Science.gov

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, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Ensuring that the salvors and marine firefighters are adequate. 155.4050 Section 155.4050 Navigation and Navigable Waters COAST GUARD... firefighters are adequate. (a) You are responsible for determining the adequacy of the resource providers...

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

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Ensuring that the salvors and marine firefighters are adequate. 155.4050 Section 155.4050 Navigation and Navigable Waters COAST GUARD... firefighters are adequate. (a) You are responsible for determining the adequacy of the resource providers...

  4. 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...

  5. Barriers to adequate prenatal care utilization in American Samoa

    PubMed Central

    Hawley, Nicola L; Brown, Carolyn; Nu’usolia, 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 2007–2008, 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 2007–2008 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

  6. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...REGULATIONS FOR VESSELS Salvage and Marine Firefighting § 155.4050 Ensuring that the...successful salvage and/or marine firefighting operations, including equipment deployment...continuous training program. For marine firefighting providers, they meet the...

  7. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...REGULATIONS FOR VESSELS Salvage and Marine Firefighting § 155.4050 Ensuring that the...successful salvage and/or marine firefighting operations, including equipment deployment...continuous training program. For marine firefighting providers, they meet the...

  8. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...REGULATIONS FOR VESSELS Salvage and Marine Firefighting § 155.4050 Ensuring that the...successful salvage and/or marine firefighting operations, including equipment deployment...continuous training program. For marine firefighting providers, they meet the...

  9. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...REGULATIONS FOR VESSELS Salvage and Marine Firefighting § 155.4050 Ensuring that the...successful salvage and/or marine firefighting operations, including equipment deployment...continuous training program. For marine firefighting providers, they meet the...

  10. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...REGULATIONS FOR VESSELS Salvage and Marine Firefighting § 155.4050 Ensuring that the...successful salvage and/or marine firefighting operations, including equipment deployment...continuous training program. For marine firefighting providers, they meet the...

  11. 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 scheme—under which it would be illegal to sell to smokers who had not demonstrated an adequate level of awareness—as 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

  12. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT... and Adequate Veterinary Care § 2.40 Attending veterinarian and adequate veterinary care (dealers and... veterinary care to its animals in compliance with this section. (1) Each dealer and exhibitor shall employ...

  13. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT... and Adequate Veterinary Care § 2.40 Attending veterinarian and adequate veterinary care (dealers and... veterinary care to its animals in compliance with this section. (1) Each dealer and exhibitor shall employ...

  14. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE... adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall provide adequate veterinary care to its animals in compliance with this section: (1) Each research facility...

  15. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE... adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall provide adequate veterinary care to its animals in compliance with this section: (1) Each research facility...

  16. 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.

  17. 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…

  18. 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

  19. 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 (12–18 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 team’s 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

  20. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... one Doctor of Veterinary Medicine (DVM) may appoint to the IACUC another DVM with delegated program... veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE... adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall...

  1. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... one Doctor of Veterinary Medicine (DVM) may appoint to the IACUC another DVM with delegated program... veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE... adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall...

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

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... one Doctor of Veterinary Medicine (DVM) may appoint to the IACUC another DVM with delegated program... veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE... adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall...

  3. Individual and contextual determinants of adequate maternal health care services in Kenya.

    PubMed

    Achia, Thomas N O; Mageto, Lillian E

    2015-01-01

    This study aimed to examine individual and community level factors associated with adequate use of maternal antenatal health services in Kenya. Individual and community level factors associated with adequate use of maternal health care (MHC) services were obtained from the 2008-09 Kenya Demographic and Health Survey data set. Multilevel partial-proportional odds logit models were fitted using STATA 13.0 to quantify the relations of the selected covariates to adequate MHC use, defined as a three-category ordinal variable. The sample consisted of 3,621 women who had at least one live birth in the five-year period preceding this survey. Only 18 percent of the women had adequate use of MHC services. Greater educational attainment by the woman or her partner, higher socioeconomic status, access to medical insurance coverage, and greater media exposure were the individual-level factors associated with adequate use of MHC services. Greater community ethnic diversity, higher community-level socioeconomic status, and greater community-level health facility deliveries were the contextual-level factors associated with adequate use of MHC. To improve the use of MHC services in Kenya, the government needs to design and implement programs that target underlying individual and community level factors, providing focused and sustained health education to promote the use of antenatal, delivery, and postnatal care. PMID:25774561

  4. 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

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

    PubMed

    Jung, Sylvia; Wiedemann, Ruth; Höhl, 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

  6. 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.

  7. 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)

  8. 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

  9. 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

  10. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... That daily observation of animals may be accomplished by someone...accurate information on problems of animal health, behavior, and well-being is conveyed...involved in the care and use of animals regarding handling,...

  11. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... That daily observation of animals may be accomplished by someone...accurate information on problems of animal health, behavior, and well-being is conveyed...involved in the care and use of animals regarding handling,...

  12. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... That daily observation of animals may be accomplished by someone...accurate information on problems of animal health, behavior, and well-being is conveyed...involved in the care and use of animals regarding handling,...

  13. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... That daily observation of animals may be accomplished by someone...accurate information on problems of animal health, behavior, and well-being is conveyed...involved in the care and use of animals regarding handling,...

  14. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... That daily observation of animals may be accomplished by someone...accurate information on problems of animal health, behavior, and well-being is conveyed...involved in the care and use of animals regarding handling,...

  15. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... That daily observation of animals may be accomplished by someone...accurate information on problems of animal health, behavior, and well-being is conveyed...involved in the care and use of animals regarding handling,...

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

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

    PubMed Central

    2011-01-01

    Background An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB) - a contributory benefits social program aimed at informal P/EOL caregivers - operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. Methods As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. Results Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. Conclusions This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the potential it holds for serving as one public health response to caregiver burden that forms part of a healthy public policy that addresses the determinants of this burden. PMID:21592383

  2. 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

  3. 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…

  4. 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…

  5. 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 DCM’s 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

  6. 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, Félix; Noumen-Djeunga, Blanbin; Simé, Joseph; Wantong, Fidèle 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]?=?[0.2–0.9], p-value (p)?=?0.04), cleansing wounds with soap (OR [95%CI]?=?0.1 [0.03–0.3], p<0.0001) and growing cassava (OR [95%CI]?=?0.3 [0.2–0.7], p?=?0.005) as independent protective factors. Independent risk factors were bathing in the Mbam River (OR [95%CI]?=?6.9 [1.4–35], p?=?0.02) and reporting scratch lesions after insect bites (OR [95%CI]?=?2.7 [1.4–5.4], 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

  7. Asparagus and rhubarb are perennial vegetables that produce a new crop year after year for 10 to 15 years or longer if the plants are given adequate care. Because these crops remain in the same

    E-print Network

    New Hampshire, University of

    successive cover crops the season before you plant asparagus. Fertilizer Have soil tested before plantingAsparagus and rhubarb are perennial vegetables that produce a new crop year after year for 10 to 15 years or longer if the plants are given adequate care. Because these crops remain in the same location

  8. Maintaining adequate hydration and nutrition in adult enteral tube feeding.

    PubMed

    Dunn, Sasha

    2015-01-01

    Predicting the nutritional and fluid requirements of enterally-fed patients can be challenging and the practicalities of ensuring adequate delivery must be taken into consideration. Patients who are enterally fed can be more reliant on clinicians, family members and carers to meet their nutrition and hydration needs and identify any deficiencies, excesses or problems with delivery. Estimating a patient's requirements can be challenging due to the limitations of using predictive equations in the clinical setting. Close monitoring by all those involved in the patient's care, as well as regular review by a dietitian, is therefore required to balance the delivery of adequate feed and fluids to meet each patient's individual needs and prevent the complications of malnutrition and dehydration. Increasing the awareness of the signs of malnutrition and dehydration in patients receiving enteral tube feeding among those involved in a patient's care will help any deficiencies to be detected early on and rectified before complications occur. PMID:26087203

  9. 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…

  10. Grantee Spotlight: Isabel Scarinci, Ph.D., M.P.H. - Ensuring Latina Immigrants Have Equal Breast and Cervical Cancer Care

    Cancer.gov

    A majority of Latinos living in Alabama face significant health disparities due to low-income, language barriers and cultural differences. Isabel C. Scarinci, Ph.D., MPH is a CRCHD U54 grantee who is ensuring that this population group has access to cancer prevention and treatment. In a recent interview, Scarinci explained that Latinos living in the region have limited access to health care. In 2011, the state of Alabama drew up legislation that has had impacted access to health services among Latino immigrants.

  11. 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…

  12. 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

  13. Radiology clinical synopsis: a simple solution for obtaining an adequate clinical history for the accurate reporting of imaging studies on patients in intensive care units.

    PubMed

    Cohen, Mervyn D; Alam, Khurshaid

    2005-09-01

    Lack of clinical history on radiology requisitions is a universal problem. We describe a simple Web-based system that readily provides radiology-relevant clinical history to the radiologist reading radiographs of intensive care unit (ICU) patients. Along with the relevant history, which includes primary and secondary diagnoses, disease progression and complications, the system provides the patient's name, record number and hospital location. This information is immediately available to reporting radiologists. New clinical information is immediately entered on-line by the radiologists as they are reviewing images. After patient discharge, the data are stored and immediately available if the patient is readmitted. The system has been in routine clinical use in our hospital for nearly 2 years. PMID:15912412

  14. Ensuring Quality Nursing Home Care

    MedlinePLUS

    ... 00 2014-03-27T12:12:44-04:00 Adobe InDesign CS6 (Windows) uuid:d2311842-e3a4-46d2-817c- ... converted from application/x-indesign to application/pdf Adobe InDesign CS6 (Windows) / 2014-03-27T12:12:44- ...

  15. Recognizing the Importance of Cancer Program Accreditation in Ensuring Comprehensive, High Quality, Patient-centered Cancer Care (H.Res. 487)

    Cancer.gov

    The resolution notes the role of the American College of Surgeons Commission on Cancer (CoC) in ensuring that cancer patients have access to quality diagnosis, treatment, and rehabilitation through its accreditation of cancer programs, and calls for an

  16. Child Care--Supportive Services. Hearing on Examining the Role of Child Care as a Supportive Service To Ensure Access to Education, Job Training, and the Labor Market before the Subcommittee on Children, Family, Drugs and Alcoholism of the Committee on Labor and Human Resources. United States Senate, Ninety-Ninth Congress, First Session (Fort Lauderdale, Florida, December 2, 1985).

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

    Testimony was heard from two panels concerning: (1) child care as a supportive service designed to ensure parents' access to education, job training, and the labor market; and (2) the effectiveness of federal programs in administering to child care needs. Witnesses appearing in the first panel described (1) experience as a single parent; (2)…

  17. 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

  18. Recommendations for ensuring early thrombolytic therapy for acute myocardial infarction. The Heart and Stroke Foundation of Canada, the Canadian Cardiovascular Society and the Canadian Association of Emergency Physicians for the Emergency Cardiac Care Coalition.

    PubMed Central

    1996-01-01

    OBJECTIVE: To recommend practical steps to ensure early thrombolytic therapy and thereby reduce mortality and morbidity associated with acute myocardial infarction (AMI). OPTIONS: Various factors were considered that influence time to thrombolysis related to patients, independent practitioners and health care systems. OUTCOMES: Reduction in morbidity and mortality associated with AMI. EVIDENCE: Early initiation of thrombolytic therapy reduces morbidity and mortality associated with AMI. The ECC Coalition analysed the factors that might impede early implementation of thrombolytic therapy. VALUES: Published data were reviewed, and recommendations were based on consensus opinion of the Emergency Cardiac Care (ECC) Coalition. The ECC Coalition comprises 20 professional, nongovernment and government organizations and has a mandate to improve emergency cardiac care services through collaboration. BENEFITS, HARMS AND COSTS: Early thrombolytic therapy reduces morbidity and mortality associated with AMI. Implementation of the recommendations will result in reduced time to thrombolytic therapy, streamlining of current practices and enhanced cooperation among health care professionals to expedite care. Depending on existing practices, implementation may require protocol development, and public and professional education. Although costs are associated with educating the public and health care professionals, they are outweighed by the financial and social benefits of reduced morbidity and mortality. RECOMMENDATIONS: Early recognition of AMI symptoms by the public and health care professionals, early access to the emergency medical services system and early action by emergency care providers in administering thrombolytic therapy (within 30 minutes after the patient's arrival at the emergency department). VALIDATION: No similar consensus statements or practice guidelines for thrombolytic therapy in Canada are available for comparison. PMID:8630837

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

    PubMed Central

    Grégoire, 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

  20. 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…

  1. 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

  2. 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

    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

  3. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance... adequate for the anticipated number of enrollees for the service area. (2) Maintains a network of...

  4. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., DEPARTMENT OF HOMELAND SECURITY (CONTINUED) POLLUTION OIL OR HAZARDOUS MATERIAL POLLUTION PREVENTION..., Fire Science, etc.). (5) Resource provider has 24-hour availability of personnel and equipment,...

  5. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., DEPARTMENT OF HOMELAND SECURITY (CONTINUED) POLLUTION OIL OR HAZARDOUS MATERIAL POLLUTION PREVENTION..., Fire Science, etc.). (5) Resource provider has 24-hour availability of personnel and equipment,...

  6. 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…

  7. 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…

  8. Defining an Adequate Education for English Learners

    ERIC Educational Resources Information Center

    Gandara, Patricia; Rumberger, Russell W.

    2008-01-01

    This article explores the components of an "adequate" education for linguistic minority students in California and attempts to distinguish these from the components of an adequate education for low-income students who are native English speakers. About 1.6 million students were classified as English learners (ELs) in California in 2006. We argue…

  9. 31 CFR 19.900 - Adequate evidence.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Adequate evidence. 19.900 Section 19.900 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE DEBARMENT AND...

  10. 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…

  11. 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…

  12. 2013, . 28, . 1?? IS LANGRANGIAN FORMALISM ADEQUATELY

    E-print Network

    Kreinovich, Vladik

    2013, . 28, . 1­?? 000.000 IS LANGRANGIAN FORMALISM ADEQUATELY DESCRIBING ENERGY CONSERVATION? V. Kreinovich, O. Kosheleva In most physical theories, total energy is conserved. For example, when the kinetic energy of a particle decreases, the potential energy increases accord- ingly. For some physical

  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. Using microfiber and steam technology to improve cleaning outcomes in an intensive care unit.

    PubMed

    Gillespie, Elizabeth; Williams, Natalie; Sloane, Tracy; Wright, Louise; Kotsanas, Despina; Stuart, Rhonda L

    2015-02-01

    The use of microfiber and steam technology may be seen as a novel cleaning method that can improve the outcome of cleaning. We describe its use in an intensive care setting, its impact on vancomycin-resistant enterococci acquisition, and the importance of ensuring adequate education of cleaning staff. Such new methods can have a significant impact on the transmission of multidrug-resistant organisms, provided systems are in place to ensure that the methodology is adhered to and that cleaning hours are adequate. PMID:25637118

  15. 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…

  16. 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

  17. Is Bohmian Mechanics an empirically adequate theory?

    E-print Network

    Kim Joris Boström

    2015-09-17

    Bohmian mechanics (BM) draws a picture of nature, which is completely different from that drawn by standard quantum mechanics (SQM): Particles are at any time at a definite position, and the universe evolves deterministically. Astonishingly, according to a proof by Bohm the empirical predictions of these two very different theories coincide. From the very beginning, BM has faced all kinds of criticism, most of which are either technical or philosophical. There is, however, a criticism first raised by Correggi et al. (2002) and recently strengthened by Kiukas and Werner (2010), which holds that, in spite of Bohm's proof, the predictions of BM do not agree with those of SQM in the case of local position measurements on entangled particles in a stationary state. Hence, given that SQM has been proven to be tremendously successful in the past, BM could most likely not be considered an empirically adequate theory. My aim is to resolve the conflict by showing that 1) it relies on hidden differences in the conceptual thinking, and that 2) the predictions of both theories approximately coincide if the process of measurement is adequately accounted for. My analysis makes no use of any sort of wavefunction collapse, refuting a widespread belief that an "effective collapse" is needed to reconcile BM with the predictions of SQM.

  18. 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.…

  19. 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.

  20. Costs of Emergency Care

    MedlinePLUS

    ... to our communities and must be adequately funded. Q. What are the costs of emergency care? The ... visit. The hospital fees make up the difference. Q. Is emergency care cost effective? Yes: The fact ...

  1. Improving children's access to health care: the role of decategorization.

    PubMed Central

    Hughes, D. C.; Halfon, N.; Brindis, C. D.; Newacheck, P. W.

    1996-01-01

    Far too many children in this country are unable to obtain the health care they need because of barriers that prohibit easy access. Among the most significant obstacles are financial barriers, including lack of adequate health insurance and inadequate funding of programs for low-income children and those with special health-care needs. Another set of "non-financial" barriers are related to the categorical nature of addressing children's health-care needs, which impedes access by increasing the complexity and burden of seeking care and discourages providers from providing care. Decategorization represents an appealing partial remedy to these problems because it can lead to fundamental and lasting changes in financing and delivering health services. The greatest appeal of decategorization is its potential to improve access to care with the expenditure of little or no new funds. Decategorization also holds considerable risk. Depending on how it is designed and implemented, decategorization may lead to diminished access to care by serving as a foil for budget cuts or by undermining essential standards of care. However, these risks do not negate the value of exploring decategorization as an approach that can be taken today to better organize services and ensure that existing resources adequately meet children's needs. In this report we examine the role of decategorization as a mechanism for removing the barriers to care that are created by categorical funding of health programs. PMID:8982519

  2. 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

  3. Quality in Action Ensuring Head and Neck Oncology Patients Receive

    E-print Network

    Liu, Xiaole Shirley

    Quality in Action Ensuring Head and Neck Oncology Patients Receive Recommended Pretreatment Dental Care at Erie County Medical Center, Buffalo, NY Abstract Purpose: Head and neck (H&N) cancer therapy of the head and neck (H&N) are treated with surgery, chemotherapy, radiation therapy (RT), or a multimodality

  4. Should transplantation be a part of a health care system?

    PubMed

    Balk, Roger A

    1990-06-01

    The inclusion of organ transplantation in our health care system raises several questions about the basis for the decision and the process by which it was approved. To function, our health care system requires not only an adequate method for technical evaluation, but also a means for ensuring informed public support for the policies that determine what services are available. In the future, this approval process could lead to the exclusion of a treatment because the system as a whole would not be able to afford its cost. This exclusion could have important implications for the philosophy of medicine and the work of the clinical investigator. PMID:11650933

  5. 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...

  6. Diabetic Wound Care

    MedlinePLUS

    ... care, and what is being applied to the wound. Healing may occur within weeks or require several months. ... may seem to you. The key to successful wound healing is regular podiatric medical care to ensure the ...

  7. Improving depression care: barriers, solutions, and research needs.

    PubMed

    Von Korff, M; Katon, W; Unützer, J; Wells, K; Wagner, E H

    2001-06-01

    Potential solutions for barriers to improved organization of care of depressive illness were identified. These included (1) aligning efforts to improve depression care with broader strategies for improving care of other chronic conditions; (2) increasing the availability of depression case management services in primary care; (3) developing registries and reminder systems to ensure active follow-up of depressed patients; (4) achieving agreement on how depression outcomes should be measured to provide outcomes-based performance standards; (5) providing greater support from mental health specialists for management of depressed patients by primary care providers; (6) campaigns to reduce the stigma associated with treatment of depressive illness; (7) increased dissemination of interventions that activate and empower patients managing a depressive illness; (8) redefining the lack of time of primary care providers for high-quality depression care as issues in organization of care and provider training; and (9) development of incentives (organizational or financial) for high-quality depression care. Research needs were identified according to what has been learned to date. Identified research needs included: studies of approaches to organization of case management, research in new populations (e.g., new diagnostic groups, rural populations, the disadvantaged, the elderly, and those with chronic medical illnesses), research on stepped care and relapse prevention strategies, evaluation of the societal benefits of improved depression care, and multisite trials and meta-analytic approaches that can provide adequate statistical power to assess societal benefits of improved care. PMID:11401751

  8. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated...if an establishment is not in a sanitary condition nor unless the establishment...condition and provides adequate facilities for conducting such...

  9. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated...if an establishment is not in a sanitary condition nor unless the establishment...condition and provides adequate facilities for conducting such...

  10. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated...if an establishment is not in a sanitary condition nor unless the establishment...condition and provides adequate facilities for conducting such...

  11. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated...if an establishment is not in a sanitary condition nor unless the establishment...condition and provides adequate facilities for conducting such...

  12. 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

  13. 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.

  14. 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

  15. Barriers to nutritional care for the undernourished hospitalised older people†

    PubMed Central

    Eide, Helene Dahl; Halvorsen, Kristin; Almendingen, Kari

    2015-01-01

    Aims and objectives To identify what nurses experience as barriers to ensuring adequate nutritional care for the undernourished hospitalized elderly. Background Undernutrition occurs frequently among the hospitalised elderly and can result in a variety of negative consequences if not treated. Nevertheless, undernutrition is often unrecognised and undertreated. Nurses have a great responsibility for nutritional care, as this is part of the patient's basic needs. Exploring nurses' experiences of preventing and treating undernourishment among older patients in hospitals is therefore highly relevant. Design A focus group study was employed based on a hermeneutic phenomenological methodological approach. Methods Four focus group interviews with totally 16 nurses working in one large university hospital in Norway were conducted in spring 2012. The nurses were recruited from seven somatic wards, all with a high proportion of older (?70 years) inpatients. The data were analysed in the three interpretative contexts: self-understanding, a critical common-sense understanding and a theoretical understanding. Results We identified five themes that reflect barriers the nurses experience in relation to ensuring adequate nutritional care for the undernourished elderly: loneliness in nutritional care, a need for competence in nutritional care, low flexibility in food service practices, system failure in nutritional care and nutritional care is being ignored. Conclusions The results imply that nutritional care at the university hospital has its limits within the hospital structure and organisation, but also regarding the nurses' competence. Moreover, the barriers revealed that the undernourished elderly are not identified and treated properly as stipulated in the recommendations in the national guidelines on the prevention and treatment of undernutrition. Relevance to clinical practice The barriers revealed in this study are valuable when considering improvements to nutritional care practices on hospital wards to enable undernourished older inpatients to be identified and treated properly. PMID:24646060

  16. Humanitarian and civic assistance health care training and cultural awareness promoting health care pluralism.

    PubMed

    Facchini, Rose E

    2013-05-01

    Integration between traditional and contemporary health care in a host nation can be beneficial to nation- and capacity-building and, subsequently, to the overall health of the society. "Traditional" health care in this sense refers to the indigenous health care system in the host nation, which includes characteristic religious or cultural practices, whereas "contemporary" health care is also known as "conventional" or "Westernized"; integration is a synchronization of these two health care forms. However, the choice of integration depends on the political and cultural situation of the nation in which the Department of Defense health care personnel are intervening. Thus, cultural awareness training is essential to ensure the success of missions related to global health and in promoting a health care system that is most beneficial to the society. The present study attempts to show the benefits of both cultural training and health care integration, and how adequately evaluating their efficacy has been problematic. The author proposes that determinants of this efficacy are better documentation collection, extensive predeployment cultural awareness and sensitivity training, and extensive after-action reports for future development. PMID:23756013

  17. Child Health USA 2013: Prenatal Care Utilization

    MedlinePLUS

    ... given the timing of prenatal care entry and gestational age at delivery. Non-Hispanic American Indian/Alaska Native ... given the timing of prenatal care entry and gestational age at delivery (Kotelchuck Index). Adequate prenatal care is ...

  18. 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...

  19. 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...

  20. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 2 2010-07-01 2010-07-01 false Adequate tools and resources. 51.354 Section 51.354 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall...

  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 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of...

  2. 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 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of...

  3. "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…

  4. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...Animal Products 2 2010-01-01 2010-01-01 false Sanitation and adequate facilities. 305.3 Section 305.3 Animals...WITHDRAWAL OF INSPECTION; REPORTS OF VIOLATION § 305.3 Sanitation and adequate facilities. Inspection shall not be...

  5. 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...

  6. 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...

  7. Legislation allows Black Lung benefits to be awarded without adequate evidence of disability

    SciTech Connect

    Not Available

    1980-07-28

    Social Security Administration approval of black lung claims is based on provisions of law which GAO believes do not adequately ensure that benefits are provided only to those entitled to them. Under the 1977 amendments to the Federal Coal Mine Health and Safety Act such claims were based on affidavits from spouses and other dependent persons, inconclusive medical evidence, and presumptions based on years of coal mine employment. GAO believes that medical evidence should be the basis for determining disability and death from black lung.

  8. Quality of Care

    Cancer.gov

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

  9. 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– ...

  10. 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

  11. 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:...

  12. 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:...

  13. 75 FR 8272 - Defense Federal Acquisition Regulation Supplement; Acquisition Strategies To Ensure Competition...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-24

    ...; Acquisition Strategies To Ensure Competition Throughout the Life Cycle of Major Defense Acquisition Programs... life cycle as a means to improve contractor performance; and (2) adequate documentation of the... level and subcontract level (at such tier or tiers as are appropriate) throughout the program life...

  14. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL REGULATIONS OF THE ENVIRONMENTAL DATA SERVICE DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration...

  15. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL REGULATIONS OF THE ENVIRONMENTAL DATA SERVICE DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration...

  16. Broadband inversion of 1JCC responses in 1,n-ADEQUATE spectra

    NASA Astrophysics Data System (ADS)

    Reibarkh, Mikhail; Williamson, R. Thomas; Martin, Gary E.; Bermel, Wolfgang

    2013-11-01

    Establishing the carbon skeleton of a molecule greatly facilitates the process of structure elucidation, both manual and computer-assisted. Recent advances in the family of ADEQUATE experiments demonstrated their potential in this regard. 1,1-ADEQUATE, which provides direct 13C-13C correlation via 1JCC, and 1,n-ADEQUATE, which typically yields 3JCC and 1JCC correlations, are more sensitive and more widely applicable experiments than INADEQUATE and PANACEA. A recently reported modified pulse sequence that semi-selectively inverts 1JCC correlations in 1,n-ADEQUATE spectra provided a significant improvement, allowing 1JCC and nJCC correlations to be discerned in the same spectrum. However, the reported experiment requires a careful matching of the amplitude transfer function with 1JCC coupling constants in order to achieve the inversion, and even then some 1JCC correlations could still have positive intensity due to the oscillatory nature of the transfer function. Both shortcomings limit the practicality of the method. We now report a new, dual-optimized inverted 1JCC 1,n-ADEQUATE experiment, which provides more uniform inversion of 1JCC correlations across the range of 29-82 Hz. Unlike the original method, the dual optimization experiment does not require fine-tuning for the molecule's 1JCC coupling constant values. Even more usefully, the dual-optimized version provides up to two-fold improvement in signal-to-noise for some long-range correlations. Using modern, cryogenically-cooled probes, the experiment can be successfully applied to samples of ˜1 mg under favorable circumstances. The improvements afforded by dual optimization inverted 1JCC 1,n-ADEQUATE experiment make it a useful and practical tool for NMR structure elucidation and should facilitate the implementation and utilization of the experiment.

  17. Ensuring Safe Use of Contact Lens Solution

    MedlinePLUS

    ... Consumer Updates RSS Feed Ensuring Safe Use of Contact Lens Solution Printer-friendly PDF (234 KB) On ... About Eye Infections Dos and Don'ts for Contact Lens Wearers Not emptying the solution out of ...

  18. Considerable challenges in ensuring patient safety.

    PubMed

    Prendergast, John

    2015-08-01

    John Prendergast, a decontamination engineer working within the specialist team at NHS Wales Shared Services Partnership / Specialist Estates Services dedicated to decontamination and reprocessing of medical devices, considers 'the array of standards that are in place to provide rules, guidance, or characteristics, for various decontamination activities'. He also sets out some of the key steps to take to ensure that instrument decontamination is undertaken to the high standards needed to ensure patient safety. PMID:26495557

  19. Maltreatment and mental health in institutional care--comparing early and late institutionalized children in Tanzania.

    PubMed

    Hermenau, Katharin; Hecker, Tobias; Elbert, Thomas; Ruf-Leuschner, Martina

    2014-01-01

    Research has shown the harmful potential of institutional care on young children; however, little is known about the consequences of institutional care on infants in Sub-Saharan Africa. We compared 35 Tanzanian children who were institutionalized at birth to 4 years of age with a matched group of 35 children who were institutionalized at 5 to 14 years of age. We examined adverse childhood experiences over the course of their entire lives, in their family of origin and in institutional care, and mental health problems at primary school age, such as depressive symptoms, aggressive behavior, and internalizing and externalizing problems. Results showed that early institutionalized children reported more adverse experiences during their time in institutional care and a greater variety of mental health problems than did late institutionalized children. Moreover, maltreatment in institutional care was positively related to mental health problems only in early institutionalized children. We conclude that adverse experiences in institutional care play an important role for early institutionalized children who need special care from adequately educated caregivers. Therefore, training concepts focusing on the needs of the youngest children have to be developed, tested, and established. Countries such as Tanzania need policies that apply to all orphanages to ensure an adequate standard of quality in childcare. PMID:25798516

  20. INTRODUCTION Terrestrial animals face the challenge of maintaining an adequate

    E-print Network

    Williams, Jos. B.

    1690 INTRODUCTION Terrestrial animals face the challenge of maintaining an adequate state of hydration of internal tissues while being exposed to a desiccating external environment. Among important evolutionary innovations of animals that became terrestrial were mechanisms that reduced overall water loss

  1. 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…

  2. 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.…

  3. Are hotspots of evolutionary potential adequately protected in southern California?

    E-print Network

    Bohonak, Andrew J.

    Are hotspots of evolutionary potential adequately protected in southern California? Amy G-level biodiversity, but typically ignores the evolutionary processes that control the gain and loss of biodiversity pinpoint six hotspots where interpop- ulation genetic divergence is consistently high, five evolutionary

  4. 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

  5. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...designed and equipped for adequate nursing care, comfort, and privacy of residents...accommodate an increased quality of care for patients, a nursing home...female) 25 (per fixture) Child day care 1 Medical support (staff...

  6. 38 CFR 59.140 - Nursing home care requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...designed and equipped for adequate nursing care, comfort, and privacy of residents...accommodate an increased quality of care for patients, a nursing home...female) 25 (per fixture) Child day care 1 Medical support (staff...

  7. 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…

  8. 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…

  9. 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)

  10. 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...

  11. Control Measures: Proper control measures ensure that

    E-print Network

    Lance, Veronica P.

    to the eyes, which are the most sensitive body part to light. Laser Classifications The American NationalControl Measures: Proper control measures ensure that exposure to the eyes & skin are minimal during operation & maintenance. Engineering: Warning lights, Shutters/Attenuators, Beam Housings

  12. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT...animals to assess their health and well-being; Provided, however, That...of animal health, behavior, and well-being is conveyed to the attending...

  13. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT...animals to assess their health and well-being; Provided, however, That daily...of animal health, behavior, and well-being is conveyed to the attending...

  14. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT...animals to assess their health and well-being; Provided, however, That daily...of animal health, behavior, and well-being is conveyed to the attending...

  15. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT...animals to assess their health and well-being; Provided, however, That daily...of animal health, behavior, and well-being is conveyed to the attending...

  16. 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

  17. Perioperative care following complex laryngotracheal reconstruction in infants and children

    PubMed Central

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

    2010-01-01

    Laryngotracheal reconstruction (LTR) involves surgical correction of a stenotic airway with cartilage interpositional grafting, followed by either placement of a tracheostomy and an intraluminal stent (two-stage LTR) or placement of an endotracheal tube with postoperative sedation and mechanical ventilation for an extended period of time (singlestage LTR). With single-stage repair, there may be several perioperative challenges including the provision of adequate sedation, avoidance of the development of tolerance to sedative and analgesia agents, the need to use neuromuscular blocking agents, the maintenance of adequate pulmonary toilet to avoid perioperative nosocomial infections, and optimization of postoperative respiratory function to facilitate successful tracheal extubation. We review the perioperative management of these patients, discuss the challenges during the postoperative period, and propose recommendations for the prevention of reversible causes of extubation failure in this article. Optimization to ensure a timely tracheal extubation and successful weaning of mechanical ventilator, remains the primary key to success in these surgeries as extubation failure or the need for prolonged postoperative mechanical ventilation can lead to failure of the graft site, the need for prolonged Pediatric Intensive Care Unit care, and in some cases, the need for a tracheostomy to maintain an adequate airway. PMID:21189858

  18. 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.

  19. 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

  20. 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

  1. "Lost to follow-up": the public health goals of accountable care.

    PubMed

    Calman, Neil S; Hauser, Diane; Chokshi, Dave A

    2012-04-01

    The Affordable Care Act made admirable strides toward the "triple aim" of reducing health care costs, increasing health care quality, and improving the health of the community at large. A key element of reform is the accountable care organization (ACO), which restructures health care delivery such that networks of providers are held responsible for a group of patients they serve. The recently announced Medicare ACO program lays the foundation for 2 of its 3 major goals by allowing ACOs to share in any cost savings, provided they meet quality criteria. Yet it seems that the public health goals of accountable care-arguably the most important of the 3-have been left behind. To better address public health goals, we propose a novel method for quality reporting within ACOs: introducing an "expanded denominator" that attributes patients to a health system if they have ever been seen within the system. An expanded denominator would ensure that ACOs are held accountable not only for patients already engaged in primary care but also for patients with fragmented care and high-risk community members not receiving adequate care. Ultimately, payment reform in Medicare, and potentially Medicaid, must support this new approach to quality measurement for it to have lasting ramifications. PMID:22493465

  2. 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.

  3. 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

  4. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...false Who determines when there is adequate snow cover? 13.960 Section 13.960 Parks...960 Who determines when there is adequate snow cover? The superintendent will determine when snow cover is adequate for snowmachine use....

  5. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...false Who determines when there is adequate snow cover? 13.960 Section 13.960 Parks...960 Who determines when there is adequate snow cover? The superintendent will determine when snow cover is adequate for snowmachine use....

  6. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...false Who determines when there is adequate snow cover? 13.960 Section 13.960 Parks...960 Who determines when there is adequate snow cover? The superintendent will determine when snow cover is adequate for snowmachine use....

  7. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...false Who determines when there is adequate snow cover? 13.960 Section 13.960 Parks...960 Who determines when there is adequate snow cover? The superintendent will determine when snow cover is adequate for snowmachine use....

  8. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...false Who determines when there is adequate snow cover? 13.960 Section 13.960 Parks...960 Who determines when there is adequate snow cover? The superintendent will determine when snow cover is adequate for snowmachine use....

  9. 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

    ...Hemoglobin Standards and Maintaining Adequate Iron Stores in Blood Donors; Public Workshop...Hemoglobin Standards and Maintaining Adequate Iron Stores in Blood Donors.'' The purpose...potential measures to maintain adequate iron stores in blood donors. The public...

  10. 50 CFR 530.2 - Ensuring that environmental documents are actually considered in agency decision-making.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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....

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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....

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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....

  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

    ... 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....

  14. 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....

  15. 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…

  16. 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...

  17. Dairy products: how they fit in nutritionally adequate diets.

    PubMed

    Clerfeuille, Edouard; Maillot, Matthieu; Verger, Eric O; Lluch, Anne; Darmon, Nicole; Rolf-Pedersen, Nathalie

    2013-07-01

    Individual diet modeling with linear programming recently provided evidence that plant-based products, fish, and fresh dairy products consumption should be increased in the French population to reach nutrient-based recommendations. The aim of our study was to estimate the number of portions of the different milk-based food categories fitting into nutritionally adequate diets. Starting from the diet observed for each adult in the 1999 French Enquête Individuelle et Nationale sur les Consommations Alimentaires survey (n=1,171), an isocaloric nutritionally adequate diet was modeled that simultaneously met a whole set of nutrient constraints (based on nutrient recommendations) while deviating the least from the observed diet food content. Variations in weight, energy, and nutrients between observed and modeled diets were calculated for each food group (n=7), with a focus on milk-based products (n=4 categories). The diet optimization process increased the weights of three food groups: fruit and vegetables (+62%), starchy foods (+37%), and dairy products (+19%). Across milk-based food categories, the optimization increased yogurts (+60%) and milk (+17%) and decreased cheeses (-48%) without change to milk desserts. Cheeses represented one out of two consumed portions of milk-based products in observed diets, whereas in modeled diets cheeses, milk, and yogurts each represented about one portion per day. Milk desserts were similar before and after optimization, at approximately one portion per week. These results confirm that a large increase in intake of plant-based products is needed. They show that rebalancing the intake of milk-based products in favor of the least energy-dense ones (ie, yogurts and milk) will help individuals in this population reach nutritional adequacy. PMID:23790410

  18. Ensuring content integrity when using commercial support.

    PubMed

    Lubejko, Barbara G

    2014-10-01

    Preventing continuing education program bias when commercial support is used can be challenging. Standards have been developed by health care professional accreditation organizations that focus on independence, conflict of interest, appropriate management of commercial funds, content integrity, and disclosure to learners. Implementation of these standards can significantly reduce the risk of bias and improve dissemination of balanced clinical information. PMID:25280188

  19. Ensuring cultural diversity among California nurses.

    PubMed

    Martin-Holland, Judy; Bello-Jones, Teresa; Shuman, Ann; Rutledge, Dana N; Sechrist, Karen R

    2003-06-01

    The California Strategic Planning Committee for Nursing cultural diversity work group surveyed deans and directors from RN prelicensure and vocational nurse education programs in California in 1998. With a 49% response rate, key survey findings were that 48% of programs were actively recruiting ethnically diverse students using a variety of strategies; various approaches were being used to retain students; barriers to student success were primarily financial and educational; and most programs included curricular content and programming designed to ensure culturally competent and sensitive graduates. PMID:12814214

  20. 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

  1. 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.

  2. 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 ...

  3. [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

  4. 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

  5. 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…

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. The Role of Corporations in Ensuring Biodiversity

    PubMed

    KELLY; HODGE

    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 win-win 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.KEY WORDS: Partnerships; Stewardship; International; Habitats; Biodiversity PMID:8895418

  15. 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.

  16. Are Vancomycin Trough Concentrations Adequate for Optimal Dosing?

    PubMed Central

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

    2014-01-01

    The current vancomycin therapeutic guidelines recommend the use of only trough concentrations to manage the dosing of adults with Staphylococcus aureus infections. Both vancomycin efficacy and toxicity are likely to be related to the area under the plasma concentration-time curve (AUC). We assembled richly sampled vancomycin pharmacokinetic data from three studies comprising 47 adults with various levels of renal function. With Pmetrics, the nonparametric population modeling package for R, we compared AUCs estimated from models derived from trough-only and peak-trough depleted versions of the full data set and characterized the relationship between the vancomycin trough concentration and AUC. The trough-only and peak-trough depleted data sets underestimated the true AUCs compared to the full model by a mean (95% confidence interval) of 23% (11 to 33%; P = 0.0001) and 14% (7 to 19%; P < 0.0001), respectively. In contrast, using the full model as a Bayesian prior with trough-only data allowed 97% (93 to 102%; P = 0.23) accurate AUC estimation. On the basis of 5,000 profiles simulated from the full model, among adults with normal renal function and a therapeutic AUC of ?400 mg · h/liter for an organism for which the vancomycin MIC is 1 mg/liter, approximately 60% are expected to have a trough concentration below the suggested minimum target of 15 mg/liter for serious infections, which could result in needlessly increased doses and a risk of toxicity. Our data indicate that adjustment of vancomycin doses on the basis of trough concentrations without a Bayesian tool results in poor achievement of maximally safe and effective drug exposures in plasma and that many adults can have an adequate vancomycin AUC with a trough concentration of <15 mg/liter. PMID:24165176

  17. 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?kg·m?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?mOsm·kg?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

  18. 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…

  19. 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

  20. 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

  1. 23 CFR 657.19 - Effect of failure to certify or to enforce State laws adequately.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...of failure to certify or to enforce State laws adequately. 657.19 Section...of failure to certify or to enforce State laws adequately. If a State fails...State is not adequately enforcing all State laws respecting maximum vehicle...

  2. 23 CFR 657.19 - Effect of failure to certify or to enforce State laws adequately.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...of failure to certify or to enforce State laws adequately. 657.19 Section...of failure to certify or to enforce State laws adequately. If a State fails...State is not adequately enforcing all State laws respecting maximum vehicle...

  3. 23 CFR 657.19 - Effect of failure to certify or to enforce State laws adequately.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...of failure to certify or to enforce State laws adequately. 657.19 Section...of failure to certify or to enforce State laws adequately. If a State fails...State is not adequately enforcing all State laws respecting maximum vehicle...

  4. 23 CFR 657.19 - Effect of failure to certify or to enforce State laws adequately.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...of failure to certify or to enforce State laws adequately. 657.19 Section...of failure to certify or to enforce State laws adequately. If a State fails...State is not adequately enforcing all State laws respecting maximum vehicle...

  5. 23 CFR 657.19 - Effect of failure to certify or to enforce State laws adequately.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...of failure to certify or to enforce State laws adequately. 657.19 Section...of failure to certify or to enforce State laws adequately. If a State fails...State is not adequately enforcing all State laws respecting maximum vehicle...

  6. 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

    ... SERVICES Food and Drug Administration Hemoglobin Standards and Maintaining Adequate Iron Stores in Blood... Maintaining Adequate Iron Stores in Blood Donors.'' The purpose of this public workshop is to discuss blood... and blood availability, and potential measures to maintain adequate iron stores in blood donors....

  7. 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...

  8. 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...

  9. 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...

  10. 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. 801.5 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...

  11. 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...

  12. 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. 801.5 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...

  13. 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... (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...

  14. 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...

  15. 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...

  16. 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...

  17. 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.

  18. 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

  19. Preconception Care and Prenatal Care

    MedlinePLUS

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

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

    PubMed

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

    2009-12-01

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

  1. Respite Care

    MedlinePLUS

    ... traditional home-based care, as well as adult day care, skilled nursing, home health, and short term institutional ... take any one of the following forms: Adult Day Care: These programs are designed to provide care 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. 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 ...

  4. [The "Bolsa Família" family grant scheme: the interface between professional practice and the human right to adequate food and nutrition].

    PubMed

    Ramos, Camila Irigonhé; Cuervo, Maria Rita Macedo

    2012-08-01

    The Human Right to Adequate Nutrition must be ensured through the public policies included in SAN, namely the Food and Nutritional Security campaign. Besides the income transfer geared to ensuring access to basic social rights, the "Bolsa Família" Program (PBF) is included in this context. This study seeks to analyze the operational aspects of the PBF and also ascertain whether or not the health professionals see the program as a core element of the SAN public policy. With this in mind, semi-structured interviews were conducted with primary healthcare workers involved directly both with the PBF and with the families who receive this benefit. By the end of the study, it was possible to perceive the importance of training health professionals who work in this area, because when one dissociates the social reality in which the beneficiaries live from the program objectives, this can lead to the simple mechanization of these practices. In this respect, it should be stressed that health professionals need to understand the proposals of the program as political and social strategies which, in addition to providing immediate relief, strive to overcome the problems related to poverty and hunger. PMID:22899156

  5. 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.

  6. 42 CFR 9.6 - Animal care, well-being, husbandry, veterinary care, and euthanasia.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...adequate veterinary care and animal health program? The...College of Laboratory Animal Medicine document...introduction to the rest of the group. The stabilization...chimpanzee and human and animal safety concerns. ...be documented in the form of operating...

  7. 42 CFR 9.6 - Animal care, well-being, husbandry, veterinary care, and euthanasia.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...adequate veterinary care and animal health program? The...College of Laboratory Animal Medicine document...introduction to the rest of the group. The stabilization...chimpanzee and human and animal safety concerns. ...be documented in the form of operating...

  8. 42 CFR 9.6 - Animal care, well-being, husbandry, veterinary care, and euthanasia.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...adequate veterinary care and animal health program? The...College of Laboratory Animal Medicine document...introduction to the rest of the group. The stabilization...chimpanzee and human and animal safety concerns. ...be documented in the form of operating...

  9. 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

  10. 31 CFR 10.36 - Procedures to ensure compliance.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 false Procedures to ensure compliance. 10.36 Section 10.36 Money...Service § 10.36 Procedures to ensure compliance. (a) Requirements for covered opinions...of providing advice concerning Federal tax issues must take reasonable steps...

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. Adequate use of allele frequencies in Hispanics—a problem elucidated in nephrotic syndrome

    PubMed Central

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

  16. 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…

  17. SAFETY PRECAUTIONS Before hot work commences, check to ensure

    E-print Network

    is adequately ventilated. IlF~&Ik6X$@lt%% o Cl All flammable or highly combustible materials are removed or properly covered. ~1~~~~~~~~1~~~~~~~,~~~~~~~~~~~~~~ o [] Combustible flooring is properly protected. FB%;t~&&$~E%4F o [] Openings or cracks floor or walls are adequately covered to prevent welding sparks or slag

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

    MedlinePLUS

    ... Hypertension is Adequately Controlled Percentage of Adults with High Blood Pressure Whose Hypertension is Adequately Controlled Heart disease and ... Examination Survey. Age Group Percentage of People with High Blood Pressure that is Controlled by Age Group f94q-uyye ...

  19. 21 CFR 514.117 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... recognized as the essentials of an adequate and well-controlled study. Well controlled, as used in the phrase... (FDA) considers these characteristics in determining whether a study is adequate and well controlled... and well-controlled study should provide sufficient details of study design, conduct, and analysis...

  20. 21 CFR 314.126 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... evidence” to support the claims of effectiveness for new drugs. Therefore, the study report should provide sufficient details of study design, conduct, and analysis to allow critical evaluation and a determination of whether the characteristics of an adequate and well-controlled study are present. (b) An adequate and...

  1. 21 CFR 314.126 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... evidence” to support the claims of effectiveness for new drugs. Therefore, the study report should provide sufficient details of study design, conduct, and analysis to allow critical evaluation and a determination of whether the characteristics of an adequate and well-controlled study are present. (b) An adequate and...

  2. 21 CFR 514.117 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... include a clear statement of the study objective(s). (2) The study is conducted in accordance with an... recognized as the essentials of an adequate and well-controlled study. Well controlled, as used in the phrase... (FDA) considers these characteristics in determining whether a study is adequate and well...

  3. 40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The...

  4. Our Reasoning is Clearly Fuzzy, so Why Is Crisp Logic So Often Adequate?

    E-print Network

    Kreinovich, Vladik

    Our Reasoning is Clearly Fuzzy, so Why Is Crisp Logic So Often Adequate? Hung T. Nguyen1,2 , Berlin is clearly fuzzy, so why is crisp logic so often adequate? We explain this phenomenon by showing "small", "young", etc., there is no crisp boundary: some people are clearly 1 #12;young, some are clearly

  5. Paying physicians for charity care.

    PubMed

    Covert, D F; Westendorf, G A

    1995-12-01

    The Internal Revenue Service's (IRS's) Announcement 95-25 gives important new legal support to the practice of compensating physicians for providing charity care. The announcement describes a situation in which tax-exempt hospitals may compensate non-employee physicians who are members of their staffs for providing charity care--a practice that in the past has had only indirect legal support. Before creating arrangements to compensate physicians for charity care, however, healthcare executives first must establish guidelines that ensure the arrangements comply with IRS rules and Federal antikickback laws. Careful planning on the part of healthcare executives can ensure that an important community service is provided without jeopardizing the hospital's tax-exempt status or exposing it to monetary penalties. PMID:10152895

  6. Priorities for diabetes primary care in Europe.

    PubMed

    Eygen Luk, Van; Patricia, Sunaert; Luc, Feyen; Liesbeth, Borgermans; Jan, De Maeseneer

    2008-02-01

    The European Forum for Primary Care (EFPC) held a consultation process among European experts and identified the elements considered to be essential for high quality diabetes care. More attention should go to diabetes prevention. An interdisciplinary team should provide comprehensive shared care, focused on patient empowerment. The further development of ICT is important to facilitate communication and quality monitoring. The EFPC argues the case for a primary care-centred approach to ensure equity and cost-effectiveness. But this is only possible with a strong primary care infrastructure. In many European countries important investments are needed to strengthen primary care. PMID:18684414

  7. 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...

  8. 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…

  9. 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

  10. Smart Grid Embedded Cyber Security: Ensuring Security While Promoting Interoperability 

    E-print Network

    Ragsdale, G.

    2010-01-01

    Cyber Security: Ensuring Security While Promoting Interoperability Communications and Embedded Systems Department Southwest Research Institute Gary Ragsdale, Ph.D., P.E. August 24 ? 25, 2010 ESL-HH-10-08-09 Proceedings of the 17th Symposium...

  11. Modifying Boolean Functions to Ensure Maximum Algebraic Immunity

    E-print Network

    International Association for Cryptologic Research (IACR)

    1 Modifying Boolean Functions to Ensure Maximum Algebraic Immunity Konstantinos Limniotis, Nicholas Kolokotronis, Member, IEEE, and Nicholas Kalouptsidis Abstract--The algebraic immunity of cryptographic Boolean functions is studied in this paper. Proper modifications of functions achieving maximum algebraic immunity

  12. 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...

  13. Ensuring that fire doors are fit for purpose.

    PubMed

    Ashdown, Neil

    2015-03-01

    Neil Ashdown, general manager of the Fire Door lnspecion Scheme (FDIS), considers the key steps for ensuring that fire doors are correctly specified, installed, maintained, inspected, and, when necessary, repaired, to enable them to effectively fulfil their role. PMID:26268024

  14. Pregnancy care

    MedlinePLUS

    ... gets a head start on a healthy life. PRENATAL CARE Good prenatal care includes good nutrition and health habits before and ... your pregnancy and childbirth . This provider will provide prenatal care, delivery, and postpartum services. Take folic acid. If ...

  15. 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 ...

  16. 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 ...

  17. 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 ...

  18. Hospice Care

    MedlinePLUS

    HOSPICE CARE Hospice offers a special type of care that focuses on providing you and your family with comfort, pain relief, ... or those we choose to call family. About Hospice Care. Provides pain and symptom relief tailored to ...

  19. Managed Care

    MedlinePLUS

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

  20. 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.

  1. 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…

  2. How do we ensure that our costly investments in health care lead to the best possible

    E-print Network

    Toronto, University of

    's help in developing a plan to reduce wait times for cataract operations, as well as hip and knee. The target was met for cataract surgeries, and although personnel limitations hindered progress on hip

  3. LIABILITY FOR INDEPENDENT CONTRACTORS IN CONTRACT AND TORT: DUTIES TO ENSURE THAT CARE IS TAKEN

    E-print Network

    Morgan, Jonathan

    2015-03-26

    . It has accordingly been dismissed as a “logical fraud”66—nothing more than a sleight-of-hand to produce what is supposed to be impossible, namely vicarious liability for the torts of independent contractors. Now from a strictly doctrinal point of view...

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

    PubMed

    Stolk, J; Verdonschot, N; Huiskes, R

    2001-07-01

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

  5. 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

  6. 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

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

    ERIC Educational Resources Information Center

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

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

  8. Parents' Perceptions of Child Care for Children with Disabilities

    ERIC Educational Resources Information Center

    Ceglowski, Deborah Ann; Logue, Mary Ellin; Ullrich, Annette; Gilbert, Jaesook

    2009-01-01

    Sixteen Minnesota families with children with disabilities participated in a 2-year interview study of their care experiences. Findings show that families developed a network of care providers, struggled to pay additional costs for care, were not informed of community services and programs, and believed that their children received adequate child…

  9. America's Child Care Crisis: A Crime Prevention Tragedy.

    ERIC Educational Resources Information Center

    Newman, Sanford; Brazelton, T. Berry; Zigler, Edward; Sherman, Lawrence W.; Bratton, William; Sanders, Jerry; Christeson, William

    This report presents findings relating the reduction of crime and violence with access to good educational child care programs. The report discusses the affordability of such programs, suggests that federal and state governments are not adequately funding educational child care programs, and argues that investing in high-quality child care and…

  10. 75 FR 5893 - Suspension of Community Eligibility for Failure To Maintain Adequate Floodplain Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-05

    ...Eligibility for Failure To Maintain Adequate Floodplain Management Regulations AGENCY: Federal...community because of its failure to maintain floodplain management regulations meeting minimum...indicating they have brought their floodplain management regulations into...

  11. 40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 false Exemptions for pesticides adequately regulated by another Federal agency...ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES...

  12. 21 CFR 314.126 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...example, certain malignancies) and studies in which the effect of the drug is self-evident (general anesthetics, drug metabolism). (3) The method of selection of subjects provides adequate assurance that they have the disease or condition...

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

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...example, certain malignancies) and studies in which the effect of the drug is self-evident (general anesthetics, drug metabolism). (3) The method of selection of subjects provides adequate assurance that they have the disease or condition...

  14. Genomic analysis in the clinic: benefits and challenges for health care professionals and patients in Brazil.

    PubMed

    Ashton-Prolla, Patrícia; Goldim, José Roberto; Vairo, Filippo Pinto E; da Silveira Matte, Ursula; Sequeiros, Jorge

    2015-07-01

    Despite significant advances in the diagnosis and treatment of genetic diseases in the last two decades, there is still a significant proportion where a causative mutation cannot be identified and a definitive genetic diagnosis remains elusive. New genome-wide or high-throughput multiple gene tests have brought new hope to the field, since they can offer fast, cost-effective and comprehensive analysis of genetic variation. This is particularly interesting in disorders with high genetic heterogeneity. There are, however, limitations and concerns regarding the implementation of genomic analysis in everyday clinical practice, including some particular to emerging and developing economies, as Brazil. They include the limited number of actionable genetic variants known to date, difficulties in determining the clinical validity and utility of novel variants, growth of direct-to-consumer genetic testing using a genomic approach and lack of proper training of health care professionals to adequately request, interpret and use genetic information. Despite all these concerns and limitations, the availability of genomic tests has grown at an extremely rapid pace and commercially available services include initiatives in almost all areas of clinical genetics, including newborn and carrier screening. We discuss the benefits and limitations of genomic testing, as well as the ethical implications and the challenges for genetic education and enough available and qualified health care professionals, to ensure the adequate process of informed consent, meaningful interpretation and use of genomic data and definition of a clear regulatory framework in the particular context of Brazil. PMID:26040235

  15. UNIVERSITY ANIMAL CARE COMMITTEE Created July 2010

    E-print Network

    Fletcher, Robin

    UNIVERSITY ANIMAL CARE COMMITTEE Created July 2010 Reviewed and Approved by UACC January 2013 July for Senior Administrators Responsible for Animal Care and Use Programs (2008) states that It is the institution's responsibility to have in place a mechanism to ensure that proposed animal use for research

  16. 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

  17. Service Users and Providers Expectations of Mental Health Care in Iran: A Qualitative Study

    PubMed Central

    Setareh Forouzan, Ameneh; Ghazinour, Mehdi; Dejman, Masoumeh; Rafeiey, Hassan; Baradaran Eftekhari, Monir; San Sebastian, Miguel

    2013-01-01

    Abstract Background Mental disorders are known to be an important cause of disabilities worldwide. Despite their importance, about two thirds of mentally ill people do not seek treatment, probably because of the mental health system’s inability to decrease the negative side effects of the interaction with the mental health services. The World Health Organization has suggested the concept of responsiveness as a way to better understand the active interaction between the health system and the population. This study aimed to explore the expectations of mental health service users and providers. Methods Six focus group discussions were carried in Tehran, the capital of Iran. In total, seventy-four participants comprising twenty-one health providers and fifty-three users of mental health system were interviewed. Interviews were analyzed through content analysis. The coding was synchronized between the researchers through two discussion sessions to ensure the credibility of the findings. The results were then discussed with two senior researchers to strengthen plausibility. Results Five common domains among all groups were identified: accessibility, quality of interpersonal relationships, adequate infrastructure, participation in decisions, and continuity of care. The importance of cultural appropriateness of care was only raised by service users as an expectation of an ideal mental health service. Conclusions Both users and providers identified the most relevant expectations from the mental health care system in Iran. More flexible community mental health services which are responsive to users’ experiences may contribute to improving the process of care for mental health patients. PMID:26060618

  18. Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care.

    PubMed

    Miller, Margaret; Hearn, Lydia; van der Pligt, Paige; Wilcox, Jane; Campbell, Karen J

    2014-01-01

    Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period. PMID:24176286

  19. The California Challenge: Ensuring Primary Care Access for Medi-Cal Recipients under the Affordable Care Act

    E-print Network

    Barr, Donald A.

    2011-01-01

    In paral- lel, the expansion of Medicaid to all people belowof the national expansion of Medicaid eligibility under ACA.and expansion of health insurance to poor individuals and families under the Medicaid

  20. Ethics of drug research in the pediatric intensive care unit.

    PubMed

    Kleiber, Niina; Tromp, Krista; Mooij, Miriam G; van de Vathorst, Suzanne; Tibboel, Dick; de Wildt, Saskia N

    2015-02-01

    Critical illness and treatment modalities change pharmacokinetics and pharmacodynamics of medications used in critically ill children, in addition to age-related changes in drug disposition and effect. Hence, to ensure effective and safe drug therapy, research in this population is urgently needed. However, conducting research in the vulnerable population of the pediatric intensive care unit (PICU) presents with ethical challenges. This article addresses the main ethical issues specific to drug research in these critically ill children and proposes several solutions. The extraordinary environment of the PICU raises specific challenges to the design and conduct of research. The need for proxy consent of parents (or legal guardians) and the stress-inducing physical environment may threaten informed consent. The informed consent process is challenging because emergency research reduces or even eliminates the time to seek consent. Moreover, parental anxiety may impede adequate understanding and generate misconceptions. Alternative forms of consent have been developed taking into account the unpredictable reality of the acute critical care environment. As with any research in children, the burden and risk should be minimized. Recent developments in sample collection and analysis as well as pharmacokinetic analysis should be considered in the design of studies. Despite the difficulties inherent to drug research in critically ill children, methods are available to conduct ethically sound research resulting in relevant and generalizable data. This should motivate the PICU community to commit to drug research to ultimately provide the right drug at the right dose for every individual child. PMID:25354987

  1. 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

  2. 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

  3. 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 ...

  4. PERFORMANCE-BASED MEASUREMENT SYSTEMS - ENSURING DATA DEFENSIBILITY

    EPA Science Inventory

    The use of established methods for the analysis of environmental samples procedures has been one factor that courts have used to determine if the science use in the analysis is adequate for the purposes intended. This established "comfort-zone" may be shaken by efforts to appro...

  5. 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

  6. 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

  7. Quality and Safety in Health Care, Part IV: Quality and Cancer Care.

    PubMed

    Harolds, Jay A

    2015-11-01

    The 1999 Institute of Medicine report Ensuring Quality Cancer Care discussed the difference between the actual cancer care received in the United States and the care that the patients should get, as well as some points to consider in delivering optimum care. In 2012, a follow-up review article in the journal Cancer entitled "Ensuring quality cancer care" indicated that there had been some interval progress, but more are needed to be done. The 2013 Institute of Medicine report Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis indicated that there are continuing major problems with cancer care and that they advocated a national system of quality reporting and a major information technology system to capture and help assess the data. PMID:26444648

  8. Managing in the trenches of consumer care: the challenges of understanding and initiating the advance care planning process.

    PubMed

    Baughman, Kristin R; Aultman, Julie; Hazelett, Susan; Palmisano, Barbara; O'Neill, Anne; Ludwick, Ruth; Sanders, Margaret

    2012-01-01

    To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized. PMID:23078607

  9. 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…

  10. COMPLIANCE WITH TRI-AGENCY REQUIREMENTS: ENSURING THAT

    E-print Network

    Shoubridge, Eric

    COMPLIANCE WITH TRI-AGENCY REQUIREMENTS: ENSURING THAT MCGILL'S RESEARCH FUNDING CAN GROW 26 March;2 June ­ September 2010: routine financial monitoring visit by Tri-Agency delegation November 2011: final report issued by the Tri-Agency 11 findings; 8 sub-findings 2 recurring findings from previous

  11. Ensuring Good Character and Civic Education: Connecting through Service Learning

    ERIC Educational Resources Information Center

    Shumer, Robert; Lam, Carolina; Laabs, Bonnie

    2012-01-01

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

  12. 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.

  13. RESEARCH ARTICLE Ensuring the security of synthetic biology--towards

    E-print Network

    Sussex, University of

    RESEARCH ARTICLE Ensuring the security of synthetic biology--towards a 5P governance strategy the label ``synthetic biology'' has been attached to a number of diverse research and commercial activities companies. Based on the analysis of bio- security issues surrounding synthetic biology during the SYNBIOSAFE

  14. Patient Controlled Encryption: Ensuring Privacy of Electronic Medical Records

    E-print Network

    Horvitz, Eric

    provisions authorizing the fed- eral government to spend 19 billion dollars to digitize U.S. health records the federal government is acutely aware.2 Computerized medical records are open to potential abusesPatient Controlled Encryption: Ensuring Privacy of Electronic Medical Records Josh Benaloh, Melissa

  15. Inspection criteria ensure quality control of parallel gap soldering

    NASA Technical Reports Server (NTRS)

    Burka, J. A.

    1968-01-01

    Investigation of parallel gap soldering of electrical leads resulted in recommendation on material preparation, equipment, process control, and visual inspection criteria to ensure reliable solder joints. The recommendations will minimize problems in heat-dwell time, amount of solder, bridging conductors, and damage of circuitry.

  16. 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…

  17. 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…

  18. 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 ...

  19. INTRODUCTION Telomeres function to ensure the complete replication of

    E-print Network

    de Lange, Titia

    INTRODUCTION Telomeres function to ensure the complete replication of chromosome ends, a task which can not be accomplished by conventional DNA polymerases. Telomeres are maintained by telomerase and Blackburn, 1985; reviewed by Nugent and Lundblad, 1998). Cells have mechanisms to monitor telomere length

  20. 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…

  1. 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

  2. COMPRESSION INDEPENDENT OBJECT ENCRYPTION FOR ENSURING PRIVACY IN VIDEO SURVEILLANCE

    E-print Network

    Kalva, Hari

    COMPRESSION INDEPENDENT OBJECT ENCRYPTION FOR ENSURING PRIVACY IN VIDEO SURVEILLANCE Paula Carrillo the performance of the system when using H.264 video encoding. Index Terms-- video surveillance, compression authorization. The few existing solutions are specific to video and image compression algorithms used

  3. Isotope production at Los Alamos National Laboratory ensures

    E-print Network

    Isotope production at Los Alamos National Laboratory ensures: · A safe, secure and reliable domestic supply of radionuclides that reduces our dependence on foreign-supplied isotope materials products and impurities in a variety of irradiation environments. Isotopes for Threat Reduction Isotopes

  4. CHILDREN IN COMMON: ENSURING THE EMOTIONAL WELL-BEING OF

    E-print Network

    CHILDREN IN COMMON: ENSURING THE EMOTIONAL WELL-BEING OF CHILDREN WHEN PARENTING APART Children's Mental Health eReivew Center for Family Development Children, Youth & Family Consortium #12; CHILDREN'S MENTAL HEALTH eREVIEW: CHILDREN IN COMMON 2 Authors: Ellie M

  5. 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

  6. 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…

  7. Tribal Child Care and Development Fund: Guide for New Administrators

    ERIC Educational Resources Information Center

    Child Care Bureau, 2008

    2008-01-01

    Tribal Child Care and Development Fund administrators work each day to ensure that the children and families in tribal communities have the child care services that best meet their needs. The Child Care and Development Fund (CCDF), a federal block grant for States, Tribes, and Territories, is a key resource to help increase the availability,…

  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. Navigating an Educational Program through the Treacherous 90s: Dynamics of the Health Care System.

    ERIC Educational Resources Information Center

    Van Ostenburg, Paul

    1991-01-01

    Health care system changes since 1965 are reviewed. Areas in which hospital dental care can contribute to improved dental services are discussed, including the promotion of dentistry as primary care, progress in obtaining adequate reimbursement for oral health care, integration with other health professions, and improvement of credentialing and…

  10. An approach for representing and managing medical exceptions in care pathways based on

    E-print Network

    Fernández Olivares, Juan

    An approach for representing and managing medical exceptions in care pathways based on temporal of a patient- centered care pathway. Personalized care pathways are generated auto- matically by means is evaluated with oncology care plans, seems to be an adequate exception recovery mechanism maintaining

  11. Cascading Goals and Objectives to Ensure Accountability and Action 

    E-print Network

    Tarifi, M.; Bingham, P. R.

    2000-01-01

    Bristol-Myers Squibb Worldwide Beauty Care Group has adopted a methodology that is reaping benefits throughout the company. The underlying principle in cascading goals and objectives is that every employee is accountable for achieving any corporate...

  12. 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 ...

  13. CARES Foundation

    MedlinePLUS

    ... a walk in your area. For more information, contact Dina@CaresFoundation.org Support Our Mission Research, education ... Meeting. Beaver County, PA, 2:00pm More events>>> Contact Us CARES Foundation is a nonprofit organization committed ...

  14. Hospice care

    MedlinePLUS

    Hospice care helps people with illnesses that cannot be cured and who are nearing death. The goal ... give comfort and peace instead of a cure. Hospice care provides: Support for the patient and the ...

  15. Hospice Care

    MedlinePLUS

    ... Caregiver Questions to Ask about Advanced Cancer Research Hospice Care On This Page What is hospice, and ... organizations can provide more information about hospice. National Hospice and Palliative Care Organization 1–800–658–8898 ( ...

  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. 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...

  18. [The homeless alcoholic: who cares?].

    PubMed

    van Laere, I R A L

    2002-10-19

    Two homeless alcoholics, males aged 58 and 40 years, suffered from multiple health problems. Sleeping outdoors, excessive drinking and incompetence refrained them from seeking proper assistance. The patients were assessed on many occasions at primary care services provided in shelters in Amsterdam, at police stations and in the streets. They were also frequently admitted to shelter infirmaries, alcohol clinics and general hospitals. Despite substantial individual health damage, community costs and extreme care consumption, coercive treatment was not applied to prevent the death of the first patient and to stabilise the situation of the second. It is stated that a specific group such as homeless alcoholics can hardly be treated except during moments of crisis. Coercive treatment should be applicable in order to stabilise these patients so as to prevent early mortality among the alcoholic homeless with comparable health problems. Outreach primary care services for the alcoholic homeless should actively cooperate with addiction and mental health services in providing adequate care. PMID:12420419

  19. Hospice Care

    MedlinePLUS

    ... Pressure High Blood Pressure Tools & Resources Stroke More Hospice Care Updated:Aug 9,2013 Hospice – or “comfort” – care helps patients and their families ... including medical care, financial concerns and living arrangements. Hospice can be offered in a patient’s home or ...

  20. 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

  1. A Model for Touch Technique and Computation of Adequate Cane Length.

    ERIC Educational Resources Information Center

    Plain-Switzer, Karen

    1993-01-01

    This article presents a model for the motion of a long-cane executing the touch technique and presents formulas for the projected length of a cane adequate to protect an individual with blindness against wall-type and pole-type hazards. The paper concludes that the long-cane should reach from the floor to the user's armpit. (JDD)

  2. WAIS-R Performance Patterns of 565 Incarcerated Adults Characterized as Underachieving Readers and Adequate Readers.

    ERIC Educational Resources Information Center

    Kender, Joseph P.; And Others

    1985-01-01

    Prison inmates (N=565) classified as underachievers or adequate readers were administered the Wechsler Adult Intelligence Scale-Revised. Analysis of recategorized WAIS-R scores suggested that, as a group, the underachieving readers exhibited a pattern different from that of genetic dyslexic Ss and different from that of reading and learning…

  3. 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…

  4. 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…

  5. 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 Applications and Abbreviated Applications §...

  6. 75 FR 69648 - Safety Analysis Requirements for Defining Adequate Protection for the Public and the Workers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-15

    ... Secretary of Energy requesting an amendment to the Department of Energy's nuclear safety rule, 10 CFR part... TO THE SECRETARY OF ENERGY Safety Analysis Requirements for Defining Adequate Protection for the Public and the Workers Pursuant to 42 U.S.C. Sec. 2286a(a)(5) Atomic Energy Act of 1954, As Amended...

  7. 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 ...

  8. 12 CFR 702.303 - Prompt corrective action for “adequately capitalized” new credit unions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... capitalizedâ new credit unions. 702.303 Section 702.303 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS PROMPT CORRECTIVE ACTION Alternative Prompt Corrective Action for New Credit Unions § 702.303 Prompt corrective action for “adequately capitalized” new credit...

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

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... capitalizedâ credit unions. 702.201 Section 702.201 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS PROMPT CORRECTIVE ACTION Mandatory and Discretionary Supervisory Actions § 702.201 Prompt corrective action for “adequately capitalized” credit unions. (a) Earnings...

  10. 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…

  11. 75 FR 74022 - Safety Analysis Requirements for Defining Adequate Protection for the Public and the Workers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-30

    ... November 15, 2010 (75 FR 69648). The corrected text of the recommendation approved by the Board is below... or telephone number (202) 694-7000. Correction: In the Federal Register of November 15, 2010 (75 FR... SAFETY BOARD Safety Analysis Requirements for Defining Adequate Protection for the Public and the...

  12. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... financial records, statistical data, and cost finding. (a) Maintenance of records. (1) An HMO or CMP must... on its financial and statistical records, that can be verified by qualified auditors. (2) The cost... 42 Public Health 3 2010-10-01 2010-10-01 false Adequate financial records, statistical data,...

  13. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... financial records, statistical data, and cost finding. (a) Maintenance of records. (1) An HMO or CMP must... on its financial and statistical records, that can be verified by qualified auditors. (2) The cost... 42 Public Health 3 2011-10-01 2011-10-01 false Adequate financial records, statistical data,...

  14. 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…

  15. 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.

  16. Special or Not so Special: Special Education Background Experiences of Principals and Adequate Yearly Progress

    ERIC Educational Resources Information Center

    Wilcox, Jennifer E.

    2011-01-01

    This mixed-methods study researched the special education background experience of principals and the effect on students in the subgroup of Students with Disabilities in making Adequate Yearly Progress (AYP). In the state of Ohio, schools and districts are expected to make AYP as a whole and additionally make AYP for each subgroup (various…

  17. ARE RADON GAS MEASUREMENTS ADEQUATE FOR EPIDEMIOLOGICAL STUDIES AND CASE CONTROL

    E-print Network

    Yu, Peter K.N.

    ARE RADON GAS MEASUREMENTS ADEQUATE FOR EPIDEMIOLOGICAL STUDIES AND CASE CONTROL STUDIES OF RADON 2004 The lung dose derived from radon is not attributed to the radon gas itself, but instead to its of the radon risk, the excess number of cancers are related to the radon gas exposure, and not to the radon

  18. 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…

  19. The GUIDO Notation Format A Novel Approach for Adequately Representing Score-Level Music

    E-print Network

    Hoos, Holger H.

    , music databases, and music on the WWW. Introduction and Background The GUIDO Music Notation Format1, plain-text and human-readable way. The GUIDO design concentrates on general musical concepts as opposedThe GUIDO Notation Format A Novel Approach for Adequately Representing Score-Level Music Holger H

  20. The GUIDO Notation Format A Novel Approach for Adequately Representing ScoreLevel Music

    E-print Network

    Hoos, Holger H.

    systems and tools, music databases, and music on the WWW. Introduction and Background The GUIDO Music in a platform independent, plain­text and human­readable way. The GUIDO design concentrates on general musicalThe GUIDO Notation Format A Novel Approach for Adequately Representing Score­Level Music Holger H

  1. 40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 24 2014-07-01 2014-07-01 false Exemptions for pesticides adequately regulated by another Federal agency. 152.20 Section 152.20 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION...

  2. 40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 24 2011-07-01 2011-07-01 false Exemptions for pesticides adequately regulated by another Federal agency. 152.20 Section 152.20 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION...

  3. 40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 25 2012-07-01 2012-07-01 false Exemptions for pesticides adequately regulated by another Federal agency. 152.20 Section 152.20 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION...

  4. 40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 25 2013-07-01 2013-07-01 false Exemptions for pesticides adequately regulated by another Federal agency. 152.20 Section 152.20 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION...

  5. Towards A More Physically Adequate Definition of Randomness: A Topological Approach

    E-print Network

    Kreinovich, Vladik

    Towards A More Physically Adequate Definition of Randomness: A Topological Approach Vladik definition is too general: e.g., it includes some clearly non­physical situations when the set of all random Kreinovich Department of Computer Science, University of Texas at El Paso El Paso, TX 79968, USA, vladik

  6. Towards A More Physically Adequate Definition of Randomness: A Topological Approach

    E-print Network

    Kreinovich, Vladik

    Towards A More Physically Adequate Definition of Randomness: A Topological Approach Vladik definition is too general: e.g., it includes some clearly non-physical situations when the set of all random Kreinovich Department of Computer Science, University of Texas at El Paso El Paso, TX 79968, USA, vladik

  7. 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...

  8. Adequate Motion Simulation and Collision Detection for Soccer Playing Humanoid Robots

    E-print Network

    Stryk, Oskar von

    Adequate Motion Simulation and Collision Detection for Soccer Playing Humanoid Robots Martin Friedmann, Karen Petersen, Oskar von Stryk Simulation, Systems Optimization and Robotics Group Technische.tu-darmstadt.de Abstract-- In this paper a humanoid robot simulator built with the Multi-Robot-Simulation-Framework (Mu

  9. Adequate Reconstruction of Transparent Objects on a Shoestring Budget Sai-Kit Yeung 1,2

    E-print Network

    Ferguson, Thomas S.

    -preserving exterior surface representation is adequate for vision and robotics applications where transparent ob- jects are to be grabbed by a robotic arm, or avoided by a navigating robot in a cluttered scene. In our The working principle of our system is: given de

  10. 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...

  11. Adequate Numerical Solution of Air Pollution Problems by positive Di#erence Schemes on

    E-print Network

    Ehrhardt, Matthias

    Adequate Numerical Solution of Air Pollution Problems by positive Di#erence Schemes on unbounded In this work we deal with the numerical solution of some problems of air pollution. Since the problems) pollution. The e#ciency and accuracy of our method is illustrated by an example. Key words: air pollution

  12. Adequate Numerical Solution of Air Pollution Problems by positive Difference Schemes on

    E-print Network

    Ehrhardt, Matthias

    Adequate Numerical Solution of Air Pollution Problems by positive Difference Schemes on unbounded In this work we deal with the numerical solution of some problems of air pollution. Since the problems) pollution. The efficiency and accuracy of our method is illustrated by an example. Key words: air pollution

  13. Immediate prosthetic breast reconstruction: the ensured subpectoral pocket (ESP).

    PubMed

    Loustau, Hugo D; Mayer, Horacio F; Sarrabayrouse, Manuel

    2007-01-01

    Implant exposure due to cutaneous necrosis is one of the most feared complications of mastectomy with immediate prosthetic reconstruction. A key issue is to ensure good blood supply to the skin and complete integrity of the submuscular pocket. The latter is created with the pectoralis major and supplemented with the serratus anterior, the rectus abdominis sheat, the obliquus mayor and the pectoralis minor. The main drawback is that those muscles, when sutured to create a complete pocket, only allow the setting of small-sized implants. The authors present the application of polyglycolic mesh in an original fashion, mimicking the anatomy of the muscles usually employed in pocket creation. The proposed technique has been denominated Ensured Subpectoral Pocket and has proved to be a valid strategy in immediate single stage prosthetic breast reconstruction. It allows the setting of bigger implants without previous tissue expansion while preventing implant displacement. In addition, it reduces emotional trauma on patients and lowers surgical costs. PMID:17889630

  14. Strategies for ensuring quality data from Indian investigational sites

    PubMed Central

    Hajos, Antal K.; Kamble, Sujal K.

    2011-01-01

    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

  15. A manufacturer's approach to ensure long term structural integrity

    NASA Technical Reports Server (NTRS)

    Ansell, Hans; Fredriksson, Billy; Holm, Ingvar

    1992-01-01

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

  16. Problems and conception of ensuring radiation safety during Mars missions.

    PubMed

    Petrov, V M

    2004-01-01

    The Mars mission differs from near-Earth manned space flights by radiation environment and duration. The importance of effective using the weight of the spacecraft increases greatly because all the necessary things for the mission must be included in its starting weight. For this reason the development of optimal systems of radiation safety ensuring (RSES) acquires especial importance. It is the result of sharp change of radiation environment in the interplanetary space as compared to the one in the near-Earth orbits and significant increase of the interplanetary flight duration. The demand of a harder limitation of unfavorable factors effects should lead to radiation safety (RS) standards hardening. The main principles of ensuring the RS of the Mars mission (optimizing, radiation risk, ALARA) and the conception of RSES, developed on the basis of the described approach and the experience obtained during orbital flights are presented in the report. The problems that can impede the ensuring of the crew members' RS are also given here. PMID:15881790

  17. 36 CFR 79.9 - Standards to determine when a repository possesses the capability to provide adequate long-term...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... repository possesses the capability to provide adequate long-term curatorial services. 79.9 Section 79.9... possesses the capability to provide adequate long-term curatorial services. The Federal Agency Official shall determine that a repository has the capability to provide adequate long-term curatorial...

  18. 36 CFR 79.9 - Standards to determine when a repository possesses the capability to provide adequate long-term...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... repository possesses the capability to provide adequate long-term curatorial services. 79.9 Section 79.9... possesses the capability to provide adequate long-term curatorial services. The Federal Agency Official shall determine that a repository has the capability to provide adequate long-term curatorial...

  19. What is palliative care?

    MedlinePLUS

    Comfort care; End of life - palliative care; Hospice - palliative care ... Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis, and at the same time as treatment. Hospice care begins ...

  20. 75 FR 15597 - Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-29

    ...Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection...Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection...ensure that Federal funds are not used for abortion services (except in cases of rape...

  1. 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

    ...Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection...Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection...ensure that Federal funds are not used for abortion services (except in cases of...

  2. 75 FR 8272 - Defense Federal Acquisition Regulation Supplement; Acquisition Strategies To Ensure Competition...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-24

    ...Supplement; Acquisition Strategies To Ensure Competition Throughout the Life Cycle of Major Defense...202, Acquisition Strategies to Ensure Competition throughout the Lifecycle of Major Defense...includes: (1) Measures to ensure competition at both the prime contract and...

  3. 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

  4. Reporting Animal Mistreatment or Animal Protocol Noncompliance The IACUC is responsible for ensuring that all animals used in research and teaching programs

    E-print Network

    Jiang, Jiancheng

    Reporting Animal Mistreatment or Animal Protocol Noncompliance The IACUC is responsible for ensuring that all animals used in research and teaching programs are treated in accordance with the Federal Animal Welfare Act, the PHS "Policy on Humane Care and Use of Laboratory Animals", the NIH, the National

  5. End-of-life care issues in advanced dementia

    PubMed Central

    2013-01-01

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

  6. 9 CFR 3.17 - Care in transit.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...Care, Treatment, and Transportation of Dogs and Cats 1 Transportation Standards...Animal Welfare regulations transporting dogs or cats in commerce must ensure that...accompanying the operator, observes the dogs or cats as often as...

  7. 9 CFR 3.17 - Care in transit.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...Care, Treatment, and Transportation of Dogs and Cats 1 Transportation Standards...Animal Welfare regulations transporting dogs or cats in commerce must ensure that...accompanying the operator, observes the dogs or cats as often as...

  8. 9 CFR 3.17 - Care in transit.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...Care, Treatment, and Transportation of Dogs and Cats 1 Transportation Standards...Animal Welfare regulations transporting dogs or cats in commerce must ensure that...accompanying the operator, observes the dogs or cats as often as...

  9. 9 CFR 3.17 - Care in transit.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...Care, Treatment, and Transportation of Dogs and Cats 1 Transportation Standards...Animal Welfare regulations transporting dogs or cats in commerce must ensure that...accompanying the operator, observes the dogs or cats as often as...

  10. 9 CFR 3.17 - Care in transit.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...Care, Treatment, and Transportation of Dogs and Cats 1 Transportation Standards...Animal Welfare regulations transporting dogs or cats in commerce must ensure that...accompanying the operator, observes the dogs or cats as often as...

  11. 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

  12. Maintenance of the adequate function is a general principle of survival of organisms.

    PubMed

    Yabrov, A

    1979-05-01

    A general theory which describes the existence of live organisms is introduced; this theory is the Principle of Adequate Function and it describes all the situations in which live organisms may exist, whether healthy or sick at both physiological and pathological conditions. In biology, so far, the existence of living organisms under physiological conditions is described by homeostasis, and under pathological conditions specific immunity is used. As it is shown below, adaptation and non-specific resistance provide a much broader basis of how living organisms exist under both physiological and pathological conditions. This general theory does not interfere with the notions of homeostasis, adaptation, and specific immunity but includes them as particular cases. It is proposed that the principle of adequate function supplements the description of life processes by the evolutionary principle; it describes the laws of existence and function of a particular individual. PMID:548708

  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 µg/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 µg/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 µg/kg (95% confidence intervals [CI] 0.14-0.44) and 0.86 µg/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 µg/kg. However, dose higher than 0.5 µg/kg can lead to hemodynamic instability. PMID:26634081

  14. Child Care Assistance Spending and Participation in 2012: A Record Low

    ERIC Educational Resources Information Center

    Matthews, Hannah; Schmit, Stephanie

    2014-01-01

    Child care subsidies help make quality child care affordable for low-income parents, allowing them to attend work or school to support their families while ensuring their children's healthy development. Access to quality child care is also proven to strengthen families' economic security. The Child Care and Development Block Grant (CCDBG) is the…

  15. Child Care and Development Block Grant (CCDBG) Participation Continues to Fall

    ERIC Educational Resources Information Center

    Matthews, Hannah; Schmit, Stephanie

    2014-01-01

    Child care subsidies help make quality child care affordable for low-income parents, allowing them to attend work or school to support their families while ensuring their children's healthy development. The Child Care and Development Block Grant (CCDBG) is the primary source of federal funding for child care subsidies for low-income working…

  16. Investing in Quality Child Care: A Report for AT&T.

    ERIC Educational Resources Information Center

    Galinsky, Ellen; Friedman, Dana E.

    More than 50 child care experts were asked (1) What aspects of child care are most likely to ensure high quality? (2) What are the current barriers to achieving quality in child care? and (3) What corporate or labor initiative would make the greatest difference in improving the quality of child care services? Recommendations generated from the…

  17. 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.

  18. 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 Wirén, 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

  19. Child Care Options MSU Child Development Center

    E-print Network

    Maxwell, Bruce D.

    ! The Family Care Room in Hamilton Hall is a dedicated space for breastfeeding women on campus and includes supports and encourages the practice of breastfeeding, accommodates breastfeeding needs of employees, and provides adequate facilities for breastfeeding or the expres- sion of milk. For procedural information

  20. 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…

  1. Health care policies for children in out-of-home care.

    PubMed

    Risley-Curtiss, C; Kronenfeld, J J

    2001-01-01

    Placement in out-of-home care is one intervention used to protect children from abuse and neglect. While children are in such care, it is the child welfare agency's responsibility to ensure that their health needs are met. The study reported here examined health care policies and services for children in 46 state child welfare agencies. Virtually all states had some sort of written policies regarding health care for children in out-of-home care. Half, however, reported having no information management system to record health care data, and only six of the 23 had computerized systems. Most states fell short of meeting the standards set by the Child Welfare League of America for the health care of children in out-of-home care. PMID:11380045

  2. 'Trust but verify' - five approaches to ensure safe medical apps.

    PubMed

    Wicks, Paul; Chiauzzi, Emil

    2015-01-01

    Mobile health apps are health and wellness programs available on mobile devices such as smartphones or tablets. In three systematic assessments published in BMC Medicine, Huckvale and colleagues demonstrate that widely available health apps meant to help patients calculate their appropriate insulin dosage, educate themselves about asthma, or perform other important functions are methodologically weak. Insulin dose calculators lacked user input validation and made inappropriate dose recommendations, with a lack of documentation throughout. Since 2011, asthma apps have become more interactive, but have not improved in quality; peak flow calculators have the same issues as the insulin calculators. A review of the accredited National Health Service Health Apps Library found poor and inconsistent implementation of privacy and security, with 28 % of apps lacking a privacy policy and one even transmitting personally identifying data the policy claimed would be anonymous. Ensuring patient safety might require a new approach, whether that be a consumer education program at one extreme or government regulation at the other. App store owners could ensure transparency of algorithms (whiteboxing), data sharing, and data quality. While a proper balance must be struck between innovation and caution, patient safety must be paramount.Please see related articles: http://dx.doi.org/10.1186/s12916-015-0444-y , http://www.biomedcentral.com/1741-7015/13/106 and http://www.biomedcentral.com/1741-7015/13/58. PMID:26404791

  3. Performance of new alternative providers of primary care services in England: an observational study

    PubMed Central

    Greaves, Felix; Laverty, Anthony A; Pape, Utz; Ratneswaren, Anenta; Majeed, Azeem

    2015-01-01

    Summary Objectives Health system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants – including private companies – have been allowed into the primary care market under ‘alternative provider of medical services’ contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice. Design Open cohort study of English general practices. We used linear regression in cross-sectional and time series analyses, adjusting for practice and population characteristics, to compare quality in practices using alternative provider contracts to traditional practices. We created regression models using practice fixed effects to estimate the impact of practices changing to the new contract type. Setting The English National Health Service. Participants All general practices open from 2008/2009 to 2012/2013. Main outcome measures Seventeen established quality indicators – covering clinical effectiveness, efficiency, access and patient experience. Results In total, 4.1% (347 of 8300) of general practices in England were run by alternative contract providers. These practices tended to be smaller, and serve younger, more diverse and more deprived populations than traditional providers. Practices run by alternative providers performed worse than traditional providers on 15 of 17 indicators after adjusting for practice and population characteristics (p?care services in England has not led to improvements in quality and may have resulted in worse care. Regulators should ensure that new entrants to clinical provider markets are performing to adequate standards and at least as well as traditional providers. PMID:25908312

  4. Assessing the Extent of Adherence to the Recommended Antenatal Care Content in Malaysia: Room for Improvement

    PubMed Central

    Yeoh, Ping Ling; Hornetz, Klaus; Ahmad Shauki, Nor Izzah; Dahlui, Maznah

    2015-01-01

    Background Recent papers on monitoring of health services affirmed that while antenatal care (ANC) is an effective measure, quality is still a problem. Quality in maternal services “…involves providing a minimum level of care to all pregnant women…” Yet adherence to a minimum level of recommended ANC content appears to be unmet. Comprehensive review of ANC content rendered in environments with rapid changes in demographic, socio-economic, lifestyle and morbidity was sparse. Malaysia is such a country that has undergone these transitions with tremendous progress in health. However, recent progress in pregnancy outcomes is stagnating. This study aims to analyse adherence to recommended ANC; specifically, to examine the extent of adherence to recommended ANC content and to determine the factors influencing ANC content score. Methods A retrospective cohort study of 522 randomly selected women who used ANC was conducted. Data were extracted from individual records. The study examined adherence to essential ANC guidelines using weighted scoring for physical examination, health screening, case management, and health education. GLM Univariate analysis procedure was used to determine the factors associated with ANC content score. Binary logistic regression was used to assess ANC content level and pregnancy outcomes, controlled for ANC utilisation. Results Around half of the women had <80% of recommended ANC content documented. Health education had the lowest mean score, at around 35%. The low-risk pregnancies had a higher ANC content score than the high-risk pregnancies (78% vs. 75%; P = 0.002). The smallest clinics had a higher ANC content score than the bigger clinics (78% vs. 74–76%; P<0.001). ANC content score among the women with “adequate” ANC utilisation, as defined by the modified Adequacy of Prenatal Care Utilisation Index, was lower than the women with “adequate-plus” ANC utilisation (75% vs. 78%, P<0.001). Assessment of symphysis-fundal height, foetal presentation and foetal heart auscultation were initiated earlier than recommended. Inadequate ANC content was associated with higher prevalence of preterm birth. Conclusions Our findings indicate the presence of issues related to delivery of recommended ANC content. We advocate for all pregnant women to be ensured of adherence to the recommended ANC content. We also recommend monitoring the delivery of health advice. Conforming to recommended timing of initiation for ANC practices is essential due to resource implication and possible implication on maternal wellbeing. The association of inadequate ANC content and preterm birth may be due to lesser opportunities to receive some of the care because of lower number of ANC visits among preterm birth; this may also indicate the importance of having adequate ANC content. PMID:26270471

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

    PubMed Central

    2012-01-01

    Background Contact lens-related infections are often associated with inadequate contact lens hygiene, and therefore, contact lens care products should be able to sufficiently minimise the amount of pathogens that are responsible for these infections. In 2001, the EN ISO 14729 was introduced to ensure adequate disinfection efficacy of contact lens care solutions, but this norm has recently been criticised. Methods In this study, six frequently used contact lens care solutions were retested according to the Stand Alone Test of the EN ISO 14729 (2001). The Stand Alone Test is a quantitative suspension test. In addition, the products were tested in a modified setting adding an organic load. The load was a mixture of human blood serum, lysozyme, and mucine, which resembles tear fluid. Results The criteria of the Stand Alone Test recommended in EN ISO 14729 were only met by Aosept Plus. This 3% hydrogen-peroxide-based contact lens care solution attained a reduction factor of > 5 log units for bacteria and > 4 for fungi in all cases. Two further contact lens care solutions, Blue Vision and Optifree Replenish, met the criteria of a reduction factor of > 3 log units for bacteria and > 1 log unit for fungi, but only in the presence of artificial tear fluid. The three remaining products did not exhibit adequate disinfecting efficacy, at least against one of the tested microorganisms. Conclusions Through the observation that the artificial tear fluid used in this study influences the disinfecting efficacy of contact lens care solutions, especially that of multi-purpose solutions, in a different way than does albumin, mucine, or even the organic load suggested in EN ISO 14729, it becomes obvious that the test conditions in the EN ISO 14729 should be revised in order to create more realistic conditions, e.g., by using a more realistic artificial tear fluid. Furthermore, we suggest adapting the EN ISO 14729 to the European test hierarchy for chemical disinfectants and antiseptics, which consists of three test phases and also requests meeting stricter criteria in order to pass the test. Unless the test conditions guarantee a sufficient reduction of potential pathogens, the risk of contact lens-related microbial keratitis and other infections will remain for the users. PMID:23033880

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

    NASA Astrophysics Data System (ADS)

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

    2012-12-01

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

  7. Day Care.

    ERIC Educational Resources Information Center

    Merro, John; And Others

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

  8. Retention in mental health care of Portuguese-speaking patients

    PubMed Central

    Gonçalves, Marta; Cook, Benjamin; Mulvaney-Day, Norah; Alegría, Margarita; Kinrys, Gustavo

    2013-01-01

    We compared service outcomes of dedicated language and cultural competency services in adequacy of care, ER, and inpatient care among Portuguese-speaking patients in ethnic- and non-ethnic-specific behavioral health clinics. We assessed adequacy of mental health care, and use of inpatient emergency department among Portuguese-speaking patients, comparing individuals receiving care from a culturally and linguistically competent mental health care setting (the Portuguese Mental Health Program [PMHP]) with usual mental health care in a community health care system in the USA. Propensity score matching was used to balance patients in treatment and control groups on gender, marital status, age, diagnosis of mental disorder, and insurance status. We used de-identified, longitudinal, administrative data of 854 Portuguese-speaking patients receiving care from the PMHP and 541 Portuguese-speaking patients receiving usual care from 2005–2008. Adequate treatment was defined as receipt of at least eight outpatient psychotherapy visits, or at least four outpatient visits of which one was a psychopharmacological visit. PMHP patients were more likely to receive adequate care. No differences were found in rates of ER use or inpatient mental health care. The present study suggests increased quality of care for patients that have contact with a clinic that dedicates resources specifically to a minority/immigrant group. Advantages of this setting include greater linguistic and cultural concordance among providers and patients. Further research is warranted to better understand the mechanisms by which culturally appropriate mental health care settings benefit minority/immigrant patients. PMID:23427258

  9. Universal health care in India: Panacea for whom?

    PubMed

    Qadeer, Imrana

    2013-01-01

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

  10. Organization theory. Analyzing health care organizations.

    PubMed

    Cors, W K

    1997-02-01

    Organization theory (OT) is a tool that can be applied to analyze and understand health care organizations. Transaction cost theory is used to explain, in a unifying fashion, the myriad changes being undertaken by different groups of constituencies in health care. Agency theory is applied to aligning economic incentives needed to ensure Integrated Delivery System (IDS) success. By using tools such as OT, a clearer understanding of organizational changes is possible. PMID:10164970

  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

    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

  13. 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

  14. 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

  15. 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

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

    PubMed

    Glazowski, Christopher; Rajadhyaksha, Milind

    2012-08-01

    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

  17. 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

  18. A Systematic Review of Clinician and Staff Views on the Acceptability of Incorporating Remote Monitoring Technology into Primary Care

    PubMed Central

    Freeman, Michele; Kaye, Jeffrey; Vuckovic, Nancy; Buckley, David I.

    2014-01-01

    Abstract Objective: Remote monitoring technology (RMT) may enhance healthcare quality and reduce costs. RMT adoption depends on perceptions of the end-user (e.g., patients, caregivers, healthcare providers). We conducted a systematic review exploring the acceptability and feasibility of RMT use in routine adult patient care, from the perspectives of primary care clinicians, administrators, and clinic staff. Materials and Methods: We searched the databases of Medline, IEEE Xplore, and Compendex for original articles published from January 1996 through February 2013. We manually screened bibliographies of pertinent studies and consulted experts to identify English-language studies meeting our inclusion criteria. Results: Of 939 citations identified, 15 studies reported in 16 publications met inclusion criteria. Studies were heterogeneous by country, type of RMT used, patient and provider characteristics, and method of implementation and evaluation. Clinicians, staff, and administrators generally held positive views about RMTs. Concerns emerged regarding clinical relevance of RMT data, changing clinical roles and patterns of care (e.g., reduced quality of care from fewer patient visits, overtreatment), insufficient staffing or time to monitor and discuss RMT data, data incompatibility with a clinic's electronic health record (EHR), and unclear legal liability regarding response protocols. Conclusions: This small body of heterogeneous literature suggests that for RMTs to be adopted in primary care, researchers and developers must ensure clinical relevance, support adequate infrastructure, streamline data transmission into EHR systems, attend to changing care patterns and professional roles, and clarify response protocols. There is a critical need to engage end-users in the development and implementation of RMT. PMID:24731239

  19. Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability-An Emerging Framework.

    PubMed

    Holve, Erin

    2013-01-01

    Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four "pillars" of sustainability are discussed based on the experiences of EDM Forum grantees and other research and QI networks. These include trust and value, governance, management, and financial and administrative support. Two "foundational considerations," adaptive capacity and policy levers, are also discussed. PMID:25848557

  20. Integral resource capacity planning for inpatient care services based on hourly bed census predictions

    E-print Network

    Boucherie, Richard J.

    to assist hospital management in adequately organizing their inpatient care services. Effectively designing.kortbeek@utwente.nl Abstract The design and operations of inpatient care facilities are typically largely historically shaped on hospital budgets. Effectively organizing inpatient care requires simultaneous consideration of several

  1. Child Care and Employed Parents of Children with Emotional or Behavioral Disorders

    ERIC Educational Resources Information Center

    Rosenzweig, Julie M.; Brennan, Eileen M.; Huffstutter, Katherine; Bradley, Jennifer R.

    2008-01-01

    Lack of appropriate child care is frequently reported by parents of children with disabilities as a major obstacle to finding and maintaining their employment. Care for children with emotional or behavioral disorders is particularly difficult to locate because child care providers often lack adequate training. Findings are presented from…

  2. Hospice Care

    MedlinePLUS

    ... a special program of care for terminally ill (dying) patients and their families. Rather than trying to ... to provide the best quality of life for dying patients by providing a holistic approach. That means ...

  3. Home Care

    MedlinePLUS

    ... social workers, personal care aides, home medical equipment suppliers, and most importantly, informal caregivers (eg, family members). ... medications that may get in the way of management or treatment of the disease. House calls also ...

  4. Delivering best care in war and peace.

    PubMed

    Moore, Alison

    2014-06-24

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

  5. Caring Encounters

    ERIC Educational Resources Information Center

    Gunn, Alyson

    2012-01-01

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

  6. 21 CFR 1.283 - What happens to food that is imported or offered for import without adequate prior notice?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...2012-04-01 false What happens to food that is imported or offered for import without adequate... § 1.283 What happens to food that is imported or offered for import without adequate... (a) For each article of food that is imported or offered for import into...

  7. 21 CFR 1.283 - What happens to food that is imported or offered for import without adequate prior notice?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...2013-04-01 false What happens to food that is imported or offered for import without adequate... § 1.283 What happens to food that is imported or offered for import without adequate... (a) For each article of food that is imported or offered for import into...

  8. 21 CFR 1.283 - What happens to food that is imported or offered for import without adequate prior notice?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...2014-04-01 false What happens to food that is imported or offered for import without adequate... § 1.283 What happens to food that is imported or offered for import without adequate... (a) For each article of food that is imported or offered for import into...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 40 CFR 141.522 - How does the State determine whether my system's watershed control requirements are adequate?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... my system's watershed control requirements are adequate? 141.522 Section 141.522 Protection of... Additional Watershed Control Requirements for Unfiltered Systems § 141.522 How does the State determine whether my system's watershed control requirements are adequate? During an onsite inspection...

  15. 40 CFR 141.522 - How does the State determine whether my system's watershed control requirements are adequate?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... my system's watershed control requirements are adequate? 141.522 Section 141.522 Protection of... Additional Watershed Control Requirements for Unfiltered Systems § 141.522 How does the State determine whether my system's watershed control requirements are adequate? During an onsite inspection...

  16. 40 CFR 141.522 - How does the State determine whether my system's watershed control requirements are adequate?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... my system's watershed control requirements are adequate? 141.522 Section 141.522 Protection of... Additional Watershed Control Requirements for Unfiltered Systems § 141.522 How does the State determine whether my system's watershed control requirements are adequate? During an onsite inspection...

  17. 40 CFR 141.522 - How does the State determine whether my system's watershed control requirements are adequate?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... my system's watershed control requirements are adequate? 141.522 Section 141.522 Protection of... Additional Watershed Control Requirements for Unfiltered Systems § 141.522 How does the State determine whether my system's watershed control requirements are adequate? During an onsite inspection...

  18. 40 CFR 141.522 - How does the State determine whether my system's watershed control requirements are adequate?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... my system's watershed control requirements are adequate? 141.522 Section 141.522 Protection of... Additional Watershed Control Requirements for Unfiltered Systems § 141.522 How does the State determine whether my system's watershed control requirements are adequate? During an onsite inspection...

  19. 48 CFR 52.216-29 - Time-and-Materials/Labor-Hour Proposal Requirements-Non-Commercial Item Acquisition With Adequate...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...Item Acquisition With Adequate Price Competition. 52.216-29 Section 52.216-29...Item Acquisition With Adequate Price Competition. As prescribed in 16.601(e...Item Acquisition With Adequate Price Competition (FEB 2007) (a) The...

  20. 48 CFR 52.216-29 - Time-and-Materials/Labor-Hour Proposal Requirements-Non-Commercial Item Acquisition With Adequate...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...Item Acquisition With Adequate Price Competition. 52.216-29 Section 52.216-29...Item Acquisition With Adequate Price Competition. As prescribed in 16.601(f...Item Acquisition With Adequate Price Competition (FEB 2007) (a) The...

  1. Medical Care: "Say Ahh!". Health and the Consumer.

    ERIC Educational Resources Information Center

    Florida State Dept. of Education, Tallahassee. Div. of Elementary and Secondary Education.

    Secondary level students learn about medical care in this learning activity package, which is one in a series. The developers believe that consumer education in the health field would ensure better patient care and help eliminate incompetent medical practices and practitioners. The learning package includes instructions for the teacher,…

  2. UNIVERSITY ANIMAL CARE COMMITTEE UACC Approved: November 2012

    E-print Network

    Fletcher, Robin

    UNIVERSITY ANIMAL CARE COMMITTEE UACC Approved: November 2012 Policy on Pedagogical Merit of Teaching Protocols It is the responsibility of the University Animal Care Committee (UACC) to ensure that no teaching program (including field studies) involving vertebrate animals be commenced and that no animals

  3. UNIVERSITY OF CONNECICUT HEALTH CENTER CORRECTIONAL MANAGED HEALTH CARE

    E-print Network

    Oliver, Douglas L.

    UNIVERSITY OF CONNECICUT HEALTH CENTER CORRECTIONAL MANAGED HEALTH CARE POLICY AND PROCEDURES Managed Health Care (CMHC) shall ensure that newly admitted inmates to Connecticut Department FOR USE WITHIN THE CONNECTICUT DEPARTMENT OF CORRECTION NUMBER: E 1.01 Page 1 of 2 INFORMATION ON HEALTH

  4. Caregivers' Level of Trust in Their Children's Health Care Providers

    ERIC Educational Resources Information Center

    Chen, Huey Jen; Boothroyd, Roger A.

    2006-01-01

    Trust in healthcare providers is associated with clinical outcomes among adult patients. Children with disabilities have complex health needs that place stress on caregivers. Consequently, they are increasingly likely to rely on their children's health care providers to ensure children's health care needs are met. However, no studies have explored…

  5. Transportation barriers to health care: assessing the Texas Medicaid program 

    E-print Network

    Borders, Stephen Boyce

    2007-09-17

    immunizations; • Health education; • Vision screening; • Hearing screening; • Dental screening, follow up care and some orthodontics; and • Referrals to other health care providers (16). The THSteps program ensures that the children of Texas have... states must assure access to covered Medicaid services. Medicaid recipients are entitled to NEMT, and both the states and 19 federal government must pay for those transportation services. Federal regulations...

  6. Pediatric advance care planning from the perspective of health care professionals: A qualitative interview study

    PubMed Central

    Jox, Ralf J; Borasio, Gian Domenico; Führer, Monika

    2015-01-01

    Background: Pediatric advance care planning differs from the adult setting in several aspects, including patients’ diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals’ perspective. Aim: We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. Design: This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. Setting/participants: We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. Results: Perceived problems with pediatric advance care planning relate to professionals’ discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor’s advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. Conclusion: Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers. PMID:25389347

  7. [Shared care in BPH. First national experience].

    PubMed

    Padilla León, M; Marchal Escalona, C; Caballero Alcántara, J; Padilla León, F; Lucas de Vega, I M

    1998-06-01

    The high prevalence of Benign Prostate Hyperplasia and the increased demand for care of this condition, should compel us to plan for shared care models in parallel to Primary Care, in the way it has happened with entities such as HBP and Diabetes. The set of measurements to be adopted when sharing services with primary care is known as "shared care". This paper presents the first national experience of "shared care" with primary care in BPH. The project has consisted in a series of steps to increase awareness, train and make available for family physicians, a clinical practice guide defining the criteria for initial evaluation, medical treatment and referral of patients to Urology surgeries, including with the referral document the appropriate diagnostic tests. A Quality Commission has been created to study the level of compliance of the documentation used for referral to the specialist and the clinical histories of patients treated in primary care. The results obtained are significant and most studies carried out fulfill the requirements in 60% cases, which has allowed to reduce overcrowding in the Urology outpatient offices (4200 surgery visits saved/year in our environment), has provided easy access of patients to adequate diagnosis and treatment, as well as significant financial savings (30 million pesetas/year). In short "shared care" is a reality in our environment that allows a more effective, fast medical assistance and improved access to specialist care by reducing the demand of specialized surgery hours. PMID:9734123

  8. Robust mitotic entry is ensured by a latching switch

    PubMed Central

    Tuck, Chloe; Zhang, Tongli; Potapova, Tamara; Malumbres, Marcos; Novák, Béla

    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

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

    PubMed

    Ribeiro, Luís S; Viana-Ferreira, Carlos; Oliveira, José Luís; 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

  10. General Practitioner Supervisor assessment and teaching of Registrars consulting with Aboriginal patients – is cultural competence adequately considered?

    PubMed Central

    2014-01-01

    Background General Practitioner (GP) Supervisors have a key yet poorly defined role in promoting the cultural competence of GP Registrars who provide healthcare to Aboriginal and Torres Strait Islander people during their training placements. Given the markedly poorer health of Indigenous Australians, it is important that GP training and supervision of Registrars includes assessment and teaching which address the well documented barriers to accessing health care. Methods A simulated consultation between a GP Registrar and an Aboriginal patient, which illustrated inadequacies in communication and cultural awareness, was viewed by GP Supervisors and Medical Educators during two workshops in 2012. Participants documented teaching points arising from the consultation which they would prioritise in supervision provided to the Registrar. Content analysis was performed to determine the type and detail of the planned feedback. Field notes from workshop discussions and participant evaluations were used to gain insight into participant confidence in cross cultural supervision. Results Sixty four of 75 GPs who attended the workshops participated in the research. Although all documented plans for detailed teaching on the Registrar’s generic communication and consultation skills, only 72% referred to culture or to the patient’s Aboriginality. Few GPs (8%) documented a plan to advise on national health initiatives supporting access for Aboriginal and Torres Strait Islander people. A lack of Supervisor confidence in providing guidance on cross cultural consulting with Aboriginal patients was identified. Conclusions The role of GP Supervisors in promoting the cultural competence of GP Registrars consulting with Aboriginal and Torres Strait Islander patients could be strengthened. A sole focus on generic communication and consultation skills may lead to inadequate consideration of the health disparities faced by Indigenous peoples and of the need to ensure Registrars utilise health supports designed to decrease the disadvantage faced by vulnerable populations. PMID:25115609

  11. Collaborative drug therapy management: case studies of three community-based models of care.

    PubMed

    Snyder, Margie E; Earl, Tara R; Gilchrist, Siobhan; Greenberg, Michael; Heisler, Holly; Revels, Michelle; Matson-Koffman, Dyann

    2015-01-01

    Collaborative drug therapy management agreements are a strategy for expanding the role of pharmacists in team-based care with other providers. However, these agreements have not been widely implemented. This study describes the features of existing provider-pharmacist collaborative drug therapy management practices and identifies the facilitators and barriers to implementing such services in community settings. We conducted in-depth, qualitative interviews in 2012 in a federally qualified health center, an independent pharmacy, and a retail pharmacy chain. Facilitators included 1) ensuring pharmacists were adequately trained; 2) obtaining stakeholder (eg, physician) buy-in; and 3) leveraging academic partners. Barriers included 1) lack of pharmacist compensation; 2) hesitation among providers to trust pharmacists; 3) lack of time and resources; and 4) existing informal collaborations that resulted in reduced interest in formal agreements. The models described in this study could be used to strengthen clinical-community linkages through team-based care, particularly for chronic disease prevention and management. PMID:25811494

  12. 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.

  13. When one is not enough: prevalence and characteristics of homes not adequately protected by smoke alarms

    PubMed Central

    Peek-Asa, C; Allareddy, V; Yang, J; Taylor, C; Lundell, J; Zwerling, C

    2005-01-01

    Objective: The National Fire Protection Association (NFPA) has specific recommendations about the number, location, and type of smoke alarms that are needed to provide maximum protection for a household. No previous studies have examined whether or not homes are completely protected according to these guidelines. The authors describe the prevalence and home characteristics associated with compliance to recommendations for smoke alarm installation by the NFPA. Design, setting, and subjects: Data are from the baseline on-site survey of a randomized trial to measure smoke alarm effectiveness. The trial was housed in a longitudinal cohort study in a rural Iowa county. Of 1005 homes invited, 691 (68.8%) participated. Main outcome measures: Information about smoke alarm type, placement, and function, as well as home and occupant characteristics, was collected through an on-site household survey. Results: Although 86.0% of homes had at least one smoke alarm, only 22.3% of homes (approximately one in five) were adequately protected according to NFPA guidelines. Fourteen percent of homes had no functioning smoke alarms. More than half of the homes with smoke alarms did not have enough of them or had installed them incorrectly, and 42.4% of homes with alarms had at least one alarm that did not operate. Homes with at least one high school graduate were nearly four times more likely to be fully protected. Homes that had multiple levels, a basement, or were cluttered or poorly cleaned were significantly less likely to be fully protected. Conclusion: These findings indicate that consumers may not be knowledgeable about the number of alarms they need or how to properly install them. Occupants are also not adequately maintaining the alarms that are installed. PMID:16326772

  14. 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-1?) 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-1? 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.

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

    PubMed Central

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

    2009-01-01

    Background A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. Methods We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. Results We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). Conclusion Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening. PMID:19735562

  16. Home care by general practitioners for cancer patients in the last 3 months of life: An epidemiological study of quality and associated factors

    PubMed Central

    Pivodic, Lara; Harding, Richard; Calanzani, Natalia; McCrone, Paul; Hall, Sue; Deliens, Luc; Higginson, Irene J; Gomes, Barbara

    2016-01-01

    Background: Stronger generalist end-of-life care at home for people with cancer is called for but the quality of end-of-life care delivered by general practitioners has been questioned. Aim: To determine the degree of and factors associated with bereaved relatives’ satisfaction with home end-of-life care delivered by general practitioners to cancer patients. Design: Population-based mortality followback survey. Setting/participants: Bereaved relatives of people who died of cancer in London, United Kingdom (identified from death registrations in 2009–2010), were invited to complete a postal questionnaire surveying the deceased’s final 3?months of life. Results: Questionnaires were completed for 596 decedents of whom 548 spent at least 1?day at home in the last 3?months of life. Of the respondents, 55% (95% confidence interval: 51%–59%) reported excellent/very good home care by general practitioners, compared with 78% (95% confidence interval: 74%–82%) for specialist palliative care providers and 68% (95% confidence interval: 64%–73%) for district/community/private nurses. The odds of high satisfaction (excellent/very good) with end-of-life care by general practitioners doubled if general practitioners made three or more compared with one or no home visits in the patient’s last 3?months of life (adjusted odds ratio: 2.54 (95% confidence interval: 1.52–4.24)) and halved if the patient died at hospital rather than at home (adjusted odds ratio: 0.55 (95% confidence interval: 0.31–0.998)). Conclusion: There is considerable room for improvement in the satisfaction with home care provided by general practitioners to terminally ill cancer patients. Ensuring an adequate offer of home visits by general practitioners may help to achieve this goal. PMID:26036688

  17. Integrating Health Information Technology to Achieve Seamless Care Transitions.

    PubMed

    Marcotte, Leah; Kirtane, Janhavi; Lynn, Joanne; McKethan, Aaron

    2015-12-01

    Improving care transitions, or "handoffs" as patients migrate from one care setting to another, is a priority across stakeholder groups and health-care settings and additionally is included in national health-care goals set forth in the National Quality Strategy. Although many demonstrations of improved care transitions have succeeded, particularly for hospital discharges, ensuring consistent, high-quality, and safe transitions of care remains challenging. This paper highlights the potential for health information technology to become an increasing part of effective transitional care interventions, with the potential to reduce the resource burden currently associated with effective care transitions, the ability to spread improved practices to larger numbers of patients and providers efficiently and at scale, and, as health technology interoperability increases, the potential to facilitate critical information flow and feedback loops to clinicians, patients, and caregivers across disparate information systems and care settings. PMID:24522208

  18. Measuring patients' attitudes to care across the primary/secondary interface: the development of the patient career diary

    PubMed Central

    Baker, R.; Preston, C.; Cheater, F.; Hearnshaw, H.

    1999-01-01

    Background - A growing number of new ways of organising services across the primary/secondary interface are being introduced and evaluated. The principal motive for such reorganisation is to improve the efficiency of health care. However, unless the impact of the new services on patients is investigated and taken into account, it is possible that patients' reactions could be negative, a factor that could lead to unexpected consequences in the use and costs of services. Objective - To develop a measure of patients' attitudes towards care across the interface between primary and secondary care. Design - Generation of questions to be included in the measure from a qualitative study of patients' experiences of care across the interface; administration of pilot versions of the measure to samples of patients referred to secondary care; refinement of questions guided by analysis of response patterns, principal components analysis and internal consistency; administration of the final version of the patient career diary in complete form retrospectively to patients referred to secondary care, and one section alone to patients attending outpatient departments for follow up appointments. Face validity was assessed by analysis of open comments in a sample of 50 diaries, and review of the diary by 34 health professionals. Construct validity was assessed by investigation of levels of correlation between components of each section of the diary and the components of the healthcare section overall. Setting - In the final field test, patients were attending various hospital services, including cardiology, dermatology, neurology, gynaecology, general surgery, general medicine, ophthalmology, trauma and orthopaedics, and gastroenterology. Results - The final version of the diary included 109 questions in seven sections: general practitioner (GP) visits and referral, other GP visits, first outpatient visit, other outpatient visits, inpatient stay and discharge, care after discharge, and care overall. Response rates were poor for retrospective completion of the entire diary, but excellent when a section was given separately. Principal components analysis confirmed that components relating to issues identified as important to patients in the qualitative study had been included in the diary. Levels of internal consistency were good, and comments of patients and health professionals supported validity. Conclusion - The patient career diary is a valid and reliable measure of patients' attitudes to care across the interface. It should be given in sections to ensure adequate response rates, and is suitable for use in the evaluation or quality of patterns of care across the interface. In future, the impact on patients of new ways of organising services across the interface should be investigated by use of measures such as the patient career diary. PMID:10847871

  19. 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.

  20. 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

  1. 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

  2. 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

  3. Mechanism to ensure safety of fission system during launch

    NASA Astrophysics Data System (ADS)

    Godfroy, Thomas; Ring, Peter; Patton, Bruce; Houts, Mike; Pedersen, Kevin

    2001-02-01

    The potential for fission-based propulsion systems in opening the solar system to extensive exploration, development, and settlement has been recognized for decades. Work toward a first-generation flight demonstrator is underway at MSFC. Safety is one of the main concerns in the planning, development, and design of the system. The purpose of this research is to design, fabricate, and test a mechanism that will (1) enable complete separation of high reactivity worth nuclear fuel elements from the reactor core during launch and (2) enable reliable insertion of these elements into the core immediately prior to reactor startup. The mechanism will preclude any potential for inadvertent reactor startup during a launch accident. The mechanism thus represents one option for ensuring that the launch of space fission systems is fully safe. Early in the concept phase it became clear that there were many different ways to accomplish fuel separation followed by in-space insertion. The benefits of each method ultimately depended on the overall system (spacecraft or otherwise) design and the mission requirements or uses for the reactor. It became evident that since this information was not yet available the best solution would be to provide multiple designs and let the mission and spacecraft requirements dictate which design to use. With this in mind, two different in-space fueling methods were pursued with the available funding. The first method involves placing the nuclear fuel off axis and external to the fuel. The second method involves replacing some of the fuel with a neutron absorber until the reactor is ready to be fueled. Each method has its benefits and constraints that should be balanced with system and mission requirements. .

  4. Dementia - home care

    MedlinePLUS

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

  5. Advance Care Planning

    MedlinePLUS

    ... raquo Advance Care Planning Heath and Aging Advance Care Planning What Is Advance Care Planning? Decisions That ... burden off family and friends. What Is Advance Care Planning? Advance care planning involves learning about the ...

  6. Affordable Care Act (Medicaid)

    MedlinePLUS

    ... Affordable Care Act Affordable Care Act Provisions Affordable Care Act See Affordable Care Act Federal Policy Guidance. ... related policy guidance can be found below. AFFORDABLE CARE ACT PROVISIONS DESCRIPTION Eligibility Fills in current gaps ...

  7. Models for Designing Long-Term Care Service Plans and Care Programs for Older People

    PubMed Central

    Tsuru, Satoko; Iizuka, Yoshinori

    2013-01-01

    The establishment of a system for providing appropriate long-term care services for older people is a national issue in Japan, and it will likely become a worldwide issue in the years to come. Under Japanese Long-term Care Insurance System, long-term care is provided based on long-term care programs, which were designed by care providers on the basis of long-term care service plans, which were designed by care managers. However, defined methodology for designing long-term care service plans and care programs has not been established yet. In this paper, we propose models for designing long-term care service plans and care programs for older people, both by incorporating the technical issues from previous studies and by redesigning the total methodology according to these studies. Our implementation model consists of “Function,” “Knowledge Structure,” and “Action Flow.” In addition, we developed the concrete knowledgebases based on the Knowledge Structure by visualizing, summarizing, and structuring the inherent knowledge of healthcare/welfare professionals. As the results of the workshop and retrospective verification, the adequacy of the models was suggested, while some further issues were pointed. Our models, knowledgebases, and application make it possible to ensure the quality of long-term care for older people. PMID:23589773

  8. 34 CFR 602.18 - Ensuring consistency in decision-making.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Ensuring consistency in decision-making. 602.18 Section 602... Ensuring consistency in decision-making. The agency must...information the agency relies on for making accrediting decisions is accurate; and...

  9. 34 CFR 602.18 - Ensuring consistency in decision-making.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Ensuring consistency in decision-making. 602.18 Section 602... Ensuring consistency in decision-making. The agency must...information the agency relies on for making accrediting decisions is accurate; and...

  10. 34 CFR 602.18 - Ensuring consistency in decision-making.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Ensuring consistency in decision-making. 602.18 Section 602... Ensuring consistency in decision-making. The agency must...information the agency relies on for making accrediting decisions is accurate; and...

  11. 34 CFR 602.18 - Ensuring consistency in decision-making.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Ensuring consistency in decision-making. 602.18 Section 602... Ensuring consistency in decision-making. The agency must...information the agency relies on for making accrediting decisions is accurate; and...

  12. 34 CFR 602.18 - Ensuring consistency in decision-making.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Ensuring consistency in decision-making. 602.18 Section 602... Ensuring consistency in decision-making. The agency must...information the agency relies on for making accrediting decisions is accurate; and...

  13. 36 CFR 805.4 - Ensuring environmental documents are actually considered in Council decisionmaking.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2014-07-01 false Ensuring environmental documents are actually considered in...PROCEDURES FOR IMPLEMENTATION OF NATIONAL ENVIRONMENTAL POLICY ACT § 805.4 Ensuring environmental documents are actually considered...

  14. 36 CFR 805.4 - Ensuring environmental documents are actually considered in Council decisionmaking.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 false Ensuring environmental documents are actually considered in...PROCEDURES FOR IMPLEMENTATION OF NATIONAL ENVIRONMENTAL POLICY ACT § 805.4 Ensuring environmental documents are actually considered...

  15. 36 CFR 805.4 - Ensuring environmental documents are actually considered in Council decisionmaking.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  16. 36 CFR 805.4 - Ensuring environmental documents are actually considered in Council decisionmaking.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  17. 21 CFR 212.20 - What activities must I perform to ensure drug quality?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  18. 21 CFR 212.20 - What activities must I perform to ensure drug quality?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...activities must I perform to ensure drug quality? 212.20 Section 212.20 Food...TOMOGRAPHY DRUGS (Eff. 12-12-2011) Quality Assurance § 212.20 What activities must I perform to ensure drug quality? (a) Production...

  19. Palliative Care.

    PubMed

    2015-11-26

    To the Editor: Kelley and Morrison (Aug. 20 issue)(1) describe the changes in palliative care over the past decade and its distinct meaning vis-à-vis hospice care in the United States and, increasingly, most other countries. Unfortunately, the category of "most countries" does not include many countries in Asia, where attitudes and practices vary widely according to regional, economic, cultural, and religious differences and differences in legal systems.(2) Neither does this category include Iran, a nation of more than 75 million people in which medical science is advanced; sophisticated therapies such as kidney, heart, and lung transplantation are available; and investigational . . . PMID:26605938

  20. Palliative Care.

    PubMed

    Hashemian, S Mohammadreza; Beheshti, Shahid; Miller, James

    2015-11-26

    To the Editor: Kelley and Morrison (Aug. 20 issue)(1) describe the changes in palliative care over the past decade and its distinct meaning vis-à-vis hospice care in the United States and, increasingly, most other countries. Unfortunately, the category of "most countries" does not include many countries in Asia, where attitudes and practices vary widely according to regional, economic, cultural, and religious differences and differences in legal systems.(2) Neither does this category include Iran, a nation of more than 75 million people in which medical science is advanced; sophisticated therapies such as kidney, heart, and lung transplantation are available; and investigational . . . PMID:26605939

  1. Palliative Care.

    PubMed

    McGovern, Terrance; Catapano, Anthony; Shroff, Ninad

    2015-11-26

    To the Editor: Kelley and Morrison (Aug. 20 issue)(1) describe the changes in palliative care over the past decade and its distinct meaning vis-à-vis hospice care in the United States and, increasingly, most other countries. Unfortunately, the category of "most countries" does not include many countries in Asia, where attitudes and practices vary widely according to regional, economic, cultural, and religious differences and differences in legal systems.(2) Neither does this category include Iran, a nation of more than 75 million people in which medical science is advanced; sophisticated therapies such as kidney, heart, and lung transplantation are available; and investigational . . . PMID:26605940

  2. Wound Care.

    PubMed

    Balsa, Ingrid M; Culp, William T N

    2015-09-01

    Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve. PMID:26022525

  3. Ensuring confidence in radionuclide-based sediment chronologies and bioturbation rates

    USGS Publications Warehouse

    Crusius, John; Kenna, Timothy C.

    2007-01-01

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

  4. 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

  5. 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

  6. USING PROGRAM EVALUATION TO ENSURE THE SUCCESS OF YOUR ADVANCE PROGRAM

    E-print Network

    Sheridan, Jennifer

    USING PROGRAM EVALUATION TO ENSURE THE SUCCESS OF YOUR ADVANCE PROGRAM ADVANCE: INSTITUTIONAL........................................................................................................................................................ 7 BASICS OF PROGRAM EVALUATION

  7. Transitional Care Strategies From Hospital to Home

    PubMed Central

    Ranji, Sumant R.

    2015-01-01

    Hospitals are challenged with reevaluating their hospital’s transitional care practices, to reduce 30-day readmission rates, prevent adverse events, and ensure a safe transition of patients from hospital to home. Despite the increasing attention to transitional care, there are few published studies that have shown significant reductions in readmission rates, particularly for patients with stroke and other neurologic diagnoses. Successful hospital-initiated transitional care programs include a “bridging” strategy with both predischarge and postdischarge interventions and dedicated transitions provider involved at multiple points in time. Although multicomponent strategies including patient engagement, use of a dedicated transition provider, and facilitation of communication with outpatient providers require time and resources, there is evidence that neurohospitalists can implement a transitional care program with the aim of improving patient safety across the continuum of care. PMID:25553228

  8. Adequate sleep among adolescents is positively associated with health status and health-related behaviors

    PubMed Central

    Chen, Mei-Yen; Wang, Edward K; Jeng, Yi-Jong

    2006-01-01

    Background Amount of sleep is an important indicator of health and well-being in children and adolescents. Adequate sleep (AS: adequate sleep is defined as 6–8 hours per night regularly) is a critical factor in adolescent health and health-related behaviors. The present study was based on a health promotion project previously conducted on adolescents in Tao-Yuan County, Taiwan. The aim was to examine the relationship between AS during schooldays and excessive body weight, frequency of visiting doctors and health-related behaviors among Taiwanese adolescents. Methods A cross-sectional study design, categorical and multivariate data analyses were used. The hypotheses investigated were: high frequency of AS is positively associated with lack of obesity and less frequent visits to doctors; and high frequency AS is positively associated with health-related behavior. Results A total of 656 boys (53.2%) and girls (46.8%), ranging in age from 13–18 years were studied between January and June 2004. Three hundred and fifty seven subjects (54%) reported that they slept less than the suggested 6–8 hours on schooldays. A significant negative association was found between low sleep and of the following health-related behaviors: (1) life appreciation; (2) taking responsibility for health; (3) adopting healthy diet; (4) effective stress management; (5) regular exercise; and (6) total AHP score. High frequency AS was associated with low frequencies of obesity after potential confounding factors were controlled. Junior high school adolescents reported significantly higher frequencies of AS than high school participants. Gender, family structure, home location and frequency of television watching or computer use were not significantly associated with AS. Conclusion These findings support the proposition that AS is associated with good health status and high-frequency adoption of health-related behavior. Furthermore, these findings suggest that inadequate sleep may be a screening indicator for an unhealthy lifestyle and poor health status. The results might be useful for future research into the development of intervention strategies to assist adolescents who are not receiving enough hours of sleep. PMID:16524482

  9. Imaging surveillance programs for women at high breast cancer risk in Europe: Are women from ethnic minority groups adequately included? (Review).

    PubMed

    Belki?, Karen; Cohen, Miri; Wilczek, Brigitte; Andersson, Sonia; Berman, Anne H; Márquez, Marcela; Vukojevi?, Vladana; Mints, Miriam

    2015-09-01

    Women from ethnic minority groups, including immigrants and refugees are reported to have low breast cancer (BC) screening rates. Active, culturally-sensitive outreach is vital for increasing participation of these women in BC screening programs. Women at high BC risk and who belong to an ethnic minority group are of special concern. Such women could benefit from ongoing trials aimed at optimizing screening strategies for early BC detection among those at increased BC risk. Considering the marked disparities in BC survival in Europe and its enormous and dynamic ethnic diversity, these issues are extremely timely for Europe. We systematically reviewed the literature concerning European surveillance studies that had imaging in the protocol and that targeted women at high BC risk. The aim of the present review was thereby to assess the likelihood that women at high BC risk from minority ethnic groups were adequately included in these surveillance programs. Twenty-seven research groups in Europe reported on their imaging surveillance programs for women at increased BC risk. The benefit of strategies such as inclusion of magnetic resonance imaging and/or more intensive screening was clearly documented for the participating women at increased BC risk. However, none of the reports indicated that sufficient outreach was performed to ensure that women at increased BC risk from minority ethnic groups were adequately included in these surveillance programs. On the basis of this systematic review, we conclude that the specific screening needs of ethnic minority women at increased BC risk have not yet been met in Europe. Active, culturally-sensitive outreach is needed to identify minority women at increased BC risk and to facilitate their inclusion in on-going surveillance programs. It is anticipated that these efforts would be most effective if coordinated with the development of European-wide, population-based approaches to BC screening. PMID:26134040

  10. 41 CFR 102-118.100 - What must my agency ensure is on each SF 1113?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... What must my agency ensure is on each SF 1113? 102-118.100 Section 102-118... What must my agency ensure is on each SF 1113? Your agency must ensure during...the TSP filled out the Public Vouchers, SF 1113, completely including the...

  11. Quality of Antenatal Care in Primary Health Care Centers of Bangladesh

    PubMed Central

    Mansur, Ahmed M. S. A.; Rezaul, Karim M.; Mahmudul, Hoque. M.; S, Chowdhury

    2014-01-01

    Objective: To find out the quality of ANC in the Upazila Health Complexes (PHC centres) of Bangladesh. Materials and methods: This cross sectional study was done in purposively selected three upazilas among the clients receiving antenatal care (ANC). Data were collected with questionnaire cum checklist in the context of two aspects of quality issues, namely assessment of physical arrangements for ANC (input) and services rendered by the providers (process). Results: The mean age of respondents was 24.6±4.5 years. Majority of the respondents were with primary level education (60.3%). About half (52.8%) of the families had monthly income ranging from 3000-5000 taka (38-64 US$). Nearly half (48.9%) had no child, little more than one third (42.3%) were primigravida and 528 (57.7%) were multigravida. Out of 528 multigravid respondents 360 (68.2%) took ANC in their previous pregnancy whereas 168 (31.8%) did not take ANC Pregnancy outcome was found to be associated with receiving ANC (?2=73.599; p=0.000). Respondents receiving ANC had more good pregnancy outcome. The mean waiting time for receiving ANC was 0.77±.49 hours. Out of the 13 centers, only 3 (23.1%) have sufficient instruments to render ANC services. Findings showed that where the modes of ANC service delivery in the ANC centers are fairly satisfactory. Though some of the points of standard operation procedures (SOPs) on ANC are not covered by some ANC centers, those were not considered necessary. But, regarding the physical facilities available for rendering ANC services, it is seen that facilities are not quite satisfactory. Number of doctors and nurses are not very satisfactory. One of the centers under this study has no doctor, where ANC services are given by nurses. Conclusion: It can be concluded that the ANC services at the primary health care level is not adequate in Bangladesh. To ensure further improvement of the quality of ANC services, instruments used in logistics and supplies should be enhanced. PMID:25530770

  12. Prenatal Care

    MedlinePLUS

    ... and has cared for other pregnant women with diabetes A pediatrician (children's doctor) or neonatologist (doctor for newborn babies) who knows and can treat special problems that can happen in babies of women with diabetes A registered dietitian who can change your meal ...

  13. Just caring.

    PubMed

    Hussey, Trevor

    2012-01-01

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

  14. Infant Care.

    ERIC Educational Resources Information Center

    North, A. Frederick

    This new addition of a government pamphlet is a guide offering advice and information to new parents. Sections include: You and Your New Baby (handling the baby, care of the mother, feeding, etc.); First Weeks at Home (equipment, formula preparation, bathing, sleeping, crying, colic, etc.); After the First Weeks (temperament, "difficult" babies,…

  15. Secure Knowledge Management for Health Care Organizations Authors: D.Mundy, D.W.Chadwick

    E-print Network

    Kent, University of

    Secure Knowledge Management for Health Care Organizations Authors: D.Mundy, D.W.Chadwick Abstract As the health care industry enters the era of knowledge management it must place security at the foundation initially we present a conceptual model for ensuring secure knowledge management in health care. Then we

  16. 42 CFR 441.102 - Plan of care for institutionalized recipients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Plan of care for institutionalized recipients...Mental Diseases § 441.102 Plan of care for institutionalized recipients...provide for a recorded individual plan of treatment and care to ensure that...

  17. 78 FR 78258 - Duty Periods for Establishing Eligibility for Health Care

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-26

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AO25 Duty Periods for Establishing Eligibility for Health Care ACTION... concerning eligibility for health care to re- establish the definitions of ``active military, naval, or air... Regulations (CFR) to ensure proper determination of eligibility for VA health care. We are also providing...

  18. 28 CFR 115.35 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... health care. 115.35 Section 115.35 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE... Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in its facilities have been trained in:...

  19. 28 CFR 115.35 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... health care. 115.35 Section 115.35 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE... Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in its facilities have been trained in:...

  20. 28 CFR 115.35 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... health care. 115.35 Section 115.35 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE... Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in its facilities have been trained in:...

  1. 28 CFR 115.335 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... health care. 115.335 Section 115.335 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON....335 Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in its facilities...

  2. 28 CFR 115.235 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... health care. 115.235 Section 115.235 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON... Education § 115.235 Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in...

  3. 28 CFR 115.335 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... health care. 115.335 Section 115.335 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON....335 Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in its facilities...

  4. 28 CFR 115.235 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... health care. 115.235 Section 115.235 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON... Education § 115.235 Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in...

  5. 28 CFR 115.235 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... health care. 115.235 Section 115.235 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON... Education § 115.235 Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in...

  6. 28 CFR 115.335 - Specialized training: Medical and mental health care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... health care. 115.335 Section 115.335 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON....335 Specialized training: Medical and mental health care. (a) The agency shall ensure that all full- and part-time medical and mental health care practitioners who work regularly in its facilities...

  7. 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.

  8. 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

  9. 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

  10. 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

  11. 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.

  12. 23 CFR 669.13 - Effect of failure to certify or to adequately obtain proof of payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS ENFORCEMENT OF HEAVY VEHICLE USE TAX § 669.13 Effect of failure... not adequately obtaining proof of payment of the heavy vehicle use tax as a condition of...

  13. 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

    ...2014-04-01 2014-04-01 false Labeling of cosmetic products for which adequate substantiation of safety...DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS Warning Statements...

  14. 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

    ...2013-04-01 2013-04-01 false Labeling of cosmetic products for which adequate substantiation of safety...DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS Warning Statements...

  15. 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

    ...2012-04-01 2012-04-01 false Labeling of cosmetic products for which adequate substantiation of safety...DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS Warning Statements...

  16. 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

    ...2011-04-01 2010-04-01 true Labeling of cosmetic products for which adequate substantiation of safety...DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS Warning Statements...

  17. Palliative care in adolescents and young adults with cancer.

    PubMed

    Pritchard, Sheila; Cuvelier, Geoff; Harlos, Mike; Barr, Ronald

    2011-05-15

    Adolescents and young adults (AYA) with advanced or terminal cancer have distinctive medical and psychosocial needs that may not have been adequately provided by either pediatric or adult palliative care services. A discussion group, as part of a larger workshop on AYA with cancer, was held in Toronto on March 11-13, 2010;117:-. Recommendations were as follows: Develop a specific AYA screening tool designed to detect increased anxiety or new symptoms and to initiate discussion about palliative or symptom care; Set Canadian standards for palliative care in AYA patients. These standards should be included in hospital accreditation; Involve the palliative/symptom care team early in the disease trajectory to help manage clinically important symptoms that may not be associated with imminent death; Establish specific AYA multidisciplinary palliative care teams throughout Canada that are flexible and can work in both pediatric and adult facilities, and are able to work in a "virtual" environment to support patients being cared for at home; Improve physical facilities in hospices and hospitals to meet the distinctive needs of terminally ill AYA patients; Enhance support for palliative care at home by: changing legislation to improve Compassionate Care Benefits and developing "virtual palliative care support teams". Adequate provision of AYA palliative care and symptom management services will likely confer notable benefits to AYA patients and their families, and is likely to be cost saving to the tax payer by avoiding prolonged hospitalization and promoting easier return to work for the families and caregivers. PMID:21523753

  18. 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.

  19. Critical Care In Korea: Present and Future.

    PubMed

    Lim, Chae-Man; Kwak, Sang-Hyun; Suh, Gee Young; Koh, Younsuck

    2015-11-01

    Critical (or intensive) care medicine (CCM) is a branch of medicine concerned with the care of patients with potentially reversible life-threatening conditions. Numerous studies have demonstrated that adequate staffing is of crucial importance for patient outcome. Adequate staffing also showed favorable cost-effectiveness in terms of ICU stay, decreased use of resources, and lower re-admission rates. The current status of CCM of our contry is not comparable to that of advanced countries. The global pandemic episodes in the past decade showed that our society is not well prepared for severe illnesses or mass casualty. To improve CCM in Korea, reimbursement of the government must be amended such that referral hospitals can hire sufficient number of qualified intensivists and nurses. For the government to address these urgent issues, public awareness of the role of CCM is also required. PMID:26538995

  20. Critical Care In Korea: Present and Future

    PubMed Central

    Lim, Chae-Man; Kwak, Sang-Hyun; Suh, Gee Young

    2015-01-01

    Critical (or intensive) care medicine (CCM) is a branch of medicine concerned with the care of patients with potentially reversible life-threatening conditions. Numerous studies have demonstrated that adequate staffing is of crucial importance for patient outcome. Adequate staffing also showed favorable cost-effectiveness in terms of ICU stay, decreased use of resources, and lower re-admission rates. The current status of CCM of our contry is not comparable to that of advanced countries. The global pandemic episodes in the past decade showed that our society is not well prepared for severe illnesses or mass casualty. To improve CCM in Korea, reimbursement of the government must be amended such that referral hospitals can hire sufficient number of qualified intensivists and nurses. For the government to address these urgent issues, public awareness of the role of CCM is also required. PMID:26538995

  1. Practical Issues in Palliative and Quality-of-Life Care

    PubMed Central

    Hennessy, John E.; Lown, Beth A.; Landzaat, Lindy; Porter-Williamson, Karin

    2013-01-01

    Although palliative care is not new to health care or to oncology, oncologists still struggle to maximize the value of this type of care across the entire care continuum and across the patient's trajectory of illness. When we don't use what may be the best tools for the job, at the right times in the care path, we miss opportunities to optimize patient and family coping, to limit suffering, and to ensure that our care plans are patient centered. In this article, we look at how we define palliative care and how the tools of palliative medicine can be used to enhance patient care in the outpatient oncology practice setting. PMID:23814513

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

    NASA Astrophysics Data System (ADS)

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

    2013-12-01

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

  3. Reflections on curative health care in Nicaragua.

    PubMed Central

    Slater, R G

    1989-01-01

    Improved health care in Nicaragua is a major priority of the Sandinista revolution; it has been pursued by major reforms of the national health care system, something few developing countries have attempted. In addition to its internationally recognized advances in public health, considerable progress has been made in health care delivery by expanding curative medical services through training more personnel and building more facilities to fulfill a commitment to free universal health coverage. The very uneven quality of medical care is the leading problem facing curative medicine now. Underlying factors include the difficulty of adequately training the greatly increased number of new physicians. Misdiagnosis and mismanagement continue to be major problems. The curative medical system is not well coordinated with the preventive sector. Recent innovations include initiation of a "medicina integral" residency, similar to family practice. Despite its inadequacies and the handicaps of war and poverty, the Nicaraguan curative medical system has made important progress. PMID:2705603

  4. Survivorship care in breast cancer

    PubMed Central

    Smith, Sally L.; Murchison, Sonja; Singh-Carlson, Savitri; Alexander, Cheryl; Wai, Elaine S.

    2015-01-01

    Abstract Objective To compare the perceptions of breast cancer survivors and primary care physicians (PCPs) about PCPs’ ability to deliver survivorship care in breast cancer. Design Mailed survey. Setting British Columbia. Participants A total of 1065 breast cancer survivors who had completed treatment of nonmetastatic breast cancer within the previous year, and 587 PCPs who had patients with nonmetastatic breast cancer discharged to their care within the preceding 18 months. Main outcome measures Breast cancer survivors’ and PCPs’ confidence ratings of PCPs’ ability to deliver the following aspects of care: screening for recurrence; managing osteoporosis, lymphedema, endocrine therapy, menopausal symptoms, and anxiety about or fear of recurrence; and providing nutrition and exercise counseling, sex and body image counseling, and family counseling. Response options for each question included low, adequate, or good. Responses were summarized as frequencies and compared using ?2 tests. Results Response rates for breast cancer survivors and PCPs were 47% and 59%, respectively. Responses were statistically different in all categories (P < .05). Both groups were most confident in the ability of PCPs to screen for recurrence, but breast cancer survivors were 10 times as likely to indicate low confidence (10% of breast cancer survivors vs 1% of PCPs) in this aspect of care. More breast cancer survivors (23%) expressed low confidence in PCPs’ ability to provide counseling about fear of recurrence compared with PCPs (3%). Aspects of care in which both breast cancer survivors and PCPs were most likely to express low confidence included sex and body image counseling (35% of breast cancer survivors vs 26% of PCPs) and family counseling (33% of breast cancer survivors vs 24% of PCPs). Primary care physicians (24%) described low confidence in their ability to manage lymphedema. Conclusion Breast cancer survivors and PCPs are reasonably confident in a PCP-based model of survivorship care. Primary care physicians are confident in their ability to manage physical effects related to breast cancer, with the exception of lymphedema. Low confidence ratings among both groups in psychosocial aspects of care suggest an area for improvement.

  5. The adequate stimulus for avian short latency vestibular responses to linear translation

    NASA Technical Reports Server (NTRS)

    Jones, T. A.; Jones, S. M.; Colbert, S.

    1998-01-01

    Transient linear acceleration stimuli have been shown to elicit eighth nerve vestibular compound action potentials in birds and mammals. The present study was undertaken to better define the nature of the adequate stimulus for neurons generating the response in the chicken (Gallus domesticus). In particular, the study evaluated the question of whether the neurons studied are most sensitive to the maximum level of linear acceleration achieved or to the rate of change in acceleration (da/dt, or jerk). To do this, vestibular response thresholds were measured as a function of stimulus onset slope. Traditional computer signal averaging was used to record responses to pulsed linear acceleration stimuli. Stimulus onset slope was systematically varied. Acceleration thresholds decreased with increasing stimulus onset slope (decreasing stimulus rise time). When stimuli were expressed in units of jerk (g/ms), thresholds were virtually constant for all stimulus rise times. Moreover, stimuli having identical jerk magnitudes but widely varying peak acceleration levels produced virtually identical responses. Vestibular response thresholds, latencies and amplitudes appear to be determined strictly by stimulus jerk magnitudes. Stimulus attributes such as peak acceleration or rise time alone do not provide sufficient information to predict response parameter quantities. Indeed, the major response parameters were shown to be virtually independent of peak acceleration levels or rise time when these stimulus features were isolated and considered separately. It is concluded that the neurons generating short latency vestibular evoked potentials do so as "jerk encoders" in the chicken. Primary afferents classified as "irregular", and which traditionally fall into the broad category of "dynamic" or "phasic" neurons, would seem to be the most likely candidates for the neural generators of short latency vestibular compound action potentials.

  6. A Better Diet Quality is Attributable to Adequate Energy Intake in Hemodialysis Patients.

    PubMed

    Kim, Hyerang; Lim, Hyunjung; Choue, Ryowon

    2015-01-01

    Poor diet quality is one of strong predictors of subsequent increased mortality in hemodialysis patients. To determine diet quality and to define major problems contributing to poor diet quality in hemodialysis patients, a cross-sectional study was conducted between June 2009 and October 2010. Sixty-three hemodialysis patients (31 men, 32 women; aged 55.3 ± 11.9 years) in stable condition were recruited from the Artificial Kidney Center in Kyung Hee University, Seoul, Korea. Three-day diet records were obtained for dietary assessment. Mean adequacy ratio (MAR) is the average of the ratio of intakes to Dietary Reference Intakes (DRI) for 12 nutrients. Index of nutritional quality (INQ) was determined as the nutritional density per 1,000 kcal of calories. Overall diet quality was evaluated using the Diet Quality Index-International (DQI-I). Statistics were used to determine diet quality, comparing dietary intake to DRI. Dietary calories (21.9 ± 6.7 kcal/kg/day) and protein (0.9 ± 0.3 g/kg/day) were found insufficient in the participants. The overall intake of 12 nutrients appeared to be also inadequate (0.66 ± 0.15), but INQs of overall nutrients, except for folate (0.6) and calcium (0.8), were found relatively adequate (INQ ? 1). As a result of diet quality assessment using DQI-I, dietary imbalance and inadequacy were found to be the most problematic in hemodialysis patients. This study suggests that the main reason for insufficient intake of essential nutrients is insufficient calorie intake. Hemodialysis patients should be encouraged to use various food sources to meet their energy requirements as well as satisfy overall balance and nutrient adequacy. PMID:25713792

  7. A Better Diet Quality is Attributable to Adequate Energy Intake in Hemodialysis Patients

    PubMed Central

    Kim, Hyerang

    2015-01-01

    Poor diet quality is one of strong predictors of subsequent increased mortality in hemodialysis patients. To determine diet quality and to define major problems contributing to poor diet quality in hemodialysis patients, a cross-sectional study was conducted between June 2009 and October 2010. Sixty-three hemodialysis patients (31 men, 32 women; aged 55.3 ± 11.9 years) in stable condition were recruited from the Artificial Kidney Center in Kyung Hee University, Seoul, Korea. Three-day diet records were obtained for dietary assessment. Mean adequacy ratio (MAR) is the average of the ratio of intakes to Dietary Reference Intakes (DRI) for 12 nutrients. Index of nutritional quality (INQ) was determined as the nutritional density per 1,000 kcal of calories. Overall diet quality was evaluated using the Diet Quality Index-International (DQI-I). Statistics were used to determine diet quality, comparing dietary intake to DRI. Dietary calories (21.9 ± 6.7 kcal/kg/day) and protein (0.9 ± 0.3 g/kg/day) were found insufficient in the participants. The overall intake of 12 nutrients appeared to be also inadequate (0.66 ± 0.15), but INQs of overall nutrients, except for folate (0.6) and calcium (0.8), were found relatively adequate (INQ ? 1). As a result of diet quality assessment using DQI-I, dietary imbalance and inadequacy were found to be the most problematic in hemodialysis patients. This study suggests that the main reason for insufficient intake of essential nutrients is insufficient calorie intake. Hemodialysis patients should be encouraged to use various food sources to meet their energy requirements as well as satisfy overall balance and nutrient adequacy. PMID:25713792

  8. Determining median urinary iodine concentration that indicates adequate iodine intake at population level.

    PubMed Central

    Delange, François; de Benoist, Bruno; Burgi, Hans

    2002-01-01

    OBJECTIVE: Urinary iodine concentration is the prime indicator of nutritional iodine status and is used to evaluate population-based iodine supplementation. In 1994, WHO, UNICEF and ICCIDD recommended median urinary iodine concentrations for populations of 100- 200 micro g/l, assuming the 100 micro g/l threshold would limit concentrations <50 micro g/l to 100 micro g/l. The total population was 55 892, including 35 661 (64%) schoolchildren. Median urinary iodine concentrations were 111-540 (median 201) micro g/l for all populations, 100-199 micro g/l in 23 (48%) populations and >/=200 micro g/l in 25 (52%). The frequencies of values <50 micro g/l were 0-20.8 (mean 4.8%) overall and 7.2% and 2.5% in populations with medians of 100-199 micro g/l and >200 micro g/l, respectively. The frequency reached 20% only in two places where iodine had been supplemented for <2 years. CONCLUSION: The frequency of urinary iodine concentrations <50 micro g/l in populations with median urinary iodine concentrations >/=100 micro g/l has been overestimated. The threshold of 100 micro g/l does not need to be increased. In populations, median urinary iodine concentrations of 100-200 micro g/l indicate adequate iodine intake and optimal iodine nutrition. PMID:12219154

  9. [Medical care for asylum seekers and refugees at the University Medical Center Hamburg-Eppendorf - A case series].

    PubMed

    Sothmann, Peter; Auf der Günne, Nina Schmedt; Addo, Marylyn; Lohse, Ansgar; Schmiedel, Stefan

    2016-01-01

    As the number of refugees rises, medical care for refugees, asylum seekers and people with unclear residence status becomes a priority task for our health system. While access to health care is restricted for these groups of people in many German states, Hamburg provides unrestricted access to healthcare for refugees by handing out health insurance cards on arrival. Daily practice shows, however, that adequate medical care is still not always easy to achieve. In this case series we demonstrate that barriers to health care still exist on many levels. We discuss these barriers and further propose strategies to improve and to secure access to adequate health care. PMID:26710201

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

    PubMed Central

    2014-01-01

    Background The Institute of Medicine (IOM) has endorsed six dimensions of patient-centredness as crucial to providing quality healthcare. These dimensions outline that care must be: 1) respectful to patients’ values, preferences, and expressed needs; 2) coordinated and integrated; 3) provide information, communication, and education; 4) ensure physical comfort; 5) provide emotional support—relieving fear and anxiety; and 6) involve family and friends. However, whether patient-reported outcome measures (PROMs) comprehensively cover these dimensions remains unexplored. This systematic review examined whether PROMs designed to assess the quality of patient-centred cancer care addressed all six IOM dimensions of patient-centred care and the psychometric properties of these measures. Methods Medline, PsycINFO, Current Contents, Embase, CINAHL and Scopus were searched to retrieve published studies describing the development and psychometric properties of PROMs assessing the quality of patient-centred cancer care. Two authors determined if eligible PROMs included the six IOM dimensions of patient-centred care and evaluated the adequacy of psychometric properties based on recommended criteria for internal consistency, test-retest reliability, face/content validity, construct validity and cross-cultural adaptation. Results Across all 21 PROMs, the most commonly included IOM dimension of patient-centred care was “information, communication and education” (19 measures). In contrast, only five measures assessed the “involvement of family and friends.” Two measures included one IOM-endorsed patient-centred care dimension, two measures had two dimensions, seven measures had three dimensions, five measures had four dimensions, and four measures had five dimensions. One measure, the Indicators (Non-small Cell Lung Cancer), covered all six IOM dimensions of patient-centred care, but had adequate face/content validity only. Eighteen measures met the recommended adequacy criteria for construct validity, 15 for face/content validity, seven for internal consistency, three for cross-cultural adaptation and no measure for test-retest reliability. Conclusions There are no psychometrically rigorous PROMs developed with cancer patients that capture all six IOM dimensions of patient-centred care. Using more than one measure or expanding existing measures to cover all six patient-centred care dimensions could improve assessment and delivery of patient-centred care. Construction of new comprehensive measures with acceptable psychometric properties that can be used with the general cancer population may also be warranted. PMID:24460829

  11. Are community-level financial data adequate to assess population health investments?

    PubMed

    Casper, Tim; Kindig, David A

    2012-01-01

    The variation in health outcomes among communities results largely from different levels of financial and nonfinancial policy investments over time; these natural experiments should offer investment and policy guidance for a business model on population health. However, little such guidance exists. We examined the availability of data in a sample of Wisconsin counties for expenditures in selected categories of health care, public health, human services, income support, job development, and education. We found, as predicted by the National Committee on Vital and Health Statistics in 2002, that availability is often limited by the challenges of difficulty in locating useable data, a lack of resources among public agencies to upgrade information technology systems for making data more usable and accessible to the public, and a lack of enterprise-wide coordination and geographic detail in data collection efforts. These challenges must be overcome to provide policy-relevant information for optimal population health resource allocation. PMID:22877572

  12. Getting the priorities right in end-of-life care.

    PubMed

    Anderson, Pat

    The Leadership Alliance for the Care of Dying People has drawn up five priorities for the care of dying people. The priorities replace the Liverpool Care Pathway, which was widely criticised for promoting a tick-box approach to the care of the dying. The five priorities focus on: recognising that someone is dying; communicating sensitively with them and their family; involving them in decisions; supporting them and their family; and creating an individual plan of care that includes adequate nutrition and hydration. The alliance has outlined the duties and responsibilities of nurses and other health professionals when caring for people at the end of their lives, with an emphasis on compassionate care. PMID:25188966

  13. Foster care and Medicaid managed care.

    PubMed

    Leslie, Laurel K; Kelleher, Kelly J; Burns, Barbara J; Landsverk, John; Rolls, Jennifer A

    2003-01-01

    Children in the foster care system are often dependent on Medicaid for health care. These children, however, have more complex health care needs than the typical child receiving Medicaid. States are implementing Medicaid managed care programs as a way to control escalating costs while providing necessary services. This article reviews the issues surrounding delivery of managed health care services to children in foster care and describes several solutions. PMID:12769396

  14. The global state of palliative care-progress and challenges in cancer care.

    PubMed

    Reville, Barbara; Foxwell, Anessa M

    2014-07-01

    All persons have a right to palliative care during cancer treatment and at the end-of-life. The World Health Organization (WHO) defines palliative care as a medical specialty that addresses physical, psychological, social, legal, and spiritual domains of care by an interdisciplinary team of professional and lay health care providers. Widespread adoption of this universal definition will aid policy development and educational initiatives on a national level. The need for palliative care is expanding due to the aging of the world's population and the increase in the rate of cancer in both developed and developing countries. However, in one third of the world there is no access to palliative care for persons with serious or terminal illness. Palliative care improves symptoms, most frequently pain, and improves quality of life for patients and their families, especially in the terminal disease phase. Accessibility to palliative care services, adequately trained health care professionals, availability of essential medicines, and gaps in education vary greatly throughout the world. Pain management is an integral concept in the practice of palliative care; however, opioiphobia, insufficient supply of opioids, and regulatory restrictions contribute to undue suffering for millions. Ongoing advocacy efforts call for increased awareness, palliative care integration with cancer care, and public and professional education. Enacting necessary change will require the engagement of health ministries and the recognition of the unique needs and resources of each country. The aim of this review is to examine progress in palliative care development and explore some of the barriers influencing cancer care across the globe. PMID:25841689

  15. Focusing on Patient Safety: the Challenge of Securely Sharing Electronic Medical Records in Complex Care Continuums.

    PubMed

    Key, Diana; Ferneini, Elie M

    2015-09-01

    The Patient Protection and Affordable Care Act's (PPACA) regulated approach to inclusive provision of care will increase the challenge health care administrators face ensuring secure communication and secure sharing of electronic medical records between divisions and care subcontractors. This analysis includes a summary overview of the PPACA; the Health Care and Education Reconciliation Act (HCERA) of 2010; and required Essential Health Benefits (EHB). The analysis integrates an overview of how secure communication and secure sharing of electronic medical records will be essential to clinical outcomes across complex care continuums; as well as the actionable strategies health care leadership can employ to overcome associated IT security challenges. PMID:26506680

  16. 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.

  17. Human milk feeding supports adequate growth in infants ? 1250 grams birth weight

    PubMed Central

    2013-01-01

    Background 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 objective of this study was to evaluate growth velocities and incidence of extrauterine growth restriction in infants ? 1250 grams (g) birth weight (BW) receiving an exclusive human milk-based diet with early and rapid advancement of fortification using a donor human milk derived fortifier. Methods In a single center, prospective observational cohort study, preterm infants weighing ? 1250 g BW were fed an exclusive human milk-based diet until 34 weeks postmenstrual age. Human milk fortification with donor human milk derived fortifier was started at 60 mL/kg/d and advanced to provide 6 to 8 additional kilocalories per ounce (or 0.21 to 0.28 kilocalories per gram). Data for growth were compared to historical growth standards and previous human milk-fed cohorts. Results We consecutively evaluated 104 infants with mean gestational age of 27.6 ± 2.0 weeks and BW of 913 ± 181 g (mean ± standard deviation). Weight gain was 24.8 ± 5.4 g/kg/day with length 0.99 ± 0.23 cm/week and head circumference 0.72 ± 0.14 cm/week. There were 3 medical NEC cases and 1 surgical NEC case. 22 infants (21%) were small for gestational age at birth. Overall, 45 infants (43%) had extrauterine growth restriction. Weight velocity was affected by day of fortification (p = 0.005) and day of full feeds (p = 0.02). Our cohort had significantly greater growth in weight and length compared to previous entirely human milk-fed cohorts. Conclusions A feeding protocol for infants ? 1250 g BW providing an exclusive human milk-based diet with early and rapid advancement of fortification leads to growth meeting targeted standards with a low rate of extrauterine growth restriction. Consistent nutritional policies using this approach may be considered for this population. PMID:24220185

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

    NASA Astrophysics Data System (ADS)

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

    2009-12-01

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

  19. 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

  20. Development and implementation of a quality improvement program for Ryan White Title I care services using a stakeholder-based model.

    PubMed

    Linsk, Nathan L; Bruce, Douglas; Schechtman, Barbara; Warnecke, Richard; Tunney, Kathleen; Bass, Michael

    2005-03-01

    Both medical and community support services for people living with HIV and/or AIDS have been implemented on a widespread basis since the implementation of the 1990 Ryan White CARE Act. However, many services are provided without adequate evaluation or quality assurance, in spite of federal directions to both evaluate and ensure quality. This report details the development and implementation of a quality improvement project to evaluate Ryan White CARE services using a community stakeholder-based effort. The evaluation was consumer rather than administratively driven, including both consumers and providers to define, measure, and improve services. Project phases included: (1) developing service standards for 14 areas of service provided under Title I of the Ryan White CARE Act; (2) creating and implementing a provider/consumer peer site visit instrument to assess agencies' activities in meeting the service standards; and (3) developing a mechanism to improve quality by linking agencies to technical assistance resources in the metropolitan provider community. By involving providers and consumers in evaluation roles, recommendations by peers could serve as the basis for ongoing quality improvement. PMID:15798385