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Sample records for ensure adequate care

  1. ENSURING ADEQUATE SAFETY WHEN USING HYDROGEN AS A FUEL

    SciTech Connect

    Coutts, D

    2007-01-22

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

  2. Ensuring quality and accountability in managed care.

    PubMed

    Dobalian, A; Rivers, P A

    1998-01-01

    The rapid growth of new forms of managed care in the United States in recent decades has brought with it increasing concerns regarding the quality of care delivered by practitioners in these plans. This article examines the various regulatory demands that are being placed on Managed Care Organizations (MCOs). The authors look at the major determinants that are likely to bring about significant changes in the health care sector for both patients and providers and predict how these shifts will affect the quality of health care services in the near future. They discuss how the quality of health care, rather than the cost of those services, can become and remain the primary factor in the delivery of health care services. Ultimately, they conclude that increased participation by the federal government is required to protect the rights of patients and ensure better quality and accountability for health care services delivered by MCOs. PMID:10345539

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

    ERIC Educational Resources Information Center

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

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

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

    NASA Astrophysics Data System (ADS)

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

    2006-12-01

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

  5. Ensuring Adequate Health and Safety Information for Decision Makers during Large-Scale Chemical Releases

    NASA Astrophysics Data System (ADS)

    Petropoulos, Z.; Clavin, C.; Zuckerman, B.

    2015-12-01

    The 2014 4-Methylcyclohexanemethanol (MCHM) spill in the Elk River of West Virginia highlighted existing gaps in emergency planning for, and response to, large-scale chemical releases in the United States. The Emergency Planning and Community Right-to-Know Act requires that facilities with hazardous substances provide Material Safety Data Sheets (MSDSs), which contain health and safety information on the hazardous substances. The MSDS produced by Eastman Chemical Company, the manufacturer of MCHM, listed "no data available" for various human toxicity subcategories, such as reproductive toxicity and carcinogenicity. As a result of incomplete toxicity data, the public and media received conflicting messages on the safety of the contaminated water from government officials, industry, and the public health community. Two days after the governor lifted the ban on water use, the health department partially retracted the ban by warning pregnant women to continue avoiding the contaminated water, which the Centers for Disease Control and Prevention deemed safe three weeks later. The response in West Virginia represents a failure in risk communication and calls to question if government officials have sufficient information to support evidence-based decisions during future incidents. Research capabilities, like the National Science Foundation RAPID funding, can provide a solution to some of the data gaps, such as information on environmental fate in the case of the MCHM spill. In order to inform policy discussions on this issue, a methodology for assessing the outcomes of RAPID and similar National Institutes of Health grants in the context of emergency response is employed to examine the efficacy of research-based capabilities in enhancing public health decision making capacity. The results of this assessment highlight potential roles rapid scientific research can fill in ensuring adequate health and safety data is readily available for decision makers during large

  6. Ensuring Competent Care by Senior Physicians.

    PubMed

    Hawkins, Richard E; Welcher, Catherine M; Stagg Elliott, Victoria; Pieters, Richard S; Puscas, Liana; Wick, Paul H

    2016-01-01

    The increasing number of senior physicians and calls for increased accountability of the medical profession by the public have led regulators and policymakers to consider implementing age-based competency screening. Some hospitals and health systems have initiated age-based screening, but there is no agreed upon assessment process. Licensing and certifying organizations generally do not require that senior physicians pass additional assessments of health, competency, or quality performance. Studies suggest that physician performance, on average, declines with increasing years in medical practice, but the effect of age on an individual physician's competence is highly variable. Many senior physicians practice effectively and should be allowed to remain in practice as long as quality and safety are not endangered. Stakeholders in the medical profession should consider the need to develop guidelines and methods for monitoring and/or screening to ensure that senior physicians provide safe and effective care for patients. Any screening process needs to achieve a balance between protecting patients from harm due to substandard practice, while at the same time ensuring fairness to physicians and avoiding unnecessary reductions in workforce. PMID:27584000

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

    PubMed Central

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

    2010-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Juarez, Alfredo; Harper, Susana A.

    2016-01-01

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

  9. Ensuring optimal health care for LGBT patients.

    PubMed

    Glasper, Alan

    2016-07-14

    Emeritus Professor Alan Glasper, from the University of Southampton, discusses a Royal College of Nursing policy that highlights the complexities of providing high-quality and non-discriminatory health care. PMID:27409790

  10. Local Health Department Activities to Ensure Access to Care

    PubMed Central

    Luo, Huabin; Sotnikov, Sergey; Shah, Gulzar

    2016-01-01

    Background Local health departments (LHDs) can play an important role in linking people to personal health services and ensuring the provision of health care when it is otherwise unavailable. However, the extent to which LHDs are involved in ensuring access to health care in its jurisdictions is not well known. Purpose To provide nationally representative estimates of LHD involvement in specific activities to ensure access to healthcare services and to assess their association with macro-environment/community and LHD capacity and process characteristics. Methods Data used were from the 2010 National Profile of Local Health Departments Study, Area Resource Files, and the Association of State and Territorial Health Officials’ 2010 Profile of State Public Health Agencies Survey. Data were analyzed in 2012. Results Approximately 66.0% of LHDs conducted activities to ensure access to medical care, 45.9% to dental care, and 32.0% to behavioral health care. About 28% of LHDs had not conducted activities to ensure access to health care in their jurisdictions in 2010. LHDs with higher per capita expenditures and larger jurisdiction population sizes were more likely to provide access to care services (p <0.05). Conclusions There is substantial variation in LHD engagement in activities to ensure access to care. Differences in LHD capacity and the needs of the communities in which they are located may account for this variation. Further research is needed to determine whether this variation is associated with adverse population health outcomes. PMID:24237913

  11. 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. PMID:27035008

  12. 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…

  13. Systems and processes that ensure high quality care.

    PubMed

    Bassett, Sally; Westmore, Kathryn

    2012-10-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

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

    PubMed Central

    2014-01-01

    Background Type 1 diabetes is one of the most frequent long-term endocrine childhood disorders and the Swedish National Diabetes Register for children states that adolescents (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

  17. Family Structure Types and Adequate Utilization of Antenatal Care in Kenya.

    PubMed

    Owili, Patrick Opiyo; Muga, Miriam Adoyo; Chou, Yiing-Jenq; Hsu, Yi-Hsin Elsa; Huang, Nicole; Chien, Li-Yin

    2016-01-01

    Features of the health care delivery system may not be the only expounding factors of adequate utilization of antenatal care among women. Other social factors such as the family structure and its environment contribute toward pregnant women's utilization of antenatal care. An understanding of how women in different family structure types and social groups use basic maternal health services is important toward developing and implementing maternal health care policy in the post-Millennium Development Goal era, especially in the sub-Saharan Africa where maternal mortality still remains high. PMID:27214674

  18. Self-esteem, social support, and satisfaction differences in women with adequate and inadequate prenatal care.

    PubMed

    Higgins, P; Murray, M L; Williams, E M

    1994-03-01

    This descriptive, retrospective study examined levels of self-esteem, social support, and satisfaction with prenatal care in 193 low-risk postpartal women who obtained adequate and inadequate care. The participants were drawn from a regional medical center and university teaching hospital in New Mexico. A demographic questionnaire, the Coopersmith self-esteem inventory, the personal resource questionnaire part 2, and the prenatal care satisfaction inventory were used for data collection. Significant differences were found in the level of education, income, insurance, and ethnicity between women who received adequate prenatal care and those who received inadequate care. Women who were likely to seek either adequate or inadequate prenatal care were those whose total family income was $10,000 to $19,999 per year and high school graduates. Statistically significant differences were found in self-esteem, social support, and satisfaction between the two groups of women. Strategies to enhance self-esteem and social support have to be developed to reach women at risk for receiving inadequate prenatal care. PMID:8155221

  19. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... animal health, behavior, and well-being is conveyed to the attending veterinarian; (4) Guidance to... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION...

  2. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... on problems of animal health, behavior, and well-being is conveyed to the attending veterinarian; (4... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND...

  3. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... on problems of animal health, behavior, and well-being is conveyed to the attending veterinarian; (4... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND...

  4. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... on problems of animal health, behavior, and well-being is conveyed to the attending veterinarian; (4... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND...

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

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... animal health, behavior, and well-being is conveyed to the attending veterinarian; (4) Guidance to... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION...

  6. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... on problems of animal health, behavior, and well-being is conveyed to the attending veterinarian; (4... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND...

  7. [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

  8. 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.

  9. Health Workforce: Ensuring Adequate Supply and Distribution Remains Challenging. Testimony before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives.

    ERIC Educational Resources Information Center

    Heinrich, Janet

    The General Accounting Office's (GAO's) director of health care-public health issues testified before Congress regarding growing concerns about the adequacy of the health care work force and lessons learned from the experience of the National Health Service Corps (NHSC) in addressing the maldistribution of health care professionals. The following…

  10. [The pregnant employee in anaesthesia and intensive care - An evidence-based approach to designing adequate workplaces].

    PubMed

    Röher, Katharina; Göpfert, Matthias S

    2015-07-01

    In the light of a rising percentage of women among employees in anaesthesia and intensive care designing adequate workplaces for pregnant employees plays an increasingly important role. Here it is necessary to align the varied interests of the pregnant employee, fellow employees and the employer, where the legal requirements of the Maternity Protection Act ("Mutterschutzgesetz") form the statutory framework. This review describes how adequate workplaces for pregnant employees in anaesthesia and intensive care can be established considering the scientific evidence on the subject. PMID:26230896

  11. 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)

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

    PubMed

    Daniel, Marguerite; Mathias, Angela

    2012-10-01

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

  13. 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

  14. Ineffective Staff, Ineffective Supervision, or Ineffective Administration? Why Some Nursing Homes Fail to Provide Adequate Care.

    ERIC Educational Resources Information Center

    Sheridan, John E.; And Others

    1992-01-01

    This study involved 530 nursing staff working in 25 for-profit and nonprofit nursing homes, 2 of which failed to meet residential care standards. Nursing home climate in failed homes was perceived as being significantly lower in human relations and higher in laissez-faire and status orientation dimensions that the climate in the successful homes.…

  15. 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

  16. 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

  17. Are rehabilitation services for patients in UK eye clinics adequate? A survey of eye care professionals

    PubMed Central

    Gillespie-Gallery, H; Conway, M L; Subramanian, A

    2012-01-01

    Purpose The purpose of this study is to determine whether specific services such as emotional and family support are currently available in the United Kingdom for people with visual impairment. Methods A validated online survey was created and distributed to clinical staff in eye clinics (for example, ophthalmologists and optometrists) and rehabilitation staff (for example, social and rehabilitation workers) in the community, who worked with people with visual impairment. A total of 67 clinical and 42 rehabilitation staff completed the entire survey online. Results Only 67% of the respondents claimed their clinics provide emotional support and 44% of respondent's clinics provided family support. Clinical and rehabilitation staff have differences in opinion over what constitutes an essential service for a visually impaired patient. Rehabilitation staff considered emotional support and referral to social services as essential more often than clinical staff (P<0.05). There is some confusion over the type of personnel who provides each type of service, with some services showing substantial repetition. Conclusion In the clinics sampled, there appears to be an underprovision of emotional support (attentive listening plus constructive suggestions) and family support (emotional support and advice for family members) for visually impaired patients in the United Kingdom. There also seems to be some discrepancy in services that eye care professionals feel are available and previous reports by visually impaired patients of the service they receive. There is a need to develop standardised pathways across the United Kingdom, to solve some of these issues. PMID:22814804

  18. Health care strategy for ensuring work ability in an aging Korea.

    PubMed

    Park, Jungsun; Park, Jong-Tae; Kim, Soo Geun; Yoo, Cheol-In; Son, Junseok; Yim, Jun; Kim, Dae-Seong; Rhee, Kyung Young; Kim, Yangho

    2016-01-01

    The rapid aging trend in South Korea will cause a growing shortage of labor and decreasing quality of the labor force. The purpose of this commentary is to recommend a health care strategy to maintain and promote the work ability of employees in an aging Korea. Strategies to promote the work ability require the collaboration of governmental agencies at the central and local levels. First, the common goal should be the reinforcement of follow-up measure in general medical examinations and the promotion of healthy lifestyles for workers. Second, collaborating activities should be performed among the Worker's Health Center, the Health Promotion Center, and community health centers. In conclusion, health care strategies for ensuring the work ability in an aging Korea require the collaboration of governmental agencies at the central and local levels. PMID:27610236

  19. Disparate British Breast Reconstruction Utilization: Is Universal Coverage Sufficient to Ensure Expanded Care?

    PubMed Central

    Offodile, Anaeze C.

    2016-01-01

    Summary: Our intent is to improve the understanding of the ability of healthcare providers to deliver high-quality care as we approach an era of universal coverage. We adopted 2 unique vantage points in this article: (1) the mandated coverage for immediate breast reconstruction (IBR) surgery as a microcosmic surrogate for universal coverage overall and (2) we then scrutinized the respective IBR utilization rates in a contemporaneous system of 2 healthcare delivery models in the United Kingdom, that is, the public National Health Service trust versus private-sector hospitals. A literature review was performed for IBR rates across public trust and private-sector hospitals in the United Kingdom. The IBR rate among public trust hospitals was 17% compared with 43% in the private sector. In the trust hospital setting, the enactment of 2 government mandates, intended to increase the access to cancer care, seemed to fall short in maximizing the ability of surgical practitioners to deliver quality care to patients. Among women who did not receive IBR, 65% felt that they had received the sufficient amount of information to appropriately inform their decision. In addition, only 46% of this same cohort reported a consultation with a reconstructive surgeon preoperatively. Private-sector hospitals delivered better IBR care because of the likely presence of infrastructure and financial incentives for physicians. These results serve as a call for a better alignment between policy initiatives designed to expand care access and the perogatives of physicians to ensure an optimized delivery of the expanded care such policy mandates. PMID:27482486

  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

  1. 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

  2. Ensuring Quality Cancer Care: A Follow-Up Review of the Institute of Medicine’s Ten Recommendations for Improving the Quality of Cancer Care in America

    PubMed Central

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

    2011-01-01

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

  3. An Android-enabled mobile framework for ensuring quality of life through patient-centric care.

    PubMed

    Koufi, Vassiliki; Malamateniou, Flora; Vassilacopoulos, George

    2012-01-01

    The drive to achieve excellence in healthcare delivery while containing costs, underlies the need for a new generation of applications which facilitate the realization of a patient-centric care model. Under this emerging care model healthcare delivery can be integrated across the continuum of services, from prevention to follow up, and care can be coordinated across all settings. With care moving out into the community, health systems require real-time information to deliver coordinated care to patients. The integration of leading-edge technologies, such as mobile technology, with Personal Health Records (PHRs) can meet this requirement by making comprehensive and unified health information available to authorized users at any point of care or decision making through familiar environments such as Google's Android. This paper presents a framework that provides ubiquitous access to patients' PHRs via Android-enabled mobile devices. Where possible health information access and management is performed in a transparent way, thus enabling healthcare professionals to devote more time on practicing medicine and patients to manage their own health with the least possible intervention. This depends heavily on the context, which is collected by both Android-specific core system services and special purpose software agents with the latter being also responsible for preserving PHR data privacy. PMID:22874352

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

    PubMed

    Nash, David A

    2011-07-01

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

  5. 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

  6. 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…

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  8. 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…

  9. [Factors associated with adequate prenatal care and delivery in São Tomé and Príncipe, 2008-2009].

    PubMed

    Reis, Patrícia Alexandra da Graça Dantas Dos; Pereira, Claudia Cristina de Aguiar; Leite, Iuri da Costa; Theme Filha, Mariza Miranda

    2015-09-01

    We investigated factors associated with adequacy of prenatal and childbirth care for women in São Tomé and Príncipe. Data were analyzed from the Demographic and Health Survey on a sample of 1,326 newborn infants whose mothers were 15-49 years of age. The survey took place from September 2008 to March 2009. We used multilevel and multinomial logistic regression to analyze the association between demographic and socioeconomic factors and the target outcomes. Prenatal care was adequate in 26% of the sample, and 7% of deliveries were performed by physicians and 76% by nurses or nurse assistants. Statistically significant factors for prenatal care were birth order, maternal schooling, and index of economic well-being. The most important variables for adequate delivery were: birth order, maternal schooling, index of economic well-being, and place of residence. The study showed that socioeconomic factors have the greatest influence on adequate prenatal care and delivery. Future health policies should target social inequalities in São Tomé and Príncipe. PMID:26578017

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

    PubMed

    Sharpe, Virginia Ashby; Uchendu, Uchenna S

    2014-09-01

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

  11. Ensuring quality: a key consideration in scaling-up HIV-related point-of-care testing programs

    PubMed Central

    Fonjungo, Peter N.; Osmanov, Saladin; Kuritsky, Joel; Ndihokubwayo, Jean Bosco; Bachanas, Pam; Peeling, Rosanna W.; Timperi, Ralph; Fine, Glenn; Stevens, Wendy; Habiyambere, Vincent; Nkengasong, John N.

    2016-01-01

    Objective: The objective of the WHO/US President's Emergency Plan for AIDS Relief consultation was to discuss innovative strategies, offer guidance, and develop a comprehensive policy framework for implementing quality-assured HIV-related point-of-care testing (POCT). Methods: The consultation was attended by representatives from international agencies (WHO, UNICEF, UNITAID, Clinton Health Access Initiative), United States Agency for International Development, Centers for Disease Control and Prevention/President's Emergency Plan for AIDS Relief Cooperative Agreement Partners, and experts from more than 25 countries, including policy makers, clinicians, laboratory experts, and program implementers. Main outcomes: There was strong consensus among all participants that ensuring access to quality of POCT represents one of the key challenges for the success of HIV prevention, treatment, and care programs. The following four strategies were recommended: implement a newly proposed concept of a sustainable quality assurance cycle that includes careful planning; definition of goals and targets; timely implementation; continuous monitoring; improvements and adjustments, where necessary; and a detailed evaluation; the importance of supporting a cadre of workers [e.g. volunteer quality corps (Q-Corps)] with the role to ensure that the quality assurance cycle is followed and sustained; implementation of the new strategy should be seen as a step-wise process, supported by development of appropriate policies and tools; and joint partnership under the leadership of the ministries of health to ensure sustainability of implementing novel approaches. Conclusion: The outcomes of this consultation have been well received by program implementers in the field. The recommendations also laid the groundwork for developing key policy and quality documents for the implementation of HIV-related POCT. PMID:26807969

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

    PubMed

    Levin, Roger

    2004-09-01

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

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

    PubMed

    Smalley, Hannah K; Keskinocak, Pinar

    2016-03-01

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

  14. External Ventricular Catheters: Is It Appropriate to Use an Open/Monitor Position to Adequately Trend Intracranial Pressure in a Neuroscience Critical Care Environment?

    PubMed

    Sunderland, Nicole E; Villanueva, Nancy E; Pazuchanics, Susan J

    2016-10-01

    Intracranial pressure (ICP) monitoring can be an important assessment tool in critically and acutely ill patients. An external ventricular drain offers a comprehensive way to monitor ICP and drain cerebrospinal fluid. The Monro-Kellie hypothesis, Pascal's principle, and fluid dynamics were used to formulate an assumption that an open/monitor position on the stopcock is an adequate trending measure for ICP monitoring while concurrently draining cerebrospinal fluid. Data were collected from 50 patients and totaled 1053 separate number sets. The open/monitor position was compared with the clamped position every hour. An order for "open to drain" was needed for appropriate measurement and nursing care. Results showed the absolute average differences between open/monitor and clamped positions at 1.6268 mm Hg. This finding suggests that it is appropriate to use an open/monitor position via an external ventricular drain for adequate trending of patients' ICP. PMID:27579963

  15. Ensuring the Early Identification of Children with Special Needs: Strategies for Working with the Health Care Community. Resource Packet from the NECTAS Audio Conference (October 1, 1997).

    ERIC Educational Resources Information Center

    National Early Childhood Technical Assistance System, Chapel Hill, NC.

    This packet was assembled to share the contents of an audio conference sponsored by the National Early Childhood Technical Assistance System (NECTAS) on October 1, 1997. The purpose of the audio conference was to identify strategies for improving communication and working relationships with the health care community, including HMOs, to ensure the…

  16. 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…

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

    PubMed Central

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

    2012-01-01

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

  18. 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

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

    PubMed

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

    2009-11-01

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

  20. 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…

  1. Ensuring Quality Nursing Home Care

    MedlinePlus

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

    PubMed

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

    2016-02-01

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

  3. 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

  4. Subjects’ views of obligations to ensure post-trial access to drugs, care, and information: Qualitative results from the Experiences of Participants in Clinical Trials (EPIC) Study

    PubMed Central

    Sofaer, Neema; Thiessen, Carrie; Goold, Susan Dorr; Ballou, Janice; Getz, Kenneth A.; Koski, Greg; Krueger, Richard A.; Weissman, Joel S.

    2011-01-01

    Objectives To report the attitudes and opinions of subjects in US clinical trials about whether or not, and why, they should receive post-trial access (PTA) to the trial drug, care, and information. Design Focus groups, short self-administered questionnaires. Setting Boston, Dallas, Detroit, Oklahoma City. Participants Current and recent subjects in clinical trials, primarily for chronic diseases. Results Ninety-three individuals participated in ten focus groups. Many thought researchers, sponsors, health insurers, and others share obligations to facilitate PTA to the trial drug, if it benefited the subject, or to a therapeutic equivalent. Some thought PTA obligations include providing transition care (referrals to non-trial physicians or other trials, limited follow-up, short-term drug supply) or care for long-term adverse events. Others held, in contrast, that there are no PTA obligations regarding drugs or care. However, there was agreement that former subjects should receive information (drug name, dosage received, market approval date, long-term adverse effects, trial results). Participants frequently appealed to health need, cost, relationships, reciprocity, free choice, and sponsor self-interest to support their views. Many of their reasons overlapped with those commonly discussed by bioethicists. Conclusion Many participants in US trials for chronic conditions thought there are obligations to facilitate PTA to the trial drug at a “fair” price; these views were less demanding than those of non-US subjects in other studies. However, our participants’ views about informational obligations were broader than those of other subjects and many bioethicists. Our results suggest that the PTA debate should expand beyond the trial drug and aggregate results. PMID:19251971

  5. 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

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

    PubMed

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

    2015-01-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... provider has personnel with documented training certification and degree experience (Naval Architecture, Fire Science, etc.). (5) Resource provider has 24-hour availability of personnel and equipment,...

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

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... provider has personnel with documented training certification and degree experience (Naval Architecture, Fire Science, etc.). (5) Resource provider has 24-hour availability of personnel and equipment,...

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

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... provider has personnel with documented training certification and degree experience (Naval Architecture, Fire Science, etc.). (5) Resource provider has 24-hour availability of personnel and equipment,...

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... provider has personnel with documented training certification and degree experience (Naval Architecture, Fire Science, etc.). (5) Resource provider has 24-hour availability of personnel and equipment,...

  11. 33 CFR 155.4050 - Ensuring that the salvors and marine firefighters are adequate.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... provider has personnel with documented training certification and degree experience (Naval Architecture, Fire Science, etc.). (5) Resource provider has 24-hour availability of personnel and equipment,...

  12. 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…

  13. Towards ensuring gender equity.

    PubMed

    Basu, A

    1996-01-01

    All people should participate in the development process. Many, however, remain excluded from the benefits of development. For example, women are privy to only a small share of developmental opportunities. The goals of equality, development, and peace were stated during the Fourth World Conference on Women held in Beijing in September 1995. The author considers whether women truly have equitable access to literacy, education, food, nutrition, health, employment, and the political and economic decision making process. She stresses that the goals pronounced at the Fourth World Conference on Women must be backed up with the necessary resources, including institutions established at the local, state, and national levels to ensure that the objectives are implemented and the implementation is monitored. The author further argues that in order for women to achieve equality with men, all girls must have access to primary and secondary schools; basic literacy is inadequate. Moreover, gender stereotyping must be avoided and gender sensitization ensured at all levels. PMID:12347385

  14. Is a vegetarian diet adequate for children.

    PubMed

    Hackett, A; Nathan, I; Burgess, L

    1998-01-01

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

  15. 21 CFR 1404.900 - Adequate evidence.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 1404.900 Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a particular...

  16. 29 CFR 98.900 - Adequate evidence.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Adequate evidence. 98.900 Section 98.900 Labor Office of the Secretary of Labor GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 98.900 Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

  17. 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…

  18. 29 CFR 452.110 - Adequate safeguards.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Adequate safeguards. 452.110 Section 452.110 Labor... DISCLOSURE ACT OF 1959 Election Procedures; Rights of Members § 452.110 Adequate safeguards. (a) In addition to the election safeguards discussed in this part, the Act contains a general mandate in section...

  19. 29 CFR 452.110 - Adequate safeguards.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 2 2011-07-01 2011-07-01 false Adequate safeguards. 452.110 Section 452.110 Labor... DISCLOSURE ACT OF 1959 Election Procedures; Rights of Members § 452.110 Adequate safeguards. (a) In addition to the election safeguards discussed in this part, the Act contains a general mandate in section...

  20. 34 CFR 85.900 - Adequate evidence.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) Definitions § 85.900 Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a particular act or omission has occurred. Authority: E.O. 12549 (3 CFR, 1986 Comp., p. 189); E.O 12689 (3 CFR, 1989 Comp., p. 235); 20 U.S.C. 1082, 1094, 1221e-3 and 3474; and Sec....

  1. Americans Getting Adequate Water Daily, CDC Finds

    MedlinePlus

    ... medlineplus/news/fullstory_158510.html Americans Getting Adequate Water Daily, CDC Finds Men take in an average ... new government report finds most are getting enough water each day. The data, from the U.S. National ...

  2. Americans Getting Adequate Water Daily, CDC Finds

    MedlinePlus

    ... gov/news/fullstory_158510.html Americans Getting Adequate Water Daily, CDC Finds Men take in an average ... new government report finds most are getting enough water each day. The data, from the U.S. National ...

  3. Blood Pressure Management Controversies in Neurocritical Care.

    PubMed

    McNett, Molly; Koren, Jay

    2016-03-01

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

  4. 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…

  5. Virtual Oncological Networks--IT Support for an Evidence-based, Oncological Health Care Management.

    PubMed

    Heiden, Katja; Sinha, Monika; Böckmann, Britta

    2015-01-01

    An interdisciplinary and intersectoral coordinated therapy management along Clinical Practice Guidelines can ensure that all patients receive adequate diagnostic, treatment, and supportive services that lead most likely to optimal outcomes. Within the research project "Virtual Oncological Networks", guideline-compliant pathways are defined and enacted within a Health Care Management Platform to support treatment planning and ongoing care of oncological diseases. PMID:26262255

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

    PubMed

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

    2015-07-01

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

  7. Asbestos/NESHAP adequately wet guidance

    SciTech Connect

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

    1990-12-01

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

  8. 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…

  9. 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…

  10. 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.

  11. Purchasing a cycle helmet: are retailers providing adequate advice?

    PubMed Central

    Plumridge, E.; McCool, J.; Chetwynd, J.; Langley, J. D.

    1996-01-01

    OBJECTIVES: The aim of this study was to examine the selling of cycle helmets in retail stores with particular reference to the adequacy of advice offered about the fit and securing of helmets. METHODS: All 55 retail outlets selling cycle helmets in Christchurch, New Zealand were studied by participant observation. A research entered each store as a prospective customer and requested assistance to purchase a helmet. She took detailed field notes of the ensuing encounter and these were subsequently transcribed, coded, and analysed. RESULTS: Adequate advice for helmet purchase was given in less than half of the stores. In general the sales assistants in specialist cycle shops were better informed and gave more adequate advice than those in department stores. Those who have good advice also tended to be more good advice also tended to be more active in helping with fitting the helmet. Knowledge about safety standards was apparent in one third of sales assistants. Few stores displayed information for customers about the correct fit of cycle helmets. CONCLUSIONS: These findings suggest that the advice and assistance being given to ensure that cycle helmets fit properly is often inadequate and thus the helmets may fail to fulfil their purpose in preventing injury. Consultation between retailers and policy makers is a necessary first step to improving this situation. PMID:9346053

  12. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... requirements: (1) Offers an appropriate range of preventive, primary care, and specialty services that is adequate for the anticipated number of enrollees for the service area. (2) Maintains a network of providers... enrollment in its service area in accordance with the State's standards for access to care under this...

  13. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... requirements: (1) Offers an appropriate range of preventive, primary care, and specialty services that is adequate for the anticipated number of enrollees for the service area. (2) Maintains a network of providers... enrollment in its service area in accordance with the State's standards for access to care under this...

  14. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... requirements: (1) Offers an appropriate range of preventive, primary care, and specialty services that is adequate for the anticipated number of enrollees for the service area. (2) Maintains a network of providers... enrollment in its service area in accordance with the State's standards for access to care under this...

  15. 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

  16. 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…

  17. 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...

  18. Are PPS payments adequate? Issues for updating and assessing rates

    PubMed Central

    Sheingold, Steven H.; Richter, Elizabeth

    1992-01-01

    Declining operating margins under Medicare's prospective payment system (PPS) have focused attention on the adequacy of payment rates. The question of whether annual updates to the rates have been too low or cost increases too high has become important. In this article we discuss issues relevant to updating PPS rates and judging their adequacy. We describe a modification to the current framework for recommending annual update factors. This framework is then used to retrospectively assess PPS payment and cost growth since 1985. The preliminary results suggest that current rates are more than adequate to support the cost of efficient care. Also discussed are why using financial margins to evaluate rates is problematic and alternative methods that might be employed. PMID:10127450

  19. Ensuring excellence in immunization services.

    PubMed

    MacDonald, Pauline

    2016-01-01

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

  20. Ensuring the quality of asthma case management.

    PubMed

    Aït-Khaled, N; Enarson, D A

    2006-07-01

    An evaluation based on recording the number of patients and evaluating their treatment outcomes provides the information necessary to plan the provision of care, determine the analysis of the situation and revise practice if the results are not satisfactory. The standardised tools proposed for this evaluation are: a district register for new persistent asthma patients, quarterly reports of case finding and an annual report of cohort patient follow-up. The main indicators of quality of care based on register information given by the cohort analysis are the percentage of defaulters and the percentage of patients whose asthma is controlled or well controlled after 1 year of follow-up. The services involved in asthma management should be adapted to the local situation in each country. In particular, the health service structure and national guidelines must be respected, and services involved in asthma management should be implemented in stages. Operational research within the services is essential to ensure that the services provided are appropriate. This type of research involves the health personnel responsible for patient management, provides them with new knowledge and helps them to resolve problems they are confronted with on a regular basis. It also inspires critical thinking, which is crucial to both research and practice. PMID:16848332

  1. Two pathways ensuring social harmony

    NASA Astrophysics Data System (ADS)

    Konrad, Matthias; Pamminger, Tobias; Foitzik, Susanne

    2012-08-01

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

  2. 36 CFR 805.4 - Ensuring environmental documents are actually considered in Council decisionmaking.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... POLICY ACT § 805.4 Ensuring environmental documents are actually considered in Council decisionmaking. (a) Section 1505.1 of the NEPA regulations (40 CFR 1505.1) contains requirements to ensure adequate... the NEPA process begins, the point at which it ends, and the key officials required to...

  3. Ensuring the Health of Refugees: Taking a Broader Vision.

    ERIC Educational Resources Information Center

    Kuntz, Diane; And Others

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

  4. 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

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

    PubMed

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

    2014-10-10

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

  6. 4 CFR 200.14 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 4 Accounts 1 2011-01-01 2011-01-01 false Responsibility for maintaining adequate safeguards. 200....14 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining adequate technical, physical, and security safeguards to prevent unauthorized disclosure...

  7. 21 CFR 201.5 - Drugs; adequate directions for use.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Drugs; adequate directions for use. 201.5 Section...) DRUGS: GENERAL LABELING General Labeling Provisions § 201.5 Drugs; adequate directions for use. Adequate directions for use means directions under which the layman can use a drug safely and for the purposes...

  8. 21 CFR 201.5 - Drugs; adequate directions for use.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 4 2011-04-01 2011-04-01 false Drugs; adequate directions for use. 201.5 Section...) DRUGS: GENERAL LABELING General Labeling Provisions § 201.5 Drugs; adequate directions for use. Adequate directions for use means directions under which the layman can use a drug safely and for the purposes...

  9. 4 CFR 200.14 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 4 Accounts 1 2010-01-01 2010-01-01 false Responsibility for maintaining adequate safeguards. 200.14 Section 200.14 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PRIVACY ACT OF 1974 § 200.14 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining adequate technical, physical, and...

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

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  11. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  12. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... with the State's requirements for availability of services, as set forth in § 438.206. (e) CMS' right... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance... 42 Public Health 4 2010-10-01 2010-10-01 false Assurances of adequate capacity and services....

  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

  14. Ensuring Child Care for Working Families Act of 2012

    THOMAS, 112th Congress

    Rep. McDermott, Jim [D-WA-7

    2012-04-27

    09/26/2012 Referred to the Subcommittee on Early Childhood, Elementary, and Secondary Education. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  15. Ensuring the Power of Caring for One Child

    ERIC Educational Resources Information Center

    Silva, Peggy

    2006-01-01

    Schools must be places where powerful adults step into children's lives. Adolescence is the most difficult time in the course of building an individual's identity and sense of worth. In this article, the author emphasizes that all students should walk paths that enable them to make essential connections with the adults in their lives, and that it…

  16. Ensuring Veterans Access to Care Act of 2014

    THOMAS, 113th Congress

    Sen. Sanders, Bernard [I-VT

    2014-06-03

    06/04/2014 Read the second time. Placed on Senate Legislative Calendar under General Orders. Calendar No. 408. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  17. Selected topics in point-of-care testing. Urinalysis, pregnancy testing, microbiology, fecal occult blood, and other tests.

    PubMed

    Lee-Lewandrowski, E; Lewandrowski, K

    2001-06-01

    The menu of tests available at the point of care continues to expand. Many of these tests present unique opportunities to deploy point-of-care technologies in the home, outpatient, and hospital settings. The future will inevitably create new applications for POCT. The success of these efforts will be in part determined by how technologies for specific applications are selected and by the ability to manage new point-of-care tests as part of an organizational point-of-care program. The possibilities to improve patient care are obvious, provided adequate attention is paid to ensuring quality testing and to managing patient data from these novel technologies. PMID:11396091

  18. Comparison of four standards for determining adequate water intake of nursing home residents.

    PubMed

    Gaspar, Phyllis M

    2011-01-01

    Adequate hydration for nursing home residents is problematic. The purpose of this study was to compare four standards used to determine a recommended water intake among nursing home residents. Inconsistencies in the amount of water intake recommended based on the standards compared were identified. The standard based on height and weight provides the most individualized recommendation. An individualized recommendation would facilitate goal setting for the care plan of each older person and assist in the prevention of dehydration. It is essential that a cost-effective and clinically feasible approach to determine adequate water intake be determined for this population to prevent the adverse outcomes associated with dehydration. PMID:21469538

  19. Ensuring Maintenance of Oral Hygiene in Persons with Special Needs.

    PubMed

    Buda, Lisa V

    2016-07-01

    Patients with special needs often must rely on inadequately trained caregivers for oral health maintenance. Consequently, full compliance is often not achieved. It is crucial that dentists carefully consider restorative materials and restoration design to maximize durability and facilitate cleansing in these challenging circumstances. This article discusses materials selection, prosthetic design, and oral hygiene techniques for caregivers to ensure longevity and maintenance of oral health in the special needs population. PMID:27264852

  20. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 2 2011-07-01 2011-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain the administrative resources necessary to perform all of the program functions including...

  1. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  2. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  3. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  4. 7 CFR 4290.200 - Adequate capital for RBICs.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Adequate capital for RBICs. 4290.200 Section 4290.200 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND... Qualifications for the RBIC Program Capitalizing A Rbic § 4290.200 Adequate capital for RBICs. You must meet...

  5. 13 CFR 107.200 - Adequate capital for Licensees.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Adequate capital for Licensees... INVESTMENT COMPANIES Qualifying for an SBIC License Capitalizing An Sbic § 107.200 Adequate capital for... Licensee, and to receive Leverage. (a) You must have enough Regulatory Capital to provide...

  6. 13 CFR 107.200 - Adequate capital for Licensees.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Adequate capital for Licensees... INVESTMENT COMPANIES Qualifying for an SBIC License Capitalizing An Sbic § 107.200 Adequate capital for... Licensee, and to receive Leverage. (a) You must have enough Regulatory Capital to provide...

  7. 7 CFR 4290.200 - Adequate capital for RBICs.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Adequate capital for RBICs. 4290.200 Section 4290.200 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND... Qualifications for the RBIC Program Capitalizing A Rbic § 4290.200 Adequate capital for RBICs. You must meet...

  8. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  9. 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 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...

  10. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... ENVIRONMENTAL DATA SERVICE DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may certify an application, the Administrator must find... 15 Commerce and Foreign Trade 3 2011-01-01 2011-01-01 false Adequate exploration plan....

  11. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... ENVIRONMENTAL DATA SERVICE DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may certify an application, the Administrator must find... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Adequate exploration plan....

  12. 10 CFR 503.35 - Inability to obtain adequate capital.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Inability to obtain adequate capital. 503.35 Section 503.35 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS NEW FACILITIES Permanent Exemptions for New Facilities § 503.35 Inability to obtain adequate capital. (a) Eligibility. Section 212(a)(1)(D)...

  13. 10 CFR 503.35 - Inability to obtain adequate capital.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Inability to obtain adequate capital. 503.35 Section 503.35 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS NEW FACILITIES Permanent Exemptions for New Facilities § 503.35 Inability to obtain adequate capital. (a) Eligibility. Section 212(a)(1)(D)...

  14. "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…

  15. 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...

  16. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  17. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  18. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  19. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

  20. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

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

    PubMed

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

    2015-12-01

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

  2. Determining Adequate Margins in Head and Neck Cancers: Practice and Continued Challenges.

    PubMed

    Williams, Michelle D

    2016-09-01

    Margin assessment remains a critical component of oncologic care for head and neck cancer patients. As an integrated team, both surgeons and pathologists work together to assess margins in these complex patients. Differences in method of margin sampling can impact obtainable information and effect outcomes. Additionally, what distance is an "adequate or clear" margin for patient care continues to be debated. Ultimately, future studies and potentially secondary modalities to augment pathologic assessment of margin assessment (i.e., in situ imaging or molecular assessment) may enhance local control in head and neck cancer patients. PMID:27469263

  3. Ensuring Safe Use of Contact Lens Solution

    MedlinePlus

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

  4. Ensuring the Consistency of Silicide Coatings

    NASA Technical Reports Server (NTRS)

    Ramani, V.; Lampson, F. K.

    1982-01-01

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

  5. Ensuring the Safety of Your Endoscopic Procedure

    MedlinePlus

    ... an endoscope are as follows: Mechanical cleaning The operating channels and external portions of the endoscope are ... that there are no leaks in its internal operating channels. This not only ensures peak performance of ...

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

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

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

    Code of Federal Regulations, 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:...

  8. 41 CFR 51-7.3 - Ensuring environmental documents are actually considered in agency determinations.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  9. 41 CFR 51-7.3 - Ensuring environmental documents are actually considered in agency determinations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 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:...

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

    PubMed

    Zobel, Richard W

    2016-01-01

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

  11. Ensuring equine biosecurity at London 2012.

    PubMed

    Slater, Josh

    2013-02-01

    The London 2012 Olympic and Paralympic Equestrian Games were the highest profile event in the 2012 equestrian calendar and were the culmination of four years of detailed and meticulous biosecurity planning to ensure that all horses arrived, competed and returned home safely and in good health. Josh Slater, Anthony Greenleaves and Andy Paterson describe how this was achieved. PMID:23378308

  12. Subcutaneous immunoglobulin replacement therapy: ensuring success.

    PubMed

    Younger, M Elizabeth M; Blouin, William; Duff, Carla; Epland, Kristin Buehler; Murphy, Elyse; Sedlak, Debra

    2015-01-01

    Subcutaneous immunoglobulin (SCIg) infusions are an option for patients requiring immunoglobulin therapy. Nurses are uniquely positioned to advocate for patients and to teach them how to successfully manage their infusions. The purpose of this review is to describe SCIg therapy and to provide teaching instructions as well as creative tips to ensure treatment success. PMID:25545976

  13. 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...

  14. Structuring the Talk: Ensuring Academic Conversations Matter

    ERIC Educational Resources Information Center

    Frey, Nancy; Fisher, Douglas

    2011-01-01

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

  15. 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. 305.3 Section 305.3 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY INSPECTION AND CERTIFICATION...

  16. 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.…

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

    ERIC Educational Resources Information Center

    Menon, Maria Eliophotou

    2012-01-01

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

  18. Is the Marketing Concept Adequate for Continuing Education?

    ERIC Educational Resources Information Center

    Rittenburg, Terri L.

    1984-01-01

    Because educators have a social responsibility to those they teach, the marketing concept may not be adequate as a philosophy for continuing education. In attempting to broaden the audience for continuing education, educators should consider a societal marketing concept to meet the needs of the educationally disadvantaged. (SK)

  19. 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…

  20. 34 CFR 200.13 - Adequate yearly progress in general.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 1 2011-07-01 2011-07-01 false Adequate yearly progress in general. 200.13 Section 200.13 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION TITLE I-IMPROVING THE ACADEMIC ACHIEVEMENT OF THE...

  1. 34 CFR 200.20 - Making adequate yearly progress.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 1 2011-07-01 2011-07-01 false Making adequate yearly progress. 200.20 Section 200.20 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION TITLE I-IMPROVING THE ACADEMIC ACHIEVEMENT OF THE DISADVANTAGED...

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

    ERIC Educational Resources Information Center

    Gerdes, Karen E.; And Others

    1995-01-01

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

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

    PubMed

    Crul, B J; van Weel, C

    2001-10-20

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

  4. 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

  5. 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

  6. Ensuring preparedness: Testing an emergency action plan

    SciTech Connect

    Gibson, J.Z.; Hildebrand, L.G. )

    1992-12-01

    For dam owners, having a plan for responding to dam failure is not enough. To ensure that operating personnel and local authorities and emergency response agencies are prepared, the plan needs to be tested periodically. This article describes how Washington Water Power tested its emergency action plan at its Cabinet Gorge project in September, 1990. The objectives, details, and critique of the test are described, as is FERC's five-level exercise testing program.

  7. Ensuring Quality in AFRINEST and SATT

    PubMed Central

    2013-01-01

    Background: Three randomized open-label clinical trials [Simplified Antibiotic Therapy Trial (SATT) Bangladesh, SATT Pakistan and African Neonatal Sepsis Trial (AFRINEST)] were developed to test the equivalence of simplified antibiotic regimens compared with the standard regimen of 7 days of parenteral antibiotics. These trials were originally conceived and designed separately; subsequently, significant efforts were made to develop and implement a common protocol and approach. Previous articles in this supplement briefly describe the specific quality control methods used in the individual trials; this article presents additional information about the systematic approaches used to minimize threats to validity and ensure quality across the trials. Methods: A critical component of quality control for AFRINEST and SATT was striving to eliminate variation in clinical assessments and decisions regarding eligibility, enrollment and treatment outcomes. Ensuring appropriate and consistent clinical judgment was accomplished through standardized approaches applied across the trials, including training, assessment of clinical skills and refresher training. Standardized monitoring procedures were also applied across the trials, including routine (day-to-day) internal monitoring of performance and adherence to protocols, systematic external monitoring by funding agencies and external monitoring by experienced, independent trial monitors. A group of independent experts (Technical Steering Committee/Technical Advisory Group) provided regular monitoring and technical oversight for the trials. Conclusions: Harmonization of AFRINEST and SATT have helped to ensure consistency and quality of implementation, both internally and across the trials as a whole, thereby minimizing potential threats to the validity of the trials’ results. PMID:23945575

  8. Assessing juvenile sex offenders to determine adequate levels of supervision.

    PubMed

    Gerdes, K E; Gourley, M M; Cash, M C

    1995-08-01

    The present study analyzed the internal consistency of four inventories currently being used by probation officers in the state of Utah to determine adequate and efficacious supervision levels and placement for juvenile sex offenders. The internal consistency or reliability of the inventories ranged from moderate to good. Factor analysis was utilized to significantly increase the reliability of the four inventories by collapsing them into the following three factors: (a) Custodian's and Juvenile's Attitude Toward Intervention; (b) Offense Characteristics; and (c) Historical Risk Factors. These three inventories/factors explained 41.2% of the variance in the combined inventories' scores. Suggestions are made regarding the creation of an additional inventory. "Characteristics of the Victim" to account for more of the variance. In addition, suggestions as to how these inventories can be used by probation officers to make objective and consistent decisions about adequate supervision levels and placement for juvenile sex offenders are discussed. PMID:7583754

  9. Do low standing biomass and leaf area index of sub-tropical coastal dunes ensure that plants have an adequate supply of water?

    PubMed

    Ripley, Brad S; Pammenter, Norman W

    2004-05-01

    Water status in relation to standing biomass and leaf area indices (LAI) of the subtropical foredune species Arctotheca populifolia, Ipomoea pes-caprae and Scaevola plumieri were studied in the Eastern Cape, South Africa. The plants showed little evidence of water stress, never developing leaf water potentials more negative than -1.55 MPa, a value which is typical of mesophytes rather than xerophytes. The plants showed no seasonal changes in osmotic potential, an indication that they did not need to osmoregulate, nor were there significant alterations in tissue elasticity. Turgor potential for the most part remained positive throughout the day or recovered positive values at night, a condition suitable for the maintenance of growth that may be essential to cope with sand accretion. All three species show relatively high transpiration rates and only I. pes-caprae showed any evidence of strong limitations of transpiration rate through reductions in midday stomatal conductance. All three species had relatively high instantaneous water use efficiencies as a result of high assimilation rates rather than low transpiration rates. Simple water budgets, accounting for losses by transpiration and inputs from rainfall, suggest that the water stored in the dune sands is sufficient to meet the requirements of the plants, although water budgets calculated for I. pes-caprae suggest that this species may on occasion be water limited. The results suggest that it is the low biomass and LAI that lead to these favourable water relations. PMID:15042456

  10. Nurse Delegation in Home Care: Research Guiding Policy Change.

    PubMed

    Young, Heather M; Farnham, Jennifer; Reinhard, Susan C

    2016-09-01

    The current study evaluated nurse delegation in home care, a pilot program introduced in 2007 in New Jersey to promote home care options for consumers needing assistance with medical/nursing tasks. Findings on readiness for the program, barriers and facilitating factors, experience with the program, and recommendations are summarized and presented. Methods included surveys and interviews with participants in nurse delegation, observations of planning and implementation meetings, and review meeting minutes. Major findings were no negative outcomes for consumers, improvements in quality of life and quality of care for consumers, high readiness and increasing satisfaction with experience in delegation, perception of nurse delegation in home care as a valued option, and the challenges of ensuring adequate staffing. Subsequent changes in regulation in New Jersey are underway, translating this research into policy. [Journal of Gerontological Nursing, 42(9), 7-15.]. PMID:27571400

  11. Three factors critical for end-of-life care.

    PubMed

    Franey, S G

    1996-01-01

    Appropriate care of persons with life-threatening illnesses requires a different, perhaps higher level of response from organized healthcare than has been typical in the past. This involves three critical components: Leaders must be committed, visible advocates of high-quality end-of-life care. This enables them to plan changes, deploy resources, and integrate this commitment throughout the organization's strategic plan. Ensuring appropriate care of the dying requires adequate human and financial resources. First, the organization must fully identify the educational and service needs of patients, families, and care givers experiencing life-threatening illnesses. The organization must work well with other community-based organizations to address identified needs. Senior managers can improve care by personally commissioning teams, acknowledging success, and rewarding performance. Finally, organizational goals, strategies, and performance objectives must be shaped by a commitment to ensure appropriate care of the dying. Our commitment to the dying must be based on our values. An organizational "statement of rights and responsibilities" is one way of providing a visible expression of the mission, core values, and mutual responsibilities among care givers and patients, residents, HMO members, and clients. PMID:10161793

  12. Patient safety and hydration in the care of older people.

    PubMed

    Burns, Julie

    2016-05-01

    Ensuring patients are adequately hydrated is a fundamental part of nursing care, however, it is clear from the literature that dehydration remains a significant problem in the NHS with implications for patient safety. The development of dehydration is often multifactorial and older age is an independent risk factor for the condition. However, the media often blame nursing staff for simply not giving patients enough to drink. This article discusses the scale of the problem in acute care settings and aims to raise awareness of the importance of hydration management and accurate documentation in nursing practice. It suggests that intentional hourly rounding may provide an opportunity for nurses to ensure older patients are prompted or assisted to take a drink. PMID:27125939

  13. Investing in Nurses is a Prerequisite for Ensuring Universal Health Coverage.

    PubMed

    Kurth, Ann E; Jacob, Sheena; Squires, Allison P; Sliney, Anne; Davis, Sheila; Stalls, Suzanne; Portillo, Carmen J

    2016-01-01

    Nurses and midwives constitute the majority of the global health workforce and the largest health care expenditure. Efficient production, successful deployment, and ongoing retention based on carefully constructed policies regarding the career opportunities of nurses, midwives, and other providers in health care systems are key to ensuring universal health coverage. Yet nurses are constrained by practice regulations, workplaces, and career ladder barriers from contributing to primary health care delivery. Evidence shows that quality HIV care, comparable to that of physicians, is provided by trained nurses and associate clinicians, but many African countries' health systems remain dependent on limited numbers of physicians and fail to meet the demand for treatment. The World Health Organization endorses task sharing to ensure universal health coverage in HIV and maternal health, which requires an investment in nursing education, retention, and professional growth opportunities. Exemplars from Haiti, Rwanda, Republic of Georgia, and multi-country efforts are described. PMID:27086193

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

    PubMed Central

    Brown, Marty Skemp; Maurer, Martha A

    2014-01-01

    Abstract Objective To determine whether national drug control laws ensure that opioid drugs are available for medical and scientific purposes, as intended by the 1972 Protocol amendment to the 1961 Single Convention on Narcotic Drugs. Methods The authors examined whether the text of a convenience sample of drug laws from 15 countries: (i) acknowledged that opioid drugs are indispensable for the relief of pain and suffering; (ii) recognized that government was responsible for ensuring the adequate provision of such drugs for medical and scientific purposes; (iii) designated an administrative body for implementing international drug control conventions; and (iv) acknowledged a government’s intention to implement international conventions, including the Single Convention. Findings Most national laws were found not to contain measures that ensured adequate provision of opioid drugs for medical and scientific purposes. Moreover, the model legislation provided by the United Nations Office on Drugs and Crime did not establish an obligation on national governments to ensure the availability of these drugs for medical use. Conclusion To achieve consistency with the Single Convention, as well as with associated resolutions and recommendations of international bodies, national drug control laws and model policies should be updated to include measures that ensure drug availability to balance the restrictions imposed by the existing drug control measures needed to prevent the diversion and nonmedical use of such drugs. PMID:24623904

  15. Cross-functional support ensures success.

    PubMed

    Paree, Tim

    2012-04-01

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

  16. 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

  17. Adequation of mini satellites to oceanic altimetry missions

    NASA Astrophysics Data System (ADS)

    Bellaieche, G.; Aguttes, J. P.

    1993-01-01

    Association of the mini satellite concept and oceanic altimetry missions is discussed. Mission definition and most constraining requirements (mesoscale for example) demonstrate mini satellites to be quite adequate for such missions. Progress in altimeter characteristics, orbit determination, and position reporting allow consideration of oceanic altimetry missions using low Earth orbit satellites. Satellite constellation, trace keeping and orbital period, and required payload characteristics are exposed. The mission requirements covering Sun synchronous orbit, service area, ground system, and launcher characteristics as well as constellation maintenance strategy are specified. Two options for the satellite, orbital mechanics, propulsion, onboard power and stabilizing subsystems, onboard management, satellite ground linkings, mechanical and thermal subsystems, budgets, and planning are discussed.

  18. 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

  19. 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.

  20. Outsourcing your medical practice call center: how to choose a vendor to ensure regulatory compliance.

    PubMed

    Johnson, Bill

    2014-01-01

    Medical practices receive hundreds if not thousands of calls every week from patients, payers, pharmacies, and others. Outsourcing call centers can be a smart move to improve efficiency, lower costs, improve customer care, ensure proper payer management, and ensure regulatory compliance. This article discusses how to know when it's time to move to an outsourced call center, the benefits of making the move, how to choose the right call center, and how to make the transition. It also provides tips on how to manage the call center to ensure the objectives are being met. PMID:25807604

  1. 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

  2. Ensuring patient satisfaction in medical groups.

    PubMed

    Choong, P

    2000-01-01

    Delivering satisfaction to patients has become increasingly important among professionals in the medical community. However, administrators in medical group practices charged with the task of nurturing customer satisfaction are often required to allocate their limited funds across an array of initiatives intended to ensure the delivery of the right amount and types of services to improve satisfaction among their customers. This requires the ability to locate areas that yield the greatest response per unit of investment. This paper shows that the impact of attribute performance on satisfaction is asymmetric. Positive attribute performance is shown to have a smaller impact on satisfaction than negative attribute performance. The paper also discusses how an understanding of this asymmetry will enable administrators to allocate their resources more wisely as they decide whether to maintain or increase attribute-level performance. PMID:10787726

  3. The role of corporations in ensuring biodiversity

    NASA Astrophysics Data System (ADS)

    Kelly, Joyce M.; Hodge, Michael R.

    1996-11-01

    Corporations own approximately 25% of all private land in the United States and, therefore, play an essential role in protecting biodiversity and maintaining natural habitats. The Wildlife Habitat Council (WHC) is a unique joint venture between conservation organizations and corporations to utilize corporate lands for ensuring biodiversity. The following case studies demonstrate how corporations have helped ensure healthy ecosystems and provided critical leadership in regional efforts. Amoco Chemical Company's Cooper River Plant has been instrumental in developing a cooperative project that involves numerous corporations, plantation owners, private citizens, nonprofit organizations, government agencies, and community groups to develop a comprehensive, ecosystem-based management plan for part of the Cooper River in Charleston, South Carolina, USA. The second case focuses on the Morie Company, a national sand quarry operator headquartered in southern New Jersey, USA. Morie Company is working with WHC, community groups, the Pinelands Commission, and other state regulatory agencies to explore sustainable development opportunities for companies within the Pinelands regulations. The third case takes us to DuPont Company's Asturias, Spain, site. A 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.

  4. 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.

  5. 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

  6. Mobile intensive care unit. Present conception and realisation.

    PubMed

    Reinhold, H; Hanegreefs, G; Hanquet, M; Rolly, G; de Temmerman, P; Van De Walle, J; Delooz, H

    1976-01-01

    A new Mobile Intensive Care Unit has been put in use at the "Service 900" of the Ministry of Health in Belgium. Its size was decided to enable efficient treatment of one patient. The type of suspension was chosen to give the patient adequate protection against untoward effects of travelling sickness. Radio-communication with the control center and hospital is ensured. The O2 supply-system provides an autonomy of 11 hours. Besides an electric distribution of 12 V. DC, a 220 V. AC is also available. PMID:1070899

  7. Preparation of patients for anaesthesia - achieving quality care.

    PubMed

    Lau, L; Jan, G; Chan, T F

    2002-04-01

    Implementation of anaesthesia begins with a preoperative assessment of the surgical patient and development of an anaesthetic plan. Preparation of the patient includes the preoperative assessment, review of preoperative tests, optimisation of medical conditions, adequate preoperative fasting, appropriate premedication, and the explanation of anaesthetic risk to patients. The goals of preoperative preparation are to reduce the morbidity of surgery, to increase the quality while decreasing the cost of perioperative care, and to return the patient to desirable functioning as quickly as possible. A knowledgeable anaesthesiologist is the 'final clinical gatekeeper', who coordinates perioperative management and ensures that the patient is in the optimal state for anaesthesia and surgery. PMID:11937664

  8. How to ensure quality of health accounts.

    PubMed

    van Mosseveld, Cornelis; Hernández-Peña, Patricia; Arán, Daniel; Cherilova, Veneta; Mataria, Awad

    2016-05-01

    Policy makers need up-to-date and reliable information to formulate health policies and monitor their implementation. Given that financing is one of the pillars of the health system, quality of financing data is essential. Quality is a key element but difficult to measure. Increasing quality on financing data involves the use of standard procedures and methods. Current standard framework, the System of Health Accounts 2011, needs to be implemented with checks and controls on the individual as well as aggregated data. Data input on the construction of the accounts and their related metadata are subject to quality measures. In this paper we address a first proposal of the components of the quality in health accounts reporting. The paper assesses Quality Of Health Accounts at four stages: (1) Design; (2) Development; (3) Management; and (4) Reporting. It explains what is needed at each stage to ensure reliable results which are fit for informing decision-making. Quality is essential for reliability and trust among all stakeholders, who are responsible of data provision, construction of the accounts and using their results. Quality measurement in health accounts is a reality needing effort. PMID:27048758

  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. Universal health insurance in India: ensuring equity, efficiency, and quality.

    PubMed

    Prinja, Shankar; Kaur, Manmeet; Kumar, Rajesh

    2012-07-01

    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

  11. Providing care to children in times of war.

    PubMed

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

    2015-06-01

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

  12. Timely Access to Quality Health Care Among Georgia Children Ages 4 to 17 Years

    PubMed Central

    Ogbuanu, Chinelo; Goodman, David A.; Kahn, Katherine; Long, Cherie; Noggle, Brendan; Bagchi, Suparna; Barradas, Danielle; Castrucci, Brian

    2015-01-01

    We examined factors associated with children's access to quality health care, a major concern in Georgia, identified through the 2010 Title V Needs Assessment. Data from the 2007 National Survey of Children's Health were merged with the 2008 Area Resource File and Health Resources and Services Administration medically under-served area variable, and restricted to Georgia children ages 4–17 years (N = 1,397). The study outcome, access to quality health care was derived from access to care (timely utilization of preventive medical care in the previous 12 months) and quality of care (compassionate/culturally effective/family-centered care). Andersen's behavioral model of health services utilization guided independent variable selection. Analyses included Chi-square tests and multinomial logit regressions. In our study population, 32.8 % reported access to higher quality care, 24.8 % reported access to moderate quality care, 22.8 % reported access to lower quality care, and 19.6 % reported having no access. Factors positively associated with having access to higher/moderate versus lower quality care include having a usual source of care (USC) (adjusted odds ratio, AOR:3.27; 95 % confidence interval, 95 % CI 1.15–9.26), and special health care needs (AOR:2.68; 95 % CI 1.42–5.05). Lower odds of access to higher/moderate versus lower quality care were observed for non-Hispanic Black (AOR:0.31; 95 % CI 0.18–0.53) and Hispanic (AOR:0.20; 95 % CI 0.08–0.50) children compared with non-Hispanic White children and for children with all other forms of insurance coverage compared with children with continuous-adequate-private insurance. Ensuring that children have continuous, adequate insurance coverage and a USC may positively affect their access to quality health care in Georgia. PMID:23054451

  13. Environmental education: Ensuring a sustainable future

    SciTech Connect

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

    1997-12-31

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

  14. 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.

  15. 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.

  16. Adequate peritoneal dialysis: theoretical model and patient treatment.

    PubMed

    Tast, C

    1998-01-01

    The objective of this study was to evaluate the relationship between adequate PD with sufficient weekly Kt/V (2.0) and Creatinine clearance (CCR) (60l) and necessary daily dialysate volume. This recommended parameter was the result of a recent multi-centre study (CANUSA). For this there were 40 patients in our hospital examined and compared in 1996, who carried out PD for at least 8 weeks and up to 6 years. These goals (CANUSA) are easily attainable in the early treatment of many individuals with a low body surface area (BSA). With higher BSA or missing RRF (Residual Renal Function) the daily dose of dialysis must be adjusted. We found it difficult to obtain the recommended parameters and tried to find a solution to this problem. The simplest method is to increase the volume or exchange rate. The most expensive method is to change from CAPD to APD with the possibility of higher volume or exchange rates. Selection of therapy must take into consideration: 1. patient preference, 2. body mass, 3. peritoneal transport rates, 4. ability to perform therapy, 5. cost of therapy and 6. risk of peritonitis. With this information in mind, an individual prescription can be formulated and matched to the appropriate modality of PD. PMID:10392062

  17. 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…

  18. 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...

  19. 40 CFR 142.306 - What are the responsibilities of the public water system, State and the Administrator in ensuring...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... meets the source water quality requirements for installing the small system variance technology... through compliance with § 142.307, ensure adequate protection of human health, considering the following: (i) The quality of the source water for the public water system; and (ii) Removal efficiencies...

  20. 40 CFR 142.306 - What are the responsibilities of the public water system, State and the Administrator in ensuring...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... meets the source water quality requirements for installing the small system variance technology... through compliance with § 142.307, ensure adequate protection of human health, considering the following: (i) The quality of the source water for the public water system; and (ii) Removal efficiencies...

  1. 40 CFR 142.306 - What are the responsibilities of the public water system, State and the Administrator in ensuring...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... meets the source water quality requirements for installing the small system variance technology... through compliance with § 142.307, ensure adequate protection of human health, considering the following: (i) The quality of the source water for the public water system; and (ii) Removal efficiencies...

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

    PubMed Central

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

    2001-01-01

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

  3. Challenges and solutions ensuring EUVL photomask integrity

    NASA Astrophysics Data System (ADS)

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

    2012-06-01

    significant role to ensure EUV mask integrity. With this concept in mind a system for particle detection has been integrated into MTP InSync. This allows verifying the POR performance for backside cleaning by measuring particles down to 150nm size. A dynamic capture rate of larger 97% at 200nm particle size based on PSLs was achieved; for EIP cleaning, a dry-cleaning technology is under investigation. During feasibility studies high particle removal efficiency (PRE) results larger 99% has been achieved for particles down to 100nm. In this paper, the full scope and roadmap of the MTP InSync will be discussed. Preliminary results of backside particle detection and challenges on EUV Inner Pod (EIP) cleaning will be presented.

  4. Ensuring the survival of the clinician-scientist.

    PubMed

    Schrier, R W

    1997-07-01

    Many forces threaten the survival of the clinician-scientist as an academic species, among them: (1) the changing health environment; (2) the complexity of and rapid advances in biomedical science, which necessitate that MD-PhD graduates "retool" after completing their clinical training; (3) the length and rigor of the research training required to train clinician-scientists adequately; (4) the scarcity of funding for subspecialty training positions; (5) the perception that the successful clinician-scientists in academic medicine are those who focus on basic, rather than clinical, research; (6) the indebtedness of young physicians when they complete medical schools; (7) the fierce competition for research funding; and (8) pessimism among senior faculty about the clinician-scientist's potential for survival. There are solutions to these issues that must be vigorously pursued to ensure the survival of the clinician-scientist: (1) Rigorous six- to seven-year programs (e.g., two in internal medicine, four to five in a subspecialty) for physicians must be established. They should include a minimum of three years of research and should lead to board certification in internal medicine, pediatrics, psychiatry, etc., board certification in a subspecialty, and a PhD in clinical science. (2) These programs must have a choice of three tracks, (a) disease-oriented basic research, (b) clinical investigation in patients, and (c) health services research. Such a program--the PhD in Clinical Science program--has recently been approved and begun at the University of Colorado. (3) Funding organizations such as the National Institutes of Health should designate their training resources primarily for programs with a minimum of three years of formal and rigorous research training. (4) These rigorous research training programs must be integrated with young-faculty awards for clinician-scientists to ensure continuity in their investigative careers. (5) Loan-repayment programs must be

  5. Human subject protection in India - is it adequate?

    PubMed

    Mahaluxmivala, Narges

    2010-01-01

    India's experience in clinical trials is shorter in time than that of the developed countries but as in everything else in the current globalizing environment, business compulsions characterized by compressed timelines are strong persuaders to catch up. Most global pharmaceutical and biotechnology organizations include India in their strategic plans, Immediate implementation of aspects that attract benefit are an urgent necessity. Technical and ethical issues that remain unresolved constrain India from reaching its deserved potential. To take fullest advantage of the current inflow of clinical trials, India must adopt, without delay, an all-inclusive approach and invest in a widespread and comprehensive GCP-compliance programme taking into account India-related cultural and socioeconomic issues. The initiative should not be allowed to flag. Government, the pharmaceutical and biotechnological research industries, the medical and pharmacy profession including relevant training institutes, the media and the public have a stake in such investment. The programme should involve assessing gaps in current clinical trial compliance measures and possible solutions, set the field for rectification and ensure implementation through mandate and penalty as feasible. PMID:21829776

  6. Human Subject Protection In India – Is It Adequate?

    PubMed Central

    Mahaluxmivala, Narges

    2010-01-01

    India′s experience in clinical trials is shorter in time than that of the developed countries but as in everything else in the current globalizing environment, business compulsions characterized by compressed timelines are strong persuaders to catch up. Most global pharmaceutical and biotechnology organizations include India in their strategic plans, Immediate implementation of aspects that attract benefit are an urgent necessity. Technical and ethical issues that remain unresolved constrain India from reaching its deserved potential. To take fullest advantage of the current inflow of clinical trials, India must adopt, without delay, an all-inclusive approach and invest in a widespread and comprehensive GCP-compliance programme taking into account India-related cultural and socioeconomic issues. The initiative should not be allowed to flag. Government, the pharmaceutical and biotechnological research industries, the medical and pharmacy profession including relevant training institutes, the media and the public have a stake in such investment. The programme should involve assessing gaps in current clinical trial compliance measures and possible solutions, set the field for rectification and ensure implementation through mandate and penalty as feasible. PMID:21829776

  7. A curriculum to ensure nursing staff competency.

    PubMed

    Maylor, Miles E

    Nurses and healthcare assistants (HCAs) involved in tissue viability are expected to be competent, but there is little agreement over how to define competence or the expertise required by people filling different roles. Most training in England is provided in house by tissue viability nurses or interested non-specialists; England is lagging behind Scotland and Wales in terms of learning materials and other resources. Staff members at a strategic health authority were surveyed so a consensus could be reached over a basic curriculum for tissue viability and the competence expected of nurses and HCAs at different levels of seniority. Respondents agreed that five topics should be covered by both nurses and HCAs: wound healing; leg ulceration; pressure ulceration; diabetic foot; and skin care. Levels of expertise and competence would depend on seniority. The curriculum provides a checklist that local tissue viability nurses can use as a basis for training colleagues. Trusts and educational providers should set a curriculum for tissue viability and standards of competence. PMID:22874826

  8. Developing nursing care plans.

    PubMed

    Ballantyne, Helen

    2016-02-24

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

  9. 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

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

    NASA Technical Reports Server (NTRS)

    Chullen, Cinda

    2011-01-01

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

  11. Ensuring US National Aeronautics Test Capabilities

    NASA Technical Reports Server (NTRS)

    Marshall, Timothy J.

    2010-01-01

    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.

  12. 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

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

    ERIC Educational Resources Information Center

    Schock, Lisa; Daugherty, Jane

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

  14. 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

  15. Is reimbursement for childhood immunizations adequate? evidence from two rural areas in colorado.

    PubMed Central

    Glazner, J. E.; Steiner, J. F.; Haas, K. J.; Renfrew, B.; Deutchman, M.; Berman, S.

    2001-01-01

    OBJECTIVE: To assess adequacy of reimbursement for childhood vaccinations in two rural regions in Colorado, the authors measured medical practice costs of providing childhood vaccinations and compared them with reimbursement. METHODS: A "time-motion" method was used to measure labor costs of providing vaccinations in 13 private and public practices. Practices reported non-labor costs. The authors determined reimbursement by record review. RESULTS: The average vaccine delivery cost per dose (excluding vaccine cost) ranged from $4.69 for community health centers to $5.60 for private practices. Average reimbursement exceeded average delivery costs for all vaccines and contributed to overhead in private practices. Average reimbursement was less than total cost (vaccine-delivery costs + overhead) in private practices for most vaccines in one region with significant managed care penetration. Reimbursement to public providers was less than the average vaccine delivery costs. CONCLUSIONS: Current reimbursement may not be adequate to induce private practices to provide childhood vaccinations, particularly in areas with substantial managed care penetration. PMID:12034911

  16. Design as a Critical Tool in Bariatric Patient Care

    PubMed Central

    Wignall, Doug

    2008-01-01

    Both men and women in the United States are roughly an inch taller and 25 pounds heavier than they were in 1960, says the National Center for Health Statistics at the Centers for Disease Control and Prevention. An increasing number are also overweight or obese. In fact, obesity has become an alarming epidemic with enormous implications for our health care system. A critical concern is the ability to care physically and emotionally for this segment of the patient population. Respecting patient dignity and delivering optimum clinical care are primary issues, as are establishing procedures for safeguarding the health and well-being of these patients and their caregivers. Design is a critical tool in the care of and the improved long-term clinical outcomes for bariatric patients; success mandates a three-prong approach to the design process: appropriate facilities and space, proper equipment and furnishings, and training and standardized care protocols. Together, these components ensure the ability of a health care provider to adequately care for all patients—including this newest and rapidly growing patient segment—with equality and dignity. PMID:19885353

  17. 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…

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

    MedlinePlus

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

  19. Identifying Markers of Dignity-Conserving Care in Long-Term Care: A Modified Delphi Study

    PubMed Central

    Thompson, Genevieve N.; McArthur, Jennifer; Doupe, Malcolm

    2016-01-01

    Ensuring that people living in nursing homes (NHs) are afforded with dignity in their daily lives is an essential and humane concern. Promoting dignity-conserving care is fundamentally important. By nature, however, this care is all-encompassing and holistic, and from current knowledge it is challenging to create explicit strategies for measuring dignity-conserving care. In practice the majority of current NH indicators of quality care are derived from information that is routinely collected on NH residents using the RAI-Minimum Data Set (MDS). In this regard, issues that are more tangible to resident dignity such as being treated with respect, compassion, and having opportunities to engage with others are not adequately captured in current NH quality of care indicators. An initial set of markers was created by conducting an integrative literature review of existing markers and indicators of dignity in the NH setting. A modified Delphi process was used to prioritize essential dignity-conserving care markers for use by NH providers, based on factors such as the importance to fostering a culture of dignity, the impact it may have on the residents, and how achievable it is in practice. Through this consensus building technique, we were able to develop a comprehensive set of markers that capture the range and diversity of important dignity-conserving care strategies for use in NHs. The final 10 markers were judged as having high face validity by experts in the field and have explicit implications for enhancing the provision of daily dignified care to NH residents. These markers make an important addition to the traditional quality indicators used in the NH setting and as such, bridge an important gap in addressing the psychosocial and the less easily quantified needs of NH residents. PMID:27304853

  20. Identifying Markers of Dignity-Conserving Care in Long-Term Care: A Modified Delphi Study.

    PubMed

    Thompson, Genevieve N; McArthur, Jennifer; Doupe, Malcolm

    2016-01-01

    Ensuring that people living in nursing homes (NHs) are afforded with dignity in their daily lives is an essential and humane concern. Promoting dignity-conserving care is fundamentally important. By nature, however, this care is all-encompassing and holistic, and from current knowledge it is challenging to create explicit strategies for measuring dignity-conserving care. In practice the majority of current NH indicators of quality care are derived from information that is routinely collected on NH residents using the RAI-Minimum Data Set (MDS). In this regard, issues that are more tangible to resident dignity such as being treated with respect, compassion, and having opportunities to engage with others are not adequately captured in current NH quality of care indicators. An initial set of markers was created by conducting an integrative literature review of existing markers and indicators of dignity in the NH setting. A modified Delphi process was used to prioritize essential dignity-conserving care markers for use by NH providers, based on factors such as the importance to fostering a culture of dignity, the impact it may have on the residents, and how achievable it is in practice. Through this consensus building technique, we were able to develop a comprehensive set of markers that capture the range and diversity of important dignity-conserving care strategies for use in NHs. The final 10 markers were judged as having high face validity by experts in the field and have explicit implications for enhancing the provision of daily dignified care to NH residents. These markers make an important addition to the traditional quality indicators used in the NH setting and as such, bridge an important gap in addressing the psychosocial and the less easily quantified needs of NH residents. PMID:27304853

  1. 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

  2. Managing Medicaid managed care: are states becoming prudent purchasers?

    PubMed

    Fossett, J W; Goggin, M; Hall, J S; Johnston, J; Plein, L C; Roper, R; Weissert, C

    2000-01-01

    This paper examines the extent to which five states are becoming "prudent purchasers" in their oversight of Medicaid managed care. Our conclusions are mixed. These states are making more sustained efforts along these lines than most private purchasers are and have improved the amount and quality of the data they collect on the experiences of Medicaid clients when compared with the traditional fee-for-service program. They have been less successful in ensuring data quality that is adequate to support contracting decisions and in developing the analytical or political capacity to use data to "manage" the managed care system. Becoming a prudent purchaser appears to be a complex task for states that may prove difficult to achieve. PMID:10916959

  3. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  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 514.117 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... production performance, or biased observation. One or more adequate and well-controlled studies are required... 21 Food and Drugs 6 2013-04-01 2013-04-01 false Adequate and well-controlled studies. 514.117... Applications § 514.117 Adequate and well-controlled studies. (a) Purpose. The primary purpose of...

  11. 21 CFR 514.117 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... production performance, or biased observation. One or more adequate and well-controlled studies are required... 21 Food and Drugs 6 2012-04-01 2012-04-01 false Adequate and well-controlled studies. 514.117... Applications § 514.117 Adequate and well-controlled studies. (a) Purpose. The primary purpose of...

  12. 21 CFR 514.117 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... production performance, or biased observation. One or more adequate and well-controlled studies are required... 21 Food and Drugs 6 2011-04-01 2011-04-01 false Adequate and well-controlled studies. 514.117... Applications § 514.117 Adequate and well-controlled studies. (a) Purpose. The primary purpose of...

  13. 21 CFR 514.117 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... production performance, or biased observation. One or more adequate and well-controlled studies are required... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Adequate and well-controlled studies. 514.117... Applications § 514.117 Adequate and well-controlled studies. (a) Purpose. The primary purpose of...

  14. 21 CFR 514.117 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... production performance, or biased observation. One or more adequate and well-controlled studies are required... 21 Food and Drugs 6 2014-04-01 2014-04-01 false Adequate and well-controlled studies. 514.117... Applications § 514.117 Adequate and well-controlled studies. (a) Purpose. The primary purpose of...

  15. 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

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

  16. 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...

  17. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  18. 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...

  19. Barriers to the collaborative care of patients with orofacial injury.

    PubMed

    Wong, Eunice C; Marshall, Grant N

    2010-05-01

    Collaborative care interventions show significant promise in facilitating integrative care, which addresses the physical and mental health needs of patients with orofacial trauma. Ensuring the successful implementation of collaborative care interventions depends on having an adequate understanding of the potential barriers to the provision and receipt of mental health services within specific clinical settings. This article reviews recent findings on the patients' and providers' perceptions of barriers to psychosocial aftercare services in oral and maxillofacial trauma care settings. These findings indicate that although patients and providers recognize the need for psychosocial aftercare, they report substantial barriers to these services. Structural barriers, such as not knowing where to obtain services and financial cost, are the major obstacles among patients. Among providers, structural barriers also serve as significant impediments to the provision of psychosocial services. Some of the most common structural barriers reported by providers include a shortage of financial resources, trained clinical staff, and space. Although collaborative care interventions may be well suited to capitalize on patients' and providers' interests in psychosocial aftercare programs, further research is needed to determine the viability of this promising aftercare model within oral and maxillofacial trauma care settings. PMID:20403556

  20. [Patient-oriented quality assurance. Information and cooperation of the health services as a condition for integrated care].

    PubMed

    Müller-Mundt, G; Schulz, B; Höhmann, U

    1998-08-01

    The increasing care needs of the elderly and chronically ill have a growing impact on health care services. With complex needs to meet, the patient's quality of life depends on multiple factors, of which the continuity of care plays an important role. Information on the past and present health state and on self care resources are prerequisites for adequate rehabilitation efforts that are patient-oriented and of high quality. Institutionally induced "cascade episodes of incompetence" (Ulmer & Saller, 1994) have to be avoided. To make sure that interventions promote or stabilize the quality of life, the participation of the client is crucial in all stages of the process of care planning and coordination. Integrated care requires the exchange of information and close coordination on the concept of care between all participants in the care process. Yet, collaborative care is often seriously jeopardized by lack of knowledge about the concepts, scope of action and requests of the involved health professionals and services. At the Agnes Karll Institute of Nursing Research an action research project aiming at cooperative quality assurance was carried out. It became obvious that there is a large amount of intersectoral knowledge necessarily needed by all professionals and services to ensure seamless professional care. But often they have no access to the information needed. Therefore a client's accompanying booklet was developed to pass on basic information. It is kept by the client and shall be used and filled out by them, their relatives and the different health professionals and health care services involved. PMID:9775922

  1. [Level of awareness and the adequate application of sunscreen by beauticians].

    PubMed

    Cortez, Diógenes Aparício Garcia; Machado, Érica Simionato; Vermelho, Sonia Cristina Soares Dias; Teixeira, Jorge Juarez Vieira; Cortez, Lucia Elaine Ranieri

    2016-06-01

    The scope of this research was to establish the level of awareness of beauticians regarding the importance of the application of sunscreen and to identify whether their patients had been properly instructed by these professionals. It involved a descriptive and exploratory study with interviews applying qualitative methodology among 30 beauticians. Data were gathered using the semi-structured interview technique in Maringá, in the southern state of Paraná. The data were analyzed using Atlas.ti software after applying quantitative analysis and response classification. Of those interviewed, 83.33% had a degree in Aesthetics, 20% attended ongoing training activities on sunscreen and 73.17% acquired sunscreen for its quality, though 86.67% were not familiar with sunscreens with natural anti-free radical components. Of those interviewed, 80% had never treated patients with skin cancer, though they reported having knowledge of care in relation to sun exposure and how to use the sunscreen and the relationship of these practices with the disease. The results showed that the recommendations and use of sunscreen by beauticians and users has been conducted in an adequate and conscientious manner. PMID:27383359

  2. Evaluation of catheter-manometer systems for adequate intravascular blood pressure measurements in small animals.

    PubMed

    Idvall, J; Aronsen, K F; Lindström, K; Ulmsten, U

    1977-09-30

    Various catheter-manometer systems possible for intravascular blood pressure measurments on rats have been elaborated and tested in vitro and in vivo. Using a pressure-step calibrator, it was observed from in vitro studies that microtransducers had superior frequency response compared to conventional transducers. Of the catheters tested, Pe-90 tapered to a 40 mm tip with an inner diameter of 0.3 mm had the best frequency response as judged from fall and settling times. Because of the damping effect, tapering increased fall time to 1.8 ms, which was still quite acceptable. By the same token settling time was minimized to 22.4 ms. With a special calculation method the theoretical percentile fault of the recordings was estimated to be 9.66%. When the measurement error was calculated from the actual in vivo recordings, it was found to be no more than 2.7%. These results show that the technique described is adequate for continuous intravascular blood pressure recordings on small animals. Finally it is emphasized that careful handling of the catheters and avoidance of stopcocks and air bubbles are essential for obtaining accurate and reproducible values. PMID:928971

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

    PubMed

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

    2003-11-01

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

  4. 28 CFR 61.10 - Ensuring Department NEPA compliance.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Ensuring Department NEPA compliance. 61.10 Section 61.10 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROCEDURES FOR IMPLEMENTING THE NATIONAL ENVIRONMENTAL POLICY ACT Implementing Procedures § 61.10 Ensuring Department...

  5. 28 CFR 61.10 - Ensuring Department NEPA compliance.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Ensuring Department NEPA compliance. 61.10 Section 61.10 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROCEDURES FOR IMPLEMENTING THE NATIONAL ENVIRONMENTAL POLICY ACT Implementing Procedures § 61.10 Ensuring Department...

  6. 28 CFR 61.10 - Ensuring Department NEPA compliance.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Ensuring Department NEPA compliance. 61.10 Section 61.10 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROCEDURES FOR IMPLEMENTING THE NATIONAL ENVIRONMENTAL POLICY ACT Implementing Procedures § 61.10 Ensuring Department...

  7. 28 CFR 61.10 - Ensuring Department NEPA compliance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  8. 28 CFR 61.10 - Ensuring Department NEPA compliance.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Ensuring Department NEPA compliance. 61.10 Section 61.10 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROCEDURES FOR IMPLEMENTING THE NATIONAL ENVIRONMENTAL POLICY ACT Implementing Procedures § 61.10 Ensuring Department...

  9. School Personnel Records: New Requirements for Ensuring Employee Privacy.

    ERIC Educational Resources Information Center

    Allred, Stephen

    1988-01-01

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

  10. 34 CFR 300.154 - Methods of ensuring services.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... insurance or private insurance will not be treated as program income for purposes of 34 CFR 80.25. (2) If a... 34 Education 2 2012-07-01 2012-07-01 false Methods of ensuring services. 300.154 Section 300.154... CHILDREN WITH DISABILITIES State Eligibility Methods of Ensuring Services § 300.154 Methods of...