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1

ENSURING ADEQUATE SAFETY WHEN USING HYDROGEN AS A FUEL  

SciTech Connect

Demonstration projects using hydrogen as a fuel are becoming very common. Often these projects rely on project-specific risk evaluations to support project safety decisions. This is necessary because regulations, codes, and standards (hereafter referred to as standards) are just being developed. This paper will review some of the approaches being used in these evolving standards, and techniques which demonstration projects can implement to bridge the gap between current requirements and stakeholder desires. Many of the evolving standards for hydrogen-fuel use performance-based language, which establishes minimum performance and safety objectives, as compared with prescriptive-based language that prescribes specific design solutions. This is being done for several reasons including: (1) concern that establishing specific design solutions too early will stifle invention, (2) sparse performance data necessary to support selection of design approaches, and (3) a risk-adverse public which is unwilling to accept losses that were incurred in developing previous prescriptive design standards. The evolving standards often contain words such as: ''The manufacturer shall implement the measures and provide the information necessary to minimize the risk of endangering a person's safety or health''. This typically implies that the manufacturer or project manager must produce and document an acceptable level of risk. If accomplished using comprehensive and systematic process the demonstration project risk assessment can ease the transition to widespread commercialization. An approach to adequately evaluate and document the safety risk will be presented.

Coutts, D

2007-01-22

2

9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).  

Code of Federal Regulations, 2010 CFR

...Attending veterinarian and adequate veterinary care (dealers and exhibitors...Attending Veterinarian and Adequate Veterinary Care § 2.40 Attending veterinarian and adequate veterinary care (dealers and...

2010-01-01

3

9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).  

Code of Federal Regulations, 2010 CFR

...Attending veterinarian and adequate veterinary care (dealers and exhibitors...Attending Veterinarian and Adequate Veterinary Care § 2.40 Attending veterinarian and adequate veterinary care (dealers and...

2009-01-01

4

A high UV environment does not ensure adequate Vitamin D status  

NASA Astrophysics Data System (ADS)

Queensland has the highest rates of skin cancer in the world and due to the high levels of solar UV in this region it is assumed that incidental UV exposure should provide adequate vitamin D status for the population. This research was undertaken to test this assumption among healthy free-living adults in south-east Queensland, Australia (27S), at the end of winter. This research was approved by Queensland University of Technology Human Research Ethics Committee and conducted under the guidelines of the Declaration of Helsinki. 10.2% of the sample had serum vitamin D levels below 25nm/L (deficiency) and a further 32.3% had levels between 25nm/L and 50nm/L (insufficiency). Vitamin D deficiency and insufficiency can occur at the end of winter, even in sunny climates. The wintertime UV levels in south-east Queensland (UV index 4-6) are equivalent to summertime UV levels in northern regions of Europe and the USA. These ambient UV levels are sufficient to ensure synthesis of vitamin D requirements. We investigated individual UV exposure (through a self reported sun exposure questionnaire) and found correlations between exposure and Vitamin D status. Further research is needed to explore the interactions between the solar UV environment and vitamin D status, particularly in high UV environments, such as Queensland.

Kimlin, M. G.; Lang, C. A.; Brodie, A.; Harrison, S.; Nowak, M.; Moore, M. R.

2006-12-01

5

Role of primary health care in ensuring access to medicines.  

PubMed

To examine ways of ensuring access to health services within the framework of primary health care (PHC), since the goal of PHC to make universal health care available to all people has become increasingly neglected amid emerging themes of globalization, trade, and foreign policy. From a public health point of view, we argue that the premise of PHC can unlock barriers to health care services and contribute greatly to determining collective health through the promotion of universal basic health services. PHC has the most sophisticated and organized infrastructure, theories, and political principles, with which it can deal adequately with the issues of inequity, inequality, and social injustice which emerge from negative economic externalities and neo-liberal economic policies. Addressing these issues, especially the complex social and political influences that restrict access to medicines, may require the integration of different health initiatives into PHC. Based on current systems, PHC remains the only conventional health delivery service that can deal with resilient public health problems adequately. However, to strengthen its ability to do so, we propose the revitalization of PHC to incorporate scholarship that promotes human rights, partnerships, research and development, advocacy, and national drug policies. The concept of PHC can improve access; however, this will require the urgent interplay among theoretical, practical, political, and sociological influences arising from the economic, social, and political determinants of ill health in an era of globalization. PMID:20564760

Sambala, Evanson Z; Sapsed, Susan; Mkandawire, Mercy L

2010-06-01

6

The role of Taiwan's National Health Insurance program in influencing adequate prenatal care.  

PubMed

This paper reviews achievements in the utilization of prenatal care by pregnant women in Taiwan by analysing the 1989 and 1996 National Maternal and Infant Health Survey data. More precisely, it identifies and examines the programmatic and non-programmatic factors that influence prenatal care utilization, thus determining the areas that require further attention from the programe. Logistic regression results show that the adequacy of prenatal care use was significantly associated with the implementation of the National Health Insurance (NHI). A higher likelihood of adequate care utilization was found among women who were married or employed, had a higher level of education, had more experience with regard to pregnancy and were at higher risk in terms of obstetrics. The effect of facility choice showed variations after the implementation of the NHI programme. Prior to NHI, no differences were noted between the use of clinics and hospitals. After the implementation of NHI, on the other hand, women who received most of their care from clinics had a higher likelihood of receiving more adequate prenatal care than those who received care from hospitals. Regional differences in seeking adequate prenatal care were also evident. Mothers who were living in southern areas were less likely to receive adequate prenatal care despite the implementation of NHI. The Bureau of NHI, therefore, still needs to work on mechanisms to ensure that more attention is given to the distribution of its medical resources and that additional health care accessibility is provided to pregnant women in these areas. PMID:15239208

Liu, Tsai-Ching; Chen, Chin-Shyan

2004-01-01

7

Gender perspectives and quality of care: towards appropriate and adequate health care for women.  

PubMed

Gender inequalities in health are a consequence of the basic inequality between men and women in many societies. Despite the importance of socio-economic factors, women's health is also greatly affected by the extent and quality of health services available to them. Both non-governmental women's organizations and feminist health researchers have in recent years identified major gender inequalities in access to services and in the way men and women are treated by the health care system. Firstly, although women are major health care users as well as providers, they are under-represented in decision-making in health care. Secondly, no justice is done in general to existing differences in position and needs of women and men in defining quality of health care, i.e. gender aspects. Among women's organizations, there is general agreement that "gender sensitive health care should be available, accessible, affordable, appropriate and acceptable". In addition, health care for women should be adequate and not depart from a male model of health and illness. In this paper, we pay attention to inappropriate health care for women on the one hand, as illustrated by the increasing medicalization of women's reproductive life [menstruation, menopause, pregnancy and childbirth and (in)fertility]. On the other hand, we discuss gender bias in the management of serious, life-threatening diseases such as cardiovascular disease, lung cancer, and kidney failure, as a form of inadequate care. These examples are followed by a global vision on quality of care from a gender perspective, as formulated by the women's health care movement in the Netherlands and at the Fourth International Conference on Women in Beijing. If anything, the recommendations agreed upon in Beijing will have to ensure the consolidation and enhancement of good quality health care for women around the world. The final discussion, attempts to give some general recommendations for achieving more adequate (gender sensitive) and appropriate (non-medicalizing) health care for women. These recommendations pertain to health and health care research, policy, education, and organization from a women's perspective. PMID:8870135

Gijsbers van Wijk, C M; van Vliet, K P; Kolk, A M

1996-09-01

8

Ensuring smokers are adequately informed: reflections on consumer rights, manufacturer responsibilities, and policy implications  

PubMed Central

The right to information is a fundamental consumer value. Following the advent of health warnings, the tobacco industry has repeatedly asserted that smokers are fully informed of the risks they take, while evidence demonstrates widespread superficial levels of awareness and understanding. There remains much that tobacco companies could do to fulfil their responsibilities to inform smokers. We explore issues involved in the meaning of "adequately informed" smoking and discuss some of the key policy and regulatory implications. We use the idea of a smoker licensing schemeunder which it would be illegal to sell to smokers who had not demonstrated an adequate level of awarenessas a device to explore some of these issues. We also explore some of the difficulties that addiction poses for the notion that smokers might ever voluntarily assume the risks of smoking.

Chapman, S; Liberman, J

2005-01-01

9

9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).  

...Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 ...Attending Veterinarian and Adequate Veterinary Care 2.40 Attending veterinarian and adequate veterinary care (dealers and exhibitors). (a)...

2014-01-01

10

Factors affecting adequate prenatal care and the prenatal care visits of immigrant women to Taiwan.  

PubMed

This paper investigates prenatal care utilization, identifies factors affecting the adequacy of prenatal care, and explores the effect of adequate initial timing of prenatal care on total prenatal care visits among Taiwan new immigrant females. Data was obtained from the 2008 Prenatal Care Utilization among Taiwan New Immigrant Females Survey on women who either had at least one preschool-aged child or had delivered their infants but were still hospitalized (N = 476). The Adequacy of Prenatal Care Utilization Index was applied to rate the prenatal care adequacy. The logistic regression model was used to investigate factors associated with the adequacy of prenatal care utilization, and the linear regression model was estimated to identify the impact of influential factors on the prenatal care usage. Females' nationality, employment, and transportation convenience increased the likelihood of receiving adequate prenatal care. Having adequate initial timing of prenatal care was found to be positively related to the frequency of prenatal care visits. Prenatal care utilization can be affected by factors within the health care system and by characteristics of the population; therefore, a measure of prenatal care utilization cannot distinguish these factors but reflects the result of all of them in varying combinations. PMID:23065308

Liang, Yia-Wun; Chang, Hua-Pin; Lin, Yu-Hsiu; Lin, Long-Yau; Chen, Wen-Yi

2014-02-01

11

Systems and processes that ensure high quality care.  

PubMed

This is the second in a series of articles examining the components of good corporate governance. It considers how the structures and processes for quality governance can affect an organisation's ability to be assured about the quality of care. Complex information systems and procedures can lead to poor quality care, but sound structures and processes alone are insufficient to ensure good governance, and behavioural factors play a significant part in making sure that staff are enabled to provide good quality care. The next article in this series looks at how the information reporting of an organisation can affect its governance. PMID:23252087

Bassett, Sally; Westmore, Kathryn

2012-10-01

12

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.  

...Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and...Attending veterinarian and adequate veterinary care. (a) Each research facility shall...veterinarian who shall provide adequate veterinary care to its animals in compliance with...

2014-01-01

13

Caring for an Ageing Population: Are Physiotherapy Graduates Adequately Prepared?  

ERIC Educational Resources Information Center

In view of South African policy developments related to the care of older persons, it was necessary to examine the nature of the geriatrics content within physiotherapy curricula. A survey was conducted amongst final-year student physiotherapists at South African universities, together with content analysis of physiotherapy curricula. Very little

Ramklass, Serela S.; Butau, Anne; Ntinga, Nomusa; Cele, Nozipho

2010-01-01

14

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.  

Code of Federal Regulations, 2010 CFR

...and adequate veterinary care. (a) Each research facility shall...written program of veterinary care and regularly...visits to the research facility...however, That a research facility with...one Doctor of Veterinary...

2010-01-01

15

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.  

Code of Federal Regulations, 2010 CFR

...and adequate veterinary care. (a) Each research facility shall...written program of veterinary care and regularly...visits to the research facility...however, That a research facility with...one Doctor of Veterinary...

2009-01-01

16

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.  

Code of Federal Regulations, 2010 CFR

...and adequate veterinary care. (a) Each research facility shall...written program of veterinary care and regularly...visits to the research facility...however, That a research facility with...one Doctor of Veterinary...

2002-01-01

17

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.  

Code of Federal Regulations, 2010 CFR

...and adequate veterinary care. (a) Each research facility shall...written program of veterinary care and regularly...visits to the research facility...however, That a research facility with...one Doctor of Veterinary...

2000-01-01

18

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.  

Code of Federal Regulations, 2010 CFR

...and adequate veterinary care. (a) Each research facility shall...written program of veterinary care and regularly...visits to the research facility...however, That a research facility with...one Doctor of Veterinary...

2005-01-01

19

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.  

Code of Federal Regulations, 2010 CFR

...and adequate veterinary care. (a) Each research facility shall...written program of veterinary care and regularly...visits to the research facility...however, That a research facility with...one Doctor of Veterinary...

2011-01-01

20

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.  

Code of Federal Regulations, 2010 CFR

...and adequate veterinary care. (a) Each research facility shall...written program of veterinary care and regularly...visits to the research facility...however, That a research facility with...one Doctor of Veterinary...

2003-01-01

21

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.  

Code of Federal Regulations, 2010 CFR

...and adequate veterinary care. (a) Each research facility shall...written program of veterinary care and regularly...visits to the research facility...however, That a research facility with...one Doctor of Veterinary...

1998-01-01

22

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.  

Code of Federal Regulations, 2010 CFR

...and adequate veterinary care. (a) Each research facility shall...written program of veterinary care and regularly...visits to the research facility...however, That a research facility with...one Doctor of Veterinary...

1997-01-01

23

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.  

Code of Federal Regulations, 2010 CFR

...and adequate veterinary care. (a) Each research facility shall...written program of veterinary care and regularly...visits to the research facility...however, That a research facility with...one Doctor of Veterinary...

1999-01-01

24

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.  

Code of Federal Regulations, 2010 CFR

...and adequate veterinary care. (a) Each research facility shall...written program of veterinary care and regularly...visits to the research facility...however, That a research facility with...one Doctor of Veterinary...

2001-01-01

25

Ensuring competency in end-of-life care: controlling symptoms  

PubMed Central

Background Palliative medicine is assuming an increasingly important role in patient care. The Education for Physicians in End-of-life Care (EPEC) Project is an ambitious program to increase core palliative care skills for all physicians. It is not intended to transmit specialty level competencies in palliative care. Method The EPEC Curriculum was developed to be a comprehensive syllabus including trainer notes, multiple approaches to teaching the material, slides, and videos of clinical encounters to trigger discussion are provided. The content was developed through a combination of expert opinion, participant feedback and selected literature review. Content development was guided by the goal of teaching core competencies not included in the training of generalist and non-palliative medicine specialist physicians. Results Whole patient assessment forms the basis for good symptom control. Approaches to the medical management of pain, depression, anxiety, breathlessness (dyspnea), nausea/vomiting, constipation, fatigue/weakness and the symptoms common during the last hours of life are described. Conclusion While some physicians will have specialist palliative care services upon which to call, most in the world will need to provide the initial approaches to symptom control at the end-of-life.

Ferris, Frank D; von Gunten, Charles F; Emanuel, Linda L

2002-01-01

26

Actions Needed to Ensure Scientific and Technical Information is Adequately Reviewed at Goddard Space Flight Center, Johnson Space Center, Langley Research Center, and Marshall Space Flight Center  

NASA Technical Reports Server (NTRS)

This audit was initiated in response to a hotline complaint regarding the review, approval, and release of scientific and technical information (STI) at Johnson Space Center. The complainant alleged that Johnson personnel conducting export control reviews of STI were not fully qualified to conduct those reviews and that the reviews often did not occur until after the STI had been publicly released. NASA guidance requires that STI, defined as the results of basic and applied scientific, technical, and related engineering research and development, undergo certain reviews prior to being released outside of NASA or to audiences that include foreign nationals. The process includes technical, national security, export control, copyright, and trade secret (e.g., proprietary data) reviews. The review process was designed to preclude the inappropriate dissemination of sensitive information while ensuring that NASA complies with a requirement of the National Aeronautics and Space Act of 1958 (the Space Act)1 to provide for the widest practicable and appropriate dissemination of information resulting from NASA research activities. We focused our audit on evaluating the STI review process: specifically, determining whether the roles and responsibilities for the review, approval, and release of STI were adequately defined and documented in NASA and Center-level guidance and whether that guidance was effectively implemented at Goddard Space Flight Center, Johnson Space Center, Langley Research Center, and Marshall Space Flight Center. Johnson was included in the review because it was the source of the initial complaint, and Goddard, Langley, and Marshall were included because those Centers consistently produce significant amounts of STI.

2008-01-01

27

Ensuring Patient Safety in Care Transitions: An Empirical Evaluation of a Handoff Intervention Tool  

PubMed Central

Successful handoffs ensure smooth, efficient and safe patient care transitions. Tools and systems designed for standardization of clinician handoffs often focuses on ensuring the communication activity during transitions, with limited support for preparatory activities such as information seeking and organization. We designed and evaluated a Handoff Intervention Tool (HAND-IT) based on a checklist-inspired, body system format allowing structured information organization, and a problem-case narrative format allowing temporal description of patient care events. Based on a pre-post prospective study using a multi-method analysis we evaluated the effectiveness of HAND-IT as a documentation tool. We found that the use of HAND-IT led to fewer transition breakdowns, greater tool resilience, and likely led to better learning outcomes for less-experienced clinicians when compared to the current tool. We discuss the implications of our results for improving patient safety with a continuity of care-based approach.

Abraham, Joanna; Kannampallil, Thomas; Patel, Bela; Almoosa, Khalid; Patel, Vimla L.

2012-01-01

28

Ensuring emergency medicine performance standards for stroke and transient ischemic attack care.  

PubMed

This article reviews emergency medicine evaluation and management performance standards for cerebrovascular event patients and provides a practical process for ensuring high quality care. Areas of practice that most frequently generate questions and controversy are highlighted. The term "cerebrovascular event" is used throughout the text when both stroke and transient ischemic attack apply to the discussion. Recommendations are based on literature review and the author's experience with the successful certification of multiple primary stroke centers and appointments in neurology, emergency medicine, and nursing specialties. PMID:18655941

LaMonte, Marian P

2008-08-01

29

Pressure sores and specialty beds: cost containment and ensurance of quality care.  

PubMed

The monitoring of specialty bed use by the certified ET nurse and the NQAC has been in full implementation since June 1989 with significant yearly cost reductions in the use of specialty care beds. The $238,000 costs from fiscal year 1987 (July 1986 to June 30, 1987) were reduced to $60,000 in fiscal year 1989 with an approximate cost savings of 75%. Additional cost savings have been achieved through the implementation of the other recommendations in this study. Although cost savings would have resulted from a stricter policy in specialty bed approval and utilization alone, such savings probably would have affected the quality of patient care. This project allowed nursing and medical staff members to work with the departments of Administration and Finance to ensure that patient care would not be significantly affected. Significant cost savings were obtained through use of the five interventions that are indicated in the introduction. Nursing was permitted to examine its own practice and implement changes in documentation, nursing standards, skin-care products, policies and procedures, and in other areas to strive for clinical excellence as monitored through its quality assurance plan. The addition of a certified ET nurse to coordinate a hospital-wide multidisciplinary approach that is consistent with and clinically relevant to current practice standards is essential to a successful program for pressure-sore prevention and management within the current reimbursement systems. PMID:1954298

Lubin, B S; Powell, T

1991-01-01

30

Ensuring tuberculosis infection control to support greater involvement of people living with HIV in health care.  

PubMed

Health care workers (HCWs) in high TB burden countries bear significant risks of being infected with Mycobacterium tuberculosis and developing TB disease through their work. In recent years, an increasing number of people living with HIV (PLHIV) are taking part in delivering HIV and other health services in resource-limited settings with high TB burden. The greater involvement of PLHIV in health service delivery has many beneficial consequences on individuals and health systems, however, the involvement creates considerable opportunities for them to be exposed to patients with infectious TB disease. Due to their immunodeficiency, PLHIV are far more likely to develop active TB following the infection. Available evidence and recently revised WHO policy guidance on TB infection control suggest simple, predominantly administrative control measures are feasible and effective in reducing the infection. Nevertheless, many countries are still at the early stage of developing infection control policies. We call for evidence-based infection control measures in order to ensure a safe working environment for PLHIV in support of their greater involvement in health care. More research is needed to strengthen knowledge on TB infection risks amongst PLHIV through involvement in service delivery, and optimal interventions to reduce it. PMID:24038493

Kato, Masaya; Osuga, Katsunori; Fujita, Masami; Jimba, Masamine

2011-12-01

31

The role that graduate medical education must play in ensuring health equity and eliminating health care disparities.  

PubMed

Despite the 2002 Institute of Medicine report that described the moral and financial impact of health care disparities and the need to address them, it is evident that health care disparities persist. Recommendations for addressing disparities include collecting and reporting data on patient race and ethnicity, supporting language interpretation services, increasing awareness of health care disparities through education, requiring cultural competency training for all health care professionals, and increasing diversity among those delivering health care. The Accreditation Council on Graduate Medical Education places strong emphasis on graduate medical education's role in eliminating health care disparities by asking medical educators to objectively evaluate and report on their trainees' ability to practice patient-centered, culturally competent care. Moreover, one of the objectives of the Accreditation Council on Graduate Medical Education Clinical Learning Environment Review visits as part of the Next Accreditation System is to identify how sponsoring institutions engage residents and fellows in the use of data to improve systems of care, reduce health care disparities, and improve patient outcomes. Residency and fellowship programs should ensure the delivery of meaningful curricula on cultural competency and health care disparities, for which there are numerous resources, and ensure resident assessment of culturally competent care. Moreover, training programs and institutional leadership need to collaborate on ensuring data collection on patient satisfaction, outcomes, and quality measures that are broken down by patient race, cultural identification, and language. A diverse physician workforce is another strategy for mitigating health care disparities, and using strategies to enhance faculty diversity should also be a priority of graduate medical education. Transparent data about institutional diversity efforts should be provided to interested medical students, residents, and faculty. Graduate medical education has a clear charge to ensure a generation of physicians who are firmly grounded in the principles of practicing culturally competent care and committed to the reduction of health care disparities. PMID:24708150

Maldonado, Maria E; Fried, Ethan D; DuBose, Thomas D; Nelson, Consuelo; Breida, Margaret

2014-05-01

32

Ensuring the Service Quality of Long-Term Care Provided through Competitive Markets: The Experience of Care Workers' Training in Japan  

Microsoft Academic Search

Ensuring the service quality of long-term care provided through competitive markets is a major concern among the governments of OECD members. The public officials in these nations recognise the importance of care workers' training to address this issue. However, most of them have hesitated to introduce comprehensive training due to financial constraints. Analysing the experience of Japan, this paper reveals

Yoshihiko Kadoya

2012-01-01

33

HealthCare Reform in Japan: Controlling Costs, Improving Quality and Ensuring Equity  

Microsoft Academic Search

Japans health-care system has provided universal access to care and contributed to the outstanding health status of the Japanese. Public spending has been kept below the OECD average through high co-payment rates and reductions in medical fees. However, with continued upward pressure on expenditure, in part due to rapid population ageing, reforms are needed to limit spending increases through greater

Randall S. Jones

2009-01-01

34

Public long-term care insurance: a way to ensure sustainable continuity of care for frail older people.  

PubMed

A necessary component of the prescribed continuing care act should be the creation of a long-term care insurance program in Canada. This social innovation has been implemented in many countries in recent decades to address the aging of the population and associated pandemic of chronic diseases. A specific autonomy insurance fund would have to be created and funded through transfers of current funding for long-term care, tax credits for disabled individuals and substantial new investment to make the shift from institutional to home care. Following a standardized assessment by case managers, an autonomy support benefit would be determined to fund "in kind" public or private services or a "cash-for-care" allowance for older people to purchase services. Case managers would be responsible for coordinating the care, controlling the quality of services and reassessing needs according to changes in individuals' conditions. Funding reform of long-term care would prioritize home care and optimize the functioning of integrated care to improve support for frail older people. PMID:21464632

Hbert, Rjean

2011-01-01

35

Mentoring and social skills training: ensuring better outcomes for youth in foster care.  

PubMed

Youth in foster care face significant life challenges that make it more likely that they will face negative outcomes (i.e., school failure, homelessness, and incarceration). While the reason(s) for out-of-home placement (i.e., family violence, abuse, neglect and/or abandonment) provide some context for negative outcomes, such negative outcomes need not be a foregone conclusion. In fact, interventions created to serve at-risk youth could ostensibly address the needs of youth in foster care as well, given that they often face similar social, emotional, and other challenges. Specifically, the author posits that supporting foster care youth through the use ofmentoring and social skills training could reduce the negative outcomes far too common for many of these youth. PMID:21950175

Williams, Charles A

2011-01-01

36

Canada's Compassionate Care Benefit: Is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?  

PubMed Central

Background An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB) - a contributory benefits social program aimed at informal P/EOL caregivers - operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. Methods As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. Results Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. Conclusions This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the potential it holds for serving as one public health response to caregiver burden that forms part of a healthy public policy that addresses the determinants of this burden.

2011-01-01

37

Infant Day Care and the Family: Regulatory Strategies to Ensure Parent Participation.  

ERIC Educational Resources Information Center

This paper examines federal requirements which promote parent involvement in day care, particularly in services for children under 3 years of age. The rationale for parent participation in poverty programs for children is discussed from three perspectives--political, economic, and socio-psychological--and Project Head Start's application of this

Fein, Greta G.

38

Mentoring and Social Skills Training: Ensuring Better Outcomes for Youth in Foster Care  

ERIC Educational Resources Information Center

Youth in foster care face significant life challenges that make it more likely that they will face negative outcomes (i.e., school failure, homelessness, and incarceration). While the reason(s) for out-of-home placement (i.e., family violence, abuse, neglect and/or abandonment) provide some context for negative outcomes, such negative outcomes

Williams, Charles A.

2011-01-01

39

Ensuring intercultural maternal health care for Mayan women in Guatemala: a qualitative assessment.  

PubMed

Indigenous (Mayan) women in Guatemala experience a disproportionate burden of maternal mortality and morbidity, as well as institutional failures to respect their rights. The Guatemalan Ministry of Health has started to offer 'intercultural' services that respect Mayan obstetric practices and integrate them with biomedical care. We purposefully selected 19 secondary-level public health facilities of 9 departments that provided maternal healthcare to indigenous women. We carried out semi-structured interviews with biomedical providers (44), Mayan midwives or comadronas (45), and service users (18), exploring the main characteristics of intercultural care. We found that most facilities initiated the implementation of culturally appropriate services, such as accompaniment by a comadrona or family member, use the traditional teas or choosing the birthing position, but they still lacked standardisation. Comadronas generally felt excluded from the health system, although most biomedical providers reported that they were making important strides to be respectful and inclusive. Most users wanted the option of culturally appropriate services but typically did not receive them. In the health facilities, biomedicine is still the dominant discourse. Efforts at offering intercultural care still need strengthening and further monitoring. Involvement and participation of comadronas and indigenous women is key to moving forward to true intercultural services. PMID:23713447

van Dijk, Marieke; Ruiz, Marta Julia; Letona, Diana; Garca, Sandra G

2013-01-01

40

Adequate Prenatal Care Reduces the Risk of Adverse Pregnancy Outcomes in Women with History of Infertility: A Nationwide Population-Based Study  

PubMed Central

Objectives To investigate the effects of various measures of prenatal care on adverse pregnancy outcomes in women with a history of infertility. Study Design A retrospective cohort study. Methods Data were derived by linking 2 large nationwide population-based datasets, the National Health Insurance Research Database and Taiwan Birth Certificate Registry. The study sample included 15,056 women with an infertility diagnosis and 60,224 randomly selected women without infertility matched to the study sample by maternal age. A conditional logistic regression analysis was performed for the analysis. Results Women diagnosed with infertility respectively had 1.39 (95% CI, 1.06~1.83), 1.15 (95% CI, 1.08~1.24), 1.13 (95% CI, 1.08~1.18), and 1.08 (95% CI, 1.05~1.12) higher odds of having very low birth weight (VLBW) babies, preterm births, labor complications, and cesarean sections (CSs) compared to women without infertility. Inadequate numbers of total and major prenatal visits and late initiation of prenatal care increased the risks of adverse pregnancy outcomes in women with infertility, especially the risk of a VLBW baby. However, no significant associations were found for the risks of adverse birth outcomes in infertile women with adequate prenatal care compared to fertile women with adequate care. Conclusions Study findings suggest that adequate prenatal care can reduce the risk of adverse pregnancy outcomes in women with infertility.

Alibekova, Raushan; Huang, Jian-Pei; Chen, Yi-Hua

2013-01-01

41

A New Approach to Ensuring Oral Health Care for People Living With HIV/AIDS: The Dental Case Manager  

PubMed Central

Introduction The American Dental Association has identified several barriers to adequate dental care for vulnerable populations, including appropriate case management. The objective of this study was to examine the perceptions, attitudes, and beliefs of dental patients living with HIV/AIDS on the role and value of the dental case manager (DCM) and the effect of DCM services on their oral or overall health. Methods We used a qualitative descriptive study design and focus groups. Twenty-five people who had received DCM services on Cape Cod, Massachusetts, attended 1 of 5 focus groups in 2009 and 2010. Digital recordings of the groups were transcribed verbatim. Textual data were categorized using directed qualitative content analysis techniques. We identified major themes and representative quotes. Results The following themes emerged from discussions on the DCMs role: being available, knowledgeable about clients and insurance, and empathetic; increasing access; and providing comfort. Most participants credited their oral and overall health improvements to the DCM. All participants believed that the DCM was a valuable addition to the clinic and noted that other at-risk populations, including the elderly and developmentally disabled, likely would benefit from working with a DCM. Conclusion The addition of a DCM facilitated access to dental care among this sample of people living with HIV/AIDS, providing them with an advocate and resulting in self-reported improvements to oral and overall health.

Cashman, Suzanne B.; McDonald, Anne; Graves, John R.

2012-01-01

42

Determining unmet, adequately met, and overly met needs for health care and services for persons living with HIV/AIDS in Mississippi.  

PubMed

A statewide needs assessment of persons living with HIV/AIDS (PLWHA) was conducted to determine what is known about access to care, utilization of services, and perceived barriers to receiving care and services. Our objective was to determine which needs were being met or unmet among PLWHA in Mississippi to provide a better understanding of how effectively to allocate funding to provide for the needs of that group. In this cross-sectional study, a true random sample of PLWHA in Mississippi was interviewed in 2005-2006. Questions were asked to identify opinions about respondents' experiences with 23 health care services and 30 public or private assistance services. The kappa statistic was used to measure agreement between level of services needed and level of services provided. Services with the lowest kappa scores revealed which services were being either mostly unmet, or even overly met. Greatest service needs were HIV viral load test, Pap smear, CD4/T-cell count test, and medication for HIV/AIDS, which were reasonably well met. The most significantly unmet needs were dental care and dental exams, eye care and eye exams, help paying for housing, subsidized housing assistance, mental health therapy or counseling, access to emotional support groups, and job placement or employment. Overly met services included medical care at a physician's office or clinic and free condoms. This study identified needs perceived to be significantly unmet by PLWHA, as well as areas that were perceived to be adequately or overly met. This information may be used to target areas with the greatest impact for improvement and provide insight into how to effectively allocate health care resources and public/private assistance. PMID:23252519

Krause, Denise D; May, Warren L; Butler, Kenneth R

2013-08-01

43

Considering Accreditation in Gerontology: The Importance of Interprofessional Collaborative Competencies to Ensure Quality Health Care for Older Adults  

ERIC Educational Resources Information Center

The health care needs of older adults can be complex and multifaceted. Safe, effective, equitable, and person-centered service provision relies on skilled interprofessional, team-based practice. Too often, students seeking a career specializing in gerontology are not exposed to such interprofessional, team-based learning and practice during their

Goldberg, Lynette R.; Koontz, Jennifer Scott; Rogers, Nicole; Brickell, Jean

2012-01-01

44

Considering accreditation in gerontology: the importance of interprofessional collaborative competencies to ensure quality health care for older adults.  

PubMed

The health care needs of older adults can be complex and multifaceted. Safe, effective, equitable, and person-centered service provision relies on skilled interprofessional, team-based practice. Too often, students seeking a career specializing in gerontology are not exposed to such interprofessional, team-based learning and practice during their coursework. This article details the core interprofessional collaborative competencies that need to be an integral component of any program providing quality education on issues in aging. PMID:22289069

Goldberg, Lynette R; Koontz, Jennifer Scott; Rogers, Nicole; Brickell, Jean

2012-01-01

45

Stroke outcomes measures must be appropriately risk adjusted to ensure quality care of patients: a presidential advisory from the American Heart Association/American Stroke Association.  

PubMed

Because stroke is among the leading causes of death, disability, hospitalizations, and healthcare expenditures in the United States, there is interest in reporting outcomes for patients hospitalized with acute ischemic stroke. The American Heart Association/American Stroke Association, as part of its commitment to promote high-quality, evidence-based care for cardiovascular and stroke patients, fully supports the development of properly risk-adjusted outcome measures for stroke. To accurately assess and report hospital-level outcomes, adequate risk adjustment for case mix is essential. During the development of the Centers for Medicare & Medicaid Services 30-day stroke mortality and 30-day stroke readmission measures, concerns were expressed that these measures were not adequately designed because they do not include a valid initial stroke severity measure, such as the National Institutes of Health Stroke Scale. These outcome measures, as currently constructed, may be prone to mischaracterizing the quality of stroke care being delivered by hospitals and may ultimately harm acute ischemic stroke patients. This article details (1) why the Centers for Medicare & Medicaid Services acute ischemic stroke outcome measures in their present form may not provide adequate risk adjustment, (2) why the measures as currently designed may lead to inaccurate representation of hospital performance and have the potential for serious unintended consequences, (3) what activities the American Heart Association/American Stroke Association has engaged in to highlight these concerns to the Centers for Medicare & Medicaid Services and other interested parties, and (4) alternative approaches and opportunities that should be considered for more accurately risk-adjusting 30-day outcomes measures in patients with ischemic stroke. PMID:24523036

Fonarow, Gregg C; Alberts, Mark J; Broderick, Joseph P; Jauch, Edward C; Kleindorfer, Dawn O; Saver, Jeffrey L; Solis, Penelope; Suter, Robert; Schwamm, Lee H

2014-05-01

46

Sustaining a "culture of silence" in the neonatal intensive care unit during nonemergency situations: A grounded theory on ensuring adherence to behavioral modification to reduce noise levels  

PubMed Central

The aim of this study was to generate a substantive theory explaining how the staff in a resource-limited neonatal intensive care unit (NICU) of a developing nation manage to ensure adherence to behavioral modification components of a noise reduction protocol (NsRP) during nonemergency situations. The study was conducted after implementation of an NsRP in a level III NICU of south India. The normal routine of the NICU is highly dynamic because of various categories of staff conducting clinical rounds followed by care-giving activities. This is unpredictably interspersed with very noisy emergency management of neonates who suddenly fall sick. In-depth interviews were conducted with 36 staff members of the NICU (20 staff nurses, six nursing aides, and 10 physicians). Group discussions were conducted with 20 staff nurses and six nursing aides. Data analysis was done in line with the reformulated grounded theory approach, which was based on inductive examination of textual information. The results of the analysis showed that the main concern was to ensure adherence to behavioral modification components of the NsRP. This was addressed by using strategies to sustain a culture of silence in NICU during nonemergency situations (core category). The main strategies employed were building awareness momentum, causing awareness percolation, developing a sense of ownership, expansion of caring practices, evolution of adherence, and displaying performance indicators. The culture of silence reconditions the existing staff and conditions new staff members joining the NICU. During emergency situations, a noisy culture prevailed because of pragmatic neglect of behavioral modification when life support overrode all other concerns. In addition to this, the process of operant conditioning should be formally conducted once every 18 months. The results of this study may be adapted to create similar strategies and establish context specific NsRPs in NICUs with resource constraints.

Swathi, S.; Ramesh, A.; Nagapoornima, M.; Fernandes, Lavina M.; Jisina, C.; Suman Rao, P. N.

2014-01-01

47

Sustaining a "culture of silence" in the neonatal intensive care unit during nonemergency situations: a grounded theory on ensuring adherence to behavioral modification to reduce noise levels.  

PubMed

The aim of this study was to generate a substantive theory explaining how the staff in a resource-limited neonatal intensive care unit (NICU) of a developing nation manage to ensure adherence to behavioral modification components of a noise reduction protocol (NsRP) during nonemergency situations. The study was conducted after implementation of an NsRP in a level III NICU of south India. The normal routine of the NICU is highly dynamic because of various categories of staff conducting clinical rounds followed by care-giving activities. This is unpredictably interspersed with very noisy emergency management of neonates who suddenly fall sick. In-depth interviews were conducted with 36 staff members of the NICU (20 staff nurses, six nursing aides, and 10 physicians). Group discussions were conducted with 20 staff nurses and six nursing aides. Data analysis was done in line with the reformulated grounded theory approach, which was based on inductive examination of textual information. The results of the analysis showed that the main concern was to ensure adherence to behavioral modification components of the NsRP. This was addressed by using strategies to "sustain a culture of silence in NICU during nonemergency situations" (core category). The main strategies employed were building awareness momentum, causing awareness percolation, developing a sense of ownership, expansion of caring practices, evolution of adherence, and displaying performance indicators. The "culture of silence" reconditions the existing staff and conditions new staff members joining the NICU. During emergency situations, a "noisy culture" prevailed because of pragmatic neglect of behavioral modification when life support overrode all other concerns. In addition to this, the process of operant conditioning should be formally conducted once every 18 months. The results of this study may be adapted to create similar strategies and establish context specific NsRPs in NICUs with resource constraints. PMID:24646472

Swathi, S; Ramesh, A; Nagapoornima, M; Fernandes, Lavina M; Jisina, C; Rao, P N Suman; Swarnarekha, A

2014-01-01

48

Sunscreens: obtaining adequate photoprotection.  

PubMed

Adequate photoprotection plays a paramount role in reducing the burden of both photoaging and photocarcinogenesis. The scope of photoprotective strategies employed by the public, from most to least effective, includes: sun avoidance, seeking shade, the use of protective clothing, and the application of sunscreen. Among these options, sunscreen use remains the strategy most frequently employed by the public--a reversal of the preferred order of photoprotection. Given this trend, it is clear why sunscreens invariably take center stage in any discussion regarding obtaining adequate photoprotection. PMID:22913442

Burnett, Mark E; Hu, Judy Y; Wang, Steven Q

2012-01-01

49

Is health insurance enough? A usual source of care may be more important to ensure a child receives preventive health counseling.  

PubMed

Despite the promise of expanded health insurance coverage for children in the United States, a usual source of care (USC) may have a bigger impact on a child's receipt of preventive health counseling. We examined the effects of insurance versus USC on receipt of education and counseling regarding prevention of childhood injuries and disease. We conducted secondary analyses of 2002-2006 data from a nationally-representative sample of child participants (?17 years) in the Medical Expenditure Panel Survey (n = 49,947). Children with both insurance and a USC had the lowest rates of missed counseling, and children with neither one had the highest rates. Children with only insurance were more likely than those with only a USC to have never received preventive health counseling from a health care provider regarding healthy eating (aRR 1.21, 95% CI 1.12-1.31); regular exercise (aRR 1.06, 95% CI 1.01-1.12), use of car safety devices (aRR 1.10, 95% CI 1.03-1.17), use of bicycle helmets (aRR 1.11, 95% CI 1.05-1.18), and risks of second hand smoke exposure (aRR 1.12, 95% CI 1.04-1.20). A USC may play an equally or more important role than insurance in improving access to health education and counseling for children. To better meet preventive counseling needs of children, a robust primary care workforce and improved delivery of care in medical homes must accompany expansions in insurance coverage. PMID:21373938

DeVoe, Jennifer E; Tillotson, Carrie J; Wallace, Lorraine S; Lesko, Sarah E; Pandhi, Nancy

2012-02-01

50

Is Health Insurance Enough? A Usual Source of Care May be More Important to Ensure a Child Receives Preventive Health Counseling  

PubMed Central

Objectives Despite the promise of expanded health insurance coverage for children in the United States, a usual source of care (USC) may have a bigger impact on a childs receipt of preventive health counseling. We examined the effects of insurance versus USC on receipt of education and counseling regarding prevention of childhood injuries and disease. Methods We conducted secondary analyses of 2002-2006 data from a nationally-representative sample of child participants (?17 years) in the Medical Expenditure Panel Survey (n=49,947). Results. Children with both insurance and a USC had the lowest rates of missed counseling, and children with neither one had the highest rates. Children with only insurance were more likely than those with only a USC to have never received preventive health counseling from a health care provider regarding healthy eating (aRR 1.21, 95% CI 1.12-1.31); regular exercise (aRR 1.06, 95% CI 1.01-1.12), use of car safety devices (aRR 1.10, 95% CI 1.03-1.17), use of bicycle helmets (aRR 1.11, 95% CI 1.05-1.18), and risks of second hand smoke exposure (aRR 1.12, 95% CI 1.04-1.20). Conclusions A USC may play an equally or more important role than insurance in improving access to health education and counseling for children. To better meet preventive counseling needs of children, a robust primary care workforce and improved delivery of care in medical homes must accompany expansions in insurance coverage.

Tillotson, Carrie J.; Wallace, Lorraine S.; Lesko, Sarah E.; Pandhi, Nancy

2011-01-01

51

Ensuring safe access to medication for palliative care while preventing prescription drug abuse: innovations for American inner cities, rural areas, and communities overwhelmed by addiction  

PubMed Central

This article proposes and develops novel components of community-oriented programs for creating and affording access to safe medication dispensing centers in existing retail pharmacies and in permanent or travelling pharmacy clinics that are guarded by assigned or off-duty police officers. Pharmacists at these centers would work with police, medical providers, social workers, hospital administrators, and other professionals in: planning and overseeing the safe storage of controlled substance medications in off-site community safe-deposit boxes; strengthening communication and cooperation with the prescribing medical provider; assisting the prescribing medical provider in patient monitoring (checking the state prescription registry, providing pill counts and urine samples); expanding access to lower-cost, and in some cases, abuse-resistant formulations of controlled substance medications; improving transportation access for underserved patients and caregivers to obtain prescriptions; and integrating community agencies and social networks as resources for patient support and monitoring. Novel components of two related community-oriented programs, which may be hosted outside of safe medication dispensing centers, are also suggested and described: (1) developing medication purchasing cooperatives (ie, to help patients, families, and health institutions afford the costs of medications, including tamper-or abuse-resistant/deterrent drug formulations); and (2) expanding the role of inner-city methadone maintenance treatment programs in palliative care (ie, to provide additional patient monitoring from a second treatment team focusing on narcotics addiction, and potentially, to serve as an untapped source of opioid medication for pain that is less subject to abuse, misuse, or diversion).

Francoeur, Richard B

2011-01-01

52

Ensuring Quality in a Virtual Reference Environment  

ERIC Educational Resources Information Center

Soon after AskALibrarian, Florida's Statewide Virtual Reference Desk, began to offer Chat Reference to the public in 2003, a Quality Assurance Workgroup was established to ensure that the service patrons received would be friendly, accurate, and adequate. To make certain that best practices were used in answering the real time questions, two

Barbier, Pat; Ward, Joyce

2004-01-01

53

Minimum Standards for Tribal Child Care Centers.  

ERIC Educational Resources Information Center

These minimum standards for tribal child care centers are being issued as guidance. An interim period of at least 1 year will allow tribal agencies to identify implementation issues, ensure that the standards reflect tribal needs, and guarantee that the standards provide adequate protection for children. The standards will be issued as regulations

Administration on Children, Youth, and Families (DHHS), Washington, DC. Child Care Bureau.

54

"Whatever My Mother Wants": Barriers to Adequate Pain Management  

PubMed Central

Abstract Opioids are the preferred medications to treat cancer pain; however, several barriers to cancer pain management exist, including those related to the patient, health care provider, and family caregiver. We describe one such situation in which a family member prevents the patient from receiving adequate pain management at the end of life despite interdepartmental and interdisciplinary efforts. This case highlights the importance of understanding and addressing fears regarding opioid use and implementing an integrated approach including oncologists and palliative care physicians, along with early referrals to palliative care.

Yennurajalingam, Sriram; Bruera, Eduardo

2013-01-01

55

"Whatever my mother wants": barriers to adequate pain management.  

PubMed

Opioids are the preferred medications to treat cancer pain; however, several barriers to cancer pain management exist, including those related to the patient, health care provider, and family caregiver. We describe one such situation in which a family member prevents the patient from receiving adequate pain management at the end of life despite interdepartmental and interdisciplinary efforts. This case highlights the importance of understanding and addressing fears regarding opioid use and implementing an integrated approach including oncologists and palliative care physicians, along with early referrals to palliative care. PMID:22946542

Reddy, Akhila; Yennurajalingam, Sriram; Bruera, Eduardo

2013-06-01

56

Ensuring High Quality Research Services.  

ERIC Educational Resources Information Center

This paper discusses ensuring high quality research services that meet client needs, based on experiences at the Research and Information Services of the Ontario Legislative Library (Canada). The first section is an introduction that provides an overview of the Research and Information Services and summarizes factors related to quality control.

Gardner, Bob

57

Children in State Care: Ensuring Their Protection and Support. Hearing before the Select Committee on Children, Youth, and Families. House of Representatives, Ninety-Ninth Congress, Second Session (Washington, DC, September 25, 1986).  

ERIC Educational Resources Information Center

This document contains witnesses' testimonies and prepared statements from the Congressional hearing called to examine the living conditions of children in state care. Parents, youth workers, legal advocates, program administrators and state officials discuss the cost effectiveness of community-based services and the effectiveness of various

Congress of the U.S., Washington, DC. House Select Committee on Children, Youth, and Families.

58

Ensuring integrity in biomedical publication.  

PubMed

The author discusses the role of the editors of scientific journals in ensuring the high quality and integrity of the research they publish. Woolf urges editorial leadership in such areas as defining and enforcing standards for responsible authorship; establishing policies for data retention and availability, for handling allegations of fraud, and for publishing retractions; and enforcing peer review. She concludes that editors can be instrumental in alerting authors to questionable data and research practices. PMID:3682141

Woolf, P K

1987-12-18

59

Overcoming issues related adoption usability requires concerted effort ensure personal health records adopt standards based approach service development implementation evidence based agenda research efficacy realizable benefits supported health care sector. particularly important institutions still tend view pars aspect patient-entered care considering longer term benefits information integration focus patient owned data. becomes increasingly important healthcare demands information available providers AND -only OR patient OR is OR form OR patient OR understand OR contribute OR to OR possibly OR control OR directly OR move OR providers OR other OR care OR settings  

EPA Pesticide Factsheets

Did you mean: Overcoming issues related adoption usability requires concerted effort ensure personal health records adopt standards based approach service development implementation evidence based agenda research efficacy realizable benefits supported health care sector. particularly important institutions still tend view pars aspect patient-entered care considering longer term benefits information integration focus patient owned data. becomes increasingly important healthcare demands information available providers AND -only OR patient OR is OR form OR patient OR understand OR contribute OR to OR possibly OR control OR directly OR move OR providers OR other OR care OR settings ?

60

Asbestos/NESHAP adequately wet guidance  

SciTech Connect

The Asbestos NESHAP requires facility owners and/or operators involved in demolition and renovation activities to control emissions of particulate asbestos to the outside air because no safe concentration of airborne asbestos has ever been established. The primary method used to control asbestos emissions is to adequately wet the Asbestos Containing Material (ACM) with a wetting agent prior to, during and after demolition/renovation activities. The purpose of the document is to provide guidance to asbestos inspectors and the regulated community on how to determine if friable ACM is adequately wet as required by the Asbestos NESHAP.

Shafer, R.; Throwe, S.; Salgado, O.; Garlow, C.; Hoerath, E.

1990-12-01

61

42 CFR 438.207 - Assurances of adequate capacity and services.  

Code of Federal Regulations, 2013 CFR

...to demonstrate that it complies with the following requirements: (1) Offers an appropriate range of preventive, primary care, and specialty services that is adequate for the anticipated number of enrollees for the service area. (2)...

2013-10-01

62

42 CFR 438.207 - Assurances of adequate capacity and services.  

Code of Federal Regulations, 2010 CFR

...to demonstrate that it complies with the following requirements: (1) Offers an appropriate range of preventive, primary care, and specialty services that is adequate for the anticipated number of enrollees for the service area. (2)...

2010-10-01

63

42 CFR 438.207 - Assurances of adequate capacity and services.  

Code of Federal Regulations, 2011 CFR

...to demonstrate that it complies with the following requirements: (1) Offers an appropriate range of preventive, primary care, and specialty services that is adequate for the anticipated number of enrollees for the service area. (2)...

2011-10-01

64

Knowledge about Medical Genetics in Health Care  

Microsoft Academic Search

Effective genetic services depend upon co-operation between medical geneticists and many different non-geneticist professionals to ensure that the most appropriate patients are referred to geneticists and that those that require long-term care receive it. Important determinants of the quality of genetic services are the knowledge that professionals have about clinical genetics and the equitable distribution of adequately resourced genetic centres.

Rodney Harris; Hilary Harris

1999-01-01

65

Predictors of Adequate Correction Following Vision Screening Failure  

PubMed Central

Purpose To determine if compliance with referral one year after vision screening failure was associated with care model, demographic, or ocular factors. Methods Data were analyzed from 798 children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study with habitual logMAR visual acuity (VA) ? 0.26 (20/40 +2 or worse) in either eye due to uncorrected or under-corrected refractive error and who returned the following year. The parents of 492 children failing in TX and CA were sent letters indicating the need for a complete vision exam (screening model), while 306 children seen primarily in AZ and AL received a free complete exam and eyeglasses if needed (complete care model). Presenting to follow-up with adequate correction (logMAR < 0.26) in each eye was considered compliant. Logistic regression models for compliance were fit to assess if care model, ethnicity, sex, age, uncorrected logMAR in the better eye, or parental income, education or myopia were predictors. Results Overall compliance was 28%. Age (p=0.01, odds ratio (OR) = 1.12) and uncorrected logMAR (p<0.001, OR = 1.13) were associated with compliance but care model, ethnicity, and sex were not. Among the 447 children on whom data on parental factors was available, 27% were compliant. In this model, age, ethnicity, sex, parental income, parental education and parental myopia were not associated with compliance, but uncorrected logMAR (p=0.005; OR = 1.13) was predictive. An interaction between unaided VA and care model predicted improved compliance with poorer unaided VA in the complete care model. Conclusions Expensive complete care screening programs may not improve compliance over typical notification and referral screening protocols in school-aged children, unless unaided VA is worse than the common 20/40 referral criteria. Unaided VA had less impact on predicted compliance in the screening only protocol.

Manny, Ruth E.; Sinnott, Loraine T.; Jones-Jordan, Lisa A; Messer, Dawn; Twelker, J. Daniel; Cotter, Susan A.; Kleinstein, Robert N.; Crescioni, Mabel

2012-01-01

66

Ensuring the Health of Refugees: Taking a Broader Vision.  

ERIC Educational Resources Information Center

Refugee assistance policies and programs should be reoriented to ensure both short- and long-term physical, social, and mental well-being. This approach must fully encompass primary health care and embrace a wide range of activities and programs that are not traditionally viewed as health-related. The refugee assistance community is sometimes

Kuntz, Diane; And Others

67

Veterans Health Administration Audit of Physician Staffing Levels for Specialty Care Services.  

National Technical Information Service (NTIS)

In January 2002, Public Law 107-135 mandated that VA establish a nationwide policy to ensure medical facilities have adequate staff to provide appropriate, high-quality care and services. However, audits and inspections continued to identify the need for ...

2012-01-01

68

A community-based programme to provide prompt and adequate treatment of presumptive malaria in children  

Microsoft Academic Search

A community-based programme to ensure prompt and adequate treatment of presumptive episodes of clinical malaria in children has been established in a rural province of Burkina Faso. The implementation strategy was based on training a core group of mothers in every village and supplying community health workers with essential antimalarial drugs specially packed in age-specific bags containing a full course

Franco Pagnoni; Nathalie Convelbo; Justin Tiendrebeogo; Simon Cousens; Fulvio Esposito

1997-01-01

69

[Family as challenge: contexts of adequate counselling].  

PubMed

We live in a world of competing family models of which the standard model--two adults of different sex with two children of different sex--is only one among many others. Besides this sociocultural context this article focusses on the inner contexts of familytherapeutic dialogues. Processphantasies and the role of metaphor are underlined. This articles gives clinical advice how to carefully listen to the use of metaphors by family members and how to deal with them. Three extended transkripts of family sessions are presented. PMID:16231597

Buchholz, Michael B

2005-10-01

70

Adequate mathematical modelling of environmental processes  

NASA Astrophysics Data System (ADS)

In environmental observations and laboratory visualization both large scale flow components like currents, jets, vortices, waves and a fine structure are registered (different examples are given). The conventional mathematical modeling both analytical and numerical is directed mostly on description of energetically important flow components. The role of a fine structures is still remains obscured. A variety of existing models makes it difficult to choose the most adequate and to estimate mutual assessment of their degree of correspondence. The goal of the talk is to give scrutiny analysis of kinematics and dynamics of flows. A difference between the concept of "motion" as transformation of vector space into itself with a distance conservation and the concept of "flow" as displacement and rotation of deformable "fluid particles" is underlined. Basic physical quantities of the flow that are density, momentum, energy (entropy) and admixture concentration are selected as physical parameters defined by the fundamental set which includes differential D'Alembert, Navier-Stokes, Fourier's and/or Fick's equations and closing equation of state. All of them are observable and independent. Calculations of continuous Lie groups shown that only the fundamental set is characterized by the ten-parametric Galilelian groups reflecting based principles of mechanics. Presented analysis demonstrates that conventionally used approximations dramatically change the symmetries of the governing equations sets which leads to their incompatibility or even degeneration. The fundamental set is analyzed taking into account condition of compatibility. A high order of the set indicated on complex structure of complete solutions corresponding to physical structure of real flows. Analytical solutions of a number problems including flows induced by diffusion on topography, generation of the periodic internal waves a compact sources in week-dissipative media as well as numerical solutions of the same problems are constructed. They include regular perturbed function describing large scale component and a rich family of singular perturbed function corresponding to fine flow components. Solutions are compared with data of laboratory experiments performed on facilities USU "HPC IPMec RAS" under support of Ministry of Education and Science RF (Goscontract No. 16.518.11.7059). Related problems of completeness and accuracy of laboratory and environmental measurements are discussed.

Chashechkin, Yu. D.

2012-04-01

71

4 CFR 200.14 - Responsibility for maintaining adequate safeguards.  

Code of Federal Regulations, 2011 CFR

...maintaining adequate technical, physical, and security safeguards to prevent unauthorized...and automated records systems. These security safeguards shall apply to all...are adequately trained to protect the security and privacy of such records....

2011-01-01

72

Ensuring Safe Use of Contact Lens Solution  

MedlinePLUS

... Consumer Updates RSS Feed Ensuring Safe Use of Contact Lens Solution Search the Consumer Updates Section Printer- ... About Eye Infections Dos and Don'ts for Contact Lens Wearers Not emptying the solution out of ...

73

Ensuring the Consistency of Silicide Coatings  

NASA Technical Reports Server (NTRS)

Diagram specifies optimum fusing time for given thicknesses of refractory metal-silicide coatings on columbium C-103 substrates. Adherence to indicated fusion times ensures consistent coatings and avoids underdiffusion and overdiffusion. Accuracy of diagram has been confirmed by tests.

Ramani, V.; Lampson, F. K.

1982-01-01

74

Child Care Center Operations.  

National Technical Information Service (NTIS)

Purpose. To provide policy and guidance for the operation of all child care programs in order to ensure a healthy, safe environment and to promote quality child care on naval installations. Summary of Revisions: (a) Provides guidance in developing program...

1984-01-01

75

Ancillary Care in Community-Based Public Health Intervention Research  

PubMed Central

Community-based public health intervention research in developing countries typically takes place not in clinics but in people's homes and other living spaces. Research subjects and their communities may lack adequate nutrition, clean water, sanitation, and basic preventive and therapeutic services. Researchers often encounter unmet health needs in their interactions with individual subjects and need ethical guidelines to help them decide how to respond. To what extent do researchers have an ethical obligation to provide ancillary carehealth care beyond what is necessary to ensure scientific validity and subjects' safety? We discuss a case example from Nepal and propose a simple 2-step sequence of questions to aid decision making.

Taylor, Holly A.; Mullany, Luke C.

2010-01-01

76

[Neonatal asphyxia: a care experience using hypothermic therapy].  

PubMed

Hypothermia therapy, used to treat hypoxic-ischemic encephalopathy in neonates, has been shown to effectively decrease asphyxia complications and mortality. This article reports on an experience using this therapy approach to care for a neonatal asphyxic patient. Due to our lack of an appropriate cooling device, we adjusted the number of cool water bags to successfully perform hypothermic therapy. Despite this added procedural complication, we succeeded in saving the patient's life. The holistic care process for this type of case requires family-centered care to help family members deal with the critical condition and assist parents to face depression and guilt, reduce anxiety, and reaffirm the parent-child relationship. We used hypothermia in the initial stage. Relevant standards of critical care for this condition should be established to ensure adequate nursing care safety and quality. PMID:24310560

Wang, Mo-Mei; Wang, Mei-Hua

2013-12-01

77

Self-reported segregation experience throughout the life course and its association with adequate health literacy  

PubMed Central

Residential segregation has been shown to be associated with health outcomes and health care utilization. We examined the association between racial composition of five physical environments throughout the life course and adequate health literacy among 836 community health center patients in Suffolk County, NY. Respondents who attended a mostly White junior high school or currently lived in a mostly White neighborhood were more likely to have adequate health literacy compared to those educated or living in predominantly minority or diverse environments. This association was independent of the respondents race, ethnicity, age, education, and country of birth.

Gaskin, Darrell J.; Si, Xuemei; Stafford, Jewel D.; Lachance, Christina; Kaphingst, Kimberly A.

2012-01-01

78

DATABASE MANAGEMENT TECHNIQUES TO ENSURE PROJECT INTEGRITY  

EPA Science Inventory

The Drinking Water Research Division of the Risk Reduction Engineering Laboratory in Cincinnati, Ohio is responsible for conducting field scale research projects on the cost and performance of drinking water treatment technology in support of the Safe Drinking Water Act. o ensure...

79

Ensuring the Safety of Your Endoscopic Procedure  

MedlinePLUS

Ensuring the Safety of Your Endoscopic Procedure The Benefits of Endoscopy Endoscopy involves the use of flexible tubes, known as endoscopes, to provide a close-up, color television view of the inside of your digestive tract. Upper endoscopes are passed through the mouth to visualize ...

80

Heater Ensures Strain-Gage Bond Reliability  

NASA Technical Reports Server (NTRS)

Aluminum block with embedded heating element provides concentrated and controllable heat for curing strain-gage adhesives. Device replaces heat lamps and hot-air guns; provides higher temperatures, allows shorter curing times, and ensures more reliable bond. Low temperatures and wind do not significantly affect operation of heater, therefore suited to outdoor use.

Brown, J. K.; Davenport, M. L.

1984-01-01

81

Structuring the Talk: Ensuring Academic Conversations Matter  

ERIC Educational Resources Information Center

This article focuses on structures that should be in place to engage students in academic discussions. The authors focus on establishing purpose, using language frames, and productive group work. The authors provide multiple examples of students engaged in structured conversations that ensure they practice both content and language.

Frey, Nancy; Fisher, Douglas

2011-01-01

82

Hip-joint and abductor-muscle forces adequately represent in vivo loading of a cemented total hip reconstruction  

Microsoft Academic Search

Using finite element analyses, we investigated which muscle groups acting around the hip-joint most prominently affected the load distributions in cemented total hip reconstructions with a bonded and debonded femoral stem. The purpose was to determine which muscle groups should be included in pre-clinical tests, predicting bone adaptation and mechanical failure of cemented reconstructions, ensuring an adequate representation of in

J. Stolk; NJJ Verdonschot; R. Huiskes

2001-01-01

83

Improving access to health care in Latino communities.  

PubMed Central

Public debate about health care reform often focuses on the need for health insurance coverage, but in Latino communities many other barriers also inhibit access to medical care. In addition, basic public health services often go underfunded or ignored. Thus, health care reform efforts, nationally and in each State, must embrace a broader view of the issues if the needs of Latino communities are to be served. This report reviews and summarizes information about the mounting problems Latino communities face in gaining access to medical care. Access to appropriate medical care is reduced by numerous financial, structural, and institutional barriers. Financial barriers include the lack of health insurance coverage and low family incomes common in Latino communities. More than 7 million Latinos (39 percent) go without health insurance coverage. Latinos without health insurance receive about half as much medical care as those who are insured. Structurally, the delivery system organization rarely reflects the cultural or social concerns of the communities where they are located. Therefore, providers and patients fail to communicate their concerns adequately. These communication problems are exacerbated by the extreme shortage of Latino health care professionals and other resources available. Institutional barriers often reflect the failure to consider what it means to provide good service as well as high-quality medical care. Reducing these barriers to medical care requires modifying governmental and institutional policies, expanding the supply of competent providers, restructuring delivery system incentives to ensure primary care and public health services, and enhancing service and satisfaction with care.

Valdez, R B; Giachello, A; Rodriguez-Trias, H; Gomez, P; de la Rocha, C

1993-01-01

84

[Providing regular relief; considerations for palliative care in the Netherlands].  

PubMed

Over the last few decades the attention devoted to the palliative aspects of medicine, particularly those in hospital care, has declined due to the emphasis on medical technology. In Anglo-Saxon countries a review of this development resulted in structured palliative care that benefited terminally ill patients with a progressive fatal disease, especially cancer patients. Due to increasing national and international criticism of both the practice of euthanasia (assumed to be too liberal) and the lack of attention devoted to structured palliative care in the Netherlands, the Dutch government decided to improve the structure of palliative care. The government's viewpoint is based on the assumption that good palliative care that includes adequate pain control benefits patient care and might eventually lead to fewer requests for euthanasia. The improvements to palliative care should be realised by means of improvements in the structure, training and knowledge. Six academic medical clusters have been designated as Centres for the Development of Palliative Care (Dutch acronym: COPZ) for a 5-year period. Each COPZ must develop the various aspects needed to improve palliative care within the region it serves and ensure that its activities are carefully coordinated with those in the other centres. Research will focus on measuring the efficacy of palliative care as well as ethical and epidemiological aspects. A government committee will assess the appropriateness of the activities undertaken by each of the centres. PMID:11695096

Crul, B J; van Weel, C

2001-10-20

85

"Something Adequate"? In Memoriam Seamus Heaney, Sister Quinlan, Nirbhaya  

ERIC Educational Resources Information Center

Seamus Heaney talked of poetry's responsibility to represent the "bloody miracle", the "terrible beauty" of atrocity; to create "something adequate". This article asks, what is adequate to the burning and eating of a nun and the murderous gang rape and evisceration of a medical student? It considers Njabulo

Parker, Jan

2014-01-01

86

40 CFR 51.354 - Adequate tools and resources.  

Code of Federal Regulations, 2013 CFR

...2013-07-01 2013-07-01 false Adequate tools and resources. 51.354 Section 51...Program Requirements § 51.354 Adequate tools and resources. (a) Administrative...all of the program functions including quality assurance, data analysis...

2013-07-01

87

Major Difficulties the US Nephrologist Faces in Providing Adequate Dialysis  

Microsoft Academic Search

Aim: To identify the major difficulties nephrologists in the US face in providing adequate dialysis. Methods: To identify the perceived obstacles to achieving adequate dialysis in the US, 30 clinical support specialists responsible for nursing education and training were polled. Their responses together with those found in the recent literature were summarized and analyzed. Results: The obstacles identified fell into

Jose A. Diaz-Buxo; Terri L. Crawford-Bonadio

2007-01-01

88

Risk-analysis procedures ensure system safety  

Microsoft Academic Search

Conducting risk analysis and safety- engineering studies before construction of a sour-gas pipeline system will build redundancies into the system and ensure safe operation and maintenance. A recent analysis of a sour-gas pipeline built in Texas provides an example of procedures for safety engineering and risk assessment. This first of two articles presents the risk-analysis methodology and minimum safety systems

M. Mannan; D. B. Pfenning; C. D. Zinn

1991-01-01

89

Cross-functional support ensures success.  

PubMed

A comprehensive PPE program that has the support of key stakeholders at the corporate and plant levels has the potential to yield significant safety, productivity, and cost improvements. An automotive manufacturer, for example, was able to decrease injuries by 70 percent and reduce SKUs 24 percent by implementing recommendations resulting from a comprehensive PPE program that had the endorsement of key safety, procurement, operations, and production personnel from the start. Gaining cross-functional commitment for a comprehensive PPE program not only will move the improvement process forward, but also will ensure the company benefits from optimal cost and performance advantages that positively impact the bottom line. PMID:22590821

Paree, Tim

2012-04-01

90

Do national drug control laws ensure the availability of opioids for medical and scientific purposes?  

PubMed Central

Abstract Objective To determine whether national drug control laws ensure that opioid drugs are available for medical and scientific purposes, as intended by the 1972 Protocol amendment to the 1961 Single Convention on Narcotic Drugs. Methods The authors examined whether the text of a convenience sample of drug laws from 15 countries: (i)acknowledged that opioid drugs are indispensable for the relief of pain and suffering; (ii)recognized that government was responsible for ensuring the adequate provision of such drugs for medical and scientific purposes; (iii)designated an administrative body for implementing international drug control conventions; and (iv)acknowledged a governments intention to implement international conventions, including the Single Convention. Findings Most national laws were found not to contain measures that ensured adequate provision of opioid drugs for medical and scientific purposes. Moreover, the model legislation provided by the United Nations Office on Drugs and Crime did not establish an obligation on national governments to ensure the availability of these drugs for medical use. Conclusion To achieve consistency with the Single Convention, as well as with associated resolutions and recommendations of international bodies, national drug control laws and model policies should be updated to include measures that ensure drug availability to balance the restrictions imposed by the existing drug control measures needed to prevent the diversion and nonmedical use of such drugs.

Brown, Marty Skemp; Maurer, Martha A

2014-01-01

91

Measuring corporate culture to ensure mission fulfillment.  

PubMed

Ancilla Systems, Inc., Elk Grove Village, Il, developed a mission-based performance evaluation program to provide tangible evidence of mission fulfillment and ensure the provision of high-quality healthcare. the program--Characteristics of Service--translates the language of healthcare action and evaluates corporate culture to ensure that it fulfills the expectations of its sponsor. The nine Characteristics of Service are: Respect for the dignity of all persons. Orientation toward the family unit. Quality and personalized services. Local health systems with a spectrum of services responsive to the unique needs of the community. Formal and informal partnerships with physicians. Active participation and collaboration with related community service agencies and other healthcare providers. Faithfulness to Catholic identity through close relationships with Church and religious institute resources. Effective political advocacy through education. Research and development of innovative approaches to healthcare. In establishing the behavior standards that would exemplify the characteristics, program developers used terms that correspond to specific, observable, measurable performance. All healthcare facilities are evaluated on how well they meet the behavior standards. The evaluation process includes data collection, analysis, and a final report. Data collection begins with a review of regular hospital-conducted surveys, which provide quantifiable information to measure performance against key expected behaviors. Additional data are derived from medical staff development plans and the monthly quality assurance audit. On-site surveys fill information gaps that remain after all written reports are collected. PMID:10290848

Hulsebus-Fong, C

1988-11-01

92

Ensuring patient safety and optimizing efficiency during gastrointestinal endoscopy.  

PubMed

The volume of outpatient gastrointestinal (GI) endoscopy has grown dramatically in the past three decades, fueled by advancing technologies and evolving payment policies. This magnifies the need to ensure high-quality, safe, and cost-effective endoscopic services. In recent years, publicized breaches in standards of care for GI endoscopy have intensified the focus on patient safety. Because of these patient safety concerns and changes in regulatory policies, some ambulatory surgery center surveyors and inspectors have held GI endoscopy suites to the same standards as hospital ORs. The American Society for Gastrointestinal Endoscopy and other endorsing organizations drafted the Guidelines for Safety in the Gastrointestinal Endoscopy Unit, which published in January 2014. These safety guidelines relevant to sedation, infection control, staffing, training, technical equipment, traffic patterns, and personal protective equipment differ from other published guidelines for the outpatient surgical setting. PMID:24581646

Deas, Tom; Sinsel, Lisa

2014-03-01

93

Quality of Care  

Cancer.gov

The Institute of Medicine (IOM) defines quality of care as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." In 1999, the IOM issued Ensuring Quality Cancer Care, a report that documented significant gaps in the quality of cancer care in the United States.

94

The role of corporations in ensuring biodiversity  

NASA Astrophysics Data System (ADS)

Corporations own approximately 25% of all private land in the United States and, therefore, play an essential role in protecting biodiversity and maintaining natural habitats. The Wildlife Habitat Council (WHC) is a unique joint venture between conservation organizations and corporations to utilize corporate lands for ensuring biodiversity. The following case studies demonstrate how corporations have helped ensure healthy ecosystems and provided critical leadership in regional efforts. Amoco Chemical Company's Cooper River Plant has been instrumental in developing a cooperative project that involves numerous corporations, plantation owners, private citizens, nonprofit organizations, government agencies, and community groups to develop a comprehensive, ecosystem-based management plan for part of the Cooper River in Charleston, South Carolina, USA. The second case focuses on the Morie Company, a national sand quarry operator headquartered in southern New Jersey, USA. Morie Company is working with WHC, community groups, the Pinelands Commission, and other state regulatory agencies to explore sustainable development opportunities for companies within the Pinelands regulations. The third case takes us to DuPont Company's Asturias, Spain, site. A winwin success story of improved habitat and cost savings is the result of DuPont's concern for the environment, ability to work with a variety of groups, and willingness to consider innovative restoration techniques. The fourth case discusses Consumers Power Company's Campbell Plant in West Olive, Michigan, USA. In addition to implementing projects that contribute to biodiversity, Consumers Power has developed an environmental education field station to teach others about the importance of natural habitats. The final case highlights Baltimore Gas & Electric Company's efforts to maintain habitat for endangered species at their Calvert Cliffs site in Maryland.

Kelly, Joyce M.; Hodge, Michael R.

1996-11-01

95

Future of Assurance: Ensuring that a System is Trustworthy  

NASA Astrophysics Data System (ADS)

Significant efforts are put in defining and implementing strong security measures for all components of the comput-ing environment. It is equally important to be able to evaluate the strength and robustness of these measures and establish trust among the components of the computing environment based on parameters and attributes of these elements and best practices associated with their production and deployment. Today the inventory of techniques used for security assurance and to establish trust -- audit, security-conscious development process, cryptographic components, external evaluation - is somewhat limited. These methods have their indisputable strengths and have contributed significantly to the advancement in the area of security assurance. However, shorter product and tech-nology development cycles and the sheer complexity of modern digital systems and processes have begun to decrease the efficiency of these techniques. Moreover, these approaches and technologies address only some aspects of security assurance and, for the most part, evaluate assurance in a general design rather than an instance of a product. Additionally, various components of the computing environment participating in the same processes enjoy different levels of security assurance, making it difficult to ensure adequate levels of protection end-to-end. Finally, most evaluation methodologies rely on the knowledge and skill of the evaluators, making reliable assessments of trustworthiness of a system even harder to achieve. The paper outlines some issues in security assurance that apply across the board, with the focus on the trustworthiness and authenticity of hardware components and evaluates current approaches to assurance.

Sadeghi, Ahmad-Reza; Verbauwhede, Ingrid; Vishik, Claire

96

Universal Health Insurance in India: Ensuring Equity, Efficiency, and Quality  

PubMed Central

Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP) health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI). Large proportion of informal sector labor in India's workforce prevents major upscaling of social health insurance (SHI). Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS), with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete.

Prinja, Shankar; Kaur, Manmeet; Kumar, Rajesh

2012-01-01

97

Prioritization of inpatient hospital services to prisoners: a method for justifying care and costs.  

PubMed

As a response to rising health care costs and substantial cuts in state funding for correctional health care in Texas, we developed and applied a process framework for systematically prioritizing the provision of inpatient hospital services to prisoners. Specifically, all inpatient services provided from September 2009 through August 2011 at the University of Texas Medical Branch/Texas Department of Criminal Justice Hospital were sorted according to levels of care consistent with those previously defined by the Oregon Department of Corrections and the Federal Bureau of Prisons. Nearly all inpatient services (94%) were deemed medically mandatory (Level 1) or medically necessary (Level 2). These services must be funded to ensure an adequate level of care, and capitated-funding mechanisms may not be sufficiently flexible to cover their costs. Correctional health care systems may adapt the framework used here to inform state policymakers regarding provision of inpatient services and funding requirements. PMID:24858890

Schneider, Bryan C; Harzke, Amy Jo; Ivanitskaya, Lana; Murray, Owen J

2014-05-01

98

Child Health USA 2013: Barriers to Prenatal Care  

MedlinePLUS

... Utilization > Barriers to Prenatal Care Barriers to Prenatal Care Narrative Early and adequate prenatal care is important ... Data Mothers Who Experienced Barriers to Receiving Prenatal Care as Early as Desired, by Maternal Age, 2009– ...

99

Do Beginning Teachers Receive Adequate Support from Their Headteachers?  

ERIC Educational Resources Information Center

The article examines the problems faced by beginning teachers in Cyprus and the extent to which headteachers are considered to provide adequate guidance and support to them. Data were collected through interviews with 25 school teachers in Cyprus, who had recently entered teaching (within 1-5 years) in public primary schools. According to the

Menon, Maria Eliophotou

2012-01-01

100

Problems of excess noise and adequate laser models  

Microsoft Academic Search

We discuss the problem of excess noise in lasers of different dynamical classes, as well as adequate models for the description of such noise. It is shown that the excess noise in lasers is caused by mode-mode coupling. The linear coupling leads to the phenomenon of excess noise in the narrow sense (Petermanns excess noise), while the nonlinear mode coupling

Ya. I. Khanin

2004-01-01

101

Understanding Your Adequate Yearly Progress (AYP), 2011-2012  

ERIC Educational Resources Information Center

The "No Child Left Behind Act (NCLB) of 2001" requires all schools, districts/local education agencies (LEAs) and states to show that students are making Adequate Yearly Progress (AYP). NCLB requires states to establish targets in the following ways: (1) Annual Proficiency Target; (2) Attendance/Graduation Rates; and (3) Participation Rates.

Missouri Department of Elementary and Secondary Education, 2011

2011-01-01

102

Do comments explain codes adequately?: investigation by text filtering  

Microsoft Academic Search

Comment lines in the software source code include descriptions of codes, usage of codes, copyrights, unused codes, comments, and so on. It is required for comments to explain the content of written code adequately, since the wrong description in the comment may causes further bug and confusion in maintenance. In this paper, we try to clarify a research question: \\

Yukinao Hirata; Osamu Mizuno

2011-01-01

103

Is the Stock of VET Skills Adequate? Assessment Methodologies.  

ERIC Educational Resources Information Center

In Australia and elsewhere, four approaches have been used to determine whether stocks of vocational education and training (VET) skills are adequate to meet industry needs. The four methods are as follows: (1) the manpower requirements approach; (2) the international, national, and industry comparisons approach; (3) the labor market analysis

Blandy, Richard; Freeland, Brett

104

Comparability and Reliability Considerations of Adequate Yearly Progress  

ERIC Educational Resources Information Center

The purpose of this study is to develop an estimate of Adequate Yearly Progress (AYP) that will allow for reliable and valid comparisons among student subgroups, schools, and districts. A shrinkage-type estimator of AYP using the Bayesian framework is described. Using simulated data, the performance of the Bayes estimator will be compared to

Maier, Kimberly S.; Maiti, Tapabrata; Dass, Sarat C.; Lim, Chae Young

2012-01-01

105

Establishing Technically Adequate Measures of Progress in Early Numeracy  

Microsoft Academic Search

The purpose of this study was to examine the use of three early numeracy measures to monitor the mathematics progress of students across time. One hundred and seven kindergarten and Grade 1 students were administered quantity discrimination, number identification, and missing-number measures once each month for 7 months. Alternate form reliability was adequate for instructional decision making, whereas criterion validity

Erica S. Lembke; Anne Foegen; Tiffany A. Whittaker; David Hampton

2008-01-01

106

Impact of adequate empirical combination therapy on mortality from bacteremic Pseudomonas aeruginosa pneumonia  

PubMed Central

Background Pseudomonas aeruginosa has gained an increasing amount of attention in the treatment of patients with pneumonia. However, the benefit of empirical combination therapy for pneumonia remains unclear. We evaluated the effects of adequate empirical combination therapy and multidrug-resistance in bacteremic Pseudomonas pneumonia on the mortality. Methods A retrospective cohort study was performed at the 2,700-bed tertiary care university hospital. We reviewed the medical records of patients with bacteremic pneumonia between January 1997 and February 2011. Patients who received either inappropriate or appropriate empirical therapy were compared by using marginal structural model. Furthermore, we investigated the direct impact of combination therapy on clinical outcomes in patients with monomicrobial bacteremic pneumonia. Results Among 100 consecutive patients with bacteremic Pseudomonas pneumonia, 65 patients were classified in the adequate empirical therapy group, 32 of whom received monotherapy and 33 combination therapy. In the marginal structural model, only inadequate therapy was significantly associated with 28-day mortality (p?=?0.02), and multidrug-resistance was not a significant risk factor. To examine further the direct impact of combination therapy, we performed a subgroup analysis of the 65 patients who received adequate therapy. Multivariate logistic regression analysis identified absence of septic shock at the time of bacteremia (OR, 0.07; 95% CI, 0.01-0.49; p?=?0.008), and adequate combination therapy (OR, 0.05; 95% CI, 0.01-0.34; p?=?0.002) as variables independently associated with decreased all-cause 28-day mortality. Conclusions Our study suggests that adequate empirical combination therapy can decrease mortality in patients with bacteremic Pseudomonas pneumonia.

2012-01-01

107

Quality-of-care challenges for rural health.  

PubMed

The purpose of this article is to examine the issue of quality of care in rural America and to help others examine this issue in a way that is consistent with the very real challenges faced by rural communities in ensuring the availability of adequate health services. Rural citizens have a right to expect that their local health care meets certain basic standards. Unless rural providers can document that the quality of local health care meets objective external standards, third-party payers might refuse to contract with rural providers, and increasingly sophisticated consumers might leave their communities for basic medical care services. To improve the measurement of health care quality in a rural setting, a number of issues specific to the rural environment must be addressed, including small sample sizes (volume and outcome issues), limited data availability, the ability to define rural health service areas, rural population preferences and the lower priority of formal quality-of-care assessment in shortage areas. Several current health policy initiatives have substantial implications for monitoring and measuring the quality of rural health services. For example, to receive community acceptance and achieve fiscal stability, critical access hospitals (CAHs) must be able to document that the care they provide is at least comparable to that of their predecessor institutions. The expectations for quality assurance activities in CAHs should consider their limited institutional resources and community preferences. As managed care extends from urban areas, there will be an inevitable collision between the ability to provide care and the ability to measure quality. As desirable as it might be to have a national standard for health care quality, this is not an attainable goal. The spectrum and content of rural health care are different from the spectrum and content of care provided in large cities. Accrediting agencies, third-party carriers and health insurance purchasers need to develop rural health care quality standards that are practical, useful and affordable. PMID:10981369

Moscovice, I; Rosenblatt, R

2000-01-01

108

Rate Setting Policies: Ensuring Access and Improving Quality. Issues Meeting Proceedings (Washington, D.C., November 28-29, 2000).  

ERIC Educational Resources Information Center

In November 2000, the Child Care Bureau, Administration for Children and Families, U.S. Department of Health and Human Services, convened an Issues Meeting focused on Rate-Setting Policies: Ensuring Access and Improving Quality. The meeting brought together state child care administrators and others for discussions on conducting effective market

Schock, Lisa; Daugherty, Jane

109

[Mechanism of action of electromagnetic fields biologically adequate to man].  

PubMed

The paper analyzes 10-year experience in making experimental observations and clinically using electromagnetic fields (EMF) biologically adequate to man. Basic investigations of the electromechanical process that lead to the occurrence of currents in the bone tissue and blood vascular walls in their functional deformation were conducted. They showed that the piezoelectric effect is the most marked in the intact bone tissue. Experimental studies determined the amplitude and shape of impulses of currents emerging in the intact bone tissue of the extremities and in the walls of blood vessels during pulse blood filling. The bioelectric tissue metabolism changes in various human locomotor abnormalities. The lost part in the diseased area can be restored by means of external EMF. On this basis, devices for human biologically adequate electromagnetic therapy were designed. The efficiency of each session of electromagnetic therapy was evaluated from the normalization of blood circulation in the diseased area. The efficiency of this therapy in vascular disease was noted to depend on the synchronization of the generated electromagnetic pulse with the pulse wave of a patient and its phases. An experiment on 13 intact mongrel dogs was made to reveal the impact of EMF biologically adequate to man on bone marrow hemopoiesis. EMF 2 was found to have a stimulating effect on granulocytopoiesis. Platelet counts were elevated in the peripheral blood of animals. Analysing 2000 clinical cases and canine experimental findings provided evidence for the following mechanism of action of the electromagnetic fields biologically adequate to man. The fields exert a primary initial and virtually rapid action on the active areas of nerve structures and smooth muscle of blood vascular walls. They show a primary, but slower action on blood cells and on the vascular endothelial structure. There may be a secondary impact of EMF on some endocrine glands, which causes changes in the protein metabolism of a biological object and appears as stimulation of granulocytopoiesis and depot platelet release into the peripheral blood stream. PMID:8924828

Schastny?, S A; Shchukin, S I; Rosly?, I M; Zubenko, V G; Beliaev, K R; Semikin, G I; Morozov, A A

1996-01-01

110

What are the best strategies for ensuring quality in hospitals?  

Microsoft Academic Search

ABSTRACT Health Evidence Network (HEN) synthesis report on the best strategies for ensuring quality in hospitals Ensuring the safety of patients and personnel and improving,quality have become,important objectives for

John vretveit

111

EL CUIDADO DE S DE LA EMBARAZADA DIABTICA COMO UNA VIA PARA ASEGURAR UN HIJO SANO SELF-CARE OF DIABETIC PREGNANT WOMEN, A WAY OF ENSURING A HEALTHY BABY O CUIDADO DE SI DE GESTANTES DIABTICAS COMO UM CAMINHO PARA ASSEGURAR UM FILHO SAUDVEL  

Microsoft Academic Search

This focused ethnography explored the beliefs, values, habits and behavioral patterns of diabetic pregnant women who were treated in Hospital Doutor Enrique Tejera, residents of three poor, urban communities in the city of Valencia, Venezuela. The purpose of this study was to find the meaning of self-care for these pregnant women. The Health Analysis, the Theory of Diversity, and the

Carmen Amarilis; Guerra de Castillo; Marta Luca Vsquez

2006-01-01

112

VA Health Care: Adequancy of Resident Supervision Is Not Assured, but Plans Could Improve Oversight.  

National Technical Information Service (NTIS)

The Department of Veterans Affairs (VA) provides graduate medical education (GME) to as many as one-third of U.S. resident physicians, but oversight responsibilities spread across VA's organizational components and multiple affiliated hospitals and medica...

2003-01-01

113

Melanoma screening behavior among primary care physicians.  

PubMed

The incidence of malignant melanoma is rising concomitantly with dramatic changes in our healthcare system. Primary care physicians (PCPs) are responsible for an increasing number of skin-related healthcare visits. Therefore, PCPs must be on the forefront of early detection of suspicious pigmented lesions. Understanding the PCPs' screening and referral patterns for pigmented lesions is the first step in ensuring that atypical pigmented lesions will be properly evaluated within the confines of the present healthcare system. To develop a better understanding of how PCPs (internists, family practitioners, and pediatricians) manage pigmented lesions in their practice, we mailed a 28-question survey to 999 PCPs in Connecticut. Fewer than half of the 248 respondents indicated they "often" performed full skin examinations. However, when suspicious lesions were found, most PCPs referred patients to a dermatologist for a biopsy of the lesion. PCPs did not feel pressure from managed care companies to limit these referrals. However, many PCPs did not feel highly confident in their ability to recognize melanoma and thought their training was not adequate to prepare them to diagnose and manage pigmented lesions. Family practitioners were more likely than internists and pediatricians to manage suspicious pigmented lesions and to perform a biopsy on their own. Family practitioners also were more confident in performing these tasks and were more likely to think their training in these areas was adequate. Very few PCPs reported sending their biopsy specimens to a dermatopathology laboratory. In fact, many PCPs seemed unaware of who interpreted the histopathology. PCPs do not emphasize full skin examinations in their practice and seem unaware of the advantages inherent in using dermatopathologists in the histopathologic interpretation of pigmented lesions. Furthermore, lack of confidence on the part of PCPs, as well as their concern about adequate training in the management of pigmented lesions, suggest there is need for improvement in the education of primary care residents and physicians. PMID:15605968

Friedman, Kent P; Whitaker-Worth, Diane L; Grin, Caron; Grant-Kels, Jane M

2004-11-01

114

Finding a lasting cure for U.S. health care.  

PubMed

In "Making Competition in Health Care Work" (July-August 1994), Elizabeth Olmsted Teisberg, Michael E. Porter, and Gregory B. Brown ask a question that has been absent from the national debate on health care reform: How can the United States achieve sustained cost reductions while at the same time maintaining quality of care? The authors argue that innovation driven by rigorous competition is the key to successful reform. A lasting cure for health care in the United States should include four basic elements: corrected incentives to spur productive competition, universal insurance to secure economic efficiency, relevant information to ensure meaningful choice, and innovation to guarantee dynamic improvement. In this issue's Perspectives section, eleven experts examine the current state of the health care system and offer their views on the shape that reform should take. Some excerpts: "On the road to innovation, let us not forget to develop the tools that allow physicians, payers, and patients to make better decisions." I. Steven Udvarhelyi; "Health care is not a product or service that can be standardized, packaged, marketed, or adequately judged by consumers according to quality and price." Arnold S. Relman; "Just as antitrust laws are the wise restraints that make competition free in other sectors of the economy, so the right kind of managed competition can work well in health care." Edward M. Kennedy "Biomedical research should be considered primarily an investment in the national economic well-being with additional humanitarian benefits." Elizabeth Marincola. PMID:10137002

Udvarhelyi, I S; Relman, A S; Binder, G M; Spence, R K; Kennedy, E M; Grossman, J H; Termeer, H A; Raines, L J; Marincola, E; Pyle, T O

1994-01-01

115

[The human right to adequate food: an urban vision].  

PubMed

The human right to adequate food is comprehended in two dimensions: being free of hunger and denutrition and having access to an adequate food. The urban context, in which the possession of food is done primarily through merchandising because of its strong consuming appealing, became a big challenge to debate this topic in poor districts today. Here we combine considerations of a qualitative study carried out in So Joo de Meriti, Rio de Janeiro State, joining leaders from Pastoral da Criana in focal group sessions. The unemployment, the sub-employment and the difficulty in reaching the public health system, the social assistance and basic sanitation were presented as the major obstacles to bring into effect the human right to food. It was possible to determine that, among the strategies to fight the poverty and hunger, a big highlight is the establishment of mutual help mechanisms. The social support, generosity and religiousness were presented as the most important categories among the thoughts of the leaders. Facing a reality in which poverty and hunger appear as something inherent or become a mechanism of change during elections, the issue of the clienteles appears as a huge concern and challenge for those leaders. PMID:20694330

Casemiro, Juliana Pereira; Valla, Victor Vincent; Guimares, Maria Beatriz Lisboa

2010-07-01

116

The Last Word: Magnetic Storm-Still an Adequate Name?  

NASA Astrophysics Data System (ADS)

The magnetic storm is the principal and most complex collective phenomenon in geospace. It involves the magnetic fields of the Sun and the Earth, as well as plasma originating in the solar and terrestrial atmosphere. Magnetic storms involve more than just the geomagnetic field, as the original perception suggests. They involve a variety of dynamic processes among which charged particle acceleration and electric current intensification are the most important. Is the name still adequate, or should we switch to something more general and wide-ranging, such as ``space storms,'' or ``geospace storms''? The oldest printed record of ``magnetic storms'' that I was able to find appears in a letter published in Annalen der Physik written by the famous explorer Alexander von Humboldt to Paul Erman. I located this paper in the amazingly rich library of the Air Force Research Laboratory at Hanscom Air Force Base in Massachusetts with the kind help of Mike Heinemann.

Daglis, Ioannis A.

117

World oil supply adequate for 93's healthy demand  

SciTech Connect

This paper reports that world oil supply and demand fundamentals have changed little in the past year, bringing some stability to the market. That could change in 1993 as demand resumes a more healthy growth rate, and production declines continue in the U.S. and the C.I.S. Though there's little chance average prices will increase significantly, crude markets could be more volatile this year. Offsetting upward pressures on oil prices resulting from accelerated demand are plans by Persian Gulf producers to expand productive capacity, the possibility that Iraq will reenter the international oil market, and continued economic decline in eastern Europe and the former republics of the Soviet Union. When it's all added up, world oil supply looks more than adequate for 1993. If events occur in a particular combination, prices could weaken.

Beck, R.J.

1993-01-25

118

Ensuring Safety, Security, and Sustainability of Mission-Critical CyberPhysical Systems  

Microsoft Academic Search

Cyberphysical systems (CPSs) couple their cyber and physical parts to provide mission-critical services, including automated pervasive health care, smart electricity grid, green cloud computing, and surveillance with unmanned aerial vehicles (UAVs). CPSs can use the information available from the physical environment to provide such ubiquitous, energy-efficient and low-cost functionalities. Their operation needs to ensure three key properties, collectively referred to

Ayan Banerjee; Krishna K. Venkatasubramanian; Tridib Mukherjee; Sandeep Kumar S. Gupta

2012-01-01

119

Carrier screening in preconception consultation in primary care.  

PubMed

Discussing carrier screening during preconception consultation in primary care has a number of advantages in terms of promoting autonomy and enabling the greatest range of reproductive choices. For those with a family history of an inherited condition, this ought to be a routine discussion; however, this can be expanded to include the wider population, especially for those conditions for which carrier frequencies are considered relatively common. There is published literature from around the world regarding experiences with carrier screening in primary care for cystic fibrosis, haemoglobinopathies, fragile X syndrome, Tay-Sachs disease and spinal muscular atrophy, although many of these have tended to focus on consultations during rather than before pregnancy. Overall, these studies reveal that population carrier screening is well received by the participants with apparent minimal psychosocial harms; however, challenges exist in terms of approaches to ensure couples receive adequate information to make personally relevant decisions and for ongoing health professional engagement. PMID:22183783

Metcalfe, Sylvia A

2012-07-01

120

Perioperative care following complex laryngotracheal reconstruction in infants and children  

PubMed Central

Laryngotracheal reconstruction (LTR) involves surgical correction of a stenotic airway with cartilage interpositional grafting, followed by either placement of a tracheostomy and an intraluminal stent (two-stage LTR) or placement of an endotracheal tube with postoperative sedation and mechanical ventilation for an extended period of time (singlestage LTR). With single-stage repair, there may be several perioperative challenges including the provision of adequate sedation, avoidance of the development of tolerance to sedative and analgesia agents, the need to use neuromuscular blocking agents, the maintenance of adequate pulmonary toilet to avoid perioperative nosocomial infections, and optimization of postoperative respiratory function to facilitate successful tracheal extubation. We review the perioperative management of these patients, discuss the challenges during the postoperative period, and propose recommendations for the prevention of reversible causes of extubation failure in this article. Optimization to ensure a timely tracheal extubation and successful weaning of mechanical ventilator, remains the primary key to success in these surgeries as extubation failure or the need for prolonged postoperative mechanical ventilation can lead to failure of the graft site, the need for prolonged Pediatric Intensive Care Unit care, and in some cases, the need for a tracheostomy to maintain an adequate airway.

Gupta, Punkaj; Tobias, Joseph D.; Goyal, Sunali; Hashmi, Sana F.; Shin, Jennifer; Hartnick, Christopher J.; Noviski, Natan

2010-01-01

121

Dose Limits for Man do not Adequately Protect the Ecosystem  

SciTech Connect

It has been known for quite some time that different organisms display differing degrees of sensitivity to the effects of ionizing radiations. Some microorganisms such as the bacterium Micrococcus radiodurans, along with many species of invertebrates, are extremely radio-resistant. Humans might be categorized as being relatively sensitive to radiation, and are a bit more resistant than some pine trees. Therefore, it could be argued that maintaining the dose limits necessary to protect humans will also result in the protection of most other species of flora and fauna. This concept is usually referred to as the anthropocentric approach. In other words, if man is protected then the environment is also adequately protected. The ecocentric approach might be stated as; the health of humans is effectively protected only when the environment is not unduly exposed to radiation. The ICRP is working on new recommendations dealing with the protection of the environment, and this debate should help to highlight a number of relevant issues concerning that topic.

Higley, Kathryn A.; Alexakhin, Rudolf M.; McDonald, Joseph C.

2004-08-01

122

Quantifying variability within water samples: the need for adequate subsampling.  

PubMed

Accurate and precise determination of the concentration of nutrients and other substances in waterbodies is an essential requirement for supporting effective management and legislation. Owing primarily to logistic and financial constraints, however, national and regional agencies responsible for monitoring surface waters tend to quantify chemical indicators of water quality using a single sample from each waterbody, thus largely ignoring spatial variability. We show here that total sample variability, which comprises both analytical variability and within-sample heterogeneity, of a number of important chemical indicators of water quality (chlorophyll a, total phosphorus, total nitrogen, soluble molybdate-reactive phosphorus and dissolved inorganic nitrogen) varies significantly both over time and among determinands, and can be extremely high. Within-sample heterogeneity, whose mean contribution to total sample variability ranged between 62% and 100%, was significantly higher in samples taken from rivers compared with those from lakes, and was shown to be reduced by filtration. Our results show clearly that neither a single sample, nor even two sub-samples from that sample is adequate for the reliable, and statistically robust, detection of changes in the quality of surface waters. We recommend strongly that, in situations where it is practicable to take only a single sample from a waterbody, a minimum of three sub-samples are analysed from that sample for robust quantification of both the concentrations of determinands and total sample variability. PMID:17706740

Donohue, Ian; Irvine, Kenneth

2008-01-01

123

DARHT - an `adequate` EIS: A NEPA case study  

SciTech Connect

The Dual Axis Radiographic Hydrodynamic Test (DARHT) Facility Environmental Impact Statement (EIS) provides a case study that is interesting for many reasons. The EIS was prepared quickly, in the face of a lawsuit, for a project with unforeseen environmental impacts, for a facility that was deemed urgently essential to national security. Following judicial review the EIS was deemed to be {open_quotes}adequate.{close_quotes} DARHT is a facility now being built at Los Alamos National Laboratory (LANL) as part of the Department of Energy (DOE) nuclear weapons stockpile stewardship program. DARHT will be used to evaluate the safety and reliability of nuclear weapons, evaluate conventional munitions and study high-velocity impact phenomena. DARHT will be equipped with two accelerator-driven, high-intensity X-ray machines to record images of materials driven by high explosives. DARHT will be used for a variety of hydrodynamic tests, and DOE plans to conduct some dynamic experiments using plutonium at DARHT as well.

Webb, M.D.

1997-08-01

124

Can Surface EMG Be Adequately Described by Digital Sampling?  

PubMed

Surface electromyography (SEMG) is a common tool to evaluate muscle function in kinesiological studies, musculoskeletal rehabilitation, prosthetics, clinical research and neurological disease diagnosis. The acquisition of SEMG is a crucially basic issue to gain an insight into musculoskeletal system function. The aim of this study is to investigate if the sampled surface EMG signals can reflect adequately the neural activity of the underlying musculature. The surface EMG signals of four muscles (abductor pollicis muscles and abductor digiti minimi muscles of right hand and left hand) are studied on the amplitude, frequency and nonlinear measure based on symplectic geometry. There are obvious differences in nonlinear measures of the different sampled signals, although there are little significant changes in their amplitude and frequency measures. Meanwhile, surface EMG signals obviously differ from their surrogate data at higher sampling frequencies. The results indicate that surface EMG signals contain nonlinear components. To gather the sufficient information of surface EMG signal, the data acquisition should be required at the higher sampling frequency. Furthermore, the nonlinear measure based on symplectic geometry can be used as a sensitive index for evaluation of the activity of the human muscles. PMID:24894263

Min, Lei; Sarkar, Nilanjan; Guang, Meng; Yudong, Gu; Kaili, Zhang; Dong, Tian

2014-07-01

125

Guidelines for maintaining adequate nutrition in old age.  

PubMed

Nutrient requirements do not change markedly with advancing age, but life style, socioeconomic status, psychologic changes, and the presence of chronic disease alter nutrient intake in the elderly. It is important to recognize and deal with these factors in attempting to correct malnutrition and in prescribing dietary treatment. Malnutrition includes a variety of disorders: undernutrition, nutrient deficiencies and imbalances, and obesity. Frequent small feedings, with nutritional supplements for patients with profound weight loss, are the initial treatment for undernutrition. Iron supplements and a diet of foods rich in iron and in promoting iron absorption are required in treating iron deficiency anemia. Management of macrocytic anemia should include specific nutrient therapy plus improvement of diet to include leafy vegetables and animal foodstuffs. Diet is an important adjunct in treating chronic diseases. Maturity-onset diabetes mellitus often can be managed by diet alone, with attention to correct proportions of fat, carbohydrate, and protein and to the decreased caloric requirements of elderly patients. The importance of continuing dietary modifications in hyperlipidemia and hypertension is well known. Although dietary manipulation in osteoporosis is not curative, a diet high in calcium and containing adequate floride and vitamin D affords maximum dietary protection against progress of the disease. PMID:648878

Todhunter, E N; Darby, W J

1978-06-01

126

Facilitators and barriers to implementing clinical care pathways  

PubMed Central

Background The promotion of care pathways in the recent Governmental health policy reports of Lord Darzi is likely to increase efforts to promote the use of care pathways in the NHS. Evidence on the process of pathway implementation, however, is sparse and variations in how organisations go about the implementation process are likely to be large. This paper summarises what is known about factors which help or hinder clinicians in adopting and putting care pathways into practice, and which consequently promote or hinder the implementation of scientific evidence in clinical practice. Discussion Care pathways can provide patients with clear expectations of their care, provide a means of measuring patient's progress, promote teamwork on a multi-disciplinary team, facilitate the use of guidelines, and may act as a basis for a payment system. In order to achieve adequate implementation, however, facilitators and barriers must be considered, planned for, and incorporated directly into the pathway with full engagement among clinical and management staff. Barriers and/or facilitators may be present at each stage of development, implementation and evaluation; and, barriers at any stage can impede successful implementation. Important considerations to be made are ensuring the inclusion of all types of staff, plans for evaluating and incorporating continuous improvements, allowing for organisational adaptations and promoting the use of multifaceted interventions. Summary Although there is a dearth of information regarding the successful implementation of care pathways, evidence is available which may be applied when implementing a care pathway. Multifaceted interventions which incorporate all staff and facilitate organisational adaptations must be seriously considered and incorporated alongside care pathways in a continuous manner. In order to better understand the mechanism upon which care pathways are effective, however, more research specifically addressing conditions under which providers become engaged in using care pathways is needed.

2010-01-01

127

28 CFR 61.10 - Ensuring Department NEPA compliance.  

Code of Federal Regulations, 2013 CFR

...2013-07-01 2013-07-01 false Ensuring Department NEPA compliance. 61.10 Section 61.10 Judicial Administration...ACT Implementing Procedures § 61.10 Ensuring Department NEPA compliance. The Land and Natural Resources Division shall...

2013-07-01

128

School Personnel Records: New Requirements for Ensuring Employee Privacy.  

ERIC Educational Resources Information Center

North Carolina's Privacy of Employee Personnel Records Act requires school systems to ensure that school employees and others have access to personnel records while, at the same time, ensuring employee privacy. Provides an overview of the new legislation and identifies some potential problems a school system may encounter in compliance. (MLF)

Allred, Stephen

1988-01-01

129

Maintaining Adequate CO2 Washout for an Advanced EMU via a New Rapid Cycle Amine Technology  

NASA Technical Reports Server (NTRS)

Over the past several years, NASA has realized tremendous progress in Extravehicular Activity (EVA) technology development. This has been evidenced by the progressive development of a new Rapic Cycle Amine (RCA) system for the Advanced Extravehicular Mobility Unit (AEMU) Portable Life Support Subsystem (PLSS). The PLSS is responsible for the life support of the crew member in the spacesuit. The RCA technology is responsible for carbon dioxide (CO2) and humidity control. Another aspect of the RCA is that it is on-back vacuum-regenerable, efficient, and reliable. The RCA also simplifies the PLSS schematic by eliminating the need for a condensing heat exchanger for humidity control in the current EMU. As development progresses on the RCA, it is important that the sizing be optimized so that the demand on the PLSS battery is minimized. As well, maintaining the CO2 washout at adequate levels during an EVA is an absolute requirement of the RCA and associated ventilation system. Testing has been underway in-house at NASA Johnson Space Center and analysis has been initiated to evaluate whether the technology provides exemplary performance in ensuring that the CO2 is removed sufficiently enough and the ventilation flow is adequate enough to maintain CO2 1 Project Engineer, Space Suit and Crew Survival Systems Branch, Crew and Thermal Systems Division, 2101 NASA Parkway, Houston, TX 77058/EC5. washout in the AEMU spacesuit helmet of the crew member during an EVA. This paper will review the recent developments of the RCA unit, the testing results performed in-house with a spacesuit simulator, and the associated analytical work along with insights from the medical aspect on the testing.

Chullen, Cinda

2011-01-01

130

A community-based programme to provide prompt and adequate treatment of presumptive malaria in children.  

PubMed

A community-based programme to ensure prompt and adequate treatment of presumptive episodes of clinical malaria in children has been established in a rural province of Burkina Faso. The implementation strategy was based on training a core group of mothers in every village and supplying community health workers with essential antimalarial drugs specially packed in age-specific bags containing a full course of treatment. Drugs were sold under a cost-recovery scheme. The programme was run in 1994 by the national malaria control centre (CNLP), and in 1995 it was developed to the provincial health team (PHT). Knowledge and awareness of malaria increased with the intervention. Drug consumption by age group was compatible with the distribution of disease, and no major problem of misuse emerged. The actual implementation costs of the intervention were US$ 0.06 per child living in the province. An evaluation of the impact of the intervention on the severity of malaria, using routine data from the health information system and taking as an indicator the proportion of malaria cases which were recorded as severe in health centres, was performed. In 1994, when the intervention was implemented on a provincial scale by CNLP, this proportion was lower than the average of the 4 preceding years (3.7% vs. 4.9%). In 1995, when the programme was implemented by the PHT, the proportion of severe cases was lower in health centres achieving a programme coverage of > or = 50% in their catchment area compared with the others (4.2% vs. 6.1%). Our experience shows that a low-cost, community-based intervention aimed at providing children with prompt and adequate treatment of presumptive episodes of clinical malaria is feasible, and suggests that it may lead to a reduction in the morbidity from severe malaria. PMID:9463653

Pagnoni, F; Convelbo, N; Tiendrebeogo, J; Cousens, S; Esposito, F

1997-01-01

131

Maintaining Adequate Carbon Dioxide Washout for an Advanced Extravehicular Mobility Unit  

NASA Technical Reports Server (NTRS)

Over the past several years, NASA has realized tremendous progress in technology development that is aimed at the production of an Advanced Extravehicular Mobility Unit (AEMU). Of the many functions provided by the spacesuit and portable life support subsystem within the AEMU, delivering breathing gas to the astronaut along with removing the carbon dioxide (CO2) remains one of the most important environmental functions that the AEMU can control. Carbon dioxide washout is the capability of the ventilation flow in the spacesuit helmet to provide low concentrations of CO2 to the crew member to meet breathing requirements. CO2 washout performance is a critical parameter needed to ensure proper and sufficient designs in a spacesuit and in vehicle applications such as sleep stations and hygiene compartments. Human testing to fully evaluate and validate CO2 washout performance is necessary but also expensive due to the levied safety requirements. Moreover, correlation of math models becomes challenging because of human variability and movement. To supplement human CO2 washout testing, a breathing capability will be integrated into a suited manikin test apparatus to provide a safe, lower cost, stable, easily modeled alternative to human testing. Additionally, this configuration provides NASA Johnson Space Center (JSC) the capability to evaluate CO2 washout under off-nominal conditions that would otherwise be unsafe for human testing or difficult due to fatigue of a test subject. Testing has been under way in-house at JSC and analysis has been initiated to evaluate whether the technology provides sufficient performance in ensuring that the CO2 is removed sufficiently and the ventilation flow is adequate for maintaining CO2 washout in the AEMU spacesuit helmet of the crew member during an extravehicular activity. This paper will review recent CO2 washout testing and analysis activities, testing planned in-house with a spacesuit simulator, and the associated analytical work along with insights from the medical aspect on the testing.

Chullen, Cinda; Navarro, Moses; Conger, Bruce; Korona, Adam; McMillin, Summer; Norcross, Jason; Swickrath, Mike

2013-01-01

132

Drinking Water in Schools and Child Care Facilities  

MedlinePLUS

... Drinking Water in Schools & Child Care Facilities Drinking Water in Schools & Child Care Facilities This one-stop EPA site provides information about drinking water quality in schools and child care facilities. Ensuring ...

133

Are Vancomycin Trough Concentrations Adequate for Optimal Dosing?  

PubMed Central

The current vancomycin therapeutic guidelines recommend the use of only trough concentrations to manage the dosing of adults with Staphylococcus aureus infections. Both vancomycin efficacy and toxicity are likely to be related to the area under the plasma concentration-time curve (AUC). We assembled richly sampled vancomycin pharmacokinetic data from three studies comprising 47 adults with various levels of renal function. With Pmetrics, the nonparametric population modeling package for R, we compared AUCs estimated from models derived from trough-only and peak-trough depleted versions of the full data set and characterized the relationship between the vancomycin trough concentration and AUC. The trough-only and peak-trough depleted data sets underestimated the true AUCs compared to the full model by a mean (95% confidence interval) of 23% (11 to 33%; P = 0.0001) and 14% (7 to 19%; P < 0.0001), respectively. In contrast, using the full model as a Bayesian prior with trough-only data allowed 97% (93 to 102%; P = 0.23) accurate AUC estimation. On the basis of 5,000 profiles simulated from the full model, among adults with normal renal function and a therapeutic AUC of ?400 mg h/liter for an organism for which the vancomycin MIC is 1 mg/liter, approximately 60% are expected to have a trough concentration below the suggested minimum target of 15 mg/liter for serious infections, which could result in needlessly increased doses and a risk of toxicity. Our data indicate that adjustment of vancomycin doses on the basis of trough concentrations without a Bayesian tool results in poor achievement of maximally safe and effective drug exposures in plasma and that many adults can have an adequate vancomycin AUC with a trough concentration of <15 mg/liter.

Youn, Gilmer; Jones, Brenda; Jelliffe, Roger W.; Drusano, George L.; Rodvold, Keith A.; Lodise, Thomas P.

2014-01-01

134

Guidelines in the care of the dying cancer patient.  

PubMed

The care of patients in the final stages of cancer requires a high level of clinical vigilance and skill to ensure that the passage from life to death is as free from suffering as possible. Patients who are dying have a right to adequate relief of physical and psychological symptoms, and they and their families have a right to adequate support. The care of patients and their families requires (1) interdisciplinary cooperation of a healthcare team incorporating physicians, nurses, social workers, and other auxiliary supports, and (2) a high level of clinical flexibility to address the evolving needs of the patient and family. Participation in this process challenges the clinician's emotional resources and medical skills. There is, however, the potential for professional satisfaction in helping to orchestrate a "good death," because the relief of suffering is at the very heart of medicine. Familiarity with guidelines in the care of the dying can reduce the potential for distress in this important clinical endeavor. PMID:8821571

Cherny, N I; Coyle, N; Foley, K M

1996-02-01

135

Infant Care Suggestions for Parents  

MedlinePLUS

... the Hospital Parent education should include explanation and demonstration of the procedures for holding, lifting, diapering, and general infant care. The return demonstration will ensure that the parents are comfortable with ...

136

Perceived Access to General Medical and Psychiatric Care Among Veterans With Bipolar Disorder  

PubMed Central

Objectives. We examined associations between patient characteristics and self-reported difficulties in accessing mental health and general medical care services. Methods. Patients were recruited from the Continuous Improvement for Veterans in CareMood Disorders study. We used multivariable logistic regression analyses to assess whether predisposing (demographic characteristics), enabling (e.g., homelessness), or need (bipolar symptoms, substance abuse) factors were associated with difficulties in obtaining care, difficulties in locating specialty providers, and forgoing care because of cost. Results. Patients reported greater difficulty in accessing general medical services than in accessing psychiatric care. Individuals experiencing bipolar symptoms more frequently avoided psychiatric care because of cost (odds ratio [OR] = 2.43) and perceived greater difficulties in accessing medical specialists (OR = 2.06). Homeless individuals were more likely to report hospitalization barriers, whereas older and minority patients generally encountered fewer problems accessing treatment. Conclusions. Need and enabling factors were most influential in predicting self-reported difficulties in accessing care, subsequently interfering with treatment dynamics and jeopardizing clinical outcomes. Efforts in the Department of Veterans Affairs to expand mental health care access should be coupled with efforts to ensure adequate access to general medical services among patients with chronic mental illnesses.

Copeland, Laurel A.; McCarthy, John F.; Bauer, Mark S.; Kilbourne, Amy M.

2009-01-01

137

Driving through: postpartum care during World War II.  

PubMed Central

In 1996, public outcry over shortened hospital stays for new mothers and their infants led to the passage of a federal law banning "drive-through deliveries." This recent round of brief postpartum stays is not unprecedented. During World War II, a baby boom overwhelmed maternity facilities in American hospitals. Hospital births became more popular and accessible as the Emergency Maternal and Infant Care program subsidized obstetric care for servicemen's wives. Although protocols before the war had called for prolonged bed rest in the puerperium, medical theory was quickly revised as crowded hospitals were forced to discharge mothers after 24 hours. To compensate for short inpatient stays, community-based services such as visiting nursing care, postnatal homes, and prenatal classes evolved to support new mothers. Fueled by rhetoric that identified maternal-child health as a critical factor in military morale, postpartum care during the war years remained comprehensive despite short hospital stays. The wartime experience offers a model of alternatives to legislation for ensuring adequate care of postpartum women. Images FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6

Temkin, E

1999-01-01

138

Driving through: postpartum care during World War II.  

PubMed

In 1996, public outcry over shortened hospital stays for new mothers and their infants led to the passage of a federal law banning "drive-through deliveries." This recent round of brief postpartum stays is not unprecedented. During World War II, a baby boom overwhelmed maternity facilities in American hospitals. Hospital births became more popular and accessible as the Emergency Maternal and Infant Care program subsidized obstetric care for servicemen's wives. Although protocols before the war had called for prolonged bed rest in the puerperium, medical theory was quickly revised as crowded hospitals were forced to discharge mothers after 24 hours. To compensate for short inpatient stays, community-based services such as visiting nursing care, postnatal homes, and prenatal classes evolved to support new mothers. Fueled by rhetoric that identified maternal-child health as a critical factor in military morale, postpartum care during the war years remained comprehensive despite short hospital stays. The wartime experience offers a model of alternatives to legislation for ensuring adequate care of postpartum women. PMID:10191809

Temkin, E

1999-04-01

139

Waiting for attention and care: birthing accounts of women in rural Tanzania who developed obstetric fistula as an outcome of labour  

PubMed Central

Background Obstetric fistula is a physically and socially disabling obstetric complication that affects about 3,000 women in Tanzania every year. The fistula, an opening that forms between the vagina and the bladder and/or the rectum, is most frequently caused by unattended prolonged labour, often associated with delays in seeking and receiving appropriate and adequate birth care. Using the availability, accessibility, acceptability and quality of care (AAAQ) concept and the three delays model, this article provides empirical knowledge on birth care experiences of women who developed fistula after prolonged labour. Methods We used a mixed methods approach to explore the birthing experiences of women affected by fistula and the barriers to access adequate care during labour and delivery. Sixteen women were interviewed for the qualitative study and 151 women were included in the quantitative survey. All women were interviewed at the Comprehensive Community Based Rehabilitation Tanzania in Dar es Salaam and Bugando Medical Centre in Mwanza. Results Women experienced delays both before and after arriving at a health facility. Decisions on where to seek care were most often taken by husbands and mothers-in-law (60%). Access to health facilities providing emergency obstetric care was inadequate and transport was a major obstacle. About 20% reported that they had walked or were carried to the health facility. More than 50% had reported to a health facility after two or more days of labour at home. After arrival at a health facility women experienced lack of supportive care, neglect, poor assessment of labour and lack of supervision. Their birth accounts suggest unskilled birth care and poor referral routines. Conclusions This study reveals major gaps in access to and provision of emergency obstetric care. It illustrates how poor quality of care at health facilities contributes to delays that lead to severe birth injuries, highlighting the need to ensure women's rights to accessible, acceptable and adequate quality services during labour and delivery.

2011-01-01

140

The occasional case against broad dissemination and implementation: retaining a role for specialty care in the delivery of psychological treatments.  

PubMed

Mental illness imposes a staggering public health burden in the United States. Although the past 40 years have witnessed tremendous advances in the identification of evidence-based practices (EBPs) in psychological treatments, gaps persist between treatment in experimental settings and services available in the community. In response, considerable attention and large financial commitments have focused in recent years on broad dissemination and implementation efforts designed to improve the quality of psychological services delivered by a variety of generalist practitioners across practice settings. Increasingly, under the influence of the Patient Protection and Affordable Care Act, it is envisioned that these generalists will practice in integrated primary care settings. These advances hold enormous potential, and yet, given the tremendous diversity of mental health problems and human suffering, broad dissemination and implementation efforts to generalists alone may not be sufficient to adequately address the burden of mental illness. Some EBPs may prove too complex for universal dissemination, and the time and expense required for quality dissemination and implementation preclude large-scale training in the treatment of low base rate disorders. As dissemination and implementation efforts work to ensure a quality generalist mental health care workforce, herein we highlight the vital need for available specialty care in the delivery of psychological treatments. Given traditional barriers that interfere with the accessibility of specialty care, we propose the transformative potential of a specialty behavioral telehealth care workforce, transacting with the generalist practitioner workforce to collectively ensure the highest quality and timely delivery of needed treatments to affected individuals. PMID:23915401

Comer, Jonathan S; Barlow, David H

2014-01-01

141

Prenatal Care  

MedlinePLUS

Home > Publications > Our publications > Our publications Publications Prenatal care fact sheet Print this fact sheet Prenatal care ... More information on prenatal care What is prenatal care? Prenatal care is the health care you get ...

142

Strategies for ensuring quality data from Indian investigational sites  

PubMed Central

The topic of ensuring quality and compliance is and must be a top priority in the conduct of clinical trials, as warranted by regulatory guidelines as well as the inherent responsibility of the professionals conducting such research. Fast-growing emerging clinical geographies such as India demand special attention due to rapid growth and associated factors that may put study quality at risk. In this paper, we used the basic principle of PDCA (Plan, Do, Check, and Adjust) to structure the processes of a clinical trial from protocol to final analysis in order to highlight the interactive nature of involved people and processes required to ensure quality of data and site functioning.

Hajos, Antal K.; Kamble, Sujal K.

2011-01-01

143

QUALITY ENSUREMENT SYSTEM FOR THE DISTANT ENGINEER STUDIES MODEL  

Microsoft Academic Search

In the article there is presented the model of distant education system SPrINT, as incorporated during the distant engineering studies within Warsaw Technical University, using the Internet. There are the basics of education shown as well as the basics of informatical structures incorporated within this model. There has been attention pointed towards the problem of providing the adequate quality for

Marek Zawadzki

144

Adequate iodine intake of Slovenian adolescents is primarily attributed to excessive salt intake.  

PubMed

In Slovenia, table salt iodization has been applied to combat iodine deficiency. Recently, we found that Slovenian adolescents attained iodine sufficiency (median urinary iodine concentration was 140 microg/L; prevalence of goiter was <1%). National data indicate that salt intake of Slovenian population is too high (150% above the recommended limit); therefore, we hypothesized that sufficient iodine intake in adolescents can be primarily attributed to excessive salt intake. In a cross-sectional study, we investigated iodine and salt intake in Slovenian adolescents as well as the contributions of different foods to their intake. We determined the iodine and salt intake of a national representative sample of 2581 adolescents, aged 14 to 17 years, using the Food Frequency Questionnaire (FFQ). The FFQ covered habitual diets over the past year, and 2485 (96%) adolescents completed a valid FFQ (1370 girls, 1115 boys). The iodine intake was 189.7 +/- 2.6 microg/d (mean +/- standard error of mean), well above the recommended 150 microg/d (P < .001). Table salt was by far the biggest dietary source of iodine and sodium for both sexes. Total salt intake (mean +/- standard error of mean, 10.4 +/- 0.2 g/d) significantly exceeded the upper World Health Organization limit (<5 g/d, P < .001), especially in boys (11.5 +/- 0.3 vs 9.4 +/- 0.2 g/d in girls, P < .001). The main food sources of salt were table salt (33%), bread (24%), salty snack products (10%), meat products (8%), fish products (6%), and milk (4%). Salt intake from foods, excluding table salt, was 6.9 g/d (67% of total salt intake). We conclude that although Slovenian adolescents are iodine sufficient, their salt intake, especially among boys, is too high. Several nutritional interventions are proposed to reduce total salt intake while ensuring adequate iodine intake. PMID:19963163

Stimec, Matevz; Kobe, Helena; Smole, Katarina; Kotnik, Primoz; Sirca-Campa, Andreja; Zupancic, Mirjana; Battelino, Tadej; Krzisnik, Ciril; Fidler Mis, Natasa

2009-12-01

145

Ensuring Good Character and Civic Education: Connecting through Service Learning  

ERIC Educational Resources Information Center

Character and citizenship education are part of the vision of many countries, including Singapore. Ensuring they are implemented in academic environments, service learning has been shown to be a natural bridge between the two. Research has shown that service learning, when done well, produces outcomes related to character development and

Shumer, Robert; Lam, Carolina; Laabs, Bonnie

2012-01-01

146

Ensuring Student Loan Repayment: A National Handbook of Best Practices.  

ERIC Educational Resources Information Center

During a symposium on ensuring student loan repayment, writers were recording best practices and ideas for improvements in student loan programs. The chapters of this handbook are organized in the same way that the symposium discussions occurred. Chapter 1 summarizes recent trends in student loan defaults and the general themes that emerged during

Office of Student Financial Assistance (ED), Washington, DC.

147

Ensuring consistency in multidatabases by preserving two-level serializability  

Microsoft Academic Search

The concept of serializability has been the traditionally accepted correctness criterion in database systems. However in multidatabase systems (MDBSs), ensuring global serializability is a difficult task. The difficulty arises due to the heterogeneity of the concurrency control protocols used by the participating local database management systems (DBMSs), and the desire to preserve the autonomy of the local DBMSs. In general,

Sharad Mehrotra; Rajeev Rastogi; Henry F. Korth; Abraham Silberschatz

1998-01-01

148

INTERIOR VIEW WITH ANNEALING OVEN AND OPERATOR ENSURING THAT ALL ...  

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

INTERIOR VIEW WITH ANNEALING OVEN AND OPERATOR ENSURING THAT ALL ENTERING PIPE IS STRAIGHT AND THAT THE CORE HAS BEEN REMOVED FROM THE BELL END OF EACH PIPE - McWane Cast Iron Pipe Company, Pipe Casting Area, 1201 Vanderbilt Road, Birmingham, Jefferson County, AL

149

Improved molding process ensures plastic parts of higher tensile strength  

NASA Technical Reports Server (NTRS)

Single molding process ensures that plastic parts /of a given mechanical design/ produced from a conventional thermosetting molding compound will have a maximum tensile strength. The process can also be used for other thermosetting compounds to produce parts with improved physical properties.

Heier, W. C.

1968-01-01

150

PRACTICAL APPROACHES TO ENSURE ANIMAL WELFARE ON FARMS  

Microsoft Academic Search

Although animal welfare can be defined in terms of animals' feelings, determining how this is manifested on farms relies on professional judgement. Various guidelines, both general and specific have been developed that provide direction on ensuring good animal welfare on farms. To achieve this, managers must demonstrate that they place a high value on animal welfare through their practices. These

Harold Gonyou

2005-01-01

151

Water quality--how to ensure a pure supply.  

PubMed

Mark Bosley, systems specialist at designer, developer and manufacturer of water purification systems for the healthcare and research sectors Purite, examines the growing regulatory framework governing the purity and quality of water supplied to decontamination centres, and discusses some of the latest technologies used to ensure the required standards are met. PMID:19711671

Bosley, Mark

2009-08-01

152

Ensuring Quality E-Learning: Creating Engaging Tasks.  

ERIC Educational Resources Information Center

Focuses on several examples of software design that have been pedagogically successful and have demonstrated what is possible in software design and online learning. Contrasts are made with some examples of the current push into e-learning and how best to structure learning environments to ensure student participation and high quality learning

Hedberg, John G.

2003-01-01

153

Ensuring supply chain safety through time temperature integrators  

Microsoft Academic Search

Purpose The technology of time temperature integrators (TTI) is used to ensure the safety and quality of temperature sensitive goods such as food and drugs along their entire lifespan. This work aims to provide a better understanding of potential benefits that can be expected from the use of TTIs in terms of supply chain improvement. Design\\/methodology\\/approach Based on

Evren Sahin; Mohamed Zied Baba; Yves Dallery; Renaud Vaillant

2007-01-01

154

Ensuring Equal Access to High-Quality Education. Revised  

ERIC Educational Resources Information Center

The Office for Civil Rights (OCR) in the U.S. Department of Education (Department) is a law enforcement agency charged with enforcing federal civil rights laws to ensure that educational institutions receiving federal financial assistance do not engage in discriminatory conduct. OCR enforces the federal civil rights laws that prohibit

Office for Civil Rights, US Department of Education, 2011

2011-01-01

155

Strengthening Internal Quality to Ensure Changing External Requirements Are Met  

Microsoft Academic Search

As a result of AUQA Audits in 2002 and 2008 Curtin University of Technology has had the opportunity to reflect on its experiences and identify ways to improve its approach to quality to ensure that its systems are robust and sustainable. This paper identifies the major steps taken in its preparation for the 2008 audit and the particular aspects that

Bernie McKenna

156

Good Work Ensures Employment Success. Myths and Realities No. 2.  

ERIC Educational Resources Information Center

It is a myth that skills alone ensure employment. Other keys to workplace success include continuous learning, emotional intelligence, networking, flexibility, and commitment to business objectives. Although academic degrees, skill certifications, and other documentation of accomplishments provide access to employment, they are significant only at

Brown, Bettina Lankard

157

A corporate treasurer toolkit to ensure fund delivery in disaster zones.  

PubMed

In a disaster situation, the corporate treasury department of an organisation is also responsible for ensuring business continuity. The treasury department's key role would be to ensure that vendors, suppliers and employees are adequately remunerated and that operations do not seize due to a lack of working capital. Treasury practitioners concerned with business continuity have traditionally focused on three mainstay aspects of the initiative: (1) creating virtual or remote treasury offices; (2) training key backup staff on emergency procedures; (3) maintaining power and telecommunication connectivity with their cash concentration bank to guarantee treasury is able to transmit funding instructions to them. This paper aims to take business continuity measures for corporate treasury departments to a higher level of preparedness by asking one critical question: 'What will happen if the cash concentration bank or the entire banking system of a country in which a company has operations collapses?' Rarely have treasury professionals contemplated such a cataclysmic scenario. This paper aims to (1) validate that banking system failures are common, (2) rationalise why treasury practitioners need to devise contingency funding strategies outside of the banking system and (3) offer some viable alternatives to commercial banks. In this regard the author will draw from the experience of international non-governmental organisations that routinely respond to and operate in cataclysmic emergencies. PMID:23315248

Parandeh, Sassan Cyrus

158

Ensuring safe water in post-chemical, biological, radiological and nuclear emergencies  

PubMed Central

Disaster scenarios are dismal and often result in mass displacement and migration of people. In eventuality of emergency situations, people need to be rehabilitated and provided with an adequate supply of drinking water, the most essential natural resource needed for survival, which is often not easily available even during non-disaster periods. In the aftermath of a natural or human-made disaster affecting mankind and livestock, the prime aim is to ensure supply of safe water to reduce the occurrence and spread of water borne disease due to interrupted, poor and polluted water supply. Chemical, biological, radiological and nuclear (CBRN) emergencies augment the dilemma as an additional risk of contamination is added. The associated risks posed to health and life should be reduced to as low as reasonably achievable. Maintaining a high level of preparedness is the crux of quick relief and efficient response to ensure continuous supply of safe water, enabling survival and sustenance. The underlying objective would be to educate and train the persons concerned to lay down the procedures for the detection, cleaning, and treatment, purification including desalination, disinfection, and decontamination of water. The basic information to influence the organization of preparedness and execution of relief measures at all levels while maintaining minimum standards in water management at the place of disaster, are discussed in this article.

Amar, Praveen Kumar

2010-01-01

159

The Influence of Cognitive Impairment, Special Care Unit Placement, and Nursing Facility Characteristics on Resident Quality of Life  

PubMed Central

Objectives We examined the (a) influence of nursing facility characteristics on resident quality of life and (b) the impact of cognitive impairment and residence on a dementia special care unit(SCU) on QOL after controlling for resident and facility characteristics. Method Multilevel models (resident and facility) were estimated for residents with and without cognitive impairment on conventional units and dementia SCU. Data came from the 2007 Minnesota Nursing Home Resident Quality of Life and Consumer Satisfaction Survey (N = 13,983). Results Level of resident CI was negatively related to QOL, although residing on a dementia SCU was positively related to QOL. Certified Nursing Assistant and activity personnel hours per resident day had a positive relationship with resident QOL. Discussion Our results highlight the need to ensure adequate levels of paraprofessional direct care staff and the availability of dementia-focused (SCU)s despite current constraints on long-term care funding.

Abrahamson, Kathleen; Lewis, Teresa; Perkins, Anthony; Clark, Daniel; Nazir, Arif; Arling, Greg

2014-01-01

160

Pharmacy Continuity of Care: What do Community Pharmacists Need from an Acute Care Hospital to Improve Continuity of Pharmaceutical Care?  

Microsoft Academic Search

The concept of `continuity of care' or `seamless care' refers to the transition that occurs when a patient is discharged from an acute care setting to an outpatient community environment. In order to prevent errors and to ensure appropriate follow-up during this transition, communication between all healthcare disciplines is required to guarantee the implementation of an appropriate, successful treatment plan

Cherokee Layson-Wolf; Jill A. Morgan

2008-01-01

161

Home Care  

MedlinePLUS

Home Care Basic Facts & Information Role of Health Care Professionals in Home Care Your physician is the leader of an interdisciplinary ... travel to see the healthcare team. Is Home Care Right for You? Home care is especially useful ...

162

Hospice care  

MedlinePLUS

... person in charge of care is called the primary care giver. This may be a spouse, life partner, ... some settings the hospice team will teach the primary care giver how to care for the patient. Caring ...

163

A Safety Ensuring Mechanism for Holonic Manufacturing Systems  

NASA Astrophysics Data System (ADS)

This paper discusses a mechanism to ensure safe behaviors of HMSs (Holonic Manufacturing Systems). The change from low-variety high-volume to high-variety low-volume production requires highly flexible and adaptive manufacturing systems. Multi agent systems, in which decisions are made through cooperation among autonomous and cooperative elements, fulfill these requirements by exploiting full abilities of individual elements while eliminating various bottlenecks that exist in conventional systems. However, highly adaptive features induce non-deterministic behaviors of systems, and make it difficult to adopt multi agent systems as primary bases of manufacturing systems. In order to apply these systems to large and complicated applications, mechanisms that make their behaviors more predictable are essential. HMSs are a kind of multi agent systems, and an HMS safety ensuring mechanism proposed here is one of the attempts to make behaviors of multi agent systems more predictable.

Tamura, Shinsuke; Yanase, Tatsuro; Nishi, Naoya

164

Strategies for ensuring quality data from Indian investigational sites.  

PubMed

The topic of ensuring quality and compliance is and must be a top priority in the conduct of clinical trials, as warranted by regulatory guidelines as well as the inherent responsibility of the professionals conducting such research. Fast-growing emerging clinical geographies such as India demand special attention due to rapid growth and associated factors that may put study quality at risk. In this paper, we used the basic principle of PDCA (Plan, Do, Check, and Adjust) to structure the processes of a clinical trial from protocol to final analysis in order to highlight the interactive nature of involved people and processes required to ensure quality of data and site functioning. PMID:21731855

Hajos, Antal K; Kamble, Sujal K

2011-04-01

165

A manufacturer's approach to ensure long term structural integrity  

NASA Technical Reports Server (NTRS)

The main features of the design concepts for the Saab 340 and Saab 2000 aircraft are described with respect to structural integrity and high reliability. Also described is the approach taken at Saab Aircraft to ensure structural integrity and high reliability. The concepts of global and local loads and sequences, and the fatigue and damage tolerance sizing and their verification are discussed. Also described is quality assurance in the production and structural maintenance program. Structural repair and feedback from operators are also covered.

Ansell, Hans; Fredriksson, Billy; Holm, Ingvar

1992-01-01

166

Cep63 and Cep152 Cooperate to Ensure Centriole Duplication  

PubMed Central

Centrosomes consist of two centrioles embedded in pericentriolar material and function as the main microtubule organising centres in dividing animal cells. They ensure proper formation and orientation of the mitotic spindle and are therefore essential for the maintenance of genome stability. Centrosome function is crucial during embryonic development, highlighted by the discovery of mutations in genes encoding centrosome or spindle pole proteins that cause autosomal recessive primary microcephaly, including Cep63 and Cep152. In this study we show that Cep63 functions to ensure that centriole duplication occurs reliably in dividing mammalian cells. We show that the interaction between Cep63 and Cep152 can occur independently of centrosome localisation and that the two proteins are dependent on one another for centrosomal localisation. Further, both mouse and human Cep63 and Cep152 cooperate to ensure efficient centriole duplication by promoting the accumulation of essential centriole duplication factors upstream of SAS-6 recruitment and procentriole formation. These observations describe the requirement for Cep63 in maintaining centriole number in dividing mammalian cells and further establish the order of events in centriole formation.

Brown, Nicola J.; Marjanovic, Marko; Luders, Jens; Stracker, Travis H.; Costanzo, Vincenzo

2013-01-01

167

Adequate Levels of Adherence with Controller Medication Is Associated with Increased Use of Rescue Medication in Asthmatic Children  

PubMed Central

Background The role of asthma controller medication adherence and the level of asthma control in children is poorly defined. Aims To assess the association between asthma controller medication adherence and asthma control in children using routinely acquired prescribing data. Methods A retrospective observational study of children aged 018 years prescribed inhaled corticosteroids only (ICS), leukotriene receptors antagonists (LTRA), or long-acting ?2 agonists (LABA) and ICS prescribed as separate or combined inhalers, between 01/09/2001 and 31/08/2006, registered with primary care practices contributing to the Practice Team Information database. The medication possession ratio (MPR) was calculated and associations with asthma control explored. Poor asthma control was defined as the issue of prescriptions for ?1 course of oral corticosteroids (OCS) and/or ?6 short-acting ?2 agonists (SABA) canisters annually. Results A total of 3172 children prescribed asthma controller medication were identified. Of these, 1539% (depending on controller medication) demonstrated adequate MPR. Adequate MPR was associated with male gender, good socio-economic status, and oral LTRA therapy. Adequate MPR was more likely to be associated with increased use of rescue medication. However logistic regression only identified a significant relationship for ICS only (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.352.48; p<0.001), LTRA (OR, 2.11; 95% CI, 1.273.48; p?=?0.004) and LABA/ICS (OR, 2.85; 95% CI, 1.625.02; p<0.001). Conclusion Poor adherence was observed for all asthma controller medications, although was significantly better for oral LRTA. In this study adequate adherence was not associated with the use of less rescue medication, suggesting that adherence is a complex issue.

Elkout, Hajer; Helms, Peter J.; Simpson, Colin R.; McLay, James S.

2012-01-01

168

Migrant-friendly hospitals: a paediatric perspective - improving hospital care for migrant children  

PubMed Central

Background The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. Methods Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. Results Paediatric care can be complex, usually involving both the patient and the patients family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. Conclusions International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care for PMs at both policy and service levels is an investment in the future that will benefit native and migrant families.

2013-01-01

169

Preconception Care and Prenatal Care  

MedlinePLUS

... Clinical Trials Resources and Publications En Espaol Preconception Care and Prenatal Care: Condition Information Skip sharing on social media links Share this: Page Content What is preconception care? Preconception care is the care a woman receives ...

170

Is it recorded in the notes? Documentation of end-of-life care and preferred place to die discussions in the final weeks of life  

PubMed Central

Background Over the past ten years there has been an increasing focus on the need for improving the experience of end of life care. A number of policy initiatives have been introduced to develop approaches to discussing and documenting individual preferences for end of life care, in particular preferred place to die. Methods The aim was to investigate practice in relation to discussing and documenting end of life care and preferred place to die in the last 4 weeks of life with patients and their families. The study utilised an audit of 65 case notes, alongside four group interviews with a mix of health care professionals involved in palliative care provision. Results While there was evidence that discussions relating to end of life care and preferred place to die had taken place in around half of the audited case notes, there appeared to be a lack of a systematic approach to the recording of discussions with patients or carers about these kind of issues. Health care staff subsequently highlighted that initiating discussions about end of life care and preferences in relation to place of death was challenging and that the recording and tracking of such preferences was problematic. Conclusions Further work is required to establish how information may be adequately recorded, revised and transferred across services to ensure that patients' preferences in relation to end of life care and place of death are, as far as possible, achieved.

2011-01-01

171

Having the right proportions: Interacting interfaces ensure robust spatial patterning  

PubMed Central

We propose a new mechanism for robust biological patterning. The mechanism bears analogy to interface dynamics in condensed media. We apply this method to study how gene networks control segmentation of Drosophila. The proposed model is minimal involving only 4 genes and a morphogen gradient. We discuss experimental data for which developmental genes are expressed within domains spatially limited by kinks (interfaces) and the gene interaction scheme contains both weak and strong repulsion. We show how kink-kink interactions can be calculated from the gene interactions and how the gene interaction scheme ensures the control of proportions (size regulation).

Vakulenko, Sergei; Manu; Reinitz, John; Radulescu, Ovidiu

2010-01-01

172

45 CFR 50.5 - Waivers for the delivery of health care service.  

Code of Federal Regulations, 2013 CFR

... (b) Waivers are limited to primary care physicians and general psychiatrists who have completed their primary care or psychiatric residency training...to ensure that the physicians' primary care training is current...

2013-10-01

173

45 CFR 50.5 - Waivers for the delivery of health care service.  

Code of Federal Regulations, 2011 CFR

... (b) Waivers are limited to primary care physicians and general psychiatrists who have completed their primary care or psychiatric residency training...to ensure that the physicians' primary care training is current...

2011-10-01

174

45 CFR 50.5 - Waivers for the delivery of health care service.  

Code of Federal Regulations, 2010 CFR

... (b) Waivers are limited to primary care physicians and general psychiatrists who have completed their primary care or psychiatric residency training...to ensure that the physicians' primary care training is current...

2010-10-01

175

45 CFR 50.5 - Waivers for the delivery of health care service.  

Code of Federal Regulations, 2012 CFR

... (b) Waivers are limited to primary care physicians and general psychiatrists who have completed their primary care or psychiatric residency training...to ensure that the physicians' primary care training is current...

2012-10-01

176

Ensuring Patient Safety in Wireless Medical Device Networks  

Microsoft Academic Search

WMDNs provide many alarms and related clinical data that are life-critical. To avoid exposing patients to serious injuries or death, these systems must be protected from data delays, distortions, loss, or other erratic delivery problems. Despite the careful planning, procurement, installation, and management that goes into selecting and deploying WMDN systems, by nature many intentional and unintentional ad hoc changes

Vijay Gehlot; Elliot B. Sloane

2006-01-01

177

Turning on the care coordination switch in rural primary care: voices from the practices--clinician champions, clinician partners, administrators, and nurse care managers.  

PubMed

This study sought to understand the acceptability and feasibility of office-based nurse care management in medium to large rural primary care practices. A qualitative assessment of Care Management Plus (a focused medical home model for complex patients) implementation was conducted using semistructured interviews with 4 staff cohorts. Cohorts included clinician champions, clinician partners, practice administrators, and nurse care managers. Seven key implementation attributes were: a proven care coordination program; adequate staffing; practice buy-in; adequate time; measurement; practice facilitation; and functional information technology. Although staff was positive about the care coordination concept, model acceptability was varied and additional study is required to determine sustainability. PMID:21673531

Fagnan, Lyle J; Dorr, David A; Davis, Melinda; McGinnis, Paul; Mahler, Jo; King, Molly McCarthy; Michaels, LeAnn

2011-01-01

178

Gaps in continuity of care at the interface between primary care and specialized care: general practitioners' experiences and expectations  

PubMed Central

Introduction Discontinuity of care at the interface between inpatient and outpatient management can lead to increased morbidity and mortality. Appropriate communication and flow of information is indispensable to ensure continuity of care. Consequently, the aim of this study was to assess general practitioners (GPs) experiences of cooperation with a university hospital, as well as their needs and obvious barriers regarding an optimized information flow. Methods A qualitative study was performed. In March 2011, 300 GPs from the Zurich Canton were invited to participate in two focus group meetings. Based on a review of the literature, an interview guide was created addressing two main issues. In the first part, experiences and barriers regarding cooperation with the university were explored. In the second part, needs and suggestions to improve cooperation were addressed. Results Fifteen GPs participated in two focus groups. GPs complained that they have often not been adequately informed about ongoing treatments or appointments for their patients. GPs feel responsible for the continuity of care and wish to be more involved, especially in long-term treatment decisions or at the end of life. By not involving them, they stated, important information concerning patients medical history and social setting was not taken into account. Improvements are also required at discharge: GPs often do not receive important information about treatments in the hospital and further requirements within a reasonable time. Conclusion Exchange of information between the hospital and the GP at admission and discharge is essential. However, at present, involvement during hospitalization of the patient is lacking. This includes the exchange of information after an unexpected clinical procedure and input from GPs when difficult clinical decisions are made, such as at the beginning or termination of long-term therapies.

Tandjung, Ryan; Rosemann, Thomas; Badertscher, Nina

2011-01-01

179

Preconception Care  

MedlinePLUS

... should speak with your healthcare provider about preconception care. Preconception care is care you receive before you get pregnant. It involves finding and taking care of any problems that might affect you and ...

180

Hospice Care  

MedlinePLUS

... Page Resize Text Printer Friendly Online Chat Hospice Care What is Hospice Care? When is Hospice Care ... Family Counseling and Support Services What is Hospice Care? Hospice programs are available to help terminally ill ...

181

Residential Care  

MedlinePLUS

... will not sell or share your name. Residential Care Tweet Bookmark this page | Email | Print If the ... setting Care facility checklist Costs Types of residential care A good long-term care facility should feel ...

182

Fish research and the institutional animal care and use committee.  

PubMed

Fish represent the most diverse group of animals in the vertebrate phylum. The more than 25,000 species are characterized by an array of anatomical, biochemical, physiological, and behavioral repertoires. For this reason, it is difficult to develop a comprehensive guideline on the care and use of fishes. Institutional animal care and use committees (IACUCs) meet the challenge of ensuring adequate fish welfare using guidelines (Animal Welfare Act [AWA] and Public Health Service [PHS] Policy and their guides) derived mainly from the care and use of mammalian species, which may not be optimal for regulating fish research, teaching, or extension activities. Discussion focuses on various issues that often confront IACUCs in meeting regulatory requirements while assuring proper fish welfare. Issues include questions concerning animal tracking and inventory, utilization of fisheries bycatch, facility inspections in remote locations, and euthanasia. Common sense solutions appropriate for field and laboratory fish activities are suggested, which should help investigators, IACUCs, and regulatory agencies meet PHS and AWA objectives. PMID:13130159

Borski, Russell J; Hodson, Ronald G

2003-01-01

183

[Use of music in palliative care].  

PubMed

Man is mortal, which means that as the earthly body perishes being, final. Disease and death will always be an inevitable and integral part of human experience. The way in which we try to identify and respond to the unique and individual needs of the dying is an indication of our maturity as a society. The number of people requiring palliative care is growing. Palliative care does not intend to either accelerate or postpone death she emphasizes the life and looks at dying as a normal process. It is an active form of care for patients with advanced, progressive illness, with the aim of suppressing pain and other symptoms in addition to providing psychological, social and spiritual support which ensures the best possible quality of life for patients and their families. Therefore requires a coordinated and interdisciplinary contribution team. The variety of professions in a team, and determine the needs of patients should be ready to provide physical, psychological, social and spiritual support using methods that result from an interdisciplinary, collaborative team approach. Development of a holistic approach and awareness in the medical and allied professions has led to a renewal of interest in the inclusion of music and other expressive media in contemporary concepts of palliative care, which are consistent with problem areas, clinical manifestations and the needs of patients. Music offers a direct and uncomplicated medium of intimacy, living in a man who listens to her, has a place where words lose their power. Music is like our existence, constantly polarizing and emotionally stimulating, as it touches the medium of the earliest layers of our becoming. The use of music in palliative care has proved very effective for a variety of effects that music creates in patients. These effects are achieved through the use of various musical techniques, such as musical improvisation, songwriting, receiving creative techniques, guided by imagination and music. These techniques allow the diversity of objectives in treating patients such as reducing anxiety and stress, relaxation, pain control, reducing confusion spiritual, emotional expression, experience, self-awareness, encourage creative expression, causing mood swings - emotional, cognitive and behavioral, inducing the patient's imagination, enabling patient's chronological classification of life experiences, and the elaboration of unresolved pain, sorrow or errors. Adequate selection and use of musical techniques in palliative care in the service of achieving the best possible quality of life for patients at the end of life. PMID:22994012

Skrbina, Dijana; Simunovi?, Dubravka; Santek, Vjerocka; Njegovan-Zvonarevi?, Tatjana

2011-12-01

184

An institution-based process to ensure clinical software quality.  

PubMed

Clinical software can have a major impact on the delivery of care. It is imperative that clinical software undergo regular quality review, to evaluate the clinical correctness of the specification, the technical correctness of the software, problems that have arisen, and maintenance of the software as conditions change. We have developed a process using existing hospital review groups to perform clinical review, and using a project specification form and analysis of likely problem areas to effect technical review. PMID:10566401

Abookire, S A; Teich, J M; Bates, D W

1999-01-01

185

Ensuring minimal humidity levels in hermetic implant housings.  

PubMed

The electronic circuitry of active implantable devices is commonly protected against the risk of water-induced corrosion by using gas-tight (hermetic) packages, preventing moisture from the host body to reach the electronics. However, when closing the package, one has to ensure that the packaged components do not contain moisture that could rise humidity inside the package to critical levels by outgassing. For our miniature metal/ceramic packages, we found a drying procedure of 120 C at 180 mbar absolute pressure for one hour, followed by a dry helium purge sufficient to keep the relative humidity below 2.5% over a time span of 300 days at 80 C, corresponding to over 15 years at 37 C. The additional integration of a desiccant inside the package permits to keep the relative humidity below 0.1%, the detection limit of the integrated sensor. This sensor was selected based on an evaluation of 17 commercially available humidity sensors. PMID:22254800

Schuettler, Martin; Schatz, Andreas; Ordonez, Juan S; Stieglitz, Thomas

2011-01-01

186

Neuronal Oscillations Enhance Stimulus Discrimination by Ensuring Action Potential Precision  

PubMed Central

Although oscillations in membrane potential are a prominent feature of sensory, motor, and cognitive function, their precise role in signal processing remains elusive. Here we show, using a combination of in vivo, in vitro, and theoretical approaches, that both synaptically and intrinsically generated membrane potential oscillations dramatically improve action potential (AP) precision by removing the membrane potential variance associated with jitter-accumulating trains of APs. This increased AP precision occurred irrespective of cell type andat oscillation frequencies ranging from 3 to 65 Hzpermitted accurate discernment of up to 1,000 different stimuli. At low oscillation frequencies, stimulus discrimination showed a clear phase dependence whereby inputs arriving during the trough and the early rising phase of an oscillation cycle were most robustly discriminated. Thus, by ensuring AP precision, membrane potential oscillations dramatically enhance the discriminatory capabilities of individual neurons and networks of cells and provide one attractive explanation for their abundance in neurophysiological systems.

Schaefer, Andreas T; Angelo, Kamilla; Spors, Hartwig

2006-01-01

187

Intake rigour: ensuring only "reportable deaths" become coroners' cases.  

PubMed

The failure of medical practitioners to discharge their obligation consistently to report sudden or unnatural deaths to coroners has rightly prompted concern. Following recent public scandals, coroners and health authorities have increasingly developed procedures to ensure that concerning deaths are reported to coroners. However, the negative consequences of deaths being unnecessarily reported have received less attention: unnecessary intrusion into bereavement; a waste of public resources; and added delay and hindrance to the investigation of matters needing a coroner's attention. Traditionally, coroners have largely unquestioningly assumed jurisdiction over any deaths for which a medical practitioner has not issued a cause of death certificate. The Office of the State Coroner in Queensland has recently trialled a system to assess more rigorously whether deaths apparently resulting from natural causes, which have been reported to a coroner, should be investigated by the coroner, rather than being finalised by a doctor issuing a cause of death certificate. This article describes that trial and its results. PMID:24804529

Barnes, Michael; Kirkegaard, Ainslie; Carpenter, Belinda

2014-03-01

188

Expanded Medical Home Model Works for Children in Foster Care  

ERIC Educational Resources Information Center

The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates. These

Jaudes, Paula Kienberger; Champagne, Vince; Harden, Allen; Masterson, James; Bilaver, Lucy A.

2012-01-01

189

The Quest to Standardize Hemodialysis Care  

Microsoft Academic Search

A large global dialysis providers core activities include providing dialysis care with excellent quality, ensuring a low variability across the clinic network and ensuring strong focus on patient safety. In this article, we summarize the pertinent components of the quality assurance and safety program of the Diaverum Renal Services Group. Concerning medical performance, the key components of a successful quality

Jrgen Hegbrant; Giorgio Gentile; Giovanni F. M. Strippoli

2011-01-01

190

[Opening up psychiatric care].  

PubMed

The post-war phase of the deinstitutionalisation of psychiatry, which led to the legal recognition of the sector, has been followed by the years of economic crisis. As in the past, such times favour the exclusion of the weakest. As resources dwindle, only the clinical meaning, the dynamism and creativity of the nursing teams can ensure the emergence of new solutions for complex care situations. PMID:23951739

Plas, Jol

2013-01-01

191

FINANCE COMMITTEE REPORTS ON BUDGET 2008 CONSULTATIONS VICTORIA - After hearing the budgetary priorities of 5,800-plus British Columbians, the Select Standing Committee on Finance and Government Services has concluded its Budget 2008 consultation process. In response to this year's budget consultation questionnaire, the committee's report contains 55 recommendations - including 17 recommendations for addressing climate change; nine suggestions for ensuring the sustainability of B.C.'s health-care system; and four recommendations on enhancing housing supports  

Microsoft Academic Search

The Finance Committee also received hundreds of submissions on other budgetary priorities. The committee's report includes recommendations on topics such as arts funding, wildlife conservation, child care accessibility, post-secondary education costs, and funding for restorative justice programs. With respect to enhancing economic growth, the Finance Committee makes recommendations to bolster B.C.'s mining and forestry sectors, review personal and corporate income

Bill Bennett; Bruce Ralston; Harry Bloy; Randy Hawes; Dave S. Hayer; John Horgan; Jenny Wai; Ching Kwan; Richard T. Lee; Bob Simpson

192

English Proficiency and Access to Health Insurance in Hispanics Who Are Elderly: Implications for Adequate Health Care  

ERIC Educational Resources Information Center

Medicare, as a publicly funded insurance program, has produced significant improvement in the overall health of America's elderly populations. However, health disparities still persist between Hispanic and non-Hispanic White populations in terms of overall access to health services. This study utilized data from the Hispanic Established Population

Caesar, Lena G.

2006-01-01

193

HealthCare Systems: Lessons from the Reform Experience  

Microsoft Academic Search

This study reviews health-system reforms in OECD countries over the past several decades and their impact on the following policy goals: ensuring access to services; improving the quality of care and its outcomes; allocating an appropriate level of resources to health care (macroeconomic efficiency); and ensuring microeconomic efficiency in service provision. While nearly all OECD countries have achieved universal insurance

Howard Oxley

2003-01-01

194

The argument for integrating vector control with multiple drug administration campaigns to ensure elimination of lymphatic filariasis  

PubMed Central

Background There is a danger that mass drug administration campaigns may fail to maintain adequate treatment coverage to achieve lymphatic filariasis elimination. Hence, additional measures to suppress transmission might be needed to ensure the success of the Global Program for the Elimination of Lymphatic Filariasis. Discussion Vector control successfully eliminated lymphatic filariasis when implemented alone or with mass drug administration. Challenges to lymphatic filariasis elimination include uncertainty of the exact level and duration of microfilarial suppression required for elimination, the mobility of infected individuals, consistent non-participation of some infected individuals with mass drug administration, the possible development of anti-filarial drug resistance and treatment strategies in areas co-endemic with loasis. Integration of vector control with mass drug administration can address some of these challenges. The potential benefits of vector control would include: (1) the ability to suppress filariasis transmission without the need to identify all individual 'foci of infection'; (2) minimizing the risk of reestablishment of transmission from imported microfilaria positive individuals; and (3) decreasing the risk of dengue or malaria transmission where, respectively, Aedes or Anopheles are lymphatic filariasis vectors. Summary With adequate sustained treatment coverage, mass drug administration should meet the criteria for elimination of lymphatic filariasis. However, it may be difficult to sustain sufficiently high mass drug administration coverage to achieve lymphatic filariasis elimination in some areas, particularly, where Aedes species are the vectors. Since vector control was effective in controlling and even eliminating lymphatic filariasis transmission, integration of vector control with mass drug administration will ensure the sustainability of transmission suppression and thereby better ensure the success of national filariasis elimination programs. Although trials of some vector control interventions are needed, proven vector control strategies are ready for immediate integration with mass drug administration for many important vectors. Vector control is the only presently available additional lymphatic filariasis control measure with the potential for immediate implementation.

Burkot, TR; Durrheim, DN; Melrose, WD; Speare, R; Ichimori, K

2006-01-01

195

Hip-joint and abductor-muscle forces adequately represent in vivo loading of a cemented total hip reconstruction.  

PubMed

Using finite element analyses, we investigated which muscle groups acting around the hip-joint most prominently affected the load distributions in cemented total hip reconstructions with a bonded and debonded femoral stem. The purpose was to determine which muscle groups should be included in pre-clinical tests, predicting bone adaptation and mechanical failure of cemented reconstructions, ensuring an adequate representation of in vivo loading of the reconstruction. Loads were applied as occurring during heel-strike, mid-stance and push-off phases of gait. The stress/strain distributions within the reconstruction, produced by the hip-joint contact force, were compared to ones produced after sequentially including the abductors, the iliotibial tract and the adductors and vastii. Inclusion of the abductors had the most pronounced effect. They neutralized lateral bending of the reconstruction at heel-strike and increased medial bending at mid-stance and push-off. Bone strains and stem stresses were changed accordingly. Peak tensile cement stresses were reduced during all gait phases by amounts up to 50% around a bonded stem and 11% around a debonded one. Additional inclusion of the iliotibial tract, the adductors and the vastii produced relatively small effects during all gait phases. Their most prominent effect was a slight reduction of bone strains at the level of the stem tip during heel-strike. These results suggest that a loading configuration including the hip-joint contact force and the abductor forces can adequately reproduce in vivo loading of cemented total hip reconstructions in pre-clinical tests. PMID:11410175

Stolk, J; Verdonschot, N; Huiskes, R

2001-07-01

196

32 CFR 199.16 - Supplemental Health Care Program for active duty members.  

Code of Federal Regulations, 2013 CFR

...adequate to provide the needed primary care services to the active duty service...adequate to provide the needed primary care services to the active duty service...member will select or be assigned a primary care manager. In the absence of a...

2013-07-01

197

32 CFR 199.16 - Supplemental Health Care Program for active duty members.  

Code of Federal Regulations, 2012 CFR

...adequate to provide the needed primary care services to the active duty service...adequate to provide the needed primary care services to the active duty service...member will select or be assigned a primary care manager. In the absence of a...

2012-07-01

198

32 CFR 199.16 - Supplemental Health Care Program for active duty members.  

Code of Federal Regulations, 2010 CFR

...adequate to provide the needed primary care services to the active duty service...adequate to provide the needed primary care services to the active duty service...member will select or be assigned a primary care manager. In the absence of a...

2010-07-01

199

32 CFR 199.16 - Supplemental Health Care Program for active duty members.  

Code of Federal Regulations, 2011 CFR

...adequate to provide the needed primary care services to the active duty service...adequate to provide the needed primary care services to the active duty service...member will select or be assigned a primary care manager. In the absence of a...

2011-07-01

200

Effect of Tranquilizers on Animal Resistance to the Adequate Stimuli of the Vestubular Apparatus.  

National Technical Information Service (NTIS)

The effect of tranquilizers on vestibulospinal reflexes and motor activity was studied in 900 centrifuged albino mice. Actometric studies have shown that the tranquilizers have a group capacity for increasing animal resistance to the action of adequate st...

Y. B. Maksimovich N. V. Khinchikashvili

1980-01-01

201

Percentage of Adults with High Cholesterol Whose LDL Cholesterol Levels Are Adequately Controlled  

MedlinePLUS

Skip to main content Skip to footer links ASPE.hhs.gov U.S. Department of Health & Human ... with High Cholesterol Whose LDL Cholesterol Levels are Adequately Controlled High cholesterol can double a person's risk for heart disease, the ...

202

Techniques for ensuring the correct length of new mitral chords.  

PubMed

Repair of degenerative mitral insufficiency has extensively been shown to be superior to replacement. In the majority of cases, the culprit lesion is limited to the posterior mitral leaflet (PML), which is treated with quadrangular resection of the prolapsing PML, annular plication of the corresponding segment of the annulus, and prosthetic annuloplasty. Anterior mitral leaflet (AML) prolapse is less common and is not always considered an indication for repair despite availability of a variety of surgical maneuvers specifically designed for its treatment. Although reliable if properly performed, chordal shortening at the papillary muscle level is technically demanding. Chordal transfer from the PML with the 'flip-over' technique is highly reproducible, but limited by the very frequent presence of an abnormal PML. Although feasible, transfer of an anterior basal chord to the prolapsing free edge assumes that the basal chords can be sectioned with impunity. More recently, chord replacement with expanded polytetrafluoroethylene (PTFE) sutures has become increasingly popular because of its availability, theoretical simplicity, and demonstrated long-term durability. Although papillary and leaflet anchoring of the neo-chord has not been shown to be a problem, the determination of its appropriate length remains intuitive and based on personal experience. Here, simple surgical maneuvers designed to ensure safe and reproducible results of single or multiple chord replacement with PTFE sutures are described. PMID:12701786

Duran, Carlos M G; Pekar, Filip

2003-03-01

203

Robust mitotic entry is ensured by a latching switch  

PubMed Central

Summary Cell cycle events are driven by Cyclin dependent kinases (CDKs) and by their counter-acting phosphatases. Activation of the Cdk1:Cyclin B complex during mitotic entry is controlled by the Wee1/Myt1 inhibitory kinases and by Cdc25 activatory phosphatase, which are themselves regulated by Cdk1:Cyclin B within two positive circuits. Impairing these two feedbacks with chemical inhibitors induces a transient entry into M phase referred to as mitotic collapse. The pathology of mitotic collapse reveals that the positive circuits play a significant role in maintaining the M phase state. To better understand the function of these feedback loops during G2/M transition, we propose a simple model for mitotic entry in mammalian cells including spatial control over Greatwall kinase phosphorylation. After parameter calibration, the model is able to recapture the complex and non-intuitive molecular dynamics reported by Potapova et al. (Potapova et al., 2011). Moreover, it predicts the temporal patterns of other mitotic regulators which have not yet been experimentally tested and suggests a general design principle of cell cycle control: latching switches buffer the cellular stresses which accompany cell cycle processes to ensure that the transitions are smooth and robust.

Tuck, Chloe; Zhang, Tongli; Potapova, Tamara; Malumbres, Marcos; Novak, Bela

2013-01-01

204

XDS-I Outsourcing Proxy: Ensuring Confidentiality While Preserving Interoperability.  

PubMed

The interoperability of services and the sharing of health data have been a continuous goal for health professionals, patients, institutions, and policy makers. However, several issues have been hindering this goal, such as incompatible implementations of standards (e.g., HL7, DICOM), multiple ontologies, and security constraints. Cross-enterprise document sharing (XDS) workflows were proposed by Integrating the Healthcare Enterprise (IHE) to address current limitations in exchanging clinical data among organizations. To ensure data protection, XDS actors must be placed in trustworthy domains, which are normally inside such institutions. However, due to rapidly growing IT requirements, the outsourcing of resources in the Cloud is becoming very appealing. This paper presents a software proxy that enables the outsourcing of XDS architectural parts while preserving the interoperability, confidentiality, and searchability of clinical information. A key component in our architecture is a new searchable encryption (SE) scheme-Posterior Playfair Searchable Encryption (PPSE)-which, besides keeping the same confidentiality levels of the stored data, hides the search patterns to the adversary, bringing improvements when compared to the remaining practical state-of-the-art SE schemes. PMID:25014941

Ribeiro, Luis S; Viana-Ferreira, Carlos; Oliveira, Jose Luis; Costa, Carlos

2014-07-01

205

Integrated care requires integrated supervision  

PubMed Central

Introduction Given recent developments in integrated care, it is becoming increasingly important for the Dutch Health Care Inspectorate to direct its supervision in a way that may help speed up the implementation of integrated care. Description of care practice Since the implementation of integrated care for chronic patients is facing obstacles, alternative methods are required to ensure that the implementation process does not run into any delays. By applying a risk-based approach to integrated care providers, the Inspectorate can analyse the care providers' performance by means of quality indicators and rank them. In order to be effective, appropriated supervision arrangements will be applied to the care providers of integrated care. Discussion With a ranking model transparency will be improved and this may encourage integrated care providers to strive for greater quality due to the competition inherent in the system. Supervision based on advice and encouragement might be helpful in the implementation of integrated care. Conclusion Integrated care also requires integrated supervision, which means the Inspectorate may have to reconsider its working methods and the composition of its inspection teams.

Ketelaars, Corry A.J

2011-01-01

206

Beyond Care?  

ERIC Educational Resources Information Center

Care is a feature of all of our lives, all of the time. An analysis of Scotland's Curriculum for Excellence reveals that care and caring permeate complex dimensions of life in and after school and we ask here, if, on some accounts, care can do the work required of it. Acknowledging the significance of her contribution to care, we focus on the work

Hedge, Nicki; Mackenzie, Alison

2012-01-01

207

Building consensus on key priorities for rural health care in South Africa using the Delphi technique  

PubMed Central

Background South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. Methods The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Results Response rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Conclusion Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential.

Versteeg, Marije; du Toit, Lilo; Couper, Ian

2013-01-01

208

Multiple sensors ensure guide strand selection in human RNAi pathways  

PubMed Central

Small RNAs guide RNA-induced silencing complexes (RISCs) to bind to cognate mRNA transcripts and trigger silencing of protein expression during RNA interference (RNAi) in eukaryotes. A fundamental aspect of this process is the asymmetric loading of one strand of a short interfering RNA (siRNA) or microRNA (miRNA) duplex onto RISCs for correct target recognition. Here, we use a reconstituted system to determine the extent to which the core components of the human RNAi machinery contribute to RNA guide strand selection. We show that Argonaute2 (Ago2), the endonuclease that binds directly to siRNAs and miRNAs within RISC, has intrinsic but substrate-dependent RNA strand selection capability. This activity can be enhanced substantially when Ago2 is in complex with the endonuclease Dicer and the double-stranded RNA-binding proteins (dsRBPs)trans-activation response (TAR) RNA-binding protein (TRBP) or protein activator of PKR (PACT). The extent to which human Dicer/dsRBP complexes contribute to strand selection is dictated by specific duplex parameters such as thermodynamics, 5? nucleotide identity, and structure. Surprisingly, our results also suggest that strand selection for some miRNAs is enhanced by PACT-containing complexes but not by those containing TRBP. Furthermore, overall mRNA targeting by miRNAs is disfavored for complexes containing TRBP but not PACT. These findings demonstrate that multiple proteins collaborate to ensure optimal strand selection in humans and reveal the possibility of delineating RNAi pathways based on the presence of TRBP or PACT.

Noland, Cameron L.; Doudna, Jennifer A.

2013-01-01

209

Daily Care  

MedlinePLUS

... You Need to Know Online Tools Enhancing Daily Life Daily Plan Activities Communication Food & Eating Music & Art Personal Care Incontinence Bathing Dressing & Grooming Dental Care Medical Care Working with the Doctor Treatments ...

210

Palliative Care  

MedlinePLUS

Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

211

Palliative Care  

MedlinePLUS

... team, supportive care team, comfort care team or quality of life team. At some centers, the palliative care team works with a patient and family to manage comfort throughout treatment. At other centers, ...

212

Advance care planning along the continuum  

Microsoft Academic Search

What will happen if you experience a sudden illness that prevents you from making your own medical decisions? How will you ensure that you will receive the kind of care you want? Will your family or loved ones know enough about what you value and believe to feel comfortable making decisions about your care?

Patricia A. Bomba

2005-01-01

213

Sharing the Care of Infants and Toddlers  

ERIC Educational Resources Information Center

Most Family Today share the care of their babies and toddlers with someone else--often an early childhood professional, a teacher, or a family child care provider. Each family and professional must learn to work and make decisions together to support the child's healthy development and to ensure the family's well-being. Although it is the norm for

Dombro, Amy Laura; Lerner, Claire

2006-01-01

214

How to create awareness and ensure broad dissemination of health informatics standards.  

PubMed

There is a range of organisations with responsibility for information standards development within Australia. These include Standards Australia, which is formally linked to the International Organisation for Standards (ISO), the National Health Information Management Group, which deals with the government sector and several statutory organisations such as the Australian Institute of Health and Welfare and the National Centre for Classification in Health. The different constituencies involved with each of these organisations, the scope of healthcare informatics and the rate of organisational and technological change in the industry present a significant challenge in ensuring that the standard setting process is highly visible, responsive and capable of demonstrating its value through effective implementation. Creating awareness and ensuring broad dissemination of healthcare informatics standards is a key component in meeting this challenge. This can operate at a number of levels from strategic to operational. At the strategic level, it requires active engagement and commitment of the key decision-makers, both political and professional. This may require directly lobbying and promoting the benefits of standardisation to those decision-makers but can be achieved even more effectively by creating industry awareness and demand through carefully targeted presentations on the impact of standards to broader health industry forums. At the tactical level, the standards development medium itself can be used to engage and gain commitment from government, professionals, vendors and the health industry by operating as an inclusive, open and effective process. At the operational level, there is the opportunity for much more efficient use of technology to create awareness of both these processes and their outcomes. The establishment in Australia of a web enabled National Health Information Knowledge base built around ISO standards is one example of the type of development which will assist in the acceleration of awareness of standards and standardisation, which is needed to cope with the increasing demand. PMID:9600403

Williams, P

1998-02-01

215

The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO).  

PubMed

The number of cancer patients in Europe is rising and significant advances in basic and applied cancer research are making the provision of optimal care more challenging. The concept of cancer as a systemic, highly heterogeneous and complex disease has increased the awareness that quality cancer care should be provided by a multidisciplinary team (MDT) of highly qualified healthcare professionals. Cancer patients also have the right to benefit from medical progress by receiving optimal treatment from adequately trained and highly skilled medical professionals. Built on the highest standards of professional training and continuing medical education, medical oncology is recognised as an independent medical specialty in many European countries. Medical oncology is a core member of the MDT and offers cancer patients a comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire 'cancer journey'. Medical oncologists are also engaged in clinical and translational research to promote innovation and new therapies and they contribute to cancer diagnosis, prevention and research, making a difference for patients in a dynamic, stimulating professional environment. Medical oncologists play an important role in shaping the future of healthcare through innovation and are also actively involved at the political level to ensure a maximum contribution of the profession to Society and to tackle future challenges. This position paper summarises the multifarious and vital contributions of medical oncology and medical oncologists to today's and tomorrow's professional cancer care. PMID:24335854

Popescu, R A; Schfer, R; Califano, R; Eckert, R; Coleman, R; Douillard, J-Y; Cervantes, A; Casali, P G; Sessa, C; Van Cutsem, E; de Vries, E; Pavlidis, N; Fumasoli, K; Wrmann, B; Samonigg, H; Cascinu, S; Cruz Hernndez, J J; Howard, A J; Ciardiello, F; Stahel, R A; Piccart, M

2014-01-01

216

U.S. Health Care Policy and the Rising Uninsured  

Microsoft Academic Search

The lack of adequate health insurance affects one's ability to access care, which directly affects one's health. In the 21st century, there are 44 million people in the United States without health care insurance. The majority of people without health care insurance are working people under age 65, because most people over age 65 are retired and have health insurance

Thomas Falen

2005-01-01

217

Toward Better Child Care Worker Compensation: Advocacy in Three States.  

ERIC Educational Resources Information Center

Although the demand for child care in the United States has risen over the past 40 years, the supply of good quality child care remains both limited and costly, and the supply of well-trained and adequately compensated workers remains low. This study reviewed how advocates have moved the issue of child care worker compensation forward in the

De Vita, Carol J.; Twombly, Eric C.; Montilla, Maria D.

218

Health Care Reform Act is Constitutional and Necessary  

Microsoft Academic Search

It has been nearly a year since President Obama signed into law the most important piece of civil and social rights legislation since the 1960s. The Patient Protection and Affordable Care Act not only offers responsible solutions to our impending national health care crisis, it also protects the right to adequate health care for our most physically, financially and politically

Ian C. Bartrum

2011-01-01

219

Ensuring Credit to Data Creators: A Case Study for Geodesy  

NASA Astrophysics Data System (ADS)

UNAVCO, the NSF and NASA-funded facility that supports and promotes Earth science by advancing high-precision techniques for the measurement of crustal deformation, has operated a Global Navigation Satellite System (GNSS) Data Archive since 1992. For the GNSS domain, the UNAVCO Archive has established best practices for data and metadata preservation, and provides tools for openly tracking data provenance. The GNSS data collection at the UNAVCO Archive represents the efforts of over 400 principal investigators and uncounted years of effort by these individuals and their students in globally distributed field installations, sometimes in situations of significant danger, whether from geologic hazards or political/civil unrest. Our investigators also expend considerable effort in following best practices for data and metadata management. UNAVCO, with the support of its consortium membership, has committed to an open data policy for data in the Archive. Once the data and metadata are archived by UNAVCO, they are distributed by anonymous access to thousands of users who cannot be accurately identified. Consequently, the UNAVCO commitment to open data access was reached with a degree of trepidation on the part of a segment of the principal investigators who contribute their data with no guarantee that their colleagues (or competitors) will follow a code of ethics in their research and publications with respect to the data they have downloaded from the UNAVCO Archive. The UNAVCO community has recognized the need to develop, adopt, and follow a data citation policy among themselves and to advocate for data citation more generally within the science publication arena. The role of the UNAVCO Archive in this process has been to provide data citation guidance and to develop and implement mechanisms to assign digital object identifiers (DOIs) to data sets within the UNAVCO Archive. The UNAVCO community is interested in digital object identifiers primarily as a means to facilitate citation for the purpose of ensuring credit to the data creators. UNAVCO's archiving and metadata management systems are generally well-suited to assigning and maintaining DOIs for two styles of logical collections of data: campaigns, which are spatially and temporally well-defined; and stations, which represent ongoing collection at a single spatial position at the Earth's surface. These two styles form the basis for implementing approximately 3,000 DOIs that can encompass the current holdings in the UNAVCO Archive. In addition, aggregations of DOIs into a superset DOI is advantageous for numerous cases where groupings of stations are naturally used in research studies. There are about 100 such natural collections of stations. However, research using GNSS data can also utilize several hundred or more stations in unique combinations, where tallying the individual DOIs within a reference list is cumbersome. We are grappling with the complexities that inevitably crop up when assigning DOIs, including subsetting, versioning, and aggregating. We also foresee the need for mechanisms for users to go beyond our predefined collections and/or aggregations to define their own ad-hoc collections. Our goal is to create a system for DOI assignment and utilization that succeeds in facilitating data citation within our community of geodesy scientists.

Boler, F. M.; Gorman, A.

2011-12-01

220

Transitional Care  

ERIC Educational Resources Information Center

Transitional care encompasses a broad range of services and environments designed to promote the safe and timely passage of patients between levels of health care and across care settings. High-quality transitional care is especially important for older adults with multiple chronic conditions and complex therapeutic regimens, as well as for their

Naylor, Mary; Keating, Stacen A.

2008-01-01

221

Perioperative care of the surgical patient.  

PubMed

Efficient care of the surgical patient necessitates attention to key elements of preoperative patient preparation prior to the day of surgery, a standardized approach to patient monitoring and education on the day of surgery, and careful postoperative monitoring. Patient education is fundamental to all phases of surgical management so that patient expectations and concerns are practically addressed. Quality assurance endeavors must also be integrated into these preioperative phases so that optimal care of the surgical patient is ensured. PMID:15584686

Wilde, Joseph; Hauser, Debbie; Leshin, Barry

2004-09-01

222

Bioethics for clinicians: 6. Advance care planning.  

PubMed Central

Advance rate planning is a process whereby a patient, in consultation with health care providers, family members and important others, makes decisions about his or her future health care. Grounded in the ethical principle of autonomy and the legal doctrine of consent, advance care planning helps to ensure that the norm of consent is respected should the patient become incapable of participating in treatment decisions. Physicians can play an important role by informing patients about advance care planning directing them to appropriate resources, counselling them as they engage in advance care planning and helping them to tailor advance directives to their prognosis.

Singer, P A; Robertson, G; Roy, D J

1996-01-01

223

36 CFR 805.4 - Ensuring environmental documents are actually considered in Council decisionmaking.  

Code of Federal Regulations, 2013 CFR

...2013-07-01 2012-07-01 true Ensuring environmental documents are actually considered in...PROCEDURES FOR IMPLEMENTATION OF NATIONAL ENVIRONMENTAL POLICY ACT § 805.4 Ensuring environmental documents are actually considered...

2013-07-01

224

Which way around does this go? A simple method for ensuring the correct glenosphere offset.  

PubMed

The correct glenosphere offset in a reverse total shoulder replacement ensures prosthetic stability, longevity and avoids scapula notching. We present a simple technique for ensuring the correct glenosphere offset when the prosthesis is implanted. PMID:24426680

Javed, Saqib; Heasley, Richard; Ravenscroft, Matt

2013-12-01

225

21 CFR 212.20 - What activities must I perform to ensure drug quality?  

Code of Federal Regulations, 2013 CFR

...activities must I perform to ensure drug quality? 212.20 Section 212.20 Food...POSITRON EMISSION TOMOGRAPHY DRUGS Quality Assurance § 212.20 What activities must I perform to ensure drug quality? (a) Production...

2013-04-01

226

Pre-Operative Assessment and Post-Operative Care in Elective Shoulder Surgery  

PubMed Central

Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately. This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common post-operative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and post-operative analgesia following shoulder surgery.

Akhtar, Ahsan; MacFarlane, Robert J; Waseem, Mohammad

2013-01-01

227

Towards Defining Adequate Lithium Trials for Individuals with Mental Retardation and Mental Illness.  

ERIC Educational Resources Information Center

Use of lithium with mentally retarded individuals with psychiatric conditions and/or behavior disturbances is discussed. The paper describes components of an adequate clinical trial and reviews case studies and double-blind cases. The paper concludes that aggression is the best indicator for lithium use, and reviews treatment parameters and

Pary, Robert J.

1991-01-01

228

Middle East (Is the US Policy Adequate Today to Promote Peace in the Middle East).  

National Technical Information Service (NTIS)

The basic question is whether or not the US policy in the Middle East is adequate to promote peace over the next decade. Is modification required or should we devise a new policy based upon the current situation. Data was gathered using literature search,...

E. Hammonds

1972-01-01

229

Effect of tranquilizers on animal resistance to the adequate stimuli of the vestibular apparatus  

NASA Technical Reports Server (NTRS)

The effect of tranquilizers on vestibulospinal reflexes and motor activity was studied in 900 centrifuged albino mice. Actometric studies have shown that the tranquilizers have a group capacity for increasing animal resistance to the action of adequate stimuli to the vestibular apparatus.

Maksimovich, Y. B.; Khinchikashvili, N. V.

1980-01-01

230

Basic Writers in the Workplace: Writing Adequately for Careers after College.  

ERIC Educational Resources Information Center

Studies how formerly weak writers manage to write adequately for their jobs. Concludes that the rhetorical, psychological, and social environment of the workplace fosters better writing in basic writers than the academic environment. Recommends writing across the curriculum for duplicating the workplace-writing content in college writing classes.

Agnew, Eleanor

1992-01-01

231

The Neonatal Bowel Output Study: Indicators of Adequate Breast Milk Intake in Neonates  

Microsoft Academic Search

Purpose: This study describes the bowel habits of neonates who were exclusively breastfed during the first 14 days following birth to determine whether bowel output (frequency and character) could be used as a proxy measure for adequate breast milk intake. Study Design: A prospective, descriptive study was conducted. During the 14-day study period, mothers kept a log of their infants'

Linda C. Shrago; Elizabeth Reifsnider; Kathleen Insel

2006-01-01

232

Identifying the Factors Impacting the Adequately Yearly Progress Performance in the United States  

ERIC Educational Resources Information Center

The NCLB (No Child Left Behind Act) specifies that states must develop AYP (adequate yearly progress) statewide measurable objectives for improved achievement by all students, including economically disadvantaged students, students from minority races, students with disabilities, and students with limited English proficiency. By the 2013-2014

Hsieh, Ju-Shan

2013-01-01

233

Oxygen uptake-to-delivery relationship: a way to assess adequate flow  

Microsoft Academic Search

Invasive and noninvasive monitoring facilitates clinical evaluation when resuscitating patients with complex haemodynamic disorders. If the macrocirculation is to be stable, then it must adapt to blood flow or blood flow must be optimized. The objective of flow monitoring is to assist with matching observed oxygen consumption (VO2) to pathophysiological needs. If an adequate balance cannot be maintained then dysoxia

Vincent Caille; Pierre Squara

2006-01-01

234

Final 2004 Report on Adequate Yearly Progress in the Montgomery County Public Schools  

ERIC Educational Resources Information Center

The vast majority of Montgomery County public schools made sufficient progress on state testing and accountability standards in 2004 to comply with the adequate yearly progress (AYP) requirements under the "No Child Left Behind (NCLB) Act of 2001." Information released by the Maryland State Department of Education (MSDE) in October 2004 shows that

Stevenson, Jose W.

2005-01-01

235

Does Current Army Physical Fitness Training Doctrine Adequately Prepare Soldiers for War.  

National Technical Information Service (NTIS)

The U.S. Army has continually adjusted its fitness regimen to best prepare Soldiers for combat. This paper attempts to answer a critical question: Does the current U.S. Army physical fitness training doctrine adequately prepare soldiers for war. Since 194...

C. T. Lowman

2010-01-01

236

Determining Adequate Yearly Progress in a State Performance or Proficiency Index Model  

ERIC Educational Resources Information Center

The purpose of this paper is to present an overview regarding how several states use a performance or proficiency index in their determination of adequate yearly progress (AYP) under the No Child Left Behind Act of 2001 (NCLB). Typically, indexes are based on one of two weighting schemes: (1) either they weight academic performance levels--also

Erpenbach, William J.

2009-01-01

237

Note on the Well-Foundedness of Adequate Orders Used for Truncating Unfoldings.  

National Technical Information Service (NTIS)

Petri net unfolding prefixes are an important technique for formal verification and synthesis. In this paper we show that the requirement that the adequate order used for truncating a Petri net unfolding must be well-founded is superfluous in many importa...

T. Chatain V. Khomenko

2007-01-01

238

Sequential transfer of day 3 embryos and blastocysts after previous IVF failures despite adequate ovarian response  

Microsoft Academic Search

The purpose of this study was to compare IVF outcome following sequential embryo transfer (ET) with that following the transfer of early cleavage embryos among patients with previous multiple IVF failures but adequate ovarian response. A retrospective matched casecontrol analysis was made of the medical files of 66 women who underwent sequential transfer of day 3 embryos and blastocysts in

Ronit Machtinger; Jehoshua Dor; Matbeii Margolin; Jacob Levron; Micha Baum; Betty Ferber; Adrian Shulman; David Bider; Daniel S Seidman

2006-01-01

239

Literacy and hazard communication: ensuring workers understand the information they receive.  

PubMed

More than 30 million American workers are exposed to hazardous chemicals in the workplace. The Occupational Safety and Health Administration first promulgated the Hazard Communication Standard in 1983 to ensure that workers were informed of the hazardous chemicals with which they work. Nine research studies published from 1983 to 2005 evaluating the relationship between literacy and hazard communication were reviewed. Three main gaps were identified: lack of learner involvement to improve hazard communication, lack of employer assessment of employee understanding of training provided, and lack of studies assessing retention of the material taught and its application at the worksite. Studies need to involve learners, assist employers in assessing employees' understanding of the material taught, and assess retention and application of the material at a later date. Nurses are often the only health care providers at worksites.Thus, they may be responsible for teaching hazard communication content, or possibly reinforcing material covered during training. Some workers may have low health literacy levels. Occupational health nurses must provide workers with hazard communication training they understand, retain, and can apply at the worksite. PMID:17260677

Bouchard, Christine

2007-01-01

240

Ensuring confidence in radionuclide-based sediment chronologies and bioturbation rates  

USGS Publications Warehouse

Sedimentary records of naturally occurring and fallout-derived radionuclides are widely used as tools for estimating both the ages of recent sediments and rates of sedimentation and bioturbation. Developing these records to the point of data interpretation requires careful sample collection, processing, analysis and data modeling. In this work, we document a number of potential pitfalls that can impact sediment core records and their interpretation. This paper is not intended as an exhaustive treatment of these potential problems. Rather, the emphasis is on potential problems that are not well documented in the literature, as follows: (1) the mere sampling of sediment cores at a resolution that is too coarse can result in an apparent diffusive mixing of the sedimentary record at rates comparable to diffusive bioturbation rates observed in many locations; (2) 210Pb profiles in slowly accumulating sediments can easily be misinterpreted to be driven by sedimentation, when in fact bioturbation is the dominant control. Multiple isotopes of different half lives and/or origin may help to distinguish between these two possible interpretations; (3)??apparent mixing can occur due simply to numerical artifacts inherent in the finite difference approximations of the advection diffusion equation used to model sedimentation and bioturbation. Model users need to be aware of this potential problem. Solutions to each of these potential pitfalls are offered to ensure the best possible sediment age estimates and/or sedimentation and bioturbation rates can be obtained. ?? 2006 Elsevier Ltd. All rights reserved.

Crusius, J.; Kenna, T. C.

2007-01-01

241

Health Care in Europe for Women with Genital Mutilation  

Microsoft Academic Search

The increasing number of immigrants from African countries practicing female genital mutilation (FGM) has raised concern in Europe. Health care professionals have developed three main responses: (1) technical guidelines for clinical management; (2) codes of conduct on quality of care; and (3) specialised health services for medical and psychological care and counselling. Much remains to be done, however, to ensure

Els Leye; Richard A. Powell; Gerda Nienhuis; Patricia Claeys; Marleen Temmerman

2006-01-01

242

77 FR 26909 - National Foster Care Month, 2012  

Federal Register 2010, 2011, 2012, 2013

...advocates for children in foster care. We all have a role to play...every infant and child in foster care, and to promoting a successful transition to adulthood for older youth...rates of re-entry into foster care; and to ensure all...

2012-05-07

243

Older people in care homes: sexuality and intimate relationships.  

PubMed

The Royal College of Nursing has developed guidance to help nurses and care staff work effectively with issues of sexuality, intimate relationships and sex, particularly for older people living in care homes. This article looks at the barriers to ensuring the sexual rights and freedoms of care home residents are protected and suggest how the new guidance might help. PMID:21850859

Heath, Hazel

2011-07-01

244

Leaders, managers, and employee care.  

PubMed

With the economic and market changes currently taking place, organizations cannot survive or prosper without quality employees. Key to employee loyalty, performance, and retention is the relationship between the leader, manager, and employee. Leaders are visionaries who make sure that the right things are done for the organization. Managers are in a position to make sure that things are done right within the organization. There are traits and qualities that good leaders and managers must possess to ensure organizational success. Displaying these characteristics will ensure that employees are taken care of, which will benefit both the employees and the organization. PMID:22282003

Stewart, Della W

2012-01-01

245

The concept of adequate causation and Max Weber's comparative sociology of religion.  

PubMed

Max Weber's The Protestant Ethic and the Spirit of Capitalism, studied in isolation, shows mainly an elective affinity or an adequacy on the level of meaning between the Protestant ethic and the 'spirit' of capitalism. Here it is suggested that Weber's subsequent essays on 'The Economic Ethics of World Religions' are the result of his opinion that adequacy on the level of meaning needs and can be verified by causal adequacy. After some introductory remarks, particularly on elective affinity, the paper tries to develop the concept of adequate causation and the related concept of objective possibility on the basis of the work of v. Kries on whom Weber heavily relied. In the second part, this concept is used to show how the study of the economic ethics of India, China, Rome and orthodox Russia can support the thesis that the 'spirit' of capitalism, although it may not have been caused by the Protestant ethic, was perhaps adequately caused by it. PMID:15260028

Buss, A

1999-06-01

246

Cancer Care in the United States: What's Right, What's Wrong? - September 16, 1999  

Cancer.gov

CANCER CARE IN THE UNITED STATES: WHAT'S RIGHT, WHAT'S WRONG? ENSURING THE QUALITY OF CANCER CARE Robert Hiatt, M.D., Ph.D., Deputy Director of the Division of Cancer Control and Population Sciences National Cancer Institute National Institutes

247

Adequate Relief in a Treatment Trial with IBS Patients: A Prospective Assessment  

PubMed Central

Background Adequate relief of IBS symptoms (IBS-AR) has been used as a primary endpoint in many randomized controlled trials of IBS and is considered by the Rome III Committee to be an acceptable primary endpoint. However, controversy exists on whether baseline severity confounds the effect of this treatment patient outcome. Aims In a randomized controlled treatment trial (1) to compare subjective report of IBS-AR to global assessment of improvement (IBS-GAI), change in IBS symptom severity scale (IBS-SSS) and IBS Quality of Life (IBS-QOL); (2) to explore whether initial IBS symptom severity influences the sensitivity of these outcome measures; (3) to determine whether psychological symptoms influence the sensitivity of these measures. Methods 289 adult IBS patients were recruited to a treatment trial. Baseline IBS-SSS scores were used to classify IBS severity as mild (<150), moderate (150-300), or severe (>300). Questionnaires were completed at baseline and after 3 weeks of treatment with sham acupuncture or waitlist control. Results IBS baseline severity significantly affected the proportion of patients who reported IBS-AR at 3 weeks (mild, 70%; moderate, 49.7%; severe, 38.8%) (p<0.05). However, once the patients who reported IBS-AR at baseline (28.0%) were excluded from the analysis, baseline severity no longer affected the proportion of patients reporting IBS-AR. Baseline severity did not have a significant of effect patients reporting moderate or significant improvement on the IBS-GAI (mild, 30%; moderate, 25.3%; severe, 18.8%) (p=NS). Psychological symptoms had no significant correlations with responders after adjusting for baseline severity. Conclusions These data suggest that IBS-AR as an endpoint is confounded with initial IBS symptom severity as measured by baseline reporting of adequate relief. The confounding effects of adequate relief can be eliminated if patients who report adequate relief at screening are excluded from study participation.

Passos, Maria C. F.; Lembo, Anthony J.; Conboy, Lisa A; Kaptchuk, Ted J.; Kelly, John M; Quilty, Mary T.; Kerr, Catherine E.; Jacobson, Eric E; Hu, Rong; Friedlander, Elizabeth; Drossman, Douglas

2009-01-01

248

Myth 19: Is Advanced Placement an Adequate Program for Gifted Students?  

ERIC Educational Resources Information Center

Is it a myth that Advanced Placement (AP) is an adequate program for gifted students? AP is so covered with myths and assumptions that it is hard to get a clear view of the issues. In this article, the author finds the answer about AP by looking at current realties. First, AP is hard for gifted students to avoid. Second, AP never was a program

Gallagher, Shelagh A.

2009-01-01

249

[Effect of tranquilizers on animal resistance to adequate stimulus exposure of the vestibular apparatus].  

PubMed

The effect of tranquilizers on the intensity of vestibulospinal reflexes and motor activity was studied in 900 centrifuged albino mice. Chemically heterogenous tranquilizers (meprobamate, elenium, nicolit) were applied in therapeutic doses. Actometric studies have shown that the tranquilizers possess group capacity for increasing animal resistance to the action of adequate stimuli to the vestibular apparatus. Meprobamate has exhibited the most pronounced protective effect. PMID:40818

Maksimovich, Ia B; Khinchikashvili, N V

1979-01-01

250

Conducting tests of hypotheses: The need for an adequate sample size  

Microsoft Academic Search

This article addresses the importance of obtaining a sample of an adequate size for the purpose of testing hypotheses. The\\u000a logic underlying the requirement for a minimum sample size for hypothesis testing is discussed, as well as the criteria for\\u000a determining it. Implications for researchers working with convenient samples of a fixed size are also considered, and suggestions\\u000a are given

Ratnawati Mohd Asraf; James K. Brewer

2004-01-01

251

How much is enough? Adequate sample size for littoral macroinvertebrates in lowland lakes  

Microsoft Academic Search

Littoral macroinvertebrates are increasingly used for assessing the ecological status of lakes according to the EU Water Framework\\u000a Directive. This requires harmonised sampling methods, but information on the appropriate spatial scale of the sampling as\\u000a well as on the adequate sample sizes are mostly lacking. In this study, we compared the spatial variability of littoral (<1.2m\\u000a water depth) macroinvertebrate community

Jrgen Schreiber; Mario Brauns

2010-01-01

252

Ending Discrimination in Health Care: A Dream Deferred.  

National Technical Information Service (NTIS)

The advent of major Federal health financing programs such as Medicare and Medicaid has failed to bring minorities into the mainstream of the American health care system. A disproportionately large number of the 45 million Americans without adequate acces...

S. D. Ivie

1980-01-01

253

Palliative Care  

MedlinePLUS

... growing practice specialty for highly trained physicians, nurses, social workers, chaplains, and others. Palliative medicine is the medical specialty dedicated to excellence in palliative care. Palliative care specialists typically work in teams and usually are needed when the ...

254

Foster Care  

MedlinePLUS

... spend long periods of time in care awaiting adoption or other permanent arrangement. Making decisions about the ... formal legal procedure) to be followed, hopefully, by adoption; or long-term care with foster parents or ...

255

Male and female broiler responses to low and adequate dietary threonine on nitrogen and energy balance.  

PubMed

This study evaluated nitrogen and energy utilization by male and female broilers that were at 46 and 54 d of age fed diets deficient or adequate in threonine. Birds were reared in floor pens of an open-sided house and were provided diets that met NRC (1994) nutrient recommendations from placement until 6 wk of age. At 42 d, 48 birds (24 per sex) were selected and individually penned in Petersime batteries and were given feeds that were formulated to contain 0.52 or 0.74% total threonine having 18% CP and 3,200 kcal ME/kg. Two 24-h excreta collection periods were conducted on Days 46 and 54 to assess nitrogen and energy recovery. Males receiving adequate threonine had an advantage in retention of nitrogen and recovery of AMEn over males consuming the low threonine diet. Utilization of nitrogen by females was similar at both threonine concentrations, and AMEn corresponded to the concentration recovered by males when threonine was adequate. Inadequate threonine appears to create conditions that reduce recovery of energy by male broilers. PMID:11469656

Dozier, W A; Moran, E T; Kidd, M T

2001-07-01

256

An adequate Fe nutritional status of maize suppresses infection and biotrophic growth of Colletotrichum graminicola.  

PubMed

Iron (Fe) is an essential element for plant pathogens as well as for their host plants. As Fe plays a central role in pathogen virulence, most plants have evolved Fe-withholding strategies to reduce Fe availability to pathogens. On the other hand, plants need Fe for an oxidative burst in their basal defense response against pathogens. To investigate how the plant Fe nutritional status affects plant tolerance to a hemibiotrophic fungal pathogen, we employed the maize-Colletotrichum graminicola pathosystem. Fungal infection progressed rapidly via biotrophic to necrotrophic growth in Fe-deficient leaves, while an adequate Fe nutritional status suppressed the formation of infection structures of C. graminicola already during the early biotrophic growth phase. As indicated by Prussian blue and 3,3'-diaminobenzidine (DAB) staining, the retarding effect of an adequate Fe nutritional status on fungal development coincided temporally and spatially with the recruitment of Fe to infection sites and a local production of H2 O2 . A similar coincidence between local Fe and H2 O2 accumulation was found in a parallel approach employing C. graminicola mutants affected in Fe acquisition and differing in virulence. These results indicate that an adequate Fe nutritional status delays and partially suppresses the fungal infection process and the biotrophic growth phase of C. graminicola, most likely via the recruitment of free Fe to the fungal infection site for a timely oxidative burst. PMID:24512386

Ye, Fanghua; Albarouki, Emad; Lingam, Brahmasivasenkar; Deising, Holger B; von Wirn, Nicolaus

2014-07-01

257

Global risk assessment of aflatoxins in maize and peanuts: are regulatory standards adequately protective?  

PubMed

The aflatoxins are a group of fungal metabolites that contaminate a variety of staple crops, including maize and peanuts, and cause an array of acute and chronic human health effects. Aflatoxin B1 in particular is a potent liver carcinogen, and hepatocellular carcinoma (HCC) risk is multiplicatively higher for individuals exposed to both aflatoxin and chronic infection with hepatitis B virus (HBV). In this work, we sought to answer the question: do current aflatoxin regulatory standards around the world adequately protect human health? Depending upon the level of protection desired, the answer to this question varies. Currently, most nations have a maximum tolerable level of total aflatoxins in maize and peanuts ranging from 4 to 20ng/g. If the level of protection desired is that aflatoxin exposures would not increase lifetime HCC risk by more than 1 in 100,000 cases in the population, then most current regulatory standards are not adequately protective even if enforced, especially in low-income countries where large amounts of maize and peanuts are consumed and HBV prevalence is high. At the protection level of 1 in 10,000 lifetime HCC cases in the population, however, almost all aflatoxin regulations worldwide are adequately protective, with the exception of several nations in Africa and Latin America. PMID:23761295

Wu, Felicia; Stacy, Shaina L; Kensler, Thomas W

2013-09-01

258

Barriers to Prenatal Care for Mexican and Mexican American Women  

Microsoft Academic Search

Despite the presumed health benefits, Latinas are less likely than women from other ethnic groups to receive adequate prenatal care during their pregnancy. However, it is unclear whether this trend is the result of political economic conditions that limit access of many Latinos in the United States to adequate health services in general, or of sociocultural conditions that restrict the

Ippolytos Kalofonos; Lawrence A. Palinkas

1999-01-01

259

Inequalities in public health care delivery in Zambia  

PubMed Central

Background Access to adequate health services that is of acceptable quality is important in the move towards universal health coverage. However, previous studies have revealed inequities in health care utilisation in the favour of the rich. Further, those with the greatest need for health services are not getting a fair share. In Zambia, though equity in access is extolled in government documents, there is evidence suggesting that those needing health services are not receiving their fair share. This study seeks therefore, to assess if socioeconomic related inequalities/inequities in public health service utilisation in Zambia still persist. Methods The 2010 nationally representative Zambia Living Conditions and Monitoring Survey data are used. Inequality is assessed using concentration curves and concentrations indices while inequity is assessed using a horizontal equity index: an index of inequity across socioeconomic status groups, based on standardizing health service utilisation for health care need. Public health services considered include public health post visits, public clinic visits, public hospital visits and total public facility visits. Results There is evidence of pro-poor inequality in public primary health care utilisation but a pro-rich inequality in hospital visits. The concentration indices for public health post visits and public clinic visits are ?0.28 and ?0.09 respectively while that of public hospitals is 0.06. After controlling for need, the pro-poor distribution is maintained at primary facilities and with a pro-rich distribution at hospitals. The horizontal equity indices for health post and clinic are estimated at ?0.23 and ?0.04 respectively while that of public hospitals is estimated at 0.11. A pro-rich inequity is observed when all the public facilities are combined (horizontal equity index?=?0.01) though statistically insignificant. Conclusion The results of the paper point to areas of focus in ensuring equitable access to health services especially for the poor and needy. This includes strengthening primary facilities that serve the poor and reducing access barriers to ensure that health care utilisation at higher-level facilities is distributed in accordance with need for it. These initiatives may well reduce the observed inequities and accelerate the move towards universal health coverage in Zambia.

2014-01-01

260

Diabetes care  

Microsoft Academic Search

Providing good quality diabetes care is complex but achievable. Many aspects of the care do not require high tech medicine but, rather, good organisation. Diabetes is a costly disease, consuming 1500 pounds per diabetic patient per year versus 500 pounds on average for a non-diabetic member of the population in health service costs. Investment now in good quality diabetes care

J D Ward; M MacKinnon

1992-01-01

261

76 FR 57044 - Announcement of Requirements and Registration for Ensuring Safe Transitions From Hospital to Home  

Federal Register 2010, 2011, 2012, 2013

...innovative approaches to care transitions and improving patient...large proportion of readmissions can be prevented...and coordinating care before and after...The Centers for Medicare and Medicaid Services...to improve care transitions and build...

2011-09-15

262

What do health care unions do?: A response to Manthous.  

PubMed

In response to Manthous, we discuss the role of unions in health care. The ethical quandary that Manthous perceives in health care worker unions is overstated because patient and worker interests are frequently aligned. The search for a "selfless" union overlooks the importance of adequate compensation for providing excellent care. The collective actions employed by health care workers' unions need not include strikes or slowdowns and can be consistent with patient safety and well-being. PMID:24638116

Ash, Michael; Seago, Jean Ann; Spetz, Joanne

2014-05-01

263

The Evaluation of the National Long Term Care Demonstration: Final Report. Executive Summary.  

ERIC Educational Resources Information Center

This report describes the evaluation of the National Long-Term Care (Channeling) Demonstration, a rigorous test of comprehensive case management of community care as a way of containing long-term care costs for the impaired elderly while providing adequate care to those in need. The evaluation process is presented as an experimental design with

Mathematica Policy Research, Inc., Plainsboro, NJ.

264

Disorders of swallowing: palliative care.  

PubMed

This article defines palliative care for swallowing disorders as treatment for severe and chronic dysphagia or intractable aspiration when the recovery of normal swallowing is not anticipated and attempts to restore normal swallowing have been unsuccessful. Palliative treatment for dysphagia is not only for the dying patient because patients with difficulty swallowing can live for a long time. Palliative care for dysphagia is aimed at maximizing swallowing function, maintaining pulmonary health, and supporting healthy nutrition despite the impaired ability to swallow. When despite all attempts at intervention a patient becomes totally unable to swallow, the goal of therapy changes toward finding ways to provide adequate nutrition for the patient. PMID:19134493

Langmore, Susan E; Grillone, Gregory; Elackattu, Alphi; Walsh, Michael

2009-02-01

265

Pain management in neurocritical care.  

PubMed

The core challenge of pain management in neurocritical care is to keep the patient comfortable without masking or overlooking any neurological deterioration. Clearly in patients with a neurological problem there is a conflict of clinical judgement and adequate pain relief. Here we review the presentation, assessment, and development of pain in the clinical spectrum of patients with associated neurological problems seen in a general intensive care setting. Many conditions predispose to the development of chronic pain. There is evidence that swift and targeted pain management may improve the outcome. Importantly pain management is multidisciplinary. The available non-invasive, pharmacological, and invasive treatment strategies are discussed. PMID:23893074

Petzold, Axel; Girbes, Armand

2013-10-01

266

Failures in transition: learning from incidents relating to clinical handover in acute care.  

PubMed

The appropriate handover of patients, whereby responsibility and accountability of care is transferred between healthcare providers, is a critical component of quality healthcare delivery. This paper examines data from recent incidents relating to clinical handover in acute care settings, in order to provide a basis for the design and implementation of preventive and corrective strategies. A sample of incidents (n = 459) relating to clinical handover was extracted from an Australian health service's incident reporting system using a manual search function. Incident narratives were subjected to classification according to the system safety and quality concepts of failure type, error type, and failure detection mechanism. The most prevalent failure types associated with clinical handover were those relating to the transfer of patients without adequate handover 28.8% (n = 132), omissions of critical information about the patient's condition 19.2% (n = 88), and omissions of critical information about the patient's care plan during the handover process 14.2% (n = 65). The most prevalent failure detection mechanisms were those of expectation mismatch 35.7% (n = 174), clinical mismatch 26.9% (n = 127), and mismatch with other documentation 24.0% (n = 117). The findings suggest the need for a structured approach to handover with a recording of standardized sets of information to ensure that critical components are not omitted. Limitations of existing reporting processes are also highlighted. PMID:22268639

Thomas, Matthew J W; Schultz, Timothy J; Hannaford, Natalie; Runciman, William B

2013-01-01

267

Health care and the elderly.  

PubMed

America's health care crisis is hitting our elderly and threatens to cripple Medicare, the elderly's financial support system. Medicare was designed to ensure that every elderly American would be protected against the destruction of life savings as a result of illness. Elderly Americans would be able to enjoy their golden years without the financial burden of medical bills. Today, this vision is almost extinct. Medicare has been placed on the endangered species list. Market predictions indicate that Medicare's Hospital insurance Trust Fund will be depleted by 1988 if current trends continue. The elderly presently must pay on the average about 14% of their health care bill. In addition, Medicare pays little for long-term care; and about 45% of long-term care is paid for out-of-pocket by the elderly and their families. Alternative approaches are desperately needed of Medicare if our elderly are to survive. PMID:10311941

Eisdorfer, C

1985-01-01

268

Financing Primary Health Care: Experiences in Pharmaceutical Cost Recovery.  

National Technical Information Service (NTIS)

Substantial country and donor efforts in recent years have been directed toward the development and implementation of child survival, primary health care, and maternal health services. Concern is now being focussed on how to best ensure the sustainability...

R. B. Blakney J. I. Litvack J. D. Quick

1989-01-01

269

Patient Telephone Appointment System for High Volume Primary Care Sites.  

National Technical Information Service (NTIS)

The purpose of this research is to design a patient telephone appointment system for use in the Naval Medical Center San Diego's high volume Primary Care sites, which will reduce variation and ensure efficient, timely, convenient, and appropriate access t...

F. M. Worthington

2000-01-01

270

Optimal detection pinhole for lowering speckle noise while maintaining adequate optical sectioning in confocal reflectance microscopes  

PubMed Central

Abstract. Coherent speckle influences the resulting image when narrow spectral line-width and single spatial mode illumination are used, though these are the same light-source properties that provide the best radiance-to-cost ratio. However, a suitable size of the detection pinhole can be chosen to maintain adequate optical sectioning while making the probability density of the speckle noise more normal and reducing its effect. The result is a qualitatively better image with improved contrast, which is easier to read. With theoretical statistics and experimental results, we show that the detection pinhole size is a fundamental parameter for designing imaging systems for use in turbid media.

Glazowski, Christopher; Rajadhyaksha, Milind

2012-01-01

271

25 CFR 39.409 - How does the OIEP Director ensure accountability?  

Code of Federal Regulations, 2011 CFR

...Bureau line officers' reviews; (2) Hearing and making decisions on appeals from school officials; (3) Reviewing reports to ensure that standards and policies are applied consistently, education line...

2011-04-01

272

End-of-life care issues in advanced dementia.  

PubMed

Appropriate management of advanced dementia requires it to be recognised as a terminal condition that needs palliative care. Interventions during this stage should be carefully chosen to ensure the improvement or maintenance of the quality of life of the person with dementia. Advanced care planning is an important aspect of dementia care. Carers and relatives should be educated and encouraged to actively participate in discussions related to artificial nutrition, cardiopulmonary resuscitation (CPR) and other medical interventions. PMID:24427179

Kumar, Ct Sudhir; Kuriakose, Jacob Roy

2013-09-01

273

Integrated transitional care: patient, informal caregiver and health care provider perspectives on care transitions for older persons with hip fracture  

PubMed Central

Introduction Complex older adults, such as those with hip fracture, frequently require care from multiple professionals across a variety of settings. Integrated care both between providers and across settings is important to ensure care quality and patient safety. The purpose of this study was to determine the core factors related to poorly integrated care when hip fracture patients transition between care settings. Methods A qualitative, focused ethnographic approach was used to guide data collection and analysis. Patients, their informal caregivers and health care providers were interviewed and observed at each care transition. A total of 45 individual interviews were conducted. Interview transcripts and field notes were coded and analysed to uncover emerging themes in the data. Results Four factors related to poorly integrated transitional care were identified: confusion with communication about care, unclear roles and responsibilities, diluted personal ownership over care, and role strain due to system constraints. Conclusions Our research supports a broader notion of collaborative practice that extends beyond specific care settings and includes an appropriate, informed role for patients and informal caregivers. This research can help guide system-level and setting-specific interventions designed to promote high-quality, patient-centred care during care transitions.

Toscan, Justine; Mairs, Katie; Hinton, Stephanie; Stolee, Paul

2012-01-01

274

Ensuring Quality  

ERIC Educational Resources Information Center

This article discusses why building commissioning for education institutions is needed. School facilities owners and operators should confirm whether their building systems are performing as expected. The more comprehensive the confirmation process, the greater opportunity there is for reducing operations and maintenance costs, and improving

Erickson, Paul W.

2009-01-01

275

Accountable care: are you ready?  

PubMed

Ten steps are required to develop an ACO that can thrive in the emerging healthcare environment: Assess readiness for accountable care. Assemble the right project team. Create a legal and organizational framework for an ACO. Form the right leadership team. Strategically align human capital. Ensure minimal operational requirements are met. Assess all dimensions of financial readiness. Integrate IT to the point of "meaningful use." Strengthen partner relationships and business networks. Engage the community as an ally. PMID:21866726

Nguyen, James; Choi, Ben

2011-08-01

276

Adequate Systemic Perfusion Maintained by a CentriMag during Acute Heart Failure  

PubMed Central

Mechanical circulatory support during severe acute heart failure presents options for myocardial recovery or cardiac replacement. Short-term circulatory support with the newest generation of magnetically levitated centrifugal-flow pumps affords several potential advantages. Herein, we present our experience with such a pumpthe CentriMag (Levitronix LLC; Waltham, Mass) centrifugal-flow ventricular assist devicein 4 critically ill patients who were in cardiogenic shock. From November 2007 through March 2008, 3 patients were supported after cardiac surgery, and 1 after chronic heart failure worsened. Two patients were bridged to heart transplantation, and 2 died during support. Perfusion during support was evaluated in terms of serum lactic acid levels and oxygenation values. In all of the patients, the CentriMag's pump flow was adequate, and continuous mechanical ventilation support was provided. Lactic acid levels substantially improved with CentriMag support and were maintained at near-normal levels throughout. At the same time, arterial pH, PO2, and carbon dioxide levels remained within acceptable ranges. No thromboembolic events or mechanical failures occurred. Our experience indicates that short-term use of the CentriMag ventricular assist device during acute heart failure can restore and adequately support circulation until recovery or until the application of definitive therapy.

Favaloro, Roberto R.; Bertolotti, Alejandro; Diez, Mirta; Favaloro, Liliana; Gomez, Carmen; Peradejordi, Margarita; Trentadue, Julio; Hellman, Lorena; Arzani, Yanina; Otero, Pilar Varela

2008-01-01

277

Selecting an adequate respiratory protective device: the choice between a respirator and breathing apparatus.  

PubMed

An adequate respiratory protective device should keep the concentration of the pollutant inside the facepiece below the appropriate occupational exposure limit. Filtering respirators will not provide adequate protection if the device fails in an atmosphere which is immediately dangerous to life or health (IDLH). It has therefore been suggested that in contaminant concentrations above an IDLH level it is more appropriate to select breathing apparatus with an emergency breathing facility. In this paper IDLH levels published by the US National Institute of Occupational Safety and Health have been compared with UK occupational exposure limits. For some substances there was a relatively small difference between the IDLH level and the short-term occupational exposure limit (STEL). The median ratio of the IDLH level to the STEL was 10 for gases and vapours and 50 for aerosols. For almost half the substances with UK occupational exposure limits there is no IDLH value. It is concluded that the published IDLH concentrations are, on their own, an insufficient basis for selecting breathing apparatus over a filtering respirator. It is equally important to consider the likelihood that a filtering device may fail catastrophically since this determines the risk from wearing a respirator in an IDLH atmosphere. More emphasis should be placed on the control of potentially high exposure levels by means other than respiratory protection. PMID:9559569

Cherrie, J W

1998-02-01

278

Narita Target Heart Rate Equation Underestimates the Predicted Adequate Exercise Level in Sedentary Young Boys  

PubMed Central

Purpose Optimal training intensity and the adequate exercise level for physical fitness is one of the most important interests of coaches and sports physiologists. The aim of this study was to investigate the validity of the Narita et al target heart rate equation for the adequate exercise training level in sedentary young boys. Methods Forty two sedentary young boys (19.071.16 years) undertook a blood lactate transition threshold maximal treadmill test to volitional exhaustion with continuous respiratory gas measurements according to the Craig method. The anaerobic threshold (AT) of the participants then was calculated using the Narita target heart rate equation. Results Hopkin's spreadsheet to obtain confidence limit and the chance of the true difference between gas measurements and Narita target heart rate equation revealed that the Narita equation most likely underestimates the measured anaerobic threshold in sedentary young boys (168.7615 vs. 130.0814.36) (Difference 90% confidence limit: 38.118). Intraclass correlation coefficient (ICC) showed a poor agreement between the criterion method and Narita equation (ICC= 0.03). Conclusion According to the results, the Narita equation underestimates the measured AT. It seems that the Narita equation is a good predictor of aerobic not AT which can be investigated in the future studies.

Siahkouhian, Marefat; Khodadadi, Davar

2013-01-01

279

A MATURITY MODEL FOR THE INTERNATIONALIZATION OF CUSTOMER CARE IN THE AUTOMOTIVE INDUSTRY  

Microsoft Academic Search

In the context of customer relationship management, customer care management takes the role of dealing with customer requests as well as complaints. Organizations have to ensure that service quality in customer care centers meets the customers' expectations to ensure customer satisfaction. The maturity model developed in this paper aims to support a global automotive manufacturer in his activities to identify

Bernhard Schindlholzer; Lukas Gysi; Michael Klaas; Walter Brenner

280

Do US Emergency Medicine Residency Programs Provide Adequate Training for Bioterrorism?  

Microsoft Academic Search

Currently, there is no standardized curriculum for training of emergency physicians about the health hazards related to weapons of mass destruction. Opportunities for the widespread teaching of this material have remained limited, and the range of knowledge regarding even general disaster medical care is also variable among most residency training programs in the United States. We developed a survey to

Nicki Pesik; Mark Keim; Tomoko Rie Sampson

1999-01-01

281

Are single species toxicity tests alone adequate for estimating environmental hazard?  

Microsoft Academic Search

Most biologists agree that at each succeeding level of biological organization new properties appear that would not have been evident even by the most intense and careful examination of lower levels of organization. These levels might be crudely characterized as subcellular, cellular, organ, organism, population, multispecies, community, and ecosystem. The field of ecology developed because even the most meticulous study

1983-01-01

282

Are single species toxicity tests alone adequate for estimating environmental hazard?  

Microsoft Academic Search

Most biologists agree that at each succeeding level of biological organization new properties appear that would not have been evident by even the most intense and careful examination of lower levels of organization. These levels might be crudely characterized as subcellular, cellular, organ, organism, population, multispecies, community, and ecosystem. The field of ecology developed because even the most meticulous study

1984-01-01

283

An extended XACML model to ensure secure information access for web services  

Microsoft Academic Search

More and more software systems based on web services have been developed. Web service development techniques are thus becoming crucial. To ensure secure information access, access control should be taken into consideration when developing web services. This paper proposes an extended XACML model named EXACML to ensure secure information access for web services. It is based on the technique of

Shih-chien Chou; Chun-hao Huang

2010-01-01

284

Strategic Plan To Ensure Racial and Ethnic Diversity in Connecticut Public Higher Education. Annual Report 2004  

ERIC Educational Resources Information Center

Creation of a Strategic Plan to Ensure Racial and Ethnic Diversity in Connecticut Public Higher Education was among the original statutory mandates assigned to the Board of Governors of Higher Education by its 1982 enabling legislation. The purpose of the plan is to "ensure that students, faculty, administrators and staff at each public

Connecticut Department of Higher Education (NJ1), 2004

2004-01-01

285

20 CFR 670.993 - How does Job Corps ensure that contract disputes will be resolved?  

Code of Federal Regulations, 2013 CFR

...2013-04-01 2013-04-01 false How does Job Corps ensure that contract disputes will...DEPARTMENT OF LABOR (CONTINUED) THE JOB CORPS UNDER TITLE I OF THE WORKFORCE INVESTMENT...Management Provisions § 670.993 How does Job Corps ensure that contract disputes...

2013-04-01

286

Clinical care for opioid-using pregnant and postpartum women: the role of obstetric providers.  

PubMed

We review clinical care issues that are related to illicit and therapeutic opioid use among pregnant women and women in the postpartum period and outline the major responsibilities of obstetrics providers who care for these patients during the antepartum, intrapartum, and postpartum periods. Selected patient treatment issues are highlighted, and case examples are provided. Securing a strong rapport and trust with these patients is crucial for success in delivering high-quality obstetric care and in coordinating services with other specialists as needed. Obstetrics providers have an ethical obligation to screen, assess, and provide brief interventions and referral to specialized treatment for patients with drug use disorders. Opioid-dependent pregnant women often can be treated effectively with methadone or buprenorphine. These medications are classified as pregnancy category C medications by the Food and Drug Administration, and their use in the treatment of opioid-dependent pregnant patients should not be considered "off-label." Except in rare special circumstances, medication-assisted withdrawal during pregnancy should be discouraged because of a high relapse rate. Acute pain management in this population deserves special consideration because patients who use opioids can be hypersensitive to pain and because the use of mixed opioid-agonist/antagonists can precipitate opioid withdrawal. In the absence of other indications, pregnant women who use opioids do not require more intense medical care than other pregnant patients to ensure adequate treatment and the best possible outcomes. Together with specialists in pain and addiction medicine, obstetricians can coordinate comprehensive care for pregnant women who use opioids and women who use opioids in the postpartum period. PMID:24120973

Jones, Hendre E; Deppen, Krisanna; Hudak, Mark L; Leffert, Lisa; McClelland, Carol; Sahin, Leyla; Starer, Jacquelyn; Terplan, Mishka; Thorp, John M; Walsh, James; Creanga, Andreea A

2014-04-01

287

Oral Care  

Microsoft Academic Search

Adequate dental and oral hygiene may become a challenge for all users and especially for elderly people and young children because of their limited motor skills. The same holds true for patients undergoing\\/recovering from chemo-\\/radiotherapy with accompanying sensitive mucosal conditions. Poor dental hygiene can result in tooth decay, gingivitis, periodontitis, tooth loss, bad breath (halitosis), fungal infection and gum diseases.

Irne Hitz Lindenmller; J. Thomas Lambrecht

2011-01-01

288

Universal health care in India: Panacea for whom?  

PubMed

This paper examines the current notion of universal health care (UHC) in key legal and policy documents and argues that the recommendations for UHC in these entail further abdication of the State's responsibility in health care with the emphasis shifting from public provisioning of services to merely ensuring universal access to services. Acts of commission (recommendations for public private partnership [PPPs], definition and provision of an essential health package to vulnerable populations to ensure universal access to care) and omission (silence maintained on tertiary care) will eventually strengthen the private and corporate sector at the cost of the public health care services and access to care for the marginalized. Thus, the current UHC strategy uses equity as a tool for promoting the private sector in medical care rather than health for all. PMID:24351383

Qadeer, Imrana

2013-01-01

289

Aurally-adequate time-frequency analysis for scattered sound in auditoria  

NASA Astrophysics Data System (ADS)

The goal of this work was to apply an aurally-adequate time-frequency analysis technique to the analysis of sound scattering effects in auditoria. Time-frequency representations were developed as a motivated effort that takes into account binaural hearing, with a specific implementation of interaural cross-correlation process. A model of the human auditory system was implemented in the MATLAB platform based on two previous models [A. Hrm and K. Palomki, HUTear, Espoo, Finland; and M. A. Akeroyd, A. Binaural Cross-correlogram Toolbox for MATLAB (2001), University of Sussex, Brighton]. These stages include proper frequency selectivity, the conversion of the mechanical motion of the basilar membrane to neural impulses, and binaural hearing effects. The model was then used in the analysis of room impulse responses with varying scattering characteristics. This paper discusses the analysis results using simulated and measured room impulse responses. [Work supported by the Frank H. and Eva B. Buck Foundation.

Norris, Molly K.; Xiang, Ning; Kleiner, Mendel

2005-04-01

290

Do measures commonly used in body image research perform adequately with African American college women?  

PubMed

This study examines reliability and validity estimates for 3 widely used measures in body image research in a sample of African American college women (N = 278). Internal consistency estimates were adequate (? coefficients above .70) for all measures, and evidence of convergent and discriminant validity was found. Confirmatory factor analyses failed to replicate the hypothesized factor structures of these measures. Exploratory factor analyses indicated that 4 factors found for the Sociocultural Attitudes Toward Appearance Questionnaire were similar to the hypothesized subscales, with fewer items. The factors found for the Multidimensional Body-Self Relations Questionnaire-Appearance Scales and the Body Dissatisfaction subscale of the Eating Disorders Inventory-3 were not similar to the subscales developed by the scale authors. Validity and reliability evidence is discussed for the new factors. PMID:23731233

Kashubeck-West, Susan; Coker, Angela D; Awad, Germine H; Stinson, Rebecca D; Bledman, Rashanta; Mintz, Laurie

2013-07-01

291

Saliency-Based Sensorless Drive of an Adequately Designed IPM Motor for Robot Vehicle Application  

NASA Astrophysics Data System (ADS)

Technology fusion between motor design and control can produce new applications. This paper introduces a saliency-based sensorless drive of adequate designed IPM motor for a specific application in a robot vehicle. The motor is deliberately designed to meet the requirements of robot application and lend itself better for saliency based sensorless control. The speed and position of multiple wheel-motors are synchronously controlled by the drive amplifiers and a single motion controller over the speed range from zero to maximum speed for the robot vehicle application. Finally, two types of robot vehicles, one being a two-wheeled differential drive and the other being an omni directional drive, are developed to transport objects and human. This paper mainly focuses on the concept of motor design and its control. Some analysis and test data are given in this paper.

Ide, Kozo; Takaki, Mamoru; Morimoto, Shinya; Kawazoe, Yosuke; Maemura, Akihiko; Ohto, Motomichi

292

Submicroscopic infections among children with adequate clinical and parasitological response (ACPR).  

PubMed

The aim of the study was to re-assess the treatment outcomes of Gabonese children, treated with sulfadoxine-pyrimethamine (SP) and artesunate-mefloquine (AM) and categorized by microscopy as adequate clinical and parasitological response (ACPR), using polymerase chain reaction (PCR). Dried blood spots were collected at day 0 and day 28 and stevor gene amplification was performed to detect Plasmodium falciparum infections. Plasmodial DNA was found in 27.5% (n=19/69) of the isolates collected at day 28; this proportion was 34.3% (n=12/35) in the SP group and 20.6% (n=7/34) in the AM group. This study underlines the need of an accurate and more appropriate technique such as PCR to evaluate antimalarial drug efficacy during clinical trials. PMID:24561075

Mawili-Mboumba, D P; Bouyou-Akotet, M K; Kombila, M

2014-06-01

293

J-modulated ADEQUATE experiments using different kinds of refocusing pulses.  

PubMed

Owing to the recent developments concerning residual dipolar couplings (RDCs), the interest in methods for the accurate determination of coupling constants is renascenting. We intended to use the J-modulated ADEQUATE experiment by Kvr et al. for the measurement of (13)C - (13)C coupling constants at natural abundance. The use of adiabatic composite chirp pulses instead of the conventional 180 degrees pulses, which compensate for the offset dependence of (13)C 180 degrees pulses, led to irregularities of the line shapes in the indirect dimension causing deviations of the extracted coupling constants. This behaviour was attributed to coupling evolution, during the time of the adiabatic pulse (2 ms), in the J-modulation spin echo. The replacement of this pulse by different kinds of refocusing pulses indicated that a pair of BIPs (broadband inversion pulses), which behave only partially adiabatic, leads to correct line shapes and coupling constants conserving the good sensitivity obtained with adiabatic pulses. PMID:17729234

Thiele, Christina M; Bermel, Wolfgang

2007-10-01

294

Day Care.  

ERIC Educational Resources Information Center

Interviews on the quality of day care in the United States are presented in this transcript of a program broadcast in the National Public Radio weekly series, "Options in Education." Writers, day care center personnel and others describe and evaluate the current situation. Federal legislation concerning children is examined, and researchers

Merro, John; And Others

295

Caring Reflexivity  

ERIC Educational Resources Information Center

This article provides a brief summary of the seven articles in this special issue through the lens of the concept of "caring reflexivity". In joining "caring" and "reflexivity", we deepen the conversation about what constitutes reflexivity, encouraging an explicit focus on the relational. Revisiting the first article, we argue that

Rallis, Sharon F.; Rossman, Gretchen B.

2010-01-01

296

Are the Psychological Needs of Adolescent Survivors of Pediatric Cancer Adequately Identified and Treated?  

PubMed Central

Objectives To describe the psychological needs of adolescent survivors of acute lymphoblastic leukemia (ALL) or brain tumor (BT), we examined: (a) the occurrence of cognitive, behavioral, and emotional concerns identified during a comprehensive psychological evaluation, and (b) the frequency of referrals for psychological follow-up services to address identified concerns. Methods Psychological concerns were identified on measures according to predetermined criteria for 100 adolescent survivors. Referrals for psychological follow-up services were made for concerns previously unidentified in formal assessment or not adequately addressed by current services. Results Most survivors (82%) exhibited at least one concern across domains: behavioral (76%), cognitive (47%), and emotional (19%). Behavioral concerns emerged most often on scales associated with executive dysfunction, inattention, learning, and peer difficulties. CRT was associated with cognitive concerns, ?2(1,N=100)=5.63, p<0.05. Lower income was associated with more cognitive concerns for ALL survivors, t(47)=3.28, p<0.01, and more behavioral concerns for BT survivors, t(48)=2.93, p<0.01. Of survivors with concerns, 38% were referred for psychological follow-up services. Lower-income ALL survivors received more referrals for follow-up, ?2(1,N=41)=8.05, p<0.01. Referred survivors had more concerns across domains than non-referred survivors, ALL: t(39)=2.96, p<0.01, BT: t(39)=3.52, p<0.01. Trends suggest ALL survivors may be at risk for experiencing unaddressed cognitive needs. Conclusions Many adolescent survivors of cancer experience psychological difficulties that are not adequately managed by current services, underscoring the need for long-term surveillance. In addition to prescribing regular psychological evaluations, clinicians should closely monitor whether current support services appropriately meet survivors needs, particularly for lower-income survivors and those treated with CRT.

Kahalley, Lisa S.; Wilson, Stephanie J.; Tyc, Vida L.; Conklin, Heather M.; Hudson, Melissa M.; Wu, Shengjie; Xiong, Xiaoping; Stancel, Heather H.; Hinds, Pamela S.

2012-01-01

297

Estimating the Cost of Adequate K-12 Educational Expenditure in Selected Midwestern States: An Adjusted Miner/McMahon Approach.  

ERIC Educational Resources Information Center

According to a formula developed to measure the adequacy of state educational finance levels, only three of six selected midwestern states provided adequate levels of expenditure per pupil in 1981-82. The formula for determining adequacy, developed by Jerry Miner and Walter McMahon, consists of totaling adequate levels of expenditure in seven

Johnson, Wayne Paul; Hickrod, G. Alan

298

In-vitro analysis of the microbicidal activity of 6 contact lens care solutions  

PubMed Central

Background Contact lens-related infections are often associated with inadequate contact lens hygiene, and therefore, contact lens care products should be able to sufficiently minimise the amount of pathogens that are responsible for these infections. In 2001, the EN ISO 14729 was introduced to ensure adequate disinfection efficacy of contact lens care solutions, but this norm has recently been criticised. Methods In this study, six frequently used contact lens care solutions were retested according to the Stand Alone Test of the EN ISO 14729 (2001). The Stand Alone Test is a quantitative suspension test. In addition, the products were tested in a modified setting adding an organic load. The load was a mixture of human blood serum, lysozyme, and mucine, which resembles tear fluid. Results The criteria of the Stand Alone Test recommended in EN ISO 14729 were only met by Aosept Plus. This 3% hydrogen-peroxide-based contact lens care solution attained a reduction factor of > 5 log units for bacteria and > 4 for fungi in all cases. Two further contact lens care solutions, Blue Vision and Optifree Replenish, met the criteria of a reduction factor of > 3 log units for bacteria and > 1 log unit for fungi, but only in the presence of artificial tear fluid. The three remaining products did not exhibit adequate disinfecting efficacy, at least against one of the tested microorganisms. Conclusions Through the observation that the artificial tear fluid used in this study influences the disinfecting efficacy of contact lens care solutions, especially that of multi-purpose solutions, in a different way than does albumin, mucine, or even the organic load suggested in EN ISO 14729, it becomes obvious that the test conditions in the EN ISO 14729 should be revised in order to create more realistic conditions, e.g., by using a more realistic artificial tear fluid. Furthermore, we suggest adapting the EN ISO 14729 to the European test hierarchy for chemical disinfectants and antiseptics, which consists of three test phases and also requests meeting stricter criteria in order to pass the test. Unless the test conditions guarantee a sufficient reduction of potential pathogens, the risk of contact lens-related microbial keratitis and other infections will remain for the users.

2012-01-01

299

Space medicine innovation and telehealth concept implementation for medical care during exploration-class missions  

NASA Astrophysics Data System (ADS)

Medical care on the International Space Station (ISS) is provided using real-time communication with limited medical data transmission. In the occurrence of an off-nominal medical event, the medical care paradigm employed is 'stabilization and transportation', involving real-time management from ground and immediate return to Earth in the event that the medical contingency could not be resolved in due time in space. In preparation for future missions beyond Low-Earth orbit (LEO), medical concepts of operations are being developed to ensure adequate support for the new mission profiles: increased distance, duration and communication delays, as well as impossibility of emergency returns and limitations in terms of medical equipment availability. The current ISS paradigm of medical care would no longer be adequate due to these new constraints. The Operational Space Medicine group at the Canadian Space Agency (CSA) is looking towards synergies between terrestrial and space medicine concepts for the delivery of medical care to deal with the new challenges of human space exploration as well as to provide benefits to the Canadian population. Remote and rural communities on Earth are, in fact, facing similar problems such as isolation, remoteness to tertiary care centers, resource scarcity, difficult (and expensive) emergency transfers, limited access to physicians and specialists and limited training of medical and nursing staff. There are a number of researchers and organizations, outside the space communities, working in the area of telehealth. They are designing and implementing terrestrial telehealth programs using real-time and store-and-forward techniques to provide isolated populations access to medical care. The cross-fertilization of space-Earth research could provide support for increased spin-off and spin-in effects and stimulate telehealth and space medicine innovations to engage in the new era of human space exploration. This paper will discuss the benefits of space-Earth research projects for the advancement of both terrestrial and space medicine and will use examples of operational space medicine projects conducted at the CSA in areas such as remote training, tele-mentoring and remote control of an ultrasound.

Martin, Annie; Sullivan, Patrick; Beaudry, Catherine; Kuyumjian, Raffi; Comtois, Jean-Marc

2012-12-01

300

Access to Health Care: Does Neighborhood Residential Instability Matter?  

ERIC Educational Resources Information Center

Many Americans do not have access to adequate medical care. Previous research on this problem focuses primarily on individual-level determinants of access such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed medical care, however, has not received much attention. We

Kirby, James B.; Kaneda, Toshiko

2006-01-01

301

End-of-Life Care: An Agenda for Policy Improvement  

Microsoft Academic Search

Health care in the United States has not adequately addressed the needs of a growing population with serious, eventually fatal chronic illness. In 1982, legislation established Medicare hospice, although experience and research have since highlighted many shortcomings with that program. Hospice is well suited to the care of patients with cancer and people who need support at home for a

Lisa R. Shugarman; Karl Lorenz; Joanne Lynn

2005-01-01

302

Residential Group Care Quarterly. Volume 5, Number 3, Winter 2005  

ERIC Educational Resources Information Center

This issue of "Residential Group Care Quarterly" contains the following articles: (1) "Promising Practices for Adequately Funding and Reimbursing Residential Services" (Lloyd Bullard); (2) "Closing the Gender Gap" (Erin Andersen); (3) "Residential Child Care: Guidelines for Physical Techniques, Crisis Prevention, and Management" (Kurk Lalemand);

Michael, Jennifer, Ed.

2005-01-01

303

Assessing Child-Care Quality with a Telephone Interview.  

ERIC Educational Resources Information Center

Examined whether data on child care quality obtained from a telephone interview with the provider could serve as an adequate proxy for data obtained from direct observation of 89 child care homes and 92 centers. Found that a 25-item interview predicted accurately the quality classification of 92 percent of homes and 89 percent of centers.

Holloway, Susan D.; Kagan, Sharon L.; Fuller, Bruce; Tsou, Lynna; Carroll, Jude

2001-01-01

304

Community Endowment Funds for Early Care and Education. Technical Report.  

ERIC Educational Resources Information Center

Noting that most early care and education programs do not have adequate resources to achieve high quality, this report examines the potential of community-based endowment funds for early care and education. Section 1 of the report provides general background information about endowments, their uses, characteristics of successful endowment-building

Monroe, Helen

305

Role of Quality in the Demand for Health Care Cebu, Philippines. Small Applied Research Paper No. 12.  

National Technical Information Service (NTIS)

A mixed multinominal logit model is used in this document to estimate the effects of quality, price, distance, and individual demand for health care on Cebu Island in the Philippines. Data collected from both households and health care facilities ensures ...

D. Hotchkiss

1993-01-01

306

[Dying in the intensive care unit].  

PubMed

Modern intensive care is responsible both for curative interventions in critical health situations and palliative terminal care for the dying ICU patient. By applying an integrated ethics approach, this article examines organizational and cultural factors shaping good terminal care in the ICU. Starting with a reflection on what it means to be human, ethical goals for care of the dying are formulated. Among them, the article focuses on practices ensuring a dignified dying process, on the structured engagement of patients' families, on respecting cultural and spiritual values, and on a clinical pathway for terminal care as an institutional framework. In conclusion, it becomes evident that good terminal care in the ICU not only depends on ethically sound decisions on withholding or withdrawing medical interventions but also on organizational and cultural aspects which must be acknowledged and shaped. PMID:24352620

Wallner, J

2014-02-01

307

Lots of Funds for Dependent Care.  

ERIC Educational Resources Information Center

Corporate funding is now being used to invest in the improvement of community dependent care. This strategy benefits the firms by: (1) ensuring that employees will be absent from work less frequently due to childcare responsibilities; (2) providing a flexible strategy for meeting a variety of community needs; (3) improving community-firm

Friedman, Dana E.

308

Insurance and Innovation in Health Care Markets  

Microsoft Academic Search

Innovation policy often involves an uncomfortable trade-off between rewarding innovators sufficiently and providing the innovation at the lowest possible price. However, in health care markets with insurance for innovative goods, society may be able to ensure efficient rewards for inventors and the efficient dissemination of inventions. Health insurance resembles a two-part pricing contract in which a group of consumers pay

Darius Lakdawalla; Neeraj Sood

2005-01-01

309

Legislating health care coverage for the unemployed.  

PubMed

Because the unemployed and their families are often likely to develop stress-related health problems, ensuring them access to health care is a public health issue. Congressional efforts thus far to legislate health coverage for the unemployed have proposed a system that recognizes people's basic need for coverage but has several limitations. PMID:4029798

Palley, H A; Feldman, G; Gallner, I; Tysor, M

1985-01-01

310

Long-Term Care Research and Policy  

ERIC Educational Resources Information Center

This article provides a framework for understanding how long-term care (LTC) research contributes to policy, develops a typology of research contributions to policy with examples of each type, and suggests ways to ensure that contributions continue in the future. The article draws on in-depth interviews with LTC experts working at the interface

Kemper, Peter

2003-01-01

311

Delivering best care in war and peace.  

PubMed

Col Alan Finnegan, the fi rst Ministry of Defence professor of nursing, is driving forward research into preparing nurses for deployment and ensuring they deliver the best care possible in war and peace. Research topics range from the role of autonomous practitioners to the effects on soldiers of injuries to their genitalia. PMID:24938961

Moore, Alison

2014-06-24

312

Can the ASAR Global Monitoring Mode Product Adequately Capture Spatial Soil Moisture Variability?  

NASA Astrophysics Data System (ADS)

Global soil moisture (SM) monitoring in the past several decades has been undertaken mainly at coarse spatial resolution, which is not adequate for addressing small-scale phenomena and processes. The currently operational Advanced Microwave Scanning Radiometer (NASA) and future planned missions such as the Soil Moisture and Ocean Salinity (ESA) and the Soil Moisture Active Passive (NASA) will remain resolution limited. Finer scale soil moisture estimates can be achieved either by down-scaling the available coarse resolution radiometer and scatterometer (i.e. ERS1/2, ASCAT) observations or by using high resolution active microwave SAR type systems (typical resolution is in the order of meters). Considering the complex land surface - backscatter signal interaction, soil moisture inversion utilizing active microwave observations is difficult and generally needs supplementary data. Algorithms based on temporal change detection offer an alternative less complex approach for deriving (and disaggregating coarse) soil moisture estimates. Frequent monitoring and low frequency range along with a high pixel resolution are essential preconditions when characterizing spatial and temporal soil moisture variability. An alternative active system that meets these requirements is the Advance Synthetic Aperture Radar (ASAR) on ENVISAT [C-band, global, 1 km in Global Monitoring (GM) Mode]. The Vienna University of Technology (TU Wien) has developed a 1 km soil moisture product using the temporal change detection approach and the ASAR GM. The TU Wien SM product sensitivity was evaluated at two scales: point (using in situ data from permanent soil moisture stations) and regional [using ground measured data and aircraft estimates derived from the Polarimetric L-band Microwave Radiometer (PLMR)] over the National Airborne Field Experiment (NAFE'05) area located in the Goulburn catchment, SE Australia. The month long (November 2005) campaign was undertaken in a region predominantly covered by grasslands and partly by forests and croplands. Point scale analysis revealed high ASAR sensitivity and adequate response to changes in moisture conditions (R = 0.69 and RMSE = 0.08 v/v). Regional analysis was performed at several different spatial resolutions (1 km to 25 km). ASAR exhibited high noise level and significant wet bias. Increase in pixel size resulted in improving R and RMSE from R = 0.59 and RMSE = 0.14 to R = 0.91 and RMSE = 0.05 at 1 km and 25 km respectively; however, despite the reasonable statistical agreement at 1 km, the soil moisture spatial patterns clearly visible in the PLMR images, the later were verified with ground data, were lacking in the ASAR product.

Mladenova, I.; Lakshmi, V.; Walker, J.; Panciera, R.; Wagner, W.; Doubkova, M.

2008-12-01

313

Glucksberg, the putative right to adequate pain relief, and death with dignity.  

PubMed

This Article focuses on the legality of the aggressive use of analgesics and deep sedation for terminally ill patients. The author analyzes the 1997 Supreme Court decisions on physician-assisted suicide, examines the tension between controversial palliative care practices and the traditional legal framework, and explores the contours of an emerging constitutional right to avoid suffering at the end of life. In addition, the author argues that deep sedation together with withholding of artificial nutrition and hydration should be an option for dying patients suffering from severe physical or emotional pain. PMID:11571891

Cantor, N L

2001-01-01

314

Utilization of dental care: An Indian outlook  

PubMed Central

Oral health has a significant impact on the quality of life, appearance, and self-esteem of the people. Preventive dental visits help in the early detection and treatment of oral diseases. Dental care utilization can be defined as the percentage of the population who access dental services over a specified period of time. There are reports that dental patients only visit the dentist when in pain and never bother to return for follow-up in most cases. To improve oral health outcomes an adequate knowledge of the way the individuals use health services and the factors predictive of this behavior is essential. The interest in developing models explaining the utilization of dental services has increased; issues like dental anxiety, price, income, the distance a person had to travel to get care, and preference for preservation of teeth are treated as barriers in regular dental care. Published materials which pertain to the use of dental services by Indian population have been reviewed and analyzed in depth in the present study. Dental surgeons and dental health workers have to play an adequate role in facilitating public enlightenment that people may appreciate the need for regular dental care and make adequate and proper use of the available dental care facilities.

Gambhir, Ramandeep Singh; Brar, Prabhleen; Singh, Gurminder; Sofat, Anjali; Kakar, Heena

2013-01-01

315

Recommendations for Long Term Care in an Elderly Medicaid Population.  

ERIC Educational Resources Information Center

The State of Virginia has had a statewide nursing home preadmission screening program since 1977 and has made efforts to ensure appropriate placement of individuals in long term care settings. In a major effort to divert certain individuals from institutionalization, a personal care option has been provided. Using data from the Preadmission

Travis, Shirley S.; McAuley, William J.

316

28 CFR 97.20 - Standards to ensure the safety of violent prisoners during transport.  

Code of Federal Regulations, 2010 CFR

...govern the safety of violent prisoners during transport. In addition...officials in the event of a prisoner escape; (c) Policies...are in effect to ensure the health and physical safety of the prisoners during transport,...

2009-07-01

317

28 CFR 97.20 - Standards to ensure the safety of violent prisoners during transport.  

Code of Federal Regulations, 2010 CFR

...govern the safety of violent prisoners during transport. In addition...officials in the event of a prisoner escape; (c) Policies...are in effect to ensure the health and physical safety of the prisoners during transport,...

2010-07-01

318

Different Approaches for Ensuring Performance/Reliability of Plastic Encapsulated Microcircuits (PEMs) in Space Applications  

NASA Technical Reports Server (NTRS)

This paper presents viewgraphs on Plastic Encapsulated Microcircuits (PEMs). Different approaches are addressed to ensure good performance and reliability of PEMs. The topics include: 1) Mitigating Risk; and 2) Program results.

Gerke, R. David; Sandor, Mike; Agarwal, Shri; Moor, Andrew F.; Cooper, Kim A.

1999-01-01

319

Hospice Care  

MedlinePLUS

... coverage for Medicare, Medicaid, and private health plans http://www.caringinfo.org/i4a/ pages/index.cfm?pageid= ... for Medicare & Medicaid Services Information for Medicare beneficiaries http://www.medicare.gov/ coverage/hospice-and-respite- care. ...

320

Hospice Care  

MedlinePLUS

... by providing a holistic approach. That means giving spiritual, mental, emotional and physical comfort to the patients, ... care. The team includes doctors, nurses, social workers, spiritual counselors, home health aides, bereavement counselors and volunteers. ...

321

Integrated care  

PubMed Central

Abstract The WHO European Office for Integrated Health Care Services in Barcelona is an integral part of the World Health Organizations' Regional Office for Europe. The main purpose of the Barcelona office is within the integration of services to encourage and facilitate changes in health care services in order to promote health and improve management and patient satisfaction by working for quality, accessibility, cost-effectiveness and participation. This position paper outlines the need for Integrated Care from a European perspective, provides a theoretical framework for the meaning of Integrated Care and its strategies and summarizes the programmes of the office that will support countries in the WHO European Region to improve health services.

Grone, Oliver; Garcia-Barbero, Mila

2001-01-01

322

Hospice care.  

PubMed

Hospice of Peel is a community-based hospice serving a population of between 750-800,000. Hospice care evolved to meet the needs of the terminally ill. It can, and does, take many forms, as you will see in the brief case scenarios detailed below. The individuals and situations described are real and typical of day-to-day-hospice care in a large urban environment. Both the sick and their families are in need of support and assistance to enable them to cope during this time of crisis in their lives. Increased awareness of hospice care is resulting in more and more people with a life-threatening or terminal illness and their families turning to hospice care. PMID:9611457

Bennett, L

1997-01-01

323

Respite Care  

MedlinePLUS

... local church group or area agency on aging (AAA) will even run a formal Friendly Visitor Program ... of the cost of respite care. Your local AAA will have more information on whether financial assistance ...

324

A test of the cerebellar hypothesis of dyslexia in adequate and inadequate responders to reading intervention  

PubMed Central

The cerebellar hypothesis of dyslexia posits that cerebellar deficits are associated with reading disabilities and may explain why some individuals with reading disabilities fail to respond to reading interventions. We tested these hypotheses in a sample of children who participated in a grade 1 reading intervention study (n = 174) and a group of typically achieving children (n = 62). At posttest, children were classified as adequately responding to the intervention (n = 82), inadequately responding with decoding and fluency deficits (n = 36), or inadequately responding with only fluency deficits (n = 56). Based on the Bead Threading and Postural Stability subtests from the Dyslexia Screening Test-Junior, we found little evidence that assessments of cerebellar functions were associated with academic performance or responder status. In addition, we did not find evidence supporting the hypothesis that cerebellar deficits are more prominent for poor readers with specific reading disabilities (i.e., with discrepancies relative to IQ) than for poor readers with reading scores consistent with IQ. In contrast, measures of phonological awareness, rapid naming, and vocabulary were strongly associated with responder status and academic outcomes. These results add to accumulating evidence that fails to associate cerebellar functions with reading difficulties.

Barth, Amy E.; Denton, Carolyn A.; Stuebing, Karla K.; Fletcher, Jack M.; Cirino, Paul T.; Francis, David J.; Vaughn, Sharon

2013-01-01

325

Gaussian membership functions are most adequate in representing uncertainty in measurements  

NASA Technical Reports Server (NTRS)

In rare situations, like fundamental physics, we perform experiments without knowing what their results will be. In the majority of real-life measurement situations, we more or less know beforehand what kind of results we will get. Of course, this is not the precise knowledge of the type 'the result will be between alpha - beta and alpha + beta,' because in this case, we would not need any measurements at all. This is usually a knowledge that is best represented in uncertain terms, like 'perhaps (or 'most likely', etc.) the measured value x is between alpha - beta and alpha + beta.' Traditional statistical methods neglect this additional knowledge and process only the measurement results. So it is desirable to be able to process this uncertain knowledge as well. A natural way to process it is by using fuzzy logic. But, there is a problem; we can use different membership functions to represent the same uncertain statements, and different functions lead to different results. What membership function do we choose? In the present paper, we show that under some reasonable assumptions, Gaussian functions mu(x) = exp(-beta(x(exp 2))) are the most adequate choice of the membership functions for representing uncertainty in measurements. This representation was efficiently used in testing jet engines to airplanes and spaceships.

Kreinovich, V.; Quintana, C.; Reznik, L.

1992-01-01

326

Are image quality metrics adequate to evaluate the quality of geometric objects?  

NASA Astrophysics Data System (ADS)

Geometric objects are often represented by many millions of triangles or polygons, which limits the ease with which they can be transmitted and displayed electronically. This has lead to the development of many algorithms for simplifying geometric models, and to the recognition that metrics are required to evaluate their success. The goal is to create computer graphic renderings of the object that do not appear to be degraded to a human observer. The perceptual evaluation of simplified objects is a new topic. One approach has been to sue image-based metrics to predict the perceived degradation of simplified 3D models. Since that 2D images of 3D objects can have significantly different perceived quality, depending on the direction of the illumination, 2D measures of image quality may not adequately capture the perceived quality of 3D objects. To address this question, we conducted experiments in which we explicitly compared the perceived quality of animated 3D objects and their corresponding 2D still image projections. Our results suggest that 2D judgements do not provide a good predictor of 3D image quality, and identify a need to develop 'object quality metrics.'

Rogowitz, Bernice E.; Rushmeier, Holly E.

2001-06-01

327

The placental pursuit for an adequate oxidant balance between the mother and the fetus  

PubMed Central

The placenta is the exchange organ that regulates metabolic processes between the mother and her developing fetus. The adequate function of this organ is clearly vital for a physiologic gestational process and a healthy baby as final outcome. The umbilico-placental vasculature has the capacity to respond to variations in the materno-fetal milieu. Depending on the intensity and the extensity of the insult, these responses may be immediate-, mediate-, and long-lasting, deriving in potential morphostructural and functional changes later in life. These adjustments usually compensate the initial insults, but occasionally may switch to long-lasting remodeling and dysfunctional processes, arising maladaptation. One of the most challenging conditions in modern perinatology is hypoxia and oxidative stress during development, both disorders occurring in high-altitude and in low-altitude placental insufficiency. Hypoxia and oxidative stress may induce endothelial dysfunction and thus, reduction in the perfusion of the placenta and restriction in the fetal growth and development. This Review will focus on placental responses to hypoxic conditions, usually related with high-altitude and placental insufficiency, deriving in oxidative stress and vascular disorders, altering fetal and maternal health. Although day-to-day clinical practice, basic and clinical research are clearly providing evidence of the severe impact of oxygen deficiency and oxidative stress establishment during pregnancy, further research on umbilical and placental vascular function under these conditions is badly needed to clarify the myriad of questions still unsettled.

Herrera, Emilio A.; Krause, Bernardo; Ebensperger, German; Reyes, Roberto V.; Casanello, Paola; Parra-Cordero, Mauro; Llanos, Anibal J.

2014-01-01

328

Quantification of gold nanoparticle cell uptake under controlled biological conditions and adequate resolution.  

PubMed

Aim: We examined cellular uptake mechanisms of fluorescently labeled polymer-coated gold nanoparticles (NPs) under different biological conditions by two quantitative, microscopic approaches. Materials & methods: Uptake mechanisms were evaluated using endocytotic inhibitors that were tested for specificity and cytotoxicity. Cellular uptake of gold NPs was analyzed either by laser scanning microscopy or transmission electron microscopy, and quantified by means of stereology using cells from the same experiment. Results: Optimal inhibitor conditions were only achieved with chlorpromazine (clathrin-mediated endocytosis) and methyl-?-cyclodextrin (caveolin-mediated endocytosis). A significant methyl-?-cyclodextrin-mediated inhibition (63-69%) and chlorpromazine-mediated increase (43-98%) of intracellular NPs was demonstrated with both imaging techniques, suggesting a predominant uptake via caveolin-medicated endocytois. Transmission electron microscopy imaging revealed more than 95% of NPs localized in intracellular vesicles and approximately 150-times more NP events/cell were detected than by laser scanning microscopy. Conclusion: We emphasize the importance of studying NP-cell interactions under controlled experimental conditions and at adequate microscopic resolution in combination with stereology. Original submitted 10 July 2012; Revised submitted 23 January 2013. PMID:23738633

Rothen-Rutishauser, Barbara; Kuhn, Dagmar A; Ali, Zulqurnain; Gasser, Michael; Amin, Faheem; Parak, Wolfgang J; Vanhecke, Dimitri; Fink, Alke; Gehr, Peter; Brandenberger, Christina

2014-04-01

329

A test of the cerebellar hypothesis of dyslexia in adequate and inadequate responders to reading intervention.  

PubMed

The cerebellar hypothesis of dyslexia posits that cerebellar deficits are associated with reading disabilities and may explain why some individuals with reading disabilities fail to respond to reading interventions. We tested these hypotheses in a sample of children who participated in a grade 1 reading intervention study (n = 174) and a group of typically achieving children (n = 62). At posttest, children were classified as adequately responding to the intervention (n = 82), inadequately responding with decoding and fluency deficits (n = 36), or inadequately responding with only fluency deficits (n = 56). Based on the Bead Threading and Postural Stability subtests from the Dyslexia Screening Test-Junior, we found little evidence that assessments of cerebellar functions were associated with academic performance or responder status. In addition, we did not find evidence supporting the hypothesis that cerebellar deficits are more prominent for poor readers with "specific" reading disabilities (i.e., with discrepancies relative to IQ) than for poor readers with reading scores consistent with IQ. In contrast, measures of phonological awareness, rapid naming, and vocabulary were strongly associated with responder status and academic outcomes. These results add to accumulating evidence that fails to associate cerebellar functions with reading difficulties. PMID:20298639

Barth, Amy E; Denton, Carolyn A; Stuebing, Karla K; Fletcher, Jack M; Cirino, Paul T; Francis, David J; Vaughn, Sharon

2010-05-01

330

Caring Encounters  

ERIC Educational Resources Information Center

Children with autism may seem to not care about things or have the same range of emotions as those of us who see them and care for them. But they do have empathy and they can be taught how to communicate it, says the author, a teacher of children with autism. We simply need to listen to them, watch them, and be with them in their moment.

Gunn, Alyson

2012-01-01

331

Persistence of energy savings: What do we know and how can it be ensured?  

SciTech Connect

This paper presents a conceptual framework for analyzing persistence of energy savings, summarizes the limited experience of what we know about persistence, provides guidance for conducting retrospective and prospective persistence studies, and suggests strategies for ensuring persistence. Because this area of research is in its infancy, unequivocal conclusions about persistence would be premature. Accordingly, this paper provides guidance for both conducting research in this area and developing policies and mechanisms to help ensure the persistence of energy savings.

Vine, E.

1992-05-01

332

Persistence of energy savings: What do we know and how can it be ensured  

SciTech Connect

This paper presents a conceptual framework for analyzing persistence of energy savings, summarizes the limited experience of what we know about persistence, provides guidance for conducting retrospective and prospective persistence studies, and suggests strategies for ensuring persistence. Because this area of research is in its infancy, unequivocal conclusions about persistence would be premature. Accordingly, this paper provides guidance for both conducting research in this area and developing policies and mechanisms to help ensure the persistence of energy savings.

Vine, E.

1992-05-01

333

Measuring organizational readiness for knowledge translation in chronic care  

Microsoft Academic Search

BackgroundKnowledge translation (KT) is an imperative in order to implement research-based and contextualized practices that can answer\\u000a the numerous challenges of complex health problems. The Chronic Care Model (CCM) provides a conceptual framework to guide\\u000a the implementation process in chronic care. Yet, organizations aiming to improve chronic care require an adequate level of\\u000a organizational readiness (OR) for KT. Available instruments

Marie-Pierre Gagnon; Jenni Labarthe; Mathieu Ouimet; Carole A Estabrooks; Genevive Roch; El Kebir Ghandour; Jeremy Grimshaw

2011-01-01

334

Movement and spawning migration patterns suggest small marine reserves can offer adequate protection for exploited emperorfishes  

NASA Astrophysics Data System (ADS)

A critical feature of effective marine reserves is to be large enough to encompass home ranges of target species, thereby allowing a significant portion of the population to persist without the threat of exploitation. In this study, patterns of movement and home range for Lethrinus harak and Lethrinus obsoletus were quantified using an array of 33 acoustic receivers that covered approximately three quarters of Piti Marine Reserve in the Pacific island of Guam. This array was designed to ensure extensive overlap of receiver ranges throughout the study area. Eighteen individuals (12 L. harak and 6 L. obsoletus) were surgically implanted with ultrasonic transmitters and passively tracked for 4 months. Both species displayed high site fidelity and had relatively small home ranges. The home ranges of L. harak expanded with increasing body size. Feeding of fish by humans, which was common but restricted to a small area within the study site, had little effect on the distribution of the resident populations. L. harak made nightly spawning migrations within the reserve between full moon and last quarter moon of each lunar cycle, coinciding with a strong ebbing tide. Results indicate that even small reserves can include many individual home ranges of these emperorfishes and can protect spawning sites for L. harak. These species are heavily targeted in Guam, and there are major demographic differences between fished and protected sites. This study shows the potential for protected areas to sustain reproductive viability in exploited populations.

Taylor, B. M.; Mills, J. S.

2013-12-01

335

Maintaining technical quality of care in the introduction of Cyclofem in a national family planning program: findings from Indonesia.  

PubMed

This paper discusses the technical dimensions of "quality of care" in contraceptive service delivery in both the Cyclofem Introductory Trial, as well as in routine service delivery of other injectables in Indonesia. Although the quality of care in the Cyclofem trial was generally acceptable, substantial weaknesses in screening, clinical technique, the management of side-effects, and knowledge concerning re-injection time frames were identified in the provision of injectable contraceptives in routine service delivery. The findings suggest that in order for Cyclofem and other injectables to be delivered in the routine program with an adequate standard of care, considerable managerial adaptation and strengthening of providers' technical capabilities would be necessary prior to actual introduction. This would include providing training and updated technical guidelines concerning both Cyclofem and other contraceptives to providers, with an emphasis on technical issues including contraceptive indications and contraindications, re-injection time frames, maintenance of asepsis and the management of side-effects. Strengthening the existing management information system and logistics systems to facilitate differentiation between injectable contraceptives provided by the program so as to ensure sufficient supplies of both contraceptives and associated materials such as needles and syringes will also be necessary. PMID:8045136

Lubis, F; Fajans, P; Simmons, R

1994-05-01

336

The importance of clinical practice guidelines (CPGs) for the quality and development of supportive care in Central and Eastern European (CEE) countries  

Microsoft Academic Search

Supportive care CPGs are intended to improve the quality of supportive care received by cancer patients. They hold potential benefits for health-care professionals, health-care organizations and patients. In order to provide an effective influence of CPGs on supportive care development in CEE countries their validity and successful implementation in clinical practice must be ensured. This would involve several important steps:

Snezana Bosnjak

2003-01-01

337

Foster Care: State Practices for Assessing Health Needs, Facilitating Service Delivery, and Monitoring Children's Care. Report to the Chairman, Subcommittee on Income Security and Family Support, Committee on Ways and Means, House of Representatives. GAO-09-26  

ERIC Educational Resources Information Center

Providing health care services for foster children, who frequently have significant health care needs, can be challenging. The Administration for Children and Families (ACF) oversees foster care, but state child welfare agencies are responsible for ensuring that these children receive health care services, which are often financed by Medicaid. In

Brown, Kay; Bascetta, Cynthia A.

2009-01-01

338

Telepsychiatry and e-Mental Health Services: Potential for Improving Access to Mental Health Care  

Microsoft Academic Search

Reforming mental health care is a focus of many ongoing initiatives in the United States, both at the national and state levels. Access to adequate mental health care services is one of the identified problems. Telepsychiatry and e-mental health services could improve access to mental health care in rural, remote and underserved areas. The authors discuss the required technology, common

Kaye L. McGinty; Sy Atezaz Saeed; Scott C. Simmons; Yilmaz Yildirim

2006-01-01

339

Postruminal Lysine and Methionine Infussion in Steers Fed a Urea-Supplemented Diet Adequate in Sulfur1  

Microsoft Academic Search

Postruminal utilization of methionine by growing steer calves fed ground shelled corn, urea, and cottonseed hulls adequate in sulfur was studied by abomasal infusion of graded quantities of methionine with lysine adequate. A 6 x 6 Latin square of treatments was replicated in which infusions provided lysine and methionine in grams per day: A) 0,0; B) 24,0; C) 24,4; D)

G. M. Hill; J. A. Boling; N. W. Bradley

1980-01-01

340

Segmenting into Adequate Units for Automatic Recognition of Emotion-Related Episodes: A Speech-Based Approach  

Microsoft Academic Search

In this article, we deal with the topic of segmenting emotion-related (emotional\\/affective) episodes into adequate units for analysis and automatic processing\\/classification - a topic that has not been addressed adequately so far. We concentrate on speech and illustrate promising approaches by using a database with children's emotional speech. We argue in favour of the word as basic unit and map

Anton Batliner; Dino Seppi; Stefan Steidl

2010-01-01

341

Ethical problems with the mental health evaluation standards of care for adult gender variant prospective patients.  

PubMed

The World Professional Association for Transgender Health's "Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons" (SOC) set forth standards clinicians must meet to ensure ethical care of adequate quality. The SOC also set requirements gender variant prospective patients must meet to receive medical interventions to change their sexual characteristics to those more typical for the sex to which they were not assigned at birth. One such requirement is that mental health professionals must ascertain that prospective patients have met the SOC's eligibility and readiness criteria. This article raises two objections to this requirement: ethically obligatory considerations of the overall balance of potential harms and benefits tell against it, and it violates the principle of respect for autonomy. This requirement treats gender variant prospective patients who request medical intervention as different in kind, not merely degree, from other patient populations, as it constructs the very request as a phenomenon of incapacity. This is ethically indefensible in and of itself, but it is especially pernicious in a sociocultural and political context that already denies gender variant people full moral status. PMID:17951884

Hale, C Jabob

2007-01-01

342

Dose Adjusting Enoxaparin is Necessary to Achieve Adequate Venous Thromboembolism Prophylaxis in Trauma Patients  

PubMed Central

Background Standard venous thromboembolism (VTE) prophylaxis with enoxaparin results in inadequate protection in certain patients, with sub-therapeutic plasma anti-Xa levels associated with elevated VTE rates. We hypothesized that many trauma patients would be sub-therapeutic on the standard prophylactic dose of enoxaparin. Our goal was to adjust the enoxaparin dose to achieve target anti-Xa levels to take advantage of the drug based on its pharmacologic properties. Methods Patients admitted to the trauma service were included if they received at least 3 doses of prophylactic enoxaparin and underwent at least 2 screening venous duplex. Peak plasma anti-Xa levels ? 0.2 IU/ml were considered low and the dose was increased by 10mg bid until adequate anti-Xa levels were obtained. A strict screening venous duplex protocol was followed. Patients were excluded if they were diagnosed with a DVT prior to beginning enoxaparin or did not have correctly timed anti-Xa levels. Results Sixty-one trauma patients met inclusion criteria. There were 3 patients diagnosed with VTE (4.9%). Patients had a mean age of 45.9 years and were predominantly male (70.5%). Of the 61 patients, 18 (29.5%) had therapeutic anti-Xa levels on standard enoxaparin 30mg bid. Compared to patients who had therapeutic anti-Xa levels on enoxaparin 30mg bid, the 43 patients (70.5%) who were sub-therapeutic were more likely to be male, have larger body weight, and larger body surface area. There were no significant bleeding events in the group that received an enoxaparin dose adjustment. Conclusions A majority of patients had sub-therapeutic anti-Xa levels while on enoxaparin 30mg bid suggesting inadequate VTE prophylaxis. The need for routine use of a higher dose of prophylactic enoxaparin in trauma patients and the effects of routinely dose adjusting enoxaparin on VTE rates should be the study of future prospective, randomized trials.

Costantini, Todd W.; Min, Emily; Box, Kevin; Tran, Vy; Winfield, Robert D.; Fortlage, Dale; Doucet, Jay; Bansal, Vishal; Coimbra, Raul

2014-01-01

343

Are Community-Level Financial Data Adequate to Assess Population Health Investments?  

PubMed Central

The variation in health outcomes among communities results largely from different levels of financial and nonfinancial policy investments over time; these natural experiments should offer investment and policy guidance for a business model on population health. However, little such guidance exists. We examined the availability of data in a sample of Wisconsin counties for expenditures in selected categories of health care, public health, human services, income support, job development, and education. We found, as predicted by the National Committee on Vital and Health Statistics in 2002, that availability is often limited by the challenges of difficulty in locating useable data, a lack of resources among public agencies to upgrade information technology systems for making data more usable and accessible to the public, and a lack of enterprise-wide coordination and geographic detail in data collection efforts. These challenges must be overcome to provide policy-relevant information for optimal population health resource allocation.

Casper, Tim

2012-01-01

344

Attracting and Retaining Nurses in HIV Care.  

PubMed

Attracting and retaining nurses in HIV care is essential to treatment success, preventing the spread of HIV, slowing its progression, and improving the quality of life of people living with HIV. Despite the wealth of studies examining HIV care, few have focused on the factors that influenced nurses' choices to specialize in HIV care. We examined the factors that attracted and retained eight nurses currently working in HIV care in two large Canadian cities. Participants were primarily women between the ages of 20 and 60 years. Interviews were conducted between November 2010 and September 2011 using interpretive description, a qualitative design. Factors that influenced participants to focus their careers in HIV care included both attracting factors and retaining factors. Although more research is needed, this exploration of attracting and retaining factors may motivate others to specialize in HIV nursing, and thus help to promote adequate support for individuals suffering from the disease. PMID:23499392

Puplampu, Gideon L; Olson, Karin; Ogilvie, Linda; Mayan, Maria

2014-01-01

345

Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care  

PubMed Central

Background Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC) has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC. Methods Diagnoses were obtained from electronic PHC records of inhabitants in Blekinge County (approx. 150,000) listed with public PHC (approx. 120,000) for three consecutive years, 2004-2006. The inhabitants were then classified into six different resource utilization bands (RUB) using the ACG case-mix system. The mean costs for primary health care were calculated for each RUB and year. Using linear regression models and log-cost as dependent variable the adjusted R2 was calculated in the unadjusted model (gender) and in consecutive models where age, listing with specific PHC and RUB were added. In an additional model the ACG groups were added. Results Gender, age and listing with specific PHC explained 14.48-14.88% of the variance in individual costs for PHC. By also adding information on level of co-morbidity, as measured by the ACG case-mix system, to specific PHC the adjusted R2 increased to 60.89-63.41%. Conclusion The ACG case-mix system explains patient costs in primary care to a high degree. Age and gender are important explanatory factors, but most of the variance in concurrent patient costs was explained by the ACG case-mix system.

Zielinski, Andrzej; Kronogard, Maria; Lenhoff, Hakan; Halling, Anders

2009-01-01

346

Preconception care of women with diabetes: a review of current guideline recommendations  

PubMed Central

Background The prevalence of type 2 diabetes mellitus (T2DM) continues to rise worldwide. More women from developing countries who are in the reproductive age group have diabetes resulting in more pregnancies complicated by T2DM, and placing both mother and foetus at higher risk. Management of these risks is best achieved through comprehensive preconception care and glycaemic control, both prior to, and during pregnancy. The aim of this review was to compare the quality and content of current guidelines concerned with the preconception care of women with diabetes and to develop a summary of recommendations to assist in the management of diabetic women contemplating pregnancy. Methods Relevant clinical guidelines were identified through a search of several databases (MEDLINE, SCOPUS and The Cochrane Library) and relevant websites. Five guidelines were identified. Each guideline was assessed for quality using the AGREE instrument. Guideline recommendations were extracted, compared and contrasted. Results All guidelines were assessed as being of high quality and strongly recommended for use in practice. All were consistent in counselling about the risk of congenital malformation related to uncontrolled blood sugar preconceptionally, ensuring adequate contraception until glycaemic control is achieved, use of HBA1C to monitor metabolic control, when to commence insulin and switching from ACE inhibitors to other antihypertensives. Major differences were in the targets recommended for optimal metabolic control and opinion regarding the usage of metformin as an adjunct or alternative treatment before or during pregnancy. Conclusions International guidelines for the care of women with diabetes who are contemplating pregnancy are consistent in their recommendations; however some are more comprehensive than others. Having established current standards for the preconception care of diabetic women, there is now a need to focus on guideline implementation through an examination of the barriers and enablers to successful implementation, and the applicability of the recommendations in the local setting.

2010-01-01

347

A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems  

PubMed Central

Background A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. Methods We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. Results We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). Conclusion Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.

Taylor, Tatiana L; Killaspy, Helen; Wright, Christine; Turton, Penny; White, Sarah; Kallert, Thomas W; Schuster, Mirjam; Cervilla, Jorge A; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Dimitrov, Hristo; Mezzina, Roberto; Wolf, Kinou; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitri; Gonidakis, Fragiskos; Caldas-de-Almeida, Jose; Cardoso, Graca; King, Michael B

2009-01-01

348

Child Care Notebook. Revised.  

ERIC Educational Resources Information Center

In six sections, this child care notebook provides basic information concerning (1) child care in general; (2) day care centers; (3) family day care; (4) employers, parents, and child care; (5) school-age child care; and (6) group care for infants and toddlers. Section I focuses on types of child care programs, sources of information about child

Spedding, Polly; And Others

349

Genetically Modified Foods: Experts View Regimen of Safety Tests as Adequate, but FDA's Evaluation Process Could Be Enhanced.  

National Technical Information Service (NTIS)

Proponents and opponents of modern agricultural biotechnology hold passionate views about the benefits and risks of using this technology to produce genetically modified (GM) food. To ensure public confidence in GM foods, the U.S. biotechnology industry r...

2002-01-01

350

Toward Improving the Quality of Cancer Care: Addressing the Interfaces of Primary & Oncology-Related Subspecialty Care  

Cancer.gov

A number of reports in the last decade, including the classic Institute of Medicine reports on the quality chasm, have identified key elements and deconstructed processes of care that must be addressed to ensure quality of care. This supplement moves beyond that important initial work in distinguishing between the steps in care that are the usual focus of guidelines to focusing on the connections between these steps that have seldom been examined in research or addressed in practice.

351

Dementia - home care  

MedlinePLUS

... include in-home care, nursing homes, or adult day care. LONG-TERM CARE A person with dementia may ... or in an institution. Possible options include: Adult day care Boarding homes Convalescent homes In-home care Many ...

352

The role of medical problems and behavioral risks in explaining patterns of prenatal care use among high-risk women.  

PubMed Central

OBJECTIVE: To examine the associations between maternal medical conditions and behavioral risks and the patterns of prenatal care use among high-risk women. DATA SOURCE/STUDY DESIGN: Data on over 25,000 high-risk deliveries to African American and white women using multinomial logistic regression to predict the odds of adequate-plus care relative to three other categories of care. DATA COLLECTION/EXTRACTION METHODS: Data were extracted from records maintained by the University of Florida/Shands Hospital maternity clinic on all deliveries between 1987 and 1994; records for white and for African American women were subset to examine racial differences in medical conditions, health behaviors, and patterns of prenatal care use. PRINCIPAL FINDINGS: Net of sociodemographic and fertility-related characteristics, African American and white women with late antepartum conditions and hypertension problems had significantly higher odds of receiving adequate-plus care, as well as no care or inadequate care, relative to adequate care. White women with gynecological disease and medical/surgical problems were significantly less likely to receive no care or inadequate care, as were African American women with gynecological disease. CONCLUSIONS: Maternal medical conditions explain much but not all of the adequate-plus prenatal care use. More than 13 percent of African American women and 20 percent of white women with no reported medical problems or behavioral risks used adequate-plus care. Additional research is needed to understand this excess use and its possibilities in mediating birth outcomes.

Clarke, L L; Miller, M K; Albrecht, S L; Frentzen, B; Cruz, A

1999-01-01

353

Can loss of balance from mesoscale eddies adequately power deep ocean mixing?  

NASA Astrophysics Data System (ADS)

The global ocean thermohaline circulation is partly composed of the sinking of dense surface waters at high latitudes. But in order to close the circulation and maintain the abyssal stratification, the dense waters must rise up again through vertical mixing. This process requires a source of energy roughly estimated to be 2 TW. Previous work has concluded that tides and winds may adequately supply the required power, but the conceivable role of loss of balance from mesoscale eddies, resulting in the generation of internal inertia-gravity waves and associated vertical mixing, has hitherto been considered to be 'of unknown importance' (Wunsch and Ferrari, 2004). We investigate the potential role of loss of balance, by studying the generation of internal inertia-gravity waves by balanced flow in a rotating two-layer annulus laboratory experiment (Williams et al., 2008). A photograph from the experiment is shown in the figure. As the Rossby number of the balanced flow decreases, the amplitude of the emitted inertia-gravity waves also decreases, but much less rapidly than is predicted by several dynamical theories. This finding suggests that inertia-gravity waves might be far more energised than previously thought. The balanced flow leaks roughly one per cent of its energy each rotation period into internal inertia-gravity waves at the peak of their generation. Crude extrapolation of this result to the global ocean suggests that the flux of energy from mesoscale eddies into internal waves may be as large as 1.5 TW. We claim no accuracy for this figure which is only indicative. Nevertheless, we are persuaded that generation of inertia-gravity waves from the balanced mesoscale flow may be an important source of energy for deep interior mixing, and deserves further study. Reference Williams, PD, Haine, TWN and Read, PL (2008) Inertia-Gravity Waves Emitted from Balanced Flow: Observations, Properties, and Consequences. Journal of the Atmospheric Sciences, 65(11), pp 3543-3556. doi:10.1175/2008JAS2480.1 Photograph showing internal inertia-gravity waves generated by loss of balance from the large-scale flow in a rotating two-layer annulus experiment in the laboratory.

Williams, P. D.; Haine, T. W.; Read, P. L.

2009-12-01

354

Seeking a standard for adequate pathologic lymph node staging in primary bladder carcinoma.  

PubMed

The purposes of this study are to evaluate the adequacy of pathologic lymph node (LN) staging in radical cystectomy specimens from patients with urothelial carcinoma of the bladder and to analyze the frequency of LN metastases among different anatomic regions. All radical cystectomies performed for primary urothelial bladder cancer over a 5-year period (January 2007-September 2012) at a single institution were reviewed. Particular attention was paid to the total number of LNs examined, the number and location of LNs with metastases (positive LNs), and the presence or absence of extranodal tumor extension and/or lymphovascular invasion in the cystectomy specimen. Results and data were analyzed with Origin 6.0 and Microsoft Office Excel 2007 software. A total of 248 radical cystectomies with 8,432 LNs were reviewed. A total of 60 (24 %) cases, with 274 positive LNs out of the 1,982 total (13.8 %), were identified with a male to female ratio of 6.5:1 (52 male, 8 female patients). The average number of LNs examined in each case was 33.0??20.9 (range 5-112). The average number of positive LNs identified in each case was 4.5??4.8 (range 1-26). Among all of the LNs, the hypogastric/obturator (internal iliac) LNs were the most commonly submitted (35.2 %) and also yielded the highest number of positive LNs (46.0 %). On average, for cases staged pN1 and pN2, there was one positive LN per 17.8 and 8.9 LNs examined from the primary drainage LNs, respectively. For pN3 cases, one out of 4.4 secondary drainage LNs was found to be positive. Similarly, one out of 4.0 distant LNs was found to be positive in cases with pM1 staging. Our study suggests that, on average, 23 LNs (including 18 primary drainage LNs and five secondary drainage LNs) should be submitted for optimal pN staging. For adequate pM1 staging, an average of four distal LNs should be evaluated. In total, an average of 27 LNs (23 for pN staging and 4 for pM staging) should be examined in radical cystectomy specimens. We also propose to stratify the number of positive LNs according to the drainage area. PMID:24699919

Wang, Lu; Mudaliar, Kumaran; Mehta, Vikas; Barkan, Gliz A; Quek, Marcus L; Flanigan, Robert C; Picken, Maria M

2014-05-01

355

Defining and Assessing the Competence of Health Care Professionals in France  

ERIC Educational Resources Information Center

Introduction: During the past decade, the public, health care professionals, and governments have shown much interest in ensuring that professionals, specifically physicians, are skilled in their work and competent in managing health care organizations. The need to assess competence in the health care sector was explored, with the aim of proposing

Matillon, Yves; LeBoeuf, Dominique; Maisonneuve, Herve

2005-01-01

356

Can developing countries achieve adequate improvements in child health outcomes without engaging the private sector?  

PubMed Central

The private sector exerts a significant and critical influence on child health outcomes in developing countries, including the health of poor children. This article reviews the available evidence on private sector utilization and quality of care. It provides a framework for analysing the private sector's influence on child health outcomes. This influence goes beyond service provision by private providers and nongovernmental organizations (NGOs). Pharmacies, drug sellers, private suppliers, and food producers also have an impact on the health of children. Many governments are experimenting with strategies to engage the private sector to improve child health. The article analyses some of the most promising strategies, and suggests that a number of constraints make it hard for policy-makers to emulate these approaches. Few experiences are clearly described, monitored, and evaluated. The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of how to engage the private sector most effectively. The starting point should include the evaluation of the presence and potential of the private sector, including actors such as professional associations, producer organizations, community groups, and patients' organizations.

Bustreo, Flavia; Harding, April; Axelsson, Henrik

2003-01-01

357

Who cares for former child soldiers? Mental health systems of care in sierra leone.  

PubMed

While numerous studies on former child soldiers (FCS) have shown mental health needs, adequate services are a challenge. This study aimed to identify priorities, barriers and facilitators of mental health care for Sierra Leonean FCS. Thematic analysis was done on 24 qualitative interviews with participants from diverse sectors. Priorities of mental distress, substance abuse, and gender-based violence were common among FCS clients. Barriers were governmental support and communication with other providers. Perceived facilitators of care were primary- and secondary-level interventions. A public mental health model would feasibly build upon local, culturally embraced interventions, targeting local priorities and reducing barriers to care. PMID:23338835

J Song, Suzan; van den Brink, Helene; de Jong, Joop

2013-10-01

358

Foot Care  

MedlinePLUS

Everyday Fitness Ideas from the National Institute on Aging at NIH www.nia.nih.gov/Go4Life Foot Care Healthy ... VIsIt www.nia.nih.gov/Go4Life Read the Fitness Shoes and Clothes tip sheet. Learn how to ...

359

Palliative Care  

MedlinePLUS

... whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses and other specialists who work together with a patients other doctors to provide ...

360

Just caring.  

PubMed

Social justice is concerned with fair distribution of the benefits and burdens of living together in society. Regarding nursing care, social justice is concerned with who should receive its benefits, how much they should receive, and who should take up the burden of providing and paying for it. A specific thesis is offered: 'Health care, including nursing care, should be distributed on the basis of need, free at the point of use, the cost being born by the community involved.' This thesis is shown to be incompatible with consequentialist (utilitarian) and libertarian approaches to social justice, but reasons are given for rejecting these theories. It is shown that it may be compatible with Rawl's liberal theory of justice and definitely compatible with a version of the teleological (Aristotelian) theory. The thesis is then defended against criticisms concerned with desert and responsibility: that the provident ought not to pay for the improvident, and that those who are responsible for their health do not deserve free care. There are answered by an epistemological argument concerning what we need to know before we can decide what people deserve, and an argument about social cohesion. The conclusion is that the thesis can be offered as a moral principle for a fair society. PMID:22176544

Hussey, Trevor

2012-01-01

361

Community Connection: Expanding Secondary Level Care for Children with Special Health Care Needs.  

National Technical Information Service (NTIS)

The purpose of the project was to ensure that children birth to 21 years of age with special health care needs received timely and appropriate medical evaluation and services as close to their local communities as possible. In addition, Community Connecti...

V. D. Menashe C. J. Sells

1993-01-01

362

FDA working to ensure the safety of medical devices used in the pediatric population.  

PubMed

Special initiatives exist in FDA's Center for Devices and Radiological Health (CDRH), the Center for Drug Evaluation and Research, and the Center for Biologics Evaluation and Research to ensure the safety and effectiveness of medical products used in the vulnerable pediatric population. This article focuses on the special programs, projects, and special studies implemented by CDRH to ensure this safety and effectiveness in devices used in pediatric patients throughout the devices' total product life-cycles. Pediatricians play a major role in keeping medical devices safe for use in children by reporting device problems to FDA. PMID:23116531

Flack, Marilyn Neder; Gross, Thomas P; Reid, Joy Samuels; Mills, Thalia T; Francis, Jacqueline

2012-12-01

363

[Lation in ensuring the sanitary-and-epidemiological well-being under the present conditions].  

PubMed

The paper describes the basic principles in and approaches to the state regulation in ensuring the sanitary-and-epidemiological well-being. The necessity of enhancing the role of state regulation in ensuring the sanitary-and-epidemiological well-being stems from the intensive development of marketing relations and the complicated realization of the state role in the protection of consumers' rights and human well-being. The investigations provide evidence for the basic tasks of the sanitary-and-epidemiological service of Moscow under the specific conditions of the megalopolis. PMID:20135859

Filatov, N N; Ivanenko, A V; Khizgiiaev, V I; Safonkina, S G; Beliavski?, A R; Kicha, D I

2009-01-01

364

New Pathways for Primary Care: An Update on Primary Care Programs From the Innovation Center at CMS  

PubMed Central

Those in practice find that the fee-for-service system does not adequately value the contributions made by primary care. The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the Affordable Care Act to test new models of health care delivery to improve the quality of care while lowering costs. All programs coming out of the Innovation Center are tests of new payment and service delivery models. By changing both payment and delivery models and moving to a payment model that rewards physicians for quality of care instead of volume of care, we may be able to achieve the kind of health care patients want to receive and primary care physicians want to provide.

Baron, Richard J.

2012-01-01

365

50 CFR 530.2 - Ensuring that environmental documents are actually considered in agency decision-making.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 false Ensuring that environmental documents are actually considered...COMMISSION COMPLIANCE WITH THE NATIONAL ENVIRONMENTAL POLICY ACT § 530.2 Ensuring that environmental documents are actually considered...

2013-10-01

366

45 CFR 261.64 - How will we determine whether a State's work verification procedures ensure an accurate work...  

Code of Federal Regulations, 2010 CFR

...we determine whether a State's work verification procedures ensure an accurate work participation measurement? 261.64 Section 261.64...procedures ensure an accurate work participation measurement? (a) We will determine...

2010-10-01

367

45 CFR 261.64 - How will we determine whether a State's work verification procedures ensure an accurate work...  

Code of Federal Regulations, 2013 CFR

...we determine whether a State's work verification procedures ensure an accurate work participation measurement? 261.64 Section 261.64...procedures ensure an accurate work participation measurement? (a) We will determine...

2013-10-01

368

Alloparental care in fishes  

Microsoft Academic Search

page 45 Abstract Alloparental care, care directed at non-descendant young, presents a potential challenge to evolutionary ecologists because investment in non-descendant eggs and young gives the appearance of maladaptive behaviour. Yet wherever there is parental care in fishes, there is usually alloparental care. As such, alloparental care is an integral part of care in fishes. Alloparental care appears to have

Brian D. Wisenden

1999-01-01

369

Reaching the poor with adequately iodized salt through the Supplementary Nutrition Programme and Midday Meal Scheme in Madhya Pradesh, India  

PubMed Central

Abstract Problem In India, adequately iodized salt needs to be made accessible to the most marginalized. Approach In an effort to provide adequately iodized salt to the most vulnerable, in 2009 Madhya Pradesh launched a state-wide initiative through two national flagship nutrition programmes: the Supplementary Nutrition Programme of the Integrated Child Development Services and the Midday Meal Scheme. Programme staff members were taught how to correctly store salt and monitor its iodine content. Field monitors assessed the iodine content of the salt in the common kitchens of participating schools and anganwadi centres monthly. Local setting Madhya Pradesh, a state in central India, is home to a substantial proportion of Indias poor. In 2009, household coverage of adequately iodized salt in the state was nearly 90% among the richest but only about 50% among the poorest. Relevant changes Two hot meals prepared with adequately iodized salt were served daily for more than 21 days per month to approximately 89% of the 12?113?584 children aged 3 to 6years enrolled in anganwadi centres (June 2011 to March 2012). One meal on school days was served to 78% of 5?751?979 primary-school children and to 79% of 2?704?692 secondary-school children (April 2011 to March 2012). Most of the kitchens visited in 2010 (79%) and 2011 (83%) were consistently using adequately iodized salt to prepare hot meals. Lessons learnt India has large-scale social safety net programmes for the poorest. Both national and state policies should mainstream the use of adequately iodized salt in these programmes.

Garg, Aashima; Naidu, Brij RG; Agrawal, Dwarka D; Pandey, Richa S; Aguayo, Victor M

2013-01-01

370

77 FR 43697 - Ensuring the Uniformed Services Employment and Reemployment Rights Act (USERRA) Protections  

Federal Register 2010, 2011, 2012, 2013

...responsibility to adopt best practices with respect to employing...and retaining the best talent means ensuring fair treatment...Veterans Affairs; (v) the Office of Personnel...efforts to implement best practices, training, and procedures...protection policies and practices, including: (i)...

2012-07-25

371

34 CFR 200.66 - Requirements to ensure that funds do not benefit a private school.  

Code of Federal Regulations, 2013 CFR

...that funds do not benefit a private school. 200.66 Section 200.66 Education...Participation of Eligible Children in Private Schools § 200.66 Requirements to ensure that funds do not benefit a private school. (a) An LEA must use...

2013-07-01

372

Ensuring Conservatism\\/Lessons Learned in Leak Path Factor Calculations with MELCOR  

Microsoft Academic Search

This paper consists of two parts. The first part discusses the steps taken to ensure that leak path factors (LPFs) calculated using the MELCOR computer code for the Los Alamos National Laboratory (LANL) Plutonium Facility Documented Safety Analysis (DSA) are conservative. The second part consists of a statistical analysis of the results from the large number of MELCOR runs performed,

Donald A. Siebe; Patrick R. McClure; Bruce C. Letellier

373

Ensuring Comfort in Office Buildings: Designing a KNX Monitoring and Control System  

Microsoft Academic Search

As a first stage task, this paper presents the study on what represents and how it is possible to ensure the indoor office comfort, which are the most important types of comfort (thermal, visual, acoustic, air quality, etc.) and how each of them could be analyzed (characterized). Few of them have a mathematical interpretation, more or less precise, which permits

Catalin Bujdei; Sorin Aurel Moraru

2011-01-01

374

Visual odometry on the Mars exploration rovers - a tool to ensure accurate driving and science imaging  

Microsoft Academic Search

In this paper, visual odometry is presented as an approach to position estimation to find features in a stereo image pair and track them from one frame to the next. Visual odometry has been a highly effective tool for maintaining vehicle safety while driving near obstacles on slopes, achieving difficult drive approaches in fewer sols, and ensuring accurate science imaging.

Yang Cheng; MARK W. MAIMONE; LARRY MATTHIES

2006-01-01

375

Ensuring Accommodations Used in Content Assessments Are Responsive to English-Language Learners  

ERIC Educational Resources Information Center

This column offers an overview of the requirements for including and accommodating English-language learners (ELLs) in content assessments and an explanation of how accommodations for ELLs work. It concludes with recommendations drawn from research and practice to ensure accommodations are assigned and implemented in ways that are likely to

Willner, Lynn Shafer; Rivera, Charlene; Acosta, Barbara D.

2009-01-01

376

Making the Grade: How Boards Can Ensure Academic Quality. Second Edition  

ERIC Educational Resources Information Center

"Making the Grade: How Boards Can Ensure Academic Quality"--popularly referred to as "The Little Yellow Book" by boards, faculty, provosts, and assessment specialists--provides clear guidance for the board's role in the most important "business" of academe: educating students. As public calls for greater accountability skyrocket, this new edition

Ewell, Peter

2012-01-01

377

Ensuring Early Literacy Success. Research Points. Volume 6, Issue 1, Winter 2009  

ERIC Educational Resources Information Center

Ensuring early literacy success is a wise investment because literacy skills are essential to success in all school subjects--literature, social sciences, natural science, and mathematics. There is a strong research base for how children learn to read, how to prevent failure, and how to intervene when reading difficulties occur. This issue of

Rangel, Elizabeth S.

2009-01-01

378

Do Fixation Cues Ensure Fixation Accuracy in Split-Fovea Studies of Word Recognition?  

ERIC Educational Resources Information Center

Many studies have claimed that hemispheric processing is split precisely at the foveal midline and so place great emphasis on the precise location at which words are fixated. These claims are based on experiments in which a variety of fixation procedures were used to ensure fixation accuracy but the effectiveness of these procedures is unclear. We

Jordan, Timothy R.; Paterson, Kevin B.; Kurtev, Stoyan; Xu, Mengyun

2009-01-01

379

Ensuring Quality Leadership. A Program Funded by the GE Fund (Formerly the General Electric Foundation).  

ERIC Educational Resources Information Center

This paper describes the Ensuring Quality Leadership (EQL) program implemented cooperatively by faculty at the University of Wisconsin-Milwaukee School of Education and School of Business Administration, business executives from the Milwaukee area, and principals from Milwaukee's Public Schools (MPS). The program was designed to: (1) provide

Kritek, William J.

380

Ensuring critical event sequences in high integrity software by applying path expressions.  

National Technical Information Service (NTIS)

The goal of this work is to extend the use of existing path expression theory and methodologies to ensure that critical software event sequences are maintained even in the face of malevolent attacks and harsh or unstable operating environments. This will ...

M. E. C. Kidd

1996-01-01

381

Beyond Recruitment: Retention and Promotion Strategies To Ensure Diversity and Success.  

ERIC Educational Resources Information Center

Discusses the need for libraries not only to recruit, but also to retain, diverse professional staffs. Topics include diversity as a multi-dimensional concept; creating an environment conducive to retention; ensuring equity in regard to promotion, professional development, and success; the tenure process in academic libraries; and mentoring

Howland, Joan

1999-01-01

382

Current state and trends of ensuring traceability for vibration and shock measurements  

Microsoft Academic Search

Recent and current activities at the level of national metrology institutes (NMIs) towards ensuring traceability of vibration and shock measurements to the International System of Units are mainly twofold: (i) initiating and contributing to new international standardization projects, within the International Organization for Standardization, ISO TC 108, to specify upgraded or new standard methods for the vibration and shock calibration

H-J von Martens

1999-01-01

383

Access and Ensuring Accessibility in the Regional Museum of Natural History (RMNH), Bhopal, India.  

ERIC Educational Resources Information Center

Identifies five types of museum accessibility: (1) physical; (2) socio-cultural; (3) economic; (4) sensory; and (5) intelligence/learning accessibility. Considers ways to coordinate museum services to ensure accessibility for potential museum patrons who are disabled. Describes various programs launched by the National Museum of Natural History in

Venugopal, B.

1999-01-01

384

No Strings Attached? Ensuring that "CFE" Funds Are Spent Effectively. Civic Report No. 42  

ERIC Educational Resources Information Center

The 2003 New York State Court of Appeals ruling in the "Campaign for Fiscal Equity" ("CFE") case has created a historic opportunity to reform New York City's troubled schools. This opening was created because the court not only required changing the state aid formula to ensure a "sound basic education" for all New York City pupils, it also ordered

Domanico, Raymond

2004-01-01

385

Building envelope design with the objective to ensure thermal, visual and acoustic comfort conditions  

Microsoft Academic Search

To ensure conditions of thermal, visual and acoustic comfort in rooms with a minimum of energy consumption is of great importance for the health of the user and the energy conservation. One of the most important functions of the building envelope is, therefore, to control physical environmental factors such as heat, light and sound in order to realise defined comfort

Gl Kolar Oral; Alpin Kknel Yener; Nurgn Tamer Bayazit

2004-01-01

386

Violence in the health care environment: strategies for prevention.  

PubMed

As nurses strive to ensure the personal safety and security of themselves and their patients, collaborative work is the key. The building of trust and respect occurs when multiple disciplines work together to assess, plan, implement, and evaluate strategies to protect all persons in the health care environment from violent incidents. The most constructive means of prevention include participation in task forces, labor-management committees, and agreements obtained through collective bargaining. The health care reform movement is emphasizing the delivery of high-quality care to all. Nurses know that assuring personal security is the most basic step in meeting a person's health care needs. Nurses are well qualified to take the lead in violence-prevention efforts so that personal security is ensured for patients and health care workers alike. PMID:8281246

Worthington, K A

1993-12-01

387

Elderly and long-term care trends and policy in Taiwan: challenges and opportunities for health care professionals.  

PubMed

The purpose of this article is to address the trends and policy of elderly and long-term care in Taiwan. In response to the increasing demand of an aging society, healthcare professionals play crucial roles in elderly and long-term care and quality assurance of services. This article focuses on the current situation of elderly health care, demands of long-term care, long-term care policy in Taiwan, draft of the Long-term Care Services Act, and draft of the Long-term Care Insurance Act. After the 10-year long-term care project was proposed by the Taiwan government, the supply of health care services and demand for long-term care have created many challenges and opportunities for innovative health professional development. Challenges consist of low old dependency ratio caused by low birth rate, lack of elderly and long-term care related manpower, services and education reform related to long-term care for the future society, and interprofessional collaboration and team work of long-term care. Opportunities include expanding the roles and the career pathways of healthcare professionals, promoting the concepts of active aging and good quality of life, and developing industrial cooperation related to long-term care services. Under these circumstances, healthcare professonals are actively involved in practice, education and research of long-term care services that ensure elderly and disabled people can live a healthier and better life. PMID:22974664

Wang, Hsiu-Hung; Tsay, Shwn-Feng

2012-09-01

388

Retinopathy of prematurity care: Patterns of care and workforce analysis  

PubMed Central

PURPOSE To describe the workforce that provides retinopathy of prematurity (ROP) care. METHODS We surveyed a random sample of ophthalmologists offices by telephone (n=1,504) and then sent a mail survey to those who were reported to provide care to infants (n=486). Workforce estimates were based on the total number of ophthalmologists in the US. RESULTS Thirty percent of ophthalmologists were reported to care for children less than one year of age; 11% of all ophthalmologists examine for (1,815, 95% confidence interval [CI]: 1,3402,379) and 6% treat ROP (983, 95% CI: 6491,421). ROP exams are provided by an equal number who have completed fellowship training in pediatric ophthalmology and strabismus (254, 95% CI: 182327) as have not completed any fellowship training (236, 95% CI: 163345). Ophthalmologists with fellowship training in any subpspecialty provide 86% of the ROP exams, with those trained in pediatric ophthalmology providing 50% overall. Some (9%) of the ophthalmologists who examine for ROP, regardless of whether or not they completed a fellowship (p= 0.22), report that their training did not adequately prepare them to do so. In contrast to exams, most treatment is provided by ophthalmologists who are fellowship trained in retina and vitreous diseases. CONCLUSIONS ROP care is offered by ophthalmologists with different training backgrounds. Future work is needed to understand the relationship between the availability of ophthalmologists and ROP care delivery and the role of new modes of care delivery (e.g., telemedicine).

Kemper, Alex R.; Freedman, Sharon F.; Wallace, David K.

2008-01-01

389

The outcomes of health care process in Iran's rural society  

PubMed Central

Background: Health care systems in rural areas face numerous challenges in meeting the community's needs and adequate attention has not been paid to this problem. The aim of this study was to describe the outcomes of health care process in rural society. Materials and Methods: Twenty-six participants including twenty-one rural health care providers and five clients were selected according to purposive sampling. The data were collected via semi-structured individual interviews and a mini focus group. Data were analyzed by using qualitative content analysis based on methods described by Granheme and Landman. Results: Data analysis eventually led to formation of one category of inefficiency in health care process in rural society including subcategories such as arbitrary self-therapy, slow care process, dissatisfaction with the care process, superficial caring, job stress and burn out of caregivers, and ineffective caring relationship. Conclusion: Outcomes in health care in rural society of Iran represents inefficiency of the current health care process. These outcomes are related to the cultural and social context of rural communities and the structure of the health system. These outcomes in health care in the rural society of Iran represent impairment of the current health care process. The necessity of modifying the existing care trend with new models designed to improve the health care process is felt.

Eskandari, Manije; Abbaszadeh, Abbas; Borhani, Fariba

2013-01-01

390

Preventive Care for Children (Affordable Care Act)  

MedlinePLUS

... Myspace Close Text Size: A A A Preventive Care for Children Many insurers are now required to ... Services Task Force Recommendations . Fact Sheet: The Affordable Care Act and Immunization Fact Sheet: The Affordable Care ...

391

Preventive Care Benefits (Affordable Care Act)  

MedlinePLUS

... All Topics Site Search Site Search Search Preventive care benefits Preventive health services for adults Most health ... health care needs. Comprehensive coverage for women??s preventive care All Marketplace health plans and many other plans ...

392

Are we missing the Institute of Medicine's mark? A systematic review of patient-reported outcome measures assessing quality of patient-centred cancer care  

PubMed Central

Background The Institute of Medicine (IOM) has endorsed six dimensions of patient-centredness as crucial to providing quality healthcare. These dimensions outline that care must be: 1) respectful to patients values, preferences, and expressed needs; 2) coordinated and integrated; 3) provide information, communication, and education; 4) ensure physical comfort; 5) provide emotional supportrelieving fear and anxiety; and 6) involve family and friends. However, whether patient-reported outcome measures (PROMs) comprehensively cover these dimensions remains unexplored. This systematic review examined whether PROMs designed to assess the quality of patient-centred cancer care addressed all six IOM dimensions of patient-centred care and the psychometric properties of these measures. Methods Medline, PsycINFO, Current Contents, Embase, CINAHL and Scopus were searched to retrieve published studies describing the development and psychometric properties of PROMs assessing the quality of patient-centred cancer care. Two authors determined if eligible PROMs included the six IOM dimensions of patient-centred care and evaluated the adequacy of psychometric properties based on recommended criteria for internal consistency, test-retest reliability, face/content validity, construct validity and cross-cultural adaptation. Results Across all 21 PROMs, the most commonly included IOM dimension of patient-centred care was information, communication and education (19 measures). In contrast, only five measures assessed the involvement of family and friends. Two measures included one IOM-endorsed patient-centred care dimension, two measures had two dimensions, seven measures had three dimensions, five measures had four dimensions, and four measures had five dimensions. One measure, the Indicators (Non-small Cell Lung Cancer), covered all six IOM dimensions of patient-centred care, but had adequate face/content validity only. Eighteen measures met the recommended adequacy criteria for construct validity, 15 for face/content validity, seven for internal consistency, three for cross-cultural adaptation and no measure for test-retest reliability. Conclusions There are no psychometrically rigorous PROMs developed with cancer patients that capture all six IOM dimensions of patient-centred care. Using more than one measure or expanding existing measures to cover all six patient-centred care dimensions could improve assessment and delivery of patient-centred care. Construction of new comprehensive measures with acceptable psychometric properties that can be used with the general cancer population may also be warranted.

2014-01-01

393

Reflections on curative health care in Nicaragua.  

PubMed Central

Improved health care in Nicaragua is a major priority of the Sandinista revolution; it has been pursued by major reforms of the national health care system, something few developing countries have attempted. In addition to its internationally recognized advances in public health, considerable progress has been made in health care delivery by expanding curative medical services through training more personnel and building more facilities to fulfill a commitment to free universal health coverage. The very uneven quality of medical care is the leading problem facing curative medicine now. Underlying factors include the difficulty of adequately training the greatly increased number of new physicians. Misdiagnosis and mismanagement continue to be major problems. The curative medical system is not well coordinated with the preventive sector. Recent innovations include initiation of a "medicina integral" residency, similar to family practice. Despite its inadequacies and the handicaps of war and poverty, the Nicaraguan curative medical system has made important progress.

Slater, R G

1989-01-01

394

Incorporating palliative care into primary care education  

Microsoft Academic Search

SummaryThe confluence of enhanced attention to primary care and palliative care education presents educators with an opportunity\\u000a to improve both (as well as patient care) through integrated teaching. Improvements in palliative care education will have\\u000a benefits for dying patients and their families, but will also extend to the care of many other primary care patients, including\\u000a geriatric patients and those

Susan D. Block; George M. Bernier; LaVera M. Crawley; Stuart Farber; David Kuhl; William Nelson; Joseph ODonnell; Lewis Sandy; Wayne Ury

1998-01-01

395

Use of a Community Mobile Health Van to Increase Early Access to Prenatal Care  

Microsoft Academic Search

Objective: To examine whether the use of a community mobile health van (the Lucile Packard Childrens Hospital Womens Health Van) in\\u000a an underserved population allows for earlier access to prenatal care and increased rate of adequate prenatal care, as compared\\u000a to prenatal care initiated in community clinics.\\u000a \\u000a \\u000a Methods: We studied 108 patients who initiated prenatal care on the van and

Laura P. Edgerley; Yasser Y. El-Sayed; Maurice L. Druzin; Michaela Kiernan; Kay I. Daniels

2007-01-01

396

Characterisation and clinical features of Enterobacter cloacae bloodstream infections occurring at a tertiary care university hospital in Switzerland: is cefepime adequate therapy?  

PubMed Central

Despite many years of clinical experience with cefepime, data regarding the outcome of patients suffering from bloodstream infections (BSIs) due to Enterobacter cloacae (Ecl) are scarce. To address the gap in our knowledge, 57 Ecl responsible for 51 BSIs were analysed implementing phenotypic and molecular methods (microarrays, PCRs for bla and other genes, rep-PCR to analyse clonality). Only two E. cloacae (3.5%) were ESBL-producers, whereas 34 (59.6%) and 18 (31.6%) possessed inducible (Ind-Ecl) or derepressed (Der-Ecl) AmpC enzymes, respectively. All isolates were susceptible to imipenem, meropenem, gentamicin and ciprofloxacin. Der-Ecl were highly resistant to ceftazidime and piperacillin/tazobactam (both MIC90 ? 256 g/mL), whereas cefepime retained its activity (MIC90 of 3 g/mL). rep-PCR indicated that the isolates were sporadic, but Ecl collected from the same patients were indistinguishable. In particular, three BSIs initially due to Ind-Ecl evolved (under ceftriaxone or piperacillin/tazobactam treatment) into Der-Ecl because of mutations or a deletion in ampD or insertion of IS4321 in the promoter. These last two mechanisms have never been described in Ecl. Mortality was higher for BSIs due to Der-Ecl than Ind-Ecl (3.8% vs. 29.4%; P = 0.028) and was associated with the Charlson co-morbidity index (P = 0.046). Using the following directed treatments, patients with BSI showed a favourable treatment outcome: cefepime (16/18; 88.9%); carbapenems (12/13; 92.3%); ceftriaxone (4/7; 57.1%); piperacillin/tazobactam (5/7; 71.4%); and ciprofloxacin (6/6; 100%). Cefepime represents a safe therapeutic option and an alternative to carbapenems to treat BSIs due to Ecl when the prevalence of ESBL-producers is low.

Hilty, Markus; Sendi, Parham; Seiffert, Salome N.; Droz, Sara; Perreten, Vincent; Hujer, Andrea M.; Bonomo, Robert A.; Muhlemann, Kathrin; Endimiani, Andrea

2014-01-01

397

21 CFR 740.10 - Labeling of cosmetic products for which adequate substantiation of safety has not been obtained.  

Code of Federal Regulations, 2010 CFR

...obtained. (a) Each ingredient used in a cosmetic product and each finished cosmetic product shall be adequately substantiated...b) An ingredient or product having a history of use in or as a cosmetic may at any time have its safety...

2010-04-01

398

21 CFR 740.10 - Labeling of cosmetic products for which adequate substantiation of safety has not been obtained.  

Code of Federal Regulations, 2010 CFR

...obtained. (a) Each ingredient used in a cosmetic product and each finished cosmetic product shall be adequately substantiated...b) An ingredient or product having a history of use in or as a cosmetic may at any time have its safety...

2009-04-01

399

Processing of ultra low carbon steels with mechanical properties adequate for automotive applications in the as-annealed condition  

Microsoft Academic Search

A series of ultra low carbon\\/Ti added steels were produced with the aim of evaluating the steelmaking route and processing conditions of slabs, in order to achieve mechanical properties on resulting annealed sheets adequate for automotive applications. Characterization of microstructure was carried out in the as-cast, deformed and annealed specimens by means of scanning and transmission electron microscope techniques. Slab

R. Mendoza; J. Huante; M. Alanis; C. Gonzalez-Rivera; J. A. Juarez-Islas

2000-01-01

400

DOD Overseas Schools: Compensation Adequate for Recruiting and Retaining Well-Qualified Teachers. Report to Congressional Requesters.  

ERIC Educational Resources Information Center

The National Defense Authorization Act for Fiscal Year 2002 directed the U.S. General Accounting Office to determine whether the Department of Defense (DOD) overseas teachers' compensation package is adequate to recruit and retain qualified teachers. The Act also required GAO to determine whether or not any revisions to the law governing DOD

Shaul, Marnie S.

401

Does the asymmetry multiplier in the 1991 NIOSH lifting equation adequately control the biomechanical loading of the spine?  

Microsoft Academic Search

The aim of this research was to evaluate whether the asymmetry multiplier incorporated in the 1991 National Institute for Occupational Safety and Health lifting equation adequately controls the biomechanical spine loads during asymmetric lifting. Sixteen male subjects lifted a box from four initial locations varying in terms of the angular deviation from the mid-sagittal plane (0, 30, 60 and 90).

S. A. Lavender; Y. C. Li; R. N. Natarajan; G. B. J. Andersson

2009-01-01

402

The Prevention and Reactivation Care Program: intervention fidelity matters  

PubMed Central

Background The Prevention and Reactivation Care Program (PReCaP) entails an innovative multidisciplinary, integrated and goal oriented approach aimed at reducing hospital related functional decline among elderly patients. Despite calls for process evaluation as an essential component of clinical trials in the geriatric care field, studies assessing fidelity lag behind the number of effect studies. The threefold purpose of this study was (1) to systematically assess intervention fidelity of the hospital phase of the PReCaP in the first year of the intervention delivery; (2) to improve our understanding of the moderating factors and modifications affecting intervention fidelity; and (3) to explore the feasibility of the PReCaP fidelity assessment in view of the modifications. Methods Based on the PReCaP description we developed a fidelity instrument incorporating nineteen (n=19) intervention components. A combination of data collection methods was utilized, i.e. data collection from patient records and individual Goal Attainment Scaling care plans, in-depth interviews with stakeholders, and non-participant observations. Descriptive analysis was performed to obtain levels of fidelity of each of the nineteen PReCaP components. Moderating factors were identified by using the Conceptual Framework for Implementation Fidelity. Results Ten of the nineteen intervention components were always or often delivered to the group of twenty elderly patients. Moderating factors, such as facilitating strategies and context were useful in explaining the non- or low-adherence of particular intervention components. Conclusions Fidelity assessment was carried out to evaluate the adherence to the PReCaP in the Vlietland Ziekenhuis in the Netherlands. Given that the fidelity was assessed in the first year of PReCaP implementation it was commendable that ten of the nineteen intervention components were performed always or often. The adequate delivery of the intervention components strongly depended on various moderating factors. Since the intervention is still developing and undergoing continuous modifications, it has been concluded that the fidelity criteria should evolve with the modified intervention. Furthermore, repeated intervention fidelity assessments will be necessary to ensure a valid and reliable fidelity assessment of the PReCaP. Trial registration The Netherlands National Trial Register: NTR2317

2013-01-01

403

Improvements Needed to Ensure Provider Enumeration and Medicare Enrollment Data are Accurate, Complete, and Consistent.  

National Technical Information Service (NTIS)

CMS has two databases with basic provider-related dataone from which providers obtain NPIs and one through which providers enroll in Medicare. Before enrolling in Medicare, a health care provider must apply through the National Plan and Provider Enumerati...

2013-01-01

404

Expansion of Coverage under the Patient Protection and Affordable Care Act and Primary Care Utilization  

PubMed Central

Context: Provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA) expand Medicaid to all individuals in families earning less than 133 percent of the federal poverty level (FPL) and make available subsidies to uninsured lower-income Americans (133 to 400 percent of FPL) without access to employer-based coverage to purchase insurance in new exchanges. Since primary care physicians typically serve as the point of entry into the health care delivery system, an adequate supply of them is critical to meeting the anticipated increase in demand for medical care resulting from the expansion of coverage. This article provides state-level estimates of the anticipated increases in primary care utilization given the PPACA's provisions for expanded coverage. Methods: Using the Medical Expenditure Panel Survey, this article estimates a multivariate regression model of annual primary care utilization. Using the model estimates and state-level information regarding the number of uninsured, it predicts, by state, the change in primary care visits expected from the expanded coverage. Finally, the article predicts the number of primary care physicians needed to accommodate this change in utilization. Findings: This expanded coverage is predicted to increase by 2019 the number of annual primary care visits between 15.07 million and 24.26 million. Assuming stable levels of physicians productivity, between 4,307 and 6,940 additional primary care physicians would be needed to accommodate this increase. Conclusions: The PPACA's health insurance expansion parameters are expected to significantly increase the use of primary care. Two strategies that policymakers may consider are creating stronger financial incentives to attract medical school students to primary care and changing the delivery of care in ways that lead to operational improvements, higher throughput, and better quality of care.

Hofer, Adam N; Abraham, Jean Marie; Moscovice, Ira

2011-01-01

405

S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system  

PubMed Central

Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft fr Thorax-, Herz- und Gefchirurgie, DGTHG) and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft fr Ansthesiologie und lntensivmedizin, DGAI) made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical Societies in Germany (AWMF).

Carl, M.; Alms, A.; Braun, J.; Dongas, A.; Erb, J.; Goetz, A.; Goepfert, M.; Gogarten, W.; Grosse, J.; Heller, A. R.; Heringlake, M.; Kastrup, M.; Kroener, A.; Loer, S. A.; Marggraf, G.; Markewitz, A.; Reuter, D.; Schmitt, D. V.; Schirmer, U.; Wiesenack, C.; Zwissler, B.; Spies, C.

2010-01-01

406

Women Veterans Health Care  

MedlinePLUS

... be a sign of dementia. Learn more Comprehensive Primary Care No other health service in the world understands ... care anywhere. Learn more Women and Dementia Comp. Primary Care WVCC Women Veterans Health Care Did you know ...

407

Home Care Services  

MedlinePLUS

Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with ...

408

Community-Based Care  

MedlinePLUS

... providing important healthcare or personal care support. Adult Day Care Adult day care is a community-based option that has become ... support services in a group setting. Most adult day care centers are either in churches or community centers. ...

409

Proper Care for Wounds  

MedlinePLUS Videos and Cool Tools

... Motor Vehicle Safety En Espaol About Emergencies Wound Care Proper Care For Wounds Most cuts are minor but it is still important to properly care for them. Wound Care Dr. David Ross, emergency ...

410

Finding Dental Care  

MedlinePLUS

... Repayment Programs NIH Loan Repayment Programs Finding Dental Care NIDCR leads the nation in conducting and supporting ... the care you need. Does NIDCR provide dental care? No, NIDCR does not provide dental care or ...

411

Wealth and antenatal care use: implications for maternal health care utilisation in Ghana  

PubMed Central

The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths. Prior to the introduction of the policy, studies found wealth to have a positive and significant influence on the use of Antenatal care. It is thus expected that with the policy, wealth should not influence the use of maternal health care significantly. Using secondary data from the 2008 Ghana Demographic and Health survey, the results have revealed that wealth still has a significant influence on adequate use of Antenatal care. Education, age, number of living children, transportation and health insurance are other factors that were found to influence the use of Antenatal care in Ghana. There also exist considerable variations in the use of Antenatal care in the geographical regions and between the rural and urban dwellers. It is recommended that to improve the use of Antenatal care and hence maternal health care utilization, some means of support is provided especially to women within the lowest wealth quintiles, like the provision and availability of recommended medication at the health center; secondly, women should be encouraged to pursue education to at least the secondary level since this improves their use of maternal health services. Policy should also target mothers who have had the experience of child birth on the need to use adequate Antenatal care for each pregnancy, since these mothers tend to use less antenatal care for subsequent pregnancies. The regional disparities found may be due to inaccessibility and unavailability of health facilities and services in the rural areas and in some of the regions. The government and other service providers (NGOs, religious institutions and private providers) may endeavor to improve on the distribution of health facilities, human resources, good roads and necessary infrastructure among other things in order to facilitate easy access to health care providers especially for the rural dwellers.

2012-01-01

412

Research Agenda Conference on Pediatric Quality of Care. Abstract and Executive Summary of Conference.  

National Technical Information Service (NTIS)

This national invitational conference - Improving Quality of Health Care for Children: An Agenda for Research - was called to identify the key research issues and questions that must be addressed to achieve a delivery system that will ensure the continuou...

A. Hersh

2001-01-01

413

42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.  

Code of Federal Regulations, 2013 CFR

...needed to ensure that plan of care outcomes are achieved and negative outcomes are avoided. (b) Standard: Twenty-four hour nursing services. (1) The hospice facility must provide 24-hour nursing services that meet the...

2013-10-01

414

42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.  

Code of Federal Regulations, 2010 CFR

...needed to ensure that plan of care outcomes are achieved and negative outcomes are avoided. (b) Standard: Twenty-four hour nursing services. (1) The hospice facility must provide 24-hour nursing services that meet the...

2009-10-01

415

42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.  

Code of Federal Regulations, 2010 CFR

...needed to ensure that plan of care outcomes are achieved and negative outcomes are avoided. (b) Standard: Twenty-four hour nursing services. (1) The hospice facility must provide 24-hour nursing services that meet the...

2010-10-01

416

42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.  

Code of Federal Regulations, 2010 CFR

...in accordance with the patient's needs if any of them so desire. The hospice must ensure that each patient and the primary care giver(s) receive education and training provided by the hospice as appropriate to their responsibilities for...

2010-10-01

417

42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.  

Code of Federal Regulations, 2012 CFR

...in accordance with the patient's needs if any of them so desire. The hospice must ensure that each patient and the primary care giver(s) receive education and training provided by the hospice as appropriate to their responsibilities for...

2012-10-01

418

42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.  

Code of Federal Regulations, 2011 CFR

...in accordance with the patient's needs if any of them so desire. The hospice must ensure that each patient and the primary care giver(s) receive education and training provided by the hospice as appropriate to their responsibilities for...

2011-10-01

419

Ensuring that informed consent is really an informed consent: Role of videography  

PubMed Central

The voluntary consent of a subject participating in research is fundamental to the principle of autonomy. This consent must be free from any coercion, intimidation, falsehood, physical, psychological, or economic pressure. It is in the interest of the subject, the investigator and the sponsor to ensure that informed consent processes conform to the guidelines and regulations, both in the letter and spirit. However, ignorance on the part of investigating team causes deviation from these norms. Videography of the entire process has been suggested as a means to ensure the compliance, and draft rules for the same published. The present article examines how best videography can be introduced in the informed consent procedure without violating other protective mechanisms.

Ghooi, Ravindra B.

2014-01-01

420

Ensure preparation and capsule endoscopy: A two-center prospective study  

PubMed Central

AIM: To compare small bowel (SB) cleanliness and capsule endoscopy (CE) image quality following Ensure, polyethylene glycol (PEG) and standard preparations. METHODS: A preparation protocol for CE that is both efficacious and acceptable to patients remains elusive. Considering the physiological function of the SB as a site for the digestion and absorption of food and not as a stool reservoir, preparation consisting of a liquid, fiber-free formula ingested one day before a CE study might have an advantage over other kinds of preparations. We conducted a prospective, blind-to-preparation, two-center study that compared four types of preparations. The participants demographic and clinical data were collected. Gastric and SB transit times were calculated. The presence of bile in the duodenum was scored by a single, blinded-to-preparation gastroenterologist expert in CE, as was cleanliness within the proximal, middle and distal part of the SB. A four-point scale was used (grade 1 = no bile or residue, grade 4 ? 90% of lumen full of bile or residual material). RESULTS: The 198 consecutive patients who were referred to CE studies due to routine medical reasons were divided into four groups. They all observed a 12-h overnight fast before undergoing CE. Throughout the 24 h preceding the fast, control group 1 (n = 45 patients) ate light unrestricted meals, control group 2 (n = 81) also ate light meals but free of fruits and vegetables, the PEG group (n = 50) ate unrestricted light meals and ingested the PEG preparation, and the Ensure group (n = 22) ingested only the Ensure formula. Preparation with Ensure improved the visualization of duodenal mucosa (a score of 1.76) by decreasing the bile content compared to preparation with PEG (a score of 2.9) (P = 0.053). Overall, as expected, there was less residue and stool in the proximal part of the SB than in the middle and distal parts in all groups. The total score of cleanliness throughout the length of the SB showed some benefit for Ensure (a score of 1.8) over control group 2 (a score of 2) (P = 0.06). The cleanliness grading of the proximal and distal parts of the SB was similar in all four groups (P = 0.6 for both). The cleanliness in the middle part of the SB in the PEG (a score of 1.8) and Ensure groups (a score of 1.7) was equally better than that of control group 2 (a score of 2.1) (P = 0.057 and P = 0.07, respectively). All 50 PEG patients had diarrhea as an anticipated side effect, compared with only one patient in the Ensure group. CONCLUSION: Preparation with Ensure, a liquid, fiber-free formula has advantages over standard and PEG preparations, with significantly fewer side effects than PEG.

Niv, Eva; Ovadia, Baruch; Ron, Yulia; Santo, Ervin; Mahajna, Elisabeth; Halpern, Zamir; Fireman, Zvi

2013-01-01

421

A review of recent literature - nurse case managers in diabetes care: equivalent or better outcomes compared to primary care providers.  

PubMed

Primary care has changed remarkably with chronic disease burden growth. Nurse case managers assist with this chronic disease by providing if not significantly better care, than equivalent care to that provided by usual primary care providers. Chronic disease management requires patient-centered skills and tools, such as registries, panel management, review of home data, communicating with patients outside of face-to-face care, and coordinating multiple services. Evidence reviewed in this article demonstrates that registered nurse care managers (RNCM) perform many actions required for diabetes chronic disease management including initiation and titration of medications with similar or improved physiologic and patient satisfaction outcomes over usual care providers. Selection and training of the nurse case managers is of utmost importance for implementation of a successful chronic disease management program. Evidence based guidelines, algorithms, protocols, and adequate ongoing education and mentoring are generally cited as necessary support tools for the nurse case managers. PMID:24816751

Watts, Sharon A; Lucatorto, Michelle

2014-07-01

422

Ensuring the operational health of droplet-based microelectrofluidic biosensor systems  

Microsoft Academic Search

Recent events have heightened the need for fast, accurate, and reliable biological\\/chemical sensor systems for critical locations. As droplet-based microelectrofluidic sensor systems become widespread in these safety-critical biomedical applications, reliability emerges as a critical performance parameter. In order to ensure the operational health of such safety-critical systems, they need to be monitored for defects, not only after manufacturing, but also

Fei Su; Sule Ozev; Krishnendu Chakrabarty

2005-01-01

423

Ensuring Content Integrity for Untrusted Peer-to-Peer Content Distribution Networks  

Microsoft Academic Search

Many existing peer-to-peer content distribution networks (CDNs) such as Na Kika, CoralCDN, and CoDeeN are deployed on PlanetLab, a relatively trusted environment. But scaling them beyond this trusted boundary requires protecting against content corruption by untrusted repli- cas. This paper presents Repeat and Compare, a system for ensuring content integrity in untrusted peer-to-peer CDNs even when replicas dynamically generate con-

Nikolaos Michalakis; Robert Soul; Robert Grimm

2007-01-01

424

Mismatch repair ensures fidelity of replication and recombination in the radioresistant organism Deinococcus radiodurans  

Microsoft Academic Search

We have characterized the mismatch repair system (MMR) of the highly radiation-resistant type strain of Deinococcus radiodurans, ATCC 13939. We show that the MMR system is functional in this organism, where it participates in ensuring the fidelity of DNA replication and recombination. The system relies on the activity of two key proteins, MutS1 and MutL, which constitute a conserved core

S. Mennecier; G. Coste; P. Servant; A. Bailone; S. Sommer

2004-01-01

425

Method of ensuring eye-to eye contact in multi-view video conference  

Microsoft Academic Search

Eye-to-eye contact is considered to be important in understanding each other in immersive video conference in the future. In this letter, a new method to guarantee participants eye-to-eye contact is presented. In the method, it is supposed that the listener is directly facing the display screen. So the technique of ensuring eye-to-eye contact can be alternatively carried out by detecting

Li Yixia; Chang Yilin; Zhou Na

2009-01-01

426

Quality of care and education provided by Greek day-care centres: an approach from researcher's and early childhood educators' perspective  

Microsoft Academic Search

The present study is aimed at examining the level of quality and care provided by Greek preschool programmes, from the researcher's and early childhood educators' perspectives and verify whether they evaluate with the same way. Research results indicate that according to the researcher's assessment both preschool and infant\\/toddler classrooms provide care and education of adequate quality, whereas according to early

Konstantina Rentzou

2012-01-01

427

Quality of care and education provided by Greek day-care centres: an approach from researcher's and early childhood educators' perspective  

Microsoft Academic Search

The present study is aimed at examining the level of quality and care provided by Greek preschool programmes, from the researcher's and early childhood educators' perspectives and verify whether they evaluate with the same way. Research results indicate that according to the researcher's assessment both preschool and infant\\/toddler classrooms provide care and education of adequate quality, whereas according to early

Konstantina Rentzou

2011-01-01

428

Physician Reimbursement for Critical Care Services Integrating Palliative Care for Patients Who Are Critically Ill  

PubMed Central

Patients with advanced illness often spend time in an ICU, while nearly one-third of patients with advanced cancer who receive Medicare die in hospitals, often with failed ICU care. For most, death occurs following the withdrawal or withholding of life-sustaining treatments. The integration of palliative care is essential for high-quality critical care. Although palliative care specialists are becoming increasingly available, intensivists and other physicians are also expected to provide basic palliative care, including symptom treatment and communication about goals of care. Patients who are critically ill are often unable to make decisions about their care. In these situations, physicians must meet with family members or other surrogates to determine appropriate medical treatments. These meetings require clinical expertise to ensure that patient values are explored for medical decision making about therapeutic options, including palliative care. Meetings with families take time. Issues related to the disease process, prognosis, and treatment plan are complex, and decisions about the use or limitation of intensive care therapies have life-or-death implications. Inadequate reimbursement for physician services may be a barrier to the optimal delivery of high-quality palliative care, including effective communication. Appropriate documentation of time spent integrating palliative and critical care for patients who are critically ill can be consistent with the Current Procedural Terminology codes (99291 and 99292) for critical care services. The purpose of this article is to help intensivists and other providers understand the circumstances in which integration of palliative and critical care meets the definition of critical care services for billing purposes.

Nelson, Judith E.; Weissman, David E.; Hays, Ross M.; Mosenthal, Anne C.; Mulkerin, Colleen; Puntillo, Kathleen A.; Ray, Daniel E.; Bassett, Rick; Boss, Renee D.; Brasel, Karen J.; Campbell, Margaret L.; Cortez, Therese B.; Curtis, J. Randall

2012-01-01

429

Anganwadi worker's participation in rural newborn care.  

PubMed

Anganwadi worker was involved in rural newborn care as a link between a dai and a health worker. She was trained to ensure that, (i) borderline LBW/preterm baby was kept warm at home and (ii) a very small baby was referred to hospital. The training was conducted during routine monthly meetings and cost of equipping each anganwadi worked out to be Rs 110. Newborn survival, infant survivals and overall MCH performance improved. Thus, newborn care formed an ideal entry point into MCH activities. PMID:8157331

Daga, S R; Daga, A S; Dighole, R V; Patil, R P

1993-01-01

430

Safety ensuring retinal prosthesis with precise charge balance and low power consumption.  

PubMed

Ensuring safe operation of stimulators is the most important issue in neural stimulation. Safety, in terms of stimulators' electrical performances, can be related mainly to two factors; the zero-net charge transfer to tissue and the heat generated by power dissipation at tissue. This paper presents a safety ensuring neuro-stimulator for retinal vision prostheses, featuring precise charge balancing capability and low power consumption, using a 0.35 ?m HV (high voltage) CMOS process. Also, the required matching accuracy of the biphasic current pulse for safe stimulation is mathematically derived. Accurate charge balance is achieved by employing a dynamic current mirror at the output of a stimulator. In experiments, using a simple electrode model (a resistor (R) and a capacitor (C) in parallel), the proposed stimulator ensures less than 30 nA DC current flowing into tissue over all stimulation current ranges (32 ?A-1 mA), without shorting. With shorting enabled, further reduction is achieved down to 1.5 nA. Low power consumption was achieved by utilising small bias current, sharing of key biasing blocks, and utilising a short duty cycle for stimulation. Less than 30 ?W was consumed during stand-by mode, mostly by bias circuitry. PMID:24681924

Chun, Hosung; Yang, Yuanyuan; Lehmann, Torsten

2014-02-01

431

The regulated death: a documentary analysis of the regulation and inspection of dying and death in English care homes for older people  

Microsoft Academic Search

In England, processes of regulation and inspection have been established to ensure that older people living in long-term care settings receive quality care. This paper describes how dying and death in care homes for older people is regulated and inspected. A documentary analysis was undertaken of the standard that addresses dying and death in the 2001 Care Homes for Older

KATHERINE FROGGATT

2007-01-01

432

Palliative wound care: principles of care.  

PubMed

Home care nursing occurs in a complex care environment. Nurses working in this setting care for a wide array of individuals who often are sicker and more complex than ever before. The high prevalence of wounds among these individuals requires that home care nurses have a certain level of knowledge to provide excellent care. Many times, individuals with wounds do not have the capacity to heal or are burdened with numerous symptoms affecting quality of life. In these cases, the home care nurse must understand concepts of palliative wound care to alleviate symptoms with the goal of improving quality of life. PMID:24326475

Dale, Barbara; Emmons, Kevin R

2014-01-01

433

Assessing child-care quality with a telephone interview  

Microsoft Academic Search

As increasing numbers of children enter child-care environments that are subsidized by federal and state funds, the demand has risen from policy makers and activists for valid, cost-effective methods of assessing the quality of those environments. In this study we asked whether data on child-care quality obtained from a telephone interview with the provider can serve as an adequate proxy

Susan D Holloway; Sharon L Kagan; Bruce Fuller; Lynna Tsou; Jude Carroll

2001-01-01

434

Animal care guidelines and future directions.  

PubMed

Two notions broadly accepted in developed western societies have made animal care guidelines inevitable. These are that domestic animals are sentient and that humans are responsible to ensure the proper care of domestic animals. Despite these common views, people have differing moral understandings of the human-animal relationship, and there are sharp divisions over how these views should be applied to domestic animal care. Animal care guidelines have been developed by different nations at several organizational levels to represent a compromise that is acceptable to most people. These organizational levels include individual poultry companies, national poultry associations, individual customers of the poultry industry, national associations of customer companies, national governments, and international organizations. Animal care guideline development has typically included input from producers and scientists and, depending on the sponsoring organization, animal advocates and government representatives as well. Animal advocacy groups have also sought to influence domestic animal care by campaigning against animal production practices or by offering their preferred guidelines for producers to adopt in the hope that the endorsement of the welfare group would add value to the product. Originally, animal care guidelines were only recommended, with little or no requirement for compliance. In recent years, the need for retail companies to assure certain welfare standards has led to animal welfare auditing of production facilities. Animal care guidelines primarily have sought to establish standards for handling and husbandry in existing production systems. Future guidelines may put increasing emphasis on adoption of alternative management practices or housing systems. International animal care guidelines are being developed on 2 levels (i.e., among national governments to create a common standard for trade in animal products and within international retail companies to create company-wide animal care standards). These initiatives should tend to unify farm animal care standards worldwide but perhaps at a level some nations might consider lower than preferable. PMID:17495102

Webster, A B

2007-06-01

435

The Leap of a Provincial SME into the Global Market Using E-commerce: The Success of Adequate Planning  

NASA Astrophysics Data System (ADS)

The leap into the global market is not easy when it involves a provincial family business. This article demonstrates how adequate planning is fundamental in a small and medium-sized enterprise (SME) with the tight budget they have available to them, in order to be able to differentiate themselves in a highly competitive market, taking into accounts the benefits and risks involved. The Information Technology (IT) tools put in place will give the necessary support and allow for the possibility of increasing and improving the infrastructure as the company requires. An adequate strategy for the future to increases sales would be e-marketing techniques as well as the current promotions which contribute to diffusing the brand.

Sainz de Abajo, Beatriz; Garca Salcines, Enrique; Burn Fernndez, F. Javier; Lpez Coronado, Miguel; de Castro Lozano, Carlos

436

The Patient Care Circle: A Descriptive Framework for Understanding Care Transitions  

PubMed Central

Background Reducing hospital readmissions depends on ensuring safe care transitions, which requires a better understanding of the challenges experienced by key stakeholders. Objective Develop a descriptive framework illustrating the interconnected roles of patients, providers and caregivers in relation to readmissions. Design Multi-method qualitative study with four focus groups and 43 semi-structured interviews. Multiple perspectives were included to increase the trustworthiness (internal validity) and transferability (external validity) of the results. Data were analyzed using Grounded Theory to generate themes associated with readmission. Setting/Patients General medicine patients with same-site 30-day readmissions, their family members, and multiple care providers at a large urban academic medical center. Results A keynote generated from the multi-perspective responses was that care transitions were optimized by a well-coordinated multidiscipline support system, described as the Patient Care Circle. In addition, issues pertaining to readmissions were identified and classified into five main themes emphasizing the necessity of a coordinated support network: (1) Teamwork; (2) Health systems navigation and management; (3) Illness severity and health needs; (4) Psychosocial stability; (5) Medications. Conclusion A well-coordinated collaborative Patient Care Circle is fundamental to ensuring safe care transitions.

Lee, Jennifer I.; Cutugno, Christine; Pickering, Sean P.; Press, Matthew J.; Richardson, Joshua E.; Unterbrink, Michelle; Kelser, Mary Elizabeth; Evans, Arthur T.

2014-01-01

437

Are forestation, bio-char and landfilled biomass adequate offsets for the climate effects of burning fossil fuels?  

Microsoft Academic Search

Forestation and landfilling purpose-grown biomass are not adequate offsets for the CO2 emission from burning fossil fuels. Their permanence is insufficiently guaranteed and landfilling purpose-grown biomass may even be counterproductive. As to permanence, bio-char may do better than forests or landfilled biomass, but there are major uncertainties about net greenhouse gas emissions linked to the bio-char life cycle, which necessitate

L. Reijnders

2009-01-01

438

Alcohol consumption in the absence of adequate nutrition may lead to activation of the glyoxylate cycle in man.  

PubMed

The consumption of alcohol prior to food intake results in alcohol metabolism occurring in the liver, and the liver is often damaged in chronic alcoholics. This paper highlights the possibility that alcohol consumption in the absence of adequate nutrition after an extended period of time may lead to activation of the glyoxylate cycle, an energy pathway associated with the conversion of fat into carbohydrate which until recently was thought to only exist in plants and bacteria. PMID:12056879

Kokavec, A; Crowe, S F

2002-05-01

439

Launching ADVANCE care planning as a collabrative approach.  

PubMed

A multi-organisational/professional project group formed to implement advance care planning, to include the Preferred Priorities of Care document. An early outcome indicated the need to develop a communication pathway and engage with the out of hours providers. Consequently the group developed the use of The Lions 'Message in a Bottle' (MIB), a plastic bottle placed in a patients fridge to hold key information about an individual's ACP and contact numbers of health professionals involved with the patient. The purpose of the MIB was to ensure patients wishes and preferences were known, and to assist the Out of Hours GPs and Ambulance service in difficult decision making. The project identified other areas to address to ensure the implementation of advance care planning was robust;? EoLC Education to Emergency Care Practitioners, (ambulance professionals with a remit to prevent admission). ? Advance care planning workshops for all health and social care professionals. ? A succinct transfer of information form ? Collaborative End of Life Care registers between in hours and out of hours. The project is being launched to an audience of 80 encompassing commissioners, GPs, user representation, Acute and Community staff, care home staff, Learning Disability and Mental Health nurses, Hospital Consultants, Adult Care Services, Hospice staff and many others. The impact of the launch will be measured using a confidence questionnaire. The longer term outcomes for commissioners will include;? Increased home deaths ? Fewer hospital admissions. These will be monitored using vital signs data. PMID:24653144

Fowler, C; Bettany, A; White, J; Finch, J

2011-06-01

440

Selecting effective incentive structures in health care: A decision framework to support health care purchasers in finding the right incentives to drive performance  

Microsoft Academic Search

BACKGROUND: The Ontario health care system is devolving planning and funding authority to community based organizations and moving from steering through rules and regulations to steering on performance. As part of this transformation, the Ontario Ministry of Health and Long-Term Care (MOHLTC) are interested in using incentives as a strategy to ensure alignment that is, health service providers' goals

Thomas Custers; Jeremiah Hurley; Niek S Klazinga; Adalsteinn D Brown

2008-01-01

441

Using surveillance data to monitor entry into care of newly diagnosed HIV-infected persons: San Francisco, 20062007  

Microsoft Academic Search

BACKGROUND: Linkage to care after HIV diagnosis is associated with both clinical and public health benefits. However, ensuring and monitoring linkage to care by public health departments has proved to be a difficult task. Here, we report the usefulness of routine monitoring of CD4 T cell counts and plasma HIV viral load as measures of entry into care after HIV

Nicola M Zetola; Kyle Bernstein; Katherine Ahrens; Julia L Marcus; Susan Philip; Giuliano Nieri; Diane Jones; C Bradley Hare; Ling Hsu; Susan Scheer; Jeffrey D Klausner

2009-01-01

442

Indoor air quality in Montral area day-care centres, Canada.  

PubMed

Indoor air quality (IAQ) has been understudied in day-care centres (DCCs), even though it can affect the respiratory health of children. This study was undertaken to assess IAQ in a randomly selected sample of 21 DCCs having space for at least 40 children in Montral, Canada, and to determine associations between building characteristics and IAQ. Questionnaires on building characteristics and operation of the DCC were administered to managers. Temperature, relative humidity, and concentrations of carbon dioxide (CO(2)), formaldehyde and volatile organic compounds were measured in January and February 2008 in rooms attended by children aged between 18 and 60 months. Most DCCs (81%) had a mechanical ventilation system. Over 85% of the DCCs had a mean CO(2) concentration higher than 1000 ppm, the value generally targeted for comfort in buildings. Mean CO(2) concentrations were significantly lower in DCCs having a floor space meeting the provincial standards. The mean (standard deviation-SD) formaldehyde concentration was 22.9 (8.2) ?g/m(3), with all participating DCCs being within Health Canada's Residential IAQ Guideline of 50 ?g/m(3). The presence of a mechanical ventilation system and a large surface of play area per child were significantly associated with lower CO(2) levels, explaining 44% of the variance in indoor CO(2) concentrations. The presence of a mechanical ventilation system was also associated with significantly lower formaldehyde and acetaldehyde levels. Moreover, 68% of the variance in indoor acetaldehyde concentrations was explained by CO(2) levels, indicating that CO(2) was a better proxy of ventilation than the presence of a ventilation system, as this latter variable did not imply that the ventilation system was running or functioning adequately. These results demonstrate the need for on-going efforts to ensure sufficient floor space and adequate ventilation in DCCs to maintain good IAQ. PMID:22857914

St-Jean, Mlissa; St-Amand, Annie; Gilbert, Nicolas L; Soto, Julio C; Guay, Mireille; Davis, Karelyn; Gyorkos, Theresa W

2012-10-01

443

Tight coupling of polymerization and depolymerization of polyhydroxyalkanoates ensures efficient management of carbon resources in Pseudomonas putida.  

PubMed

Environmental microbes oscillate between feast and famine and need to carefully manage utilization, storage and conversion of reserve products to exploitable sources of carbon and energy. Polyhydroxyalkanoates (PHAs) are storage polymers that serve bacteria as sources of food materials under physiological conditions of carbon demand. In order to obtain insights into the role of PHA depolymerase (PhaZ) and its relationship to a PHA polymerase (PhaC2) in the carbon management activity of Pseudomonas putida strain U, we created a polymerase hyperexpression strain and a depolymerase knockout mutant of this strain, and examined their synthesis of PHA and expression of their PHA genes. This study revealed that hyperexpression of PhaC2 led to the accumulation of higher amounts of PHA (44%wt) than in the wild-type strain (24%wt) after 24?h of cultivation, which then returned to wild-type levels by 48?h, as a result of elevated depolymerization. The phaZ mutant, however, accumulated higher levels of PHA than the parental strain (62%wt), which were maintained for at least 96?h. Transcriptional analysis of the pha cluster by RT-PCR revealed that PHA operon proteins, including depolymerase, are expressed from the beginning of the growth phase. Hyperexpression of the PhaC2 polymerase was accompanied by an increase in the expression of the PhaZ depolymerase and a decrease in expression of another PHA polymerase, PhaC1. This suggests tight regulatory coupling of PHA polymerase and depolymerase activities that act in synergy, and in concert with other PHA proteins, to provide dynamic PHA granule synthesis and remodelling that rapidly and sensitively respond to changes in availability of carbon and the physiological-metabolic needs of the cell, to ensure optimal carbon resource management. PMID:23445364

Arias, Sagrario; Bassas-Galia, Monica; Molinari, Gabriella; Timmis, Kenneth N

2013-09-01

444

Tight coupling of polymerization and depolymerization of polyhydroxyalkanoates ensures efficient management of carbon resources in Pseudomonas putida  

PubMed Central

Summary Environmental microbes oscillate between feast and famine and need to carefully manage utilization, storage and conversion of reserve products to exploitable sources of carbon and energy. Polyhydroxyalkanoates (PHAs) are storage polymers that serve bacteria as sources of food materials under physiological conditions of carbon demand. In order to obtain insights into the role of PHA depolymerase (PhaZ) and its relationship to a PHA polymerase (PhaC2) in the carbon management activity of Pseudomonas putida strain U, we created a polymerase hyperexpression strain and a depolymerase knockout mutant of this strain, and examined their synthesis of PHA and expression of their PHA genes. This study revealed that hyperexpression of PhaC2 led to the accumulation of higher amounts of PHA (44%wt) than in the wild-type strain (24%wt) after 24?h of cultivation, which then returned to wild-type levels by 48?h, as a result of elevated depolymerization. The phaZ mutant, however, accumulated higher levels of PHA than the parental strain (62%wt), which were maintained for at least 96?h. Transcriptional analysis of the pha cluster by RT-PCR revealed that PHA operon proteins, including depolymerase, are expressed from the beginning of the growth phase. Hyperexpression of the PhaC2 polymerase was accompanied by an increase in the expression of the PhaZ depolymerase and a decrease in expression of another PHA polymerase, PhaC1. This suggests tight regulatory coupling of PHA polymerase and depolymerase activities that act in synergy, and in concert with other PHA proteins, to provide dynamic PHA granule synthesis and remodelling that rapidly and sensitively respond to changes in availability of carbon and the physiological-metabolic needs of the cell, to ensure optimal carbon resource management.

Arias, Sagrario; Bassas-Galia, Monica; Molinari, Gabriella; Timmis, Kenneth N

2013-01-01

445

Brain tumours in Sweden 1996: care and costs  

PubMed Central

OBJECTIVESBrain tumours cause considerable concern due to a high mortality and there are increasing efforts to provide adequate care, sometimes outside hospitals. Health care utilisation, direct costs of care, and the indirect social cost of morbidity and early mortality caused by brain tumours in Sweden in the year 1996 was analysed.?METHODSQuantification of ambulatory care, care in hospital, long term and palliative/terminal care, drug consumption, temporary as well as long term morbidity, and mortality from comprehensive national data sources. Direct costs were calculated using 1996charges. Indirect costs were calculated by sex and age specific salaries. A sensitivity analysis considered the impact of alternative estimates of each item.?RESULTSIndirect costs were 75% of the total and were caused mainly by early mortality. Direct costs were predominantly for care in hospital, long term care, and home health care. Among direct costs, astrocytomas III-IV and meningiomas accounted for 42% and 30% respectively.?CONCLUSIONSThe cost of illness from brain tumours reflects the characteristics of these malignancies. Despite their low incidence rate, the economic impact caused by high mortality among young persons is a predominant trait. Costs of acute hospital care and also long term care and home care are considerable.??

Blomqvist, P; Lycke, J; Strang, P; Tornqvist, H; Ekbom, A

2000-01-01

446

Monitoring in the Intensive Care  

PubMed Central

In critical care, the monitoring is essential to the daily care of ICU patients, as the optimization of patient's hemodynamic, ventilation, temperature, nutrition, and metabolism is the key to improve patients' survival. Indeed, the decisive endpoint is the supply of oxygen to tissues according to their metabolic needs in order to fuel mitochondrial respiration and, therefore, life. In this sense, both oxygenation and perfusion must be monitored in the implementation of any resuscitation strategy. The emerging concept has been the enhancement of macrocirculation through sequential optimization of heart function and then judging the adequacy of perfusion/oxygenation on specific parameters in a strategy which was aptly coined goal directed therapy. On the other hand, the maintenance of normal temperature is critical and should be regularly monitored. Regarding respiratory monitoring of ventilated ICU patients, it includes serial assessment of gas exchange, of respiratory system mechanics, and of patients' readiness for liberation from invasive positive pressure ventilation. Also, the monitoring of nutritional and metabolic care should allow controlling nutrients delivery, adequation between energy needs and delivery, and blood glucose. The present paper will describe the physiological basis, interpretation of, and clinical use of the major endpoints of perfusion/oxygenation adequacy and of temperature, respiratory, nutritional, and metabolic monitorings.

Kipnis, Eric; Ramsingh, Davinder; Bhargava, Maneesh; Dincer, Erhan; Cannesson, Maxime; Broccard, Alain; Vallet, Benoit; Bendjelid, Karim; Thibault, Ronan

2012-01-01

447

Financial burden of health care expenditures: Turkey.  

PubMed

In this study, we examine whether and to what extent the health insurance system in Turkey provided adequate protection against high out of pocket expenditures in the period prior to "The Health Transformation Programme". Furthermore, we examine the distribution of out of pocket expenditures by demographic characteristics, poverty status, health service type, access to health care and self-reported health status. We employ the 2002/03 National Household Health Expenditure Survey data to analyze financial burden of health care expenditure. Following the literature, we define high burdens as expenses above 10 and 20% of income. We find that 19% of the nonelderly population were living in families spending more than 10% of family income and that 14% of the nonelderly population were living in families spending more than 20% of family income on health care. Furthermore, the poor and those living in economically less developed regions had the greatest risk of high out of pocket burdens. The risk of high financial burdens varied by the type of insurance among the insured due to differences in benefits among the five separate public schemes that provided health insurance in the pre-reform period. Our results are robust to three alternative specifications of the burden measure and including elderly adults in the sample population. We see that prior to the reforms there were not adequate protection against high health expenditures. Our study provides a baseline against which policymakers can measure the success of the health care reform in terms of providing financial protection. PMID:23113149

Sulku, S Nur; Bernard, D Minbay

2012-01-01

448

Ensuring Children Eat a Healthy Diet: A Theory-Driven Focus Group Study of Parents' Perceptions  

PubMed Central

The Theory of Planned Behavior (TPB) served as a framework for analyzing focus group transcripts (N = 43) focused on parents perceptions of the challenges of ensuring their children eat a healthy diet. The results suggest that parents consider their beliefs and behaviors as individuals within a society, within families, within cultures, as inheritors of family traditions, and as parents who influence or fail to influence the attitudes and behaviors of their children. The results showed the particular salience of factors related to the TPB concepts of perceived norms and control. Approaches to building theory-driven nursing interventions are suggested.

Kahlor, LeeAnn; Mackert, Michael; Junker, Dave; Tyler, Diane

2010-01-01

449

GLUE 2 deployment: Ensuring quality in the EGI/WLCG information system  

NASA Astrophysics Data System (ADS)

The GLUE 2 information model is now fully supported in the production EGI/WLCG information system. However, to make it usable and allow clients to rely on the published information it is important that the meaning is clearly defined, and that information providers and site configurations are validated to ensure as far as possible that what they publish is correct. In this paper we describe the definition of a detailed schema usage profile, the implementation of a software tool to validate published information according to the profile and the use of the tool in the production Grid, and also summarise the overall state of GLUE 2 deployment.

Burke, Stephen; Alandes Pradillo, Maria; Field, Laurence; Keeble, Oliver

2014-06-01

450

Harmonization of monographic standards is needed to ensure the quality of Chinese medicinal materials  

PubMed Central

This article provides an overview on the regulations of Chinese medicinal materials (CMMs) in various countries and regions. Harmonization of CMM monographs would provide standards for the quality control of CMM products and play an important role in the modernization and globalization of Chinese medicine. A harmonized regulatory system would improve the quality of CMMs thereby ensuring the safety of the products and assisting Chinese medicine practitioners in their practice. The fast growing demand worldwide for traditional medicines calls for harmonized monographic standards to safeguard the safety and quality of CMM products.

Chan, Kelvin; Leung, Kelvin Sze-Yin; Zhao, Sandy Shuo

2009-01-01

451

Management of complex implant aesthetics: ensuring restorative design continuity with a comprehensive outcome-based strategy.  

PubMed

Since implant therapy must be dictated by prosthetic requirements, a protocol for the comprehensive and continuous integration of the restorative blueprint through the entire treatment planning and clinical execution phases is mandatory. This article demonstrates a systematic approach where the establishment of a final restorative treatment objective is incorporated into the diagnosis and subsequently integrated through every phase of clinical execution. Design continuity is ensured, and multidisciplinary cohesiveness is enhanced by providing clearly defined treatment objectives to every member of the clinical team. PMID:11685830

Lee, E A; Jun, S K

2001-09-01

452

Yield-Ensuring DAC-Embedded Opamp Design Based on Accurate Behavioral Model Development  

NASA Astrophysics Data System (ADS)

An accurate behavioral model of a DAC-embedded opamp (DAC-opamp) is developed for a yield-ensuring LCD column driver design. A lookup table for the V-I curve of the unit differential pair in the DAC-opamp is extracted from a circuit simulation and is later manipulated through a random error insertion. Virtual ground assumption simplifies the output voltage estimation algorithm. The developed behavioral model of a 5-bit DAC-opamp shows good agreement with the circuit level simulation with less than 5% INL difference.

Jang, Yeong-Shin; Nguyen, Hoai-Nam; Ryu, Seung-Tak; Lee, Sang-Gug

453

Financing for public veterinary services to ensure that they meet international standards.  

PubMed

It is vital that public Veterinary Services develop the skills to address the challenging questions posed by national Treasury officials, who exercise an important mandate to ensure that expenditures are efficient and effective in serving the public interest. Examples of such questions are considered in this paper, along with systems and strategies for preparing for such reviews, including the use of the Performance of Veterinary Services (PVS) evaluation tools of the World Organisation for Animal Health. Some lessons and observations are drawn from PVS Evaluation and PVS Gap Analysis missions in nine countries. PMID:23413741

Stemshorn, B; Zussman, D

2012-08-01

454

Ensuring critical event sequences in high integrity software by applying path expressions  

SciTech Connect

The goal of this work is to extend the use of existing path expression theory and methodologies to ensure that critical software event sequences are maintained even in the face of malevolent attacks and harsh or unstable operating environments. This will be accomplished by providing dynamic fault management measures directly to the software developer and to their varied development environments. This paper discusses the perceived problems, a brief overview of path expressions, and the author`s proposed extension areas. The authors discuss how the traditional path expression usage and implementation differs from the intended usage and implementation.

Kidd, M.E.C.

1996-07-01

455

The Value of Data Collection within a Palliative Care Program  

Microsoft Academic Search

Collecting reliable and valid data is an increasing expectation within palliative care. Data remain the crux for demonstrating\\u000a value and quality of care, which are the critical steps to program sustainability. Parallel goals of conducting research and\\u000a performing quality assessment and improvement can also ensure program growth, financial health, and viability in an increasingly\\u000a competitive environment. Mounting expectations by patients,

Arif H. Kamal; David C. Currow; Christine Ritchie; Janet Bull; Jane L. Wheeler; Amy P. Abernethy

2011-01-01

456

Direct Care Workers' Recommendations for Training and Continuing Education  

ERIC Educational Resources Information Center

Training of direct care workers (DCWs) varies depending upon the setting in which they work and the state in which they are trained. Evidence points to the importance of adequate training as critical to DCW job satisfaction and reduction in turnover. Several approaches have been taken to enhance the training of DCWs with the objective that as job

Menne, Heather L.; Ejaz, Farida K.; Noelker, Linda S.; Jones, James A.

2007-01-01

457

A Guide to Enteral Drug Administration in Palliative Care  

Microsoft Academic Search

Enteral feeding is indicated in patients unable to ingest sufficient nutrients but whose gastrointestinal function is adequate for digestion and absorption. Indications in palliative care include patients with radical esophageal surgery, upper gastrointestinal tract obstruction, anorexia, and dysphagia. As the oral route is the preferred method of palliative drug delivery, the enteral feeding tube can become an important tool for

Peter J Gilbar; Dip Hosp Clin Pharm Pract

1999-01-01

458

About Skin-to-Skin Care (Kangaroo Care)  

MedlinePLUS

... Care Ages & Stages Listen About Skin-to-Skin Care Article Body You may be able to hold ... care, also called kangaroo care. What is Kangaroo Care? Kangaroo care was developed in South America as ...

459

Impact of a regional acute care surgery model on patient access and outcomes  

PubMed Central

Background The consolidation of acute care surgery (ACS) services at 3 of 6 hospitals in a Canadian health region sought to alleviate a relative shortage of surgeons able to take emergency call. We examined how this affected patient access and outcomes. Methods Using the generalized linear model and statistical process control, we analyzed ACS-related episodes that occurred between 39 months prior to and 17 months after the models implementation (n = 14 713). Results Time to surgery increased after the consolidation. Wait times increased primarily for patients presenting at nonreferral hospitals who were likely to require transfer to a referral hospital. Although ACS teams enabled referral hospitals to handle a much higher volume of patients without increasing within-hospital wait times, overall system wait times were lengthened by the growing frequency of patient transfers. Wait times for inpatient admission were difficult to interpret because there was a trend toward admitting patients directly to the ACS service, bypassing the emergency department (ED). For patients who did go through the ED, wait times for inpatient admission increased after the consolidation; however, this trend was cancelled out by the apparently zero waits of patients who bypassed the ED. Regionalization showed no impact on length of stay, readmissions, mortality or complications. Conclusion Consolidation enabled the region to ensure adequate surgical coverage without harming patients. The need to transfer patients who presented at nonreferral hospitals led to longer waits.

Kreindler, Sara A.; Zhang, Liping; Metge, Colleen J.; Nason, Richard W.; Wright, Brock; Rudnick, Wendy; Moffatt, Michael E.K.

2013-01-01

460

Nurses' perceptions of leadership in an adult intensive care unit: a phenomenology study.  

PubMed

The purpose of this research was to explore ICU nurses' perceptions of nursing leadership in the adult intensive care unit (ICU). The nursing profession needs leaders at all levels; ward, administration and executive and in an era in which there is a shortage of ICU nurses, nursing leadership is important, as positive leadership skills correlate with enhanced recruitment and retention of these specialist nurses. Six ICU nurses with at least 5 years experience in ICU nursing were recruited from a metropolitan hospital in Australia. Qualitative phenomenological methodology was used to depict the lived experiences of nurses' leadership in the adult ICU. Data were collected through individual semi-structured interviews using open-ended questions and analysed using Giorgi's [Giorgi A. Toward phenomenologically based research in psychology. J Phenomenol Psychol 1970;1:75-98] descriptive method for data analysis. Five themes emerged and these were all inter-related: leading by example, communication, ability to think outside the management square, knowing your staff and stepping up in times of crisis. These findings highlight the importance of nursing leadership in the adult ICU and the need to ensure that all current and future nursing ICU leaders are adequately prepared and educated for this role. This information may also be used to assist in the development of leadership skills in ICU nurses. PMID:19131249

Linton, Jenelle; Farrell, Maureen J

2009-04-01

461

Self-care: the new principal care.  

PubMed

We predict self-care will become the new principal source of care. People living with diverse chronic conditions spend more time on self-management than with their providers. The increasing burden of chronic disease and costs coupled with value-based payments and innovative care models will generate a shift away from expensive specialized care toward high-value self-care facilitated by information technology, social support, and clinical expertise. This predicted shift in the value stream carries with it risks and uncertainties but will likely prevail as society seeks to confer "agency" by enabling people to make decisions and engage effectively in care coproduction. PMID:24887523

Nelson, Eugene C; Meyer, Gregg; Bohmer, Richard

2014-01-01

462

Health care interactional suffering in palliative care.  

PubMed

A secondary analysis of 2 qualitative studies was conducted to explore the experiences of suffering caused by interactions with health care providers in the hospital setting. Interview transcripts from 20 palliative care patients and 15 palli