFACTORY § 1504.3... information to permit an assessment of the matter's environmental acceptability. (3) Identify any...

  10. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Consumer complaint and information... HOUSING AND URBAN DEVELOPMENT MANUFACTURED HOME PROCEDURAL AND ENFORCEMENT REGULATIONS Consumer Complaint Handling and Remedial Actions § 3282.403 Consumer complaint and information referral. When a...

  11. 29 CFR 15.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Referral to Department of Justice. 15.8 Section 15.8 Labor Office of the Secretary of Labor ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT AND RELATED... Justice. An award, compromise or settlement of a claim under § 2672 title 28, United States Code, and...

  12. Public Library Information and Referral Project, Phase II. Final Report.

    ERIC Educational Resources Information Center

    Childers, Thomas; Krauser, Cheri

    This study is the second of a two-phase survey of public library information and referral (I&R) service. In this phase, seven public libraries offering I&R services were studied in depth to provide descriptions of their operations, organizational factors, and the reactions of their users. Organizational factors and operations were studied through…

  13. 29 CFR 1603.201 - Referral and scheduling for hearing.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Referral and scheduling for hearing. 1603.201 Section 1603.201 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION PROCEDURES... scheduling for hearing. (a) Upon request by the complainant under paragraph (b) of this section or if...

  14. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... citations affecting § 412.96, see the List of CFR Sections Affected, which appears in the Finding Aids... 42 Public Health 2 2011-10-01 2011-10-01 false Special treatment: Referral centers. 412.96 Section... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of...

  15. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... citations affecting § 412.96, see the List of CFR Sections Affected, which appears in the Finding Aids... 42 Public Health 2 2014-10-01 2014-10-01 false Special treatment: Referral centers. 412.96 Section... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of...

  16. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... citations affecting § 412.96, see the List of CFR Sections Affected, which appears in the Finding Aids... 42 Public Health 2 2013-10-01 2013-10-01 false Special treatment: Referral centers. 412.96 Section... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of...

  17. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... citations affecting § 412.96, see the List of CFR Sections Affected, which appears in the Finding Aids... 42 Public Health 2 2012-10-01 2012-10-01 false Special treatment: Referral centers. 412.96 Section... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of...

  18. 20 CFR 628.510 - Intake, referrals and targeting.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... consistent with the equal opportunity provisions of 29 CFR part 34. ... applicant to another human service, training or education program deemed more suitable for the individual... incomplete ISS. Further tracking or follow-up of referrals out of title II is not required. (e)...

  19. 20 CFR 628.510 - Intake, referrals and targeting.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... consistent with the equal opportunity provisions of 29 CFR part 34. ... applicant to another human service, training or education program deemed more suitable for the individual... incomplete ISS. Further tracking or follow-up of referrals out of title II is not required. (e)...

  20. 20 CFR 628.510 - Intake, referrals and targeting.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... consistent with the equal opportunity provisions of 29 CFR part 34. ... applicant to another human service, training or education program deemed more suitable for the individual... incomplete ISS. Further tracking or follow-up of referrals out of title II is not required. (e)...

  1. 29 CFR 1425.5 - Referral to FSIP.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE MEDIATION ASSISTANCE IN THE FEDERAL SERVICE § 1425.5 Referral to FSIP. If the mediation process has been completed and the parties are... Federal Services Impasses Panel. The Service shall not refer a case to FSIP until the mediation...

  2. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a) Each... contract to provide treatment for alcohol problems on behalf of the operator; (3) The sole source of... for drugs, as directed by the substance abuse professional, to be performed in accordance with 49...

  3. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a) Each... contract to provide treatment for alcohol problems on behalf of the operator; (3) The sole source of... for drugs, as directed by the substance abuse professional, to be performed in accordance with 49...

  4. 49 CFR 219.403 - Voluntary referral policy.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Identification of Troubled Employees § 219.403... voluntary referral policy that affords more favorable conditions to employees troubled by alcohol or drug...: (1) A covered employee who is affected by an alcohol or drug use problem may maintain an...

  5. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a) Each... contract to provide treatment for alcohol problems on behalf of the operator; (3) The sole source of... for drugs, as directed by the substance abuse professional, to be performed in accordance with 49...

  6. 49 CFR 219.403 - Voluntary referral policy.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Identification of Troubled Employees § 219.403... voluntary referral policy that affords more favorable conditions to employees troubled by alcohol or drug...: (1) A covered employee who is affected by an alcohol or drug use problem may maintain an...

  7. 49 CFR 219.403 - Voluntary referral policy.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Identification of Troubled Employees § 219.403... voluntary referral policy that affords more favorable conditions to employees troubled by alcohol or drug...: (1) A covered employee who is affected by an alcohol or drug use problem may maintain an...

  8. Reducing Unnecessary Referrals: Guidelines for Teachers of Diverse Learners

    ERIC Educational Resources Information Center

    Hoover, John J.

    2012-01-01

    The need to reduce unnecessary referrals of culturally and linguistically diverse learners continues to challenge practitioners in today's schools and classrooms. Discerning learning difference from disability is fundamental to reversing the trend of misidentification and misplacement of diverse students in special education. One effective way for…

  9. Identification and Referral for Mental Health Services in Juvenile Detention.

    ERIC Educational Resources Information Center

    Rogers, Kenneth M.; Pumariega, Andres J.; Cuffe, Steven P.

    This report discusses the outcomes of a study that examined the mental health referral patterns of youth referred to a public sector mental health system as the result of a judicial consent decree. The study included two samples of youth ages 13-17 from the entire state of South Carolina. The first group included incarcerated youth recruited from…

  10. 32 CFR 516.34 - Referral of medical care and property claims for litigation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Referral of medical care and property claims for... States Medical Care and Property Claims § 516.34 Referral of medical care and property claims for litigation. (a) Criteria for referral. The RJA will forward the claims file and a litigation report...

  11. 34 CFR 303.310 - Post-referral timeline (45 days).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 2 2014-07-01 2013-07-01 true Post-referral timeline (45 days). 303.310 Section 303... Post-Referral Procedures-Screenings, Evaluations, and Assessments § 303.310 Post-referral timeline (45...) The lead agency must develop procedures to ensure that in the event the circumstances described in...

  12. 34 CFR 303.310 - Post-referral timeline (45 days).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 2 2013-07-01 2013-07-01 false Post-referral timeline (45 days). 303.310 Section 303... Post-Referral Procedures-Screenings, Evaluations, and Assessments § 303.310 Post-referral timeline (45...) The lead agency must develop procedures to ensure that in the event the circumstances described in...

  13. 24 CFR 902.77 - Referral to the Departmental Enforcement Center (DEC).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Referral to the Departmental Enforcement Center (DEC). 902.77 Section 902.77 Housing and Urban Development Regulations Relating to Housing... § 902.77 Referral to the Departmental Enforcement Center (DEC). (a) Referral of Troubled PHA to the...

  14. Pre-Referral Consultation: Sucessful Intervention for At-Risk Youth.

    ERIC Educational Resources Information Center

    Armil, Janet L.

    Pre-Referral Consultation (PRC) is a category of student referral separate from the conventional special education referral, through which any person can refer for help--any student who may be in crisis, falling through the cracks, or otherwise at risk. It exemplifies the integration of special education personnel into the general education…

  15. 10 CFR 1015.505 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Minimum amount of referrals to the Department of Justice... THE UNITED STATES Referrals to the Department of Justice § 1015.505 Minimum amount of referrals to the Department of Justice. (a) DOE shall not refer for litigation claims of less than $2,500, exclusive...

  16. 6 CFR 11.13 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Referrals to the Department of Justice. 11.13 Section 11.13 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CLAIMS § 11.13 Referrals to the Department of Justice. Referrals of debts to the Department of Justice for collection...

  17. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Referral to the Department of Justice. 304.9... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  18. The Relationship between Reading Fluency Intervention and the Need for Special Education Referrals

    ERIC Educational Resources Information Center

    Polcyn, Dawn M.

    2012-01-01

    Students are often referred for special education evaluations following teacher generated referrals. These referrals indicate observable poor academic progress, although often there is no indication of the cause of the poor performance as well as no indication of remediation attempts prior to a special education referral. Students who demonstrate…

  19. Cognitive Set and Clinical Inference: Referral Information May Not (Always) Affect Psychosocial Assessment.

    ERIC Educational Resources Information Center

    Abraham, Ivo L.

    1986-01-01

    Studied the effects of general referral information about a client on subsequent clinical inferences. Nursing students (N=54) were randomly assigned to "referral information" or "no referral information" conditions before being presented with additional data. Clinical inferential tasks included the assessment of maladjustment, client stress,…

  20. 34 CFR 303.310 - Post-referral timeline (45 days).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Post-referral timeline (45 days). 303.310 Section 303.310 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL... Post-Referral Procedures-Screenings, Evaluations, and Assessments § 303.310 Post-referral timeline...

  1. 22 CFR 213.37 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Referrals to the Department of Justice. 213.37 Section 213.37 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT CLAIMS COLLECTION Referrals to the Department of Justice § 213.37 Referrals to the Department of Justice. (a) The CFO, through the FMS...

  2. 22 CFR 213.37 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Referrals to the Department of Justice. 213.37 Section 213.37 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT CLAIMS COLLECTION Referrals to the Department of Justice § 213.37 Referrals to the Department of Justice. (a) The CFO, through the FMS...

  3. 22 CFR 213.37 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Referrals to the Department of Justice. 213.37 Section 213.37 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT CLAIMS COLLECTION Referrals to the Department of Justice § 213.37 Referrals to the Department of Justice. (a) The CFO, through the FMS...

  4. Lung Emergencies

    MedlinePlus

    ... Emergencies Cardiac Emergencies Eye Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at ... should be considered an emergency. Symptoms of sudden lung collapse (pneumothorax) Symptoms of a sudden lung collapse ...

  5. Epidemiology and referral patterns of patients with chronic kidney disease in the Emirate of Abu Dhabi.

    PubMed

    Richards, Nick; Hassan, Mohamed; Saleh, Abdul Karim; Dastoor, Hormazdiar; Bernieh, Bassam; Abouchacra, Samra; Al Jabri, Omar; Fleischmann, Alan; Richards, Marie; Marcelli, Daniele

    2015-09-01

    According to estimates, the dialysis prevalence in Abu Dhabi is around 370 per million population. The annual growth is 12-15% and the dialysis population is likely to double in the next five years. Most patients present to dialysis as an emergency and only 2.7% have an arteriovenous fistula at the first dialysis. The prevalence of chronic kidney disease (CKD) in the Emirate is undefined. A study of the epidemiology of CKD and referral patterns was undertaken. SEHA, the Abu Dhabi Health Service delivery company, has a unified computer system containing all measurements made in its laboratories. This study considered all serum creatinine measurements performed between 1 September 2011 and 31 October 2012 from outpatient departments or emergency rooms. The estimated glomerular filtration rate (eGRF) was calculated using the Modification of Diet in Renal Disease formula (the Schwartz formula was used for children). We identified 331,360 samples from 212,314 individuals. The mean serum creatinine was 61 ± 48 μmol/L in females (59 ± 43 μmol/L in Emiratis, 63 ± 54 μmol/L in expatriates) and 87 ± 69 μmol/L in males (80 ± 59 μmol/L in Emiratis, 92 ± 74 μmol/L in expatriates). Among Emiratis, 4.6% of males and 2.8% of females had an eGFR between CKD 3 and 5. Among expatriates, 4.2% of males and 3.2% of females had an eGFR between CKD 3 and 5. On average, eight months elapsed before a patient with CKD 3, and three months for a patient in CKD 5, to attend the nephrology clinic. This study has defined the prevalence of CKD within Abu Dhabi and demonstrated the need to improve identification and referral of CKD patients. Possible solutions include campaigns to increase public and physician awareness of CKD. PMID:26354587

  6. Referrals for Dental Care During Pregnancy

    PubMed Central

    Kloetzel, Megan K.; Huebner, Colleen E.; Milgrom, Peter

    2011-01-01

    Oral health is essential to overall health in the prenatal period. Pregnancy is not a time to delay dental care. Several studies have shown an association between periodontal disease and poor pregnancy outcomes including preterm birth. Interventions to provide periodontal treatment to pregnant women yield inconsistent results regarding preterm birth but have established the safety of periodontal therapy during pregnancy. Postpartum, women in poor dental health readily transmit the tooth decay pathogen Streptococcus mutans from their saliva to their infants resulting in increased risk of early childhood caries. Preventive services and treatment for acute problems should be recommended, fears allayed, and women referred. Dental x-rays may be performed safely with the use of appropriate shielding. Non-emergent interventions are best provided between 14 and 20 weeks of gestation for comfort and optimal fetal safety. Most gravid women do not seek dental care. Increased interprofessional communication to encourage dentists to treat pregnant women will reduce the number of women without care. In states where it is available, Medicaid coverage of dental services for pregnant women is typically allowed during pregnancy and for two months postpartum. Women’s health providers should understand the importance of protecting oral health during pregnancy and educate their patients accordingly. PMID:21429074

  7. Service referral for juvenile justice youths: associations with psychiatric disorder and recidivism.

    PubMed

    Hoeve, Machteld; McReynolds, Larkin S; Wasserman, Gail A

    2014-05-01

    Secondary multiple regression analyses related disorder profile, probation officers' mental health/substance use service referrals, and recidivism in 361 juvenile justice youths. Those with externalizing (disruptive behavior or substance use) disorder or substance offenses were most likely to receive service referrals. Substance disordered youths with service referrals had lower recidivism risk compared to counterparts without referrals; referral lowered the recidivism odds to approximately that for youths without a substance use disorder. Providing juvenile justice youths with systematic mental health assessment and linking those with substance use disorder to mental health and substance use services likely reduces recidivism risk. PMID:23397231

  8. Stigma to Sage: Learning and Teaching Safer Sex Practices Among Canadian Sex Trade Workers. NALL Working Paper.

    ERIC Educational Resources Information Center

    Meaghan, Diane

    A study interviewed 37 Canadian sex workers in 4 cities to determine how they acquire a working knowledge of safer sex practices and what that knowledge constituted. Findings indicated the vast majority exhibited high levels of knowledge and efficacy regarding safer sex practices; sex workers took the initiative to obtain information and engage in…

  9. Short-Term Impact of Safer Choices: A Multicomponent, School-Based HIV, Other STD, and Pregnancy Prevention Program.

    ERIC Educational Resources Information Center

    Coyle, Karin; Basen-Engquist, Karen; Kirby, Douglas; Parcel, Guy; Banspach, Stephen; Harrist, Ronald; Baumler, Elizabeth; Weil, Marsha

    1999-01-01

    Evaluated the effectiveness of the first year of "Safer Choices," a two-year, multicomponent HIV, STD, and pregnancy-prevention program for high school students based on social theory. Student self-report surveys indicated that "Safer Choices" succeeded in reducing selected risk behaviors and in enhancing selected protective behaviors. The…

  10. Predictors of safer sex on the college campus: a social cognitive theory analysis.

    PubMed

    O'Leary, A; Goodhart, F; Jemmott, L S; Boccher-Lattimore, D

    1992-05-01

    In April and May 1989, the authors surveyed a sample of students enrolled on four college campuses in New Jersey (N = 923) concerning their HIV transmission-related behavior, knowledge, and a variety of conceptual variables taken primarily from social cognitive theory that were thought to be potentially predictive of safer sexual behavior. Analyses of sexually active, unmarried students' responses indicated that men expected more negative outcomes of condom use and were more likely to have sexual intercourse while under the influence of alcohol or other drugs, whereas women reported higher perceived self-efficacy to practice safer sex. Regression analyses indicated that, among the factors assessed, stronger perceptions of self-efficacy to engage in safer behavior, expecting fewer negative outcomes of condom use, and less frequency of sex in conjunction with alcohol or other drug use significantly predicted safer sexual behavior. Enhanced self-efficacy to discuss personal history with a new partner was associated with a greater number of risky encounters. Implications of these findings for intervention efforts with students are discussed. PMID:1602092

  11. Incorporating Risk Assessment and Inherently Safer Design Practices into Chemical Engineering Education

    ERIC Educational Resources Information Center

    Seay, Jeffrey R.; Eden, Mario R.

    2008-01-01

    This paper introduces, via case study example, the benefit of including risk assessment methodology and inherently safer design practices into the curriculum for chemical engineering students. This work illustrates how these tools can be applied during the earliest stages of conceptual process design. The impacts of decisions made during…

  12. Seriously Mentally Ill Women's Safer Sex Behaviors and the Theory of Reasoned Action

    ERIC Educational Resources Information Center

    Randolph, Mary E.; Pinkerton, Steven D.; Somlai, Anton M.; Kelly, Jeffrey A.; McAuliffe, Timothy L.; Gibson, Richard H.; Hackl, Kristin

    2009-01-01

    Seriously mentally ill women at risk for HIV infection (n = 96) participated in structured interviews assessing sexual and substance-use behavior over a 3-month period. The majority of the women (63.5%) did not use condoms. Consistent with the theory of reasoned action, attitudes toward condom use and perceived social norms about safer sex were…

  13. Safer Choices: A Multicomponent School-Based HIV/STD and Pregnancy Prevention Program for Adolescents.

    ERIC Educational Resources Information Center

    Coyle, Karin; And Others

    1996-01-01

    The Safer Choices program, being tested in Texas and California, is a multicomponent program to change behaviors which lead to infection with HIV or other sexually transmitted diseases or pregnancy. Components include a School Health Promotion Council, curriculum and staff development activities, school environment activities implemented by peer…

  14. Are Schools Making the Grade? School Districts Nationwide Adopt Safer Pest Management Policies.

    ERIC Educational Resources Information Center

    Piper, Cortney; Owens, Kagan

    2002-01-01

    This report documents school districts that have adopted safer pest management policies, such as integrated pest management (IPM), in response to state requirements or as a voluntary measure that exceeds state law. It also documents the state of local school pest management policies and illustrates the opportunities that exist for better…

  15. Federal Policy Mandating Safer Cigarettes: A Hypothetical Simulation of the Anticipated Population Health Gains or Losses

    ERIC Educational Resources Information Center

    Tengs, Tammy O.; Ahmad, Sajjad; Moore, Rebecca; Gage, Eric

    2004-01-01

    If manufacturing a safer cigarette is technically possible--an open question--then mandating that tobacco manufacturers improve the safety of cigarettes would likely have both positive and negative implications for the nation's health. On the one hand, removing toxins may reduce the incidence of smoking-related diseases and premature mortality in…

  16. At last we may see the evidence on safer nurse staffing levels.

    PubMed

    Osborne, Susan

    2016-06-01

    Finally, the Department of Health has commissioned UK research that will identify nurse staffing requirements using the Safer Nursing Care Tool. It will model the costs and consequences of real-world application to address variations in patient need on hospital wards (for details see tinyurl.com/SNCTstudy ). PMID:27286617

  17. Understanding Barriers to Safer Sex Practice in Zimbabwean Marriages: Implications for Future HIV Prevention Interventions

    ERIC Educational Resources Information Center

    Mugweni, Esther; Omar, Mayeh; Pearson, Stephen

    2015-01-01

    Against the backdrop of high human immunodeficiency virus (HIV) prevalence in stable relationships in Southern Africa, our study presents sociocultural barriers to safer sex practice in Zimbabwean marriages. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008. Our aim was to identify…

  18. Achieving Safety: Safer Sex, Communication, and Desire among Young Gay Men

    ERIC Educational Resources Information Center

    Eisenberg, Anna; Bauermeister, Jose A.; Pingel, Emily; Johns, Michelle Marie; Santana, Matthew Leslie

    2011-01-01

    Conceptualizations of safer sex practices among young gay men (YGM) are frequently structured around communication between partners and the subsequent utilization or absence of condoms in a sexual encounter. Drawing on a sample of 34 in-depth interviews with YGM, ages 18 to 24, the authors explore the ways in which conceptualizations and…

  19. Using Social Cognitive Theory to Predict Safer Sex Behaviors in African American College Students

    ERIC Educational Resources Information Center

    Kanekar, Amar; Sharma, Manoj

    2009-01-01

    Safer sex is important for protection against STDs and HIV/AIDS. Most of the HIV-related research is targeted towards high-risk groups such as prostitutes, gays and substance abusers there is evidence that HIV/AIDS is increasing in college students particularly among African-American college students. The purpose of this study was to study…

  20. HIV-Positive Mothers' Communication about Safer Sex and Std Prevention with Their Children

    ERIC Educational Resources Information Center

    Murphy, Debra A.; Roberts, Kathleen Johnston; Herbeck, Diane M.

    2012-01-01

    Mothers play an important role in promoting the sexual health of their adolescent children. Fifty-seven HIV-positive mothers with adolescent children participated in an in-depth, qualitative interview regarding whether they have talked to their children about safer sex and sexually transmitted disease (STD) prevention, including at what age they…

  1. A Safer and Convenient Synthesis of Sulfathiazole for Undergraduate Organic and Medicinal Chemistry Classes

    ERIC Educational Resources Information Center

    Boyle, Jeff; Otty, Sandra; Sarojini, Vijayalekshmi

    2012-01-01

    A safer method for the synthesis of the sulfonamide drug sulfathiazole, for undergraduate classes, is described. This method improves upon procedures currently followed in several undergraduate teaching laboratories for the synthesis of sulfathiazole. Key features of this procedure include the total exclusion of pyridine, which has potential…

  2. The Safer Choices Project: Methodological Issues in School-Based Health Promotion Intervention Research.

    ERIC Educational Resources Information Center

    Basen-Engquist, Karen; Parcel, Guy S.; Harrist, Ronald; Kirby, Douglas; Coyle, Karin; Banspach, Stephen; Rugg, Deborah

    1997-01-01

    Uses Safer Choices--a school-based program for preventing HIV, sexually transmitted diseases, and pregnancy--to examine methodological issues in large-scale school-based health promotion research, discussing randomization of small numbers of units; reasons for using a cohort or cross-sectional design; and analysis of data by appropriate…

  3. Social Support and Maintenance of Safer Sex Practices among People Living with HIV/AIDS

    ERIC Educational Resources Information Center

    Reilly, Thom; Woo, Grace

    2004-01-01

    The study discussed in this article addressed the relationship of social support to the maintenance of long-term safer sex practices of 360 HIV-positive adults recruited from outpatient medical facilities. Medical professionals, friends, and siblings were reported the most frequent sources for assistance, whereas regular sexual partners, medical…

  4. Guidance Notes on Safer School Construction: Global Facility for Disaster Reduction and Recovery

    ERIC Educational Resources Information Center

    World Bank Publications, 2009

    2009-01-01

    This document provides a framework of guiding principles and general steps addressing the construction of safer and more disaster resilient education facilities. It is aimed to be adapted to the local context and used to develop a context-specific plan to address a critical gap to reaching the Education for All (EFA) and Millennium Development…

  5. Are some "safer alternatives" hazardous as PBTs? The case study of new flame retardants.

    PubMed

    Gramatica, Paola; Cassani, Stefano; Sangion, Alessandro

    2016-04-01

    Some brominated flame retardants (BFRs), as PBDEs, are persistent, bioaccumulative, toxic (PBT) and are restricted/prohibited under various legislations. They are replaced by "safer" flame retardants (FRs), such as new BFRs or organophosphorous compounds. However, informations on the PBT behaviour of these substitutes are often lacking. The PBT assessment is required by the REACH regulation and the PBT chemicals should be subjected to authorization. Several new FRs, proposed and already used as safer alternatives to PBDEs, are here screened by the cumulative PBT Index model, implemented in QSARINS (QSAR-Insubria), new software for the development/validation of QSAR models. The results, obtained directly from the chemical structure for the three studied characteristics altogether, were compared with those from the US-EPA PBT Profiler: the two different approaches are in good agreement, supporting the utility of a consensus approach in these screenings. A priority list of the most harmful FRs, predicted in agreement by the two modelling tools, has been proposed, highlighting that some supposed "safer alternatives" are detected as intrinsically hazardous for their PBT properties. This study also shows that the PBT Index could be a valid tool to evaluate appropriate and safer substitutes, a priori from the chemical design, in a benign by design approach, avoiding unnecessary synthesis and tests. PMID:26742016

  6. Methadone toxicity in a poisoning referral center

    PubMed Central

    Taheri, Fatemeh; Yaraghi, Ahmad; Sabzghabaee, Ali Mohammad; Moudi, Maryam; Eizadi-Mood, Nastaran; Gheshlaghi, Farzad; Farajzadegan, Ziba

    2013-01-01

    Objective: Methadone poisoning can occur accidentally or intentionally for suicide or homicide purposes. The aim of this study was to evaluate the epidemiological and clinical manifestations of Methadone poisoning. Methods: A descriptive analytical study was performed from 2010 to 2012 in the poisoning emergency and clinical toxicology departments of Noor hospital affiliated with Isfahan University of Medical Sciences (Isfahan, Iran). All patients with Methadone poisoning within this period of time were investigated. Different variables were recorded in a checklist. Findings: A total of 385 patients were studied. About 85.7% had ingested only Methadone and 14.3% had ingested other medications with Methadone. Mean ± standard deviation of the age was 32.1 ± 15 years (range: 1-90). Most of the patients were male (76.4%). Nearly 40% of the patients were narcotic addicts, 25.5% were addicts under surveillance of Methadone maintenance therapy centers and 34.5% were non-addicts. Intentional poisoning was observed in most of the patients (57.7%). Most of the patients had a low level of consciousness on admission (58.2%). Respiratory depression and hypotension was observed in 35.6% and 12.7% of the cases as the most common symptoms. Regarding vital signs, there was a significant difference in respiratory rate on admission among different evaluated groups (P = 0.02). Length of hospital stay was 18.79 ± 0.72 h (range: 4-240 h, median: 15 h). About 57 patients (25.8%) from the intentionally poisoned patients and 19 patients (12.3%) from the unintentionally poisoned patients had a history of psychiatric disorder (P = 0.001). Most of the patients survived without complications. Conclusion: Addiction, age, gender, attempt to suicide and a history of psychiatric disorder were of the most important factors effective in Methadone poisoning, which should be considered in the public training and prevention of poisoning. PMID:24991620

  7. Negotiation for safer sex among married women in Cambodia: the role of women's autonomy.

    PubMed

    Ung, Mengieng; Boateng, Godfred O; Armah, Frederick A; Amoyaw, Jonathan A; Luginaah, Isaac; Kuuire, Vincent

    2014-01-01

    Negotiating safer sex among married women has been identified as an important determinant of vulnerability or resilience to new HIV infections. Using the Cambodia Demographic and Health Survey data of 2010, this paper examined negotiation for safer sex among 11,218 married women in the context of Cambodia's highly touted reduction in HIV/AIDS prevalence. The results from a complementary log-log regression model indicate that wealthier and highly educated married women were more likely to report that they can refuse sexual intercourse and ask their husbands to use a condom. Interestingly, while women who were fully involved in decision-making on their own health care were 19% more likely to refuse sex, they were 14% less likely to be able to ask their husbands to use a condom, compared with their counterparts who were not involved in this decision-making. Women who were partially involved in decision-making on family visits were 17% less likely to be able to ask their husbands to use a condom compared with those who were not involved. In this context, involvement in decision-making may have translated into trust and risk compensation. Those who believed in HIV transmission myths were less likely to negotiate safer sex relative to their counterparts who did not hold such myths to be true. Women's ability to negotiate for safer sex is, therefore, a function of their autonomy in terms of their full participation in decision-making in health care, household expenditure and mobility. Policy implications of the capacity of women to negotiate for safer sex are delineated. PMID:23517629

  8. [Correct and timely referral of patients to centers of reference].

    PubMed

    Costa, Joana; Valença-Filipe, Rita; Rodrigues, Jorge

    2013-01-01

    The correct and timely referral of patients, from peripheral hospitals, without specialized surgical care, namely in hand surgery, like Plastic Surgery or Orthopedics is of crucial importance. The authors report the case of a patient that presents in the Plastic Surgery Department with a chronic infection of the hypothenar eminence of the right hand. The clinical history suggests the persistence of a foreign body, despite two previous surgical procedures for removal, performed in the residence hospital. Surgical exploration was performed and the foreign body was removed without complications. The intent of this presentation is to alert for the importance of the timely referral of patients that can benefit of specialized care, namely of plastic surgery, when this is no possible in the residence hospital, in view of better health care and better patient treatment. PMID:23809751

  9. Substance Use Screening, Brief Intervention, and Referral to Treatment.

    PubMed

    2016-07-01

    The enormous public health impact of adolescent substance use and its preventable morbidity and mortality show the need for the health care sector, including pediatricians and the medical home, to increase its capacity related to substance use prevention, detection, assessment, and intervention. The American Academy of Pediatrics published its policy statement "Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians" in 2011 to introduce the concepts and terminology of screening, brief intervention, and referral to treatment (SBIRT) and to offer clinical guidance about available substance use screening tools and intervention procedures. This policy statement is a revision of the 2011 SBIRT statement. An accompanying clinical report updates clinical guidance for adolescent SBIRT. PMID:27325638

  10. Referral rates and waiting lists: some empirical evidence.

    PubMed

    Goddard, J A; Tavakoli, M

    1998-09-01

    This paper provides some empirical evidence on topics discussed at greater length in a recent paper in Health Economics (Goddard, J.A., Malek, M. and Tavakoli, M. Health Economics 1995; 4: 41-55), which modelled the relationship between referral rates and waiting lists for hospital treatment for non-urgent conditions within a queuing theory framework. Here, we estimate a version of the demand function used in this model, with panel data for Scottish Health Board Areas during the period 1990-1992. Separate models are estimated for each of six broadly defined 'waiting list' specialisms, for which we have data on referral rates and waiting times. The six specialisms are General Surgery, Ear Nose and Throat Surgery, Gynaecology, Ophthalmology, Orthopaedics and Urology. PMID:9809711

  11. Eye Emergencies

    MedlinePlus

    ... Emergencies Cardiac Emergencies Eye Emergencies Lung Emergencies Surgeries Eye Emergencies Marfan syndrome significantly increases your risk of ... light-sensitive membrane in the back of the eye (the retina) from its supporting layers. It is ...

  12. 17 CFR 247.701 - Exemption from the definition of “broker” for certain institutional referrals.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... institutional customer. (iii) Suitability or sophistication determination by broker or dealer—(A) Contingent referral fees. In any case in which payment of the referral fee is contingent on completion of a securities... securities transaction. (B) Non-contingent referral fees. In any case in which payment of the referral fee...

  13. Teachers' personalities and students' behavior in referrals for special education.

    PubMed

    Hill, R B; Baldo, A J; D'Amato, R C

    1999-04-01

    84 regular classroom teachers completed four self-report personality scales (self-concept, tolerance, locus of control, and teachers' efficacy) and reviewed hypothetical records of three types of students (withdrawn, acting-out, and neutral) and made decisions for referral for each student to special education. Scores for self-concept, tolerance, locus of control, and teachers' efficacy were not related to their decisions to refer across types of students. PMID:10335062

  14. Model Information and Referral Systems: A Bridge to the Future.

    ERIC Educational Resources Information Center

    Shanahan, James L.; And Others

    This pamphlet focuses on the concept of information and referral (I&R) as a system and describes seven highly effective I&R systems that bring together people in need with the human service agencies that can help them. It is noted that when thinking in terms of I&R systems, attention must be directed to the overall quality of the structures and…

  15. mec-A-mediated Resistance in Staphylococcus aureus in a Referral Hospital, Tehran, Iran

    PubMed Central

    Rajabiani, Afsaneh; Kamrani, Fatemeh; Boroumand, Mohammad Ali; Saffar, Hiva

    2014-01-01

    Background: The emerge of rapid and accurate detection of Meticillin-Resistant Staphylococcus aureus (MRSA) has been highlighted. Objectives: The current study evaluated the prevalence of mec-A gene in biological specimens of various medical wards, in order to determine any possible relationship. Patients and Methods: Using traditional culture methods, 250 isolates were detected. The prevalence of mec-A mediated resistance was evaluated by PCR method. Results: Among 98 isolates (39.2%) with resistant inhibition zones, 92 isolates carried mec-A gene and were considered as MRSA. Significantly higher rate of MRSA was observed in the specimens from emergency department and intensive care unit (P value < 0.001). Although, the prevalence of MRSA was higher in patients with history of previous hospital admission within the past three months (P = 0.006), but only one case with the same history was hospitalized in the emergency ward that was among the wards with the highest rate of MRSA. Conclusions: The study findings show that, although there is higher rate of MRSA infection in patients with history of hospitalization, but even in cases without any history of medical admission, more detailed questions emphasizing on receiving any recent health care should be asked in a referral hospital, in order to determine the true community-acquired MRSA. PMID:25147695

  16. Assessment and Policy for Commercial Driver License Referrals

    PubMed Central

    Miller, Christopher M.; Khanna, Amit; Strohl, Kingman P.

    2007-01-01

    This report describes experiences, subsequent action, and policy recommendations regarding sleep disorders assessment of veterans in relation to a commercial driver medical examiner referral. A series of 6 veterans were seen in our sleep clinic, presenting with an order from a commercial driver medical examiner (CDME) for polysomnography and/or Multiple Sleep Latency Testing (PSG/MSLT). We searched the literature for an evidence-based justification for handling this referral, and we concluded that there is neither federal policy nor current evidence to suggest that any current diagnostic test, including PSG/MSLT and/or MWT, is capable of predicting which individual drivers are at risk for fall-asleep crashes. The best indicator of risk is self-reported sleepiness, regardless of cause. Thus, we concluded that an administrative request for a “PSG/MSLT” is not a rational use of VA resources. Procedures and a policy for the Cleveland VA system were developed to respond to the request for evaluation, recognizing that sleep problems and disorders other than sleep apnea may be present in this population. An educational component was an important feature of this response. We suspect that this approach may be appropriate for managed care systems in general. Citation: Miller CM; Khanna A; Strohl KP. Assessment and policy for commercial driver license referrals. J Clin Sleep Med 2007;3(4):417-423. PMID:17694732

  17. Determining the rate of follow-up after hospital emergency department visits for dental conditions

    PubMed Central

    Meyer, Beau; Adkins, Eric; Finnerty, Nathan M; Robinson, Fonda G

    2016-01-01

    Background Emergency department (ED) visits for dental reasons continue to impact EDs nationwide. This investigation determined the rate of follow-up in an emergency dental clinic (EDC) after hospital ED visits for nontraumatic dental conditions. Methods This prospective investigation reports the number of patients who presented to an ED for nontraumatic dental conditions and the rate of follow-up at an EDC. Upon ED discharge, patients were provided instructions to follow-up for low-cost care at the EDC. Telephone contact was attempted following failed referrals. Descriptive statistics were reported for comparing referral sources and demographic trends. Results Two hundred and forty-seven referrals were made and 31% followed up for definitive treatment at the EDC. More referrals were made on weekends than on weekdays. Failed referrals were unreachable by telephone in 75% of cases. Tooth extraction was the most common treatment rendered in the EDC. Of the ED patients who accessed EDC care, 14% became comprehensive patients in the EDC’s regular dental clinic. Conclusion Less than one-third of ED referrals to the EDC followed up for definitive care when provided an opportunity to do so, and 75% of referrals were unreachable by telephone in the week following the ED dental visit. PMID:27099530

  18. E-referral Solutions: Successful Experiences, Key Features and Challenges- a Systematic Review

    PubMed Central

    Naseriasl, Mansour; Adham, Davoud; Janati, Ali

    2015-01-01

    Background: around the world health systems constantly face increasing pressures which arise from many factors, such as an ageing population, patients and providers demands for equipment’s and services. In order to respond these challenges and reduction of health system’s transactional costs, referral solutions are considered as a key factor. This study was carried out to identify referral solutions that have had successes. Methods: relevant studies identified using keywords of referrals, consultation, referral system, referral model, referral project, electronic referral, electronic booking, health system, healthcare, health service and medical care. These searches were conducted using PubMed, ProQuest, Google Scholar, Scopus, Emerald, Web of Knowledge, Springer, Science direct, Mosby’s index, SID, Medlib and Iran Doc data bases. 4306 initial articles were obtained and refined step by step. Finally, 27 articles met the inclusion criteria. Results: we identified seventeen e-referral systems developed in UK, Norway, Finland, Netherlands, Denmark, Scotland, New Zealand, Canada, Australia, and U.S. Implemented solutions had variant degrees of successes such as improved access to specialist care, reduced wait times, timeliness and quality of referral communication, accurate health information transfer and integration of health centers and services. Conclusion: each one of referral solutions has both positive and changeable aspects that should be addressed according to sociotechnical conditions. These solutions are mainly formed in a small and localized manner. PMID:26236167

  19. A qualitative evaluation of general practitioners’ views on protocol-driven eReferral in Scotland

    PubMed Central

    2014-01-01

    Background The ever increasing volume of referrals from primary care to specialist services is putting considerable pressure on resource-constrained health services while effective communication across fragmented services remains a substantial challenge. Previous studies have suggested that electronic referrals (eReferral) can bear important benefits for cross-organisational processes and patient care management. Methods We conducted 25 semi-structured interviews and 1 focus group with primary care providers to elucidate General Practitioners’ (GPs) perspectives on information management processes in the patient pathway in NHSScotland, 1 focus group with members of the Scottish Electronic Patient Record programme and one interview with a senior architect of the Scottish Care Information national eReferral System (SCI Gateway). Using Normalisation Process Theory, we performed a qualitative analysis to elucidate GPs’ perspectives on eReferral to identify the factors which they felt either facilitated or hindered referral processes. Results The majority of GPs interviewed felt that eReferral substantially streamlined communication processes, with the immediate transfer of referral documents and the availability of an electronic audit trail perceived as two substantial improvements over paper-based referrals. Most GPs felt that the SCI Gateway system was reasonably straightforward to use. Referral protocols and templates could be perceived as useful by some GPs while others considered them to be cumbersome at times. Conclusion Our study suggests that the deployment and adoption of eReferral across the NHS in Scotland has been achieved by a combination of factors: (i) a policy context – including national mandatory targets for eReferral – which all NHS health-boards were bound to operationalise through their Local Delivery Plans and also (ii) the fact that primary care doctors considered that the overall benefits brought by the deployment of eReferral throughout

  20. Towards Safer Rocket Fuels: Hypergolic Imidazolylidene-Borane Compounds as Replacements for Hydrazine Derivatives.

    PubMed

    Huang, Shi; Qi, Xiujuan; Liu, Tianlin; Wang, Kangcai; Zhang, Wenquan; Li, Jianlin; Zhang, Qinghua

    2016-07-11

    Currently, toxic and volatile hydrazine derivatives are still the main fuel choices for liquid bipropellants, especially in some traditional rocket propulsion systems. Therefore, the search for safer hypergolic fuels as replacements for hydrazine derivatives has been one of the most challenging tasks. In this study, six imidazolylidene-borane compounds with zwitterionic structure have been synthesized and characterized, and their hypergolic reactivity has been studied. As expected, these compounds exhibited fast spontaneous combustion upon contact with white fuming nitric acid (WFNA). Among them, compound 5 showed excellent integrated properties including wide liquid operating range (-70-160 °C), superior loading density (0.99 g cm(-3) ), ultrafast ignition delay times with WFNA (15 ms), and high specific impulse (303.5 s), suggesting promising application potential as safer hypergolic fuels in liquid bipropellant formulations. PMID:27270594

  1. Community resources for psychiatric and psychosocial problems. Family physicians' referral patterns in urban Ontario.

    PubMed Central

    Craven, M. A.; Allen, C. J.; Kates, N.

    1995-01-01

    OBJECTIVE: To document the number and pattern of psychiatric and psychosocial referrals to community resources by family physicians (FPs) and to determine whether referral practices correlate with physician variables. DESIGN: Cross-sectional survey of referrals by FPs to 34 key psychiatric and psychosocial community resources identified by a panel of FPs, psychiatric social workers, psychiatric nurses, public health nurses, and the local community information service. SETTING: Regional municipality of 434,000 persons in Ontario. PARTICIPANTS: Twenty-seven of 34 (79%) community agencies identified 261 FPs who made 4487 referrals to participating agencies (range 0 to 65, median 15, mean 17.19 +/- 13.42). MAIN OUTCOME MEASURES: Number of referrals to all agencies; variables, such as physician sex, school of graduation, year of graduation, and certificate status in the College of Family Physicians of Canada, related to referral patterns. RESULTS: Referrals to outpatient psychiatric clinics, support services, and general counseling services accounted for 96% of all referrals. Physicians' average annual referral profile was as follows: 8.6 patients to a support service, 6.3 to an outpatient psychiatric service, 1.6 to a counseling service, and 0.46 to a substance abuse service. Referral profiles of individual physicians varied greatly. Female FPs made fewer referrals than male FPs to support services, but both made similar numbers of referrals to psychiatric, counseling, and substance abuse services. The more recent the year of graduation, the greater the number of referrals to psychiatric (r = 0.158, P = 0.0107) and counseling services (r = 0.137, P = 0.0272) and the higher the fraction of referrals to psychiatric services (r = 0.286, P = 0.0001). CONCLUSIONS: Family physicians in Hamilton-Wentworth made few referrals to psychiatric and psychosocial services. Only physician sex and year of graduation correlated significantly with numbers of referrals made. Recent

  2. The SAFER-Project and Seismic Early Warning in Europe (Invited)

    NASA Astrophysics Data System (ADS)

    Zschau, J.; Gasparini, P.

    2009-12-01

    SAFER (Seismic EArly Warning For EuRope) is the first large scale scientific project in Europe on earthquake early warning. It is funded by the European Commission in the context of Framework Program 6 under the theme Sustainable Development, Global Change and Ecosystems. Its general objective is to develop knowledge and tools for increasing the capability of effective earthquake early warning in Europe and to implement and test these tools in selected European cities. The SAFER project was carried out between 2006 and 2009 by a consortium formed by 20 institutes from 11 European and Mediterranean countries (Germany, Italy, Greece, Romania, Switzerland, Norway, France, the Netherlands, Iceland, Turkey and Egypt) and one each from Japan, Taiwan and USA. Five major earthquake prone cities were chosen as test areas: Athens, Bucharest, Cairo, Istanbul and Naples. The combined population of these cities is about 40 million inhabitants and all have experienced severe earthquakes in recent years. SAFER is strongly multi-disciplinary, calling upon expertise in seismology, structural and geotechnical engineering, informatics and statistics. Some of the specific problems addressed are related to - the rapid determination of earthquake size, complex earthquake features, and damage potential; - the implementation of a fully probabilistic framework for applications of earthquake early warning based on cost-benefit analysis; - the development of a new generation of early warning systems being decentralised and people-centred, and - the implementation of the real-time “shake map”-technology in large European cities. The presentation will review the major scientific findings, comment on the improvements of the earthquake early warning capabilities achieved by SAFER in the five test cities, and present some ideas for the future development of earthquake early warning in Europe.

  3. Can Computer-Mediated Interventions Change Theoretical Mediators of Safer Sex? A Meta-Analysis

    ERIC Educational Resources Information Center

    Noar, Seth M.; Pierce, Larson B.; Black, Hulda G.

    2010-01-01

    The purpose of this study was to conduct a meta-analysis of computer-mediated interventions (CMIs) aimed at changing theoretical mediators of safer sex. Meta-analytic aggregation of effect sizes from k = 20 studies indicated that CMIs significantly improved HIV/AIDS knowledge, d = 0.276, p less than 0.001, k = 15, N = 6,625; sexual/condom…

  4. Transcription of Case Report Forms from Unstructured Referral Letters: A Semantic Text Analytics Approach.

    PubMed

    Abidi, Syed Sibte Raza; Singh, Abhinav Kumar; Christie, Sean

    2016-01-01

    In this paper we present a framework for the semi-automatic extraction of medical entities from referral letters and use them to transcribe a case report form. Our framework offers the functionality to: (a) extract the medical entity from the unstructured referral letters, (b) classify them according to their semantic type, and (c) transcribe a case report form based on the extracted information from the referral letter. We take a semantic text analytics approach where SNOMED-CT ontology is used to both classify referral concepts and to establish semantic similarities between referral concepts and CRF elements. We used 100 spine injury referral letters, and a standard case report form used by Association of Dalhousie Neurosurgeons, Dalhousie University. PMID:27577396

  5. Identifying Psychosocial Variables That Predict Safer Sex Intentions in Adolescents and Young Adults.

    PubMed

    Brüll, Phil; Ruiter, Robert A C; Wiers, Reinout W; Kok, Gerjo

    2016-01-01

    Young people are especially vulnerable to sexually transmitted infections (STIs). The triad of deliberate and effective safer sex behavior encompasses condom use, combined with additional information about a partner's sexual health, and the kind of sex acts usually performed. To identify psychosocial predictors of young people's intentions to have safer sex, as related to this triad, we conducted an online study with 211 sexually active participants aged between 18 and 24 years. Predictors [i.e., perceived behavioral control (PBC), subjective norms, and intention] taken from Fishbein and Ajzen's Reasoned Action Approach (RAA), were combined with more distal variables (e.g., behavioral inhibition, sensation seeking, parental monitoring, and knowledge about STIs). Beyond the highly predictive power of RAA variables, additional variance was explained by the number of instances of unprotected sexual intercourse (SI) during the last 12 months and reasons for using barrier protection during first SI. In particular, past condom non-use behavior moderated PBC related to intended condom use. Further, various distal variables showed significant univariate associations with intentions related to the three behaviors of interest. It may, therefore, be helpful to include measures of past behavior as well as certain additional distal variables in future safer sex programs designed to promote health-sustaining sexual behavior. PMID:27148520

  6. Efficacy of ultrasound-guided mandibular block in predicting safer anesthetic induction

    PubMed Central

    Jain, Gaurav; Yadav, Ghanshyam; Singh, Anil Prasad; Singh, Yashpal; Singh, Dinesh Kumar

    2016-01-01

    Background: Mandibular nerve block reverses the trismus caused by pain and muscle spasm, thereby allowing for selection of a safer intubation technique. Aims: As ultrasonographic imaging has added newer dimensions to clinical anesthesia practice, we utilized this tool in performing mandibular nerve block and evaluated its efficacy in segregating trismus patients on etiological basis, to predict safer anesthetic induction. Settings and Design: Prospective, randomized controlled, outcome assessor blinded trial. Materials and Methods: Sixty-eight patients with unilateral mandibular fracture, acute pain, and trismus were randomized to receive mandibular nerve block by Vazirani-Akinosi approach (Group V) or the ultrasound-guided (USG) technique (Group U) before the general anesthetic induction for corrective surgery. Visual Analog Scale (VAS) score and inter-incisor distance was measured at intervals. Primary outcome measure was blocked failure (continued pain [VAS > 30] after the block procedure). Statistical Analysis Used: Mann–Whitney U-test and Wilcoxon signed rank test. Results: There was a significant decrease in pain score following the block procedure, except for six patients (block failure) in Group V. Inter-incisor distance increased to near-maximal levels after the nerve blockade, except for nine patients in Group V (including all block failures) and four in Group U having continued limited mouth opening. General anesthetic induction increased the inter-incisor gap in block failures (Group V) only. Conclusion: USG mandibular block appears to relieve reversible trismus more reliably, thereby allowing for a precise decision on a safer intubation technique. PMID:27212744

  7. Identifying Psychosocial Variables That Predict Safer Sex Intentions in Adolescents and Young Adults

    PubMed Central

    Brüll, Phil; Ruiter, Robert A. C.; Wiers, Reinout W.; Kok, Gerjo

    2016-01-01

    Young people are especially vulnerable to sexually transmitted infections (STIs). The triad of deliberate and effective safer sex behavior encompasses condom use, combined with additional information about a partner’s sexual health, and the kind of sex acts usually performed. To identify psychosocial predictors of young people’s intentions to have safer sex, as related to this triad, we conducted an online study with 211 sexually active participants aged between 18 and 24 years. Predictors [i.e., perceived behavioral control (PBC), subjective norms, and intention] taken from Fishbein and Ajzen’s Reasoned Action Approach (RAA), were combined with more distal variables (e.g., behavioral inhibition, sensation seeking, parental monitoring, and knowledge about STIs). Beyond the highly predictive power of RAA variables, additional variance was explained by the number of instances of unprotected sexual intercourse (SI) during the last 12 months and reasons for using barrier protection during first SI. In particular, past condom non-use behavior moderated PBC related to intended condom use. Further, various distal variables showed significant univariate associations with intentions related to the three behaviors of interest. It may, therefore, be helpful to include measures of past behavior as well as certain additional distal variables in future safer sex programs designed to promote health-sustaining sexual behavior. PMID:27148520

  8. Impact of Emergency Department Intimate Partner Violence Intervention

    ERIC Educational Resources Information Center

    Kendall, Jayne; Pelucio, Maria Tereza; Casaletto, Jennifer; Thompson, Karen Parker; Barnes, Sherry; Pettit, Erin; Aldrich, Mae

    2009-01-01

    The objective of the study is to assess the impact of emergency department (ED) intimate partner violence (IPV) counseling and resource referrals on patient-perceived safety and safety planning. ED patients with risk factors were offered consultation with trained IPV advocacy counselors who completed safety assessments, provided resource…

  9. [Stroke always with an emergency physician? - Pro].

    PubMed

    Harding, U; Lechleuthner, A; Ritter, M A; Schilling, M; Kros, M; Ohms, M; Bohn, A

    2013-06-01

    Good management of acute stroke is dependent on time and expertise. In Germany emergency medical care by ambulance services sometimes occurs without an emergency physician being sent to the scene. By reviewing current literature the question of patient care in the ambulance with or without an emergency physician is discussed. Presence of an emergency physician at the scene results in high diagnostic accuracy, allows for invasive procedures to be carried out, and enables referral to a specialist centre with a stroke-unit. The "rendezvous" system of separate deployment of patient ambulance and emergency physician allow flexible assignment of the physician resulting in short response times. Current research does not support a turn away from the deployment of an emergency physician in cases of acute stroke. PMID:23010854

  10. [When should a patient with abdominal pain be referred to the emergency ward?].

    PubMed

    de Saussure, Wassila Oulhaci; Andereggen, Elisabeth; Sarasin, François

    2010-08-25

    When should a patient with abdominal pain be referred to the emergency ward? The following goals must be achieved upon managing patients with acute abdominal pain: 1) identify vital emergency situations; 2) detect surgical conditions that require emergency referral without further diagnostic procedures; 3) in "non surgical acute abdomen patients" perform appropriate diagnostic procedures, or in selected cases delay tests and reevaluate the patient after an observation period, after which a referral decision is made. Clues from the history and physical examination are critical to perform this evaluation. A good knowledge of the most frequent acute abdominal conditions, and identifying potential severity criteria allow an appropriate management and decision about emergency referral. PMID:20873434

  11. Referral system for hard exudates in eye fundus.

    PubMed

    Naqvi, Syed Ali Gohar; Zafar, Muhammad Faisal; Haq, Ihsan ul

    2015-09-01

    Hard exudates are one of the most common anomalies/artifacts found in the eye fundus of patients suffering from diabetic retinopathy. These exudates are the major cause of loss of sight or blindness in people having diabetic retinopathy. Diagnosis of hard exudates requires considerable time and effort of an ophthalmologist. The ophthalmologists have become overloaded, so that there is a need for an automated diagnostic/referral system. In this paper a referral system for the hard exudates in the eye-fundus images has been presented. The proposed referral system works by combining different techniques like Scale Invariant Feature Transform (SIFT), K-means Clustering, Visual Dictionaries and Support Vector Machine (SVM). The system was also tested with Back Propagation Neural Network as a classifier. To test the performance of the system four fundus image databases were used. One publicly available image database was used to compare the performance of the system to the existing systems. To test the general performance of the system when the images are taken under different conditions and come from different sources, three other fundus image databases were mixed. The evaluation of the system was also performed on different sizes of the visual dictionaries. When using only one fundus image database the area under the curve (AUC) of maximum 0.9702 (97.02%) was achieved with accuracy of 95.02%. In case of mixed image databases an AUC of 0.9349 (93.49%) was recorded having accuracy of 87.23%. The results were compared to the existing systems and were found better/comparable. PMID:26231313

  12. Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases.

    PubMed

    Sutton, Katherine S; Stratton, Natalie; Pytyck, Jennifer; Kolla, Nathan J; Cantor, James M

    2015-01-01

    Hypersexuality remains an increasingly common but poorly understood patient complaint. Despite diversity in clinical presentations of patients referred for hypersexuality, the literature has maintained treatment approaches that are assumed to apply to the entire phenomenon. This approach has proven ineffective, despite its application over several decades. The present study used quantitative methods to examine demographic, mental health, and sexological correlates of common clinical subtypes of hypersexuality referrals. Findings support the existence of subtypes, each with distinct clusters of features. Paraphilic hypersexuals reported greater numbers of sexual partners, more substance abuse, initiation to sexual activity at an earlier age, and novelty as a driving force behind their sexual behavior. Avoidant masturbators reported greater levels of anxiety, delayed ejaculation, and use of sex as an avoidance strategy. Chronic adulterers reported premature ejaculation and later onset of puberty. Designated patients were less likely to report substance abuse, employment, or finance problems. Although quantitative, this article nonetheless presents a descriptive study in which the underlying typology emerged from features most salient in routine sexological assessment. Future studies might apply purely empirical statistical techniques, such as cluster analyses, to ascertain to what extent similar typologies emerge when examined prospectively. PMID:25032736

  13. Barriers of Referral System to Health Care Provision in Rural Societies in Iran

    PubMed Central

    Eskandari, Manijeh; Abbaszadeh, Abbas; Borhani, Fariba

    2013-01-01

    Introduction: Health care delivery systems in rural areas face numerous challenges in meeting the community's needs. This study aimed to describe barriers of health care process in rural societies in Iran. Methods: In this qualitative study, 26 participants (21 rural health care providers and five rural patients) were selected through purposive sampling. The data was collected via semi-structured individual interviews and small focus group discussions. Data was analyzed with qualitative content analysis. Results: One category, “ineffective referral system”, and five subcategories, i.e. being far from the ideal referral system, lack of adequate governmental referral system, lack of connection between different levels of the referral system, self-referential and bypassing the referral system, and insufficient knowledge about the referral system, were found. Conclusion: Considering the obstacles to the referral system, improvements in its structure are necessary to promote the quality of health care in rural areas. Such changes require coordination between the three levels of the referral system, strengthening the public sector of the system, increasing public awareness about the referral system, and prevention of self-referential. PMID:25276731

  14. The geography of genetics: an analysis of referral patterns to a cancer genetics service

    PubMed Central

    Iredale, Rachel; Higgs, Gary

    2008-01-01

    This study uses a geographical information system (GIS) and statistical analysis to look for patterns in referrals to a British cancer genetics service. In this case, familial cancers are taken to be those that can develop when an individual inherits DNA mutations that cause an increased risk of cancer. Between 1998 and 2006 the Cancer Genetics Service for Wales received nearly 11,000 referrals for patients resident in Wales and it is the service database recording those referrals which is the subject of this secondary analysis. Using postcodes to match referred patients to areas, deprivation scores were assigned. Referral rates per 10,000 head of population across the 8-year study period by unitary authority are presented, as is information on referrals from primary and secondary care sources by year. Each patient referred has their family history of cancer recorded and is assigned to a risk category; high, medium or average. There are correlations between number of GPs (General Practitioners) in a practice, number of patients referred from a practice, and deprivation as measured by the overall Welsh Index of Multiple Deprivation 2005, such that the two former factors increase as deprivation decreases. Over time there were changes in referral sources, with referrals from primary care overtaking those from secondary care in percentage and absolute terms. There were also changes in the types of cancer referred, risk categories seen and to which centre referrals were made. Referral patterns reveal an inverse relationship between deprivation and health service availability and use. PMID:18923938

  15. Patterns in Office Referral Data by Grade, Race/Ethnicity and Gender

    PubMed Central

    Kaufman, Joy S.; Jaser, Sarah S.; Vaughan, Ellen L.; Reynolds, Jesse S.; Di Donato, John; Bernard, Stanley N.; Hernandez-Brereton, Maria

    2014-01-01

    Research supports that office referral data is useful in informing programmatic decisions and in planning interventions such as Positive Behavior Interventions and Supports (PBIS). Knowledge of the different patterns of office referrals may facilitate the development of interventions that are targeted to specific groups of students. This study examines patterns in office referrals within an urban district by gender, race/ethnicity and grade. Findings reveal that there are clear differences by grade that appear to be related to developmental level, with greater numbers of referrals for aggression in younger students (grades K-8), greater numbers of referrals for disrespectful behavior in middle school students (grades 7–8), and greater numbers of referrals for attendance problems in high school students. There were also gender differences in the rate and type of referrals, with significantly more referrals for boys’ delinquent and aggressive behavior than girls, which may relate to how schools define unacceptable behavior and the method used to collect this data. Finally, there were differences by race/ethnicity, in that there were significantly more referrals for African American/black students than Hispanic students, which suggest that schools need to consider students’ racial/ethnic background in the development of behavioral expectations. PMID:25580076

  16. Obstructive jaundice in adult Ethiopians in a referral hospital.

    PubMed

    Bekele, Z; Yifru, A

    2000-10-01

    Forty-nine adult Ethiopians with obstructive jaundice were studied. Right upper quadrant pain was the main presenting complaint (89%). Most (94%) of the jaundiced patients had right upper quadrant tenderness. In 87% the obstruction was corroborated by ultrasonographic examination, but causal factors were identified in only 39%. Operative findings showed that choledocholithiasis (41%) and malignant conditions (22%) were the two important causes of obstructive jaundice among the adult patients seen at a referral hospital in Addis Ababa. The causes and the outcome of the different types of surgical procedures used in the management are discussed. PMID:11125501

  17. Referring physician satisfaction: toward a better understanding of hospital referrals.

    PubMed

    Ponzurick, T G; France, K R; Logar, C M

    1998-01-01

    Customer satisfaction literature has contributed significantly to the development of marketing strategies in the health-care arena. The research has led to the development of hospital-driven relationship marketing programs. This study examines the inclusion of referring physicians as partners in the hospital's relationship marketing program. In exploring this relationship, medical and hospital facility characteristics that referring physicians find important in making patient referrals to specialty care hospitals are identified and analyzed. The results lead to the development of strategic initiatives which hospital marketers should consider when developing relationship marketing programs designed to satisfy their referring physicians. PMID:10186254

  18. Suicide Prevention Referrals in a Mobile Health Smoking Cessation Intervention.

    PubMed

    Christofferson, Dana E; Hamlett-Berry, Kim; Augustson, Erik

    2015-08-01

    Automated mobile health (mHealth) programs deliver effective smoking cessation interventions through text message platforms. Smoking is an independent risk factor for suicide, so the Department of Veterans Affairs incorporated information about the Veterans Crisis Line into its SmokefreeVET smoking cessation text messaging program. Almost 7% of all SmokefreeVET enrollees have accessed this information. Because of the reach and automated nature of this and similar programs, we recommend including a referral to a suicide prevention hotline for all smoking cessation mHealth interventions. PMID:26066949

  19. Safer Science

    ERIC Educational Resources Information Center

    Roy, Ken

    2011-01-01

    This column provides best safety practices for the science classroom and laboratory. In this month's issue, pregnancy policy in the laboratory is discussed. One can't ignore the fact that student and faculty pregnancies--and the resulting potential hazards in the science laboratory--exist at the high school level. Science teachers need to be…

  20. Accuracy of telepsychiatric assessment of new routine outpatient referrals

    PubMed Central

    Singh, Surendra P; Arya, Dinesh; Peters, Trish

    2007-01-01

    Background Studies on the feasibility of telepsychiatry tend to concentrate only on a subset of clinical parameters. In contrast, this study utilises data from a comprehensive assessment. The main objective of this study is to compare the accuracy of findings from telepsychiatry with those from face to face interviews. Method This is a primary, cross-sectional, single-cluster, balanced crossover, blind study involving new routine psychiatric referrals. Thirty-seven out of forty cases fulfilling the selection criteria went through a complete set of independent face to face and video assessments by the researchers who were blind to each other's findings. Results The accuracy ratio of the pooled results for DSM-IV diagnoses, risk assessment, non-drug and drug interventions were all above 0.76, and the combined overall accuracy ratio was 0.81. There were substantial intermethod agreements for Cohen's kappa on all the major components of evaluation except on the Risk Assessment Scale where there was only weak agreement. Conclusion Telepsychiatric assessment is a dependable method of assessment with a high degree of accuracy and substantial overall intermethod agreement when compared with standard face to face interview for new routine outpatient psychiatric referrals. PMID:17919329

  1. 10 rare tumors that warrant a genetics referral.

    PubMed

    Banks, Kimberly C; Moline, Jessica J; Marvin, Monica L; Newlin, Anna C; Vogel, Kristen J

    2013-03-01

    The number of described cancer susceptibility syndromes continues to grow, as does our knowledge on how to manage these syndromes with the aim of early detection and cancer prevention. Oncologists now have greater responsibility to recognize patterns of cancer that warrant referral for a genetics consultation. While some patterns of common cancers are easy to recognize as related to hereditary cancer syndromes, there are a number of rare tumors that are highly associated with cancer syndromes yet are often overlooked given their infrequency. We present a review of ten rare tumors that are strongly associated with hereditary cancer predisposition syndromes: adrenocortical carcinoma, carcinoid tumors, diffuse gastric cancer, fallopian tube/primary peritoneal cancer, leiomyosarcoma, medullary thyroid cancer, paraganglioma/pheochromocytoma, renal cell carcinoma of chromophobe, hybrid oncocytoic, or oncocytoma histology, sebaceous carcinoma, and sex cord tumors with annular tubules. This review will serve as a guide for oncologists to assist in the recognition of rare tumors that warrant referral for a genetic consultation. PMID:23377869

  2. Methods to obtain referral criteria in growth monitoring.

    PubMed

    van Dommelen, Paula; van Buuren, Stef

    2014-08-01

    An important goal of growth monitoring is to identify genetic disorders, diseases or other conditions that manifest themselves through an abnormal growth. The two main conditions that can be detected by height monitoring are Turner's syndrome and growth hormone deficiency. Conditions or risk factors that can be detected by monitoring weight or body mass index include hypernatremic dehydration, celiac disease, cystic fibrosis and obesity. Monitoring infant head growth can be used to detect macrocephaly, developmental disorder and ill health in childhood. This paper describes statistical methods to obtain evidence-based referral criteria in growth monitoring. The referral criteria that we discuss are based on either anthropometric measurement(s) at a fixed age using (1) a Centile or a Standard Deviation Score, (2) a Standard Deviation corrected for parental height, (3) a Likelihood Ratio Statistic and (4) an ellipse, or on multiple measurements over time using (5) a growth rate and (6) a growth curve model. We review the potential uses of these methods, and outline their strengths and limitations. PMID:23376959

  3. Diabetes Mellitus in Outpatients in Debre Berhan Referral Hospital, Ethiopia

    PubMed Central

    Habtewold, Tesfa Dejenie; Tsega, Wendwesen Dibekulu; Wale, Bayu Yihun

    2016-01-01

    Introduction. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Most people with diabetes live in low- and middle-income countries and these will experience the greatest increase in cases of diabetes over the next 22 years. Objective. To assess the prevalence and associated factors of diabetes mellitus among outpatients of Debre Berhan Referral Hospital. Methods and Materials. A cross-sectional study was conducted from April to June 2015 among 385 patients. Random quota sampling technique was used to get individual patients and risk factors assessment. Patients diabetes status was ascertained by World Health Organization Diabetes Mellitus Diagnostic Criteria. The collected data were entered, cleaned, and analyzed and Chi-square test was applied to test any association between dependent and independent variable. Result. Out of the total 385 study patients, 368 have participated in the study yielding a response rate of 95.3%. Concerning clinical presentation of diabetes mellitus, 13.3% of patients reported thirst, 14.4% of patients declared polyurea, and 14.9% of patients ascertained unexplained weight loss. The statistically significant associated factors of diabetes mellitus were hypertensive history, obesity, the number of parities, and smoking history. Conclusion. The prevalence of diabetes mellitus among outpatients in Debre Berhan Referral Hospital was 0.34% and several clinical and behavioral factors contribute to the occurrence of diabetes mellitus which impose initiation of preventive, promotive, and curative strategies. PMID:26881245

  4. A Descriptive Study of School Discipline Referrals in First Grade

    PubMed Central

    Rusby, Julie C.; Taylor, Ted K.; Foster, E. Michael

    2006-01-01

    School discipline referrals (SDRs) may be useful in the early detection and monitoring of disruptive behavior problems to inform prevention efforts in the school setting, yet little is known about the nature and validity of SDRs in the early grades. For this descriptive study, SDR data were collected on a sample of first grade students who were at risk for developing disruptive behavior problems (n = 186) and a universal sample (n = 531) from 20 schools. Most SDRs were given for physical aggression and the predominant consequence was time out. As expected, boys and at-risk students were more likely to receive an SDR and to have more SDRs than were girls and the universal sample. A large difference between schools regarding the delivery of SDRs was found. A zero-inflated Poisson model clustered by school tested the prediction of school-level variables. Students in schools that had a systematic way of tracking SDRs were more likely to receive one. Also, schools with more low-income students and larger class sizes gave fewer SDRs. SDRs predicted teacher ratings, and to a lesser extent, parent ratings of disruptive behavior at the end of first grade. Practitioners and researchers must examine school-level influences whenever first grade discipline referrals are used to measure problem behavior for the purpose of planning and evaluating interventions. PMID:17372623

  5. Surfing Stark II: prohibition against self-referrals.

    PubMed

    Swibel, H J; Zaremski, M J

    1995-02-01

    In 1989, the Chairman of the House Ways and Means Subcommittee on Health, Fortney (Pete) Stark (D.-Calif.), turned the health care industry on its ear by introducing the "Ethics in Patient Referrals Act" to Congress. The bill, commonly known as "Stark I," prohibited physician referrals to entities in which they held a financial interest. As Stark's bill made its way through Congress, its substance was dramatically reduced by the legislative process. Ultimately, the law was incorporated as part of the Omnibus Budget Reconciliation Act of 1990. Stark I's main thrust is that it bars physicians from referring Medicare patients to clinical laboratories with which they have a financial relationship. Furthermore, laboratories providing those services must report information concerning any ownership arrangements between the referring physician and the laboratory. Now, to complicate the picture, providers must contend with amendments to the original law that extend the reach of its prohibitions. Called "Stark II," these amendments took effect on January 1, 1995. In this article, guidelines for dealing successfully with the requirements of the law are outlined. PMID:10140213

  6. Dutch general practitioners' referral of children to specialists: a comparison between 1987 and 2001

    PubMed Central

    Otters, Hanneke; van der Wouden, Johannes C; Schellevis, François G; van Suijlekom-Smit, Lisette W A; Koes, Bart W

    2004-01-01

    Background: Although children are frequently referred to specialists, detailed information on referral patterns of them is scarce. Even less information is available on how referral patterns evolve over time. Aims: To examine current referral patterns for children aged 0–17 years and compare these with referral patterns reported for 1987. Design of study: Data were analysed from two national cross-sectional surveys, performed in 2001 (91 general practices) and in 1987 (103 general practices). Setting: Dutch general practice. Method: All new referrals to specialists were assessed by age, sex, International Classification of Primary Care (ICPC) category, specialty referred to, and specific episodes of disease. Referral measures were quantified as new referrals per 1000 person–years and per 100 new episodes, a measure of likelihood of a young person with a specific diagnosis to be referred. Rates in 2001 were compared with those from 1987. Results: Referral rates decreased from 138 per 1000 person–years in 1987, to 84 per 1000 person–years in 2001. Age differences in referral rates were similar in both surveys. Compared with 1987, more boys than girls were referred to specialists. The overall likelihood of a condition being referred decreased from 8.0 per 100 episodes in 1987 to 6.5 per 100 episodes in 2001. Reasons for referral had also changed by 2001, particularly for the ear, nose, and throat (ENT) specialist and ophthalmologist. Moreover, referral rates for acute otitis media, refractive disorders, and vision problems decreased two- to fourfold in 2001. Conclusion: Presently, Dutch general practitioners tend to manage more health problems themselves and refer less young people to specialists. PMID:15527611

  7. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Minimum amount of referrals to the Department of Justice. 1.953 Section 1.953 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs §...

  8. 24 CFR 17.75 - Referral to GAO or Justice Department.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... General Provisions § 17.75 Referral to GAO or Justice Department. (a) Claims referred. Claims which cannot be collected, compromised, or terminated in accordance with 4 CFR parts 101 to 105 will be referred... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Referral to GAO or...

  9. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Minimum amount of referrals to the Department of Justice. 1.953 Section 1.953 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs §...

  10. 24 CFR 17.75 - Referral to GAO or Justice Department.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... General Provisions § 17.75 Referral to GAO or Justice Department. (a) Claims referred. Claims which cannot be collected, compromised, or terminated in accordance with 4 CFR parts 101 to 105 will be referred... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to GAO or...

  11. Barriers to Home and Community-Based Service Referrals: The Physician's Role

    ERIC Educational Resources Information Center

    Reder, Sheri; Hedrick, Susan; Guihan, Marylou; Miller, Sara

    2009-01-01

    The purpose of this study was to obtain information about Department of Veteran Affairs (VA) long-term care (LTC) referrals that could be used to develop interventions that increase the likelihood of referrals to home and community-based services (HCBS) instead of institutional care. This primarily qualitative study was conducted at five VA…

  12. 10 CFR 13.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Referral of complaint and answer to the ALJ. 13.11 Section 13.11 Energy NUCLEAR REGULATORY COMMISSION PROGRAM FRAUD CIVIL REMEDIES § 13.11 Referral of complaint and answer to the ALJ. Upon receipt of an answer, the reviewing official shall file the complaint...

  13. 25 CFR 217.4 - Referral of questions by the joint managers.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Referral of questions by the joint managers. 217.4... DISTRIBUTION CORP. § 217.4 Referral of questions by the joint managers. The business committee and the board of directors must refer to each other for resolution any questions or problems related to joint management...

  14. 22 CFR 1429.4 - Referral of policy questions to the Board.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Referral of policy questions to the Board. 1429.4 Section 1429.4 Foreign Relations FOREIGN SERVICE LABOR RELATIONS BOARD; FEDERAL LABOR RELATIONS... AUTHORITY MISCELLANEOUS AND GENERAL REQUIREMENTS Miscellaneous § 1429.4 Referral of policy questions to...

  15. 5 CFR 2429.4 - Referral of policy questions to the Authority.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Referral of policy questions to the Authority. 2429.4 Section 2429.4 Administrative Personnel FEDERAL LABOR RELATIONS AUTHORITY, GENERAL COUNSEL... REQUIREMENTS Miscellaneous § 2429.4 Referral of policy questions to the Authority. Notwithstanding...

  16. 5 CFR 2429.4 - Referral of policy questions to the Authority.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Referral of policy questions to the Authority. 2429.4 Section 2429.4 Administrative Personnel FEDERAL LABOR RELATIONS AUTHORITY, GENERAL COUNSEL... REQUIREMENTS Miscellaneous § 2429.4 Referral of policy questions to the Authority. Notwithstanding...

  17. 22 CFR 1429.4 - Referral of policy questions to the Board.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Referral of policy questions to the Board. 1429.4 Section 1429.4 Foreign Relations FOREIGN SERVICE LABOR RELATIONS BOARD; FEDERAL LABOR RELATIONS... AUTHORITY MISCELLANEOUS AND GENERAL REQUIREMENTS Miscellaneous § 1429.4 Referral of policy questions to...

  18. Referral Rates of Senior Family Practice Residents in an Ambulatory Care Clinic.

    ERIC Educational Resources Information Center

    Lawler, Frank H.

    1987-01-01

    A study of patterns in second- and third-year family practice residents' requests for referrals found higher rates for the senior students, suggesting possible differences in approach to case management, lack of experience in referral among younger students, and differences in case mix. (MSE)

  19. 12 CFR 269b.210 - Referral to National Center for Dispute Settlement.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Referral to National Center for Dispute... Referral to National Center for Dispute Settlement. (a) Within 5 days after the answer to the charge has... particularized request, to the National Center for Dispute Settlement of the American Arbitration...

  20. 45 CFR 73.735-1304 - Referral of matters arising under the standards of this part.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Referral of matters arising under the standards of this part. 73.735-1304 Section 73.735-1304 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION STANDARDS OF CONDUCT Reporting Violations § 73.735-1304 Referral of matters arising under the standards of this part. (a)...

  1. 20 CFR 355.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Referral of complaint and answer to the ALJ. 355.11 Section 355.11 Employees' Benefits RAILROAD RETIREMENT BOARD ADMINISTRATIVE REMEDIES FOR FRAUDULENT CLAIMS OR STATEMENTS REGULATIONS UNDER THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 355.11 Referral of complaint and answer to the ALJ....

  2. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  3. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  4. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  5. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  6. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  7. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Referral to the Department of Justice. 304.9 Section 304.9 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or...

  8. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Referral to the Department of Justice. 304.9 Section 304.9 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or...

  9. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Referral to the Department of Justice. 304.9 Section 304.9 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or...

  10. Service Coordinators' Perceptions of Autism-Specific Screening and Referral Practices in Early Intervention

    ERIC Educational Resources Information Center

    Pizur-Barnekow, Kris; Muusz, Marta; McKenna, Catherine; O'Connor, Emily; Cutler, Ann

    2013-01-01

    Service coordinators in a statewide early intervention program were surveyed to develop an understanding of screening and referral practices to identify children on the autism spectrum. Quantitative and qualitative data summarizing autism-specific screening and referral practices are reported. More than 50% of the respondents reported that they…

  11. The Effects of Implementing a Positive Behavior Intervention Support Program on Office Discipline Referrals

    ERIC Educational Resources Information Center

    Thomas, Cheryl Denise

    2015-01-01

    The purpose of this study was to determine if the implementation of PBIS (Positive Behavioral Intervention Support) program had a positive significant effect in decreasing office discipline referrals in a local elementary school. A sample independent t-Test was used to examine data on the school's average office discipline referrals for two years…

  12. A Qualitative Investigation of the Referral Process from School Counselors to Mental Health Providers

    ERIC Educational Resources Information Center

    Lemberger, Matthew E.; Wachter Morris, Carrie A.; Clemens, Elysia V.; Smith, Allison L.

    2010-01-01

    This qualitative study explores the referral process to mental health providers by school counselors, as perceived by school counselors. Using an open-ended survey instrument, school counselors were asked to describe the referral process, including prevalence, decisional factors, follow-up, and evaluation. Results suggest that school counselors…

  13. Contemporary Practices in School Psychology: A National Survey of Roles and Referral Problems.

    ERIC Educational Resources Information Center

    Bramlett, Ronald K.; Murphy, John J.; Johnson, Jenna; Wallingsford, Leah; Hall, John D.

    2002-01-01

    School psychologists (N=370) from a national organization were surveyed about their roles, types of referrals, consultation practices, and crisis team involvement. Assessment was the most common role. Most referrals were for academic problems. Behavioral consultation was the most common model. The majority of respondents had some involvement in…

  14. 43 CFR 10010.47 - Pre-decision referrals to CEQ.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... POLICY ACT Relationship to Decision-Making § 10010.47 Pre-decision referrals to CEQ. (a) Upon receipt of... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Pre-decision referrals to CEQ. 10010.47 Section 10010.47 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH...

  15. 43 CFR 10010.47 - Pre-decision referrals to CEQ.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... POLICY ACT Relationship to Decision-Making § 10010.47 Pre-decision referrals to CEQ. (a) Upon receipt of... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Pre-decision referrals to CEQ. 10010.47 Section 10010.47 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH...

  16. 43 CFR 10010.47 - Pre-decision referrals to CEQ.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... POLICY ACT Relationship to Decision-Making § 10010.47 Pre-decision referrals to CEQ. (a) Upon receipt of... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Pre-decision referrals to CEQ. 10010.47 Section 10010.47 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH...

  17. 43 CFR 10010.47 - Pre-decision referrals to CEQ.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... POLICY ACT Relationship to Decision-Making § 10010.47 Pre-decision referrals to CEQ. (a) Upon receipt of... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Pre-decision referrals to CEQ. 10010.47 Section 10010.47 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH...

  18. 24 CFR 103.100 - Notification and referral to substantially equivalent State or local agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Notification and referral to substantially equivalent State or local agencies. 103.100 Section 103.100 Housing and Urban Development... may accept interim referrals under 24 CFR part 115 with regard to the alleged discriminatory...

  19. Strategies for Students with Behavioral Issues Prior to Referral for Special Education Assessment

    ERIC Educational Resources Information Center

    Vallejos, Antoinette Martinez

    2010-01-01

    By law, public schools need to exhaust all general education services prior to referral for special education services (IDEA, 1990). Unfortunately, many teachers are unaware of the pre-referral interventions they can employ to teach children displaying behavior problems. The review of literature focused on the following: (a) legislative history,…

  20. 32 CFR 516.34 - Referral of medical care and property claims for litigation.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 3 2013-07-01 2013-07-01 false Referral of medical care and property claims for litigation. 516.34 Section 516.34 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... States Medical Care and Property Claims § 516.34 Referral of medical care and property claims...

  1. 32 CFR 516.34 - Referral of medical care and property claims for litigation.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 3 2012-07-01 2009-07-01 true Referral of medical care and property claims for litigation. 516.34 Section 516.34 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... States Medical Care and Property Claims § 516.34 Referral of medical care and property claims...

  2. 32 CFR 516.34 - Referral of medical care and property claims for litigation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Referral of medical care and property claims for litigation. 516.34 Section 516.34 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... States Medical Care and Property Claims § 516.34 Referral of medical care and property claims...

  3. 32 CFR 516.34 - Referral of medical care and property claims for litigation.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 3 2014-07-01 2014-07-01 false Referral of medical care and property claims for litigation. 516.34 Section 516.34 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... States Medical Care and Property Claims § 516.34 Referral of medical care and property claims...

  4. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... authorization transaction. 162.1302 Section 162.1302 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... Authorization § 162.1302 Standards for referral certification and authorization transaction. The Secretary adopts the following standards for the referral certification and authorization transaction: (a) For...

  5. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... authorization transaction. 162.1302 Section 162.1302 Public Welfare Department of Health and Human Services... Authorization § 162.1302 Standards for referral certification and authorization transaction. The Secretary adopts the following standards for the referral certification and authorization transaction: (a) For...

  6. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... authorization transaction. 162.1302 Section 162.1302 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... Authorization § 162.1302 Standards for referral certification and authorization transaction. The Secretary adopts the following standards for the referral certification and authorization transaction: (a) For...

  7. 21 CFR 20.51 - Referral to primary source of records.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Referral to primary source of records. 20.51 Section 20.51 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PUBLIC INFORMATION Procedures and Fees § 20.51 Referral to primary source of records. Upon receipt of...

  8. Patterns of Risk in Adult Protection Referrals for Sexual Abuse and People with Intellectual Disability

    ERIC Educational Resources Information Center

    Cambridge, Paul; Beadle-Brown, Julie; Milne, Alisoun; Mansell, Jim; Whelton, Beckie

    2011-01-01

    Background: Adult protection monitoring data held by local authorities in England provide opportunities to examine referrals for alleged sexual abuse for people with intellectual disability to identify patterns of risk. Methods: Adult protection monitoring data collected by two local authorities was analysed, with referrals for alleged sexual…

  9. 45 CFR 96.33 - Referral of cases to the Inspector General.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Referral of cases to the Inspector General. 96.33 Section 96.33 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION BLOCK GRANTS Financial Management § 96.33 Referral of cases to the Inspector General. State or tribal officials who...

  10. 45 CFR 96.33 - Referral of cases to the Inspector General.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Referral of cases to the Inspector General. 96.33 Section 96.33 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION BLOCK GRANTS Financial Management § 96.33 Referral of cases to the Inspector General. State or tribal officials who...

  11. 45 CFR 96.33 - Referral of cases to the Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Referral of cases to the Inspector General. 96.33 Section 96.33 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION BLOCK GRANTS Financial Management § 96.33 Referral of cases to the Inspector General. State or tribal officials who...

  12. 45 CFR 96.33 - Referral of cases to the Inspector General.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Referral of cases to the Inspector General. 96.33 Section 96.33 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION BLOCK GRANTS Financial Management § 96.33 Referral of cases to the Inspector General. State or tribal officials who...

  13. 42 CFR 411.370 - Advisory opinions relating to physician referrals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Advisory opinions relating to physician referrals. 411.370 Section 411.370 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... Advisory opinions relating to physician referrals. (a) Period during which CMS accepts requests....

  14. 42 CFR 411.370 - Advisory opinions relating to physician referrals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Advisory opinions relating to physician referrals. 411.370 Section 411.370 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... Advisory opinions relating to physician referrals. (a) Period during which CMS accepts requests....

  15. 42 CFR 411.370 - Advisory opinions relating to physician referrals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Advisory opinions relating to physician referrals. 411.370 Section 411.370 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... Advisory opinions relating to physician referrals. (a) Period during which CMS accepts requests....

  16. 42 CFR 411.370 - Advisory opinions relating to physician referrals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Advisory opinions relating to physician referrals. 411.370 Section 411.370 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... Advisory opinions relating to physician referrals. (a) Period during which CMS accepts requests....

  17. 42 CFR 411.370 - Advisory opinions relating to physician referrals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Advisory opinions relating to physician referrals. 411.370 Section 411.370 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... Advisory opinions relating to physician referrals. (a) Period during which CMS accepts requests....

  18. The Disproportionality Dilemma: Patterns of Teacher Referrals to School Counselors for Disruptive Behavior

    ERIC Educational Resources Information Center

    Bryan, Julia; Day-Vines, Norma L.; Griffin, Dana; Moore-Thomas, Cheryl

    2012-01-01

    Disproportionality plagues schools nationwide in special education placement, dropout, discipline referral, suspension, and expulsion rates. This study examined predictors of teacher referrals to school counselors for disruptive behavior in a sample of students selected from the Educational Longitudinal Study 2002 (National Center for Education…

  19. Community Determinants of Substance Abuse Treatment Referrals from Juvenile Courts: Do Rural Youths Have Equal Access?

    ERIC Educational Resources Information Center

    Pullmann, Michael D.; Heflinger, Craig Anne

    2009-01-01

    Many youths in juvenile justice are in need of substance use services, yet referral to services is often inadequate. This study examines the ecological factors related to substance use service referrals made through Tennessee's juvenile courts. A series of hierarchical binomial logistic models indicated that individual-level factors accounted for…

  20. 19 CFR 176.21 - Referral of statement of agreed facts for certification.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 19 Customs Duties 2 2013-04-01 2013-04-01 false Referral of statement of agreed facts for... of Agreed Facts § 176.21 Referral of statement of agreed facts for certification. Statements of agreed facts (also referred to as stipulations) to be used by the Department of Justice in...

  1. 19 CFR 176.21 - Referral of statement of agreed facts for certification.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 2 2012-04-01 2012-04-01 false Referral of statement of agreed facts for... of Agreed Facts § 176.21 Referral of statement of agreed facts for certification. Statements of agreed facts (also referred to as stipulations) to be used by the Department of Justice in...

  2. 19 CFR 176.21 - Referral of statement of agreed facts for certification.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 2 2014-04-01 2014-04-01 false Referral of statement of agreed facts for... of Agreed Facts § 176.21 Referral of statement of agreed facts for certification. Statements of agreed facts (also referred to as stipulations) to be used by the Department of Justice in...

  3. 19 CFR 176.21 - Referral of statement of agreed facts for certification.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 2 2011-04-01 2011-04-01 false Referral of statement of agreed facts for... of Agreed Facts § 176.21 Referral of statement of agreed facts for certification. Statements of agreed facts (also referred to as stipulations) to be used by the Department of Justice in...

  4. 20 CFR 702.504 - Vocational rehabilitation; referrals to State Employment Agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... counseling, job classification, and selective placement assistance. Referrals shall be made to State... vocational handicap and loss of wage earning capacity; (c) Disabled employees, whose initial referral to former private employers did not result in a job reassignment or in a job retention, shall be...

  5. Mental Health and Substance Use: A Qualitative Study of Resident Assistants' Attitudes and Referral Practices

    ERIC Educational Resources Information Center

    Reingle, Jennifer; Thombs, Dennis; Osborn, Cynthia; Saffian, Steven; Oltersdorf, Dan

    2010-01-01

    This study described mental health and substance use referral practices of resident assistants (RAs). Interviews were conducted with 48 RAs at three campuses. RAs generally had positive attitudes toward helping residents, and believed that existing norms supported their referral actions. However, many perceived referring residents to be…

  6. Neighborhood Communications Centers: Planning Information and Referral Services in The Urban Library.

    ERIC Educational Resources Information Center

    Yin, Robert K.; And Others

    The potential development of information and referral (I&R) services in branch libraries was explored by examining five cases where such services have been initiated. The extent to which the public library system is appropriate for information and referral services was carefully examined in the light of its ability to carry on seven functions: (1)…

  7. 7 CFR 792.18 - Referral of debts to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 792.18... § 792.18 Referral of debts to Department of Justice. (a) Debts that exceed $100,000.00 exclusive of... referred to the Department of Justice before they can be discharged. (b) Debts which cannot be...

  8. 49 CFR 1018.72 - Referral to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... prescribed by 4 CFR 105.2. Care must be taken to preserve all files, records, and exhibits on claims referred... 49 Transportation 8 2010-10-01 2010-10-01 false Referral to the Department of Justice. 1018.72... Claim § 1018.72 Referral to the Department of Justice. (a) Claims for which the gross original amount...

  9. 7 CFR 1403.17 - Referral of debts to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 1403.17... PROCEDURES § 1403.17 Referral of debts to Department of Justice. Debts which cannot be collected in accordance with these regulations may be referred to the Department of Justice for collection action....

  10. 21 CFR 20.51 - Referral to primary source of records.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Referral to primary source of records. 20.51... PUBLIC INFORMATION Procedures and Fees § 20.51 Referral to primary source of records. Upon receipt of a... primary source of the record or document....

  11. 21 CFR 20.51 - Referral to primary source of records.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Referral to primary source of records. 20.51... PUBLIC INFORMATION Procedures and Fees § 20.51 Referral to primary source of records. Upon receipt of a... primary source of the record or document....

  12. Exploring Primary Referral Source Impact on Student Initial Perceptions of Counseling

    ERIC Educational Resources Information Center

    Blau, Gary; DiMino, John; Sheridan, Natalie; Stein, Alexander; Casper, Steven; Chessler, Marcy; Beverly, Clyde

    2015-01-01

    There has been no published research to date comparing the impact of different primary referral sources for a student seeking counseling services on student initial counseling perceptions. Using 82 undergraduates in counseling, this study partitioned these students into two referral groups, where 1 = self-referred (myself), N = 45 versus 2 =…

  13. Effects of Schools Attuned on Special Education Referrals for African American Boys

    ERIC Educational Resources Information Center

    Rodriguez, Andrea B.

    2010-01-01

    This study compared the number of special education referrals for African American boys before and after the implementation of the training program, "Schools Attuned". The purpose of the research was to ascertain if the number of special education referrals for African American boys generated in schools with teachers trained in "Schools Attuned"…

  14. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Special rules for self-referral and point of... Benefits and Beneficiary Protections § 422.105 Special rules for self-referral and point of service option...) Point of service option. As a general rule, a POS benefit is an option that an MA organization may...

  15. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules for self-referral and point of... Benefits and Beneficiary Protections § 422.105 Special rules for self-referral and point of service option...) Point of service option. As a general rule, a POS benefit is an option that an MA organization may...

  16. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules for self-referral and point of... Benefits and Beneficiary Protections § 422.105 Special rules for self-referral and point of service option...) Point of service option. As a general rule, a POS benefit is an option that an MA organization may...

  17. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Special rules for self-referral and point of... Beneficiary Protections § 422.105 Special rules for self-referral and point of service option. (a) Self... item or service is covered only if further action is taken by the enrollee. (b) Point of service...

  18. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... authorization transaction. 162.1302 Section 162.1302 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... Authorization § 162.1302 Standards for referral certification and authorization transaction. The Secretary adopts the following standards for the referral certification and authorization transaction: (a) For...

  19. Intellectual Disabilities, Challenging Behaviour and Referral Texts: A Critical Discourse Analysis

    ERIC Educational Resources Information Center

    Nunkoosing, Karl; Haydon-Laurelut, Mark

    2011-01-01

    The texts of referrals written by workers in residential services for people with learning difficulties constitute sites where contemporary discourses of intellectual disabilities are being constructed. This paper uses Critical Discourse Analysis to examine referrals made to a Community Learning Disability Team (CLDT). The study finds referral…

  20. Referral of African American Children for Evaluation of Emotional or Behavioral Concerns

    ERIC Educational Resources Information Center

    Riccio, Cynthia A.; Ochoa, Salvador Hector; Garza, Sylvia G.; Nero, Collette L.

    2003-01-01

    Research indicates that high numbers of African American children receive special education services. To address the overrepresentation of African Americans in special education, this study examined the source of referral and the behaviors that precipitate the referral of African Americans for evaluation due to behavioral or emotional concerns.…

  1. Referral Pattern and Special Interests in Children and Adolescents with Asperger Syndrome: A Turkish Referred Sample

    ERIC Educational Resources Information Center

    Tanidir, Canan; Mukaddes, Nahit M.

    2014-01-01

    Objectives: To investigate the most frequent reasons for referral, the most common special interests, age at first referral to a mental health service, and the age of diagnosis in children and adolescents with Asperger syndrome living in Turkey. Methods: This study includes 61 children and adolescents diagnosed with Asperger syndrome using…

  2. 36 CFR 1260.46 - How does the Department of Defense process referrals?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... National Declassification Center (NDC) § 1260.46 How does the Department of Defense process referrals? (a) The Department of Defense (DOD) established the Joint Referral Center (JRC) to review DOD agencies... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false How does the Department...

  3. 36 CFR 1260.46 - How does the Department of Defense process referrals?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... National Declassification Center (NDC) § 1260.46 How does the Department of Defense process referrals? (a) The Department of Defense (DOD) established the Joint Referral Center (JRC) to review DOD agencies... 36 Parks, Forests, and Public Property 3 2013-07-01 2012-07-01 true How does the Department...

  4. 36 CFR 1260.46 - How does the Department of Defense process referrals?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... National Declassification Center (NDC) § 1260.46 How does the Department of Defense process referrals? (a) The Department of Defense (DOD) established the Joint Referral Center (JRC) to review DOD agencies... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false How does the Department...

  5. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  6. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  7. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 2 2011-01-01 2011-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  8. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  9. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 2 2011-01-01 2011-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  10. 10 CFR 52.23 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 2 2011-01-01 2011-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.23 Section 52.23 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Early Site Permits § 52.23 Referral to the Advisory...

  11. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  12. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  13. 10 CFR 52.23 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.23 Section 52.23 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Early Site Permits § 52.23 Referral to the Advisory...

  14. 10 CFR 52.23 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.23 Section 52.23 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Early Site Permits § 52.23 Referral to the Advisory...

  15. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  16. Faculty Referrals - The Kiss of Death or a Powerful Motivator? What Makes the Difference?

    ERIC Educational Resources Information Center

    Maxwell, Martha

    1997-01-01

    States that for faculty to make effective referrals to academic support programs, they should be knowledgeable about services and describe them to students in their classes early in the term, they must endorse the use of the service and repeatedly encourage students to attend, and they must make their referrals personal. (VWC)

  17. 5 CFR 185.111 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Referral of complaint and answer to the ALJ. 185.111 Section 185.111 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PROGRAM FRAUD CIVIL REMEDIES § 185.111 Referral of complaint and answer to the ALJ. Upon...

  18. Early Referral and Other Factors Affecting Vocational Rehabilitation Outcome for the Workers' Compensation Client.

    ERIC Educational Resources Information Center

    Gardner, John A.

    1991-01-01

    Estimated benefits from systematic early referral of injured workers for vocational rehabilitation services. Used data from Florida workers' compensation cases closed in 1985 to estimate gains from referral for evaluation not later than six months from injury date. Concludes that social benefits could be nearly $10 million annually and that…

  19. 28 CFR 115.178 - Referrals for prosecution for detainee-on-detainee sexual abuse.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Referrals for prosecution for detainee-on-detainee sexual abuse. 115.178 Section 115.178 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Lockups Discipline § 115.178 Referrals...

  20. 28 CFR 115.178 - Referrals for prosecution for detainee-on-detainee sexual abuse.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Referrals for prosecution for detainee-on-detainee sexual abuse. 115.178 Section 115.178 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Lockups Discipline § 115.178 Referrals...