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Sample records for ensure adequate care

  1. ENSURING ADEQUATE SAFETY WHEN USING HYDROGEN AS A FUEL

    SciTech Connect

    Coutts, D

    2007-01-22

    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.

  2. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Ensuring that the salvors and marine firefighters are adequate. 155.4050 Section 155.4050 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) POLLUTION OIL OR HAZARDOUS MATERIAL POLLUTION PREVENTION REGULATIONS FOR VESSELS Salvage and...

  3. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... participation in successful salvage and/or marine firefighting operations, including equipment deployment. (3... marine firefighters are adequate. 155.4050 Section 155.4050 Navigation and Navigable Waters COAST GUARD... REGULATIONS FOR VESSELS Salvage and Marine Firefighting 155.4050 Ensuring that the salvors and...

  4. Child Care: Use of Standards To Ensure High Quality Care.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

    Prepared to assist Congress in its deliberations of various child care proposals, this report identifies key child care center standards that are critical in helping to ensure high quality child care. The article also examines the extent to which states incorporate these standards into their own standards, and discusses other important issues that

  5. A high UV environment does not ensure adequate Vitamin D status

    NASA Astrophysics Data System (ADS)

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

    2006-12-01

    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.

  6. Barriers to adequate prenatal care utilization in American Samoa

    PubMed Central

    Hawley, Nicola L; Brown, Carolyn; Nuusolia, Ofeira; Ah-Ching, John; Muasau-Howard, Bethel; McGarvey, Stephen T

    2013-01-01

    Objective To describe the utilization of prenatal care in American Samoan women and to identify socio-demographic predictors of inadequate prenatal care utilization. Methods Using data from prenatal clinic records, women (n=692) were categorized according to the Adequacy of Prenatal Care Utilization Index as having received adequate plus, adequate, intermediate or inadequate prenatal care during their pregnancy. Categorical socio-demographic predictors of the timing of initiation of prenatal care (week of gestation) and the adequacy of received services were identified using one way Analysis of Variance (ANOVA) and independent samples t-tests. Results Between 2001 and 2008 85.4% of women received inadequate prenatal care. Parity (P=0.02), maternal unemployment (P=0.03), and both parents being unemployed (P=0.03) were negatively associated with the timing of prenatal care initation. Giving birth in 20072008, after a prenatal care incentive scheme had been introduced in the major hospital, was associated with earlier initiation of prenatal care (20.75 versus 25.12 weeks; P<0.01) and improved adequacy of received services (95.04% versus 83.8%; P=0.02). Conclusion The poor prenatal care utilization in American Samoa is a major concern. Improving healthcare accessibility will be key in encouraging women to attend prenatal care. The significant improvements in the adequacy of prenatal care seen in 20072008 suggest that the prenatal care incentive program implemented in 2006 may be a very positive step toward addressing issues of prenatal care utilization in this population. PMID:24045912

  7. Role of Primary Health Care in Ensuring Access to Medicines

    PubMed Central

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

    2010-01-01

    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

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

    PubMed Central

    Chapman, S; Liberman, J

    2005-01-01

    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. PMID:16046703

  9. Improved ASTM G72 Test Method for Ensuring Adequate Fuel-to-Oxidizer Ratios

    NASA Technical Reports Server (NTRS)

    Juarez, Alfredo; Harper, Susana A.

    2016-01-01

    The ASTM G72/G72M-15 Standard Test Method for Autogenous Ignition Temperature of Liquids and Solids in a High-Pressure Oxygen-Enriched Environment is currently used to evaluate materials for the ignition susceptibility driven by exposure to external heat in an enriched oxygen environment. Testing performed on highly volatile liquids such as cleaning solvents has proven problematic due to inconsistent test results (non-ignitions). Non-ignition results can be misinterpreted as favorable oxygen compatibility, although they are more likely associated with inadequate fuel-to-oxidizer ratios. Forced evaporation during purging and inadequate sample size were identified as two potential causes for inadequate available sample material during testing. In an effort to maintain adequate fuel-to-oxidizer ratios within the reaction vessel during test, several parameters were considered, including sample size, pretest sample chilling, pretest purging, and test pressure. Tests on a variety of solvents exhibiting a range of volatilities are presented in this paper. A proposed improvement to the standard test protocol as a result of this evaluation is also presented. Execution of the final proposed improved test protocol outlines an incremental step method of determining optimal conditions using increased sample sizes while considering test system safety limits. The proposed improved test method increases confidence in results obtained by utilizing the ASTM G72 autogenous ignition temperature test method and can aid in the oxygen compatibility assessment of highly volatile liquids and other conditions that may lead to false non-ignition results.

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

    PubMed

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

    2014-02-01

    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

  11. [The global and national context regarding the challenges involved in ensuring adequate access to water for human consumption].

    PubMed

    Augusto, Lia Giraldo da Silva; Gurgel, Id Gomes Dantas; Cmara Neto, Henrique Fernandes; de Melo, Carlos Henrique; Costa, Andr Monteiro

    2012-06-01

    The scope of this article is to analyze the challenges involved in ensuring access to water for human consumption taking the international and national context into consideration. Based on the UN declaration that access to safe and clean drinking water is a fundamental human right, vulnerabilities are identified that can consist in restrictions to access to adequate supplies. The distribution of water and the population across the planet, pollution, inadequate policies and management lead to environmental injustice. The iniquity of access to water constitutes the contemporary water crisis. From the 1980s onwards, the transnational water market emerged for private control that occurs at three main levels: surface and underground water sources; bottled water; and public water supply services. The conflicts of the multiple uses of water resources, the market and environmental problems have contributed to rendering the health of the population and ecosystems vulnerable. Adequate public policies are essential to ensure the basic human right to access to safe and clean drinking water. PMID:22699642

  12. Are family medicine residents adequately trained to deliver palliative care?

    PubMed Central

    Mahtani, Ramona; Kurahashi, Allison M.; Buchman, Sandy; Webster, Fiona; Husain, Amna; Goldman, Russell

    2015-01-01

    Objective To explore educational factors that influence family medicine residents (FMRs) intentions to offer palliative care and palliative care home visits to patients. Design Qualitative descriptive study. Setting A Canadian, urban, specialized palliative care centre. Participants First-year (n = 9) and second-year (n = 6) FMRs. Methods Semistructured interviews were conducted with FMRs following a 4-week palliative care rotation. Questions focused on participant experiences during the rotation and perceptions about their roles as family physicians in the delivery of palliative care and home visits. Participant responses were analyzed to summarize and interpret patterns related to their educational experience during their rotation. Main findings Four interrelated themes were identified that described this experience: foundational skill development owing to training in a specialized setting; additional need for education and support; unaddressed gaps in pragmatic skills; and uncertainty about family physicians role in palliative care. Conclusion Residents described experiences that both supported and inadvertently discouraged them from considering future engagement in palliative care. Reassuringly, residents were also able to underscore opportunities for improvement in palliative care education.

  13. Systems and processes that ensure high quality care.

    PubMed

    Bassett, Sally; Westmore, Kathryn

    2012-10-01

    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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

    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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

    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…

  16. Organizing person-centred care in paediatric diabetes: multidisciplinary teams, long-term relationships and adequate documentation

    PubMed Central

    2014-01-01

    Background Type 1 diabetes is one of the most frequent long-term endocrine childhood disorders and the Swedish National Diabetes Register for children states that adolescents (1218 years) constitute the most vulnerable patient group in terms of metabolic control. The aim of this study was to examine how a multidisciplinary team functions when caring for adolescents with type 1 diabetes. Methods Qualitative interviews were performed with 17 health professionals at a Paediatric Diabetes Care Unit in a Swedish university hospital. The interviews were analysed to gain insight into a multidisciplinary care teams experiences of various organizational processes and circumstances related to the provision of person-centred paediatric diabetes care. Results Building long-term relationships with adolescents, the establishment of a multidisciplinary care team and ensuring adequate documentation are vital for the delivery of person-centred care (PCC). Furthermore, a PCC process and/or practice requires more than the mere expression of person-centred values. The contribution of this study is that it highlights the necessity of facilitating and safeguarding the organization of PCC, for which three processes are central: 1. Facilitating long-term relationships with adolescents and their families; 2. Facilitating multi-professional teamwork; and 3. Ensuring adequate documentation. Conclusion Three processes emerged as important for the functioning of the multidisciplinary team when caring for adolescents with type 1 diabetes: building a long-term relationship, integrating knowledge by means of multidisciplinary team work and ensuring adequate documentation. This study demonstrates the importance of clearly defining and making use of the specific role of each team member in the paediatric diabetes care unit (PDCU). Team members should receive training in PCC and a PCC approach should form the foundation of all diabetes care. Every adolescent suffering from type 1 diabetes should be offered individual treatment and support according to her/his needs. However, more research is required to determine how a PCC approach can be integrated into adolescent diabetes care, and especially how PCC education programmes for team members should be implemented. PMID:24490659

  17. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  18. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  19. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  20. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  1. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  2. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian...

  3. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian...

  4. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian...

  5. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian...

  6. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian...

  7. Ensuring competencies of multidisciplinary staff in patient-focused care.

    PubMed

    Thompson, E J; Roda, P I

    1999-01-01

    Faced with rising health care costs and consumer demands, hospitals are finding creative ways to streamline the delivery of patient care. One such approach is patient-focused care (PFC), in which hospitals bring services to the patient's beside and cross-train staff. The success of PFC depends on training and measuring staff competence in the new skills. This article describes how to implement an educational plan based on competencies for a successful transition to PFC. PMID:10640030

  8. Orphan Care in Botswanas Working Households: Growing Responsibilities in the Absence of Adequate Support

    PubMed Central

    Miller, Candace M.; Gruskin, Sofia; Subramanian, S.V.; Rajaraman, Divya; Heymann, S. Jody

    2006-01-01

    Objectives. Botswana has one of the worlds highest HIV-prevalence rates and the worlds highest percentages of orphaned children among its population. We assessed the ability of income-earning households in Botswana to adequately care for orphans. Methods. We used data from the Botswana Family Health Needs Study (2002), a sample of 1033 working adults with caregiving responsibilities who used public services, to assess whether households with orphan-care responsibilities encountered financial and other difficulties. Thirty-seven percent of respondents provided orphan care, usually to extended family members. We applied logistic regression models to determine the factors associated with experiencing problems related to orphan caregiving. Results. Nearly half of working households with orphan-care responsibilities reported experiencing financial and other difficulties because of orphan care. Issues of concern included caring for multiple orphans, caring for sick adults and orphans simultaneously, receiving no assistance, and low income. Conclusions. The orphan crisis is impoverishing even working households, where caregivers lack sufficient resources to provide basic needs. Neither the public sector nor communities provide adequate safety nets. International assistance is critical to build capacity within the social welfare infrastructure and to fund community-level activities that support households. Lessons from Botswanas orphan crisis can provide valuable insights to policymakers throughout sub-Saharan Africa. PMID:16809585

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

    PubMed Central

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

    2002-01-01

    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. PMID:12149128

  10. [Resources needed to ensure inpatient psycho-oncological care].

    PubMed

    Jung, Sylvia; Wiedemann, Ruth; Hhl, Hans-Ulrich; Kusch, Michael; Singer, Susanne

    2014-02-01

    The aim of this study was to document how many patients with malignant diseases in an acute care hospital can be supported by one full time psycho-oncologist and how long each procedure takes. Over the course of 2 years, frequency and duration of all interventions provided by a psycho-oncologist were documented at 6 hospitals in Germany. A total of 4?947 patients received 20?366 psycho-oncological interventions. One full time position could care for 351 (1st year) and 436 (2nd year) patients respectively. The most frequent intervention was supportive counselling to single patients (22%) with an average duration of 29?min. Patients received on average 4 consultations. In addition, many short contacts with a duration of 10?min were provided. On average, psycho-oncological care could be provided by a person with a full-time position to 393 patients with malignant diseases. Most of the consultations were of short duration (10-30?min). PMID:23966277

  11. 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)

    2008-01-01

    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.

  12. [Difficulties in ensuring a healthy diet among primary health care users and associated factors].

    PubMed

    Lindemann, Ivana Loraine; Oliveira, Riceli Rodeghiero; Mendoza-Sassi, Raúl Andres

    2016-02-01

    This is a straightforward cross-sectional study of health services to assess the prevalence of perception of difficulties in ensuring a healthy diet, associated factors and respective motives among a sample of 1,246 adult and elderly primary care users. The prevalence of perception of difficulties was 31.1% (95% CI 28.5-33.6) and associated factors were female gender (PR = 1.69; 95% CI 1.28-2.25), adulthood (PR = 1.33; 95% CI 1.11-1.59), income, with the most marked effect in the highest quintile (PR = 0.63; 95% CI 0.47-0.83), a higher number of self-reported chronic diseases (PR = 1.31; 95% CI 1.03-1.67), food insecurity (PR = 2.28; 95% CI 1.93-2.69), not receiving food guidance (PR = 0.75; 95% CI 0.63 to 0.89) and not reading food labels (PR = 1.42; 95% CI 1.08-1.86). Among those who had difficulties, the reasons mentioned were high cost of foods considered to be healthy (57.6%), insufficient willpower (49.4%), need to give up food considered unhealthy (41.6%), lack of time (35.7%) and insufficient knowledge (31.3%). The results show the importance of the awareness of health professionals about the difficulties of users and the need for adequate actions to promote a healthy diet in order to avoid standard patient care procedures. PMID:26910167

  13. Developing from within: ensuring the ambulatory emergency care workforce is fit for purpose.

    PubMed

    Thurgate, Claire; Holmes, Sue

    2015-11-01

    Emergency healthcare provision is changing, and services need to respond to evolving health economies while providing safe, effective, patient-centred care. Ambulatory care is developing to meet these needs, but workforce planners need to ensure that staff are fit for purpose. To address this, one trust, in partnership with a local university, designed a bespoke in-house, work-based learning package on ambulatory care, which was delivered to registered nurses by practice experts. This article describes the project and discusses the evaluation, which highlighted the benefits of this way of learning for the nurses, the trust and the university, and identified some areas that require development. PMID:26508070

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

    PubMed Central

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

    2012-01-01

    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. PMID:23304268

  15. Hepatitis and the Need for Adequate Standards in Federally Supported Day Care.

    ERIC Educational Resources Information Center

    Silva, Richard J.

    1980-01-01

    This article examines findings in three epidemiological studies of day care centers and concludes that higher standards of care can reduce the incidence of hepatitis among parents and staff. (Author/DB)

  16. Calculated and experimental substantiation of operating conditions under which adequate erosion resistance of valves used in power units at nuclear power stations is ensured

    NASA Astrophysics Data System (ADS)

    Tomarov, G. V.; Shipkov, A. A.; Koreshkova, N. S.

    2010-05-01

    A procedure for revealing factors causing damage to metal and the dominating mechanism through which this damage occurs that was developed earlier is applied for substantiating the operating conditions of valves with D nom = 800 mm installed in the multiple forced circulation loop of power units at nuclear power stations equipped with RBMK-1000 reactors under which their resistance to erosion is ensured. Operating conditions under which cavitation erosion may occur are established, and practical proposals on how to prevent damage to the metal of a throttle-control valves body are presented.

  17. Ending LGBT invisibility in health care: the first step in ensuring equitable care.

    PubMed

    Makadon, Harvey J

    2011-04-01

    Lesbian, gay, bisexual, and transgender (LGBT) individuals experience health care disparities that will be eliminated only if clinicians elicit information about sexual orientation and gender identity from their patients through thoughtful, nonjudgmental discussion and history-taking. PMID:21460126

  18. Challenges and coping strategies of orphaned children in Tanzania who are not adequately cared for by adults.

    PubMed

    Daniel, Marguerite; Mathias, Angela

    2012-10-01

    Orphaned children in poor rural communities sometimes have no adult who is able to care for them or else the adult caregiver is not able to provide adequate care. Tanzania remains one of the poorest countries in the world, and poverty frequently constrains foster care. Although HIV prevalence is declining, AIDS is still a major cause of orphaning. This article explores the challenges and coping strategies accompanying two possible life trajectories for orphaned children without adequate adult care: 1) that they remain in rural areas in child-headed households, or 2) that they are trafficked to an urban area. Antonovsky's salutogenic model is used as the theoretical framework. The data come from two separate phenomenological studies with vulnerable children. In the first study, in-depth interviews were held with 12 orphaned children in a poor rural area; data concerning three child heads of households are included here. In the second study, 15 girls who were trafficked from rural areas to Dar es Salaam gave extended life-history narrations; data are included for nine of the girls who were orphaned. Loss of parents, a lack of cash, and the need to balance school attendance with food production were chronic stressors for the children heading households, while resources included income-generation strategies and the ability to negotiate with teachers for time to cultivate. For the trafficked girls chronic stressors included exploitation, long working hours, little or no pay, isolation and rape. Resources for them, although limited, included faith networks and neighbours; escape from the exploitative situation frequently involved external help. We conclude that given physical and social assets the child-headed households were able to cope with the challenges of caring for themselves and a younger child, but isolation and dependency on employers made it difficult for the trafficked girls to cope with this exploitation. The salutogenic model proved a useful tool in analysing the coping strategies of children living without adequate adult care. PMID:25860095

  19. Barriers to help-seeking, detection, and adequate treatment for anxiety and mood disorders: implications for health care policy.

    PubMed

    Mechanic, David

    2007-01-01

    Recently, the focus of health policies and initiatives has been directed toward mental health. More precisely, depressive and anxiety disorders have received particular attention because of their disabling outcomes and prevalence among most populations. Despite this increased interest, numerous issues regarding patients' willingness to seek treatment and the adequate recognition and treatment of these disorders by clinicians remain to be addressed. This article considers the factors that influence patients and physicians in their reticence to acknowledge and adequately treat depression and anxiety disorders. It also reviews the impact of society and the media, together with other factors relating to health care organization and administration that affect the treatment of depression and anxiety. In view of the multifaceted challenge involved, efforts to achieve a consensus in determining treatment for those with depressive and anxiety disorders are essential. A consensus will require easy, measurable, and reliable disability indicators; evidence that treatment of patients with varying levels of need is cost effective; and that persons who most need and would benefit from care can be reliably identified among the highly prevalent population of persons with more transient symptoms. Governments and other policymakers should be encouraged to provide appropriate coverage for access to primary and secondary care, the treatments required, and sufficient resources so that care is available when necessary. An important aspect of the challenge is to incorporate these efforts within the realistic constraints of primary care. PMID:17288503

  20. Religion, Spirituality and Speech-Language Pathology: A Viewpoint for Ensuring Patient-Centred Holistic Care.

    PubMed

    Mathisen, Bernice; Carey, Lindsay B; Carey-Sargeant, Christa L; Webb, Gwendalyn; Millar, CaraJane; Krikheli, Lilli

    2015-12-01

    This paper presents a viewpoint concerning the largely neglected clinical relevance of spirituality and religious belief in speech-language pathology (SLP) assessments, interventions and outcomes across the lifespan. An overview of the refereed SLP literature is presented with regard to religion and spirituality. It was found that while there is increasing research with regard to spirituality, health and well-being, there is very little specific to SLP. What is available and clinically relevant, generally relates to holistic care and/or cultural and linguistic diversity. Amidst the health care literature, however, there is a growing number of recommended instruments (for religious/spiritual screening) sensitive to intercultural and interfaith issues that are currently available to medical, nursing, allied health and chaplaincy practitioners. These instruments can also be of value to SLPs to ensure holistic assessments and interventions. It would seem timely for SLPs (and other allied health practitioners) to consider including spiritual screenings/assessments as part of their clinical practice so as to ensure appropriate holistic care. This would also mean undertaking research and including relevant education within tertiary institutions and professional development programs. PMID:25586135

  1. Minimally adequate mental health care and latent classes of PTSD symptoms in female Iraq and Afghanistan veterans.

    PubMed

    Hebenstreit, Claire L; Madden, Erin; Koo, Kelly H; Maguen, Shira

    2015-11-30

    Female veterans of Operations Enduring and Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) represent a growing segment of Department of Veterans Affairs (VA) health care users. A retrospective analysis used national VA medical records to identify factors associated with female OEF/OIF/OND veterans' completion of minimally adequate care (MAC) for PTSD, defined as the completion of at least nine mental health outpatient visits within a 15-week period or at least twelve consecutive weeks of medication use. The sample included female OEF/OIF/OND veterans with PTSD who initiated VA health care between 2007-2013, and were seen in outpatient mental health (N=2183). Multivariable logistic regression models examined factors associated with completing MAC for PTSD, including PTSD symptom expression (represented by latent class analysis), sociodemographic, military, clinical, and VA access factors. Within one year of initiating mental health care, 48.3% of female veterans completed MAC. Race/ethnicity, age, PTSD symptom class, additional psychiatric diagnoses, and VA primary care use were significantly associated with completion of MAC for PTSD. Results suggest that veterans presenting for PTSD treatment should be comprehensively evaluated to identify factors associated with inadequate completion of care. Treatments that are tailored to PTSD symptom class may help to address potential barriers. PMID:26330305

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

    PubMed

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

    2014-05-01

    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

  3. Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh

    PubMed Central

    Chaturvedi, Sarika; De Costa, Ayesha; Raven, Joanna

    2015-01-01

    Background Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY) cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. Design 1) Non-participant observations (n=18) of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2) Interviews (n=10) with providers to explore reasons for this care. Thematic framework analysis was used. Results Three themes emerged from the data: 1) delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2) Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3) Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as ‘go-betweens’ patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. Conclusions Our observational study did not suggest an adequate level of skilled birth attendance (SBA). The findings reveal insufficiencies in the health system and organisational structures to provide an ‘enabling environment’ for SBA. We highlight the need to ensure quality obstetric care prior to increasing coverage of facility births if cash transfer programmes like the JSY are to improve health outcomes. PMID:26160769

  4. Ensuring Quality Cancer Care: A Follow-Up Review of the Institute of Medicines Ten Recommendations for Improving the Quality of Cancer Care in America

    PubMed Central

    Spinks, Tracy; Albright, Heidi W.; Feeley, Thomas W.; Walters, Ron; Burke, Thomas W.; Aloia, Thomas; Bruera, Eduardo; Buzdar, Aman; Foxhall, Lewis; Hui, David; Summers, Barbara; Rodriguez, Alma; DuBois, Raymond; Shine, Kenneth I.

    2011-01-01

    Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US healthcare system in the late 1990s. The National Cancer Policy Board (NCPB), a twenty-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomings, and ways to measure and improve the quality of cancer care. The NCPB described an ideal cancer care system, where patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality Cancer Care. This report outlined ten recommendations, which, when implemented, would: 1) improve the quality of cancer care; 2) increase our understanding of quality cancer care; and, 3) reduce or eliminate access barriers to quality cancer care. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancer care in the United States today. Increased awareness of medical errors and barriers to quality care, coupled with escalating healthcare costs, has prompted national efforts to reform the healthcare system. These efforts by healthcare providers and policymakers should bridge the gap between the ideal state described in Ensuring Quality Cancer Care and the current state of cancer care in the United States. PMID:22045610

  5. Societal expectations and the profession's responsibility to reform the dental workforce to ensure access to care for children.

    PubMed

    Nash, David A

    2011-07-01

    Societal expectations raise the issue of the nature of a profession and a profession's relationship with society. Influential policy leaders want reform of the oral health workforce and delivery system in such a manner as to ensure that improvements are made for accessing care, particularly for vulnerable and disadvantaged populations, especially children. This essay is based on a presentation to the House of Delegates of the California Dental Association on Nov.13, 2009. PMID:21905546

  6. Ensuring palliative medicine availability: the development of the IAHPC list of essential medicines for palliative care.

    PubMed

    De Lima, Liliana; Krakauer, Eric L; Lorenz, Karl; Praill, David; Macdonald, Neil; Doyle, Derek

    2007-05-01

    In response to a request from the World Health Organization (WHO), the International Association for Hospice and Palliative Care (IAHPC) developed a List of Essential Medicines for Palliative Care based on the consensus of palliative care workers from around the world. IAHPC designed a process of five steps, which included developing a set of ethical guidelines; identifying the most common symptoms in palliative care; identifying a list of medications to treat those symptoms; carrying out a survey using a modified Delphi process with participants from developed and developing countries; and convening a meeting of representatives from regional, international, and scientific organizations to develop the final list. Twenty-one symptoms were identified as the most common in palliative care, and an initial list of 120 medications resulted from the initial survey. Seventy-one participants from developing and developed countries responded to the Delphi survey and agreed on the effectiveness and safety of 48 medications for 18 of the 21 symptoms. The final step included discussions among representatives from 26 organizations, which led to the finalization of the list. The IAHPC List of Essential Medicines for Palliative Care includes 33 medications, of which 14 are already included in the WHO Model List. The participants agreed that there is too little evidence to recommend medications for five of the symptoms and suggested that further research be carried out to solve this need. The IAHPC and all the organizations involved in this process welcome suggestions on ways to continue to improve the List of Essential Medicines for Palliative Care and to improve access to medications for patients in need. PMID:17482041

  7. Ensuring cultural sensitivity for Muslim patients in the Australian ICU: considerations for care.

    PubMed

    Bloomer, Melissa J; Al-Mutair, Abbas

    2013-11-01

    Australia is a diverse and multicultural nation, made up of a population with a predominant Christian faith. Islam, the second largest religion in the world, has demonstrated significant growth in Australia in the last decade. Coming from various countries of origin and cultural backgrounds, Muslim beliefs can range from what is considered 'traditional' to very 'liberal'. It is neither possible nor practical for every intensive care clinician to have an intimate understanding of Islam and Muslim practices, and cultural variations amongst Muslims will mean that not all beliefs/practices will be applicable to all Muslims. However, being open and flexible in the way that care is provided and respectful of the needs of Muslim patients and their families is essential to providing culturally sensitive care. This discussion paper aims to describe the Islamic faith in terms of Islamic teachings, beliefs and common practices, considering how this impacts upon the perception of illness, the family unit and how it functions, decision-making and care preferences, particularly at the end of life in the intensive care unit. PMID:23693083

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

    PubMed

    Hbert, Rjean

    2011-01-01

    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

  9. Environmental requirements related to patient care and the team working to ensure compliance.

    PubMed

    Roberts, Diane

    2015-01-01

    Healthcare providers are often surprised that regulations promulgated by the US Environmental Protection Agency (EPA) apply to patient care settings. Many find it strange that processes meant to heal have the potential to harm human health and the environment, and are, therefore, regulated by federal and state environmental agencies. The importance of compliance is emphasized by the fact that both the EPA and individual state agencies have the authority to impose civil and criminal penalties if they discover violations. The Joint Commission considers compliance important enough to include it as an element of performance in the Environment of Care standard. PMID:25651142

  10. Ensuring Safe Medication Administration to Children in New Jersey's Child Care Programs. ACNJ Special Report

    ERIC Educational Resources Information Center

    Burdette, Dianne S.; Coogan, Mary E.; Giosa, Ritamarie; Lucarelli, Patti; Pavignano, Debra

    2006-01-01

    Modern medications allow children with a variety of acute and chronic health conditions to participate in daily activities. However, parents and child care providers may not realize that there are different dosage strengths available on the market. The parent or staff may not fully understand the dosage or a miscommunication may occur. These…

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

    ERIC Educational Resources Information Center

    Williams, Charles A.

    2011-01-01

    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

  12. Early Care and Education: Policy Considerations for Ensuring High-Quality Pre-K Programs

    ERIC Educational Resources Information Center

    Best, Jane; Cohen, Courtney

    2013-01-01

    Interest in early care and education (ECE), also referred to as an early childhood education, has escalated in recent years. The interest is bipartisan, as evidenced by the multiple ECE-related bills already introduced by the 113th Congress. Further, 39 states have implemented prekindergarten (pre-K) programs. In 2013, 27 governors mentioned ECE…

  13. Ensuring Appropriate Care for LGBT Veterans in the Veterans Health Administration.

    PubMed

    Sharpe, Virginia Ashby; Uchendu, Uchenna S

    2014-09-01

    Within health care systems, negative perceptions of lesbian, gay, bisexual, and transgender persons have often translated into denial of services, denial of visitation rights to same-sex partners, reluctance on the part of LGBT patients to share personal information, and failure of workers to assess and recognize the unique health care needs of these patients. Other bureaucratic forms of exclusion have included documents, forms, and policies that fail to acknowledge a patient's valued relationships because of, for example, a narrow definition of "spouse," "parent," or "family." Bureaucratic exclusion has taken a particularly prominent form in the U.S. military. Until its repeal and termination in 2011, the "Don't Ask, Don't Tell" policy had for eighteen years barred openly gay men and lesbians from serving in the military. Among the effects of DADT is a dearth of information about the number and needs of LGBT service members who transition to the Veterans Health Administration for health care at the end of their military service. The long-standing social stigma against LGBT persons, the silence mandated by DADT, and the often unrecognized bias built into the fabric of bureaucratic systems make the task of creating a welcoming culture in the VHA urgent and challenging. The VHA has accepted a commitment to that task. Its Strategic Plan for fiscal years 2013 through 2018 stipulates that "[v]eterans will receive timely, high quality, personalized, safe, effective and equitable health care irrespective of geography, gender, race, age, culture or sexual orientation." To achieve this goal, the VHA undertook a number of coordinated initiatives to create an environment and culture that is informed, welcoming, positive, and empowering for the LGBT veterans and families whom the agency serves. PMID:25231789

  14. How home care is essential to ensuring successful orthodontic treatment outcomes.

    PubMed

    Levin, Roger

    2004-09-01

    Patients can significantly affect the outcome of their orthodontic treatment. A practice committed to developing the right systems, scripts, and educational materials will experience a more satisfied patient, increased efficiencies, and higher profits. Educating and motivating patients to maintain their oral health and providing recommendations or dispensing of home care tools such as a power toothbrush increases patient compliance, positively impacts treatment outcomes, enhances customer service, and generates a new revenue stream for the practice. In a tight economy and a highly competitive orthodontic market, a power toothbrush can positively impact your marketing and case close rate. Treatment and fees being relatively equal, patients will tend to accept treatment from a practice that can demonstrate concern for the patients' overall oral health and greater value-added components to the orthodontic case. Power toothbrushes as part of a comprehensive orthodontic treatment provide a great differentiating marketing strategy. PMID:15495447

  15. Automated medical resident rotation and shift scheduling to ensure quality resident education and patient care.

    PubMed

    Smalley, Hannah K; Keskinocak, Pinar

    2016-03-01

    At academic teaching hospitals around the country, the majority of clinical care is provided by resident physicians. During their training, medical residents often rotate through various hospitals and/or medical services to maximize their education. Depending on the size of the training program, manually constructing such a rotation schedule can be cumbersome and time consuming. Further, rules governing allowable duty hours for residents have grown more restrictive in recent years (ACGME 2011), making day-to-day shift scheduling of residents more difficult (Connors et al., J Thorac Cardiovasc Surg 137:710-713, 2009; McCoy et al., May Clin Proc 86(3):192, 2011; Willis et al., J Surg Edu 66(4):216-221, 2009). These rules limit lengths of duty periods, allowable duty hours in a week, and rest periods, to name a few. In this paper, we present two integer programming models (IPs) with the goals of (1) creating feasible assignments of residents to rotations over a one-year period, and (2) constructing night and weekend call-shift schedules for the individual rotations. These models capture various duty-hour rules and constraints, provide the ability to test multiple what-if scenarios, and largely automate the process of schedule generation, solving these scheduling problems more effectively and efficiently compared to manual methods. Applying our models on data from a surgical residency program, we highlight the infeasibilities created by increased duty-hour restrictions placed on residents in conjunction with current scheduling paradigms. PMID:25171938

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

    PubMed Central

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

    2012-01-01

    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. PMID:23098645

  17. Staffing in postnatal units: is it adequate for the provision of quality care? Staff perspectives from a state-wide review of postnatal care in Victoria, Australia

    PubMed Central

    Forster, Della A; McLachlan, Helen L; Yelland, Jane; Rayner, Jo; Lumley, Judith; Davey, Mary-Ann

    2006-01-01

    Background State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers' perspectives on the provision ofhospital postnatal care: how care is organised and provided in different hospitals; what constrains the provision of postnatal care (apart from funding) and what initiatives are being undertaken to improve service delivery. A state-widereview of organisational structures and processes in relation to the provision of hospital postnatal care in Victoria was undertaken. This paper focuses on the impact of staffing issues on the provision of quality postnatal care from the perspective of care providers. Methods A study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a structured questionnaire was sent to all public hospitals in Victoria that provided postnatal care (n = 73), exploring the structure and organisation of care (e.g. staffing, routine observations, policy framework and discharge planning). Stage two: 14 maternity units were selected and invited to participate in a more in-depth exploration of postnatal care. Thirty-eight key informant interviews were undertaken with midwives (including unit managers, associate unit managers and clinical midwives) and a medical practitioner from eachselected hospital. Results Staffing was highlighted as a major factor impacting on the provision of quality postnatal care. There were significant issues associated with inadequate staff/patient ratios; staffing mix; patient mix; prioritisation of birth suites over postnatal units; and the use of non-permanent staff. Forty-three percent of hospitals reported having only midwives (i.e. no non-midwives) providing postnatal care. Staffing issues impact on hospitals' ability to provide continuity of care. Recruitment and retention of midwives are significant issues, particularly in rural areas. Conclusion Staffing in postnatal wards is a challenging issue, and varies with hospital locality and model of care. Staff/patient ratios and recruitment of midwives in rural areas are the two areas that appear to have the greatest negative impact on staffing adequacy and provision of quality care. Future research on postnatal care provision should include consideration of any impact on staff and staffing. PMID:16817974

  18. Adequate Wound Care and Use of Bed Nets as Protective Factors against Buruli Ulcer: Results from a Case Control Study in Cameroon

    PubMed Central

    Landier, Jordi; Boisier, Pascal; Fotso Piam, Flix; Noumen-Djeunga, Blanbin; Sim, Joseph; Wantong, Fidle Gaetan; Marsollier, Laurent; Fontanet, Arnaud; Eyangoh, Sara

    2011-01-01

    Background Buruli ulcer is an infectious disease involving the skin, caused by Mycobacterium ulcerans. Its exact transmission mechanism remains unknown. Several arguments indicate a possible role for insects in its transmission. A previous case-control study in the Nyong valley region in central Cameroon showed an unexpected association between bed net use and protection against Buruli ulcer. We investigated whether this association persisted in a newly discovered endemic Buruli ulcer focus in Bankim, northwestern Cameroon. Methodology/Principal Findings We conducted a case-control study on 77 Buruli ulcer cases and 153 age-, gender- and village-matched controls. Participants were interviewed about their activities and habits. Multivariate conditional logistic regression analysis identified systematic use of a bed net (Odds-Ratio (OR)?=?0.4, 95% Confidence Interval [95%CI]?=?[0.20.9], p-value (p)?=?0.04), cleansing wounds with soap (OR [95%CI]?=?0.1 [0.030.3], p<0.0001) and growing cassava (OR [95%CI]?=?0.3 [0.20.7], p?=?0.005) as independent protective factors. Independent risk factors were bathing in the Mbam River (OR [95%CI]?=?6.9 [1.435], p?=?0.02) and reporting scratch lesions after insect bites (OR [95%CI]?=?2.7 [1.45.4], p?=?0.004). The proportion of cases that could be prevented by systematic bed net use was 32%, and by adequate wound care was 34%. Conclusions/Significance Our study confirms that two previously identified factors, adequate wound care and bed net use, significantly decreased the risk of Buruli ulcer. These associations withstand generalization to different geographic, climatic and epidemiologic settings. Involvement of insects in the household environment, and the relationship between wound hygiene and M. ulcerans infection should now be investigated. PMID:22087346

  19. Early diagnosis is critical to ensure good outcomes in HIV-infected children: outlining barriers to care.

    PubMed

    Feucht, Ute D; Meyer, Anell; Thomas, Winifred N; Forsyth, Brian W C; Kruger, Mariana

    2016-01-01

    HIV-infected children require early initiation of antiretroviral therapy (ART) to ensure good outcomes. The aim was to investigate missed opportunities in childhood HIV diagnosis leading to delayed ART initiation. Baseline data were reviewed of all children aged <15 years referred over a 1-year period for ART initiation to the Kalafong Hospital HIV services in Gauteng, South Africa. Of the 250 children, one-quarter (24.5%) was of school-going age, 34.5% in the preschool group, 18% between 6 and 12 months old and 23% below 6 months of age (median age?=?1.5 years [interquartile range 0.5-4.8]). Most children (82%) presented with advanced/severe HIV disease, particularly those aged 6-12 months (95%). Malnutrition was prominent and referrals were mostly from hospital inpatient services (61%). A structured caregiver interview was conducted in a subgroup, with detailed review of medical records and HIV results. The majority (?89%) of the 65 interviewed caregivers reported good access to routine healthcare, except for postnatal care (26%). Maternal HIV-testing was mostly done during the second and third pregnancy trimesters (69%). Maternal non-disclosure of HIV status was common (63%) and 83% of mothers reported a lack of psychosocial support. Routine infant HIV-testing was not done in 66%, and inadequate reporting on patient-held records (Road-to-Health Cards/Booklets) occurred frequently (74%). Children with symptomatic HIV disease were not investigated at primary healthcare in 53%, and in 68% of families the siblings were not tested. One-third of children (35%) had a previous HIV diagnosis, with 77% of caregivers aware of these prior results, while 50% acknowledged failing to attend ART services despite referral. In conclusion, a clear strategy on paediatric HIV case finding, especially at primary healthcare, is vital. Multiple barriers need to be overcome in the HIV care pathway to reach high uptake of services, of which especially maternal reasons for not attending paediatric ART services need further exploration. PMID:26273853

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

    ERIC Educational Resources Information Center

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

    2012-01-01

    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…

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

    ERIC Educational Resources Information Center

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

    2012-01-01

    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

  2. Action on AMD. Optimising patient management: act now to ensure current and continual delivery of best possible patient care

    PubMed Central

    Amoaku, W; Blakeney, S; Freeman, M; Gale, R; Johnston, R; Kelly, S P; McLaughlan, B; Sahu, D; Varma, D

    2012-01-01

    In recent years, there have been significant advances in the clinical management of patients with wet age-related macular degeneration (wet AMD)a rapidly progressing and potentially blinding degenerative eye disease. Wet AMD is responsible for more than half of registered severe sight impairment (blindness) in the United Kingdom, and patients who are being treated for wet AMD require frequent and long-term follow-up for treatment to be most effective. The clinical workload associated with the frequent follow-up required is substantial. Furthermore, as more new patients are diagnosed and the population continues to age, the patient population will continue to increase. It is thus vital that clinical services continue to adapt so that they can provide a fast and efficient service for patients with wet AMD. This Action on AMDdocument has been developed by eye health-care professionals and patient representatives, the Action on AMDgroup. It is intended to highlight the urgent and continuing need for change within wet AMD services. This document also serves as a guide for eye health-care professionals, NHS commissioners, and providers to present possible solutions for improving NHS retinal and macular services. Examples of good practice and service development are considered and can be drawn upon to help services meet the recommended quality of care and achieve best possible outcomes. PMID:22302094

  3. School-Based Health Centers Make Sense: Ensuring All Kids Have Access to the Health Care They Need to Be Healthy and Safe, and to Do Their Best in School. Issue Brief

    ERIC Educational Resources Information Center

    Children Now, 2014

    2014-01-01

    School-based health centers (SBHCs) are an innovative and effective way to address California's severe health care access problem among children. By providing critical health care services to kids in school, SBHCs ensure children get the medical, mental health, and dental care they need to be healthy and safe, and to support their ability to…

  4. 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

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

    2014-01-01

    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

  5. Sunscreens: obtaining adequate photoprotection.

    PubMed

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

    2012-01-01

    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

  6. Delay in the provision of adequate care to women who died from abortion-related complications in the principal maternity hospital of Gabon.

    PubMed

    Mayi-Tsonga, Sosthene; Oksana, Litochenko; Ndombi, Isabelle; Diallo, Thierno; de Sousa, Maria Helena; Faúndes, Aníbal

    2009-11-01

    Deaths resulting from unsafe induced abortions represent a major component of maternal mortality in countries with restrictive abortion laws. Delays in obtaining care for maternal complications constitute a known determinant of a woman's risk of death. However, data on the role of delays in providing care at health care facilities are sparse. The association between the cause of maternal death (abortion versus post-partum haemorrhage or eclampsia) and the time interval between admission to hospital and the initiation of treatment were evaluated among women who died at the Maternité du Centre Hospitalier de Libreville, Gabon, between 1 January 2005 and 31 December 2007. The women's characteristics and the time between diagnosis of the condition that led to death and the initiation of treatment were compared for each cause of death. After controlling for selected variables, the mean time between admission and treatment was 1.2 hours (95% CI: 0.0-5.6) in the case of women who died from post-partum haemorrhage or eclampsia and 23.7 hours (95% CI: 21.1-26.3) in the case of women who died of abortion-related complications. In conclusion, delay in initiating care was far greater in cases of women with complications of unsafe abortion compared to other pregnancy-related complications. Such delays may constitute an important determinant of the risk of death in women with abortion-related complications. PMID:19962639

  7. Ensuring Quality Nursing Home Care

    MedlinePLUS

    ... ¹ÿb2SÀ£m‡#ܕÀ !¤TjGÌ©ˆ °qOÏÞö§ ló)RÀ ‘j˜U¥í®pôz™OAÔEÊS ‹×ò %֟Íî;ðkª¾º“ ... Á«¾Ïy8` ‘ =¬¡9YH°Ü£Rì|rp©W¾9. Ëc¾G‡'$‘ J/¡ŒfåÛ ³ ¹ 2£ËZg…qê4݌›ò´ *¡¶m\\*× ... Z½ \\®ýâ×-+i¬ë,¶‡ ¬p#êâÊÕ) aÍzf °‘?ê>’J ‹Ï +ϟ‘ ¤bԅ¬º @j L5‚ºvt +^Rh)Š ...

  8. Standardised mortality ratio based on the sum of age and percentage total body surface area burned is an adequate quality indicator in burn care: An exploratory review.

    PubMed

    Steinvall, Ingrid; Elmasry, Moustafa; Fredrikson, Mats; Sjoberg, Folke

    2016-02-01

    Standardised Mortality Ratio (SMR) based on generic mortality predicting models is an established quality indicator in critical care. Burn-specific mortality models are preferred for the comparison among patients with burns as their predictive value is better. The aim was to assess whether the sum of age (years) and percentage total body surface area burned (which constitutes the Baux score) is acceptable in comparison to other more complex models, and to find out if data collected from a separate burn centre are sufficient for SMR based quality assessment. The predictive value of nine burn-specific models was tested by comparing values from the area under the receiver-operating characteristic curve (AUC) and a non-inferiority analysis using 1% as the limit (delta). SMR was analysed by comparing data from seven reference sources, including the North American National Burn Repository (NBR), with the observed mortality (years 1993-2012, n=1613, 80 deaths). The AUC values ranged between 0.934 and 0.976. The AUC 0.970 (95% CI 0.96-0.98) for the Baux score was non-inferior to the other models. SMR was 0.52 (95% CI 0.28-0.88) for the most recent five-year period compared with NBR based data. The analysis suggests that SMR based on the Baux score is eligible as an indicator of quality for setting standards of mortality in burn care. More advanced modelling only marginally improves the predictive value. The SMR can detect mortality differences in data from a single centre. PMID:26700877

  9. Ensuring Quality by Achieving Center-Based Change through the Development and Implementation of an Orientation Program for School-Age Care Staff and Parents.

    ERIC Educational Resources Information Center

    Payne, Patricia

    Due to a lack of initial orientation training for school-age child care staff, the childcare program for 6- to 18-year-olds, located at an Air Force installation, was not fully acquainting new employees with the developmental needs of school-age children. Because of a lack of financial resources to conduct extensive training, high turnover of

  10. Does accreditation by the Association for Assessment and Accreditation of Laboratory Animal Care International (AAALAC) ensure greater compliance with animal welfare laws?

    PubMed

    Goodman, Justin R; Chandna, Alka; Borch, Casey

    2015-01-01

    Accreditation of nonhuman animal research facilities by the Association for Assessment and Accreditation of Laboratory Animal Care International (AAALAC) is widely considered the "gold standard" of commitment to the well being of nonhuman animals used in research. AAALAC-accredited facilities receive preferential treatment from funding agencies and are viewed favorably by the general public. Thus, it bears investigating how well these facilities comply with U.S. animal research regulations. In this study, the incidences of noncompliance with the Animal Welfare Act (AWA) at AAALAC-accredited facilities were evaluated and compared to those at nonaccredited institutions during a period of 2 years. The analysis revealed that AAALAC-accredited facilities were frequently cited for AWA noncompliance items (NCIs). Controlling for the number of animals at each facility, AAALAC-accredited sites had significantly more AWA NCIs on average compared with nonaccredited sites. AAALAC-accredited sites also had more NCIs related to improper veterinary care, personnel qualifications, and animal husbandry. These results demonstrate that AAALAC accreditation does not improve compliance with regulations governing the treatment of animals in laboratories. PMID:25174609

  11. Adequate supervision for children and adolescents.

    PubMed

    Anderst, James; Moffatt, Mary

    2014-11-01

    Primary care providers (PCPs) have the opportunity to improve child health and well-being by addressing supervision issues before an injury or exposure has occurred and/or after an injury or exposure has occurred. Appropriate anticipatory guidance on supervision at well-child visits can improve supervision of children, and may prevent future harm. Adequate supervision varies based on the child's development and maturity, and the risks in the child's environment. Consideration should be given to issues as wide ranging as swimming pools, falls, dating violence, and social media. By considering the likelihood of harm and the severity of the potential harm, caregivers may provide adequate supervision by minimizing risks to the child while still allowing the child to take "small" risks as needed for healthy development. Caregivers should initially focus on direct (visual, auditory, and proximity) supervision of the young child. Gradually, supervision needs to be adjusted as the child develops, emphasizing a safe environment and safe social interactions, with graduated independence. PCPs may foster adequate supervision by providing concrete guidance to caregivers. In addition to preventing injury, supervision includes fostering a safe, stable, and nurturing relationship with every child. PCPs should be familiar with age/developmentally based supervision risks, adequate supervision based on those risks, characteristics of neglectful supervision based on age/development, and ways to encourage appropriate supervision throughout childhood. PMID:25369578

  12. Ensuring pain relief for children at the end of life

    PubMed Central

    Grgoire, Marie-Claude; Frager, Gerri

    2006-01-01

    Pain management in the context of pediatric palliative care can be challenging. The present article reviews, through a case-based presentation, the nonpharmacological and pharmacological methods used to ensure adequate pain control in children facing end of life. Details on the impressive range of opioid dosages required and routes of administration are highlighted from published literature and clinical experience. Where available, evidence-based recommendations are provided. Potential side effects of pain medication and barriers to good pain control are discussed. Novel analgesics and innovative delivery methods are presented as future tools enhancing pain relief at the end of life. Some challenges to ethically grounded research in this important context of care are reviewed. PMID:16960633

  13. Ensuring condensate recovery efficiency.

    PubMed

    Mayoh, Paul

    2012-09-01

    According to steam system specialist, Spirax Sarco, 'condensate contains about a quarter of the energy of the steam from which it came--a significant amount of heat available to an energy centre'. Ensuring that existing condensate recovery systems are as efficient as possible is therefore 'key' to reducing energy centre costs, the company says. Paul Mayoh, product manager, Spirax Sarco, considers ways to ensure that as much condensate as possible is re-used. PMID:23009016

  14. 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

    Francoeur, Richard B

    2011-01-01

    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). PMID:22312232

  15. Protecting Our Children: State and Federal Policies for Exempt Child Care Settings.

    ERIC Educational Resources Information Center

    Blank, Helen

    This study examined the extent to which states are adequately ensuring the health and safety of children who are cared for in informal care settings receiving public funds. Protections were analyzed for children receiving in-home care or family child care in settings that are legally exempt from state licensing or registration requirements. The

  16. Ensuring Students' Success

    ERIC Educational Resources Information Center

    Oblinger, James L.

    2006-01-01

    James L. Oblinger, Chancellor of North Carolina State University, argues that higher education must continually evolve new methods of teaching and learning to support students' lifelong skills and impending careers. Part of ensuring students' success lies in finding alternative learning models, such as the Student-Centered Activities for Large…

  17. Ensuring Students' Success

    ERIC Educational Resources Information Center

    Oblinger, James L.

    2006-01-01

    James L. Oblinger, Chancellor of North Carolina State University, argues that higher education must continually evolve new methods of teaching and learning to support students' lifelong skills and impending careers. Part of ensuring students' success lies in finding alternative learning models, such as the Student-Centered Activities for Large

  18. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., Fire Science, etc.). (5) Resource provider has 24-hour availability of personnel and equipment, and... up front capital to support an operation. (12) Resource provider has equipment and experience to...

  19. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... provider is currently working in response service needed. (2) Resource provider has documented history of...) Resource provider owns or has contracts for equipment needed to perform response services. (4) Resource.../or marine firefighting services which they intend to provide. (11) Resource provider has...

  20. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... provider is currently working in response service needed. (2) Resource provider has documented history of...) Resource provider owns or has contracts for equipment needed to perform response services. (4) Resource.../or marine firefighting services which they intend to provide. (11) Resource provider has...

  1. Ensuring safer drinking water

    SciTech Connect

    Christensen, J. . Fluid Delivery and Electrical Markets); Higgins, P. )

    1994-09-01

    Today's regulatory environment has led to the proliferation of voluntary consensus standards and certification programs that are important to ensuring safety and health in a number of areas. One such area -- the treatment and delivery of potable water -- is addressed by the Drinking Water Additives Program.'' At the request of the Environmental Protection Agency (EPA), this program was developed in the mid-1980s by an independent, voluntary consensus standards organization called NSF International (formerly known as the National Sanitation Foundation). This paper explains the need for and the structure of the Drinking Water Additives Program; the rationale for transferring responsibility for its execution from the EPA to the private sector; and the impact of its standards on users, manufacturers, and state and local regulatory bodies. Understanding the additives program is critically important to industry suppliers because, as it continues to gain greater awareness and acceptance, there are a growing number of manufacturers sourcing materials and products primarily from suppliers whose products meet the program's certification requirements.

  2. Is a vegetarian diet adequate for children.

    PubMed

    Hackett, A; Nathan, I; Burgess, L

    1998-01-01

    The number of people who avoid eating meat is growing, especially among young people. Benefits to health from a vegetarian diet have been reported in adults but it is not clear to what extent these benefits are due to diet or to other aspects of lifestyles. In children concern has been expressed concerning the adequacy of vegetarian diets especially with regard to growth. The risks/benefits seem to be related to the degree of restriction of he diet; anaemia is probably both the main and the most serious risk but this also applies to omnivores. Vegan diets are more likely to be associated with malnutrition, especially if the diets are the result of authoritarian dogma. Overall, lacto-ovo-vegetarian children consume diets closer to recommendations than omnivores and their pre-pubertal growth is at least as good. The simplest strategy when becoming vegetarian may involve reliance on vegetarian convenience foods which are not necessarily superior in nutritional composition. The vegetarian sector of the food industry could do more to produce foods closer to recommendations. Vegetarian diets can be, but are not necessarily, adequate for children, providing vigilance is maintained, particularly to ensure variety. Identical comments apply to omnivorous diets. Three threats to the diet of children are too much reliance on convenience foods, lack of variety and lack of exercise. PMID:9670174

  3. Ensuring Academic Standards in US Higher Education

    ERIC Educational Resources Information Center

    Dill, David D.

    2014-01-01

    The most recent research on college-student learning in the US by respected scholars such as Richard Arum, Josipa Roksa, and Ernest Pascarella suggests that the nation's means of ensuring academic standards in US colleges and universities are not working effectively. Like US K-12 education and health care, the US higher education system is

  4. 7 CFR 3017.900 - Adequate evidence.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Adequate evidence. 3017.900 Section 3017.900 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER... Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that...

  5. Minimum Standards for Tribal Child Care Centers.

    ERIC Educational Resources Information Center

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

    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

  6. Implementing technological safeguards to ensure patient privacy.

    PubMed

    Leestma, Ryan

    2003-02-01

    Computers play an increasingly important role in the storage and retrieval of patient data. Internet attack incidents are growing at the astronomical rate of 64 percent a year, and some estimates state that employees are responsible for more than 80 percent of all security breaches. The information security regulations of the Health Insurance Portability and Accountability Act provide an impetus for health care providers to implement processes that ensure the safety and confidentiality of patient information. PMID:12625255

  7. 29 CFR 505.5 - Adequate assurances.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Adequate assurances. 505.5 Section 505.5 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS LABOR STANDARDS ON PROJECTS OR PRODUCTIONS ASSISTED BY GRANTS FROM THE NATIONAL ENDOWMENTS FOR THE ARTS AND HUMANITIES 505.5 Adequate assurances. (a)...

  8. 29 CFR 505.5 - Adequate assurances.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 3 2012-07-01 2012-07-01 false Adequate assurances. 505.5 Section 505.5 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS LABOR STANDARDS ON PROJECTS OR PRODUCTIONS ASSISTED BY GRANTS FROM THE NATIONAL ENDOWMENTS FOR THE ARTS AND HUMANITIES 505.5 Adequate assurances. (a)...

  9. 29 CFR 505.5 - Adequate assurances.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 3 2014-07-01 2014-07-01 false Adequate assurances. 505.5 Section 505.5 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS LABOR STANDARDS ON PROJECTS OR PRODUCTIONS ASSISTED BY GRANTS FROM THE NATIONAL ENDOWMENTS FOR THE ARTS AND HUMANITIES 505.5 Adequate assurances. (a)...

  10. 29 CFR 505.5 - Adequate assurances.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 3 2011-07-01 2011-07-01 false Adequate assurances. 505.5 Section 505.5 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS LABOR STANDARDS ON PROJECTS OR PRODUCTIONS ASSISTED BY GRANTS FROM THE NATIONAL ENDOWMENTS FOR THE ARTS AND HUMANITIES 505.5 Adequate assurances. (a)...

  11. 29 CFR 505.5 - Adequate assurances.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 3 2013-07-01 2013-07-01 false Adequate assurances. 505.5 Section 505.5 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS LABOR STANDARDS ON PROJECTS OR PRODUCTIONS ASSISTED BY GRANTS FROM THE NATIONAL ENDOWMENTS FOR THE ARTS AND HUMANITIES 505.5 Adequate assurances. (a)...

  12. Blood Pressure Management Controversies in Neurocritical Care.

    PubMed

    McNett, Molly; Koren, Jay

    2016-03-01

    Blood pressure (BP) management is essential in neurocritical care settings to ensure adequate cerebral perfusion and prevent secondary brain injury. Despite consensus on the importance of BP monitoring, significant practice variations persist regarding optimal methods for monitoring and treatment of BP values among patients with neurologic injuries. This article provides a summary of research investigating various approaches for BP management in neurocritical care. Evidence-based recommendations, areas for future research, and current technological advancements for BP management are discussed. PMID:26873756

  13. Tools for Ensuring Program Integrity.

    ERIC Educational Resources Information Center

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

    This training document for financial assistance professionals discusses ensuring program integrity in student financial aid and describes some tools for ensuring internal and external program integrity. The training focuses on these tools and resources: (1) the Federal Student Aid (FSA) Schools Portal; (2) the Information for Financial Aid

  14. Tools for Ensuring Program Integrity.

    ERIC Educational Resources Information Center

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

    This training document for financial assistance professionals discusses ensuring program integrity in student financial aid and describes some tools for ensuring internal and external program integrity. The training focuses on these tools and resources: (1) the Federal Student Aid (FSA) Schools Portal; (2) the Information for Financial Aid…

  15. Modernizing Medicare's Benefit Design and Low-Income Subsidies to Ensure Access and Affordability.

    PubMed

    Schoen, Cathy; Davis, Karen; Buttorff, Christine; Andersen, Martin

    2015-07-01

    Insurance coverage through the traditional Medicare program is complex, fragmented, and incomplete. Beneficiaries must purchase supplemental private insurance to fill in the gaps. While impoverished beneficiaries may receive supplemental coverage through Medicaid and subsidies for prescription drugs, help is limited for people with incomes above the poverty level. This patchwork quilt leads to confusion for beneficiaries and high administrative costs, while also undermining coverage and care coordination. Most important, Medicare's benefits fail to limit out-of-pocket costs or ensure adequate financial protection, especially for beneficiaries with low incomes and serious health problems. This brief, part of a series about Medicare's past, present, and future, presents options for an integrated benefit for enrollees in traditional Medicare. The new benefit would not only reduce cost burdens but also could potentially strengthen the Medicare program and enhance its role in stimulating and supporting innovations throughout the health care delivery system. PMID:26219116

  16. Promoting sleep in the adult surgical intensive care unit patients to prevent delirium.

    PubMed

    Hata, Rose K L; Han, Lois; Slade, Jill; Miyahira, Asa; Passion, ChristyAnne; Ghows, Maimona; Izumi, Kara; Yu, Mihae

    2014-09-01

    Ensuring adequate sleep for hospitalized patients is important for reducing stress, improving healing, and decreasing episodes of delirium. The purpose of this project was to implement a Sleep Program for stable patients in the surgical intensive care unit, thereby changing sleep management practices and ensuring quality of care using an evidence-based practice approach. Improving patient satisfaction with sleep by 28 percentage points may be attributed to a standardized process of providing a healing environment for patients to sleep. PMID:25155537

  17. Asbestos/NESHAP adequately wet guidance

    SciTech Connect

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

    1990-12-01

    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.

  18. Small Rural Schools CAN Have Adequate Curriculums.

    ERIC Educational Resources Information Center

    Loustaunau, Martha

    The small rural school's foremost and largest problem is providing an adequate curriculum for students in a changing world. Often the small district cannot or is not willing to pay the per-pupil cost of curriculum specialists, specialized courses using expensive equipment no more than one period a day, and remodeled rooms to accommodate new…

  19. Funding the Formula Adequately in Oklahoma

    ERIC Educational Resources Information Center

    Hancock, Kenneth

    2015-01-01

    This report is a longevity, simulational study that looks at how the ratio of state support to local support effects the number of school districts that breaks the common school's funding formula which in turns effects the equity of distribution to the common schools. After nearly two decades of adequately supporting the funding formula, Oklahoma…

  20. Ensuring ethical behavior in organizations

    SciTech Connect

    Milter, R.G.

    1994-12-31

    This paper examines both the industrial-age and the information-age organization`s attempts to ensure ethical behavior. Organizational responses to deal with this task include establishing written codes, appointing ethics officers, developing ethics committees, training, and impacting educational systems.

  1. Ensuring High Quality Research Services.

    ERIC Educational Resources Information Center

    Gardner, Bob

    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.

  2. Ensuring opioid availability: methods and resources.

    PubMed

    Joranson, David E; Ryan, Karen M

    2007-05-01

    The pain and palliative care fields are encouraged to learn about government drug control policy and to engage with their governments to examine these policies and their implementation in order to address impediments to patient access to pain management. Although pain management is a necessary part of palliative care, it is often impossible because strict national and state regulations block access to opioid analgesics. It is important for us to know that in adhering to international drug treaties, governments often concentrate on drug control to the exclusion of their obligation to ensure opioid availability for medical and scientific purposes. Indeed, international health and regulatory authorities are increasingly concerned about wide disparities in national consumption of opioid analgesics and have called on governments to address barriers in their national laws and regulations that govern the prescribing of opioid analgesics. The Pain & Policy Studies Group (PPSG) has developed methods and resources to assist governments and pain and palliative care groups to examine national policies and make regulatory changes. Romania, India, and Italy are examples. The PPSG is developing several new resources, including a training program for Fellows from low- and middle-income countries, enhanced support of collaborators working on opioid availability, an internet course in international pain policy, an improved website with policy resources and country profiles, and new approaches to the study of opioid consumption indicators. PMID:17482042

  3. Ensuring equal opportunity sprinkler irrigation

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Equal opportunity for plants to sprinkler irrigation water must be carefully considered by crop producers, irrigation consultants, and the industry that supplies the irrigation equipment. Equal opportunity can be negated by improper marketing, design, and installation, as well as through improper f...

  4. Ensuring the Health of Children in Disasters.

    PubMed

    2015-11-01

    Infants, children, adolescents, and young adults have unique physical, mental, behavioral, developmental, communication, therapeutic, and social needs that must be addressed and met in all aspects of disaster preparedness, response, and recovery. Pediatricians, including primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists, have key roles to play in preparing and treating families in cases of disasters. Pediatricians should attend to the continuity of practice operations to provide services in time of need and stay abreast of disaster and public health developments to be active participants in community planning efforts. Federal, state, tribal, local, and regional institutions and agencies that serve children should collaborate with pediatricians to ensure the health and well-being of children in disasters. PMID:26482663

  5. Improving access to adequate pain management in Taiwan.

    PubMed

    Scholten, Willem

    2015-06-01

    There is a global crisis in access to pain management in the world. WHO estimates that 4.65 billion people live in countries where medical opioid consumption is near to zero. For 2010, WHO considered a per capita consumption of 216.7 mg morphine equivalents adequate, while Taiwan had a per capita consumption of 0.05 mg morphine equivalents in 2007. In Asia, the use of opioids is sensitive because of the Opium Wars in the 19th century and for this reason, the focus of controlled substances policies has been on the prevention of diversion and dependence. However, an optimal public health outcome requires that also the beneficial aspects of these substances are acknowledged. Therefore, WHO recommends a policy based on the Principle of Balance: ensuring access for medical and scientific purposes while preventing diversion, harmful use and dependence. Furthermore, international law requires that countries ensure access to opioid analgesics for medical and scientific purposes. There is evidence that opioid analgesics for chronic pain are not associated with a major risk for developing dependence. Barriers for access can be classified in the categories of overly restrictive laws and regulations; insufficient medical training on pain management and problems related to assessment of medical needs; attitudes like an excessive fear for dependence or diversion; and economic and logistical problems. The GOPI project found many examples of such barriers in Asia. Access to opioid medicines in Taiwan can be improved by analysing the national situation and drafting a plan. The WHO policy guidelines Ensuring Balance in National Policies on Controlled Substances can be helpful for achieving this purpose, as well as international guidelines for pain treatment. PMID:26068436

  6. How Much and What Kind? Identifying an Adequate Technology Infrastructure for Early Childhood Education. Policy Brief

    ERIC Educational Resources Information Center

    Daugherty, Lindsay; Dossani, Rafiq; Johnson, Erin-Elizabeth; Wright, Cameron

    2014-01-01

    To realize the potential benefits of technology use in early childhood education (ECE), and to ensure that technology can help to address the digital divide, providers, families of young children, and young children themselves must have access to an adequate technology infrastructure. The goals for technology use in ECE that a technology…

  7. How Much and What Kind? Identifying an Adequate Technology Infrastructure for Early Childhood Education. Policy Brief

    ERIC Educational Resources Information Center

    Daugherty, Lindsay; Dossani, Rafiq; Johnson, Erin-Elizabeth; Wright, Cameron

    2014-01-01

    To realize the potential benefits of technology use in early childhood education (ECE), and to ensure that technology can help to address the digital divide, providers, families of young children, and young children themselves must have access to an adequate technology infrastructure. The goals for technology use in ECE that a technology

  8. Ensuring excellence in immunization services.

    PubMed

    MacDonald, Pauline

    2016-01-01

    In order to increase uptake of measles, mumps and rubella (MMR) vaccine, a domiciliary immunization service was established in Dudley primary care trust in England in 2010. Parents of unimmunized children were offered vaccines at home. Uptake of MMR vaccine among 2 year olds rose from 89% in 2007/08 to 96.9% in 2015. Children were also given any other outstanding immunizations. The domiciliary immunization service reached vulnerable unimmunized children who may otherwise have remained unprotected against life threatening childhood illnesses. Domiciliary immunization service was set up in 2010 to reduce inequalities in uptake of MMR vaccine among children aged between 2 and 5 years. PMID:26618244

  9. Two pathways ensuring social harmony

    NASA Astrophysics Data System (ADS)

    Konrad, Matthias; Pamminger, Tobias; Foitzik, Susanne

    2012-08-01

    Reproductive division of labour is a characteristic trait of social insects. The dominant reproductive individual, often the queen, uses chemical communication and/or behaviour to maintain her social status. Queens of many social insects communicate their fertility status via cuticle-bound substances. As these substances usually possess a low volatility, their range in queen-worker communication is potentially limited. Here, we investigate the range and impact of behavioural and chemical queen signals on workers of the ant Temnothorax longispinosus. We compared the behaviour and ovary development of workers subjected to three different treatments: workers with direct chemical and physical contact to the queen, those solely under the influence of volatile queen substances and those entirely separated from the queen. In addition to short-ranged queen signals preventing ovary development in workers, we discovered a novel secondary pathway influencing worker behaviour. Workers with no physical contact to the queen, but exposed to volatile substances, started to develop their ovaries, but did not change their behaviour compared to workers in direct contact to the queen. In contrast, workers in queen-separated groups showed both increased ovary development and aggressive dominance interactions. We conclude that T. longispinosus queens influence worker ovary development and behaviour via two independent signals, both ensuring social harmony within the colony.

  10. Adequate mathematical modelling of environmental processes

    NASA Astrophysics Data System (ADS)

    Chashechkin, Yu. D.

    2012-04-01

    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.

  11. 50 CFR 530.2 - Ensuring that environmental documents are actually considered in agency decision-making.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... COMMISSION COMPLIANCE WITH THE NATIONAL ENVIRONMENTAL POLICY ACT 530.2 Ensuring that environmental... 50 Wildlife and Fisheries 9 2011-10-01 2011-10-01 false Ensuring that environmental documents are... requirements to ensure adequate consideration of environmental documents in agency decision-making....

  12. 50 CFR 530.2 - Ensuring that environmental documents are actually considered in agency decision-making.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... COMMISSION COMPLIANCE WITH THE NATIONAL ENVIRONMENTAL POLICY ACT 530.2 Ensuring that environmental... 50 Wildlife and Fisheries 11 2012-10-01 2012-10-01 false Ensuring that environmental documents are... requirements to ensure adequate consideration of environmental documents in agency decision-making....

  13. 50 CFR 530.2 - Ensuring that environmental documents are actually considered in agency decision-making.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... COMMISSION COMPLIANCE WITH THE NATIONAL ENVIRONMENTAL POLICY ACT 530.2 Ensuring that environmental... 50 Wildlife and Fisheries 11 2013-10-01 2013-10-01 false Ensuring that environmental documents are... requirements to ensure adequate consideration of environmental documents in agency decision-making....

  14. 50 CFR 530.2 - Ensuring that environmental documents are actually considered in agency decision-making.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... COMMISSION COMPLIANCE WITH THE NATIONAL ENVIRONMENTAL POLICY ACT 530.2 Ensuring that environmental... 50 Wildlife and Fisheries 11 2014-10-01 2014-10-01 false Ensuring that environmental documents are... requirements to ensure adequate consideration of environmental documents in agency decision-making....

  15. Developing a service model that integrates palliative care throughout cancer care: the time is now.

    PubMed

    Partridge, Ann H; Seah, Davinia S E; King, Tari; Leighl, Natasha B; Hauke, Ralph; Wollins, Dana S; Von Roenn, Jamie Hayden

    2014-10-10

    Palliative care is a fundamental component of cancer care. As part of the 2011 to 2012 Leadership Development Program (LDP) of the American Society of Clinical Oncology (ASCO), a group of participants was charged with advising ASCO on how to develop a service model integrating palliative care throughout the continuum of cancer care. This article presents the findings of the LDP group. The group focused on the process of palliative care delivery in the oncology setting. We identified key elements for models of palliative care in various settings to be potentially equitable, sustainable, feasible, and acceptable, and here we describe a dynamic model for the integrated, simultaneous implementation of palliative care into oncology practice. We also discuss critical considerations to better integrate palliative care into oncology, including raising consciousness and educating both providers and the public about the importance of palliative care; coordinating palliative care efforts through strengthening affiliations and/or developing new partnerships; prospectively evaluating the impact of palliative care on patient and provider satisfaction, quality improvement, and cost savings; and ensuring sustainability through adequate reimbursement and incentives, including linkage of performance data to quality indicators, and coordination with training efforts and maintenance of certification requirements for providers. In light of these findings, we believe the confluence of increasing importance of incorporation of palliative care education in oncology education, emphasis on value-based care, growing use of technology, and potential cost savings makes developing and incorporating palliative care into current service models a meaningful goal. PMID:25199756

  16. Are women with psychosis receiving adequate cervical cancer screening?

    PubMed Central

    Tilbrook, Devon; Polsky, Jane; Lofters, Aisha

    2010-01-01

    ABSTRACT OBJECTIVE To investigate the rates of cervical cancer screening among female patients with psychosis compared with similar patients without psychosis, as an indicator of the quality of primary preventive health care. DESIGN A retrospective cohort study using medical records between November 1, 2004, and November 1, 2007. SETTING Two urban family medicine clinics associated with an academic hospital in Toronto, Ont. PARTICIPANTS A random sample of female patients with and without psychosis between the ages of 20 and 69 years. MAIN OUTCOME MEASURES Number of Papanicolaou tests in a 3-year period. RESULTS Charts for 51 female patients with psychosis and 118 female patients without psychosis were reviewed. Of those women with psychosis, 62.7% were diagnosed with schizophrenia, 19.6% with bipolar disorder, 17.6% with schizoaffective disorder, and 29.4% with other psychotic disorders. Women in both groups were similar in age, rate of comorbidities, and number of full physical examinations. Women with psychosis were significantly more likely to smoke (P < .0001), to have more primary care appointments (P = .035), and to miss appointments (P = .0002) than women without psychosis. After adjustment for age, other psychiatric illnesses, number of physical examinations, number of missed appointments, and having a gynecologist, women with psychosis were significantly less likely to have had a Pap test in the previous 3 years compared with women without psychosis (47.1% vs 73.7%, respectively; odds ratio 0.19, 95% confidence interval 0.06 to 0.58). CONCLUSION Women with psychosis are more than 5 times less likely to receive adequate Pap screening compared with the general population despite their increased rates of smoking and increased number of primary care visits. PMID:20393098

  17. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Assurances of adequate capacity and services. 438.207 Section 438.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Access Standards ...

  18. On Adequate Comparisons of Antenna Phase Center Variations

    NASA Astrophysics Data System (ADS)

    Schoen, S.; Kersten, T.

    2013-12-01

    One important part for ensuring the high quality of the International GNSS Service's (IGS) products is the collection and publication of receiver - and satellite antenna phase center variations (PCV). The PCV are crucial for global and regional networks, since they introduce a global scale factor of up to 16ppb or changes in the height component with an amount of up to 10cm, respectively. Furthermore, antenna phase center variations are also important for precise orbit determination, navigation and positioning of mobile platforms, like e.g. the GOCE and GRACE gravity missions, or for the accurate Precise Point Positioning (PPP) processing. Using the EUREF Permanent Network (EPN), Baire et al. (2012) showed that individual PCV values have a significant impact on the geodetic positioning. The statements are further supported by studies of Steigenberger et al. (2013) where the impact of PCV for local-ties are analysed. Currently, there are five calibration institutions including the Institut für Erdmessung (IfE) contributing to the IGS PCV file. Different approaches like field calibrations and anechoic chamber measurements are in use. Additionally, the computation and parameterization of the PCV are completely different within the methods. Therefore, every new approach has to pass a benchmark test in order to ensure that variations of PCV values of an identical antenna obtained from different methods are as consistent as possible. Since the number of approaches to obtain these PCV values rises with the number of calibration institutions, there is the necessity for an adequate comparison concept, taking into account not only the numerical values but also stochastic information and computational issues of the determined PCVs. This is of special importance, since the majority of calibrated receiver antennas published by the IGS origin from absolute field calibrations based on the Hannover Concept, Wübbena et al. (2000). In this contribution, a concept for the adequate comparison as well as combination of PCV values will be presented. Since PCV corrections have to be applied in PPP Processing, the effect on the coordinate estimates have to be studied in detail to verify the consistent PCV modeling during the PPP processing and to quantify the impact on the coordinate domain also. Furthermore, due to the high correlation between station height, troposphere and receiver clock estimates, the impact on all estimated parameters has to be quantified. Since PPP is also frequently used for precise frequency comparison, the effect of PCV is of special interest in this field, too. References Baire Q, Pottiaux E, Bryninx C, Defraigne P, Aerts W, Legrand J, Bergeot N, Chevalier J (2012) Impact of different individual GNSS receiver antenna calibration models on geodetic positioning. EGU General Assembly 2012, #EGU2012-4963-1. Steigenberger P, Hugentobler U, Schmid R, Hessels U, Klügel T, Seitz M (2013) GPS-Specific Local Effects at the Geodetic Observatory Wettzell. In Reference Frames for Applications in Geosciences, IAG Symposia, 138: 125-130. Springer. Wübbena G, Schmitz M, Menge F, Böder V, Seeber G (2000). Automated Absolute Field Calibration of GPS Antennas in Real-Time. Proc. ION GPS 2000, pp 2512-2522.

  19. Capecitabine and temozolomide: design, implementation, and preliminary outcomes from a pilot project to ensure safe prescribing of oral chemotherapy.

    PubMed

    Jatoi, Aminah; Smith, Emily L; Gunderson, Heidi D; Hartgers, Mindy L; Looker, Sherry A; Santana-Davila, Rafael; McWilliams, Robert R

    2010-07-01

    Without adequate safety measures, oral chemotherapy can lead to undetected dosing errors. The Mayo Clinic launched a project to ensure that all capecitabine and temozolomide prescriptions receive an independent double check. PMID:21037876

  20. [Challenges Associated with Involvement of Small-Scale Pharmacies in Home Health Care].

    PubMed

    Oka, Toyoka; Takeda, Namihiro; Hamana, Tomoko; Hirohara, Masayoshi; Kushida, Kazuki

    2015-11-01

    As our society is progressing towards a composition wherein a significant portion is constituted by the elderly, a comprehensive home health care system is warranted. The provision of pharmacy services is a key factor in ensuring comprehensive home health care. Our pharmacy has been involved in home health care since its inception. This report is an attempt at evaluation of future prospects through identification and analysis of current operational issues. Our pharmacy is adequately equipped to accommodate home cared patients with significant medical dependency. However, being a small-scale business with few employees, coordinating shifts to ensure 24 hours operation in addition to providing home visits when required has been challenging. These place a substantial burden on the staff pharmacists. It is highly challenging for a single small-scale pharmacy to operate as a"self-contained pharmacy"that remains independent and still adequately serves their clients. Creating a collaborative pharmaceutical service team, consisting of several complementary small-scale pharmacies, provisionally called a "regional cooperative pharmacy,"could prove to be a more realistic alternative. In the coming decade, improving the implementation of home health care through regional level cooperation is necessary. This would require the collaboration various professionals, and the involvement of municipalities and professional organizations to ensure adequate regional support services. PMID:26809404

  1. Ensuring the Safety of Your Endoscopic Procedure

    MedlinePLUS

    ... Donate Your Gift At Work Ways to Give Testimonials Planned Giving Circle of Light Society GI Corporate ... Procedure Ensures Patient Safety In all areas of medicine and surgery, complex medical devices are generally not ...

  2. Ensuring Safe Use of Contact Lens Solution

    MedlinePLUS

    ... For Consumers Consumer Updates Ensuring Safe Use of Contact Lens Solution Share Tweet Linkedin Pin it More ... back to top Dos and Don'ts for Contact Lens Wearers DO: Always wash your hands before ...

  3. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining...

  4. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining...

  5. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining...

  6. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining...

  7. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining...

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

    ERIC Educational Resources Information Center

    Parker, Jan

    2014-01-01

    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…

  9. 34 CFR 200.14 - Components of Adequate Yearly Progress.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 1 2011-07-01 2011-07-01 false Components of Adequate Yearly Progress. 200.14 Section 200.14 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND... Components of Adequate Yearly Progress. A State's definition of AYP must include all of the following: (a)...

  10. 34 CFR 200.14 - Components of Adequate Yearly Progress.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Components of Adequate Yearly Progress. 200.14 Section 200.14 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND... Components of Adequate Yearly Progress. A State's definition of AYP must include all of the following: (a)...

  11. 34 CFR 200.14 - Components of Adequate Yearly Progress.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 1 2013-07-01 2013-07-01 false Components of Adequate Yearly Progress. 200.14 Section 200.14 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND... Components of Adequate Yearly Progress. A State's definition of AYP must include all of the following: (a)...

  12. 34 CFR 200.14 - Components of Adequate Yearly Progress.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 1 2014-07-01 2014-07-01 false Components of Adequate Yearly Progress. 200.14 Section 200.14 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND... Components of Adequate Yearly Progress. A State's definition of AYP must include all of the following: (a)...

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

    ERIC Educational Resources Information Center

    Parker, Jan

    2014-01-01

    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

  14. 13 CFR 108.200 - Adequate capital for NMVC Companies.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... VENTURE CAPITAL (NMVC) PROGRAM Qualifications for the NMVC Program Capitalizing A Nmvc Company 108.200 Adequate capital for NMVC Companies. You must meet the requirements of 108.200-108.230 in order to... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Adequate capital for...

  15. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Sanitation and adequate facilities... AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY... OF VIOLATION 305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated if...

  16. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Sanitation and adequate facilities... AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY... OF VIOLATION 305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated if...

  17. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Adequate file search. 716.25 Section... ACT HEALTH AND SAFETY DATA REPORTING General Provisions 716.25 Adequate file search. The scope of a person's responsibility to search records is limited to records in the location(s) where the...

  18. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 32 2013-07-01 2013-07-01 false Adequate file search. 716.25 Section... ACT HEALTH AND SAFETY DATA REPORTING General Provisions 716.25 Adequate file search. The scope of a person's responsibility to search records is limited to records in the location(s) where the...

  19. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 31 2011-07-01 2011-07-01 false Adequate file search. 716.25 Section... ACT HEALTH AND SAFETY DATA REPORTING General Provisions 716.25 Adequate file search. The scope of a person's responsibility to search records is limited to records in the location(s) where the...

  20. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 31 2014-07-01 2014-07-01 false Adequate file search. 716.25 Section... ACT HEALTH AND SAFETY DATA REPORTING General Provisions 716.25 Adequate file search. The scope of a person's responsibility to search records is limited to records in the location(s) where the...

  1. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 32 2012-07-01 2012-07-01 false Adequate file search. 716.25 Section... ACT HEALTH AND SAFETY DATA REPORTING General Provisions 716.25 Adequate file search. The scope of a person's responsibility to search records is limited to records in the location(s) where the...

  2. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 2 2013-07-01 2013-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain the administrative resources necessary to perform all of the program functions including...

  3. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 2 2014-07-01 2014-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain the administrative resources necessary to perform all of the program functions including...

  4. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 2 2012-07-01 2012-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain the administrative resources necessary to perform all of the program functions including...

  5. 41 CFR 51-7.3 - Ensuring environmental documents are actually considered in agency determinations.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... documents are actually considered in agency determinations. (a) 40 CFR 1505.1 of the NEPA regulations contains requirements to ensure adequate consideration of environmental documents in agency decision-making... environmental documents as a part of their decision-making: (1) Action: Request. (2) Start of NEPA process:...

  6. 41 CFR 51-7.3 - Ensuring environmental documents are actually considered in agency determinations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... documents are actually considered in agency determinations. (a) 40 CFR 1505.1 of the NEPA regulations contains requirements to ensure adequate consideration of environmental documents in agency decision-making... environmental documents as a part of their decision-making: (1) Action: Request. (2) Start of NEPA process:...

  7. 41 CFR 51-7.3 - Ensuring environmental documents are actually considered in agency determinations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... documents are actually considered in agency determinations. (a) 40 CFR 1505.1 of the NEPA regulations contains requirements to ensure adequate consideration of environmental documents in agency decision-making... environmental documents as a part of their decision-making: (1) Action: Request. (2) Start of NEPA process:...

  8. 36 CFR 805.4 - Ensuring environmental documents are actually considered in Council decisionmaking.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) Section 1505.1 of the NEPA regulations (40 CFR 1505.1) contains requirements to ensure adequate...; and, (4) Where an environmental impact statement (EIS) has been prepared consider the specific alternative analyzed in the EIS when evaluating the proposal which is the subject of the EIS. (b) For each...

  9. Consumer participation: ensuring suicide postvention research counts for end users.

    PubMed

    Wilson, Anne

    2010-02-01

    Primary health-care research is about working with those who have a vested interest in the outcomes of that research, including consumers, service providers and service organizations. This article describes how consumers were included in the research processes of a South Australian study into suicide postvention services, and illustrates important principles to consider when including consumers in research. A concurrent mixed-method approach facilitated the collection of mixed data through the application of questionnaires. The study was conducted in an Australian metropolitan area. Because of media releases, a large number of people rang to enquire and volunteer their participation. From over 200 expressions of interest, 161 individuals participated. The participation of consumers in the research process ensured the findings were relevant for end users. A number of recommendations for the care and support of those bereaved through suicide were developed as a result. PMID:20158542

  10. Creative payment strategy helps ensure a future for teaching hospitals.

    PubMed

    Vancil, D R; Shroyer, A L

    1998-11-01

    The Colorado Medicaid Program in years past relied on disproportionate share hospital (DSH) payment programs to increase access to hospital care for Colorado citizens, ensure the future financial viability of key safety-net hospitals, and partially offset the state's cost of funding the Medicaid program. The options to finance Medicaid care using DSH payments, however, recently have been severely limited by legislative and regulatory changes. Between 1991 and 1997, a creative Medicaid refinancing strategy called the major teaching hospital (MTH) payment program enabled $131 million in net payments to be distributed to the two major teaching hospitals in Colorado to provide enhanced funding related to their teaching programs and to address the ever-expanding healthcare needs of their low-income patients. This new Medicaid payment mechanism brought the state $69.5 million in Federal funding that otherwise would not have been received. PMID:10187630

  11. Leveraging community-based financing for women's nonmaternal health care: experiences of rural Indian women.

    PubMed

    Gopalan, Saji S; Durairaj, Varatharajan

    2015-03-01

    Given the increasing need for mainstreaming household financing for women's nonmaternal health care and evidences on community-based financing's contribution to women's health care in general, this study explored their scope for nonmaternal health care in Orissa. A qualitative assessment conducted focus group discussions with rural women who met the eligibility criteria. Community-based financing provided financial access and risk protection for women's nonmaternal health care during the previous 1 year, though not adequately. Schemes covering outpatient care (or mild illnesses) provided relatively more financial access. The major determinants of their restricted financial access were limited sum assured, noncomprehensive coverage of services, exclusion of elderly women, and the lower priority households gave to nonmaternal health care. Community-based financing requires relevant structural changes along with demand-side behavioral modifications to ensure optimal attention to women's nonmaternal health care. PMID:22234831

  12. Electronic Information Delivery: Ensuring Quality and Value.

    ERIC Educational Resources Information Center

    Basch, Reva, Ed.

    How do you judge the accuracy, reliability, and completeness of an electronic or online database? What measures do publishers and distributors employ to ensure that quality standards are met? Who is responsible for what part of the process? Eighteen contributors address these questions and more in their discussion of an important issue in today's

  13. USGS Laboratory Review Program Ensures Analytical Quality

    USGS Publications Warehouse

    Erdmann, David E.

    1995-01-01

    The USGS operates a review program for laboratories that analyze samples for USGS environmental investigations. This program has been effective in providing QA feedback to laboratories while ensuring that analytical data are consistent, of satisfactory quality, and meet the data objectives of the investigation.

  14. Structuring the Talk: Ensuring Academic Conversations Matter

    ERIC Educational Resources Information Center

    Frey, Nancy; Fisher, Douglas

    2011-01-01

    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.

  15. Ensuring Subjects' Understanding of Informed Consent.

    ERIC Educational Resources Information Center

    Smith, Deborah L.; And Others

    1995-01-01

    A discussion of informed consent by human subjects in experimentation presents background on the consent issue, including federal requirements; lists factors that may affect a subject's ability to understand the consent document; and offers suggestions for preparing consent forms to ensure the subject's better comprehension. (Author/MSE)

  16. Heater Ensures Strain-Gage Bond Reliability

    NASA Technical Reports Server (NTRS)

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

    1984-01-01

    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.

  17. Electronic Information Delivery: Ensuring Quality and Value.

    ERIC Educational Resources Information Center

    Basch, Reva, Ed.

    How do you judge the accuracy, reliability, and completeness of an electronic or online database? What measures do publishers and distributors employ to ensure that quality standards are met? Who is responsible for what part of the process? Eighteen contributors address these questions and more in their discussion of an important issue in today's…

  18. 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...

  19. Integrating palliative care into national policies.

    PubMed

    Stjernswärd, Jan; Foley, Kathleen M; Ferris, Frank D

    2007-05-01

    Good policies lay the groundwork for an effective health care system and society. They facilitate the implementation of palliative care programs aimed at providing care for all people in need of these services, and they ensure equitable access to affordable medications and therapies. The lack of good policies can lead to unnecessary suffering and costs for patients, families, and society. Three-quarters of cancer patients worldwide are incurable when diagnosed. Because the size of the problem--and the suffering associated with cancer--is enormous, development of a national cancer control policy is an effective point of entry to begin integrating palliative care into a country's health care system. To be comprehensive, every cancer center must include palliative care. Ideally, palliative care is incorporated as a priority within all aspects of each country's national health plan, so that all patients living with or dying from any chronic disease may have their suffering relieved, including children and the elderly. To this end, policies that address essential medicines must include a list of palliative care medications. Supplies of affordable, generic medications that are "equally efficient" must be adequate and available throughout the country wherever patients live (especially opioids for pain control). PMID:17482040

  20. Ensuring system security through formal software evaluation

    SciTech Connect

    Howell, J A; Fuyat, C; Elvy, M

    1992-01-01

    With the increasing use of computer systems and networks to process safeguards information in nuclear facilities, the issue of system and data integrity is receiving worldwide attention. Among the many considerations are validation that the software performs as intended and that the information is adequately protected. Such validations are often requested of the Safeguards Systems Group of the Los Alamos National Laboratory. This paper describes our methodology for performing these software evaluations.

  1. Attitudes about providing HIV care: voices from publicly funded clinics in California

    PubMed Central

    Barnes, Revery; Koester, Kimberly A; Waldura, Jessica F

    2014-01-01

    Background. As the enactment of health care reform becomes a reality in the USA, it has been widely predicted that HIV+ patients will increasingly be cared for by primary care physicians (PCPs), many of whom lack the experience to deliver full-spectrum HIV care. Objective. To describe PCPs preparedness for an influx of HIV+ patients. Methods. This qualitative study included interviews with 20 PCPs from community health centres in California. We inquired about clinicians experiences with HIV, their strategies for dealing with unfamiliar aspects of medicine and their management of complicated patients. We also identified the clinicians preferred types of information and consultation resources. Results. PCPs are not yet comfortable as providers of comprehensive HIV care; however, they are dedicated to delivering excellent care to all of their patients, regardless of disease process. Although they prefer to refer HIV+ patients to centres of excellence, they are willing to adopt full responsibility when necessary and believe they can deliver high-quality HIV care if provided with adequate consultation and informational resources. Conclusions. The Affordable Care Act will insure an estimated 20000 more HIV+ patients in California. With a dwindling supply of HIV specialists, many of these patients will be principally cared for by PCPs. PCPs will go to great lengths to ensure that HIV+ patients receive superior care, but they need the support of HIV specialists to expand their skills. Priority should be given to ensuring that expert consultation is widely available to PCPs who find themselves caring for HIV+ patients. PMID:25121978

  2. Arabidopsis: An Adequate Model for Dicot Root Systems?

    PubMed Central

    Zobel, Richard W.

    2016-01-01

    The Arabidopsis root system is frequently considered to have only three classes of root: primary, lateral, and adventitious. Research with other plant species has suggested up to eight different developmental/functional classes of root for a given plant root system. If Arabidopsis has only three classes of root, it may not be an adequate model for eudicot plant root systems. Recent research, however, can be interpreted to suggest that pre-flowering Arabidopsis does have at least five (5) of these classes of root. This then suggests that Arabidopsis root research can be considered an adequate model for dicot plant root systems. PMID:26904040

  3. Do Beginning Teachers Receive Adequate Support from Their Headteachers?

    ERIC Educational Resources Information Center

    Menon, Maria Eliophotou

    2012-01-01

    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

  4. Assessing Juvenile Sex Offenders to Determine Adequate Levels of Supervision.

    ERIC Educational Resources Information Center

    Gerdes, Karen E.; And Others

    1995-01-01

    This study analyzed the internal consistency of four inventories used by Utah probation officers to determine adequate and efficacious supervision levels and placement for juvenile sex offenders. Three factors accounted for 41.2 percent of variance (custodian's and juvenile's attitude toward intervention, offense characteristics, and historical…

  5. Is the Stock of VET Skills Adequate? Assessment Methodologies.

    ERIC Educational Resources Information Center

    Blandy, Richard; Freeland, Brett

    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

  6. Comparability and Reliability Considerations of Adequate Yearly Progress

    ERIC Educational Resources Information Center

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

    2012-01-01

    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…

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

    ERIC Educational Resources Information Center

    Missouri Department of Elementary and Secondary Education, 2011

    2011-01-01

    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.

  8. Cross-functional support ensures success.

    PubMed

    Paree, Tim

    2012-04-01

    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

  9. Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

    PubMed Central

    2014-01-01

    Background Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used. Methods We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics. Results The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as too esoteric, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate. Conclusions Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and fitness for purpose, and avoid omission of vital knowledge. PMID:24555812

  10. Communication skills to ensure patient satisfaction.

    PubMed

    Shendurnikar, Niranjan; Thakkar, Pareshkumar A

    2013-11-01

    Every pediatrician would want to satisfy their patients and their parents to sustain good practice, earn name and fame and simultaneously to avoid litigation in this era of consumer protection act. This can be achieved only by use of good communication skills. Today the patients demand time, information and want their questions to be answered. They expect politeness, empathy and human touch from doctors. Time constraints, arrogance, telephone calls, language barriers and cultural insensitivity are the important barriers to good communication. Research has shown that doctor, who undergoes training to acquire good communication skills, can better satisfy his patients. Good communication skill is an art which can be acquired or improved by putting conscious efforts in day to day practice. Such skills should also be incorporated as part of medical teaching curriculum. Asking open ended questions, effective listening, appropriate praise, providing enough information as part of advice and finally checking their understanding, are the key areas of communication during medical interview. During this process pediatrician should ensure to address the parental concerns, should empathize with parents and involve parents in decision making. This will not only ensure satisfaction of parents but also their adherence to the therapy and to the pediatrician. PMID:23378053

  11. The role of corporations in ensuring biodiversity

    NASA Astrophysics Data System (ADS)

    Kelly, Joyce M.; Hodge, Michael R.

    1996-11-01

    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.

  12. Will the new Australian health privacy law provide adequate protection?

    PubMed

    Bomba, David; Hallit, George

    2002-01-01

    Amendments to the original Privacy Act (1988) come at a key point in time, as a national medical record system looms on the Australian horizon. Changes to The Privacy Act have the potential to define a level of information privacy prior to the implementation of such a system. We have therefore collected expert opinions on the ability of the Health Privacy Guidelines (enacted in December 2001 under The Privacy Act and hereafter more specifically known as Health Privacy Legislation) to ensure the privacy and security of patient information. We conclude that the legislation is flawed in its capacity to withstand an increasingly corporatised health sector. Deficiencies in consent requirements, together with feeble enforcement capabilities, mean The Legislation cannot effectively ensure that personally identifiable information will not end up in corporate third party hands. To significantly bolster the new legislation, we argue that it should be supplemented with explicit health data legislation and privacy auditing. PMID:12136555

  13. Future of Assurance: Ensuring that a System is Trustworthy

    NASA Astrophysics Data System (ADS)

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

    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.

  14. Paying pharmacists for patient care

    PubMed Central

    Houle, Sherilyn K. D.; Grindrod, Kelly A.; Chatterley, Trish; Tsuyuki, Ross T.

    2014-01-01

    Background: Expansion of scope of practice and diminishing revenues from dispensing are requiring pharmacists to increasingly adopt clinical care services into their practices. Pharmacists must be able to receive payment in order for provision of clinical care to be sustainable. The objective of this study is to update a previous systematic review by identifying remunerated pharmacist clinical care programs worldwide and reporting on uptake and patient care outcomes observed as a result. Methods: Literature searches were performed in several databases, including MEDLINE, Embase and International Pharmaceutical Abstracts, for papers referencing remuneration, pharmacy and cognitive services. Searches of the grey literature and Internet were also conducted. Papers and programs were identified up to December 2012 and were included if they were not reported in our previous review. One author performed data abstraction, which was independently reviewed by a second author. All results are presented descriptively. Results: Sixty new remunerated programs were identified across Canada, the United States, Europe, Australia and New Zealand, ranging in complexity from emergency contraception counseling to minor ailments schemes and comprehensive medication management. In North America, the average fee provided for a medication review is $68.86 (all figures are given in Canadian dollars), with $23.37 offered for a follow-up visit and $15.16 for prescription adaptations. Time-dependent fees were reimbursed at $93.60 per hour on average. Few programs evaluated uptake and outcomes of these services but, when available, indicated slow uptake but improved chronic disease markers and cost savings. Discussion: Remuneration for pharmacists clinical care services is highly variable, with few programs reporting program outcomes. Programs and pharmacists are encouraged to examine the time required to perform these activities and the outcomes achieved to ensure that fees are adequate to sustain these patient care activities. PMID:25360148

  15. 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– ...

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

    PubMed Central

    Prinja, Shankar; Kaur, Manmeet; Kumar, Rajesh

    2012-01-01

    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. PMID:23112438

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

    NASA Technical Reports Server (NTRS)

    Chullen, Cinda; Conger, Bruce

    2012-01-01

    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 Rapid 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 and the ventilation flow is adequate for maintaining CO2 washout in the AEMU spacesuit helmet of the crew member during an EVA. This paper will review the recent developments of the RCA unit, testing planned in-house with a spacesuit simulator, and the associated analytical work along with insights from the medical aspect on the testing. 1

  18. Adequate illumination for otoscopy. Variations due to power source, bulb, and head and speculum design.

    PubMed

    Barriga, F; Schwartz, R H; Hayden, G F

    1986-12-01

    To determine the working condition of otoscopes used in our community to diagnose middle-ear disease in children, we examined 221 otoscopes located in a hospital clinic, four emergency rooms, and the private offices of 96 physicians. The light output of each unit was measured in "as is" condition and then remeasured after a new lamp and, when possible, a new battery had been placed in the unit. A light output of 100 foot-candles or more was judged optimal for clinical otoscopy. Replacement of the bulb was significantly more likely than replacement of the battery to restore adequate light output to those units with initially poor performance (80% vs 26%). Almost one third of physicians reported changing otoscope bulbs less often than every two years, and several did not know how to replace the bulb. Almost half of the 93 rechargeable nickel-cadmium batteries inspected were outdated, but even these "expired" batteries provided adequate power when fully charged. Office otoscopes should be maintained properly to ensure optimal performance. PMID:3776938

  19. Adequate drainage system design for heap leaching structures.

    PubMed

    Majdi, Abbas; Amini, Mehdi; Nasab, Saeed Karimi

    2007-08-17

    The paper describes an optimum design of a drainage system for a heap leaching structure which has positive impacts on both mine environment and mine economics. In order to properly design a drainage system the causes of an increase in the acid level of the heap which in turn produces severe problems in the hydrometallurgy processes must be evaluated. One of the most significant negative impacts induced by an increase in the acid level within a heap structure is the increase of pore acid pressure which in turn increases the potential of a heap-slide that may endanger the mine environment. In this paper, initially the thickness of gravelly drainage layer is determined via existing empirical equations. Then by assuming that the calculated thickness is constant throughout the heap structure, an approach has been proposed to calculate the required internal diameter of the slotted polyethylene pipes which are used for auxiliary drainage purposes. In order to adequately design this diameter, the pipe's cross-sectional deformation due to stepped heap structure overburden pressure is taken into account. Finally, a design of an adequate drainage system for the heap structure 2 at Sarcheshmeh copper mine is presented and the results are compared with those calculated by exiting equations. PMID:17321044

  20. Quantifying dose to the reconstructed breast: Can we adequately treat?

    SciTech Connect

    Chung, Eugene; Marsh, Robin B.; Griffith, Kent A.; Moran, Jean M.; Pierce, Lori J.

    2013-04-01

    To evaluate how immediate reconstruction (IR) impacts postmastectomy radiotherapy (PMRT) dose distributions to the reconstructed breast (RB), internal mammary nodes (IMN), heart, and lungs using quantifiable dosimetric end points. 3D conformal plans were developed for 20 IR patients, 10 autologous reconstruction (AR), and 10 expander-implant (EI) reconstruction. For each reconstruction type, 5 right- and 5 left-sided reconstructions were selected. Two plans were created for each patient, 1 with RB coverage alone and 1 with RB + IMN coverage. Left-sided EI plans without IMN coverage had higher heart Dmean than left-sided AR plans (2.97 and 0.84 Gy, p = 0.03). Otherwise, results did not vary by reconstruction type and all remaining metrics were evaluated using a combined AR and EI dataset. RB coverage was adequate regardless of laterality or IMN coverage (Dmean 50.61 Gy, D95 45.76 Gy). When included, IMN Dmean and D95 were 49.57 and 40.96 Gy, respectively. Mean heart doses increased with left-sided treatment plans and IMN inclusion. Right-sided treatment plans and IMN inclusion increased mean lung V{sub 20}. Using standard field arrangements and 3D planning, we observed excellent coverage of the RB and IMN, regardless of laterality or reconstruction type. Our results demonstrate that adequate doses can be delivered to the RB with or without IMN coverage.

  1. Perioperative Care of Prisoners: Providing Safe Care.

    PubMed

    Smith, Francis Duval

    2016-03-01

    Correctional nurses are trained to care for prisoners in a controlled security environment; however, when a convict is transferred to a noncorrectional health care facility, the nurses there are often unfamiliar with custody requirements or how to safely care for these patients. The care of prisoners outside of prison has not been adequately investigated, and a gap exists between research and nursing education and practice. Nurses rarely have to consider how providing care for a prisoner in custody affects their practice, the potential dissonance between routine nursing care and the requirements to maintain security, or that care of prisoners in unsecured clinical areas places the nurse and other personnel at risk for physical assault or prisoner escape. Educating perioperative nurses in the care of prisoners in a public hospital environment is important for the provision of safe care and prevention of physical and emotional repercussions to personnel. PMID:26924366

  2. Environmental education: Ensuring a sustainable future

    SciTech Connect

    Rogers, D.P.; Lee, J.C.

    1997-12-31

    It is important to remember that personal actions and decisions have a significant impact on the environment. Although they may sometimes forget, today`s school children are the policy and decision makers of tomorrow. Today`s students must be exposed to factual information about the environment so they will be able to make responsible and informed ecological decisions. Since the National Environmental Education Act was signed into law in 1990, the Environmental Protection Agency (EPA) has taken an active role in ensuring a sustainable future through environmental education. Through its education programs, the EPA strives to increase environmental literacy throughout the country and encourages young people to pursue careers in math, science, engineering, communications, and other fields essential to a sustainable environment. The US Environmental Protection Agency`s Office of Air Quality Planning and Standards (OAQPS), located in Research Triangle Park, North Carolina, is an international center for air quality research and information. One of the ways OAQPS invests in the environmental preservation of the Nation is through unique environmental education programs that target teachers and students of all ages. To be sure that environmental education programs incorporate a complete look at the environment, including issues associated with air quality, the EPA works with North Carolina teachers and students through the Education and Outreach Group`s Environmental Education Program. The EPA recognizes that the key to a sustainable future is engaging teachers and others in significant environmental education experiences. They will in turn instill a sense of environmental stewardship in America`s young people. There is hope that by the year 2000, every citizen will be fluent in the principles of ecology.

  3. 3 CFR 13535 - Executive Order 13535 of March 24, 2010. Ensuring Enforcement and Implementation of Abortion...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Enforcement and Implementation of Abortion Restrictions in the Patient Protection and Affordable Care Act... 13535 Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection and... that Federal funds are not used for abortion services (except in cases of rape or incest, or when...

  4. Ensuring School Readiness through a Successful Transition to Kindergarten: The Indiana Ready Schools Initiative

    ERIC Educational Resources Information Center

    Clark, Patricia; Zygmunt-Fillwalk, Eva

    2008-01-01

    The kindergarten year symbolizes entrance into formal schooling and is a critical juncture for young children. Easing the transition into kindergarten to ensure the maximum success in that pivotal year merits much attention and careful planning. Since the National Education Goals Panel made public its readiness goals (1997), many states across the…

  5. Ensuring School Readiness through a Successful Transition to Kindergarten: The Indiana Ready Schools Initiative

    ERIC Educational Resources Information Center

    Clark, Patricia; Zygmunt-Fillwalk, Eva

    2008-01-01

    The kindergarten year symbolizes entrance into formal schooling and is a critical juncture for young children. Easing the transition into kindergarten to ensure the maximum success in that pivotal year merits much attention and careful planning. Since the National Education Goals Panel made public its readiness goals (1997), many states across the

  6. Providing care to children in times of war.

    PubMed

    Cole, Will; Edwards, Mary J; Burnett, Mark W

    2015-06-01

    The Geneva Conventions stipulate that an occupying power must ensure adequate health care delivery to noncombatants. Special emphasis is given to children, who are among the most vulnerable in a conflict zone. Whether short-term pediatric care should be provided by Military Treatment Facilities to local nationals for conditions other than combat-related injury is controversial. A review of 1,197 children without traumatic injury cared for during 10 years in Iraq and Afghanistan was conducted. Mortality rates were less than 1% among patients with surgical conditions and resource utilization was not excessive. In view of international humanitarian law and these outcomes, children with nontraumatic conditions can and should be considered for treatment at Military Treatment Facilities. The ability to correct the condition and availability of resources necessary to do so should be taken into account. PMID:26032375

  7. Challenges and solutions ensuring EUVL photomask integrity

    NASA Astrophysics Data System (ADS)

    Brux, O.; Dreß, P.; Schmalfuß, H.; Jonckheere, R.; Koolen-Hermkens, W.

    2012-06-01

    Industry roadmaps indicate that the introduction of Extreme Ultraviolet Lithography (EUVL) is on track for high volume manufacturing. Although, there has been significant progress in each of the individual subsets of the EUVL infrastructure, the absolute management of the process outside of the scanner and up to the point-of-exposure has been highlighted as critical requirement for the adoption of EUVL. Significant changes in the EUV system environment and mask architecture are driving a zero process tolerance level. Any unforeseen contamination introduced to the scanner environment from the EUV mask could cause considerable downtime and yield loss. Absolute mask integrity at the point-of-exposure must be guaranteed. EUV mask cleaning processes-of-record have been developed and introduced to the industry [1]. The issue is not longer "how to clean the mask" but, "how to keep it clean". With the introduction of EUVL, mask cleanliness extends out beyond the traditional mask cleaning tool. Complete control of contamination and/or particles during transportation, handling and storage will require a holistic approach to mask management. A new environment specifically for EUV mask integrity must be developed and fully tested for the sub 16nm half-pitch node introduction. The SUSS MaskTrack Pro (MTP) InSync was introduced as the solution for EUV mask integrity. SUSS demonstrated the fully automated handling of EUV masks into and out of a Dual Pod System [2]. Intrinsic cleanliness of each individual handling and storage step of the inner pod (EIP) and EUV mask inside the MTP InSync Tool was investigated and reported. A target specification of a PRP <= 0.08 as criterion for the cross contamination between EIP and the EUV reticle during handling within MTP InSync has been achieved and therefore proofing the applicability for the Dual Pod automation. Moreover an appropriate automated handling, other aspects like backside particle contamination and EIP cleanliness plays a significant role to ensure EUV mask integrity. With this concept in mind a system for particle detection has been integrated into MTP InSync. This allows verifying the POR performance for backside cleaning by measuring particles down to 150nm size. A dynamic capture rate of larger 97% at 200nm particle size based on PSLs was achieved; for EIP cleaning, a dry-cleaning technology is under investigation. During feasibility studies high particle removal efficiency (PRE) results larger 99% has been achieved for particles down to 100nm. In this paper, the full scope and roadmap of the MTP InSync will be discussed. Preliminary results of backside particle detection and challenges on EUV Inner Pod (EIP) cleaning will be presented.

  8. 50 CFR 530.2 - Ensuring that environmental documents are actually considered in agency decision-making.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... actually considered in agency decision-making. 530.2 Section 530.2 Wildlife and Fisheries MARINE MAMMAL... documents are actually considered in agency decision-making. Section 1505.1 of the NEPA regulations contains requirements to ensure adequate consideration of environmental documents in agency decision-making....

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

    NASA Astrophysics Data System (ADS)

    Daglis, Ioannis A.

    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.

  10. Choices for achieving adequate dietary calcium with a vegetarian diet.

    PubMed

    Weaver, C M; Proulx, W R; Heaney, R

    1999-09-01

    To achieve adequate dietary calcium intake, several choices are available that accommodate a variety of lifestyles and tastes. Liberal consumption of dairy products in the diet is the approach of most Americans. Some plants provide absorbable calcium, but the quantity of vegetables required to reach sufficient calcium intake make an exclusively plant-based diet impractical for most individuals unless fortified foods or supplements are included. Also, dietary constituents that decrease calcium retention, such as salt, protein, and caffeine, can be high in the vegetarian diet. Although it is possible to obtain calcium balance from a plant-based diet in a Western lifestyle, it may be more convenient to achieve calcium balance by increasing calcium consumption than by limiting other dietary factors. PMID:10479229

  11. World oil supply adequate for 93's healthy demand

    SciTech Connect

    Beck, R.J.

    1993-01-25

    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.

  12. Developing nursing care plans.

    PubMed

    Ballantyne, Helen

    2016-02-24

    This article aims to enhance nurses' understanding of nursing care plans, reflecting on the past, present and future use of care planning. This involves consideration of the central theories of nursing and discussion of nursing models and the nursing process. An explanation is provided of how theories of nursing may be applied to care planning, in combination with clinical assessment tools, to ensure that care plans are context specific and patient centred. PMID:26907149

  13. Better care and better teaching. New model of postpartum care for early discharge programs.

    PubMed Central

    Yaffe, M. J.; Russillo, B.; Hyland, C.; Kovacs, L.; McAlister, E.

    2001-01-01

    PROBLEM BEING ADDRESSED: Rapid postpartum discharge has reduced opportunities to detect early newborn or parenting problems and to teach neonatal assessment and maternal postpartum care to medical trainees. OBJECTIVE OF PROGRAM: Development of a program to not only ensure adequate care of mothers and newborns after early hospital discharge, but also to teach outpatient assessment skills to family medicine residents. MAIN COMPONENTS OF PROGRAM: In an urban, secondary care, university-affiliated teaching hospital predominantly training family medicine residents, an interdisciplinary committee created and supervised a neonatal and maternal postpartum assessment program. Newborn infants and their mothers are seen by a family physician, a family medicine resident, and a nurse within 48 hours of discharge, after which care is assumed in the community by the child's primary care physician. An assessment protocol developed by the interdisciplinary group promotes standardized mother and child care and a structured learning experience for trainees. CONCLUSION: Rapid follow up of early discharged infants and their mothers can be facilitated by a program of standardized assessment by a roster of pooled, interacting family physicians and nurses. When this assessment occurs in a teaching milieu, a comprehensive learning experience can be combined with defined objectives that emphasize and encourage newborn and maternal assessment for ambulatory patients. PMID:11723597

  14. The Students with Disabilities Subgroup and Adequate Yearly Progress in Mid-Atlantic Region Schools. Issues & Answers. REL 2007-No. 018

    ERIC Educational Resources Information Center

    Johnson, Karen E.; Peck, Kyle; Wise, John

    2007-01-01

    The No Child Left Behind Act requires each state to set a series of annual targets to ensure that all students make adequate yearly progress in achieving proficiency in reading and mathematics by 2013/14. Schools must monitor annual progress toward proficiency goals for each of several subgroups, including students with disabilities, as well as

  15. Ensuring US National Aeronautics Test Capabilities

    NASA Technical Reports Server (NTRS)

    Marshall, Timothy J.

    2010-01-01

    U.S. leadership in aeronautics depends on ready access to technologically advanced, efficient, and affordable aeronautics test capabilities. These systems include major wind tunnels and propulsion test facilities and flight test capabilities. The federal government owns the majority of the major aeronautics test capabilities in the United States, primarily through the National Aeronautics and Space Administration (NASA) and the Department of Defense (DoD). However, changes in the Aerospace landscape, primarily the decrease in demand for testing over the last 20 years required an overarching strategy for management of these national assets. Therefore, NASA established the Aeronautics Test Program (ATP) as a two-pronged strategic initiative to: (1) retain and invest in NASA aeronautics test capabilities considered strategically important to the agency and the nation, and (2) establish a strong, high level partnership with the DoD. Test facility utilization is a critical factor for ATP because it relies on user occupancy fees to recover a substantial part of the operations costs for its facilities. Decreasing utilization is an indicator of excess capacity and in some cases low-risk redundancy (i.e., several facilities with basically the same capability and overall low utilization). However, low utilization does not necessarily translate to lack of strategic importance. Some facilities with relatively low utilization are nonetheless vitally important because of the unique nature of the capability and the foreseeable aeronautics testing needs. Unfortunately, since its inception, the customer base for ATP has continued to shrink. Utilization of ATP wind tunnels has declined by more than 50% from the FY 2006 levels. This significant decrease in customer usage is attributable to several factors, including the overall decline in new programs and projects in the aerospace sector; the impact of computational fluid dynamics (CFD) on the design, development, and research process; and the reductions in wind tunnel testing requirements within the largest consumer of ATP wind tunnel test time, the Aeronautics Research Mission Directorate (ARMD). Retirement of the Space Shuttle Program and recent perturbations of NASA's Constellation Program will exacerbate this downward trend. Therefore it is crucial that ATP periodically revisit and determine which of its test capabilities are strategically important, which qualify as low-risk redundancies that could be put in an inactive status or closed, and address the challenges associated with both sustainment and improvements to the test capabilities that must remain active. This presentation will provide an overview of the ATP vision, mission, and goals as well as the challenges and opportunities the program is facing both today and in the future. We will discuss the strategy ATP is taking over the next five years to address the National aeronautics test capability challenges and what the program will do to capitalize on its opportunities to ensure a ready, robust and relevant portfolio of National aeronautics test capabilities.

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

    SciTech Connect

    Webb, M.D.

    1997-08-01

    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.

  17. DARHT -- an adequate EIS: A NEPA case study

    SciTech Connect

    Webb, M.D.

    1997-08-01

    In April 1996 the US District Court in Albuquerque ruled that the Dual Axis Radiographic Hydrodynamic Test (DARHT) Facility Environmental Impact Statement (EIS), prepared by the Los Alamos Area Office, US Department of Energy (DOE), was adequate. The DARHT EIS had been prepared in the face of a lawsuit in only 10 months, a third of the time usually allotted for a DOE EIS, and for only a small fraction of the cost of a typical DOE EIS, and for only a small fraction of the cost of a typical DOE EIS. It subject was the first major facility to be built in decades for the DOE nuclear weapons stockpile stewardship program. It was the first EIS to be prepared for a proposal at DOE`s Los Alamos National Laboratory since 1979, and the first ever prepared by the Los Alamos Area Office. Much of the subject matter was classified. The facility had been specially designed to minimize impacts to a nearby prehistoric Native American ruin, and extensive consultation with American Indian Pueblos was required. The week that the draft EIS was published Laboratory biologists identified a previously unknown pair of Mexican spotted owls in the immediate vicinity of the project, bringing into play the consultation requirements of the Endangered Species Act. In spite of these obstacles, the resultant DARHT EIS was reviewed by the court and found to meet all statutory and regulatory requirements; the court praised the treatment of the classified material which served as a basis for the environmental analysis.

  18. Dose Limits for Man do not Adequately Protect the Ecosystem

    SciTech Connect

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

    2004-08-01

    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.

  19. Thrombography Reveals Thrombin Generation Potential Continues to Deteriorate Following Cardiopulmonary Bypass Surgery Despite Adequate Hemostasis

    PubMed Central

    Wong, Raymond K.; Sleep, Joseph R.; Visner, Allison J.; Raasch, David J.; Lanza, Louis A.; DeValeria, Patrick A.; Torloni, Antonio S.; Arabia, Francisco A.

    2011-01-01

    Abstract: The intrinsic and extrinsic activation pathways of the hemostatic system converge when prothrombin is converted to thrombin. The ability to generate an adequate thrombin burst is the most central aspect of the coagulation cascade. The thrombin-generating potential in patients following cardiopulmonary bypass (CPB) may be indicative of their hemostatic status. In this report, thrombography, a unique technique for directly measuring the potential of patients blood samples to generate adequate thrombin bursts, is used to characterize the coagulopathic profile in post-CPB patients. Post-CPB hemostasis is typically achieved with protamine reversal of heparin anticoagulation and occasionally supplemented with blood product component transfusions. In this pilot study, platelet poor plasma samples were derived from 11 primary cardiac surgery patients at five time points: prior to CPB, immediately post-protamine, upon arrival to the intensive care unit (ICU), 3 hours post-ICU admission, and 24 hours after ICU arrival. Thrombography revealed that the Endogenous Thrombin Potential (ETP) was not different between [Baseline] and [PostProtamine] but proceeded to deteriorate in the immediate postoperative period. At the [3HourPostICU] time point, the ETP was significantly lower than the [Baseline] values, 1233 591 versus 595 379 nM.min (mean SD; n = 9, p < .005), despite continued adequacy of hemostasis. ETPs returned to baseline values the day after surgery. Transfusions received, conventional blood coagulation testing results, and blood loss volumes are also presented. Despite adequate hemostasis, thrombography reveals an underlying coagulopathic process that could put some cardiac surgical patients at risk for postoperative bleeding. Thrombography is a novel technique that could be developed into a useful tool for perfusionists and physicians to identify coagulopathies and optimize blood management following CPB. PMID:21449230

  20. Nonshivering thermogenesis and its adequate measurement in metabolic studies.

    PubMed

    Cannon, Barbara; Nedergaard, Jan

    2011-01-15

    Alterations in nonshivering thermogenesis are presently discussed as being both potentially causative of and able to counteract obesity. However, the necessity for mammals to defend their body temperature means that the ambient temperature profoundly affects the outcome and interpretation of metabolic experiments. An adequate understanding and assessment of nonshivering thermogenesis is therefore paramount for metabolic studies. Classical nonshivering thermogenesis is facultative, i.e. it is only activated when an animal acutely requires extra heat (switched on in minutes), and adaptive, i.e. it takes weeks for an increase in capacity to develop. Nonshivering thermogenesis is fully due to brown adipose tissue activity; adaptation corresponds to the recruitment of this tissue. Diet-induced thermogenesis is probably also facultative and adaptive and due to brown adipose tissue activity. Although all mammals respond to injected/infused norepinephrine (noradrenaline) with an increase in metabolism, in non-adapted mammals this increase mainly represents the response of organs not involved in nonshivering thermogenesis; only the increase after adaptation represents nonshivering thermogenesis. Thermogenesis (metabolism) should be expressed per animal, and not per body mass [not even to any power (0.75 or 0.66)]. A 'cold tolerance test' does not examine nonshivering thermogenesis capacity; rather it tests shivering capacity and endurance. For mice, normal animal house temperatures are markedly below thermoneutrality, and the mice therefore have a metabolic rate and food consumption about 1.5 times higher than their intrinsic requirements. Housing and examining mice at normal house temperatures carries a high risk of identifying false positives for intrinsic metabolic changes; in particular, mutations/treatments that affect the animal's insulation (fur, skin) may lead to such problems. Correspondingly, true alterations in intrinsic metabolic rate remain undetected when metabolism is examined at temperatures below thermoneutrality. Thus, experiments with animals kept and examined at thermoneutrality are likely to yield an improved possibility of identifying agents and genes important for human energy balance. PMID:21177944

  1. Monitoring the eye lens: which dose quantity is adequate?

    NASA Astrophysics Data System (ADS)

    Behrens, R.; Dietze, G.

    2010-07-01

    Recent epidemiological studies suggest a rather low dose threshold (below 0.5 Gy) for the induction of a cataract of the eye lens. Some other studies even assume that there is no threshold at all. Therefore, protection measures have to be optimized and current dose limits for the eye lens may be reduced in the future. The question of which personal dose equivalent quantity is appropriate for monitoring the dose to the eye lens arises from this situation. While in many countries dosemeters calibrated in terms of the dose equivalent quantity Hp(0.07) have been seen as being adequate for monitoring the dose to the eye lens, this might be questionable in the case of reduced dose limits and, thus, it may become necessary to use the dose equivalent quantity Hp(3) for this purpose. To discuss this question, the dose conversion coefficients for the equivalent dose of the eye lens (in the following eye lens dose) were determined for realistic photon and beta radiation fields and compared with the values of the corresponding conversion coefficients for the different operational quantities. The values obtained lead to the following conclusions: in radiation fields where most of the dose comes from photons, especially x-rays, it is appropriate to use dosemeters calibrated in terms of Hp(0.07) on a slab phantom, while in other radiation fields (dominated by beta radiation or unknown contributions of photon and beta radiation) dosemeters calibrated in terms of Hp(3) on a slab phantom should be used. As an alternative, dosemeters calibrated in terms of Hp(0.07) on a slab phantom could also be used; however, in radiation fields containing beta radiation with the end point energy near 1 MeV, an overestimation of the eye lens dose by up to a factor of 550 is possible.

  2. Emotional Experiences of Obese Women with Adequate Gestational Weight Variation: A Qualitative Study

    PubMed Central

    Faria-Schützer, Débora Bicudo; Surita, Fernanda Garanhani de Castro; Alves, Vera Lucia Pereira; Vieira, Carla Maria; Turato, Egberto Ribeiro

    2015-01-01

    Background As a result of the growth of the obese population, the number of obese women of fertile age has increased in the last few years. Obesity in pregnancy is related to greater levels of anxiety, depression and physical harm. However, pregnancy is an opportune moment for the intervention of health care professionals to address obesity. The objective of this study was to describe how obese pregnant women emotionally experience success in adequate weight control. Methods and Findings Using a qualitative design that seeks to understand content in the field of health, the sample of subjects was deliberated, with thirteen obese pregnant women selected to participate in an individual interview. Data was analysed by inductive content analysis and includes complete transcription of the interviews, re-readings using suspended attention, categorization in discussion topics and the qualitative and inductive analysis of the content. The analysis revealed four categories, three of which show the trajectory of body care that obese women experience during pregnancy: 1) The obese pregnant woman starts to think about her body;2) The challenge of the diet for the obese pregnant woman; 3) The relation of the obese pregnant woman with the team of antenatal professionals. The fourth category reveals the origin of the motivation for the change: 4) The potentializing factors for change: the motivation of the obese woman while pregnant. Conclusions During pregnancy, obese women are more in touch with themselves and with their emotional conflicts. Through the transformations of their bodies, women can start a more refined self-care process and experience of the body-mind unit. The fear for their own and their baby's life, due to the risks posed by obesity, appears to be a great potentializing factor for change. The relationship with the professionals of the health care team plays an important role in the motivational support of the obese pregnant woman. PMID:26529600

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

    NASA Technical Reports Server (NTRS)

    Chullen, Cinda

    2011-01-01

    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.

  4. The Seattle Care Pathway: Defining Dental Care for Older Adults.

    PubMed

    Pretty, Iain

    2015-08-01

    It is well-recognized that the demographic shift in the population will result in a larger proportion of older adults and those adults will live longer than ever before. There is, therefore, a need to ensure dental services recognize this transition and plan for the management of older adults in primary care dental practices. This article describes the evidence for, and the details of, the Seattle Care Pathway to ensure older adults receive optimum dental care. PMID:26357813

  5. Nurses' motivation and its relationship to the characteristics of nursing care delivery systems: a test of the job characteristics model.

    PubMed

    Edgar, L

    1999-01-01

    The purpose of the study was to describe the relationship among motivation, job satisfaction and the characteristics of nursing care delivery systems using the Job Characteristics Model of Work Motivation (Hackman & Oldham, 1980), and to test a framework of nursing care delivery system attributes that have been found to contribute to job satisfaction and good patient care outcomes. The present era of cost containment pressures means that nurse administrators need to ensure that nurses have a work environment with the characteristics of work known to be linked to job satisfaction, motivation and good outcomes. The model was tested with nurses working in medical-surgical areas of four Montreal teaching hospitals. Findings included the applicability of the Job Characteristics Model to the work of nursing and that the addition of four attributes of nursing care delivery systems, namely support for autonomy, communication, adequate time for patient care and the degree of environmental uncertainty contributed to job satisfaction and motivation. PMID:11087194

  6. Perinatal mortality in rural India: intervention through primary health care. II Neonatal mortality.

    PubMed Central

    Shah, U; Pratinidhi, A K; Bhatlawande, P V

    1984-01-01

    Early neonatal mortality is unacceptably high in most developing countries. A large majority of births in rural areas of these countries occur at home, attended by relatives or traditional birth attendants and without easy access to skilled professional care. Under these circumstances cause of death has to be based on lay descriptions of terminal events. Analysis of cause of death shows that 74% of the early neonatal deaths are amenable to intervention. Admittance to hospital of the "at risk" neonates is not practicable. Intervention through primary health care can be effective if based on scientific principles and offered through female community health workers. Objectives of domiciliary care given by these workers should be to educate and guide the mother to protect the delicate newborn from the effects of adverse environmental conditions, to ensure adequate nutrition, and to prevent infections. Interventions supporting beneficial traditional cultural practices as well as simple techniques for care of the newborn are discussed. PMID:6747513

  7. Maintaining Adequate Carbon Dioxide Washout for an Advanced Extravehicular Mobility Unit

    NASA Technical Reports Server (NTRS)

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

    2013-01-01

    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.

  8. Health care for older persons in Switzerland: a country profile.

    PubMed

    Schoenenberger, Andreas W; Stuck, Andreas E

    2006-06-01

    Switzerland has the second-most-expensive healthcare system worldwide, with 11.5% of gross domestic product spent on health care in 2003. Switzerland has a healthcare system with universal insurance coverage and a social insurance system, ensuring an adequate financial situation for 96% of the 1.1 million older inhabitants. Key concerns related to the care of older persons are topics such as increasing healthcare costs, growing public awareness of patient autonomy, and challenges related to assisted suicide. In 2004, the Swiss Academy of Medical Sciences issued guidelines for the care of disabled older persons. Since 2000, geriatrics has been a board-certified discipline with a 3-year training program in addition to 5 years of training in internal or family medicine. There are approximately 125 certified geriatricians in Switzerland, working primarily in geriatric centers in urban areas. Switzerland has an excellent research environment, ranking second of all countries worldwide in life sciences research-but only 13th in aging research. This is in part due to a lack of specific training programs promoting research on aging and inadequate funding. In addition, there is a shortage of academic geriatricians in Switzerland, in part due to the fact that two of five Swiss universities had no academic geriatric departments in 2005. With more-adequate financial resources for academic geriatrics, Switzerland would have the opportunity to contribute more to aging research internationally and to improved care for older patients. PMID:16776797

  9. Honoring those who have served: how can health professionals provide optimal care for members of the military, veterans, and their families?

    PubMed

    Lee, Jennifer; Sanders, Karen M; Cox, Malcolm

    2014-09-01

    With over one million service members separating from the military over the next several years, it seems prudent to ask whether U.S. health care professionals and systems of care are prepared to evaluate and treat the obvious and more subtle injuries ascribed to military deployment and combat. The authors suggest that several systemic interventions-adding military health history sections to electronic health records, history and physical diagnosis textbooks, and licensing exams while also ensuring that this content is adequately covered in undergraduate and graduate health professional training-will enable all health care professionals to provide service members and veterans with the high-quality care that they deserve. The authors also highlight the U.S. Department of Veterans Affairs' recent innovations in education and care delivery, which are enhancing the education of thousands of students and residents, who will be better prepared to care for veterans after receiving this training. PMID:24979290

  10. Bronchoalveolar lavage (BAL) for research; obtaining adequate sample yield.

    PubMed

    Collins, Andrea M; Rylance, Jamie; Wootton, Daniel G; Wright, Angela D; Wright, Adam K A; Fullerton, Duncan G; Gordon, Stephen B

    2014-01-01

    We describe a research technique for fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) using manual hand held suction in order to remove nonadherent cells and lung lining fluid from the mucosal surface. In research environments, BAL allows sampling of innate (lung macrophage), cellular (B- and T- cells), and humoral (immunoglobulin) responses within the lung. BAL is internationally accepted for research purposes and since 1999 the technique has been performed in > 1,000 subjects in the UK and Malawi by our group. Our technique uses gentle hand-held suction of instilled fluid; this is designed to maximize BAL volume returned and apply minimum shear force on ciliated epithelia in order to preserve the structure and function of cells within the BAL fluid and to preserve viability to facilitate the growth of cells in ex vivo culture. The research technique therefore uses a larger volume instillate (typically in the order of 200 ml) and employs manual suction to reduce cell damage. Patients are given local anesthetic, offered conscious sedation (midazolam), and tolerate the procedure well with minimal side effects. Verbal and written subject information improves tolerance and written informed consent is mandatory. Safety of the subject is paramount. Subjects are carefully selected using clear inclusion and exclusion criteria. This protocol includes a description of the potential risks, and the steps taken to mitigate them, a list of contraindications, pre- and post-procedure checks, as well as precise bronchoscopy and laboratory techniques. PMID:24686157

  11. Bronchoalveolar Lavage (BAL) for Research; Obtaining Adequate Sample Yield

    PubMed Central

    Collins, Andrea M.; Rylance, Jamie; Wootton, Daniel G.; Wright, Angela D.; Wright, Adam K. A.; Fullerton, Duncan G.; Gordon, Stephen B.

    2014-01-01

    We describe a research technique for fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) using manual hand held suction in order to remove nonadherent cells and lung lining fluid from the mucosal surface. In research environments, BAL allows sampling of innate (lung macrophage), cellular (B- and T- cells), and humoral (immunoglobulin) responses within the lung. BAL is internationally accepted for research purposes and since 1999 the technique has been performed in > 1,000 subjects in the UK and Malawi by our group. Our technique uses gentle hand-held suction of instilled fluid; this is designed to maximize BAL volume returned and apply minimum shear force on ciliated epithelia in order to preserve the structure and function of cells within the BAL fluid and to preserve viability to facilitate the growth of cells in ex vivo culture. The research technique therefore uses a larger volume instillate (typically in the order of 200 ml) and employs manual suction to reduce cell damage. Patients are given local anesthetic, offered conscious sedation (midazolam), and tolerate the procedure well with minimal side effects. Verbal and written subject information improves tolerance and written informed consent is mandatory. Safety of the subject is paramount. Subjects are carefully selected using clear inclusion and exclusion criteria. This protocol includes a description of the potential risks, and the steps taken to mitigate them, a list of contraindications, pre- and post-procedure checks, as well as precise bronchoscopy and laboratory techniques. PMID:24686157

  12. Partnering for Care in HIV Prevention Trials

    PubMed Central

    MacQueen, Kathleen M.; McLoughlin, Kerry; Alleman, Patty; Burke, Holly McClain; Mack, Natasha

    2015-01-01

    Qualitative Case Studies Were conducted at seven international sites conducting HIV prevention research in Africa, Asia, and the Americas to identify strategies for ensuring that health needs of research participants identified in the course of research are adequately addressed. Key factors were identified that contribute to the balance between direct care and healthcare referrals at a research site, as well as the overall quality of the healthcare made available to research participants. The case studies exemplify the concept of “moral negotiation” in research (Weijer & LeBlanc, 2006), that is, a process where researchers and sponsors negotiate with increasingly empowered local communities and host countries to achieve meaningful and substantive benefits from biomedical research for all stakeholders. PMID:19385753

  13. Twenty-Four-Hour Urine Osmolality as a Physiological Index of Adequate Water Intake

    PubMed Central

    Perrier, Erica T.; Buendia-Jimenez, Inmaculada; Vecchio, Mariacristina; Armstrong, Lawrence E.; Tack, Ivan; Klein, Alexis

    2015-01-01

    While associations exist between water, hydration, and disease risk, research quantifying the dose-response effect of water on health is limited. Thus, the water intake necessary to maintain optimal hydration from a physiological and health standpoint remains unclear. The aim of this analysis was to derive a 24?h urine osmolality (UOsm) threshold that would provide an index of optimal hydration, sufficient to compensate water losses and also be biologically significant relative to the risk of disease. Ninety-five adults (31.5 4.3 years, 23.2 2.7?kgm?2) collected 24?h urine, provided morning blood samples, and completed food and fluid intake diaries over 3 consecutive weekdays. A UOsm threshold was derived using 3 approaches, taking into account European dietary reference values for water; total fluid intake, and urine volumes associated with reduced risk for lithiasis and chronic kidney disease and plasma vasopressin concentration. The aggregate of these approaches suggest that a 24?h urine osmolality ?500?mOsmkg?1 may be a simple indicator of optimal hydration, representing a total daily fluid intake adequate to compensate for daily losses, ensure urinary output sufficient to reduce the risk of urolithiasis and renal function decline, and avoid elevated plasma vasopressin concentrations mediating the increased antidiuretic effort. PMID:25866433

  14. Repatriation of patients--a process to ensure a safe patient transfer.

    PubMed

    Monik, Lynda A

    2007-01-01

    To ensure the safe care of patients repatriated to HDGH, we have implemented a process that identifies patient needs prior to their repatriation. The process provides us with critical information regarding a patient's condition well before repatriation so our staff can confirm that we can safely meet the patient's needs. The process is simple and easy for both the sending and receiving facilities to adopt. PMID:18019901

  15. Child Care Providers' Experiences Caring for Sick Children: Implications for Public Policy.

    ERIC Educational Resources Information Center

    Heymann, S. Jody; Vo, Phuong Hong; Bergstrom, Cara A.

    2002-01-01

    Examined the experiences of preschool and school-age child care providers regarding sick child care. Found that providers repeatedly described sick children whose health problems made it impossible to provide adequate care for sick and well children in their care. Findings pose international public health policy implications for child care and

  16. Carrier screening in preconception consultation in primary care.

    PubMed

    Metcalfe, Sylvia A

    2012-07-01

    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

  17. Preparing for Medicaid managed care.

    PubMed

    Perez, Connie

    2012-04-01

    As Medicaid enrollment continues to rise, hospitals and health systems could benefit from contracting with Medicaid managed care plans. Providers need to establish a Medicaid managed care strategy before beginning the contracting process. Revenue cycle leaders need to ensure that their front-end processes related to patient access, billing, and denials management are compatible with Medicaid managed care. PMID:22523888

  18. Restricted daily consumption of a highly palatable food (chocolate Ensure(R)) alters striatal enkephalin gene expression.

    PubMed

    Kelley, A E; Will, M J; Steininger, T L; Zhang, M; Haber, S N

    2003-11-01

    Brain opioid peptide systems are known to play an important role in motivation, emotion, attachment behaviour, the response to stress and pain, and the control of food intake. Opioid peptides within the ventral striatum are thought to play a key role in the latter function, regulating the affective response to highly palatable, energy-dense foods such as those containing fat and sugar. It has been shown previously that stimulation of mu opiate receptors within the ventral striatum increases intake of palatable food. In the present study, we examined enkephalin peptide gene expression within the striatum in rats that had been given restricted daily access to an energy-dense, palatable liquid food, chocolate Ensure(R). Rats maintained on an ad libitum diet of rat chow and water were given 3-h access to Ensure(R) daily for two weeks. One day following the end of this period, preproenkephalin gene expression was measured with quantitative in situ hybridization. Compared with control animals, rats that had been exposed to Ensure(R) had significantly reduced enkephalin gene expression in several striatal regions including the ventral striatum (nucleus accumbens), a finding that was confirmed in a different group with Northern blot analysis. Rats fed this regimen of Ensure(R) did not differ in weight from controls. In contrast to chronic Ensure(R), acute ingestion of Ensure(R) did not appear to affect enkephalin peptide gene expression. These results suggest that repeated consumption of a highly rewarding, energy-dense food induces neuroadaptations in cognitive-motivational circuits. PMID:14622160

  19. Quality of Informal Care Is Multidimensional

    PubMed Central

    Christie, Juliette; Smith, G. Rush; Williamson, Gail M.; Lance, Charles. E.; Shovali, Tamar E.; Silva, Luciana

    2010-01-01

    Purpose To demonstrate that assessing quality of informal care involves more than merely determining whether care recipient needs for assistance with activities of daily living (ADLs) are satisfied on a routine basis. Potentially harmful behavior (PHB), adequate care, and exemplary care (EC) are conceptually distinct dimensions of quality of care. We investigated the extent to which these three dimensions also are empirically distinguishable. Design 237 care recipients completed the quality of care measures, and their caregivers completed psychosocial measures of depressed affect, life events, cognitive status, and perceived pre-illness relationship quality. Results Confirmatory factor analyses indicated that PHB, adequate care, and EC are empirically distinct factors. Although PHB was moderately related to EC, adequate care was not associated with PHB and was only slightly related to EC. Psychosocial variables were not related to adequate care but were differentially associated with PHB and EC, providing further evidence for the distinction between the measures of quality of care used in this study. Conclusions Assessing quality of informal care is a complex endeavor. ADL assistance can be adequate in the presence of PHB and/or the absence of EC. Declines in EC may signal increases in PHB, independent of adequacy of care. These findings produce a brief, portable, and more comprehensive instrument for assessing quality of informal care. PMID:19469607

  20. Litigation and Community Advocacy to Ensure Health Access for Micronesian Migrants in Hawai'i.

    PubMed

    Hagiwara, Megan Kiyomi; Yamada, Seiji; Tanaka, Wayne; Ostrowski, Deja Marie

    2015-05-01

    The Federated States of Micronesia and the Republics of Palau and the Marshall Islands signed a series of treaties known as the Compacts of Free Association (COFA) with the United States (U.S.). While the islands became independent nations, certain rights and responsibilities were assigned to the U.S. However since the signing of the treaties, U.S. federal and Hawai'i state policies have reduced health care coverage for COFA migrants living in the U.S. and its territories. This commentary reports the ongoing efforts of the Micronesian community and its allies to rectify a legacy of unjust policies. We outline the need for sound policies that support appropriate health care to all members of society, and highlight the community's strength and ability to mobilize for political action. If health is a human right, providing adequate, equitable health care to all members of society is not up for debate. PMID:25981094

  1. 27 CFR 19.387 - Ensuring the quality of denaturants.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... BUREAU, DEPARTMENT OF THE TREASURY LIQUORS DISTILLED SPIRITS PLANTS Denaturing Operations and Manufacture of Articles Rules for Denaturing Spirits and Testing Denaturants 19.387 Ensuring the quality of denaturants. (a) General. Proprietors must ensure that the materials they receive for use in...

  2. 27 CFR 19.387 - Ensuring the quality of denaturants.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL DISTILLED SPIRITS PLANTS Denaturing Operations and Manufacture of Articles Rules for Denaturing Spirits and Testing Denaturants 19.387 Ensuring the quality of denaturants. (a) General. Proprietors must ensure that the materials they receive for use in...

  3. 27 CFR 19.387 - Ensuring the quality of denaturants.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL DISTILLED SPIRITS PLANTS Denaturing Operations and Manufacture of Articles Rules for Denaturing Spirits and Testing Denaturants 19.387 Ensuring the quality of denaturants. (a) General. Proprietors must ensure that the materials they receive for use in...

  4. 27 CFR 19.387 - Ensuring the quality of denaturants.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... BUREAU, DEPARTMENT OF THE TREASURY LIQUORS DISTILLED SPIRITS PLANTS Denaturing Operations and Manufacture of Articles Rules for Denaturing Spirits and Testing Denaturants 19.387 Ensuring the quality of denaturants. (a) General. Proprietors must ensure that the materials they receive for use in...

  5. 28 CFR 61.10 - Ensuring Department NEPA compliance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Ensuring Department NEPA compliance. 61.10 Section 61.10 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROCEDURES FOR IMPLEMENTING THE NATIONAL ENVIRONMENTAL POLICY ACT Implementing Procedures 61.10 Ensuring Department...

  6. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Medical devices; adequate directions for use. 801.5 Section 801.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for use. Adequate directions for...

  7. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Medical devices; adequate directions for use. 801... (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for use. Adequate directions for use means directions under which the layman can use a device...

  8. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Medical devices; adequate directions for use. 801... (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for use. Adequate directions for use means directions under which the layman can use a device...

  9. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Medical devices; adequate directions for use. 801... (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for use. Adequate directions for use means directions under which the layman can use a device...

  10. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical devices; adequate directions for use. 801... (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for use. Adequate directions for use means directions under which the layman can use a device...

  11. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... adequate snow cover? 13.960 Section 13.960 Parks, Forests, and Public Property NATIONAL PARK SERVICE... Preserve Snowmachine (snowmobile) Operations § 13.960 Who determines when there is adequate snow cover? The superintendent will determine when snow cover is adequate for snowmachine use. The superintendent will follow...

  12. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... adequate snow cover? 13.960 Section 13.960 Parks, Forests, and Public Property NATIONAL PARK SERVICE... Preserve Snowmachine (snowmobile) Operations § 13.960 Who determines when there is adequate snow cover? The superintendent will determine when snow cover is adequate for snowmachine use. The superintendent will follow...

  13. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... adequate snow cover? 13.960 Section 13.960 Parks, Forests, and Public Property NATIONAL PARK SERVICE... Preserve Snowmachine (snowmobile) Operations § 13.960 Who determines when there is adequate snow cover? The superintendent will determine when snow cover is adequate for snowmachine use. The superintendent will follow...

  14. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... adequate snow cover? 13.960 Section 13.960 Parks, Forests, and Public Property NATIONAL PARK SERVICE... Preserve Snowmachine (snowmobile) Operations § 13.960 Who determines when there is adequate snow cover? The superintendent will determine when snow cover is adequate for snowmachine use. The superintendent will follow...

  15. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... adequate snow cover? 13.960 Section 13.960 Parks, Forests, and Public Property NATIONAL PARK SERVICE... Preserve Snowmachine (snowmobile) Operations § 13.960 Who determines when there is adequate snow cover? The superintendent will determine when snow cover is adequate for snowmachine use. The superintendent will follow...

  16. Prenatal Care

    MedlinePLUS

    ... Our ePublications > Prenatal care fact sheet ePublications Prenatal care fact sheet Print this fact sheet Health Care ... More information on prenatal care What is prenatal care? Prenatal care is the health care you get ...

  17. Regulatory Considerations to Ensure Clean and Safe Drinking Water

    EPA Science Inventory

    Federal drinking water regulations are based on risk assessment of human health effects and research conducted on source water, treatment technologies, residuals, and distribution systems. The book chapter summarizes the role that EPA research plays in ensuring pure drinking wat...

  18. Patient-centered care in adult trauma intensive care unit.

    PubMed

    Hasse, Gwendolyn L

    2013-01-01

    The purpose of this study was to discover unique aspects of caring for adult trauma intensive care unit patients with respect to implementing patient-centered care. The concept of patient-centered care has been discussed since 2000, but the actual implementation is currently becoming the focus of health care. The Institute of Medicine defined patient-centered care as "providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions" in the 2001 Crossing the Quality Chasm report. Discussion and documentation of patient centered-care of the intensive care trauma patient population are limited and yield no results for publication search. This article explores the concept of delivering patient-centered care specifically in a trauma adult intensive care unit. PMID:24005121

  19. [Hospice palliative care is a universal value and the essence of nursing].

    PubMed

    Chao, Co-Shi Chantal

    2015-04-01

    This article uses four examples to illustrate the recent rise of hospice palliative care as a universal value. These examples include the story of Dame Cecily Saunders, the pioneer of the palliative care movement in the U.K.; the national healthcare plan currently promoted by United States' President Obama; a survey on the topic of quality of death in 40 countries conducted by the Lien Foundation (Singapore); and the story of the Hospice Movement in Taiwan. This article further describes how hospice palliative care has changed the healthcare culture and presents the World Health Organization's definition of palliative care and the implications of this definition. Additionally, this article identifies the common palliative-care mistakes that have been made by the general public and by healthcare workers. Healthcare professionals must acquire essential relevant knowledge and skills in order to ensure that hospice palliative care addresses the needs of terminally ill patients adequately. Finally, the author describes a novel approach to instilling proper palliative-care concepts and practices that is entitled Life, Peace, Care, and Honor (LPCH or the "3344" concept). PMID:25854942

  20. Literacy in the World of the Aged Care Worker.

    ERIC Educational Resources Information Center

    Wyse, Linda; Casarotto, Nadia

    Australia's Aged Care Act of 1997 mandates a number of key reforms aimed at ensuring consistency in the quality of care and well-being for all residents of aged care facilities. The law required residential aged care facilities to provide high-quality care within a framework of continuous improvement which requires aged care workers to perform the

  1. Considerations in establishing fees for home-care pharmaceutical services.

    PubMed

    Mirtallo, J M

    1989-07-01

    The activities of home-care pharmacists are highlighted, and factors that should be considered in establishing a reimbursement schedule are described. Pharmacists are important members of the home health-care team. Responsibilities of the pharmacist include assisting in the development of a therapeutic plan, reviewing and monitoring drug therapy, and ensuring that appropriate and correctly prepared medications are available to the patient. The degree of pharmaceutical service depends on the therapy prescribed. The traditional type of third-party reimbursement--cost of drug plus dispensing fee--is often inadequate and can discourage pharmacists from becoming involved in home health care or from providing services of optimal quality. An appropriate reimbursement schedule should take into account the variety of pharmaceutical services provided to home-care patients and should give special consideration to activities, such as discontinuation of unneeded drug therapy, that lower medical costs. Whether pharmacists are able to provide high-quality home health-care services may depend on how adequately they are reimbursed. PMID:2672803

  2. Driving through: postpartum care during World War II.

    PubMed Central

    Temkin, E

    1999-01-01

    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 PMID:10191809

  3. Ensuring the clinical competence of medical school graduates through standardized patients.

    PubMed

    Stillman, P L; Swanson, D B

    1987-06-01

    There are substantial problems with the clinical training provided to medical students and with the assessment procedure used by medical schools to ensure that students have acquired the clinical skills necessary for graduate medical education. These skills are not evaluated carefully nor systematically at any point in training or licensure. This article describes the use of standardized patients to help resolve some of these shortcomings. Standardized patients are non-physicians highly trained to function in the multiple roles of patient, teacher, and evaluator while realistically replicating a patient encounter. They are effective teachers of interviewing and physical examination skills. They can help to provide a controlled exposure to common ambulatory and difficult patient communication situations. Initial studies indicate the promise of this approach for ensuring the competence of medical school graduates. PMID:3592872

  4. Palliative Care Version 1.2016.

    PubMed

    Levy, Michael; Smith, Thomas; Alvarez-Perez, Amy; Back, Anthony; Baker, Justin N; Beck, Anna C; Block, Susan; Dalal, Shalini; Dans, Maria; Fitch, Thomas R; Kapo, Jennifer; Kutner, Jean S; Kvale, Elizabeth; Misra, Sumathi; Mitchell, William; Portman, Diane G; Sauer, Todd M; Spiegel, David; Sutton, Linda; Szmuilowicz, Eytan; Taylor, Robert M; Temel, Jennifer; Tickoo, Roma; Urba, Susan G; Weinstein, Elizabeth; Zachariah, Finly; Bergman, Mary Anne; Scavone, Jillian L

    2016-01-01

    The NCCN Guidelines for Palliative Care provide interdisciplinary recommendations on palliative care for patients with cancer. The NCCN Guidelines are intended to provide guidance to the primary oncology team on the integration of palliative care into oncology. The NCCN Palliative Care Panel's recommendations seek to ensure that each patient experiences the best quality of life possible throughout the illness trajectory. Accordingly, the NCCN Guidelines outline best practices for screening, assessment, palliative care interventions, reassessment, and after-death care. PMID:26733557

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

    PubMed Central

    2011-01-01

    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. PMID:22013991

  6. Productive Ward initiative promotes better communication between mental health teams and ensures timely discharge for patients.

    PubMed

    Lennard, C

    2014-02-01

    The Productive Ward is an initiative whereby nursing staff are empowered to bring about changes in the workplace to streamline systems and release time to care for patients. It is an evidence-based approach, which brings about improved clinical and safety outcomes. This paper discusses how three of the Productive Ward Modules - Ward Round, Admissions and Planned Discharge, and Patient Status At a Glance - have meshed to promote better communication and working between inpatient nursing and medical teams, Home Treatment Team and Community Mental Health Team, and to endeavour to ensure timely discharge for patients. PMID:23157208

  7. 45 CFR 1182.15 - Institute responsibility for maintaining adequate technical, physical, and security safeguards to...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... record systems. The Chief Information Officer has the responsibility of maintaining adequate technical... the Chief Information Officer. The log shall be maintained at all times. (6) The Institute...

  8. 45 CFR 1182.15 - Institute responsibility for maintaining adequate technical, physical, and security safeguards to...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... record systems. The Chief Information Officer has the responsibility of maintaining adequate technical... the Chief Information Officer. The log shall be maintained at all times. (6) The Institute...

  9. 45 CFR 1182.15 - Institute responsibility for maintaining adequate technical, physical, and security safeguards to...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... record systems. The Chief Information Officer has the responsibility of maintaining adequate technical... the Chief Information Officer. The log shall be maintained at all times. (6) The Institute...

  10. Building resiliency: ensuring business continuity is on the health care agenda.

    PubMed

    Geelen-Baass, Briana N L; Johnstone, Jade M K

    2008-02-01

    In light of recent disasters and terrorist attacks, private and public organisations alike are becoming increasingly concerned with their ability to continue operating in spite of unforeseen events. This paper describes a project conducted at the Royal Victorian Eye and Ear Hospital to develop a Business Continuity Management (BCM) Framework, and outlines the learning experience. It provides a Framework and describes the key issues to be considered when initiating BCM in a health organisation, concluding that a project management approach can be used to establish a framework for BCM. PMID:18241161

  11. Adequate use of allele frequencies in Hispanicsa problem elucidated in nephrotic syndrome

    PubMed Central

    Chernin, Gil; Heeringa, Saskia F.; Vega-Warner, Virginia; Schoeb, Dominik S.; Nrnberg, Peter

    2010-01-01

    Previous studies in children with focal segmental glomerulosclerosis (FSGS) and nephrotic syndrome (NS) in the USA have revealed inter-ethnic differences in their clinical presentation and outcome. However, ethnicity was based on self-identification rather than on molecular genetic data. Here, we show that genetic heterogeneity exists in self-identified Hispanic (Spanish-American) patients with steroid-resistant nephrotic syndrome (SRNS), as patients may be either of Caucasian or Mesoamerican (Native-American) genetic background. Twenty-one self-identified Hispanic patients with SRNS from 18 families were initially evaluated for mutations in the NPHS2 and WT1 genes. All patients resided and were cared for in the USA. We performed a total genome search for linkage in all Hispanic patients using 250K single nucleotide polymorphism microarrays, comparing Caucasian with Mesoamerican allele frequencies to determine regions of homozygosity by descent and to establish the correct allele frequency for each family. We found that only ten families (56%) of the 18 self-identified Hispanic families are genetically of Mesoamerican descent, whereas the other eight families (44%) are of Caucasian descent. Due to the small number of families examined, we were unable to draw any conclusion on the prevalence of NPHS2 and WT1 in this ethnic group, but the data do suggest that self-identification of ethnicity in Hispanic-American patients is not an adequate basis for genetic studies, as this cohort may represent not only patients of Mesoamerican origin but also patients of Caucasian origin. Thus, one needs to critically review previous studies of FSGS/SRNS patients that involved Hispanic patients as a group. Future larger studies may employ a total genome search for linkage to test self-identified Hispanic ethnicity for true Mesoamerican versus Caucasian ethnicity in order to generate valid genetic data. PMID:19876656

  12. Transition Care for Children With Special Health Care Needs

    PubMed Central

    Davis, Alaina M.; Brown, Rebekah F.; Taylor, Julie Lounds; Epstein, Richard A.

    2014-01-01

    BACKGROUND: Approximately 750?000 children in the United States with special health care needs will transition from pediatric to adult care annually. Fewer than half receive adequate transition care. METHODS: We had conversations with key informants representing clinicians who provide transition care, pediatric and adult providers of services for individuals with special health care needs, policy experts, and researchers; searched online sources for information about currently available programs and resources; and conducted a literature search to identify research on the effectiveness of transition programs. RESULTS: We identified 25 studies evaluating transition care programs. Most (n = 8) were conducted in populations with diabetes, with a smaller literature (n = 5) on transplant patients. We identified an additional 12 studies on a range of conditions, with no more than 2 studies on the same condition. Common components of care included use of a transition coordinator, a special clinic for young adults in transition, and provision of educational materials. CONCLUSIONS: The issue of how to provide transition care for children with special health care needs warrants further attention. Research needs are wide ranging, including both substantive and methodologic concerns. Although there is widespread agreement on the need for adequate transition programs, there is no accepted way to measure transition success. It will be essential to establish consistent goals to build an adequate body of literature to affect practice. PMID:25287460

  13. Acoustical and noise redesign considerations when trying to increase patient privacy while ensuring comfort

    NASA Astrophysics Data System (ADS)

    Klavetter, Eric

    2005-09-01

    An internal assessment was undertaken to understand the flow of patients to ensure comfort and privacy during their health care experience at Mayo Clinic. A number of different prototypes, work flows, and methodologies were utilized and assessed to determine the ``best experience for our patients.'' A number of prototypes ranging from self-check in to personal pagers were assessed along with creating environments that introduced ``passive distractions'' for acoustical and noise management, which can range from fireplaces, to coffee shops to playgrounds to ``tech corridors.'' While a number of these designs are currently being piloted, the over-reaching goal is to make the patient experience ``like no other'' when receiving their care at Mayo Clinic.

  14. Self-care: a foundational science.

    PubMed

    Denyes, M J; Orem, D E; Bekel, G; SozWiss

    2001-01-01

    Further development of conceptual elements of the theory of self-care, one of the three constituent theories of Orem's self-care deficit theory of nursing, is reported. Five content areas of a practical science of self-care are identified; one content area, self-care requisites, is refined and developed. The nature of self-care requisites is reformulated; guides and standards for the expression of self-care requisites, examples of expressed self-care requisites, and a self-care practice guide are described. These developments are illustrated using the example of the requisite to maintain an adequate fluid intake. PMID:11873354

  15. Improving outcomes in patients with melanoma: strategies to ensure an early diagnosis.

    PubMed

    Voss, Rachel K; Woods, Tessa N; Cromwell, Kate D; Nelson, Kelly C; Cormier, Janice N

    2015-01-01

    Patients with thin, low-risk melanomas have an excellent long-term prognosis and higher quality of life than those who are diagnosed at later stages. From an economic standpoint, treatment of early stage melanoma consumes a fraction of the health care resources needed to treat advanced disease. Consequently, early diagnosis of melanoma is in the best interest of patients, payers, and health care systems. This review describes strategies to ensure that patients receive an early diagnosis through interventions ranging from better utilization of primary care clinics, to in vivo diagnostic technologies, to new "apps" available in the market. Strategies for screening those at high risk due to age, male sex, skin type, nevi, genetic mutations, or family history are discussed. Despite progress in identifying those at high risk for melanoma, there remains a lack of general consensus worldwide for best screening practices. Strategies to ensure early diagnosis of recurrent disease in those with a prior melanoma diagnosis are also reviewed. Variations in recurrence surveillance practices by type of provider and country are featured, with evidence demonstrating that various imaging studies, including ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging, provide only minimal gains in life expectancy, even for those with more advanced (stage III) disease. Because the majority of melanomas are attributable to ultraviolet radiation in the form of sunlight, primary prevention strategies, including sunscreen use and behavioral interventions, are reviewed. Recent international government regulation of tanning beds is described, as well as issues surrounding the continued use artificial ultraviolet sources among youth. Health care stakeholder strategies to minimize UV exposure are summarized. The recommendations encompass both specific behaviors and broad intervention targets (eg, individuals, social spheres, organizations, celebrities, governments). PMID:26609248

  16. Improving outcomes in patients with melanoma: strategies to ensure an early diagnosis

    PubMed Central

    Voss, Rachel K; Woods, Tessa N; Cromwell, Kate D; Nelson, Kelly C; Cormier, Janice N

    2015-01-01

    Patients with thin, low-risk melanomas have an excellent long-term prognosis and higher quality of life than those who are diagnosed at later stages. From an economic standpoint, treatment of early stage melanoma consumes a fraction of the health care resources needed to treat advanced disease. Consequently, early diagnosis of melanoma is in the best interest of patients, payers, and health care systems. This review describes strategies to ensure that patients receive an early diagnosis through interventions ranging from better utilization of primary care clinics, to in vivo diagnostic technologies, to new “apps” available in the market. Strategies for screening those at high risk due to age, male sex, skin type, nevi, genetic mutations, or family history are discussed. Despite progress in identifying those at high risk for melanoma, there remains a lack of general consensus worldwide for best screening practices. Strategies to ensure early diagnosis of recurrent disease in those with a prior melanoma diagnosis are also reviewed. Variations in recurrence surveillance practices by type of provider and country are featured, with evidence demonstrating that various imaging studies, including ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging, provide only minimal gains in life expectancy, even for those with more advanced (stage III) disease. Because the majority of melanomas are attributable to ultraviolet radiation in the form of sunlight, primary prevention strategies, including sunscreen use and behavioral interventions, are reviewed. Recent international government regulation of tanning beds is described, as well as issues surrounding the continued use artificial ultraviolet sources among youth. Health care stakeholder strategies to minimize UV exposure are summarized. The recommendations encompass both specific behaviors and broad intervention targets (eg, individuals, social spheres, organizations, celebrities, governments). PMID:26609248

  17. Ensuring Quality E-Learning: Creating Engaging Tasks.

    ERIC Educational Resources Information Center

    Hedberg, John G.

    2003-01-01

    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…

  18. 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

  19. Ensuring Data Quality in Extension Research and Evaluation Studies

    ERIC Educational Resources Information Center

    Radhakrishna, Rama; Tobin, Daniel; Brennan, Mark; Thomson, Joan

    2012-01-01

    This article presents a checklist as a guide for Extension professionals to use in research and evaluation studies they carry out. A total of 40 statements grouped under eight data quality components--relevance, objectivity, validity, reliability, integrity, generalizability, completeness, and utility--are identified to ensure that research

  20. Ensuring Student Success through Collaboration. Bulletin No. 94076.

    ERIC Educational Resources Information Center

    Wisconsin State Dept. of Public Instruction, Madison.

    Wisconsin designed a proposal to the Council of Chief State School Officers (CCSSO) for funding through a grant program: "Ensuring Student Success Through Collaboration." With the financial support made available by CCSSO through this grant program, a statewide meeting on May 26, 1993, was held to explore school/community collaboration to address

  1. 34 CFR 300.154 - Methods of ensuring services.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... insurance or private insurance will not be treated as program income for purposes of 34 CFR 80.25. (2) If a... insurance program by Federal statute, regulations or policy under title XIX, or title XXI of the Social... CHILDREN WITH DISABILITIES State Eligibility Methods of Ensuring Services 300.154 Methods of...

  2. Ensuring Equal Access to High-Quality Education. Revised

    ERIC Educational Resources Information Center

    Office for Civil Rights, US Department of Education, 2011

    2011-01-01

    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…

  3. Improved molding process ensures plastic parts of higher tensile strength

    NASA Technical Reports Server (NTRS)

    Heier, W. C.

    1968-01-01

    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.

  4. 3 CFR - Ensuring Responsible Spending of Recovery Act Funds

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... accountability objectives. (b) No considerations contained in oral or written communications from any person or... purposes of the Act, the department or agency shall consult immediately with the Office of Management and... proceeding for suspension and debarment. Sec. 3. Ensuring Transparency of Registered Lobbyist...

  5. Future Testing Opportunities to Ensure Sustainability of the Biofuels Industry

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Energy Independence and Security Act (EISA) of 2007 increased the intensity of biofuel research and development throughout the U.S. For the Soil and Plant Analysis Community, this will undoubtedly create new opportunities to provide analytical services that will help ensure mandates such as the ...

  6. Ensuring Student Success: A Handbook of Evidence-Based Strategies.

    ERIC Educational Resources Information Center

    Friedman, Myles I.

    The purpose of this book is to help educational change agents and educators ensure student success through high school by implementing educational practices that research has shown to be effective. The intended audience includes legislators, school board members, educational administrators, teachers, representatives of educational organizations,

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

    ERIC Educational Resources Information Center

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

    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…

  8. Ensuring climate information guides long-term development

    NASA Astrophysics Data System (ADS)

    Jones, Lindsey; Dougill, Andrew; Jones, Richard G.; Steynor, Anna; Watkiss, Paul; Kane, Cheikh; Koelle, Bettina; Moufouma-Okia, Wilfran; Padgham, Jon; Ranger, Nicola; Roux, Jean-Pierre; Suarez, Pablo; Tanner, Thomas; Vincent, Katharine

    2015-09-01

    Many sub-Saharan countries are failing to include climate information in long-term development planning. Ensuring climate-resilient development requires a step change in how medium- to long-term climate information is produced, communicated and utilized in sub-Saharan Africa and elsewhere.

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

    ERIC Educational Resources Information Center

    Brown, Bettina Lankard

    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…

  10. 12 CFR 702.303 - Prompt corrective action for “adequately capitalized” new credit unions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Prompt corrective action for âadequately capitalizedâ new credit unions. 702.303 Section 702.303 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION.... Beginning on the effective date of classification, an “adequately capitalized” new credit union...

  11. 12 CFR 702.303 - Prompt corrective action for “adequately capitalized” new credit unions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Prompt corrective action for âadequately capitalizedâ new credit unions. 702.303 Section 702.303 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION.... Beginning on the effective date of classification, an “adequately capitalized” new credit union...

  12. 12 CFR 702.303 - Prompt corrective action for “adequately capitalized” new credit unions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Prompt corrective action for âadequately capitalizedâ new credit unions. 702.303 Section 702.303 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION.... Beginning on the effective date of classification, an “adequately capitalized” new credit union...

  13. 12 CFR 702.303 - Prompt corrective action for “adequately capitalized” new credit unions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false Prompt corrective action for âadequately capitalizedâ new credit unions. 702.303 Section 702.303 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION.... Beginning on the effective date of classification, an “adequately capitalized” new credit union...

  14. 12 CFR 702.303 - Prompt corrective action for “adequately capitalized” new credit unions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false Prompt corrective action for âadequately capitalizedâ new credit unions. 702.303 Section 702.303 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION.... Beginning on the effective date of classification, an “adequately capitalized” new credit union...

  15. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Adequate financial records, statistical data, and....568 Adequate financial records, statistical data, and cost finding. (a) Maintenance of records. (1) An HMO or CMP must maintain sufficient financial records and statistical data for proper determination...

  16. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Adequate financial records, statistical data, and....568 Adequate financial records, statistical data, and cost finding. (a) Maintenance of records. (1) An HMO or CMP must maintain sufficient financial records and statistical data for proper determination...

  17. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Adequate financial records, statistical data, and....568 Adequate financial records, statistical data, and cost finding. (a) Maintenance of records. (1) An HMO or CMP must maintain sufficient financial records and statistical data for proper determination...

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

    PubMed Central

    Amar, Praveen Kumar

    2010-01-01

    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. PMID:21829321

  19. Studies in the Delivery of Ambulatory Care.

    ERIC Educational Resources Information Center

    Kaplan, Robert; And Others

    A primary reason for increased government involvement in health care delivery resides in the acknowledged difficulty of the poor in obtaining adequate care. However, in the absence of knowledge about how health, health care, socio-economic status, race, ethnicity, and geographic location are related, policies aimed at implementing right to health…

  20. Bovine hemoglobin as the sole source of dietary iron does not support adequate iron status in copper-adequate or copper-deficient rats

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This experiment was designed to determine whether hemoglobin as the sole source of dietary iron (Fe) could sustain normal Fe status in growing rats. Because adequate copper (Cu) status is required for efficient Fe absorption in the rat, we also determined the effects of Cu deficiency on Fe status of...

  1. Opportunities for Palliative Care in Public Health.

    PubMed

    De Lima, Liliana; Pastrana, Tania

    2016-03-18

    In May 2014, the World Health Assembly, of the World Health Organization (WHO), unanimously adopted a palliative care (PC) resolution, which outlines clear recommendations to the United Nations member states, such as including PC in national health policies and in the undergraduate curricula for health care professionals, and highlights the critical need for countries to ensure that there is an adequate supply of essential PC medicines, especially those needed to alleviate pain. This resolution also carries great challenges: Every year over 20 million patients (of which 6% are children) need PC at the end of life (EOL). However, in 2011, approximately three million patients received PC, and only one in ten people in need is currently receiving it. We describe this public health situation and systems failure, the history and evolution of PC, and the components of the WHO public health model. We propose a role for public health for PC integration in community settings to advance PC and relieve suffering in the world. PMID:26989831

  2. Global development challenges and health care reform.

    PubMed

    Preker, A S

    2001-01-01

    Changes in the role of the state and private sector are seen as central to success of many health care reforms. The article argues for a more focused "stewardship" function of governments in securing equity, efficiency, and quality objectives through more effective policy making (steering), regulating, contracting, and ensuring that adequate financing arrangements are available for the whole population. At the same time, the author argues a strong case for greater private participation in providing health services (rowing). The article reviews related reform trends in health care financing, generation of inputs and service providers. It concludes that reforms often fail, not because of a flawed technical design, but because of other factors. These include a lack of political commitment to change, resistance from vested stakeholders who fear loosing some of their existing benefits, and a failure by policymakers to translate successful aspects of the reforms into something visible that ordinary people and the public can see with their own eyes when next they use the reformed services. PMID:11858008

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

    PubMed Central

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

    2014-01-01

    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. PMID:23511654

  4. HACCP approach to ensure the safety and quality of food packaging.

    PubMed

    Bovee, E H; de Kruijf, N; Jetten, J; Barendsz, A W

    1997-01-01

    EC Directive 93/43/EEC of 14 June 1993 on the hygiene of foodstuffs has been implemented in the Netherlands through the Food and Commodity Act (Warenwet) of 14 December 1995. This Directive requires food companies to identify steps in their activities that are critical to ensuring food safety, and to ensure that adequate safety procedures are identified, implemented, maintained and reviewed based on the principles of the Hazard Analysis Critical Control Point (HACCP) system. HACCP is a tool used to assess hazards, estimate risks and establish specific control measures that emphasize prevention and control rather than reliance on end-product testing. Increasing public awareness of food safety, together with the introduction of this new legislation, has led producers and retailers of food to demand higher standards from their suppliers. Suppliers of raw materials, ingredients and also food packaging will be expected to bring their standards of hygiene in line with the expectations of the food industry. Food producers will need to obtain the guarantee from their suppliers that the packaging does not negatively influence their products. HACCP is a method that can also be applied to ensure the safety and other quality aspects of all kinds of food packaging materials such as films, foils, trays, cups, boxes and tubs made of paper, cardboard, polymers, metal and other materials (single use or disposable packagings as well as re-usable and recycled packagings). At the Netherlands Organization for Applied Scientific Research (TNO), the quality and safety aspects of re-use of food packaging, and refillable bottles in particular, have been the subject of extensive investigations in the project 'Quality monitoring of synthetic refillable bottles'. In this paper the set-up of the project and the Codes of Practice for refillable bottles are described. Moreover, the applicability of HACCP to food packagings and an example of a HACCP study for refillable PET bottles will be discussed. PMID:9373535

  5. 45 CFR 1159.15 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... of maintaining adequate technical, physical, and security safeguards to prevent...

  6. 45 CFR 1159.15 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... of maintaining adequate technical, physical, and security safeguards to prevent...

  7. 45 CFR 1159.15 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... of maintaining adequate technical, physical, and security safeguards to prevent...

  8. Coordinating Care: Shifts in Perspective.

    PubMed

    Linnenkamp, Rita; Drenkard, Karen

    2016-01-01

    Effective coordination of care has consistently been a challenge for clinicians, care providers, and systems of health care. The health care system is inherently fraught with unorganized and disparate parts including multiple points of entry. A review of the current issues and the leadership implications is explored in this article with an emphasis on patients becoming more actively engaged in managing their care journey across the continuum. A case study of a primary care clinic in Annapolis, Maryland, is described to illustrate the application of evidence-based leadership skills, knowledge, and a framework to transform health care to more effectively engage patients in their care. As the constant on the continuum of care, the engaged patient is in the unique position to manage coordination, thus ensuring continuity. PMID:26938184

  9. Perceptions about prenatal care: views of urban vulnerable groups

    PubMed Central

    Milligan, Renee; Wingrove, Barbara K; Richards, Leslie; Rodan, Margaret; Monroe-Lord, Lillie; Jackson, Velishie; Hatcher, Barbara; Harris, Cynthia; Henderson, Cassandra; Johnson, Allan A

    2002-01-01

    Background In the United States, infant mortality rates remain more than twice as high for African Americans as compared to other racial groups. Lack of adherence to prenatal care schedules in vulnerable, hard to reach, urban, poor women is associated with high infant mortality, particularly for women who abuse substances, are homeless, or live in communities having high poverty and high infant mortality. This issue is of concern to the women, their partners, and members of their communities. Because they are not part of the system, these womens' views are often not included in other studies. Methods This qualitative study used focus groups with four distinct categories of people, to collect observations about prenatal care from various perspectives. The 169 subjects included homeless women; women with current or history of substance abuse; significant others of homeless women; and residents of a community with high infant mortality and poverty indices, and low incidence of adequate prenatal care. A process of coding and recoding using Ethnograph and counting ensured reliability and validity of the process of theme identification. Results Barriers and motivators to prenatal care were identified in focus groups. Pervasive issues identified were drug lifestyle, negative attitudes of health care providers and staff, and non-inclusion of male partners in the prenatal experience. Conclusions Designing prenatal care relevant to vulnerable women in urban communities takes creativity, thoughtfulness, and sensitivity. System changes recommended include increased attention to substance abuse treatment/prenatal care interaction, focus on provider/staff attitudes, and commitment to inclusion of male partners. PMID:12421466

  10. Canine public servants: caring for drug detection dogs.

    PubMed

    Davidson, Gigi S

    2008-01-01

    Dogs are utilized more and more to seek out illicit and hazardous substances under the guidance of humans. Therefore, veterinarians, dog handlers, and pharmacists must all collaborate to ensure adequate protection, treatment, and care for detection dogs in the line of duty. Ideally, veterinarians and pharmacists can work together to train and equip dog handlers with state of the art instructions and animal emergency kits that can provide life-saving decontamination at the site of exposure. Pharmacists can collaborate with veterinarians to provide animal emergency kits containing essential treatment aids such as apomorphine, hydrogen peroxide, activated charcoal/sorbitol cathartic suspension, ocular irrigants, and instructions and associated devices for administration. Immediate intervention provides the best prognosis for canine heroes that suffer exposure to occupational toxicological hazards. PMID:23969859

  11. When systems fail: improving care through technology can create risk.

    PubMed

    Bagalio, Sharon A

    2007-01-01

    Emerging medical technology is transforming the care of the modern-day patient. Hospital performance and patient safety is improving, lowering professional liability and medical malpractice costs. This advanced technology affects not only diagnosis and treatment but also hospital productivity and revenue. However, it also exposes hospitals and medical personnel to a number of unforeseeable risks. This article examines ongoing efforts to improve patient safety through the use of technology, automation and complex systems operations. It discusses the importance of skilled negotiation when vying for technology contracts and the value of maintaining a reliable data center to support it. Technology risk exposure is now a reality. A hospital needs to know how to protect itself from cyber liability, business interruption, and data loss and theft by ensuring that there is adequate coverage. PMID:20200890

  12. Palliative Care

    MedlinePLUS

    ... Emergency Cerebral Palsy: Caring for Your Child Palliative Care KidsHealth > For Parents > Palliative Care Print A A ... decisions about their child's care. Who Needs Palliative Care? Any child who has a serious, complex, or ...

  13. Strategies for ensuring quality data from Indian investigational sites.

    PubMed

    Hajos, Antal K; Kamble, Sujal K

    2011-04-01

    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

  14. Curbing the cost of interdisciplinary care plans.

    PubMed

    Dobay, N J

    1988-11-01

    Interdisciplinary care plans, if done properly, become not only a cost-effective form of planning patient care but can also be the most efficient and holistic form of care giving. The key person in the team is the coordinator. The coordinator must ensure timely care plan reviews, notify members of upcoming conferences, enforce conference rules, and ensure proper documentation and efficient utilization of time at the conference. The administrator is ultimately responsible for seeing that each discipline is held accountable for its part of the care plan process. The administrator must encourage the provision of high-quality care through the care planning process, as well as motivate and reinforce to all team members the importance of this holistic concept of patient care. The person actually writing the care plans during the conference can be chosen by the coordinator but should be someone who has a good concept of proper care plan form and medical terminology and who can write quickly. A productive care conference is only part of the answer to an effective interdisciplinary approach. Care plans must be specific, individualized and realistic, with measurable and obtainable goals. They must be made available to all personnel in such a manner that they become a precise menu of the care giving process. All care givers must be keenly aware of the value and usefulness of this patient care tool to ensure high quality in a coordinated, holistic approach. PMID:10290545

  15. Workers' compensation in the United States and the role of the primary care physician.

    PubMed

    Pye, H; Orris, P

    2000-12-01

    The workers' compensation system was designed as a no-fault system in the early years of the last century. The system is organized on a state level. There are three differing models in current use: the single public fund, the single private fund, and an open market. States range as well in the amount of choice available to the injured workers in their selection of health care providers. In each state though, the physician plays an integral role in ensuring that the injured worker obtains adequate medical care in a prompt and efficient manner. The physician's function is either as treating physician, or as one who provides an independent medical evaluation for either the employee's lawyer, the employer, the insurer or their counsel or the state. Many obvious improvements in the system have not been made because political agreement on the state level is often lacking. PMID:11072289

  16. [The transformation of the healthcare model in Catalonia to improve the quality of care].

    PubMed

    Padrosa, Josep Maria; Guarga, lex; Brosa, Francesc; Jimnez, Josep; Robert, Roger

    2015-11-01

    The changes taking place in western countries require health systems to adapt to the public's evolving needs and expectations. The healthcare model in Catalonia is undergoing significant transformation in order to provide an adequate response to this new situation while ensuring the system's sustainability in the current climate of economic crisis. This transformation is based on converting the current diseasecentred model which is fragmented into different levels, to a more patient-centred integrated and territorial care model that promotes the use of a shared network of the different specialities, the professionals, resources and levels of care, entering into territorial agreements and pacts which stipulate joint goals or objectives. The changes the Catalan Health Service (CatSalut) has undergone are principally focused on increasing resolution capacity of the primary level of care, eliminating differences in clinical practice, evolving towards more surgery-centred hospitals, promoting alternatives to conventional hospitalization, developing remote care models, concentrating and organizing highly complex care into different sectors at a territorial level and designing specific health codes in response to health emergencies. The purpose of these initiatives is to improve the effectiveness, quality, safety and efficiency of the system, ensuring equal access for the public to these services and ensuring a territorial balance. These changes should be facilitated and promoted using several different approaches, including implementing shared access to clinical history case files, the new model of results-based contracting and payment, territorial agreements, alliances between centres, harnessing the potential of information and communications technology and evaluation of results. PMID:26711056

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

    ERIC Educational Resources Information Center

    Caesar, Lena G.

    2006-01-01

    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…

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

    ERIC Educational Resources Information Center

    Caesar, Lena G.

    2006-01-01

    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

  19. Perinatal substance abuse and human subjects research: are privacy protections adequate?

    PubMed

    Marshall, Mary Faith; Menikoff, Jerry; Paltrow, Lynn M

    2003-01-01

    Privacy incursions in the clinical care of substance abusing pregnant women have gained lay and professional attention recently as the result of a high-profile Supreme Court finding in Ferguson vs City of Charleston et al. In March, 2001 the Supreme Court determined that nonconsensual drug screening of pregnant women by clinicians in a public hospital violated the women's Fourth Amendment rights to be secure against unreasonable search and seizure. Coercive or punitive policy approaches to perinatal substance abuse are often based on mistaken assumptions about the nature of addiction and the outcomes of punitive interventions. Much attention has been given to efforts to criminalize pregnancy for drug using women, and civil laws are also coming under increasing scrutiny. Although no state has passed a law criminalizing pregnancy and drug use, an estimated 250 women in more than 30 states have been prosecuted around the country on theories of "fetal abuse." A growing number of states (eighteen to date) have amended their civil child welfare laws to address specifically the subject of a woman's drug use during pregnancy. No one has examined how these laws and social policies could affect research that includes pregnant and parenting women; women (and their families) who stand to lose a great deal should their drug use be brought to the attention of child welfare or criminal justice authorities. We examine the adequacy of current protective mechanisms, such as federal certificates of confidentiality, in protecting research subjects (and investigators) who may be subject to punitive civil or criminal sanctions. We determine that current protective mechanisms may be insufficient to protect research subjects and that investigators and IRB members are often ignorant of the risks imposed by punitive policy approaches to perinatal substance abuse or fall prey to the same mistaken assumptions that inform punitive policies. We conclude that investigators and IRB members have a moral responsibility to understand local, state and national policies and laws governing perinatal substance abuse. Investigators and IRB members should balance the harms of punitive interventions against the protections that may, or may not be afforded to prospective research subjects as well as the prospective benefits, individual and social, of the research. In situations where criminal or punitive policies are in effect, investigators and IRB members should consider whether adequate protections can be achieved. In the context of inadequate protections, potential risks to prospective research subjects and their families may outweigh the individual or social benefits that accrue from the research. Clinical researchers are professionally obligated to work toward amending laws and policies that are not in the best interests of prospective research subjects. PMID:12587139

  20. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Emergency care. 460.100 Section 460.100 Public...) PACE Services § 460.100 Emergency care. (a) Written plan. A PACE organization must establish and maintain a written plan to handle emergency care. The plan must ensure that CMS, the State, and...

  1. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Emergency care. 460.100 Section 460.100 Public...) PACE Services § 460.100 Emergency care. (a) Written plan. A PACE organization must establish and maintain a written plan to handle emergency care. The plan must ensure that CMS, the State, and...

  2. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Emergency care. 460.100 Section 460.100 Public...) PACE Services § 460.100 Emergency care. (a) Written plan. A PACE organization must establish and maintain a written plan to handle emergency care. The plan must ensure that CMS, the State, and...

  3. Parent Handbook for Family Child Care Homes.

    ERIC Educational Resources Information Center

    Nebraska State Dept. of Health and Human Services, Lincoln.

    Published by Nebraska's Department of Health and Human Services, this guide provides information that will help parents and providers ensure that their child receives the best possible care from a licensed child care home provider. The guide also serves as a basis for discussion between parents and their child care providers to make a child's

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

    PubMed Central

    2013-01-01

    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 patient’s 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. PMID:24093461

  5. 34 CFR 200.21 - Adequate yearly progress of a State.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Improving Basic Programs Operated by Local Educational Agencies Adequate Yearly Progress (ayp) 200.21... attainment of English proficiency by limited English proficient students. (b) A State must include...

  6. 34 CFR 200.21 - Adequate yearly progress of a State.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Improving Basic Programs Operated by Local Educational Agencies Adequate Yearly Progress (ayp) 200.21... attainment of English proficiency by limited English proficient students. (b) A State must include...

  7. 34 CFR 200.21 - Adequate yearly progress of a State.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Improving Basic Programs Operated by Local Educational Agencies Adequate Yearly Progress (ayp) 200.21... attainment of English proficiency by limited English proficient students. (b) A State must include...

  8. 34 CFR 200.21 - Adequate yearly progress of a State.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Improving Basic Programs Operated by Local Educational Agencies Adequate Yearly Progress (ayp) 200.21... attainment of English proficiency by limited English proficient students. (b) A State must include...

  9. 34 CFR 200.21 - Adequate yearly progress of a State.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Improving Basic Programs Operated by Local Educational Agencies Adequate Yearly Progress (ayp) 200.21... attainment of English proficiency by limited English proficient students. (b) A State must include...

  10. Percentage of Adults with High Blood Pressure Whose Hypertension Is Adequately Controlled

    MedlinePLUS

    ... of Adults with High Blood Pressure Whose Hypertension is Adequately Controlled Heart disease and stroke are the ... Percentage of People with High Blood Pressure that is Controlled by Age Group f94q-uyye Download these ...

  11. Quality Child Care: At Whose Expense?

    ERIC Educational Resources Information Center

    Roseman, Marilyn J.

    1999-01-01

    Quality child care is related to the number of adequately prepared practitioners. Unfortunately, workers subsidize the cost of quality by working for substandard wages, few benefits, and little recognition. The need for adequate compensation is the most critical issue facing the profession, and the cost should be shared by all members of society.

  12. Physicians' perceptions of managed care.

    PubMed

    Levine, R A; Lieberson, A

    1998-02-01

    We wished to determine physicians' views and knowledge of managed care, particularly their beliefs about the provisions of managed care contracts in terms of legality and ethics. A questionnaire was sent to the 315 physicians of the medical staff of Norwalk Hospital in Connecticut regarding managed care and managed care contracts. Sixty-six responses were received within a 45-day period (20.9% return). Although only 1 of 11 contract provisions presented in one section of the questionnaire was illegal in Connecticut, a majority of physicians believed 7 of the 11 were illegal. On average, 50% of physicians polled thought each of the provisions was illegal, and a varying majority of physicians (53% to 95.4%) felt the various provisions were unethical. The majority of respondents (84.8% to 92.4%) believed that nondisclosure provisions were unethical. Ninety-seven percent thought managed care interferes with quality of care, and 72.7% of physicians felt that the managed care industry should be held legally responsible for ensuring quality of care. However, 92.4% of physicians considered themselves to be ethically responsible for ensuring quality of care. Physicians have a poor understanding of the legal aspects of managed care contracts but feel strongly that many provisions of these contracts are unethical. Physicians also believe that managed care is causing medicine to be practiced in a manner that is contrary to patients' interests and that legal recourse is needed to prevent this. PMID:10178489

  13. How NASA Utilizes Dashboards to Help Ensure Mission Success

    NASA Technical Reports Server (NTRS)

    Blakeley, Chris

    2013-01-01

    NASA is actively planning to expand human spaceflight and robotic exploration beyond low Earth orbit. To prepare for the challenge of exploring these destinations in space, NASA conducts missions here on Earth in remote locations that have physical similarities to extreme space environments. Program managers for the Advanced Exploration Systems program requested a simple way to track financial information to ensure that each task stayed within their budgetary constraints. Using SAP BusinessObjects Dashboards (Formerly Xcelsius), a dashboard was created to satisfy all of their key requirements. Lessons learned, along with some tips and tricks, will be highlighted during this session.

  14. Ensuring Food Security Through Enhancing Microbiological Food Safety

    NASA Astrophysics Data System (ADS)

    Mikš-Krajnik, Marta; Yuk, Hyun-Gyun; Kumar, Amit; Yang, Yishan; Zheng, Qianwang; Kim, Min-Jeong; Ghate, Vinayak; Yuan, Wenqian; Pang, Xinyi

    2015-10-01

    Food safety and food security are interrelated concepts with a profound impact on the quality of human life. Food security describes the overall availability of food at different levels from global to individual household. While, food safety focuses on handling, preparation and storage of foods in order to prevent foodborne illnesses. This review focuses on innovative thermal and non-thermal technologies in the area of food processing as the means to ensure food security through improving food safety with emphasis on the reduction and control of microbiological risks. The antimicrobial efficiency and mechanism of new technologies to extend the shelf life of food product were also discussed.

  15. Preventive Health Care for the Elderly

    PubMed Central

    Stults, Barry M.

    1984-01-01

    Demographic, economic and humanitarian considerations dictate that effective preventive health care be provided to the elderly. A disease-specific approach to geriatric preventive health care will not suffice; measures to enhance or maintain physical, mental and social function must also be emphasized. Unfortunately, the effectiveness of many preventive care procedures has not been adequately investigated in the elderly. Research is urgently needed to determine the efficacy of and appropriate target population for various geriatric preventive health care measures. PMID:6395498

  16. Who Cares? Day Care.

    ERIC Educational Resources Information Center

    Illinois State Dept. of Children and Family Services, Springfield.

    The purpose of this report prepared by the Illinois Department of Children and Family Services is to describe the growth of day care services in Illinois during 1972 and to present information which will aid state agencies and citizens in planning for and coordinating day care services. The report is divided into discussions of past, present, and

  17. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... requirements: (1) Offers an appropriate range of preventive, primary care, and specialty services that is... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance... enrollment in its service area in accordance with the State's standards for access to care under this...

  18. Observation of potentially troublesome (2) JCC correlations in 1,1-ADEQUATE spectra.

    PubMed

    Saur, Josep; Liu, Yizhou; Williamson, R Thomas; Martin, Gary E

    2016-04-01

    Despite the tremendous usage of HMBC to establish long-range (1) H-(13) C and (1) H-(15) N heteronuclear correlations, an inherent drawback of the experiment is the indeterminate nature of the (n) JXH correlations afforded by the experiment. A priori there is no reliable way of determining whether a given (n) JCH correlation is, for example, via two-, three-, or sometimes even four-bonds. This limitation of the HMBC experiment spurred the development of the ADEQUATE family of NMR experiments that rely on, in the case of 1,1-ADEQUATE, an out-and-back transfer of magnetization via the (1) JCC homonuclear coupling constant, which is significantly larger than (n) JCC (where n?=?2-4) couplings in most cases. Hence, the 1,1-ADEQUATE experiment has generally been assumed to unequivocally provide the equivalent of (2) JCH correlations. The recent development of the 1,1- and 1,n-HD-ADEQUATE experiments that can provide homodecoupling for certain (1) JCC and (n) JCC correlations has increased the sensitivity of the ADEQUATE experiments significantly and can allow acquisition of these data in a fraction of the time required for the original iterations of this pulse sequence. With these gains in sensitivity, however, there occasionally come unanticipated consequences. We have observed that the collapse of proton multiplets, in addition to providing better s/n for the desired (1) JCC correlations can facilitate the observation of typically weaker (2) JCC correlations across intervening carbonyl resonances in 1,1-HD-ADEQUATE spectra. Several examples are shown, with the results supported by the measurement of the (2) JCC coupling constants in question using J-modulated-HD-ADEQUATE and DFT calculations. Copyright 2016 John Wiley & Sons, Ltd. PMID:26845240

  19. Oral care.

    PubMed

    Hitz Lindenmller, Irne; Lambrecht, J Thomas

    2011-01-01

    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. The use of a toothbrush is the most important measure for oral hygiene. Toothbrushes with soft bristles operated carefully by hand or via an electric device help to remove plaque and to avoid mucosal trauma. A handlebar with a grip cover can be helpful for manually disabled patients or for those with reduced motor skills. In case of oral hygiene at the bedside or of patients during/after chemo-/radiotherapy a gauze pad can be helpful for gently cleaning the teeth, gums and tongue. The use of fluoride toothpaste is imperative for the daily oral hygiene. Detergents such as sodium lauryl sulphate improve the cleaning action but may also dehydrate and irritate the mucous membrane. The use of products containing detergents and flavouring agents (peppermint, menthol, cinnamon) should therefore be avoided by bedridden patients or those with dry mouth and sensitive mucosa. Aids for suitable interdental cleaning, such as dental floss, interdental brushes or dental sticks, are often complicated to operate. Their correct use should be instructed by healthcare professionals. To support dental care, additional fluoridation with a fluoride gel or rinse can be useful. Products further containing antiseptics such as chlorhexidine or triclosan reduce the quantity of bacteria in the mouth. For patients undergoing or having undergone radio-/chemotherapy, a mouthwash that concomitantly moisturizes the oral mucosa is advisable. PMID:21325845

  20. Palliative Care

    MedlinePLUS

    ... for Your Child All About Food Allergies Palliative Care KidsHealth > For Parents > Palliative Care Print A A ... decisions about their child's care. Who Needs Palliative Care? Any child who has a serious, complex, or ...

  1. 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 ...

  2. 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 ...

  3. Continuing Care

    MedlinePLUS

    ... Care Obesity at Midlife May Speed Alzheimers Onset Hello from my mom Easing the Behavior Problems of ... Services Home-Care Services Care Managers Continuing Care Hello from my mom Common Estate Planning Errors Alzheimers ...

  4. Adequate lymphadenectomy for colorectal cancer: a comparative analysis between open and laparoscopic surgery

    PubMed Central

    BATISTA, Vilson Leite; IGLESIAS, Antonio Carlos Ribeiro Garrido; MADUREIRA, Fernando Athayde Veloso; BERGMANN, Anke; DUARTE, Rachel Perez; da FONSECA, Brbara Ferreira Saraiva

    2015-01-01

    Background In the surgical treatment of colorectal cancer, a lymphadenectomy is considered adequate when at least 12 lymph nodes are removed. Aim To evaluate whether videolaparoscopic surgery positively affects the rates of adequate lymphadenectomy. Methods An observational study was conducted with patients undergoing either open or videolaparoscopic surgery for colorectal cancer between 2008 and 2013. The following variables were collected: gender, age, tumor site, histology, degree of differentiation, tumor stage, number of lymph nodes removed, and number of lymph nodes affected by the disease. Results A total of 62 patients with colorectal cancer were included; 42 (67.7%) received open surgery, and 20 (32.3%) laparoscopic surgery. Regarding lymphadenectomy, a mean of 13 lymph nodes (95% CI: 10-16) were removed in the group that received open surgery, while 19 lymph nodes were removed (95% CI: 14-24) in the laparoscopic surgery group (p=0.021). Adequate lymphadenectomy (removal of at least 12 lymph nodes) was achieved in 58.1% of the total cases, in 50.0% of the patients who received open surgery, and in 75% of those who received laparoscopic surgery. Non-elderly patients and those with an advanced disease stage were more likely to receive an adequate lymphadenectomy (p=0.004 and p=0.035, respectively). Conclusion Disease stage and patient age were the factors that had the greatest influence on achieving an adequate lymphadenectomy. The type of surgery did not affect the number of lymph nodes removed. PMID:26176245

  5. Public health strategies to ensure reduction in suicide incidence in middle and low income nations.

    PubMed

    Shrivastava, Saurabh RamBihariLal; Shrivastava, Prateek Saurabh; Ramasamy, Jegadeesh

    2015-01-01

    Worldwide, the incidence of suicide has increased at an alarming rate and in the year 2012 close to 1 million people died because of suicide. Although, it is a well-acknowledged fact that suicides are completely preventable, the public health authorities have failed to halt the rising trend of the suicide because of the presence of various social and health related factors. As suicide is a complex issue, in the low and middle-income nations, the most cost-effective approach is to ensure the integration of suicide prevention program into the primary health care network. To conclude, suicide is an important public health concern which is definitively preventable. However, the need of the hour is that all the stakeholders should take collective responsibility, and work in collaboration to develop and implement a comprehensive multi-sectoral suicide prevention strategy. PMID:26752917

  6. Does prenatal care benefit maternal health? A study of post-partum maternal care use.

    PubMed

    Liu, Tsai-Ching; Chen, Bradley; Chan, Yun-Shan; Chen, Chin-Shyan

    2015-10-01

    Most studies on prenatal care focus on its effects on infant health, while studying less about the effects on maternal health. Using the Longitudinal Health Insurance claims data in Taiwan in a recursive bivariate probit model, this study examines the impact of adequate prenatal care on the probability of post-partum maternal hospitalization during the first 6 months after birth. The results show that adequate prenatal care significantly reduces the probability of post-partum maternal hospitalization among women who have had vaginal delivery by 43.8%. This finding suggests that the benefits of prenatal care may have been underestimated among women with vaginal delivery. Timely and adequate prenatal care not only creates a positive impact on infant health, but also yields significant benefits for post-partum maternal health. However, we do not find similar benefits of prenatal care for women undergoing a cesarean section. PMID:26189913

  7. An Australian perspective on developing standards and ensuring compliance.

    PubMed

    Thornber, Peter M

    2010-01-01

    Australia is a federation of states and territories, each with their own parliament and animal-welfare laws. Australian animal-welfare legislation imposes a "duty of care" on people responsible for the care and well-being of animals under their management. In the livestock sector, this responsibility is mirrored by the ongoing development of standards, guidelines, and codes of practice to assist people to understand their responsibilities and to meet expectations concerning animal welfare. The Australian Animal Welfare Strategy (AAWS) is the national animal-welfare policy blueprint for sustainable improvements in animal welfare, and one of its key goals is to achieve greater consistency in the development, implementation, and enforcement of animal-welfare standards. Standards, guidelines, and model codes also inform the development of contemporary, evidence-based quality assurance programs for individual livestock industries and provide the basis for competency-based training programs for animal handlers. Australian standards have been developed for pigs and land transport of livestock, and work is progressing on national standards for cattle, sheep, horses, zoo animals, dogs, and cats. Other achievements include the development of requirements for the care and use of animals in research and teaching, guidelines for the welfare of aquatic animals, and codes of practice for the humane killing of pest animals. State and territory governments are developing a framework for consistent regulation and compliance in consultation with industries and welfare organizations. PMID:20378873

  8. [Use of music in palliative care].

    PubMed

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

    2011-12-01

    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

  9. The importance of care.

    PubMed

    van Schie, T; Seedhouse, D

    1997-12-01

    This paper is in three parts. In Part One we briefly explain that an unsophisticated form of utilitarianism--economic rationalism (ER)--has become dominant in many health systems. Its proponents argue that one of ER's most important effects is to increase consumer choice. However, evidence from New Zealand does not support this claim. Furthermore, the logic of ER requires the construction of systems which tend to restrict individual participation. In Part Two we argue that although some have advocated an 'ethic of care' in an attempt to counteract ER's utilitarianism, two decades of campaigning have had little influence on health policy. ER's pro-care adversaries have failed to make an impact because they have not developed a taxonomy of care--they have not established a language compatible with, or as powerful as, ER's. In Part Three, in an attempt to raise the conceptual and practical status of caring in contemporary health systems, we distinguish four different forms of care. In opposition to those who believe the 'ethic of care' can adequately direct health care practice, we demonstrate that care is a secondary notion. We show that in order for a carer to decide which form of care to adopt in different situations she requires a more powerful idea. We contend further that health care ought to be governed by a theory of health, and suggest that 'the foundations theory of health' should be adopted by planners searching for a more humane alternative to ER. We conclude that ER's dominance can and must be challenged. However, only those arguments which offer detailed theoretical analyses of health care, as well as meticulously derived practical policies, have any chance of success. PMID:10177941

  10. The autophagic machinery ensures nonlytic transmission of mycobacteria.

    PubMed

    Gerstenmaier, Lilli; Pilla, Rachel; Herrmann, Lydia; Herrmann, Hendrik; Prado, Monica; Villafano, Geno J; Kolonko, Margot; Reimer, Rudolph; Soldati, Thierry; King, Jason S; Hagedorn, Monica

    2015-02-17

    In contrast to mechanisms mediating uptake of intracellular bacterial pathogens, bacterial egress and cell-to-cell transmission are poorly understood. Previously, we showed that the transmission of pathogenic mycobacteria between phagocytic cells also depends on nonlytic ejection through an F-actin based structure, called the ejectosome. How the host cell maintains integrity of its plasma membrane during the ejection process was unknown. Here, we reveal an unexpected function for the autophagic machinery in nonlytic spreading of bacteria. We show that ejecting mycobacteria are escorted by a distinct polar autophagocytic vacuole. If autophagy is impaired, cell-to-cell transmission is inhibited, the host plasma membrane becomes compromised and the host cells die. These findings highlight a previously unidentified, highly ordered interaction between bacteria and the autophagic pathway and might represent the ancient way to ensure nonlytic egress of bacteria. PMID:25646440

  11. APOBEC3G governs to ensure cellular oncogenic transformation.

    PubMed

    Garg, Anuradha; Kaul, Deepak; Chauhan, Nalini

    2015-10-01

    The oncogenic potential of APOBEC3G gene was recently appreciated by the finding that revealed inhibitory influence of APOBEC3G upon micro-RNA mediated repression of the gene responsible for hepatic metastasis. Here we report for the first time that sustained APOBEC3G expression is the characteristic trait exhibited by various cancer cells of different tissue origins as well as APOBEC3G represses cellular gene coding for tumor suppressor KLF4 by binding to its mRNA. This phenomenon was paralleled by the sustained expression of the cellular SP1 which ensured overexpression of genes coding for c-myc, Bmi-1, BCL-2 and MDM2 coupled with downregulation of tumor suppressor p53 thereby creating a favorable situation for oncogenic transformation. PMID:26227855

  12. The autophagic machinery ensures nonlytic transmission of mycobacteria

    PubMed Central

    Gerstenmaier, Lilli; Pilla, Rachel; Herrmann, Lydia; Herrmann, Hendrik; Prado, Monica; Villafano, Geno J.; Kolonko, Margot; Reimer, Rudolph; Soldati, Thierry; King, Jason S.; Hagedorn, Monica

    2015-01-01

    In contrast to mechanisms mediating uptake of intracellular bacterial pathogens, bacterial egress and cell-to-cell transmission are poorly understood. Previously, we showed that the transmission of pathogenic mycobacteria between phagocytic cells also depends on nonlytic ejection through an F-actin based structure, called the ejectosome. How the host cell maintains integrity of its plasma membrane during the ejection process was unknown. Here, we reveal an unexpected function for the autophagic machinery in nonlytic spreading of bacteria. We show that ejecting mycobacteria are escorted by a distinct polar autophagocytic vacuole. If autophagy is impaired, cell-to-cell transmission is inhibited, the host plasma membrane becomes compromised and the host cells die. These findings highlight a previously unidentified, highly ordered interaction between bacteria and the autophagic pathway and might represent the ancient way to ensure nonlytic egress of bacteria. PMID:25646440

  13. Total Diet Studies as a Tool for Ensuring Food Safety.

    PubMed

    Lee, Joon-Goo; Kim, Sheen-Hee; Kim, Hae-Jung; Yoon, Hae-Jung

    2015-09-01

    With the diversification and internationalization of the food industry and the increased focus on health from a majority of consumers, food safety policies are being implemented based on scientific evidence. Risk analysis represents the most useful scientific approach for making food safety decisions. Total diet study (TDS) is often used as a risk assessment tool to evaluate exposure to hazardous elements. Many countries perform TDSs to screen for chemicals in foods and analyze exposure trends to hazardous elements. TDSs differ from traditional food monitoring in two major aspects: chemicals are analyzed in food in the form in which it will be consumed and it is cost-effective in analyzing composite samples after processing multiple ingredients together. In Korea, TDSs have been conducted to estimate dietary intakes of heavy metals, pesticides, mycotoxins, persistent organic pollutants, and processing contaminants. TDSs need to be carried out periodically to ensure food safety. PMID:26483881

  14. Total Diet Studies as a Tool for Ensuring Food Safety

    PubMed Central

    Lee, Joon-Goo; Kim, Sheen-Hee; Kim, Hae-Jung

    2015-01-01

    With the diversification and internationalization of the food industry and the increased focus on health from a majority of consumers, food safety policies are being implemented based on scientific evidence. Risk analysis represents the most useful scientific approach for making food safety decisions. Total diet study (TDS) is often used as a risk assessment tool to evaluate exposure to hazardous elements. Many countries perform TDSs to screen for chemicals in foods and analyze exposure trends to hazardous elements. TDSs differ from traditional food monitoring in two major aspects: chemicals are analyzed in food in the form in which it will be consumed and it is cost-effective in analyzing composite samples after processing multiple ingredients together. In Korea, TDSs have been conducted to estimate dietary intakes of heavy metals, pesticides, mycotoxins, persistent organic pollutants, and processing contaminants. TDSs need to be carried out periodically to ensure food safety. PMID:26483881

  15. Ensuring data consistency over CMS distributed computing system

    SciTech Connect

    Rossman, Paul; /Fermilab

    2009-05-01

    CMS utilizes a distributed infrastructure of computing centers to custodially store data, to provide organized processing resources, and to provide analysis computing resources for users. Integrated over the whole system, even in the first year of data taking, the available disk storage approaches 10 petabytes of space. Maintaining consistency between the data bookkeeping, the data transfer system, and physical storage is an interesting technical and operations challenge. In this paper we will discuss the CMS effort to ensure that data is consistently available at all computing centers. We will discuss the technical tools that monitor the consistency of the catalogs and the physical storage as well as the operations model used to find and solve inconsistencies.

  16. Standardization by ISO to Ensure the Sustainability of Space Activities

    NASA Astrophysics Data System (ADS)

    Kato, A.; Lazare, B.; Oltrogge, D.; Stokes, H.

    2013-08-01

    The ISO / Technical Committee 20 / Sub-committee 14 develops debris-related standards and technical reports to mitigate debris and help ensure mission and space sustainability. While UN Guidelines and the IADC Guidelines encourage national governments and agencies to promote debris mitigation design and operation, the ISO standards will help the global space industry promote and sustain its space-related business. In this paper the scope and status of each ISO standard is discussed within an overall framework. A comparison with international guidelines is also provided to demonstrate the level of consistency. Finally, as a case study, the ISO standards are applied to a CubeSat mission, thus demonstrating their usability on a relatively recent and popular class of satellite.

  17. Foster Care and Child Health.

    PubMed

    McDavid, Lolita M

    2015-10-01

    Children in foster care need more from health providers than routine well-child care. The changes in legislation that were designed to prevent children from languishing in foster care also necessitate a plan that works with the child, the biological family, and the foster family in ensuring the best outcome for the child. This approach acknowledges that most foster children will return to the biological family. Recent research on the effect of adverse childhood experiences across all socioeconomic categories points to the need for specifically designed, focused, and coordinated health and mental health services for children in foster care. PMID:26318955

  18. Competence assurance - who cares?

    PubMed

    Youngson, George G

    2014-02-01

    The provision of clinical care in the United Kingdom now requires the acquisition of a licence to practise from the regulatory authority. A review process-revalidation has been put in place to ensure that standards of care are maintained by the medical workforce, and that all doctors remain up-to-date and fit for purpose so that this licence can be retained. This article outlines how this new statutory requirement pertains to paediatric surgery and highlights those areas where adjudication of competence remains imprecise and where progress in this process of revalidation needs to be made. PMID:24528958

  19. The Challenges in Building an Adequate and Comprehensive Fund-Ensuring System for Rural Compulsory Education in China: Empirical Evidence from the Implementation of "Two Exemptions and One Subsidy" (TEOS)

    ERIC Educational Resources Information Center

    Yanqing, Ding

    2008-01-01

    Beginning in 2006, the "two exemptions and one subsidy" (TEOS) policy was integrated into the New Mechanism for Assured Funding for Rural Compulsory Education (hereafter the "New Mechanism"). The New Mechanism includes TEOS, raising the standard of public expenditure guarantees for rural compulsory education stage schools, creating a permanent

  20. Intensive care discharges: improving the quality of clinical handover through changes to discharge documentation

    PubMed Central

    Hall, William; Keane, Philip; Wang, Sarra; Debell, Frances; Allana, Alisha; Karia, Priyesh

    2015-01-01

    Patients who have stepped down from intensive care tread a precarious clinical course, and the handover of care between clinical teams at this point should be treated as a high risk event. Poor handover can leave patients vulnerable to suboptimal care and preventable harm. Properly structured written discharge summaries have been shown to improve information transfer and quality of care. The National Institute for Health and Care Excellence (NICE) has published guidelines entitled Acute illness in adults in hospital: recognising and responding to deterioration, which states that patients transferred from intensive care should have a formal structured handover supported by a written plan, and it provides minimum criteria for what information should be included. A retrospective audit was carried out (n=28) to identify if discharge summaries were compliant with these standards. Discharge summaries consistently lacked essential criteria, including psychosocial needs (29%), nutritional needs (50%), therapy needs (29%), ceilings of care (39%), and communication needs (18%). Less than a third of verbal handovers between the nursing and medical teams were documented. After consultation, a new summary template was developed and embedded into practice. The new design prompted trainees to ensure they completed adequate information in all domains of care. Additional sections were added to improve recording of when, and to whom, clinical handover took place, which led to improved clinical governance. The overall quality of discharge summaries was improved, with increased compliance in 11 out of 13 domains. Feedback from staff about the new discharge summaries was positive. This project is easily transferable, and has the potential to improve patient safety and quality of care. PMID:26734430

  1. Transition to intensive care nursing: a state-wide, workplace centred program-12 years on.

    PubMed

    Juers, Alison; Wheeler, Margaret; Pascoe, Helen; Gregory, Nicola; Steers, Cheryl

    2012-05-01

    In November 1999, the Queensland Health (QH) Transition to Practice Nurse Education Program - Intensive Care (TPNEP-IC) was initiated in QH Intensive Care Units (ICUs) across Queensland. This 12-month, state-wide, workplace based education program has set minimum standards for intensive care nursing education and therefore minimum standards for intensive care nursing practice in QH. In the 12 years of operation, 824 nurses have completed TPNEP-IC, 761 achieving academic credit status and 453 utilising this academic credit status to undertake postgraduate study in critical/intensive care nursing at three Queensland universities. These outcomes were achieved through the appointment of nurse educators within ICUs who, through a united and strong commitment to this state-wide approach formed collaborative professional networks, which resulted in the development, implementation and maintenance of the program. Furthermore, these networks enabled a framework of support for discussion and dissemination of evidence based practice, to endorse quality processes for TPNEP-IC and to nurture leadership potential among educators. Challenges to overcome included obtaining adequate resources to support all aspects of the program, gaining local management and administrative support, and embedding TPNEP-IC within ICU culture. The 12 years of operation of the program have demonstrated its long term sustainability. The program is being launched through a new blended learning approach utilising e-learning strategies. To capitalise on the current success, a strong commitment by all stakeholders will be required to ensure the ongoing sustainability of the program. PMID:21962835

  2. Challenges to HIV prevention in psychiatric settings: Perceptions of South African mental health care providers

    PubMed Central

    Collins, Pamela Y.

    2009-01-01

    Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support. PMID:16647793

  3. Ensuring quality in postgraduate medical education: competency testing is the key.

    PubMed

    Bailey, David

    2016-01-01

    The changes made to the curricula and assessment systems in the UK have resulted in pathology specialty-training programmes which assess trainees on a regular (weekly or monthly) basis. An end of first year assessment tests their aptitude for the specialty, the FRCPath examinations taking place after at least one to two (part 1) and three to four (part 2) years of training respectively, and multi-source feedback is undertaken in years 1, 3 and 5. With regular educational appraisal, this constitutes cohorts of well-assessed and supported trainees. The assessments are blueprinted to the curriculum, ensuring adequate assessment coverage of curriculum content within workplace-based assessments (WPBA), objective structured pathology examinations and the FRCPath examinations. Notably, generic non-clinical attributes and behavioural skills such as leadership and management skills can be covered in the WPBA. Many of these changes are evolutionary in nature, but some have been imposed by continuously increasing regulatory requirements. Whilst additional information is generated, the increased amount of assessment of trainees has led to complaints that trainees do not acquire enough practical experience in the laboratory. It will be important to find the balance between didactic teaching with formal assessment, and apprenticeship-style, practical hands-on learning. PMID:26374106

  4. Long-term care reimbursement issues.

    PubMed

    Stone, D; Reublinger, V

    1995-08-01

    There have been dramatic changes in long-term care funding recently. Considered only an insignificant part of the continuum of care system just a few years ago, this level of care is now looked to as a wellspring for desperately needed health care cost reductions. Government, insurance companies, intermediaries, large providers, and consumer and physician groups are actively focused on the development and expansion of alternative care provision sites; sub-acute care; hospice; home health care; social, medical, and rehabilitative day care; assisted living and adult congregate care facilities; risk or capitation contracting; expanded health maintenance organizations; alternative care providers; and alternative care approaches. In addition, the improvement in reimbursement is reviewed and is one aspect in ensuring that the economics are right for those needed services to continue to be provided. PMID:7585394

  5. Expanded Medical Home Model Works for Children in Foster Care

    ERIC Educational Resources Information Center

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

    2012-01-01

    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…

  6. Expanded Medical Home Model Works for Children in Foster Care

    ERIC Educational Resources Information Center

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

    2012-01-01

    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

  7. Innovative palliative care in Edmonton.

    PubMed Central

    Fainsinger, R. L.; Bruera, E.; MacMillan, K.

    1997-01-01

    PROBLEM BEING ADDRESSED: Access to palliative care in Edmonton has been hampered by uneven development, poor distribution of services, and more recently, economic restraints. Family physicians' involvement in palliative care has been hindered by the variety of access points, poor coordination, and inadequate reimbursement for time-consuming and difficult patient care situations. OBJECTIVE OF PROGRAM: To provide high-quality palliative care throughout Edmonton in all settings, with patients able to move easily throughout the components of the program; to lower costs by having fewer palliative care patients die in acute care facilities; and to ensure that family physicians receive support to care for most patients at home or in palliative care units. MAIN COMPONENTS OF PROGRAM: The program includes a regional office, home care, and consultant teams. A specialized 14-bed palliative care unit provides acute care. Family physicians are the primary caregivers in the 56 palliative continuing care unit beds. CONCLUSIONS: This program appears to meet most of the need for palliative care in Edmonton. Family physicians, with support from consulting teams, have a central role. Evaluation is ongoing; an important issue is how best to support patients dying at home. Images p1984-a p1986-a PMID:9386885

  8. The 2005 USDA Food Guide Pyramid is associated with more adequate nutrient intakes within energy constraints than the 1992 Pyramid.

    PubMed

    Gao, Xiang; Wilde, Parke E; Lichtenstein, Alice H; Tucker, Katherine L

    2006-05-01

    The USDA issued the Food Guide Pyramid (FGP) to help Americans choose healthy diets. We examined whether adherence to the 1992 and 2005 FGP was associated with moderate energy and adequate nutrient intakes. We used data for 2138 men and 2213 women > 18 y old, from the 2001-2002 U.S. National Health and Nutrition Examination Survey (NHANES). Quadratic programming was used to generate diets with minimal departure from intakes reported for the NHANES 2001-02. We examined the effect of the number of servings/d of Food Pyramid groups set at 1992 and at 2005 FGP recommendations for 1600, 2200, and 2800 kcal (1 kcal = 4.184 kJ) levels. We calculated energy and nutrients provided by different FGP dietary patterns. Within current U.S. dietary practices, following the 1992 FGP without sodium restriction may provide 200 more kcal than recommended for each energy level. Although it can meet most of old nutrient recommendations (1989), it fails to meet the latest dietary reference intakes, especially for the 1600 kcal level. The 2005 FGP appears to provide less energy and more adequate nutrient intakes, with the exception of vitamin E and potassium for some groups. However, without discretionary energy restriction, Americans are at risk of having excessive energy intake even if they follow the 2005 FGP food serving recommendations. Our analysis suggests that following the 2005 FGP may be associated with lower energy and optimal nutrient intake. Careful restriction of discretionary calories appears necessary for appropriate energy intakes to be maintained. PMID:16614427

  9. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance.... (b) Nature of supporting documentation. Each MCO, PIHP, and PAHP must submit documentation to...

  10. Ensuring privacy in the study of pathogen genetics.

    PubMed

    Mehta, Sanjay R; Vinterbo, Staal A; Little, Susan J

    2014-08-01

    Rapid growth in the genetic sequencing of pathogens in recent years has led to the creation of large sequence databases. This aggregated sequence data can be very useful for tracking and predicting epidemics of infectious diseases. However, the balance between the potential public health benefit and the risk to personal privacy for individuals whose genetic data (personal or pathogen) are included in such work has been difficult to delineate, because neither the true benefit nor the actual risk to participants has been adequately defined. Existing approaches to minimise the risk of privacy loss to participants are based on de-identification of data by removal of a predefined set of identifiers. These approaches neither guarantee privacy nor protect the usefulness of the data. We propose a new approach to privacy protection that will quantify the risk to participants, while still maximising the usefulness of the data to researchers. This emerging standard in privacy protection and disclosure control, which is known as differential privacy, uses a process-driven rather than data-centred approach to protecting privacy. PMID:24721230

  11. Evaluating the Reliability of Selected School-Based Indices of Adequate Reading Progress

    ERIC Educational Resources Information Center

    Wheeler, Courtney E.

    2010-01-01

    The present study examined the stability (i.e., 4-month and 12-month test-retest reliability) of six selected school-based indices of adequate reading progress. The total sampling frame included between 3970 and 5655 schools depending on the index and research question. Each school had at least 40 second-grade students that had complete Oral

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

    NASA Technical Reports Server (NTRS)

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

    1980-01-01

    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.

  13. Inferential Processing among Adequate and Struggling Adolescent Comprehenders and Relations to Reading Comprehension

    ERIC Educational Resources Information Center

    Barth, Amy E.; Barnes, Marcia; Francis, David; Vaughn, Sharon; York, Mary

    2015-01-01

    Separate mixed model analyses of variance were conducted to examine the effect of textual distance on the accuracy and speed of text consistency judgments among adequate and struggling comprehenders across grades 6-12 (n = 1,203). Multiple regressions examined whether accuracy in text consistency judgments uniquely accounted for variance in…

  14. 76 FR 51041 - Hemoglobin Standards and Maintaining Adequate Iron Stores in Blood Donors; Public Workshop

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-17

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Hemoglobin Standards and Maintaining Adequate Iron Stores in Blood Donors; Public Workshop AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public workshop. The Food and Drug Administration...

  15. 12 CFR 1229.5 - Capital distributions for adequately capitalized Banks.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Capital distributions for adequately capitalized Banks. 1229.5 Section 1229.5 Banks and Banking FEDERAL HOUSING FINANCE AGENCY ENTITY REGULATIONS CAPITAL CLASSIFICATIONS AND PROMPT CORRECTIVE ACTION Federal Home Loan Banks 1229.5...

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

    ERIC Educational Resources Information Center

    Hsieh, Ju-Shan

    2013-01-01

    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

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

    ERIC Educational Resources Information Center

    Pary, Robert J.

    1991-01-01

    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…

  18. The Relationship between Parental Involvement and Adequate Yearly Progress among Urban, Suburban, and Rural Schools

    ERIC Educational Resources Information Center

    Ma, Xin; Shen, Jianping; Krenn, Huilan Y.

    2014-01-01

    Using national data from the 2007-08 School and Staffing Survey, we compared the relationships between parental involvement and school outcomes related to adequate yearly progress (AYP) in urban, suburban, and rural schools. Parent-initiated parental involvement demonstrated significantly positive relationships with both making AYP and staying off

  19. Leadership Style and Adequate Yearly Progress: A Correlational Study of Effective Principal Leadership

    ERIC Educational Resources Information Center

    Leapley-Portscheller, Claudia Iris

    2008-01-01

    Principals are responsible for leading efforts to reach increasingly higher levels of student academic proficiency in schools associated with adequate yearly progress (AYP) requirements. The purpose of this quantitative, correlational study was to identify the degree to which perceptions of principal transformational, transactional, and…

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

    ERIC Educational Resources Information Center

    Pary, Robert J.

    1991-01-01

    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

  1. 75 FR 5893 - Suspension of Community Eligibility for Failure To Maintain Adequate Floodplain Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-05

    ... FR 51735. Executive Order 13132, Federalism. This rule involves no policies that have ] federalism....C. 4001 et seq., Reorganization Plan No. 3 of 1978, 3 CFR, 1978 Comp., p. 329; E.O. 12127, 44 FR... To Maintain Adequate Floodplain Management Regulations AGENCY: Federal Emergency Management...

  2. Perceptions of Teachers in Their First Year of School Restructuring: Failure to Make Adequate Yearly Progress

    ERIC Educational Resources Information Center

    Moser, Sharon

    2010-01-01

    The 2007-2008 school year marked the first year Florida's Title I schools that did not made Adequate Yearly Progress (AYP) for five consecutive years entered into restructuring as mandated by the "No Child Left Behind Act" of 2001. My study examines the perceptions of teacher entering into their first year of school restructuring due to failure to

  3. Leadership Style and Adequate Yearly Progress: A Correlational Study of Effective Principal Leadership

    ERIC Educational Resources Information Center

    Leapley-Portscheller, Claudia Iris

    2008-01-01

    Principals are responsible for leading efforts to reach increasingly higher levels of student academic proficiency in schools associated with adequate yearly progress (AYP) requirements. The purpose of this quantitative, correlational study was to identify the degree to which perceptions of principal transformational, transactional, and

  4. Why Johnny Can't Cooperate: Cognitive Development and the Concept of "Adequateness."

    ERIC Educational Resources Information Center

    Fullerton, Jim; Wells, Sue

    This paper examines how levels of cognitive development affect participants'"adequateness" or ability to function in adventure groups. Twenty-three women who were newly elected or appointed officers of a university campus sorority participated in the study. Prior to the group experience, participants completed a paragraph-completion exercise to…

  5. 12 CFR 702.201 - Prompt corrective action for “adequately capitalized” credit unions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Prompt corrective action for âadequately capitalizedâ credit unions. 702.201 Section 702.201 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION... credit union must increase the dollar amount of its net worth quarterly either in the current quarter,...

  6. 12 CFR 702.201 - Prompt corrective action for “adequately capitalized” credit unions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false Prompt corrective action for âadequately capitalizedâ credit unions. 702.201 Section 702.201 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION... credit union must increase the dollar amount of its net worth quarterly either in the current quarter,...

  7. 12 CFR 702.201 - Prompt corrective action for “adequately capitalized” credit unions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Prompt corrective action for âadequately capitalizedâ credit unions. 702.201 Section 702.201 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION... credit union must increase the dollar amount of its net worth quarterly either in the current quarter,...

  8. 12 CFR 702.201 - Prompt corrective action for “adequately capitalized” credit unions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Prompt corrective action for âadequately capitalizedâ credit unions. 702.201 Section 702.201 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION... credit union must increase the dollar amount of its net worth quarterly either in the current quarter,...

  9. 12 CFR 702.201 - Prompt corrective action for “adequately capitalized” credit unions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false Prompt corrective action for âadequately capitalizedâ credit unions. 702.201 Section 702.201 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION... credit union must increase the dollar amount of its net worth quarterly either in the current quarter,...

  10. The Unequal Effect of Adequate Yearly Progress: Evidence from School Visits

    ERIC Educational Resources Information Center

    Brown, Abigail B.; Clift, Jack W.

    2010-01-01

    The authors report insights, based on annual site visits to elementary and middle schools in three states from 2004 to 2006, into the incentive effect of the No Child Left Behind Act's requirement that increasing percentages of students make Adequate Yearly Progress (AYP) in every public school. They develop a framework, drawing on the physics

  11. The Relationship between Parental Involvement and Adequate Yearly Progress among Urban, Suburban, and Rural Schools

    ERIC Educational Resources Information Center

    Ma, Xin; Shen, Jianping; Krenn, Huilan Y.

    2014-01-01

    Using national data from the 2007-08 School and Staffing Survey, we compared the relationships between parental involvement and school outcomes related to adequate yearly progress (AYP) in urban, suburban, and rural schools. Parent-initiated parental involvement demonstrated significantly positive relationships with both making AYP and staying off…

  12. Prenatal zinc supplementation of zinc-adequate rats adversely affects immunity in offspring

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We previously showed that zinc (Zn) supplementation of Zn-adequate dams induced immunosuppressive effects that persist in the offspring after weaning. We investigated whether the immunosuppressive effects were due to in utero exposure and/or mediated via milk using a cross-fostering design. Pregnant...

  13. 21 CFR 314.126 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 5 2014-04-01 2014-04-01 false Adequate and well-controlled studies. 314.126 Section 314.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on...

  14. 21 CFR 314.126 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Adequate and well-controlled studies. 314.126 Section 314.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on...

  15. 21 CFR 314.126 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 5 2013-04-01 2013-04-01 false Adequate and well-controlled studies. 314.126 Section 314.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on...

  16. 21 CFR 314.126 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 5 2012-04-01 2012-04-01 false Adequate and well-controlled studies. 314.126 Section 314.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on...

  17. 21 CFR 314.126 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Adequate and well-controlled studies. 314.126 Section 314.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE APPLICATIONS FOR FDA APPROVAL TO MARKET A NEW DRUG FDA Action on...

  18. Inferential Processing among Adequate and Struggling Adolescent Comprehenders and Relations to Reading Comprehension

    ERIC Educational Resources Information Center

    Barth, Amy E.; Barnes, Marcia; Francis, David; Vaughn, Sharon; York, Mary

    2015-01-01

    Separate mixed model analyses of variance were conducted to examine the effect of textual distance on the accuracy and speed of text consistency judgments among adequate and struggling comprehenders across grades 6-12 (n=1,203). Multiple regressions examined whether accuracy in text consistency judgments uniquely accounted for variance in

  19. Performance Effects of Failure to Make Adequate Yearly Progress (AYP): Evidence from a Regression Discontinuity Framework

    ERIC Educational Resources Information Center

    Hemelt, Steven W.

    2011-01-01

    As the No Child Left Behind (NCLB) law moves through the reauthorization process, it is important to understand the basic performance impacts of its central structure of accountability. In this paper, I examine the effects of failure to make Adequate Yearly Progress (AYP) under NCLB on subsequent student math and reading performance at the school

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

    ERIC Educational Resources Information Center

    Stevenson, Jose W.

    2005-01-01

    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

  1. Human milk feeding supports adequate growth in infants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Despite current nutritional strategies, premature infants remain at high risk for extrauterine growth restriction. The use of an exclusive human milk-based diet is associated with decreased incidence of necrotizing enterocolitis (NEC), but concerns exist about infants achieving adequate growth. The ...

  2. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Adequate financial records, statistical data, and... financial records, statistical data, and cost finding. (a) Maintenance of records. (1) An HMO or CMP must maintain sufficient financial records and statistical data for proper determination of costs payable by...

  3. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Adequate financial records, statistical data, and... financial records, statistical data, and cost finding. (a) Maintenance of records. (1) An HMO or CMP must maintain sufficient financial records and statistical data for proper determination of costs payable by...

  4. Ensuring Wire Alignment for the New COMPASS Drift Chamber

    NASA Astrophysics Data System (ADS)

    Cromis, Megan; Compass Dc5 Team

    2014-09-01

    COMPASS is a fixed-target experiment at CERN investigating the internal structure of the proton. Polarized Drell-Yan measurements at COMPASS will explore how the quark orbital angular momentum contributes to the spin of the proton. To enable this measurement, several straw tube chambers need to be replaced due to long term wear. One of the replacement chambers, drift chamber DC5, is being built at Old Dominion University based on a prototype from UIUC and existing COMPASS drift chambers. DC5 consists of 4 wire planes with 513 wires (256 [20 ?m] sense wires and 257 [100 ?m] field wires alternating) and 4 wire planes at a 10 degree offset with 641 wires each. Each of these 4616 wires need to be aligned within either 100 ?m (sense wire) or 200 ?m (field wire) of the center of the solder pad to ensure the accuracy of the drift chamber. Problems that arose during stringing include initial alignment of the wire and efficient soldering techniques. Also, because the field wires charged at -1750 volts will be 4 mm from the sense wires, there should be no gaps or points in the solder to prevent arcing. This poster will discuss the alignment techniques, soldering methods, testing, and repair process for the wires. COMPASS is a fixed-target experiment at CERN investigating the internal structure of the proton. Polarized Drell-Yan measurements at COMPASS will explore how the quark orbital angular momentum contributes to the spin of the proton. To enable this measurement, several straw tube chambers need to be replaced due to long term wear. One of the replacement chambers, drift chamber DC5, is being built at Old Dominion University based on a prototype from UIUC and existing COMPASS drift chambers. DC5 consists of 4 wire planes with 513 wires (256 [20 ?m] sense wires and 257 [100 ?m] field wires alternating) and 4 wire planes at a 10 degree offset with 641 wires each. Each of these 4616 wires need to be aligned within either 100 ?m (sense wire) or 200 ?m (field wire) of the center of the solder pad to ensure the accuracy of the drift chamber. Problems that arose during stringing include initial alignment of the wire and efficient soldering techniques. Also, because the field wires charged at -1750 volts will be 4 mm from the sense wires, there should be no gaps or points in the solder to prevent arcing. This poster will discuss the alignment techniques, soldering methods, testing, and repair process for the wires. This research was supported in part by the DOE under Grant Number DE-FG03-94ER40860.

  5. XDS-I outsourcing proxy: ensuring confidentiality while preserving interoperability.

    PubMed

    Ribeiro, Lus S; Viana-Ferreira, Carlos; Oliveira, Jos Lus; Costa, Carlos

    2014-07-01

    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

  6. Ensure cogen steam supply with fresh-air-fired HRSGs

    SciTech Connect

    Froemming, J.; Hjalmarson, L.; Houshmand, M.

    1993-08-01

    Heat-recovery steam generators (HRSG) are used to capture thermal energy from the exhaust of gas turbines (GT), thus increasing a plant's overall efficiency. Where additional steaming capacity--above what can be recovered from the GT exhaust--is required, supplementary-fired duct or register burners can be installed. Because gas-turbine exhaust contains a relatively high level of excess air, no additional ambient combustion air is required in most cases; only fuel is needed. This article describes fresh-air-fired HRSGs which are similar to supplementary-fired units, but employ forced- or induced-draft (FD or ID) fans to rapidly convert to fully fired operation in the absence of hot exhaust during GT outages. Thus, fresh-air firing (FAF) is typically employed only at industrial plants where steam needs are more critical than electric-power generation requirements. In most plants using FAF, the GT is isolated using a damper or slide gate during fully fired HRSG operation. In virtually all applications, an FD fan is engaged automatically when a significant drop in exhaust flow is sensed, permitting the conversion to FAF with little or no interruption to the steam supply. However, one plant in Oklahoma employs an ID air fan, which operates even during GT operation, ensuring very rapid, reliable changeover to the FAF mode.

  7. Robust mitotic entry is ensured by a latching switch

    PubMed Central

    Tuck, Chloe; Zhang, Tongli; Potapova, Tamara; Malumbres, Marcos; Novk, Bla

    2013-01-01

    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. PMID:24143279

  8. Ensuring minimal humidity levels in hermetic implant housings.

    PubMed

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

    2011-01-01

    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

  9. Failure assessment techniques to ensure shipping container integrity

    SciTech Connect

    McConnell, P.

    1986-02-01

    This report discusses several methodologies which may be used to ensure the structural integrity of containment systems to be used for the transport and storage of high-level radioactive substances. For economic reasons, shipping containers constructed of ferritic materials are being considered for manufacture by vendors in the US and Europe. Ferritic show an inherent transition from a ductile, high energy failure mode to a brittle, low energy fracture mode with decreasing temperature. Therefore, formal consideration of means by which to avoid unstable brittle fracture is necessary prior to the licensing of ferritic casks. It is suggested that failure of a shipping container wall be defined as occurring when a flaw extends through the outer wall of the containment system. Crack initiation which may lead to unstable brittle crack growth should therefore be prevented. It is suggested that a fundamental linear elastic fracture mechanics (lefm) approach be adopted on a case-by-case basis, applied perhaps by means of appropriate modifications to ASMA Section III or Section XI. A lefm analysis requires information concerning service temperatures, loading rates, flaw sizes, and applied stresses. Tentative judgments regarding these parameters for typical shipping containers have been made.

  10. Hox Proteins Act as Transcriptional Guarantors to Ensure Terminal Differentiation.

    PubMed

    Zheng, Chaogu; Jin, Felix Qiaochu; Chalfie, Martin

    2015-11-17

    Cell differentiation usually occurs with high fidelity, but the expression of many transcription factors is variable. Using the touch receptor neurons (TRNs) in C.elegans, we found that the Hox proteins CEH-13/lab and EGL-5/Abd-B overcome this variability by facilitating the activation of the common TRN fate determinant mec-3 in the anterior and posterior TRNs, respectively. CEH-13 and EGL-5 increase the probability of mec-3 transcriptional activation by the POU-homeodomain transcription factor UNC-86 using the same Hox/Pbx binding site. Mutation of ceh-13 and egl-5 resulted in an incomplete (?40%) loss of the TRN fate in respective TRNs, which correlates with quantitative mRNA measurements showing two distinct modes (all or none) of mec-3 transcription. Therefore, Hox proteins act as transcriptional "guarantors" in order to ensure reliable and robust gene expression during terminal neuronal differentiation. Guarantors do not activate gene expression by themselves but promote full activation of target genes regulated by other transcription factors. PMID:26547238

  11. 45 CFR 1159.15 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of manual and automatic record systems? The Deputy Chairman for Management and Budget has the...

  12. Beyond Care?

    ERIC Educational Resources Information Center

    Hedge, Nicki; Mackenzie, Alison

    2012-01-01

    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

  13. Beyond Care?

    ERIC Educational Resources Information Center

    Hedge, Nicki; Mackenzie, Alison

    2012-01-01

    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…

  14. Integrating HIV care and treatment into primary healthcare: Are clinics equipped?

    PubMed Central

    Stellenberg, Ethelwynn L.

    2014-01-01

    Abstract Background The demand for HIV care and treatment services is increasing rapidly and strategies to sustain long-term care should be employed. The decentralisation and integration of HIV care and treatment services into primary healthcare (PHC) is vitally important in order to ensure optimal access to life-saving antiretroviral therapy and ongoing chronic care. Conversely, the PHC system is fraught with the current burden of disease. Setting The study was conducted in PHC clinics in the uMgungundlovu district, Kwa-Zulu Natal. Aim The objectives of the study were to assess whether PHC clinics were equipped to deliver integrated HIV services and to evaluate the availability of resources as well as support systems for HIV care and treatment in PHC clinics. Methods A quantitative, cross-sectional descriptive study was undertaken in 20 randomly-selected, eligible clinics in the uMgungundlovu district, KwaZulu-Natal, South Africa. An evaluation instrument was completed through observations and review of the clinic data records. Criteria were based on the World Health Organization's guide to indicators for antiretroviral programmes as well as South African HIV standards for PHC facilities. Results None of the clinics were equipped adequately. Clinics with a higher patient load had poorer scores, whilst clinics providing antiretroviral therapy were better equipped in terms of human resources and infrastructure. Conclusion HIV services are an essential part of primary healthcare and clinics need to be equipped adequately in order to render this service. It is unlikely that the over-burdened health system would be able to cope with an increased number of patients on antiretroviral therapy in the long term, whilst maintaining quality of services, without support being given to PHC clinics. PMID:26245407

  15. Integrated care requires integrated supervision

    PubMed Central

    Ketelaars, Corry A.J

    2011-01-01

    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. PMID:21637707

  16. Square Pegs, Round Hole? Ensuring Fit in the AYAO Spectrum for Adolescents and Young Adults with Genetic Risk for Cancer

    PubMed Central

    O'Connor, Mary L.; Smith, Kristin N.; Young, A. Elizabeth

    2013-01-01

    This paper presents a case example of a young woman at genetic risk for future cancer. We discuss psychosocial challenges that adolescents and young adults (AYAs) may share with their cancer survivor peers, and describe an example of psychosocial care. A scientific foundation denoting the needs of AYAs at risk for heritable cancers is lacking, and it is unknown if these AYAs receive adequate support services. This is a call to action for practitioners and researchers to engage in initiatives that assure these AYAs have access to valuable support and more clearly mark their place within the spectrum of AYA oncology. PMID:24066273

  17. 45 CFR 2508.10 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... ACT OF 1974 2508.10 Who has the responsibility for maintaining adequate technical, physical, and... systems? The Chief Executive Officer has the responsibility of maintaining adequate technical,...

  18. 45 CFR 2508.10 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... ACT OF 1974 2508.10 Who has the responsibility for maintaining adequate technical, physical, and... systems? The Chief Executive Officer has the responsibility of maintaining adequate technical,...

  19. Ensuring Credibility of NASA's Earth Science Data (Invited)

    NASA Astrophysics Data System (ADS)

    Maiden, M. E.; Ramapriyan, H. K.; Mitchell, A. E.; Berrick, S. W.; Walter, J.; Murphy, K. J.

    2013-12-01

    The summary description of the Fall 2013 AGU session on 'Data Curation, Credibility, Preservation Implementation, and Data Rescue to Enable Multi-Source Science' identifies four attributes needed to ensure credibility in Earth science data records. NASA's Earth Science Data Systems Program has been working on all four of these attributes: transparency, completeness, permanence, and ease of access and use, by focusing on them and upon improving our practices of them, over many years. As far as transparency or openness, NASA was in the forefront of free and open sharing of data and associated information for Earth observations. The US data policy requires such openness, but allows for the recoup of the marginal cost of distribution of government data and information - but making the data available with no such charge greatly increases their usage in scientific studies and the resultant analyses hasten our collective understanding of the Earth system. NASA's currently available Earth observations comprise primarily those obtained from satellite-borne instruments, suborbital campaigns, and field investigations. These data are complex and must be accompanied by rich metadata and documentation to be understandable. To enable completeness, NASA utilizes standards for data format, metadata content, and required documentation for any data that are ingested into our distributed Earth Observing System Data and Information System, or EOSDIS. NASA is moving to a new metadata paradigm, primarily to enable a fuller description of data quality and fit-for-purpose attributes. This paradigm offers structured approaches for storing quality measures in metadata that include elements such as Positional Accuracy, Lineage and Cloud Cover. NASA exercises validation processes for the Earth Science Data Systems Program to ensure users of EOSDIS have a predictable level of confidence in data as well as assessing the data viability for usage and application. The Earth Science Data Systems Program has been improving its data management practices for over twenty years to assure permanence of data utility through reliable preservation of bits, readability, understandability, usability and reproducibility of results. While NASA has focused on the Earth System Science research community as the primary data user community, broad interest in the data due to climate change and how it is affecting people everywhere (e.g. sea level rise) by environmental managers, public policymakers and citizen scientists has led the Program to respond with new tools and ways to improve ease of access and use of the data. NASA's standard Earth observation data will soon be buttressed with the long tail of federally-funded research data created or analyzed by grantees, in response to John Holdren's OSTP Memorandum to federal departments and agencies entitled 'Increasing Access to the Results of Federally-Funded Scientific Research'. We fully expect that NASA's Earth Science Data Systems Program will be able to work with our grantees to comply early, and flexibly improve the openness of this source of scientific data to a best practice for NASA and the grantees

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

    PubMed Central

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

    2013-01-01

    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. PMID:23364081

  1. Working together to ensure safety at hydro projects

    SciTech Connect

    Bartel, J.W. )

    1993-05-01

    Providing for public safety around a hydroelectric facility can be critically important to the welfare of a hydro-power producer. With this in mind, Wisconsin Electric Power Company and Wisconsin Public Service Corporation have worked together to develop consistent safety signage and several for their hydro projects. Although the two utilities sometimes compete for electric customers, they cooperate to ensure the safety to those customers. Both WE and WPS took steps in 1986 to make their operations safer through involvement in the Wisconsin/Michigan Hydro User Group. The organization has 25 members-primarily of electric utilities and paper companies-who operate hydro facilities in the two states. The two areas that the HUG studied in public safety were signs and warning systems. HUG established a sign committee to study how to increase safety of people around hydro plants through signs, explained Ted Handrick, hydro plant superintendent at WPS. The committee's recommendations led to development of a statewide uniform sign system adopted by all HUG members. The committee used Wisconsin Department of Natural Resources' guidelines for warning signs and portages in developing the signage standards. HUG members are converting to these new sign standards as they replace old signs and/or install new signs. Notices describing the new signage system have been placed near each hydro plant, at boat landings, and in campgrounds. The signs are mounted well above ground level so they can be seen and easily read by recreationalists. Warning systems, in accordance with HUG warning standards, were installed at WE and WPS hydro facilities. These systems alert nearby recreational users of rapid increases in water flow when generating units are turned on or when spillway gates are opened. Soon after the authors installed equipment to remotely operate its hydro facilities, the utility experienced a dramatic increase increase in intrusion on dams and other structures at the projects.

  2. Linking research and policy to ensure children's environmental health.

    PubMed

    Goldman, L R

    1998-06-01

    The U.S. Environmental Protection Agency (U.S. EPA) has made protecting children's environmental health its highest priority. Data on how and when children may be at risk are vital for accomplishing this goal. Recent examples of the link between research and policy include U.S. EPA actions to carry out the recommendations of the National Academy of Sciences on pesticides in children's food, reduce and prevent childhood lead poisoning, and revise national ambient air quality standards for ozone and particulate matter. Today, the Food Quality Protection Act (FQPA), which makes protecting children from pesticide residues in food a national priority, is contributing to the growing need for data for decision making. Further impetus comes from provisions in the FQPA and 1996 Safe Drinking Water Act Amendments for establishing a screening and testing program for potential risks from endocrine disruptors. Another factor is the analysis that will be required under President William J. Clinton's executive order directing all federal agencies, for the first time, to reduce environmental health and safety risks to children. Success of the U.S. international commitment to protect children is directly tied to the strength and availability of environmental data. To meet such challenges, the U.S. EPA is revising key science policies, expanding research opportunities, and adding to the public's right-to-know tools. In this dynamic climate, there are growing opportunities for the research community to play a greater role in helping ensure the well-being of children living today and in generations to come. PMID:9646049

  3. Ensuring accurate testing for human immunodeficiency virus in Myanmar

    PubMed Central

    Kyaw, Latt Latt; Wada, Koji; Oo, Khin Yi; Tin, Htay Htay; Yoshihara, Namiko

    2015-01-01

    Abstract Problem Until 2005, the quality of rapid diagnostic human immunodeficiency virus (HIV) testing was not monitored and no regular technical support was provided to hospital laboratories in Myanmar. Approach The national reference laboratory introduced a national external quality assessment scheme. The scheme involved (i) training laboratory technicians in HIV testing and in the requirements of the quality assessment system; (ii) implementing a biannual proficiency panel testing programme; (iii) on-site assessments of poorly-performing laboratories to improve testing procedures; and (iv) development of national guidelines. Local setting In 2011, a total of 422 public hospitals in Myanmar had laboratories providing HIV tests. In addition, private laboratories supported by nongovernmental organizations (NGOs) conducted HIV testing. Relevant changes The scheme was started in 65 public laboratories in 2005. In 2012, it had expanded nationwide to 347 laboratories, including 33 NGO laboratories. During the expansion of the scheme, laboratory response rates were greater than 90% and the proportion of laboratories reporting at least one aberrant result improved from 9.2% (6/65) in 2005 to 5.4% (17/316) in 2012. Lessons learnt National testing guidelines and a reference laboratory are needed to successfully implement quality assurance of HIV testing services. On-site assessments are crucial for all participating laboratories and the only source for insight on the causes of aberrant results; lessons that the reference laboratory can share nationally. Proficiency testing helps laboratory technicians to maintain HIV testing skills by ensuring that they regularly encountered HIV-positive samples. PMID:25558106

  4. Novel method for ensuring leg length in total hip arthroplasty.

    PubMed

    Maratt, Joseph D; Weber, Alexander E; Knesek, Michael; Lien, John R; Urquhart, Andrew G

    2013-04-01

    Despite the overwhelming clinical success of total hip arthroplasty, complications such as leg-length discrepancy can be a significant cause of functional impairment and patient dissatisfaction. Multiple intraoperative techniques are available for measuring femoral limb length; however, many require additional invasive hardware and those that do not are less accurate at measuring limb length. This article introduces a novel, noninvasive intraoperative technique that quickly and accurately measures limb length and prevents postoperative leg-length discrepancy.The authors' method relies on the accurate reproduction of a line perpendicular to the femoral axis near the proximal aspect of the greater trochanter intraoperatively and during preoperative planning and requires minor modifications to the instrumentation used. A narrow slot for the placement of a guide plate was machined into a standard trial head 37° from the axis of the neck for use with a high offset 127° Secur-Fit PLUS stem and 42° from the axis of the neck for use with a standard offset 132° Secur-Fit stem (Stryker Orthopaedics, Kalamazoo, Michigan). Once a broach is securely seated, a trial neck, slotted trial head, and guide plate are assembled and the distance from the guide plate to the proximal tip of the greater trochanter is compared with the preoperative planning measurements to assess the stem position.A retrospective radiographic analysis of 31 consecutive primary total hip arthroplasty using this technique showed the mean postoperative leg-length discrepancy to be 2.18±6.08 mm. This method is an additional tool for the arthroplasty surgeon's armamentarium to ensure accurate leg-length restoration. PMID:23590776

  5. Critical Care

    MedlinePLUS

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  6. 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 ...

  7. Hospice Care

    MedlinePLUS

    Hospice care is end-of-life care. A team of health care professionals and volunteers provides it. ... can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's ...

  8. Managed Care

    MedlinePLUS

    Managed care plans are a type of health insurance. They have contracts with health care providers and ... probably cost more. There are three types of managed care plans: Health Maintenance Organizations (HMO) usually only ...

  9. Respite Care

    MedlinePLUS

    ... Page Resize Text Printer Friendly Online Chat Respite Care What is Respite Care? How Do You Pay ... Learn More About Respite Services? What is Respite Care? Millions of Americans provide unpaid assistance each year ...

  10. Caring for Infants in a Bilingual Child Care Setting.

    ERIC Educational Resources Information Center

    Garcia, Eugene E.

    1991-01-01

    Several issues are explored regarding child care in a bilingual setting, including dismissing myths regarding the supposed negative effects of bilingualism; understanding what caregivers can do to ensure a positive and responsive environment in which communication thrives; and communicating with the family and understanding its general social

  11. [Social inequality in home care].

    PubMed

    Mller, A; Osterfeld, A; Bscher, A

    2013-06-01

    Social inequality in Germany is discussed primarily with regard to educational or social welfare issues. There is a political consensus that more action should be taken to ensure equality of chances and fulfillment of basic needs for everyone. In long-term care these considerations have not yet taken place and there are hardly any research studies in this field. However, the startling rise of the need for long-term care will definitely require a discussion of social inequality in various care arrangements. To learn more about social inequality in home care, a qualitative approach was used and 16 home care nurses were interviewed. Our study shows that many care recipients face numerous problems they cannot handle on their own, which may even worsen their situation. In addition, the results reveal that facing social inequalities place a burden on nurses and influence their work performance. PMID:23619710

  12. The contribution of beds to healthcare-associated infection: the importance of adequate decontamination.

    PubMed

    Creamer, E; Humphreys, H

    2008-05-01

    The hospital bed is comprised of different components, which pose a potential risk of infection for the patient if not adequately decontaminated. In the literature there are a number of descriptions of outbreaks or experimental investigations involving meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter spp., and other pathogens. Often only the bedrail has been sampled during investigation of outbreaks, rather than more important potential reservoirs of infection, such as mattresses and pillows, which are in direct contact with patients. It is essential that these items and other bed components are adequately decontaminated to minimise the risk of cross-infection, but detailed advice on this aspect is often lacking in reports and official documents. Clear guidelines should be formulated, specifying the decontamination procedure for each component of the bed. In outbreaks, investigation should include an assessment of mattresses and pillow contamination as a critical aspect in outbreak management. PMID:18355943

  13. Effective dose of dexmedetomidine to induce adequate sedation in elderly patients under spinal anesthesia

    PubMed Central

    Ko, Ki-Ho; Jun, In-Jung; Lim, Yunhee; Yoo, Byunghoon

    2015-01-01

    Background During sedation with dexmedetomidine, a dose adjustment may be needed based on the invasiveness of the procedure, the patient's general condition, and their age. We aim here to determine the effective dose (ED) of dexmedetomidine to induce an adequate depth of sedation in elderly patients undergoing spinal anesthesia. Methods In this study, 47 patients aged 65 years or older, American Society of Anesthesiologists physical status I or II, undergoing spinal anesthesia were included. Patients were randomly allocated into group I, II, III, IV or V according to the dexmedetomidine loading dose of 0.1, 0.3, 0.5, 0.7 and 1.0 g/kg, respectively. After spinal anesthesia, the assigned loading dose of dexmedetomidine was infused intravenously for 10 minutes, after which infusion was maintained at a rate of 0.3 g/kg/h for the next 10 minutes in all groups. We assessed the depth of sedation with the Ramsay sedation scale every five minutes and measured vital signs and the oxygen saturation. The ED50 and ED95 of dexmedetomidine to obtain adequate sedation (Ramsay sedation score ? 3) upon the completion of the loading dose were calculated with logistic regression. Results The ED50 and ED95 of dexmedetomidine for adequate sedation were 0.29 g/kg (95% confidence intervals [CI] 0.14-0.44) and 0.86 g/kg (95% CI 0.52-1.20), respectively. Hypotension was frequent in groups IV, V compared to groups I, II, III (31.6 vs. 3.6%, P = 0.013). Conclusions ED95 of dexmedetomidine loading dose for adequate sedation is 0.86 g/kg. However, dose higher than 0.5 g/kg can lead to hemodynamic instability. PMID:26634081

  14. Global Risk Assessment of Aflatoxins in Maize and Peanuts: Are Regulatory Standards Adequately Protective?

    PubMed Central

    Wu, Felicia

    2013-01-01

    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

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

    PubMed

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

    2014-07-01

    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

  16. Oil & gas in the 1990`s and beyond: Adequate supplies, growing demand, flat prices

    SciTech Connect

    Kennedy, J.L.

    1995-06-01

    Long term petroleum market fundamentals are clear: supplies are adequate and world demand will continue to grow steadily. Adequate supplies insure that prices will not increase significantly, on average, till the end of the 1990`s, probably much beyond. Despite plentiful supply and modest price increases, there will be peaks and valleys in the price graph as productive capacity is used up, then expanded. Tens of billions of dollars will be needed over the next decade to expand producing capacity. World oil consumption will increase at about 1.5% per year, at least for the next decade. Demand in Asia and Latin America will grow several times faster than this average world rate. World natural gas demand will grow at more then 2% per year well past 2000. Oil and gas companies around the world have changed the way they operate to survive the market realities of the 1990`s. restructuring, outsourcing, and partnering will continue as increasing costs and flat prices squeeze profits. Energy use patterns will change. Fuel and other product specifications will change. Market shares of oil and gas will shift. But opportunities abound in this new market environment. Growing markets always provide opportunities. Technology has helped operators dramatically lower finding, developing, and producing costs. The petroleum age is far from being over. Growing markets, adequate supply, affordable products, and a 60% market share. Those are the signs of an industry with a bright future.

  17. Current strategies for the restoration of adequate lordosis during lumbar fusion

    PubMed Central

    Barrey, Cédric; Darnis, Alice

    2015-01-01

    Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery. PMID:25621216

  18. A Conflict Between Nutritionally Adequate Diets and Meeting the 2010 Dietary Guidelines for Sodium

    PubMed Central

    Maillot, Matthieu; Drewnowski, Adam

    2012-01-01

    Background Compliance with dietary guidelines means incorporating multiple foods and nutrients into everyday diets, to be consumed in smaller or larger amounts. Feasibility studies can help determine whether one nutrient guideline comes into conflict with another. For one half of the U.S. population, the 2010 dietary guidelines for sodium were set at 1500 mg/d. Purpose To test the compatibility of the 1500mg/d sodium goal with nutrient-adequate diets. Methods Analyses, conducted in 2010, used U.S. federal nutrient composition and dietary intake databases to create modeled food patterns for six genderage groups using linear programming techniques. The food patterns were designed to meet nutritional standards for 27 nutrients as the mean sodium content was progressively reduced from levels observed in the 20012002 National Health and Nutrition Examination Survey (NHANES) down to 1500 mg/day. Results For adults aged <50 years, the 2300 mg/day sodium goal was consistent with nutrient-adequate diets but required large deviations from current eating patterns. The 1500 mg/day goal was not feasible and no mathematical solution was obtained. The lowest-sodium food patterns that were nutrient-adequate and theoretically achievable were very high in fruit juices, nuts, and seeds but were low in grains and meats. Conclusions Compliance with the 2010 sodium guidelines will require large deviations from current eating behaviors and/or a profound modification of the U.S. food supply. PMID:22261214

  19. Health Care Issues for Children and Adolescents in Foster Care and Kinship Care.

    PubMed

    2015-10-01

    Children and adolescents who enter foster care often do so with complicated and serious medical, mental health, developmental, oral health, and psychosocial problems rooted in their history of childhood trauma. Ideally, health care for this population is provided in a pediatric medical home by physicians who are familiar with the sequelae of childhood trauma and adversity. As youth with special health care needs, children and adolescents in foster care require more frequent monitoring of their health status, and pediatricians have a critical role in ensuring the well-being of children in out-of-home care through the provision of high-quality pediatric health services, health care coordination, and advocacy on their behalves. PMID:26416941

  20. Lesbian and bisexual health care.

    PubMed Central

    Mathieson, C. M.

    1998-01-01

    OBJECTIVE: To explore lesbian and bisexual women's experiences with their family physicians to learn about barriers to care and about how physicians can provide supportive care. DESIGN: Qualitative study that was part of a larger study of lesbian and bisexual women's health care. SETTING: The province of Nova Scotia, both urban and rural counties. PARTICIPANTS: Ninety-eight self-identified lesbian or bisexual women who volunteered through snowball sampling. Women were interviewed by lesbian, bisexual, or heterosexual female interviewers. METHOD: Semistructured, audiotaped, face-to-face interviews, exploring questions about demographic information, sexual orientation, general health care patterns, preferences for health care providers, disclosure issues, health care information, access issues, and important health care services. Transcription of audiotapes of interviews was followed by content, thematic, and discourse analyses. Thematic analysis is reported in this paper. MAIN OUTCOME FINDINGS: Three themes important for family physicians emerged: the importance of being gay positive, barriers to care, and strategies for providing appropriate care. CONCLUSIONS: Family physicians are in a pivotal position to ensure supportive care for lesbian and bisexual women. Physicians need to recognize barriers to care and to use gay-positive strategies, paying attention to self-education, health history, and clinic environment. PMID:9721419

  1. Effective Marketing of Quality Child Care.

    ERIC Educational Resources Information Center

    Caldwell, Bettye M.; Boyd, Harper W., Jr.

    1984-01-01

    Identifies negative public and professional attitudes that lie beneath the contemporary negative image of quality child care. Argues that concepts and principles of marketing are appropriate for influencing parents to choose high quality services and helping ensure that supplementary care is of sufficient quality to enhance, not inhibit, the…

  2. Organizing Family Medicine Geriatric Care

    PubMed Central

    Hayes, Vonda M.

    1989-01-01

    This article, written from the perceptive of a practising community physician, examines the servies available in the field of geriatric care at the present time. It suggests integration and co-ordination of existing facilities to maximize the current potential. It also considers the economic, geographical, and ethical concerns relating to geriatric care. It is a call for family physicians to co-ordinate their efforts in a multidisciplinary mode to ensure that our elderly are maintained in a comfortable caring atmosphere that encourages their maximum independence. PMID:21248994

  3. Ensuring Credit to Data Creators: A Case Study for Geodesy

    NASA Astrophysics Data System (ADS)

    Boler, F. M.; Gorman, A.

    2011-12-01

    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.

  4. Transitional Care

    ERIC Educational Resources Information Center

    Naylor, Mary; Keating, Stacen A.

    2008-01-01

    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…

  5. Prenatal Care

    MedlinePLUS

    Prenatal care is the health care you get while you are pregnant. It includes your checkups and prenatal testing. Prenatal care can help keep you and your baby healthy. It lets your health care provider spot health problems early. Early treatment ...

  6. [PUBLIC ADMINISTRATION OF PERSONNEL POLICY IN REFORMING OF UKRAINIAN HEALTH CARE SYSTEM USING THE EXAMPLE OF DERMATOVENEREOLOGICAL SERVICE].

    PubMed

    Korolenko, V V; Dykun, O P; Isayenko, R M; Remennyk, O I; Avramenko, T P; Stepanenko, V I; Petrova, K I; Volosovets, O P; Lazoryshynets, V V

    2014-01-01

    The health care system, its modernization and optimization are among the most important functions of the modern Ukrainian state. The main goal of the reforms in the field of healthcare is to improve the health of the population, equal and fair access for all to health services of adequate quality. Important place in the health sector reform belongs to optimizing the structure and function of dermatovenereological service. The aim of this work is to address the issue of human resources management of dermatovenereological services during health sector reform in Ukraine, taking into account the real possibility of disengagement dermatovenereological providing care between providers of primary medical care level (general practitioners) and providers of secondary (specialized) and tertiary (high-specialized) medical care (dermatovenerologists and pediatrician dermatovenerologists), and coordinating interaction between these levels. During research has been found, that the major problems of human resources of dermatovenereological service are insufficient staffing and provision of health-care providers;,growth in the number of health workers of retirement age; sectoral and regional disparity of staffing; the problem of improving the skills of medical personnel; regulatory support personnel policy areas and create incentives for staff motivation; problems of rational use of human resources for health care; problems of personnel training for dermatovenereological service. Currently reforming health sector should primarily serve the needs of the population in a fairly effective medical care at all levels, to ensure that there must be sufficient qualitatively trained and motivated health workers. To achieve this goal directed overall work of the Ministry of Health of Uktaine, the National Academy of Medical Sciences of Ukraine, medical universities, regional health authorities, professional medical associations. Therefore Ukrainian dermatovenereological care, in particular fixed, needs a deep and objective medical and social audit. A necessary condition for the harmonious development of dermatovenereological service is adequate staffing to ensure it to reflect changes in the structure of the provision of the assistance at various levels, as well as their effective coordination throughout the natient's medical route. PMID:26492791

  7. Setting priorities for mental health care in Nepal: a formative study

    PubMed Central

    2013-01-01

    Background There is an urgent need to address the massive treatment gap for mental health problems, especially in low income settings. Packages of care integrated in routine primary health care are posited as a strategy to scale-up mental health care, yet more needs to be known about the most feasible and effective way to go about this. Methods The study follows a combined methods design that includes engaging an expert panel in a priority setting exercise, running workshops to develop a Theory of Change and conducting in-depth qualitative interviews and focus group discussions with key stakeholders. The results of each research step were taken forward to inform the subsequent one. Results There was strong endorsement for a system of care that encompasses both the perspectives of health facility and the community. Issues related to increasing access and demand, guaranteeing a sustainable supply of psychotropic medicine, adequate human resourcing, and ensuring positive family involvement came up as priority areas of attention. Conclusion The study underlines many of the known barriers in developing mental health services. At the same time it provides a distinct pathway and concrete recommendations for overcoming these challenges in Nepal. PMID:24305432

  8. Electronic End-of-Life Care Registry: the Utah ePOLST Initiative

    PubMed Central

    Duncan, Jeffrey; Taillac, Peter; Nangle, Barry; Henry, Maureen; Houston, Janice; Talebreza, Shaida; Finch, Leisa; Brunker, Cherie; Rajeev, Deepthi; Smith, Heidi J.; North, Christie

    2013-01-01

    As a patients end-of-life approaches, it is typical for the disease to be the focus of treatment instead of the dying patient. There is limited congruence between the care preferred by patients and the treatment actually delivered to patients during their end-of-life. The Physician Orders for Life-Sustaining Treatment Paradigm has been endorsed or is in development in all but three states and the District of Columbia in an effort to ensure that patients are provided with adequate opportunities to specify their end-of-life care preferences. However, most states are using paper forms to document these preferences which may be inaccessible when needed. We have developed an electronic end-of-life care registry that allows authorized users to store and retrieve information pertaining to patients end-of-life care preferences. In this paper, we describe (a) the requirements identified for the registry from the users perspective and (b) the design and development of the electronic registry. PMID:24551342

  9. Protecting time for teaching in the ambulatory care setting.

    PubMed

    Skeff, K M; Bowen, J L; Irby, D M

    1997-08-01

    The current drive for efficient clinical teaching threatens the educational mission of academic medical centers. With pressures to increase clinical productivity, protected time and compensation for teaching have become scarce resources for clinical teachers in all settings. Although it may yield new approaches to education, the push for efficiency may ultimately result in insufficient time for teaching and may cause some clinical preceptors to stop teaching completely. Further, it may lead to the illusion that comprehensive teaching truly requires little time. Since the future of American health care depends upon the provision of high-quality clinical education to young physicians, this situation presents a potential national crisis. In this article, the authors discuss the complex nature of teaching, its time requirements, and the special challenges of teaching in outpatient settings. To avoid overemphasizing efficiency to the detriment of education they recommend adhering to two principles: (1) academic medical centers are educational as well as training institutions, and therefore should provide a broad-based education as well as training in clinical skills; and (2) the clinical teaching process is complex and adequate time must be provided for its many phases, including planning, instructing, and reflecting. Finally, the authors make recommendations for ensuring the delivery of high-quality education in ambulatory care settings. PMID:9282144

  10. Designing robots for care: care centered value-sensitive design.

    PubMed

    van Wynsberghe, Aimee

    2013-06-01

    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship--what I refer to as care robots--require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What's more, given the stage of their development and lack of standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future. PMID:22212357

  11. Are the current Australian sun exposure guidelines effective in maintaining adequate levels of 25-hydroxyvitamin D?

    PubMed

    Kimlin, Michael; Sun, Jiandong; Sinclair, Craig; Heward, Sue; Hill, Jane; Dunstone, Kimberley; Brodie, Alison

    2016-01-01

    An adequate vitamin D status, as measured by serum 25-hydroxyvitamin D (25(OH)D) concentration, is important in humans for maintenance of healthy bones and muscle function. Serum 25(OH)D concentration was assessed in participants from Melbourne, Australia (37.81S, 144.96E), who were provided with the current Australian guidelines on sun exposure for 25(OH)D adequacy (25(OH)D ?50nmol/L). Participants were interviewed in February (summer, n=104) and August (winter, n=99) of 2013. Serum 25(OH)D concentration was examined as a function of measures of sun exposure and sun protection habits with control of key characteristics such as dietary intake of vitamin D, body mass index (BMI) and skin colour, that may modify this relationship. The mean 25(OH)D concentration in participants who complied with the current sun exposure guidelines was 67.3nmol/L in summer and 41.9nmol/L in winter. At the end of the study, 69.3% of participants who complied with the summer sun exposure guidelines were 25(OH)D adequate, while only 27.6% of participants who complied with the winter sun exposure guidelines were 25(OH)D adequate at the end of the study. The results suggest that the current Australian guidelines for sun exposure for 25(OH)D adequacy are effective for most in summer and ineffective for most in winter. This article is part of a Special Issue entitled '17th Vitamin D Workshop'. PMID:25797374

  12. Clinical guidelines for postpartum women and infants in primary carea systematic review

    PubMed Central

    2014-01-01

    Background While many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care. Methods PubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument. Results Six guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest. Conclusions Only one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence supporting recommendations made within guidelines. Further improvement in the editorial independence and applicability domains of the AGREE ll criteria would strengthen the quality of the guidelines. PMID:24475888

  13. [Medical consult before taking a plane: assessment and advice by the primary care physician].

    PubMed

    Butty, Anne-Virginie; Pala, Christophe; Dao, Melissa Dominicé

    2014-09-24

    Many of our patients travel by air. During the flight, they are exposed to specific physical conditions: decrease of the PaO2, increase of body gas volume and decrease in humidity. Depending on their illness, their tolerance to these conditions may vary. The primary care physician's role is to adequately counsel patients in order to ensure their security during and after the flight, as well as to prescribe additional therapies, when needed. Patients with a hypoxemic medical condition or patients that were recently operated deserve particular attention. Complications of common ear, nose and throat diseases should not be underestimated. Preventive recommendations for thromboembolic disease need to be addressed, while drug prophylaxis is not systematically recommended any more for patients with major thromboembolic risk factors. PMID:25369695

  14. Precision medicine for the treatment of severe pneumonia in intensive care.

    PubMed

    Rello, Jordi; Perez, Antonio

    2016-03-01

    Despite advances in its management, community-acquired pneumonia (CAP) remains the most important cause of sepsis-related mortality and the reason for many ICU admissions. Severity assessment is the cornerstone of CAP patient management and the attempts to ensure the best site of care and therapy. Survival depends on a combination of host factors (genetic, age, comorbidities, defenses), pathogens (virulence, serotypes) and drugs. To reduce CAP mortality, early adequate antibiotic therapy is fundamental. The use of combination therapy with a macrolide seems to improve the clinical outcome in the subset of patients with high inflammation due to immunomodulation. Guidelines on antibiotic therapy have been associated with beneficial effects, and studies of newer adjunctive drugs have produced promising results. This paper discusses the current state of knowledge regarding of precision medicine and the treatment of severe CAP patients. PMID:26789703

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

    PubMed Central

    Glazowski, Christopher; Rajadhyaksha, Milind

    2012-01-01

    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. PMID:23224184

  16. Chronic leg ulcer: does a patient always get a correct diagnosis and adequate treatment?

    PubMed

    Mooij, Michael C; Huisman, Laurens C

    2016-03-01

    Patients with chronic leg ulcers have severely impaired quality of life and account for a high percentage of annual healthcare costs. To establish the cause of a chronic leg ulcer, referral to a center with a multidisciplinary team of professionals is often necessary. Treating the underlying cause diminishes healing time and reduces costs. In venous leg ulcers adequate compression therapy is still a problem. It can be improved by training the professionals with pressure measuring devices. A perfect fitting of elastic stockings is important to prevent venous leg ulcer recurrence. In most cases, custom-made stockings are the best choice for this purpose. PMID:26916772

  17. Improving nursing care for lesbian, bisexual, and transgender women.

    PubMed

    Rager Zuzelo, Patti

    2014-01-01

    Health care needs of lesbian, bisexual, and transgender (LBT) women are inadequately addressed in nursing education and practice, which may contribute to heterosexism and homophobia on the part of health care providers. Nurses have an obligation to use available tools and resources to assess and positively transform health care environments to ensure high-quality care for LBT women. The context within which care for LBT women is learned, practiced, and experienced requires radical improvement. PMID:24980549

  18. Nurses in independent care homes: issues, challenges and potential.

    PubMed

    Morris-Thompson, Trish; Marks-Maran, Diane

    Many registered nurses in the UK work in the social care sector in independent care homes and nursing homes. This article explores the challenges related to providing nursing care for adults in care homes, issues arising for nurses and nursing in the social care sector, and providing a career pathway for nurses in the social care sector. Steps need to be taken to ensure that cooperation, collaboration and leadership in nursing in the social care sector is recognised and that appropriate representation of nurses in social care takes place at national level. PMID:26203504

  19. Technical Basis for the Determination that Current Characterization Data and Processes are Sufficient to Ensure Safe Storage and to Design Waste Disposal

    SciTech Connect

    SIMPSON, B.C.

    1999-08-12

    This document presents the technical basis for closure of Defense Nuclear Facilities Safety Board (DNFSB) Recommendation 93-5 Implementation Plan milestone 5.6.3.13, ''Core sample all tanks by 2002'' (DOE-RL 1996). The milestone was based on the need for characterization data to ensure safe storage of the waste, to operate the tanks safely, and to plan and implement retrieval and processing of the waste. Sufficient tank characterization data have been obtained to ensure that existing controls are adequate for safe storage of the waste in the 177 waste tanks at the Hanford Site. In addition, a process has been developed, executed, and institutionalized to systemically identify information needs, to integrate and prioritize the needs, and to reliably obtain and analyze the associated samples. This document provides a technical case that the remaining 45 incompletely sampled tanks no longer require sampling to support the intent of the Implementation Plan milestone. Sufficient data have been obtained to close the Unreviewed Safety Questions (USQs), and to ensure that existing hazard controls are adequate and appropriately applied. However, in the future, additional characterization of tanks at the site will be required to support identified information needs. Closure of this milestone allows sampling and analytical data to be obtained in a manner that is consistent with the integrated priority process.

  20. Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important

    PubMed Central

    Virdun, Claudia; Luckett, Tim; Davidson, Patricia M; Phillips, Jane

    2015-01-01

    Background: The majority of expected deaths occur in hospitals where optimal end-of-life care is not yet fully realised, as evidenced by recent reviews outlining experience of care. Better understanding what patients and their families consider to be the most important elements of inpatient end-of-life care is crucial to addressing this gap. Aim and design: This systematic review aimed to ascertain the five most important elements of inpatient end-of-life care as identified by patients with palliative care needs and their families. Data sources: Nine electronic databases from 1990 to 2014 were searched along with key internet search engines and handsearching of included article reference lists. Quality of included studies was appraised by two researchers. Results: Of 1859 articles, 8 met the inclusion criteria generating data from 1141 patients and 3117 families. Synthesis of the top five elements identified four common end-of-life care domains considered important to both patients and their families, namely, (1) effective communication and shared decision making, (2) expert care, (3) respectful and compassionate care and (4) trust and confidence in clinicians. The final domains differed with financial affairs being important to families, while an adequate environment for care and minimising burden both being important to patients. Conclusion: This review adds to what has been known for over two decades in relation to patient and family priorities for end-of-life care within the hospital setting. The challenge for health care services is to act on this evidence, reconfigure care systems accordingly and ensure universal access to optimal end-of-life care within hospitals. PMID:25921707

  1. [Access to dental care during prenatal assistance].

    PubMed

    dos Santos Neto, Edson Theodoro; Oliveira, Adauto Emmerich; Zandonade, Eliana; Leal, Maria do Carmo

    2012-11-01

    This study sought to evaluate the self-perceived response to dental care during prenatal assistance in the Unified Health System (SUS) in the Metropolitan Region of Vitria, Esprito Santo, Brazil. 1032 postpartum women were interviewed and 1006 prenatal records copied. Postpartum women's self-perceived response was measured by the Oral Health Index Profile-14. When an impact was identified, dental care rendered in educational, preventive and curative terms was considered adequate. When there was no impact, assistance was considered adequate in educational and preventive terms. The Chi-square test revealed an association between prenatal care and dental care. Oral health impact on quality of life was 14.7%. Dental care received by mothers in educational terms was rated at 41.3%, while in preventive terms it was 21% and in curative terms it was 16.6%. Six or more prenatal appointments coupled with educational activities was closely associated with adequate dental care (p < 0.05). Access to dental care is facilitated when pregnant women attend health services and become involved in educational activities during the prenatal period. Consequently, educational measures appear to indicate an improvement in prenatal care in the SUS. PMID:23175312

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

    PubMed

    Bouchard, Christine

    2007-01-01

    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

  3. Hygrometers and thermohygrometers: environmental monitoring ensures the potency and stability of compounding agents.

    PubMed

    Allen, Loyd V; McKenzie, Robert; Ainsworth, Ron; Kastango, Eric S; Kaestner, Rick; Rebelo, Andre; Burnside, Paul; Schultz, Gerald

    2010-01-01

    Although the terms humidity and relative humidity are often used interchangeably, they are not synonymous. Humidity is the amount of water in the air, and relative humidity is the ratio of the amount of water vapor in the air at a specific temperature to the maximum possible amount of water vapor in the air at that temperature. Thus humidity and temperature are inextricably bound in their effects on the environment. In a compounding pharmacy, humidity can affect the stability and quality of the compounds prepared, as well as equipment, chemicals, and polymers. Devices that measure relative humidity (hygrometers) or humidity and temperature (thermohygrometers) are essential instruments in a compounding pharmacy. They must be chosen carefully, however, to ensure that the measurements they yield are accurate, that they are reliable over time. Most desirable are devices that alert the pharmacist immediately at any time if levels of humidity or temperature at a designated site differ from a specific norm. In this report, we discuss the effects of humidity on the process of compounding and on the agents used in customized preparations. A Table that lists essential features of a variety of hygrometers and thermohygrometers appropriate for use in a compounding pharmacy is presented for easy reference. PMID:23965535

  4. Adequate Systemic Perfusion Maintained by a CentriMag during Acute Heart Failure

    PubMed Central

    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

    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 pump—the CentriMag® (Levitronix LLC; Waltham, Mass) centrifugal-flow ventricular assist device—in 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. PMID:18941648

  5. 33 CFR 150.200 - Who must ensure that deepwater port personnel are qualified?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Who must ensure that deepwater..., DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Personnel § 150.200 Who must ensure that deepwater port personnel are qualified? The licensee must ensure that...

  6. 33 CFR 150.200 - Who must ensure that deepwater port personnel are qualified?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Who must ensure that deepwater..., DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Personnel § 150.200 Who must ensure that deepwater port personnel are qualified? The licensee must ensure that...

  7. 33 CFR 150.200 - Who must ensure that port personnel are qualified?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Who must ensure that port personnel are qualified? 150.200 Section 150.200 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF... ensure that port personnel are qualified? The licensee must ensure that the individual filling a...

  8. Participatory planning of a primary care service for people with severe mental disorders in rural Ethiopia.

    PubMed

    Mayston, Rosie; Alem, Atalay; Habtamu, Alehegn; Shibre, Teshome; Fekadu, Abebaw; Hanlon, Charlotte

    2016-04-01

    Little is understood about the feasibility and acceptability of primary care-based models of task-sharing care for people with severe mental disorders (SMDs) in low- and middle-income countries (LMICs). A participatory planning approach was adopted in preparation for the transition from hospital-delivered psychiatric care for SMD to a primary care-based, task-sharing model in a rural Ethiopian community. In this article, we present findings from community consultation meetings (n = 4), focus group discussions (n = 7) and in-depth interviews (n = 11) with key stakeholders (healthcare administrators and providers, caregivers, service-users and community leaders) which were carried out over a 2-year period in the context of ongoing dialogue with the community. The principle of local delivery of mental health services was agreed upon by all stakeholder groups. Key reasons for supporting local delivery were increased access for the majority due to proximity, reduced cost and reduced stress related to transportation. However, acceptance of the new service was qualified by concerns about the competence of staff to deliver a comprehensive and dependable service of equal quality to that currently provided at the hospital. Adequate training and support, as well as ensuring consistency of medication supply were identified as key components to ensure success. Encouragingly, our results suggest that there is significant support for the service change and an interest for the mobilization of community resources to support this. One of the study strengths was that we were able to present the different perspectives of multiple stakeholder groups. By nesting the study in an ongoing community-based cohort of people with SMD we were able to interview a more representative and empowered group of caregivers and service users than is often available in LMICs. Despite this, the extent to which service-users are able to express their opinions is likely limited by their marginalized role in rural Ethiopian society. PMID:26282860

  9. Single Student Parents Face Financial Difficulties, Debt, without Adequate Aid. Fact Sheet #C394

    ERIC Educational Resources Information Center

    Miller, Kevin

    2012-01-01

    Parents with dependent children were nearly one quarter of students enrolled for credit at American postsecondary institutions in 2008. These students face significant challenges to remaining enrolled and graduating, including limited access to affordable child care, difficulty balancing the demands of school with the demands of work and family,…

  10. 42 CFR 494.100 - Condition: Care at home.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Care at home. 494.100 Section 494.100... Patient Care 494.100 Condition: Care at home. A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services are...

  11. Investing in Our Future: A Guide to Child Care Financing.

    ERIC Educational Resources Information Center

    Stoney, Louise; Groginsky, Scott; Poppe, Julie

    This book investigates the innovative ways being used to ensure and finance high quality care for children. Chapter 1, "Introduction," discusses the government's role in helping to structure, build, and finance the system, as well as financing strategies. Chapter 2, "Financing Child Care Supply," addresses center-based child care, supports for…

  12. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care

    PubMed Central

    Valentijn, Pim P.; Schepman, Sanneke M.; Opheij, Wilfrid; Bruijnzeels, Marc A.

    2013-01-01

    Introduction Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care. Methods The search method involved a combination of electronic database searches, hand searches of reference lists (snowball method) and contacting researchers in the field. The process of synthesizing the literature was iterative, to relate the concepts of primary care and integrated care. First, we identified the general principles of primary care and integrated care. Second, we connected the dimensions of integrated care and the principles of primary care. Finally, to improve content validity we held several meetings with researchers in the field to develop and refine our conceptual framework. Results The conceptual framework combines the functions of primary care with the dimensions of integrated care. Person-focused and population-based care serve as guiding principles for achieving integration across the care continuum. Integration plays complementary roles on the micro (clinical integration), meso (professional and organisational integration) and macro (system integration) level. Functional and normative integration ensure connectivity between the levels. Discussion The presented conceptual framework is a first step to achieve a better understanding of the inter-relationships among the dimensions of integrated care from a primary care perspective. PMID:23687482

  13. Risk Assessment of Transmission of Sporadic Creutzfeldt-Jakob Disease in Endodontic Practice in Absence of Adequate Prion Inactivation

    PubMed Central

    Bourvis, Nadge; Boelle, Pierre-Yves; Cesbron, Jean-Yves; Valleron, Alain-Jacques

    2007-01-01

    Background Experimental results evidenced the infectious potential of the dental pulp of animals infected with transmissible spongiform encephalopathies (TSE). This route of iatrogenic transmission of sporadic Creutzfeldt-Jakob disease (sCJD) may exist in humans via reused endodontic instruments if inadequate prion decontamination procedures are used. Methodology/Principal Findings To assess this risk, 10 critical parameters in the transmission process were identified, starting with contamination of an endodontic file during treatment of an infectious sCJD patient and ending with possible infection of a subsequent susceptible patient. It was assumed that a dose-risk response existed, with no-risk below threshold values. Plausible ranges of those parameters were obtained through literature search and expert opinions, and a sensitivity analysis was conducted. Without effective prion-deactivation procedures, the risk of being infected during endodontic treatment ranged between 3.4 and 13 per million procedures. The probability that more than one case was infected secondary to endodontic treatment of an infected sCJD patient ranged from 47% to 77% depending on the assumed quantity of infective material necessary for disease transmission. If current official recommendations on endodontic instrument decontamination were strictly followed, the risk of secondary infection would become quasi-null. Conclusion The risk of sCJD transmission through endodontic procedure compares with other health care risks of current concern such as death after liver biopsy or during general anaesthesia. These results show that single instrument use or adequate prion-decontamination procedures like those recently implemented in dental practice must be rigorously enforced. PMID:18159228

  14. Intensive care unit delirium.

    PubMed

    Bruno, Jeffrey J; Warren, Mary Lou

    2010-06-01

    Once considered a benign iatrogenic consequence of intensive care unit (ICU) admission, ICU delirium is now recognized as a prominent disorder that negatively affects patient morbidity and mortality. The primary goal in the detection and treatment of ICU delirium is to ensure the safety of the patient and caregiver(s). Most critically ill patients possess 1 or more risk factors for the development of delirium; therefore, interventions that target delirium assessment and prevention are essential. This article highlights some of the recent data that have emerged regarding ICU delirium, including its definition, incidence, risk factors, diagnostic tools, and treatment. PMID:20541065

  15. Self Care

    MedlinePLUS

    ... Chronic Disease Self Assessment Self Care Connections Experiences Research Learning Evaluation Print Email Self Care If you are living with a chronic health condition, having a new set of skills to help you cope can make a real ...

  16. Hair Care

    MedlinePLUS

    ... Body Looking and feeling your best Hair care Hair care Short, long, curly, straight, up, down. Hair options can seem endless! Not all of what makes your hair look good comes from the outside, though. Good ...

  17. Hospice Care

    MedlinePLUS

    ... comfort as possible. Is hospice care available to nursing home residents? Yes. The services of hospice care programs ... home, a family member's home, a hospital, a nursing home or a hospice facility. The members of the ...

  18. Continuing Care

    MedlinePLUS

    ... Care Obesity at Midlife May Speed Alzheimer’s Onset Hello from my mom Easing the Behavior Problems of ... Managers Continuing Care FOR MORE ARTICLES CLICK HERE Hello from my mom Common Estate Planning Errors Alzheimer’s ...

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

    PubMed

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

    2013-07-01

    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

  20. Overcome of Carbon Catabolite Repression of Bioinsecticides Production by Sporeless Bacillus thuringiensis through Adequate Fermentation Technology.

    PubMed

    Ben Khedher, Saoussen; Jaoua, Samir; Zouari, Nabil

    2014-01-01

    The overcoming of catabolite repression, in bioinsecticides production by sporeless Bacillus thuringiensis strain S22 was investigated into fully controlled 3?L fermenter, using glucose based medium. When applying adequate oxygen profile throughout the fermentation period (75% oxygen saturation), it was possible to partially overcome the catabolite repression, normally occurring at high initial glucose concentrations (30 and 40?g/L glucose). Moreover, toxin production yield by sporeless strain S22 was markedly improved by the adoption of the fed-batch intermittent cultures technology. With 22.5?g/L glucose used into culture medium, toxin production was improved by about 36% when applying fed-batch culture compared to one batch. Consequently, the proposed fed-batch strategy was efficient for the overcome of the carbon catabolite repression. So, it was possible to overproduce insecticidal crystal proteins into highly concentrated medium. PMID:25309756

  1. Adequate Dextran Sodium Sulfate-induced Colitis Model in Mice and Effective Outcome Measurement Method

    PubMed Central

    Park, Yo Han; Kim, Nayoung; Shim, Young Kwang; Choi, Yoon Jin; Nam, Ryoung Hee; Choi, Yoon Jeong; Ham, Min Hee; Suh, Ji Hyung; Lee, Sun Min; Lee, Chang Min; Yoon, Hyuk; Lee, Hye Seung; Lee, Dong Ho

    2015-01-01

    Background: Dextran sodium sulfate (DSS)-induced colitis mouse model is used for research of inflammatory bowel disease. The aim of this study was to establish the adequate conditions for DSS mice model, and to find useful tool to measure inflammation. Methods: The 2.5% DSS was administered to six male C57BL/6 mice and 4% DSS to eight mice at 5 or 9 weeks of age. Each group was consisted of 6 mice with control group in which vehicle was administered instead of DSS. The mice were sacrificed on the 7th day after DSS or vehicle administration. Body weight, diarrhea, and hematochezia were recorded daily. Disease activity index (DAI) score which was composed of body weight change, diarrhea, and hematochezia was measured every day. Colon length was measured after sacrifice and colon mucosal level of interleukin 1 beta (IL-1β) was measured by ELISA assay. Histological score was compared between ascending and descending colon in the DSS group. Results: Colon length of five- and nine-week DSS group was significantly shorter than each control group but there was no statistical significance depending on DSS concentration or age. DAI score of 4% DSS group in nine-week was significantly higher than that five-week (P = 0.012) but there was no difference between 2.5% and 4% DSS group. The level of IL-1β in DSS mice was much higher than control group (P < 0.01), but there was no difference among several DSS groups. The histological score was higher in the descending colon than in the ascending colon but there was no statistical difference between each pair of DSS groups. Conclusions: The 4% DSS mice in nine-week was adequate for DSS-induced colitis model. DAI score was useful tool and descending colon was more appropriate site for histological evaluation of colitis than ascending colon. PMID:26734588

  2. Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study

    PubMed Central

    Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

    2015-01-01

    Background The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. Methods A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. Results A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Conclusions Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. PMID:25387852

  3. Three monthly doses of palivizumab are not adequate for 5-month protection: a population pharmacokinetic analysis.

    PubMed

    La Via, William V; Notario, Gerard F; Yu, Xiang-Qing; Sharma, Shringi; Noertersheuser, Peter A; Robbie, Gabriel J

    2013-12-01

    Recent guidelines in British Columbia, Canada have suggested that the use of a maximum of 3 monthly doses of palivizumab 15 mg/kg intramuscularly for RSV immunoprophylaxis of high risk infants born prior to the RSV season is adequate to provide protection against severe RSV disease for a 5-month RSV season. Efficacy was established, however, with 2 large, randomized controlled clinical studies using 5 monthly doses of immunoprophylaxis. To evaluate the differences in expected palivizumab exposures between the 2 dosing regimens (3 vs 5 monthly doses across a 5-month period), we used a population pharmacokinetic (PK) model that was developed using palivizumab PK data collected from 22 clinical studies with a total of 1800 subjects. This model adequately described observed palivizumab concentrations from the different pediatric studies and was subsequently used to simulate expected palivizumab serum concentrations for 3 monthly doses compared with 5 monthly doses in children younger than 24 months with chronic lung disease of prematurity and infants younger than 6 months postnatal age who were born at ? 35 weeks gestational age. Results from the population PK model indicated lower serum concentrations of palivizumab during the fourth and fifth months, after an abbreviated 3-monthly-dose regimen when compared with the mean trough concentrations seen with the 5-monthly-dose regimen studied in the pivotal clinical trials in premature infants. Specifically, during the fourth and fifth months, 52% and 85%, respectively, would have levels below the lowest concentration (fifth percentile) in those receiving the 5-monthly-dose regimen. Simulations using this model did not support a 3-monthly-dose regimen to protect against severe RSV disease during the typical 5-month season. PMID:23523663

  4. Residual triose phosphate isomerase activity and color measurements to determine adequate cooking of ground beef patties.

    PubMed

    Sair, A I; Booren, A M; Berry, B W; Smith, D M

    1999-02-01

    The objectives were to (i) compare the use of triose phosphate isomerase (TPI) activity and internal color scores for determination of cooking adequacy of beef patties and (ii) determine the effect of frozen storage and fat content on residual TPI activity in ground beef. Ground beef patties (24.4% fat) were cooked to five temperatures ranging from 60.0 to 82.2 degrees C. TPI activity decreased as beef patty cooking temperature was increased from 60.0 to 71.1 degrees C; however, no difference (P > 0.05) in activity (6.3 U/kg meat) was observed in patties cooked to 71.1 degrees C and above. Degree of doneness color scores, a* values and b* values, of ground beef patties decreased as internal temperature was increased from 60.0 to 71.1 degrees C; however, temperature had no effect on L* values. TPI activity in raw ground beef after five freeze-thaw cycles did not differ from the control. Three freeze-thaw cycles of raw ground beef resulted in a 57.2% decrease in TPI activity after cooking. TPI activity of cooked beef increased during 2 months of frozen storage, but TPI activity in ground beef stored for 3 months or longer did not differ from the unfrozen control. While past research has shown color to be a poor indicator of adequate thermal processing, our results suggest that undercooked ground beef patties could be distinguished from those that had been adequately cooked following U.S. Department of Agriculture guidelines using residual TPI activity as a marker. PMID:10030635

  5. Prenatal Care.

    ERIC Educational Resources Information Center

    Office of Child Development (DHEW), Washington, DC.

    Initially published by the Children's Bureau in 1913, this pamphlet has been revised frequently. Its purpose is to point out the importance of medical care during pregnancy. Comfortable pregnancies, easy labor, and better care for their new infants are the usual concerns of prospective mothers. Consequently, this 1962 edition of "Prenatal Care"…

  6. Earth caring.

    PubMed

    Schuster, E A

    1990-09-01

    This article explores the interrelationships of environment, nursing, and caring and challenges the readers, particularly in light of the ecology crisis, to examine the apparent anthropocentric emphasis of current human care and caring theory. The intent is to engage all nurses in thoughtful study and reflection and in fruitful, friendly dialogue. PMID:2122798

  7. 21 CFR 740.10 - Labeling of cosmetic products for which adequate substantiation of safety has not been obtained.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 7 2012-04-01 2012-04-01 false Labeling of cosmetic products for which adequate..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS Warning Statements § 740.10 Labeling of cosmetic products for which adequate substantiation of safety has not...

  8. 21 CFR 740.10 - Labeling of cosmetic products for which adequate substantiation of safety has not been obtained.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 7 2010-04-01 2010-04-01 false Labeling of cosmetic products for which adequate..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS Warning Statements § 740.10 Labeling of cosmetic products for which adequate substantiation of safety has not...

  9. 21 CFR 740.10 - Labeling of cosmetic products for which adequate substantiation of safety has not been obtained.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 7 2014-04-01 2014-04-01 false Labeling of cosmetic products for which adequate..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS Warning Statements § 740.10 Labeling of cosmetic products for which adequate substantiation of safety has not...

  10. 21 CFR 740.10 - Labeling of cosmetic products for which adequate substantiation of safety has not been obtained.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 7 2011-04-01 2010-04-01 true Labeling of cosmetic products for which adequate..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS Warning Statements § 740.10 Labeling of cosmetic products for which adequate substantiation of safety has not...

  11. 21 CFR 740.10 - Labeling of cosmetic products for which adequate substantiation of safety has not been obtained.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 7 2013-04-01 2013-04-01 false Labeling of cosmetic products for which adequate..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS Warning Statements § 740.10 Labeling of cosmetic products for which adequate substantiation of safety has not...

  12. Using Computerized Physician Order Entry to Ensure Appropriate Vaccination of Patients with Inflammatory Bowel Disease

    PubMed Central

    Karr, Jacob R.; Lu, Jonathan J.; Smith, Robert B.; Thomas, Austin C.

    2016-01-01

    Background: Inflammatory bowel disease (IBD) is a disorder in which an aberrant immune response in a genetically susceptible host, with influences from environmental factors, leads to intestinal inflammation. Vaccines against influenza and pneumococcal pneumonia are indicated for all patients with IBD, while vaccines such as hepatitis A and B, human papillomavirus, and meningococcal meningitis are only indicated for patients with specific risk factor profiles. Some vaccines are contraindicated for patients receiving immunosuppressive medications; typically, these are live or live attenuated vaccines such as measles-mumps-rubella, varicella zoster, and herpes zoster. Given the importance of ensuring patients with IBD are properly vaccinated, we designed a quality improvement project to determine the perceived barriers to ordering these vaccines and to make the process easier. Methods: At the outset of the study, providers in our gastroenterology department who treat patients with IBD received a survey about vaccinations. Based on the preintervention survey responses, we created an order panel in our electronic medical record (Epic Systems Corporation) to facilitate vaccination ordering. This order panel prompted physicians to order the vaccinations and informed them of contraindications. At the end of the 2-month implementation period, we distributed a second survey to assess the utility of the order panel. Results: Respondents generally agreed that the Epic SmartSet order panel made vaccinations easier to order, ensured physician confidence in ordering vaccinations, was helpful for use in practice, made the clinic more efficient, and reminded physicians which vaccinations are contraindicated because of immunosuppression. Respondents were divided regarding whether a greater number of patients with IBD were actually receiving vaccinations after the order panel was implemented. Conclusion: We used the order entry function in Epic to facilitate vaccination ordering for patients with IBD. Our results indicate that the order panel we built made ordering vaccinations easier and more efficient compared to the previous process. We hope this order panel promotes improved patient care and becomes a future area of study for how Epic and other electronic health records may be used.

  13. The role of adequate reference materials in density measurements in hemodialysis

    NASA Astrophysics Data System (ADS)

    Furtado, A.; Moutinho, J.; Moura, S.; Oliveira, F.; Filipe, E.

    2015-02-01

    In hemodialysis, oscillation-type density meters are used to measure the density of the acid component of the dialysate solutions used in the treatment of kidney patients. An incorrect density determination of this solution used in hemodialysis treatments can cause several and adverse events to patients. Therefore, despite the Fresenius Medical Care (FME) tight control of the density meters calibration results, this study shows the benefits of mimic the matrix usually measured to produce suitable reference materials for the density meter calibrations.

  14. Caring for the terminally Ill.

    PubMed

    Bascom, P B; Tolle, S W; Cassel, C K

    1996-05-15

    More than 50% of dying patients do not receive adequate symptomatic relief. Fear of hastening death is the primary reason for physicians' reluctance to prescribe high-dose pain medication. Yet the ethical principle of "double effect" clearly states that palliative care which results in respiratory depression is justified-as long as the goal of management is relief of suffering, rather than death. PMID:8632050

  15. Inequalities in public health care delivery in Zambia

    PubMed Central

    2014-01-01

    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. PMID:24645826

  16. 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

  17. Incentives in primary care and their impact on potentially avoidable hospital admissions.

    PubMed

    Fiorentini, Gianluca; Iezzi, Elisa; Lippi Bruni, Matteo; Ugolini, Cristina

    2011-08-01

    Financial incentives in primary care have been introduced with the purpose of improving appropriateness of care and containing demand. We usually observe pay-for-performance programs, but alternatives, such as pay-for-participation in improvement activities and pay-for-compliance with clinical guidelines, have also been implemented. Here, we assess the influence of different programs that ensure extra payments to GPs for containing avoidable hospitalisations. Our dataset covers patients and GPs of the Italian region Emilia-Romagna for the year 2005. By separating pay-for-performance from pay-for-participation and pay-for-compliance programs, we estimate the impact of different financial incentives on the probability of avoidable hospitalisations. As dependent variable, we consider two different sets of conditions for which timely and effective primary care should be able to limit the need for hospital admission. The first is based on 27 medical diagnostic related groups that Emilia-Romagna identifies as at risk of inappropriateness in primary care, while the second refers to the internationally recognised ambulatory care-sensitive conditions. We show that pay-for-performance schemes may have a significant effect over aggregate indicators of appropriateness, while the effectiveness of pay-for-participation schemes is adequately captured only by taking into account subpopulations affected by specific diseases. Moreover, the same scheme produces different effects on the two sets of indicators used, with performance improvements limited to the target explicitly addressed by the Italian policy maker. This evidence is consistent with the idea that a "tunnel vision" effect may occur when public authorities monitor specific sets of objectives as proxies for more general improvements in the quality of health care delivered. PMID:20424882

  18. Preconception Care and Prenatal Care

    MedlinePLUS

    ... is at risk for complications? How does stress affect pregnancy? NICHD Research Information Clinical Trials Resources and Publications Preconception Care and Prenatal Care: Condition Information Skip sharing on social media links Share this: Page Content What is preconception ...

  19. Constraining canopy biophysical simulations with daily MODIS reflectance data ensuring pixel-target adequacy

    NASA Astrophysics Data System (ADS)

    Drewry, D.; Duveiller, G.

    2013-12-01

    Modern vegetation models incorporate ecophysiological details that allow for accurate estimates of carbon dioxide uptake, water use and energy exchange, but require knowledge of dynamic structural and biochemical traits. Variations in these traits are controlled by genetic factors as well as growth stage and nutrient and moisture availability, making them difficult to predict and prone to significant error. Here we explore the use of daily MODIS optical reflectance data for constraining key canopy- and leaf-level traits required by forward biophysical models. A multi-objective optimization algorithm is used to invert the PROSAIL canopy radiation transfer model against MODIS optical reflectance observations. PROSAIL accounts for the effects of leaf-level optical properties, foliage distribution and orientation on canopy reflectance across the optical range. Inversions are conducted for several growing seasons for both soybean and maize at multiple sites across the Central US agro-ecosystem. These inversions provide estimates of seasonal variations, and associated uncertainty, of variables such as leaf area index (LAI). The inversion-derived canopy properties are used to examine the ability of MODIS data to characterize seasonal variations in these states relative to field observations. The canopy properties are then used as inputs into the MLCan biophysical model to conduct forward simulations. MLCan characterizes the ecophysiological functioning of a plant canopy at a half-hourly timestep, and has been rigorously validated for both C3 and C4 crops against observations of canopy CO2 uptake, evapotranspiration and sensible heat exchange. By utilizing the inverted canopy states to drive MLCan over several growing seasons, we are able to assess the impact of uncertainty in the MODIS inversion procedure on uncertainties in forward model flux estimates. This work requires the use of instant (non-composited) observations obtained at a daily frequency from both Terra and Aqua platforms. As a whiskbroom imaging instrument, MODIS has a complex viewing geometry which affects its spatial response, i.e. the way the electromagnetic radiation reflected from the surface is ultimately encoded in the remotely-sensed image. A model of this spatial response is used here to ensure that the footprint of the satellite observations matches adequately with the coupled model simulations of the target fields. The relationship between the purity of the remote sensing observation, with respect to the target field, and the quality of the biophysical variable inversion is also investigated.

  20. Comprehensive care of amyotrophic lateral sclerosis patients: a care model.

    PubMed

    Gell, Maria Rosa; Antn, Antonio; Rojas-Garca, Ricardo; Puy, Carmen; Pradas, Jesus

    2013-12-01

    Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that presents with muscle weakness, causing progressive difficulty in movement, communication, eating and ultimately, breathing, creating a growing dependence on family members and other carers. The ideal way to address the problems associated with the disease, and the decisions that must be taken, is through multidisciplinary teams. The key objectives of these teams are to optimise medical care, facilitate communication between team members, and thus to improve the quality of care. In our centre, we have extensive experience in the care of patients with ALS through an interdisciplinary team whose aim is to ensure proper patient care from the hospital to the home setting. In this article, we describe the components of the team, their roles and our way of working. PMID:23540596

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

    NASA Astrophysics Data System (ADS)

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

    2008-12-01

    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.

  2. Hemodynamic monitoring and care of the patient of high risk for anesthesia.

    PubMed Central

    Pietak, S P; Teasdale, S J

    1979-01-01

    Hemodynamic monitoring and care of the patient at high risk for anesthesia require a careful and systematic approach. During preoperative evaluation the patient at increased risk must be identified and correctable problems must be solved. The patient's current medications must be reviewed because they may influence the choice of anesthetic approach and may alter the physiologic response to the stresses commonly associated with anesthesia. In addition to conventional clinical and electrocardiographic monitoring, perioperative hemodynamic monitoring may be desirable for patients at special risk, who are likely to have significant associated medical problems or to undergo complicated surgical procedures. No ideal induction agent exists, and hypotension secondary to peripheral vasodilation or myocardial depression, or both, is a potential problem. Patients with an inordinately high risk may benefit from mechanical circulatory assistance prior to induction of anesthesia. Attention to oxygenation, blood volume replacement and the prevention of hypertensive episodes are particularly important during anesthesia so that optimal cardiac performance is ensured and ischemia avoided. The stresses during emergence from anesthesia contribute to lability of the cardiovascular status and hypoxemia. The period of risk does not conclude with immediate recovery from anesthesia but extends through the postoperative phase. Careful monitoring and attention to the control of pain, prevention of hypotension and hypertension, adequate oxygenation, early mobilization and resumption of the administration of cardiac medications are important factors in a successful outcome. PMID:497983

  3. Ensuring Quality

    ERIC Educational Resources Information Center

    Erickson, Paul W.

    2009-01-01

    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…

  4. Ensuring Quality

    ERIC Educational Resources Information Center

    Erickson, Paul W.

    2009-01-01

    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

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

    PubMed

    Thiele, Christina M; Bermel, Wolfgang

    2007-10-01

    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 Kövér 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

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

    PubMed Central

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

    2014-01-01

    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. PMID:25009498

  7. Cardiac catecholamines in rats fed copper deficient or copper adequate diets containing fructose or starch

    SciTech Connect

    Scholfield, D.J.; Fields, M.; Beal, T.; Lewis, C.G.; Behall, K.M. )

    1989-02-09

    The symptoms of copper (Cu) deficiency are known to be more severe when rats are fed a diet with fructose (F) as the principal carbohydrate. Mortality, in males, due to cardiac abnormalities usually occurs after five weeks of a 62% F, 0.6 ppm Cu deficient diet. These effects are not observed if cornstarch (CS) is the carbohydrate (CHO) source. Studies with F containing diets have shown increased catecholamine (C) turnover rates while diets deficient in Cu result in decreased norepinephrine (N) levels in tissues. Dopamine B-hydroxylase (EC 1.14.17.1) is a Cu dependent enzyme which catalyzes the conversion of dopamine (D) to N. An experiment was designed to investigate the effects of CHO and dietary Cu on levels of three C in cardiac tissue. Thirty-two male and female Sprague-Dawley rats were fed Cu deficient or adequate diets with 60% of calories from F or CS for 6 weeks. N, epinephrine (E) and D were measured by HPLC. Statistical analysis indicates that Cu deficiency tends to decrease N levels, while having the reverse effect on E. D did not appear to change. These findings indicate that Cu deficiency but not dietary CHO can affect the concentration of N and E in rat cardiac tissue.

  8. Gaussian membership functions are most adequate in representing uncertainty in measurements

    NASA Technical Reports Server (NTRS)

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

    1992-01-01

    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.

  9. Food intake in women two years or more after bariatric surgery meets adequate intake requirements.

    PubMed

    Novais, Patrcia Ftima Sousa; Rasera, Irineu; Leite, Celso Vieira de Souza; Marin, Flvia Andria; de Oliveira, Maria Rita Marques

    2012-05-01

    Restricted food intake after bariatric surgery can be an important factor both in the long-term control of body weight and in the onset of nutritional deficiencies. The objective of this study was to assess the adequacy of food intake in women two or more years after bariatric surgery according to the excess weight lost. A group of 141 women who underwent banded Roux-en-Y gastric bypass (RYGB) was divided according to the percentage of excess weight they lost (%EWL)<50; 50?75; = 75. The habitual energy and nutrient intakes were determined by a 24-hour recall over two days and the probability of adequate intake was based on the Dietary Reference Intake. The mean total estimated energy requirement (EER) as well as energy, macronutrient and cholesterol intakes did not differ among the groups. Only the %EWL<50 group had an intake equal to their EER, but they presented a higher number of inadequacies, such as low levels of magnesium, folic acid and vitamins C and E. Calcium and dietary fiber intakes were extremely low in all three groups. In conclusion, weight loss after surgery is associated with food habits that favor energy intake over micronutrient intake. PMID:22652372

  10. Informed consent for biobanking: consensus-based guidelines for adequate comprehension

    PubMed Central

    Beskow, Laura M.; Dombeck, Carrie B.; Thompson, Cole P.; Watson-Ormond, J. Kemp; Weinfurt, Kevin P.

    2014-01-01

    Purpose Federal regulations and best practice guidelines identify categories of information that should be communicated to prospective biobank participants during the informed consent process. However, uncertainty remains about which of this information participants must understand to provide valid consent. Methods We conducted a Delphi process to define adequate comprehension in the context of biobanking consent. The process involved an iterative series of 3 online surveys of a diverse panel of 51 experts, including genome scientists, biobank managers, ethics and policy experts, and community and participant representatives. We sought consensus (greater than 70% agreement) concerning what specific details participants should know about 16 biobank consent topics. Results Consensus was achieved for 15 of the 16 consent topics. The exception was the comprehension needed regarding the Genetic Information Nondiscrimination Act. Conclusions Our Delphi process was successful in identifying a concise set of key points that prospective participants must grasp to provide valid consent for biobanking. Specifying the level of knowledge sufficient for individuals to make an informed choice provides a basis for improving consent forms and processes, as well as an absolute metric for assessing the effectiveness of other interventions to improve comprehension. PMID:25144889

  11. Determination of the need for selenium by chicks fed practical diets adequate in vitamin E

    SciTech Connect

    Combs, G.F. Jr.; Su, Q.; Liu, C.H.; Sinisalo, M.; Combs, S.B.

    1986-03-01

    Experiments were conducted to compare the dietary needs for selenium (Se) by chicks fed either purified (amino acid-based) or practical (corn- and soy-based) diets that were adequate with respect to vitamin E (i.e., contained 100 IU/kg) and all other known nutrients with the single exception of Se (i.e., contained only 0.10 ppm Se). Studies were conducted in Ithaca using Single Comb White Leghorn chicks fed the purified basal diet and in Beijing using chicks of the same breed fed either the same purified basal diet or the practical diet formulated to be similar to that used in poultry production in some parts of China and the US. Results showed that each basal diet produced severe depletion of Se-dependent glutathione peroxidase (SeGSHpx) in plasma, liver and pancreas according to the same time-course, but that other consequences of severe uncomplicated Se deficiency were much more severe among chicks fed the purified diet (e.g., growth depression, pancreatic dysfunction as indicated by elevated plasma amylase and abnormal pancreatic histology). Chicks fed the practical Se-deficient diet showed reduced pancreas levels of copper, zinc and molybdenum and elevated plasma levels of iron; they required ca. 0.10 ppm dietary Se to sustain normal SeGSHpx in several tissues and to prevent elevated amylase in plasma. The dietary Se requirement of the chick is, therefore, estimated to be 0.10 ppm.

  12. Salt, blood pressure and cardiovascular risk: what is the most adequate preventive strategy? A Swiss perspective

    PubMed Central

    Burnier, Michel; Wuerzner, Gregoire; Bochud, Murielle

    2015-01-01

    Among the various strategies to reduce the incidence of non-communicable diseases reduction of sodium intake in the general population has been recognized as one of the most cost-effective means because of its potential impact on the development of hypertension and cardiovascular diseases. Yet, this strategic health recommendation of the WHO and many other international organizations is far from being universally accepted. Indeed, there are still several unresolved scientific and epidemiological questions that maintain an ongoing debate. Thus what is the adequate low level of sodium intake to recommend to the general population and whether national strategies should be oriented to the overall population or only to higher risk fractions of the population such as salt-sensitive patients are still discussed. In this paper, we shall review the recent results of the literature regarding salt, blood pressure and cardiovascular risk and we present the recommendations recently proposed by a group of experts of Switzerland. The propositions of the participating medical societies are to encourage national health authorities to continue their discussion with the food industry in order to reduce the sodium intake of food products with a target of mean salt intake of 5–6 grams per day in the population. Moreover, all initiatives to increase the information on the effect of salt on health and on the salt content of food are supported. PMID:26321959

  13. The rat adequately reflects human responses to exercise in blood biochemical profile: a comparative study

    PubMed Central

    Goutianos, Georgios; Tzioura, Aikaterini; Kyparos, Antonios; Paschalis, Vassilis; Margaritelis, Nikos V; Veskoukis, Aristidis S; Zafeiridis, Andreas; Dipla, Konstantina; Nikolaidis, Michalis G; Vrabas, Ioannis S

    2015-01-01

    Animal models are widely used in biology and the findings of animal research are traditionally projected to humans. However, recent publications have raised concerns with regard to what extent animals and humans respond similar to physiological stimuli. Original data on direct in vivo comparison between animals and humans are scarce and no study has addressed this issue after exercise. We aimed to compare side by side in the same experimental setup rat and human responses to an acute exercise bout of matched intensity and duration. Rats and humans ran on a treadmill at 86% of maximal velocity until exhaustion. Pre and post exercise we measured 30 blood chemistry parameters, which evaluate iron status, lipid profile, glucose regulation, protein metabolism, liver, and renal function. ANOVA indicated that almost all biochemical parameters followed a similar alteration pattern post exercise in rats and humans. In fact, there were only 2/30 significant species exercise interactions (in testosterone and globulins), indicating different responses to exercise between rats and humans. On the contrary, the main effect of exercise was significant in 15/30 parameters and marginally nonsignificant in other two parameters (copper, P=0.060 and apolipoprotein B, P=0.058). Our major finding is that the rat adequately mimics human responses to exercise in those basic blood biochemical parameters reported here. The physiological resemblance of rat and human blood responses after exercise to exhaustion on a treadmill indicates that the use of blood chemistry in rats for exercise physiology research is justified. PMID:25677548

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

    NASA Astrophysics Data System (ADS)

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

    2005-04-01

    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. Härmä and K. Palomäki, 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.

  15. Nutrition issues and tools for palliative care.

    PubMed

    Cline, David

    2006-01-01

    Adequate nutritional intake is often difficult, if not impossible, for the person with a terminal illness. Patients, families, and caregivers struggle to continue providing food and fluids in the face of declining ability and interest. Nutrition issues often need to be addressed by home care clinicians, who should be armed with the basic concepts and tools for educating and counseling those involved in the area of palliative care nutrition. PMID:16394826

  16. Pediatric treatment 2.0: ensuring a holistic response to caring for HIV-exposed and infected children.

    PubMed

    Essajee, Shaffiq M; Arpadi, Stephen M; Dziuban, Eric J; Gonzalez-Montero, Raul; Heidari, Shirin; Jamieson, David G; Kellerman, Scott E; Koumans, Emilia; Ojoo, Atieno; Rivadeneira, Emilia; Spector, Stephen A; Walkowiak, Helena

    2013-11-01

    Treatment 2.0 is an initiative launched by UNAIDS and WHO in 2011 to catalyze the next phase of treatment scale-up for HIV. The initiative defines strategic activities in 5 key areas, drugs, diagnostics, commodity costs, service delivery and community engagement in an effort to simplify treatment, expand access and maximize program efficiency. For adults, many of these activities have already been turned into treatment policies. The recent WHO recommendation to use a universal first line regimen regardless of gender, pregnancy and TB status is a treatment simplification very much in line with Treatment 2.0. But despite that fact that Treatment 2.0 encompasses all people living with HIV, we have not seen the same evolution in policy development for children. In this paper we discuss how Treatment 2.0 principles can be adapted for the pediatric population. There are several intrinsic challenges. The need for distinct treatment regimens in children of different ages makes it hard to define a one size fits all approach. In addition, the fact that many providers are reluctant to treat children without the advice of specialists can hamper decentralization of service delivery. But at the same time, there are opportunities that can be availed now and in the future to scale up pediatric treatment along the lines of Treatment 2.0. We examine each of the five pillars of Treatment 2.0 from a pediatric perspective and present eight specific action points that would result in simplification of pediatric treatment and scale up of HIV services for children. PMID:24361631

  17. Pediatric treatment 2.0: ensuring a holistic response to caring for HIV-exposed and infected children

    PubMed Central

    Arpadi, Stephen M.; Dziuban, Eric J.; Gonzalez-Montero, Raul; Heidari, Shirin; Jamieson, David G.; Kellerman, Scott E.; Koumans, Emilia; Ojoo, Atieno; Rivadeneira, Emilia; Spector, Stephen A.; Walkowiak, Helena

    2015-01-01

    Treatment 2.0 is an initiative launched by UNAIDS and WHO in 2011 to catalyze the next phase of treatment scale-up for HIV. The initiative defines strategic activities in 5 key areas, drugs, diagnostics, commodity costs, service delivery and community engagement in an effort to simplify treatment, expand access and maximize program efficiency. For adults, many of these activities have already been turned into treatment policies. The recent WHO recommendation to use a universal first line regimen regardless of gender, pregnancy and TB status is a treatment simplification very much in line with Treatment 2.0. But despite that fact that Treatment 2.0 encompasses all people living with HIV, we have not seen the same evolution in policy development for children. In this paper we discuss how Treatment 2.0 principles can be adapted for the pediatric population. There are several intrinsic challenges. The need for distinct treatment regimens in children of different ages makes it hard to define a one size fits all approach. In addition, the fact that many providers are reluctant to treat children without the advice of specialists can hamper decentralization of service delivery. But at the same time, there are opportunities that can be availed now and in the future to scale up pediatric treatment along the lines of Treatment 2.0. We examine each of the five pillars of Treatment 2.0 from a pediatric perspective and present eight specific action points that would result in simplification of pediatric treatment and scale up of HIV services for children. PMID:24361631

  18. Primary care for adolescents with developmental disabilities.

    PubMed

    Kripke, Clarissa Calliope

    2014-09-01

    Disability is a natural part of the human experience. To maximize potential, adolescents with disabilities require multidisciplinary transition planning and life-skill training. Health care professionals can reduce barriers to accessing health care. They can encourage self-determination and connect patients to self-advocacy organizations. They can facilitate smooth transitions to adult health care services. Careful descriptions of a patient's baseline traits and function are critical, not only to assist in person centered planning processes, but to ensure that new caregivers and clinicians have the information they need to recognize changes in function or behavior that can signal illness. PMID:25124203

  19. Achieving interoperability for accountable care.

    PubMed

    Bordenick, Jennifer Covich; Okubo, Tracy H; Kontur, Alex; Siddiqui, Nadeen

    2015-02-01

    Based on findings of a recent survey, accountable care organizations should keep eight points in mind as they seek to establish interoperability among their provider constituents: Create a shared governance structure to make IT decisions. Conduct a readiness assessment and gap analysis. Reconfigure the technology infrastructure and processes to support new value-based care delivery protocols. Consider targeting programs around high-risk groups. Develop real-time data-sharing systems. Ensure privacy and security policies and procedures are in place. Assess and address workforce issues expeditiously. Participate in broader interoperability efforts. PMID:26665540

  20. Why Palliative Care for Children is Preferable to Euthanasia.

    PubMed

    Carter, Brian S

    2016-02-01

    Recent laws in Europe now allow for pediatric euthanasia. The author reviews some rationale for caution, and addresses why ensuring the availability of pediatric palliative care is an important step before allowing pediatric euthanasia. PMID:25007796