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1

ENSURING ADEQUATE SAFETY WHEN USING HYDROGEN AS A FUEL  

SciTech Connect

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

Coutts, D

2007-01-22

2

|reportingchecklistforlifesciencesarticles 1. How was the sample size chosen to ensure adequate power  

E-print Network

|reportingchecklistforlifesciencesarticles May 2013 i 1. How was the sample size chosen to ensure they are relevant: · the exact sample size (n) for each experimental group/condition, given as a number, not a range adequate power to detect a pre-specified effect size? For animal studies, include a statement about sample

Cai, Long

3

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

ERIC Educational Resources Information Center

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…

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

4

Barriers to adequate prenatal care utilization in American Samoa  

PubMed Central

Objective To describe the utilization of prenatal care in American Samoan women and to identify socio-demographic predictors of inadequate prenatal care utilization. Methods Using data from prenatal clinic records, women (n=692) were categorized according to the Adequacy of Prenatal Care Utilization Index as having received adequate plus, adequate, intermediate or inadequate prenatal care during their pregnancy. Categorical socio-demographic predictors of the timing of initiation of prenatal care (week of gestation) and the adequacy of received services were identified using one way Analysis of Variance (ANOVA) and independent samples t-tests. Results Between 2001 and 2008 85.4% of women received inadequate prenatal care. Parity (P=0.02), maternal unemployment (P=0.03), and both parents being unemployed (P=0.03) were negatively associated with the timing of prenatal care initation. Giving birth in 2007–2008, after a prenatal care incentive scheme had been introduced in the major hospital, was associated with earlier initiation of prenatal care (20.75 versus 25.12 weeks; P<0.01) and improved adequacy of received services (95.04% versus 83.8%; P=0.02). Conclusion The poor prenatal care utilization in American Samoa is a major concern. Improving healthcare accessibility will be key in encouraging women to attend prenatal care. The significant improvements in the adequacy of prenatal care seen in 2007–2008 suggest that the prenatal care incentive program implemented in 2006 may be a very positive step toward addressing issues of prenatal care utilization in this population. PMID:24045912

Hawley, Nicola L; Brown, Carolyn; Nu’usolia, Ofeira; Ah-Ching, John; Muasau-Howard, Bethel; McGarvey, Stephen T

2013-01-01

5

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

PubMed

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

Liu, Tsai-Ching; Chen, Chin-Shyan

2004-01-01

6

Role of Primary Health Care in Ensuring Access to Medicines  

PubMed Central

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

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

2010-01-01

7

ENSURING ADEQUATE REACTION IN CASE OF EXTREME WATER POLLUTION THROUGH TRAINING AND EDUCATION  

Microsoft Academic Search

Extreme water pollution is a severe environmental accident, endangering the local or even regional safety of human community\\u000a and of the entire environment as well. Adequate awareness and preparedness to respond to such emergency situations must be\\u000a reached in all strata of population. Developing a national training and education strategy is the responsibility of all level\\u000a authorities. Training and education

IOAN S. BOCSAN; MARIA IRINA BRUMBECIU

8

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

PubMed

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

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

2014-02-01

9

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

PubMed

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

Augusto, Lia Giraldo da Silva; Gurgel, Idê Gomes Dantas; Câmara Neto, Henrique Fernandes; de Melo, Carlos Henrique; Costa, André Monteiro

2012-06-01

10

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

ERIC Educational Resources Information Center

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

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

2010-01-01

11

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

PubMed Central

Background Type 1 diabetes is one of the most frequent long-term endocrine childhood disorders and the Swedish National Diabetes Register for children states that adolescents (12–18 years) constitute the most vulnerable patient group in terms of metabolic control. The aim of this study was to examine how a multidisciplinary team functions when caring for adolescents with type 1 diabetes. Methods Qualitative interviews were performed with 17 health professionals at a Paediatric Diabetes Care Unit in a Swedish university hospital. The interviews were analysed to gain insight into a multidisciplinary care team’s experiences of various organizational processes and circumstances related to the provision of person-centred paediatric diabetes care. Results Building long-term relationships with adolescents, the establishment of a multidisciplinary care team and ensuring adequate documentation are vital for the delivery of person-centred care (PCC). Furthermore, a PCC process and/or practice requires more than the mere expression of person-centred values. The contribution of this study is that it highlights the necessity of facilitating and safeguarding the organization of PCC, for which three processes are central: 1. Facilitating long-term relationships with adolescents and their families; 2. Facilitating multi-professional teamwork; and 3. Ensuring adequate documentation. Conclusion Three processes emerged as important for the functioning of the multidisciplinary team when caring for adolescents with type 1 diabetes: building a long-term relationship, integrating knowledge by means of multidisciplinary team work and ensuring adequate documentation. This study demonstrates the importance of clearly defining and making use of the specific role of each team member in the paediatric diabetes care unit (PDCU). Team members should receive training in PCC and a PCC approach should form the foundation of all diabetes care. Every adolescent suffering from type 1 diabetes should be offered individual treatment and support according to her/his needs. However, more research is required to determine how a PCC approach can be integrated into adolescent diabetes care, and especially how PCC education programmes for team members should be implemented. PMID:24490659

2014-01-01

12

Blue Shield ensures uninterrupted access to quality medical care after Palm Drive Hospital ceases operations  

E-print Network

Blue Shield ensures uninterrupted access to quality medical care after Palm Drive Hospital ceases emergency care and in-patient care at Palm Drive. We are working with our members to ensure a smooth of California member in the Sonoma County area seeking emergency medical services or inpatient care, please

Ravikumar, B.

13

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

ERIC Educational Resources Information Center

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)

Silva, Richard J.

1980-01-01

14

[Mental illness among immigrants and refugees. Are needs and available care adequate?].  

PubMed

A considerable proportion of the Swedish population are of immigrant or refugee origin. This puts new demands on psychiatric care. In Stockholm county, immigrants of non-Scandinavian origin are characterised by lower psychiatric care utilisation rates than are the remainder of the county population. Population studies of multi-ethnic suburban areas in west Stockholm have shown the non-Scandinavian subgroup of the population to be characterised by somewhat lower utilisation of acute and short-term psychiatric care, as compared with native Swedes, but a clearly higher utilisation of primary psychiatric care facilities. Available evidence suggests the existence of several subgroups with high frequencies of mental ill-health in these areas. If sectorized psychiatry is to meet the demands of the population as a whole, economic prioritization is needed, as well as improved knowledge and methodology regarding cross-cultural psychiatry. PMID:9564141

Bäärnhielm, S; Saers, K

1998-04-01

15

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

Microsoft Academic Search

Background  An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision\\u000a of adequate palliative\\/end-of-life (P\\/EOL) care. Informal caregivers who take on the responsibility of providing P\\/EOL care\\u000a often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically\\u000a examine how Canada's Compassionate Care Benefit (CCB) - a contributory benefits

Allison M Williams; Jeanette A Eby; Valorie A Crooks; Kelli Stajduhar; Melissa Giesbrecht; Mirjana Vuksan; S Robin Cohen; Kevin Brazil; Diane Allan

2011-01-01

16

Do older patients receive adequate stroke care? An experience of a neurovascular clinic  

Microsoft Academic Search

Background:National guidelines and government directives have adopted policies for urgent assessment of patients with a transient ischaemic attack or minor stroke not admitted to hospital. The risk of recurrent stroke increases substantially with age, as does the potential benefit of secondary prevention. In order to develop effective strategies for older patients, it is important to identify how stroke care is

Y-Y K Kee; W Brooks; A Bhalla

2009-01-01

17

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

PubMed

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

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

2014-05-01

18

The Care Transitions Intervention: A Patient-Centered Approach to Ensuring Effective Transfers Between Sites of Geriatric Care  

Microsoft Academic Search

During an episode of illness, older patients may receive care in multiple settings; often resulting in fragmented care and poorly-executed care transitions. The negative consequences of fragmented care include duplication of services; inappropriate or conflicting care recommendations, medication errors, patient\\/caregiver distress, and higher costs of care. Despite the critical need to reduce fragmented care in this population, few interventions have

Carla Parry; Eric A. Coleman; Jodi D. Smith; Janet Frank; Andrew M. Kramer

2003-01-01

19

Reduced brain corticotropin-releasing factor receptor activation is required for adequate maternal care and maternal aggression in lactating rats.  

PubMed

The brain corticotropin-releasing factor (CRF) system triggers a variety of neuroendocrine and behavioural responses to stress. Whether maternal behaviour and emotionality in lactation are modulated by CRF has rarely been investigated. In the present study, we measured CRF mRNA expression within the parvocellular part of the paraventricular nucleus in virgin and lactating Wistar rats bred for high (HAB) and low (LAB) anxiety-related behaviour or non-selected for anxiety (NAB). Further, we intracerebroventricularly infused synthetic CRF or the CRF receptor (CRF-R) antagonist D-Phe to manipulate CRF-R1/2 non-specifically in lactating HAB, LAB, and NAB dams, and monitored maternal care, maternal motivation, maternal aggression, and anxiety. The CRF mRNA expression in the parvocellular part of the paraventricular nucleus was higher in HAB vs. LAB rats independent of reproductive status. The lactation-specific decrease of CRF mRNA was confirmed in LAB and NAB dams but was absent in HAB dams. Intracerebroventricular CRF decreased maternal care under basal conditions in the home cage in all breeding lines and reduced attack behaviour in HAB and LAB dams during maternal defence. In contrast, D-Phe rescued maternal care after exposure to maternal defence in the home cage without influencing maternal aggression. Furthermore, D-Phe decreased and CRF tended to increase anxiety in HAB/NAB and LAB dams, respectively, suggesting an anxiogenic effect of CRF in lactating females. In conclusion, low CRF-R activation during lactation is an essential prerequisite for the adequate occurrence of maternal behaviour. PMID:23742269

Klampfl, Stefanie M; Neumann, Inga D; Bosch, Oliver J

2013-09-01

20

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

PubMed Central

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

2011-01-01

21

Nursing audit as a method for developing nursing care and ensuring patient safety.  

PubMed

Nursing documentation is crucial to high quality, good and safe nursing care. According to earlier studies nursing documentation varies and the nursing classifications used in electronic patient records (EPR) is not yet stable internationally nor nationally. Legislation on patient records varies between countries, but they should contain accurate, high quality information for assessing, planning and delivering care. A unified national model for documenting patient care would improve information flow, management between multidisciplinary care teams and patient safety. Nursing documentation quality, accuracy and development needs can be monitored through an auditing instrument developed for the national documentation model. The results of the auditing process in one university hospital suggest that the national nursing documentation model fulfills nurses' expectations of electronic tools, facilitating their important documentation duty. This paper discusses the importance of auditing nursing documentation and especially of giving feedback after the implementation of a new means of documentation, to monitor the progress of documentation and further improve nursing documentation. PMID:24199107

Mykkänen, Minna; Saranto, Kaija; Miettinen, Merja

2012-01-01

22

Nursing audit as a method for developing nursing care and ensuring patient safety  

PubMed Central

Nursing documentation is crucial to high quality, good and safe nursing care. According to earlier studies nursing documentation varies and the nursing classifications used in electronic patient records (EPR) is not yet stable internationally nor nationally. Legislation on patient records varies between countries, but they should contain accurate, high quality information for assessing, planning and delivering care. A unified national model for documenting patient care would improve information flow, management between multidisciplinary care teams and patient safety. Nursing documentation quality, accuracy and development needs can be monitored through an auditing instrument developed for the national documentation model. The results of the auditing process in one university hospital suggest that the national nursing documentation model fulfills nurses’ expectations of electronic tools, facilitating their important documentation duty. This paper discusses the importance of auditing nursing documentation and especially of giving feedback after the implementation of a new means of documentation, to monitor the progress of documentation and further improve nursing documentation. PMID:24199107

Mykkanen, Minna; Saranto, Kaija; Miettinen, Merja

2012-01-01

23

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

ERIC Educational Resources Information Center

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…

Best, Jane; Cohen, Courtney

2013-01-01

24

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

ERIC Educational Resources Information Center

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…

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

2006-01-01

25

Access to Adequate Outpatient Depression Care for Mothers in the US: A Nationally Representative Population-Based Study  

PubMed Central

Maternal depression is often untreated, resulting in serious consequences for mothers and their children. Factors associated with receipt of adequate treatment for depression were examined in a population-based sample of 2,130 mothers in the USA with depression using data from the 1996-2005 Medical Expenditure Panel Survey. Chi-squared analyses were used to evaluate differences in sociodemographic and health characteristics by maternal depression treatment status (none, some, adequate). Multivariate regression was used to model the odds of receiving some or adequate treatment, compared to none. Results indicated that only 34.8% of US mothers with depression received adequate treatment. Mothers not in the paid workforce and those with health insurance were more likely to receive treatment, while minority mothers and those with less education were less likely to receive treatment. Understanding disparities in receipt of adequate treatment is critical to designing effective interventions, reducing treatment inequities, and ultimately improving the mental health and health of mothers and their families. PMID:19838806

Witt, Whitney P.; Keller, Abiola; Gottlieb, Carissa; Litzelman, Kristin; Hampton, John; Maguire, Jonathan; Hagen, Erika W.

2010-01-01

26

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

PubMed

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

Sharpe, Virginia Ashby; Uchendu, Uchenna S

2014-09-01

27

Dying in America - An Examination of Policies that Deter Adequate End-of-Life Care in Nursing Homes  

Microsoft Academic Search

This article examines current health care policies and government practices that deter appropriate end-of-life care, focusing on the use of hospice services for dying nursing home patients. The authors conclude that hospice and nursing home regulations, reimbursement for hospice and nursing homes, and enforcement of the fraud and abuse rules collude to “chill” utilization of hospice by nursing homes and

Diane E. Hoffmann; Anita J. Tarzian

2005-01-01

28

Prevailing issues in long-term care. CEOs see urgent need for adequate funding and better communications among Catholic organizations.  

PubMed

The ongoing crisis in long-term care has forced administrators and chief executive officers (CEOs) to reassess their position within the U.S. healthcare system and define their response to the challenges they face. This article identifies the issues that Catholic long-term care CEOs find most pressing based on two recent opinion surveys conducted by the Catholic Health Association (CHA). In the area of management and governance, the subject of a 1990 CHA survey, respondents rated as their top concern the inadequacy of funds to treat chronically ill elderly persons. Other important issues included threats to the tax-exempt status of healthcare providers, availability of healthcare for the poor, and scarcity of nursing staff. Respondents to a 1991 survey that focused on collaboration within the Catholic healthcare ministry cited the lack of a forum for communications as the greatest hindrance to collaborative enterprises. A lack of available time to pursue and develop collaborative projects and the absence of compelling reasons to collaborate with other Catholic organizations were also identified as important issues. Overall, the consensus among long-term care CEOs was strong on the importance of certain management and governance issues and on the need for Catholic organizations to work together more closely. PMID:10118341

Pember, C H; Fonner, E

1992-06-01

29

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

PubMed Central

Introduction The American Dental Association has identified several barriers to adequate dental care for vulnerable populations, including appropriate case management. The objective of this study was to examine the perceptions, attitudes, and beliefs of dental patients living with HIV/AIDS on the role and value of the dental case manager (DCM) and the effect of DCM services on their oral or overall health. Methods We used a qualitative descriptive study design and focus groups. Twenty-five people who had received DCM services on Cape Cod, Massachusetts, attended 1 of 5 focus groups in 2009 and 2010. Digital recordings of the groups were transcribed verbatim. Textual data were categorized using directed qualitative content analysis techniques. We identified major themes and representative quotes. Results The following themes emerged from discussions on the DCM’s role: being available, knowledgeable about clients and insurance, and empathetic; increasing access; and providing comfort. Most participants credited their oral and overall health improvements to the DCM. All participants believed that the DCM was a valuable addition to the clinic and noted that other at-risk populations, including the elderly and developmentally disabled, likely would benefit from working with a DCM. Conclusion The addition of a DCM facilitated access to dental care among this sample of people living with HIV/AIDS, providing them with an advocate and resulting in self-reported improvements to oral and overall health. PMID:23098645

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

2012-01-01

30

H. R. 4604: a bill to promote competition in the natural gas market, to ensure open access to transportation service, to encourage production of natural gas, to provide natural gas consumers with adequate supplies at reasonable prices, to eliminate demand restraints, and for other purposes. Introduced in the House of Representatives, Ninety-Ninth Congress, Second Session, April 16, 1986  

SciTech Connect

The Natural Gas Policy Act Amendments of 1986 promotes competition in the natural gas market. Title I ensures open access to transportation service by requiring that interstate pipelines not discriminate in providing transportation services. Title II encourages production of natural gas by removing wellhead price controls and repealing jurisdiction over first sales. Title III provides natural gas consumers with adequate supplies at reasonable prices and eliminates demand restraints. The bill was referred to the House Committee on Energy and Commerce.

Not Available

1986-01-01

31

Key Issues for Long-Term Care Insurance: Ensuring Quality Products, Increasing Access to Coverage, and Enabling Consumer Choice.  

National Technical Information Service (NTIS)

This report is an examination of the long term care insurance market. It describes the evolution of the market, provides an indepth review of the current products and choices. It also discusses underwriting, premiums and the regulations that govern the ma...

C. Sullivan, D. Kennell, J. Weiner, L. M. Alecxih, S. Carothers, S. Lutzky

1993-01-01

32

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

PubMed Central

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

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

2012-01-01

33

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

PubMed

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

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

2014-01-01

34

Quality maternal and newborn care to ensure a healthy start for every newborn in the World Health Organization Western Pacific Region.  

PubMed

In the World Health Organization Western Pacific Region, the high rates of births attended by skilled health personnel (SHP) do not equal access to quality maternal or newborn care. 'A healthy start for every newborn' for 23 million annual births in the region means that SHP and newborn care providers give quality intrapartum, postpartum and newborn care. WHO and the UNICEF Regional Action Plan for Healthy Newborn Infants provide a platform for countries to scale-up Early Essential Newborn Care (EENC). The plan emphasises the creation of an enabling environment for the practice of EENC; thereby, preventing 50 000 newborn deaths annually. PMID:25236650

Obara, H; Sobel, H

2014-09-01

35

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

Microsoft Academic Search

Despite the promise of expanded health insurance coverage for children in the United States, a usual source of care (USC)\\u000a may have a bigger impact on a child’s receipt of preventive health counseling. We examined the effects of insurance versus\\u000a USC on receipt of education and counseling regarding prevention of childhood injuries and disease. We conducted secondary\\u000a analyses of 2002–2006

Jennifer E. DeVoeCarrie; Carrie J. Tillotson; Lorraine S. WallaceSarah; Sarah E. Lesko; Nancy Pandhi

36

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

PubMed

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

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

2012-02-01

37

Does Accreditation by the Association for Assessment and Accreditation of Laboratory Animal Care International (AAALAC) Ensure Greater Compliance With Animal Welfare Laws?  

PubMed

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

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

2015-01-01

38

Adequate supervision for children and adolescents.  

PubMed

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. [Pediatr Ann. 2014;43(11):e260-e265.]. PMID:25369578

Anderst, James; Moffatt, Mary

2014-11-01

39

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

...experience to work in the specific regional geographic environment(s) that the vessel operates in (e.g., bottom type, water turbidity, water depth, sea state and temperature extremes). (13) Resource provider has the logistical and...

2014-07-01

40

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

Code of Federal Regulations, 2012 CFR

...experience to work in the specific regional geographic environment(s) that the vessel operates in (e.g., bottom type, water turbidity, water depth, sea state and temperature extremes). (13) Resource provider has the logistical and...

2012-07-01

41

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

Code of Federal Regulations, 2011 CFR

...experience to work in the specific regional geographic environment(s) that the vessel operates in (e.g., bottom type, water turbidity, water depth, sea state and temperature extremes). (13) Resource provider has the logistical and...

2011-07-01

42

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

Microsoft Academic Search

The right to information is a fundamental consumer value. Following the advent of health warnings, the tobacco industry has repeatedly asserted that smokers are fully informed of the risks they take, while evidence demonstrates widespread superficial levels of awareness and understanding. There remains much that tobacco companies could do to fulfil their responsibilities to inform smokers. We explore issues involved

S Chapman; J Liberman

2005-01-01

43

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

Code of Federal Regulations, 2010 CFR

...services. (4) Resource 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, and...

2010-07-01

44

From Th e F ield Exploring The Limits Of The Safety Net: Community Health Centers And Care For The Uninsured Increasing the number of community health centers is not an adequate substitute for expanding health insurance coverage  

Microsoft Academic Search

This paper explores the extent to which community health centers (CHCs) are able to manage their uninsured patient caseloads. We found that CHCs can provide primary care, medications, and medical supplies to most of their uninsured patients on site but are limited in their ability to provide diagnostic, specialty, and behavioral health services. Unin- sured patients often fail to receive

Michael K. Gusmano; Gerry Fairbrother; Heidi Park

45

Ensuring safer drinking water  

SciTech Connect

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

Christensen, J. (Advanced Elastomer Systems, St. Louis, MO (United States). Fluid Delivery and Electrical Markets); Higgins, P. (PJ Higgins and Associates Inc., Frederick, MD (United States))

1994-09-01

46

Is a vegetarian diet adequate for children.  

PubMed

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

Hackett, A; Nathan, I; Burgess, L

1998-01-01

47

Ensuring Academic Standards in US Higher Education  

ERIC Educational Resources Information Center

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…

Dill, David D.

2014-01-01

48

Minimum Standards for Tribal Child Care Centers.  

ERIC Educational Resources Information Center

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

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

49

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

PubMed Central

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

Yennurajalingam, Sriram; Bruera, Eduardo

2013-01-01

50

The Rhetoric of Rights and Justice in Health Care  

Microsoft Academic Search

Discussions of contemporary health care policy are replete with claims about justice or equity in health care allocations\\u000a and rights to treatment. In 1983 the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and\\u000a Behavioral Research spoke of society’s “moral obligation” to ensure every citizen adequate health care without excessive burden,\\u000a and concluded that government should

Thomas J. Bole

51

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

PubMed

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

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

2014-09-01

52

An Adequate Education Defined. Fastback 476.  

ERIC Educational Resources Information Center

Court decisions historically have dealt with educational equity; now they are helping to establish "adequacy" as a standard in education. Legislatures, however, have been slow to enact remedies. One debate over education adequacy, though, is settled: Schools are not financed at an adequate level. This fastback is divided into three sections.…

Thomas, M. Donald; Davis, E. E. (Gene)

53

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

E-print Network

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

Kreinovich, Vladik

54

29 CFR 505.5 - Adequate assurances.  

Code of Federal Regulations, 2010 CFR

...GRANTS FROM THE NATIONAL ENDOWMENTS FOR THE ARTS AND HUMANITIES § 505.5 Adequate...Chairperson of the National Endowment for the Arts or the Chairperson of the National Endowment...description of any injury incurred while performing under the grant and the dates and...

2010-07-01

55

42 CFR 438.207 - Assurances of adequate capacity and services.  

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

2014-10-01

56

Predictors of Adequate Correction Following Vision Screening Failure  

PubMed Central

Purpose To determine if compliance with referral one year after vision screening failure was associated with care model, demographic, or ocular factors. Methods Data were analyzed from 798 children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study with habitual logMAR visual acuity (VA) ? 0.26 (20/40 +2 or worse) in either eye due to uncorrected or under-corrected refractive error and who returned the following year. The parents of 492 children failing in TX and CA were sent letters indicating the need for a complete vision exam (screening model), while 306 children seen primarily in AZ and AL received a free complete exam and eyeglasses if needed (complete care model). Presenting to follow-up with adequate correction (logMAR < 0.26) in each eye was considered compliant. Logistic regression models for compliance were fit to assess if care model, ethnicity, sex, age, uncorrected logMAR in the better eye, or parental income, education or myopia were predictors. Results Overall compliance was 28%. Age (p=0.01, odds ratio (OR) = 1.12) and uncorrected logMAR (p<0.001, OR = 1.13) were associated with compliance but care model, ethnicity, and sex were not. Among the 447 children on whom data on parental factors was available, 27% were compliant. In this model, age, ethnicity, sex, parental income, parental education and parental myopia were not associated with compliance, but uncorrected logMAR (p=0.005; OR = 1.13) was predictive. An interaction between unaided VA and care model predicted improved compliance with poorer unaided VA in the complete care model. Conclusions Expensive complete care screening programs may not improve compliance over typical notification and referral screening protocols in school-aged children, unless unaided VA is worse than the common 20/40 referral criteria. Unaided VA had less impact on predicted compliance in the screening only protocol. PMID:22544001

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

2012-01-01

57

Genetic Modification of Preimplantation Embryos: Toward Adequate Human Research Policies  

PubMed Central

Citing advances in transgenic animal research and setbacks in human trials of somatic cell genetic interventions, some scientists and others want to begin planning for research involving the genetic modification of human embryos. Because this form of genetic modification could affect later-born children and their offspring, the protection of human subjects should be a priority in decisions about whether to proceed with such research. Yet because of gaps in existing federal policies, embryo modification proposals might not receive adequate scientific and ethical scrutiny. This article describes current policy shortcomings and recommends policy actions designed to ensure that the investigational genetic modification of embryos meets accepted standards for research on human subjects. PMID:15016248

Dresser, Rebecca

2004-01-01

58

Ensure nurse research is rigorous.  

PubMed

DR LESLIE Gelling is a Reader in Research Ethics and a nurse in the Faculty of Health, Social Care and Education at Anglia Ruskin University in Cambridge. Between 2008 and this edition, Leslie has been the editor of Nurse Researcher and he is now moving to the Journal of Clinical Nursing. PMID:25423935

Sylvester, Julie

2014-11-26

59

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

Microsoft Academic Search

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

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

1997-01-01

60

Two pathways ensuring social harmony  

NASA Astrophysics Data System (ADS)

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.

Konrad, Matthias; Pamminger, Tobias; Foitzik, Susanne

2012-08-01

61

Ensuring the Health of Refugees: Taking a Broader Vision.  

ERIC Educational Resources Information Center

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

Kuntz, Diane; And Others

62

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

PubMed

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

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

2014-10-10

63

Are women with psychosis receiving adequate cervical cancer screening?  

PubMed Central

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

Tilbrook, Devon; Polsky, Jane; Lofters, Aisha

2010-01-01

64

Ensuring Quality and Choice in End of Life Care  

Microsoft Academic Search

The presentation will provide a brief background to CQC, its role, the legislation that governs how it operates, its strategic priorities and its principal methodologies. It will identify how CQC will assess whether provider organisations are complying with regulatory requirements and the action that CQC might take if it found that organisations were not compliant.In particular, it will focus on

J Williams

2011-01-01

65

13 CFR 108.200 - Adequate capital for NMVC Companies.  

Code of Federal Regulations, 2012 CFR

...2012-01-01 false Adequate capital for NMVC Companies. 108.200...SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications...Company § 108.200 Adequate capital for NMVC Companies. You...

2012-01-01

66

13 CFR 108.200 - Adequate capital for NMVC Companies.  

Code of Federal Regulations, 2011 CFR

...2011-01-01 false Adequate capital for NMVC Companies. 108.200...SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications...Company § 108.200 Adequate capital for NMVC Companies. You...

2011-01-01

67

15 CFR 970.404 - Adequate exploration plan.  

Code of Federal Regulations, 2010 CFR

...2010-01-01 false Adequate exploration plan. 970.404 Section 970...DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may...

2010-01-01

68

[Ensure - complete and balanced nutrition, convenient on work].  

PubMed

The work conditions often may compromise a company ability to supply their employees with adequate, hot meals. For heavy labor workers and some office employees it is important to restore energy and nutrients with food, balanced in nutrients. The lack of adequate nutritive support can give a negative impact on different organs functions. One of the main principles of healthy nutrition is - diet must be balanced in nutrients. Which is easy to say, but difficult to implement, especially on some industries. Complete and balanced liquid and ready-to-use nutrition is new trend in nutrition of healthy people who cannot consume optimal diet, and in people with the risk of nutrient deficiencies. One-two packs of Ensure daily can significantly improve a worker ration. 2 and more packs could serve as a real complete and balanced lunch (>or=780 kcal). Also Ensure is easy to store and to deliver in distant places of work and can be recommended for use as a convenient, complete and balanced nutrition on work. PMID:24000730

Kurenkov, A V; Iuriatin, A A

2013-01-01

69

Pulmonary rehabilitation and self-care after ambulatory surgery.  

PubMed

Over 30 million Americans are living with chronic lung disease in the United States. The long-term ongoing care required by these individuals is a major contributor to American health care costs. Clinicians caring for persons with chronic respiratory disease are faced with minimal time in which to prepare patients for adequate self-care abilities. Often times, the clinician may assume that all of the "bases have been covered." In reality, it is because this assumption is made that persons with chronic respiratory disease are often not receiving the full breadth of information that they need to increase their self-care abilities and optimize their quality of life. This article prepares the perianesthesia clinician to ensure that the important tenets of self-care information are addressed for the person with overt and/or underlying chronic respiratory disease. PMID:9934079

Geiger-Bronsky, M

1998-12-01

70

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

ERIC Educational Resources Information Center

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

Parker, Jan

2014-01-01

71

13 CFR 108.200 - Adequate capital for NMVC Companies.  

Code of Federal Regulations, 2010 CFR

...2010-01-01 false Adequate capital for NMVC Companies. 108.200 Section 108.200 Business Credit and Assistance SMALL BUSINESS...for the NMVC Program Capitalizing A Nmvc Company § 108.200 Adequate capital for NMVC Companies. You...

2010-01-01

72

9 CFR 305.3 - Sanitation and adequate facilities.  

...Animal Products 2 2014-01-01 2014-01-01 false Sanitation and adequate facilities. 305.3 Section 305.3 Animals...WITHDRAWAL OF INSPECTION; REPORTS OF VIOLATION § 305.3 Sanitation and adequate facilities. Inspection shall not be...

2014-01-01

73

9 CFR 305.3 - Sanitation and adequate facilities.  

Code of Federal Regulations, 2012 CFR

...Animal Products 2 2012-01-01 2012-01-01 false Sanitation and adequate facilities. 305.3 Section 305.3 Animals...WITHDRAWAL OF INSPECTION; REPORTS OF VIOLATION § 305.3 Sanitation and adequate facilities. Inspection shall not be...

2012-01-01

74

9 CFR 305.3 - Sanitation and adequate facilities.  

Code of Federal Regulations, 2010 CFR

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

2010-01-01

75

9 CFR 305.3 - Sanitation and adequate facilities.  

Code of Federal Regulations, 2013 CFR

...Animal Products 2 2013-01-01 2013-01-01 false Sanitation and adequate facilities. 305.3 Section 305.3 Animals...WITHDRAWAL OF INSPECTION; REPORTS OF VIOLATION § 305.3 Sanitation and adequate facilities. Inspection shall not be...

2013-01-01

76

9 CFR 305.3 - Sanitation and adequate facilities.  

Code of Federal Regulations, 2011 CFR

...Animal Products 2 2011-01-01 2011-01-01 false Sanitation and adequate facilities. 305.3 Section 305.3 Animals...WITHDRAWAL OF INSPECTION; REPORTS OF VIOLATION § 305.3 Sanitation and adequate facilities. Inspection shall not be...

2011-01-01

77

Towards more adequate colour histograms for in-body images  

Microsoft Academic Search

Although there is a growing number of scientific papers describing classification of in-body images, most of it is based on traditional colour histograms. In this paper we explain why these might not be the most adequate visual features for in-body image classification. Based on a colour dynamic range maximization criterion, we propose a methodology for creating more adequate colour histograms,

A. Sousa; M. Dinis-Ribeiro; M. Areia; M. Correia; M. Coimbra

2008-01-01

78

Clinical practice guidelines for maintaining adequate iron status with intravenous iron dextran in hemodialysis patients.  

PubMed

While oral iron can be used to manage iron stores in some hemodialysis patients, most require intravenous iron supplementation. Maintenance of iron balance in these patients is critical, since patients with end stage renal disease often suffer from anemia caused by inadequate production of red blood cells and iron deficiency resulting from chronic blood loss. Using guidelines that include maintenance dosing ensures sustained adequate iron stores and maximizes the effects of rHuEPO therapy. Easy-to-administer clinical practice guidelines for repletion and maintenance of iron stores are presented here. PMID:10633605

Peacock, E; Lindenfeld, S M

1999-06-01

79

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

PubMed

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

Wilson, Anne

2010-02-01

80

4 CFR 200.14 - Responsibility for maintaining adequate safeguards.  

Code of Federal Regulations, 2010 CFR

...2010-01-01 false Responsibility for maintaining...Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY...1974 § 200.14 Responsibility for maintaining adequate...The Board has the responsibility for maintaining...including maintenance of accountability records showing...

2010-01-01

81

Ensuring message embedding in wet paper steganography  

E-print Network

Ensuring message embedding in wet paper steganography Daniel Augot1, Morgan Barbier1, and Caroline of this new scheme in the case of perfect codes. Keywords: steganography, syndrome coding problem, wet paper codes. 1 Introduction Hiding messages in innocuous-looking cover-media in a stealthy way, steganography

Paris-Sud XI, Université de

82

Electronic Information Delivery: Ensuring Quality and Value.  

ERIC Educational Resources Information Center

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

Basch, Reva, Ed.

83

FROM ENABLING TO ENSURING GRID WORKFLOWS  

Microsoft Academic Search

Grid workflows are becoming a mainstream paradigm for implementing complex grid applications. In addition to existing grid enabling techniques, various grid ensuring techniques are emerging, e.g. workflow analysis and temporal reasoning, to probe potential pitfalls and errors and guarantee quality of services (QoS) at a design phase. A new state ? calculus is proposed in this work, which not only

Junwei Cao; Fan Zhang; Ke Xu; Lianchen Liu; Cheng Wu

84

Ensuring system security through formal software evaluation  

SciTech Connect

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

Howell, J A; Fuyat, C [Los Alamos National Lab., NM (United States)] [Los Alamos National Lab., NM (United States); Elvy, M [Marble Associates, Boston, MA (United States)] [Marble Associates, Boston, MA (United States)

1992-01-01

85

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

NASA Astrophysics Data System (ADS)

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

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

2013-11-01

86

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

PubMed

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

Facchini, Rose E

2013-05-01

87

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

PubMed Central

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

2014-01-01

88

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

PubMed Central

Abstract Objective To determine whether national drug control laws ensure that opioid drugs are available for medical and scientific purposes, as intended by the 1972 Protocol amendment to the 1961 Single Convention on Narcotic Drugs. Methods The authors examined whether the text of a convenience sample of drug laws from 15 countries: (i) acknowledged that opioid drugs are indispensable for the relief of pain and suffering; (ii) recognized that government was responsible for ensuring the adequate provision of such drugs for medical and scientific purposes; (iii) designated an administrative body for implementing international drug control conventions; and (iv) acknowledged a 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

Brown, Marty Skemp; Maurer, Martha A

2014-01-01

89

Do Beginning Teachers Receive Adequate Support from Their Headteachers?  

ERIC Educational Resources Information Center

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

Menon, Maria Eliophotou

2012-01-01

90

Estimated healthcare savings associated with adequate dairy food intake  

Microsoft Academic Search

Medical literature that has coalesced during the past two to three decades has identified adequate intake of nutrients from dairy foods as a common factor in the reduction of the disease burden of several common medical conditions. These include obesity, hypertension, type 2 diabetes, osteoporosis, kidney stones, certain outcomes of pregnancy, and some cancers. Treatment of these disorders, particularly cardiovascular,

David A McCarron; Robert P Heaney

2004-01-01

91

Comparability and Reliability Considerations of Adequate Yearly Progress  

ERIC Educational Resources Information Center

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

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

2012-01-01

92

CAN EXPERIMENTAL MEMORY RESEARCH ADEQUATELY EXPLAIN MEMORY FOR TRAUMA?  

Microsoft Academic Search

In the debate on memories of traumatic events (especially childhood abuse), traumatic memories and dissociative amnesia are central topics. These phenomena are frequently described as dissociative memory problems. The aim of the present article is to assess to what extent memory mechanisms as identified in experimental research (such as encoding, storage, and retrieval factors) are adequate in explaining memories of

Philip Spinhoven; Ellert R. S. Nijenhuis; Richard Van Dyck

1999-01-01

93

Is the Marketing Concept Adequate for Continuing Education?  

ERIC Educational Resources Information Center

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)

Rittenburg, Terri L.

1984-01-01

94

Communication skills to ensure patient satisfaction.  

PubMed

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

Shendurnikar, Niranjan; Thakkar, Pareshkumar A

2013-11-01

95

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

PubMed Central

Background Pseudomonas aeruginosa has gained an increasing amount of attention in the treatment of patients with pneumonia. However, the benefit of empirical combination therapy for pneumonia remains unclear. We evaluated the effects of adequate empirical combination therapy and multidrug-resistance in bacteremic Pseudomonas pneumonia on the mortality. Methods A retrospective cohort study was performed at the 2,700-bed tertiary care university hospital. We reviewed the medical records of patients with bacteremic pneumonia between January 1997 and February 2011. Patients who received either inappropriate or appropriate empirical therapy were compared by using marginal structural model. Furthermore, we investigated the direct impact of combination therapy on clinical outcomes in patients with monomicrobial bacteremic pneumonia. Results Among 100 consecutive patients with bacteremic Pseudomonas pneumonia, 65 patients were classified in the adequate empirical therapy group, 32 of whom received monotherapy and 33 combination therapy. In the marginal structural model, only inadequate therapy was significantly associated with 28-day mortality (p?=?0.02), and multidrug-resistance was not a significant risk factor. To examine further the direct impact of combination therapy, we performed a subgroup analysis of the 65 patients who received adequate therapy. Multivariate logistic regression analysis identified absence of septic shock at the time of bacteremia (OR, 0.07; 95% CI, 0.01-0.49; p?=?0.008), and adequate combination therapy (OR, 0.05; 95% CI, 0.01-0.34; p?=?0.002) as variables independently associated with decreased all-cause 28-day mortality. Conclusions Our study suggests that adequate empirical combination therapy can decrease mortality in patients with bacteremic Pseudomonas pneumonia. PMID:23157735

2012-01-01

96

Ensuring content integrity when using commercial support.  

PubMed

Preventing continuing education program bias when commercial support is used can be challenging. Standards have been developed by health care professional accreditation organizations that focus on independence, conflict of interest, appropriate management of commercial funds, content integrity, and disclosure to learners. Implementation of these standards can significantly reduce the risk of bias and improve dissemination of balanced clinical information. J Contin Educ Nurs. 2014;45(10):429-431. PMID:25280188

Lubejko, Barbara G

2014-10-01

97

Developing an adequate "pneumatraumatology": understanding the spiritual impacts of traumatic injury.  

PubMed

Psychosocial interventions and systematic theology are primary resources for chaplains and congregational pastors who care for victims of physical trauma. Yet these resources may not be adequate to address the spiritual impacts of trauma. This article proposes a preliminary "pneumatraumatology," drawing on early Christian asceticism and Buddhist mysticism to describe one way of understanding the spiritual impacts of traumatic injury. It also suggests possible responses to these impacts informed by narrative/constructionist perspectives and Breggemann's understanding of the dimensions of spiritual transformation in the Hebrew Bible. PMID:12090222

Bidwell, Duane R

2002-01-01

98

The role of corporations in ensuring biodiversity  

NASA Astrophysics Data System (ADS)

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

Kelly, Joyce M.; Hodge, Michael R.

1996-11-01

99

Combine 1D and 3D color calibration methods for ensuring consistent color reproduction  

NASA Astrophysics Data System (ADS)

Printer color calibration is a crucial step to ensure consistent color reproduction. In this paper, we present a color calibration system that can not only ensure the color consistency for a same printer at different times, but also ensure the color consistency for different printers of the same model. We will analyze the most significant sources of color variations in an ink jet printing system, and show that some factors produce only the luminance (optical density) variation, and some other factors produce both luminance and chrominance (hue and saturation) variations. Two adequate color calibration methods are proposed to compensate for these variations: one is based on 1D linearization, which is used to compensate for the luminance variation; and the other is based on a 3D search in an existing color conversion table, this method is particularly designed to compensate for the chrominance variation.

Wu, Yifeng

2003-12-01

100

Paying pharmacists for patient care  

PubMed Central

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

Grindrod, Kelly A.; Chatterley, Trish; Tsuyuki, Ross T.

2014-01-01

101

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

PubMed Central

Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP) health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI). Large proportion of informal sector labor in India's workforce prevents major upscaling of social health insurance (SHI). Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS), with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete. PMID:23112438

Prinja, Shankar; Kaur, Manmeet; Kumar, Rajesh

2012-01-01

102

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

PubMed

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

Prinja, Shankar; Kaur, Manmeet; Kumar, Rajesh

2012-07-01

103

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

NASA Technical Reports Server (NTRS)

Over the past several years, NASA has realized tremendous progress in Extravehicular Activity (EVA) technology development. This has been evidenced by the progressive development of a new 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

Chullen, Cinda; Conger, Bruce

2012-01-01

104

Environmental education: Ensuring a sustainable future  

SciTech Connect

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.

Rogers, D.P. [Environmental Protection Agency, Research Triangle Park, NC (United States); Lee, J.C. [SAIC, Durham, NC (United States)

1997-12-31

105

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

SciTech Connect

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.

Chung, Eugene; Marsh, Robin B.; Griffith, Kent A.; Moran, Jean M. [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Pierce, Lori J., E-mail: ljpierce@umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)

2013-04-01

106

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

PubMed

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

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

2010-07-01

107

Planning to meet the care need challenge in Alberta, Canada.  

PubMed

The Canadian province of Alberta faces challenges in ensuring an adequate supply of nurses to meet care needs. This paper describes the approach adopted by Alberta Health Services (the public health care provider in Alberta) to address this challenge. Planning was undertaken on the basis of care needs rather than starting from a particular professional perspective and highlighted that the needs could be met by Registered Nurses, Licensed Practical Nurses or Healthcare Aides. Six scenarios, representing different potential mixes of Registered Nurses, Licensed Practical Nurses and Healthcare Aides were identified and used as the basis of stakeholder consultations. The paper identifies the workforce outcomes and needs for the different scenarios and the outcomes of the workforce planning process. PMID:22678929

Duckett, Stephen; Bloom, Judy; Robertson, Andrea

2012-01-01

108

The effect of care planning on quality of patient care.  

PubMed

Nursing care plans can be seen as a means of ensuring holistic care. This study investigated the view of nurses and support workers on the care plan as a tool to enhance quality care and how their views were reflected in practice. PMID:9873343

Webster, J

1998-11-01

109

Ensuring effective medication reconciliation in home healthcare.  

PubMed

A patient was readmitted two days after discharge with severe hypoglycemia. The treating team discharged the patient on a new insulin regimen without realizing that the patient also had insulin 70/30 at home. The patient continued to take her previous regimen as well as the new one, and was found unresponsive by her husband. The patient was in the ICU with the incident likely resulting in permanent neurological deficits. ()A patient was admitted to a hospital from a home health agency. The list of medications provided by the agency did not completely match the list provided by the patient's family physician (i.e., the antihypertensive agent metoprolol tartrate [Lopressor] was not listed by the agency as one of the medications that the patient was currently taking). Therefore, metoprolol tartrate was not initially ordered. The patient developed atrial fibrillation shortly after hospital admission and required a transfer to the ICU [intensive care unit]. A diltiazem (Cardizem) infusion was started and the patient's family physician became aware that the patient had not been receiving their antihypertensive medication and initiated an order for the metoprolol tartrate (). PMID:25268524

Fuji, Kevin T; Abbott, Amy A

2014-10-01

110

[Adequate venous autoplasty in severe superior vena cava syndrome].  

PubMed

Eleven patients underwent plastic operations on the superior vena cava (SVC) in its severe occlusion. The SVC syndrome was caused by malignant tumors of the right lung and mediastinum in 9 patients, lymphogranulomatosis in one patient, and by chronic fibrous mediastinitis in another patient. The SVC and its main branches were replaced by a multisegmental graft (lineal or bifurcation) of autogenous vein formed by parallel stitching together of 3-5 longitudinally cut segments of the vena saphena magna. Venous drainage was adequate and the graft remained unobstructed for a long time due to the anatomical conformity of the graft to the SVC and the equal diameters of the joined vessels. The immediate and late-term (3 to 26 months) results of plastics with a multisegmental graft or autogenous vein were good. PMID:2687134

Babliak, D E; Averchuk, V G

1989-01-01

111

Quality-of-care challenges for rural health.  

PubMed

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

Moscovice, I; Rosenblatt, R

2000-01-01

112

Ensuring US National Aeronautics Test Capabilities  

NASA Technical Reports Server (NTRS)

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

Marshall, Timothy J.

2010-01-01

113

Ensuring That Cosmetics Used in the United States Are Safe  

MedlinePLUS Videos and Cool Tools

... Basics Metrics Watch: FDA Basics Videos FDA Basics Video: Ensuring That Cosmetics Used in the United States ... How FDA Evaluates Regulated Products: Cosmetics FDA Basics Video: Ensuring That Cosmetics Used in the United States ...

114

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

Code of Federal Regulations, 2010 CFR

...maintaining adequate technical, physical, and security...and automatic record systems. 1182.15 Section...maintaining adequate technical, physical, and security...and automatic record systems. The Chief Information...maintaining adequate technical, physical, and...

2010-10-01

115

Dose Limits for Man do not Adequately Protect the Ecosystem  

SciTech Connect

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

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

2004-08-01

116

Melanoma screening behavior among primary care physicians.  

PubMed

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

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

2004-11-01

117

Factors influencing the documentation of care.  

PubMed

Nursing care plans should provide clear evidence of the quality of patient care provided. A study of a care plan used in a coronary care unit found that nurses were critical of the plan's format. Nurses need adequate education on the use of the chosen care plan and an understanding of the nursing model on which it is based. PMID:12026764

Kerr, C M; Lewis, D M

2000-05-01

118

Monitoring the eye lens: which dose quantity is adequate?  

NASA Astrophysics Data System (ADS)

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

Behrens, R.; Dietze, G.

2010-07-01

119

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

NASA Technical Reports Server (NTRS)

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

Chullen, Cinda

2011-01-01

120

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

PubMed

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

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

1997-01-01

121

Ensuring Safety, Security, and Sustainability of Mission-Critical Cyber–Physical Systems  

Microsoft Academic Search

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

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

2012-01-01

122

Perioperative care following complex laryngotracheal reconstruction in infants and children  

PubMed Central

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

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

2010-01-01

123

Ancillary Care in Community-Based Public Health Intervention Research  

PubMed Central

Community-based public health intervention research in developing countries typically takes place not in clinics but in people's homes and other living spaces. Research subjects and their communities may lack adequate nutrition, clean water, sanitation, and basic preventive and therapeutic services. Researchers often encounter unmet health needs in their interactions with individual subjects and need ethical guidelines to help them decide how to respond. To what extent do researchers have an ethical obligation to provide ancillary care—health care beyond what is necessary to ensure scientific validity and subjects' safety? We discuss a case example from Nepal and propose a simple 2-step sequence of questions to aid decision making. PMID:20019298

Taylor, Holly A.; Mullany, Luke C.

2010-01-01

124

38 CFR 59.140 - Nursing home care requirements.  

... 2014-07-01 false Nursing home care requirements. 59.140 Section 59...STATE HOMES § 59.140 Nursing home care requirements. As a condition for...designed and equipped for adequate nursing care, comfort, and privacy of...

2014-07-01

125

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

ERIC Educational Resources Information Center

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…

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

2002-01-01

126

Barriers to the collaborative care of patients with orofacial injury.  

PubMed

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

Wong, Eunice C; Marshall, Grant N

2010-05-01

127

42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.  

Code of Federal Regulations, 2013 CFR

...for the availability of respiratory care services, would require respiratory care as an inpatient in a hospital...to have payment made for inpatient care under the State plan; (4) Has adequate social support services to be cared...

2013-10-01

128

42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.  

Code of Federal Regulations, 2012 CFR

...for the availability of respiratory care services, would require respiratory care as an inpatient in a hospital...to have payment made for inpatient care under the State plan; (4) Has adequate social support services to be cared...

2012-10-01

129

42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.  

Code of Federal Regulations, 2011 CFR

...for the availability of respiratory care services, would require respiratory care as an inpatient in a hospital...to have payment made for inpatient care under the State plan; (4) Has adequate social support services to be cared...

2011-10-01

130

42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.  

Code of Federal Regulations, 2010 CFR

...for the availability of respiratory care services, would require respiratory care as an inpatient in a hospital...to have payment made for inpatient care under the State plan; (4) Has adequate social support services to be cared...

2010-10-01

131

Renal care: six essentials for a haemodialysis patient.  

PubMed

Once the filtration rate of the kidney falls below 10 ml/minute a patient will require haemodialysis treatment sessions typically three times per week to remove waste products and excess fluids. Due to the obvious change in life circumstances the patient will require clinical intervention and usually quality psychosocial support. Therefore, several areas have to be included in the nursing care plan to provide a complete treatment strategy. Access to the blood is provided through a surgically created access and this must be monitored regularly for adequate function and signs of infection. With little or no renal function fluid will accumulate in the body and there are a number of clinical signs that need to be recognized that are involved in determining the patient's correct hydration status. The interpretation of routine observations such as weight and blood pressure is vital to the fluid removal strategy and antihypertensive drug therapy. The patient's diet should also be carefully controlled avoiding foods with high sodium, potassium and phosphate content while ensuring adequate protein intake and vitamin supplement where necessary. Most patients require several or more medications throughout their life on haemodialysis and this requires a well-organized care plan for medication administration. PMID:17551444

Chamney, Melissa

132

Literacy in the World of the Aged Care Worker.  

ERIC Educational Resources Information Center

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

Wyse, Linda; Casarotto, Nadia

133

28 CFR 61.10 - Ensuring Department NEPA compliance.  

Code of Federal Regulations, 2012 CFR

...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 NEPA...

2012-07-01

134

28 CFR 61.10 - Ensuring Department NEPA compliance.  

Code of Federal Regulations, 2013 CFR

...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 NEPA...

2013-07-01

135

28 CFR 61.10 - Ensuring Department NEPA compliance.  

Code of Federal Regulations, 2011 CFR

...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 NEPA...

2011-07-01

136

28 CFR 61.10 - Ensuring Department NEPA compliance.  

Code of Federal Regulations, 2010 CFR

...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 NEPA...

2010-07-01

137

Ensuring Food Safety: The Cooperative Retail Food Program  

MedlinePLUS

... Articulos en Espanol Ensuring Food Safety: The Cooperative Retail Food Program Search the Consumer Updates Section Please ... and tribal agencies work cooperatively to help keep retail food safe throughout the United States. These agencies ...

138

Regulatory Considerations to Ensure Clean and Safe Drinking Water  

EPA Science Inventory

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

139

Smart Grid Embedded Cyber Security: Ensuring Security While Promoting Interoperability  

E-print Network

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

Ragsdale, G.

140

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

PubMed Central

Objectives. We examined associations between patient characteristics and self-reported difficulties in accessing mental health and general medical care services. Methods. Patients were recruited from the Continuous Improvement for Veterans in Care–Mood Disorders study. We used multivariable logistic regression analyses to assess whether predisposing (demographic characteristics), enabling (e.g., homelessness), or need (bipolar symptoms, substance abuse) factors were associated with difficulties in obtaining care, difficulties in locating specialty providers, and forgoing care because of cost. Results. Patients reported greater difficulty in accessing general medical services than in accessing psychiatric care. Individuals experiencing bipolar symptoms more frequently avoided psychiatric care because of cost (odds ratio [OR] = 2.43) and perceived greater difficulties in accessing medical specialists (OR = 2.06). Homeless individuals were more likely to report hospitalization barriers, whereas older and minority patients generally encountered fewer problems accessing treatment. Conclusions. Need and enabling factors were most influential in predicting self-reported difficulties in accessing care, subsequently interfering with treatment dynamics and jeopardizing clinical outcomes. Efforts in the Department of Veterans Affairs to expand mental health care access should be coupled with efforts to ensure adequate access to general medical services among patients with chronic mental illnesses. PMID:19150912

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

2009-01-01

141

Partnership between pharmaceutical industry and RBS ensures relevant curriculum producing top-talent graduates pharma companies need  

E-print Network

Partnership between pharmaceutical industry and RBS ensures relevant curriculum producing top-talent, creating a new demand for talented, motivated individuals with a special knowledge of the healthcare of talented managers, well-versed in health-care and pharmaceutical issues. One of the strengths

Lin, Xiaodong

142

Using the CER Hub to ensure data quality in a multi-institution smoking cessation study.  

PubMed

Comparative effectiveness research (CER) studies involving multiple institutions with diverse electronic health records (EHRs) depend on high quality data. To ensure uniformity of data derived from different EHR systems and implementations, the CER Hub informatics platform developed a quality assurance (QA) process using tools and data formats available through the CER Hub. The QA process, implemented here in a study of smoking cessation services in primary care, used the 'emrAdapter' tool programmed with a set of quality checks to query large samples of primary care encounter records extracted in accord with the CER Hub common data framework. The tool, deployed to each study site, generated error reports indicating data problems to be fixed locally and aggregate data sharable with the central site for quality review. Across the CER Hub network of six health systems, data completeness and correctness issues were prevalent in the first iteration and were considerably improved after three iterations of the QA process. A common issue encountered was incomplete mapping of local EHR data values to those defined by the common data framework. A highly automated and distributed QA process helped to ensure the correctness and completeness of patient care data extracted from EHRs for a multi-institution CER study in smoking cessation. PMID:24993545

Walker, Kari L; Kirillova, Olga; Gillespie, Suzanne E; Hsiao, David; Pishchalenko, Valentyna; Pai, Akshatha Kalsanka; Puro, Jon E; Plumley, Robert; Kudyakov, Rustam; Hu, Weiming; Allisany, Art; McBurnie, MaryAnn; Kurtz, Stephen E; Hazlehurst, Brian L

2014-11-01

143

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

PubMed Central

Background Obstetric fistula is a physically and socially disabling obstetric complication that affects about 3,000 women in Tanzania every year. The fistula, an opening that forms between the vagina and the bladder and/or the rectum, is most frequently caused by unattended prolonged labour, often associated with delays in seeking and receiving appropriate and adequate birth care. Using the availability, accessibility, acceptability and quality of care (AAAQ) concept and the three delays model, this article provides empirical knowledge on birth care experiences of women who developed fistula after prolonged labour. Methods We used a mixed methods approach to explore the birthing experiences of women affected by fistula and the barriers to access adequate care during labour and delivery. Sixteen women were interviewed for the qualitative study and 151 women were included in the quantitative survey. All women were interviewed at the Comprehensive Community Based Rehabilitation Tanzania in Dar es Salaam and Bugando Medical Centre in Mwanza. Results Women experienced delays both before and after arriving at a health facility. Decisions on where to seek care were most often taken by husbands and mothers-in-law (60%). Access to health facilities providing emergency obstetric care was inadequate and transport was a major obstacle. About 20% reported that they had walked or were carried to the health facility. More than 50% had reported to a health facility after two or more days of labour at home. After arrival at a health facility women experienced lack of supportive care, neglect, poor assessment of labour and lack of supervision. Their birth accounts suggest unskilled birth care and poor referral routines. Conclusions This study reveals major gaps in access to and provision of emergency obstetric care. It illustrates how poor quality of care at health facilities contributes to delays that lead to severe birth injuries, highlighting the need to ensure women's rights to accessible, acceptable and adequate quality services during labour and delivery. PMID:22013991

2011-01-01

144

Effects of prophylactic indomethacin in extremely low birth weight infants with and without adequate exposure to antenatal steroids  

PubMed Central

Objective To examine if antenatal steroids modify the immediate and long-term effects of prophylactic indomethacin in extremely low birth weight infants. Design Post-hoc subgroup analysis of data from the Trial of Indomethacin Prophylaxis in Preterms. Setting Thirty-two neonatal intensive care units in Canada, the United States, Australia, New Zealand, and Hong Kong. Participants A total of 1195 infants with birth weights of 500 to 999 g and known exposure to antenatal steroids. We defined as “adequate” any exposure to antenatal steroids that occurred at least 24 hours before delivery. Intervention Indomethacin or placebo intravenously once daily for the first three days. Outcome Measures Death or survival to 18 months with 1 or more of cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness; severe peri-and intraventricular hemorrhage; patent ductus arteriosus; and surgical closure of a patent ductus arteriosus. Results Of the 1195 infants in this analysis cohort, 670 had adequate and 525 had inadequate exposure to antenatal steroids. There was little statistical evidence of heterogeneity in the effects of prophylactic indomethacin between the subgroups for any of the outcomes. The adjusted p values for interaction were as low as 0.15 for the end point of death or impairment at 18 months, and as high as 0.80 for the outcome of surgical duct closure. Conclusion There was little evidence that the effects of prophylactic indomethacin vary in extremely low birth weight infants with and without adequate exposure to antenatal steroids. PMID:21727276

Schmidt, Barbara; Seshia, Mary; Shankaran, Seetha; Mildenhall, Lindsay; Tyson, Jon; Lui, Kei; Fok, Tai; Roberts, Robin

2012-01-01

145

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

NASA Astrophysics Data System (ADS)

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

Klavetter, Eric

2005-09-01

146

42 CFR 438.207 - Assurances of adequate capacity and services.  

Code of Federal Regulations, 2012 CFR

...MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance...State's standards for access to care under this subpart. (b) Nature...appropriate range of preventive, primary care, and specialty services that...

2012-10-01

147

42 CFR 438.207 - Assurances of adequate capacity and services.  

Code of Federal Regulations, 2013 CFR

...MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance...State's standards for access to care under this subpart. (b) Nature...appropriate range of preventive, primary care, and specialty services that...

2013-10-01

148

42 CFR 438.207 - Assurances of adequate capacity and services.  

Code of Federal Regulations, 2011 CFR

...MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance...State's standards for access to care under this subpart. (b) Nature...appropriate range of preventive, primary care, and specialty services that...

2011-10-01

149

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

PubMed

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

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

2008-02-01

150

26Connected Talented Innovative Ensure a sustainable environment  

E-print Network

26Connected Talented Innovative Ensure a sustainable environment Natural Landscape: Natural regions for the Native American village located between the Wabash and Tippecanoe Rivers estab- #12;Connected Talented staff. #12;28Connected Talented Innovative lished by Tecumseh. Prophetstown State Park was established

151

Inspection criteria ensure quality control of parallel gap soldering  

NASA Technical Reports Server (NTRS)

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

Burka, J. A.

1968-01-01

152

Ensuring Student Success through Collaboration. Bulletin No. 94076.  

ERIC Educational Resources Information Center

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

Wisconsin State Dept. of Public Instruction, Madison.

153

Improved molding process ensures plastic parts of higher tensile strength  

NASA Technical Reports Server (NTRS)

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

Heier, W. C.

1968-01-01

154

Ensuring system and software reliability in safety-critical systems  

Microsoft Academic Search

Reliability growth models, formal specifications, testing, safety analysis have been proposed to address system and software reliability. This paper presents a technique, called ripple effect analysis, which is well known in software maintenance, for system and software reliability. This technique is useful to ensure that all the changes that need to be done are indeed changed after a software modification.

W. T. Tsai; R. Mojdehbakhsh; F. Zhu

1998-01-01

155

Ensuring minimal humidity levels in hermetic implant housings  

Microsoft Academic Search

The electronic circuitry of active implantable devices is commonly protected against the risk of water-induced corrosion by using gas-tight (hermetic) packages, preventing moisture from the host body to reach the electronics. However, when closing the package, one has to ensure that the packaged components do not contain moisture that could rise humidity inside the package to critical levels by outgassing.

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

2011-01-01

156

A Method To Ensure Heterogeneous Mixing of Grade 9 Classes.  

ERIC Educational Resources Information Center

This paper presents outcomes of a practicum that was designed to address a need that was created when the Ministry of Education in Ontario, Canada, mandated that all grade 9 classes be "destreamed." A review of educational literature found no methods for ensuring that classes are truly heterogeneously mixed. The practicum was designed to gather…

Brydges, Bruce

157

Ensuring Good Character and Civic Education: Connecting through Service Learning  

ERIC Educational Resources Information Center

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

Shumer, Robert; Lam, Carolina; Laabs, Bonnie

2012-01-01

158

Ensuring Data Quality in Extension Research and Evaluation Studies  

ERIC Educational Resources Information Center

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

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

2012-01-01

159

Dealing with Diversity. Ensuring Success for Every Student.  

ERIC Educational Resources Information Center

Four essays consider aspects of ensuring that every child can succeed in school. The first, "Appearing Acts: Creating Readers in a High School English Class" (Joan Kernan Cone), explores the self-perceptions of students and uses them to inspire their enthusiasm for reading. The cultural sensitivity of the teacher is instrumental in making students…

Cone, Joan Kernan; And Others

160

INTRODUCTION Cell proliferation must be tightly regulated to ensure the  

E-print Network

INTRODUCTION Cell proliferation must be tightly regulated to ensure the development of properly proportioned organs and tissues. During development, most organ primordia grow by increasing in cell number until the appropriate organ size is attained. Cells then exit from the cell cycle and differentiate

Kango-Singh, Madhuri

161

INTRODUCTION Telomeres function to ensure the complete replication of  

E-print Network

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

de Lange, Titia

162

Home care: products and techniques.  

PubMed

Periodontal disease is common in dogs and cats. Prevention and treatment is important for general health and well-being of our pets. Both prevention and treatment of periodontal disease have two components, namely maintenance of oral hygiene and professional periodontal therapy. Maintenance of oral hygiene is performed by the owner and is, therefore, also called home care. The preventions and long-term control of periodontal disease requires adequate home care. This chapter details home care techniques and available products. PMID:11269998

Gorrel, C

2000-11-01

163

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

PubMed

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

Parandeh, Sassan Cyrus

164

Provider's Constraints and Difficulties in Primary Health Care System  

PubMed Central

Background: The contractualization of human resource in recent years has resulted into various human resource management issues. Objective: To explore the administrative and management issues of contractual model of human resource under primary health care system in Delhi. Materials and Methods: Comparative study was conducted on randomly selected sample of 333, comprised of Medical Officers, ANMs, Pharmacist and Laboratory Assistants and Technicians, both regular and contractual cadre. The data was collected using the semi-structured interview schedule and thematic content analysis was done. Results: The five major themes emerged in the analysis; these are (i) physical infrastructure, (ii) organization's working environment, (iii) privileges of staff, (iv) discontentment, (v) human resource development. Comparative analysis of themes between regular and contractual staff revealed significant differences in factors which are embedded into the organization's culture. Element of discontentment is high amongst contractual staff particularly for discrimination in job, undermining of authority, patient care relationship and privileges provided to regular staff. This reflects the area of dissatisfaction which varies between regular and contractual staff in the organization. Conclusion: If primary health care system fails to address genuine constraints of human resources of both regular and contractual cadre and perception of discrimination persists, it is bound to result into poor motivation for good performance in the system of health care. So, adopting good practices in human resource management keeping regular and contractual employees grievances at forefront are urgently needed to ensure the availability of adequately trained and motivated personnel's in health facilities. PMID:25161964

Kumar, Pawan; Khan, Abdul Majeed; Inder, Deep; Anu

2014-01-01

165

Global development challenges and health care reform.  

PubMed

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

Preker, A S

2001-01-01

166

Studies in the Delivery of Ambulatory Care.  

ERIC Educational Resources Information Center

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

Kaplan, Robert; And Others

167

Defining an Adequate Sample of Earlywood Vessels for Retrospective Injury Detection in Diffuse-Porous Species  

E-print Network

Defining an Adequate Sample of Earlywood Vessels for Retrospective Injury Detection in Diffuse to the elaboration of vessel sampling strategies for retrospective injury detection based on vessel lumen size an Adequate Sample of Earlywood Vessels for Retrospective Injury Detection in Diffuse-Porous Species. PLoS ONE

Stoffel, Markus

168

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

PubMed

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

Bagalio, Sharon A

2007-01-01

169

Strategies for ensuring quality data from Indian investigational sites  

PubMed Central

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

Hajos, Antal K.; Kamble, Sujal K.

2011-01-01

170

A manufacturer's approach to ensure long term structural integrity  

NASA Technical Reports Server (NTRS)

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

Ansell, Hans; Fredriksson, Billy; Holm, Ingvar

1992-01-01

171

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

Code of Federal Regulations, 2010 CFR

...maintaining adequate technical, physical, and security...and automatic record systems? 2508.10 Section...maintaining adequate technical, physical, and security...and automatic record systems? The Chief Executive...maintaining adequate technical, physical, and...

2010-10-01

172

Problems and conception of ensuring radiation safety during Mars missions  

NASA Astrophysics Data System (ADS)

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

Petrov, V. M.

2004-01-01

173

Hospice care  

MedlinePLUS

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

174

Parent Handbook for Family Child Care Homes.  

ERIC Educational Resources Information Center

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

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

175

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

PubMed Central

Background The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. Methods Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. Results Paediatric care can be complex, usually involving both the patient and the patient’s family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. Conclusions International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care for PMs at both policy and service levels is an investment in the future that will benefit native and migrant families. PMID:24093461

2013-01-01

176

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

PubMed

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

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

2003-01-01

177

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

Federal Register 2010, 2011, 2012, 2013

...Suspension of Community Eligibility for Failure To Maintain Adequate Floodplain Management...suspending one community because of its failure to maintain floodplain management regulations...community by publishing a Flood Insurance Rate Map. The effective date of this map...

2010-02-05

178

12 CFR 1229.5 - Capital distributions for adequately capitalized Banks.  

Code of Federal Regulations, 2011 CFR

...distributions for adequately capitalized Banks. 1229.5 Section 1229.5 Banks and Banking FEDERAL HOUSING FINANCE AGENCY ENTITY REGULATIONS CAPITAL...CORRECTIVE ACTION Federal Home Loan Banks § 1229.5 Capital...

2011-01-01

179

12 CFR 1229.5 - Capital distributions for adequately capitalized Banks.  

Code of Federal Regulations, 2010 CFR

...distributions for adequately capitalized Banks. 1229.5 Section 1229.5 Banks and Banking FEDERAL HOUSING FINANCE AGENCY ENTITY REGULATIONS CAPITAL...CORRECTIVE ACTION Federal Home Loan Banks § 1229.5 Capital...

2010-01-01

180

21 CFR 314.126 - Adequate and well-controlled studies.  

... 314.126 Section 314.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT...well-controlled clinical investigation. The Food and Drug Administration considers...the adequately documented natural history of the disease or...

2014-04-01

181

21 CFR 314.126 - Adequate and well-controlled studies.  

Code of Federal Regulations, 2013 CFR

... 314.126 Section 314.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT...well-controlled clinical investigation. The Food and Drug Administration considers...the adequately documented natural history of the disease or...

2013-04-01

182

21 CFR 314.126 - Adequate and well-controlled studies.  

Code of Federal Regulations, 2010 CFR

... 314.126 Section 314.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT...well-controlled clinical investigation. The Food and Drug Administration considers...the adequately documented natural history of the disease or...

2010-04-01

183

21 CFR 314.126 - Adequate and well-controlled studies.  

Code of Federal Regulations, 2012 CFR

... 314.126 Section 314.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT...well-controlled clinical investigation. The Food and Drug Administration considers...the adequately documented natural history of the disease or...

2012-04-01

184

21 CFR 314.126 - Adequate and well-controlled studies.  

Code of Federal Regulations, 2011 CFR

... 314.126 Section 314.126 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT...well-controlled clinical investigation. The Food and Drug Administration considers...the adequately documented natural history of the disease or...

2011-04-01

185

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

Code of Federal Regulations, 2011 CFR

...2011-07-01 2011-07-01 false Exemptions for pesticides adequately regulated by another Federal agency...ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES...

2011-07-01

186

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

Code of Federal Regulations, 2010 CFR

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

2010-07-01

187

UNIVERSITY OF CONNECICUT HEALTH CENTER CORRECTIONAL MANAGED HEALTH CARE  

E-print Network

UNIVERSITY OF CONNECICUT HEALTH CENTER CORRECTIONAL MANAGED HEALTH CARE POLICY AND PROCEDURES SERVICES Effective Date: 04/01/01 POLICY: University of Connecticut Health Center (UCHC), Correctional Managed Health Care (CMHC) shall ensure that newly admitted inmates to Connecticut Department

Oliver, Douglas L.

188

Ask Your Child Care Program Before a Disaster  

MedlinePLUS

... just in case. Do the state and local emergency management agencies and responders know about your child care ... and where it is located? f Ensure local emergency management agencies know about your child care provider. Call ...

189

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

Microsoft Academic Search

BACKGROUND: Amount of sleep is an important indicator of health and well-being in children and adolescents. Adequate sleep (AS: adequate sleep is defined as 6–8 hours per night regularly) is a critical factor in adolescent health and health-related behaviors. The present study was based on a health promotion project previously conducted on adolescents in Tao-Yuan County, Taiwan. The aim was

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

2006-01-01

190

Fan Aerodynamic Performance Guarantees: Do Your Policies, Procedures and Penalties Provide Adequate Certainty?  

E-print Network

FAN AERODYNAMIC PERFORMANCE GUARANTEES: Do Your Policies, Procedures and Penalties Provide Adequate Certainty? Steven G. Kaufman, P.Eng., Senior Staff Engineer Vern Martin, P.Eng., Senior Staff Engineer Mats A. Falk, P.Eng., Chief Engineer...FAN AERODYNAMIC PERFORMANCE GUARANTEES: Do Your Policies, Procedures and Penalties Provide Adequate Certainty? Steven G. Kaufman, P.Eng., Senior Staff Engineer Vern Martin, P.Eng., Senior Staff Engineer Mats A. Falk, P.Eng., Chief Engineer...

Kaufman, S. G.; Martin, V.; Falk, M. A.

2004-01-01

191

[Use of music in palliative care].  

PubMed

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

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

2011-12-01

192

Ensuring data consistency over CMS distributed computing system  

SciTech Connect

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

Rossman, Paul; /Fermilab

2009-05-01

193

A learning program that ensures prompt and versatile vocal imitation  

PubMed Central

Here we show how a migratory songbird, the chipping sparrow (Spizella passerina), achieves prompt and precise vocal imitation. Juvenile chipping sparrow males develop five to seven potential precursor songs; the normal development of these songs requires intact hearing but not imitation from external models. The potential precursor songs conform with general species-typical song parameters but differ from the song of wild, adult territorial males. As chipping sparrow males return from migration to start their first breeding season, they settle close to an older adult. The young male then stops producing all but one of its precursor songs, retaining the one that most resembles that of its neighbor. This single song then becomes more variable and, in a matter of days, is altered to closely match the neighbor's song. This elegant solution ensures species specificity and promptness of imitation. PMID:18077359

Liu, Wan-chun; Nottebohm, Fernando

2007-01-01

194

A learning program that ensures prompt and versatile vocal imitation.  

PubMed

Here we show how a migratory songbird, the chipping sparrow (Spizella passerina), achieves prompt and precise vocal imitation. Juvenile chipping sparrow males develop five to seven potential precursor songs; the normal development of these songs requires intact hearing but not imitation from external models. The potential precursor songs conform with general species-typical song parameters but differ from the song of wild, adult territorial males. As chipping sparrow males return from migration to start their first breeding season, they settle close to an older adult. The young male then stops producing all but one of its precursor songs, retaining the one that most resembles that of its neighbor. This single song then becomes more variable and, in a matter of days, is altered to closely match the neighbor's song. This elegant solution ensures species specificity and promptness of imitation. PMID:18077359

Liu, Wan-Chun; Nottebohm, Fernando

2007-12-18

195

Neuronal Oscillations Enhance Stimulus Discrimination by Ensuring Action Potential Precision  

PubMed Central

Although oscillations in membrane potential are a prominent feature of sensory, motor, and cognitive function, their precise role in signal processing remains elusive. Here we show, using a combination of in vivo, in vitro, and theoretical approaches, that both synaptically and intrinsically generated membrane potential oscillations dramatically improve action potential (AP) precision by removing the membrane potential variance associated with jitter-accumulating trains of APs. This increased AP precision occurred irrespective of cell type and—at oscillation frequencies ranging from 3 to 65 Hz—permitted accurate discernment of up to 1,000 different stimuli. At low oscillation frequencies, stimulus discrimination showed a clear phase dependence whereby inputs arriving during the trough and the early rising phase of an oscillation cycle were most robustly discriminated. Thus, by ensuring AP precision, membrane potential oscillations dramatically enhance the discriminatory capabilities of individual neurons and networks of cells and provide one attractive explanation for their abundance in neurophysiological systems. PMID:16689623

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

2006-01-01

196

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

Microsoft Academic Search

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

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

197

Importance of adequate exercise in the detection of coronary heart disease by radionuclide ventriculography  

SciTech Connect

Rest and exercise radionuclide ventriculograms were obtained on 77 symptomatic patients without prior documented coronary artery disease (CAD). Coronary artery disease was present by angiograms in 48. Radionuclide ventriculography (RNV) was abnormal in 41 patients (overall sensitivity 85%). In 29 patients with normal coronary arteries, RNV was normal in 24 (specificity 83%). To determine if the exercise level affects sensitivity, the studies were graded for adequacy of exercise. It was considered adequate if patients developed (a) chest pain, or (b) ST segment depression of at least 1 mm, or (c) if they achieved a pressure rate product greater than 250. Among the 48 patients with coronary artery disease, 35 achieved adequate exercise. Thirty-three had an abnormal RNV (sensitivity 94%). In 13 patients who failed to achieve adequate exercise, RNV was abnormal in eight (sensitivity of only 62%). Some patients with coronary artery disease may have a normal ventricular response at inadequate levels of stress.

Brady, T.J.; Thrall, J.H.; Lo, K.; Pitt, B.

1980-12-01

198

Strategies for transitioning to adult care for youth with Lennox-Gastaut syndrome and related disorders.  

PubMed

Transition is the process of preparing children with chronic illness and their families for the adult health care system. In patients with Lennox-Gastaut syndrome (LGS) and related disorders, the process of transition is complicated by the presence of intellectual handicap, treatment-resistant epilepsy, and behavioral issues. Patients who are not successfully transitioned to adult care may end up without specialty care, may not receive satisfactory adult services, may lack adequate follow-up and access to newer therapies, and may lack appropriate management of comorbid conditions. Several family related and clinician-related barriers can inhibit the transition process. Transition strategies that maximize each patient's ability to achieve his or her potential and optimize self-sufficiency may lead to better social outcomes. Adolescent clinics that include members of the pediatric and adult neurology teams may help ensure a smooth transition to adult care, although studies are needed to objectively establish the best model. Results are reported from a survey of 133 symposium attendees on the topic of practice characteristics and issues related to transitioning care. Results suggested a great deal of dissatisfaction about the process of transition, especially for patients with intellectual handicap. We provide suggestions for developing a transition program, including identifying a willing adult service, adapting a multidisciplinary approach, addressing legal and psychosocial issues, and celebrating rites of passage. PMID:21790562

Camfield, Peter R; Gibson, Patricia A; Douglass, Laurie M

2011-08-01

199

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

PubMed

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

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

2012-05-01

200

Conflict between parents over care  

Microsoft Academic Search

Conflict between parents over care of young arises when the young benefit from the effort of both parents, but each parent suffers a reduction in future reproductive success as a consequence of its own effort. Here, we review existing models and argue that they fail to capture many important components of parental con- flict. For example, we lack adequate models

Alasdair I. Houston; Tamás Székely; John M. McNamara

2005-01-01

201

fficient crop production requires an adequate supply of all essential plant nutrients. However,  

E-print Network

microorganisms. This is called "mineralization" (Fig. 2). The first step of mineralization is "ammonificationE fficient crop production requires an adequate supply of all essential plant nutrients. However- fying" bacteria in the soil through the process called "nitrification." Figure 2. The mineralization

202

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

Federal Register 2010, 2011, 2012, 2013

...blood cells and iron stores (21 CFR 640.3...donors, can develop iron deficiency, with...understanding of iron loss in blood donors may...hemoglobin measurement, iron loss and iron measurement methods...adequate donor iron stores. The first day...

2011-08-17

203

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

NASA Technical Reports Server (NTRS)

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

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

1980-01-01

204

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

ERIC Educational Resources Information Center

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

Pary, Robert J.

1991-01-01

205

Leisure Service Delivery Systems: Are They Adequate?1 Rene Fukuhara DahI2  

E-print Network

Leisure Service Delivery Systems: Are They Adequate?1 Rene Fukuhara DahI2 Abstract in which ethnic groups are excluded are discussed. The ability of leisure service agencies to respond these changes, leisure service professionals must reconceptualize their image of the individual and broaden

Standiford, Richard B.

206

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

ERIC Educational Resources Information Center

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

Moser, Sharon

2010-01-01

207

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

ERIC Educational Resources Information Center

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

Hemelt, Steven W.

2011-01-01

208

From Mean and Median Income to the Most Adequate Way of Taking Inequality Into  

E-print Network

From Mean and Median Income to the Most Adequate Way of Taking Inequality Into Account Vladik not only the total income, but also the degree of inequality in income distri- bution. Comment Kreinovich, Hung T. Nguyen, and Rujira Ouncharoen Abstract How can we compare the incomes of two different

Kreinovich, Vladik

209

Adequate antiplatelet regimen in patients on chronic anti-vitamin K treatment undergoing percutaneous coronary intervention  

PubMed Central

AIM: To investigate the impact of dual antiplatelet therapy (DAT) in patients on anti-vitamin K (AVK) regimen requiring percutaneous coronary intervention (PCI). METHODS: Between February 2006 and February 2008, 138 consecutive patients under chronic AVK treatment were enrolled in this registry. Of them, 122 received bare metal stent implantation and 16 received drug eluting stent implantation. The duration of DAT, on top of AVK treatment, was decided at the discretion of the clinician. Adequate duration of DAT was defined according to type of stent implanted and to its clinical indication. RESULTS: The baseline clinical characteristics of patients reflect their high risk, with high incidence of comorbid conditions (Charlson score ? 3 in 89% of the patients). At a mean follow-up of 17 ± 11 mo, 22.9% of patients developed a major adverse cardiac event (MACE): 12.6% died from cardiovascular disease and almost 6% had an acute myocardial infarction. Major hemorrhagic events were observed in 7.4%. Adequate DAT was obtained in only 44% of patients. In the multivariate analysis, no adequate DAT and Charlson score were the only independent predictors of MACE (both P = 0.02). CONCLUSION: Patients on chronic AVK therapy represent a high risk population and suffer from a high MACE rate after PCI. An adequate DAT regimen and absence of comorbid conditions are strongly associated with better clinical outcomes. PMID:22125672

Brugaletta, Salvatore; Martin-Yuste, Victoria; Ferreira-Gonzalez, Ignacio; Cola, Clarissa; Alvarez-Contreras, Luis; Antonio, Marta De; Garcia-Moll, Xavier; Garcia-Picart, Joan; Marti, Vicens; Balcells-Iranzo, Jordi; Sabate, Manel

2011-01-01

210

Specially Designed Assessment and Instruction for Children Who Have Not Responded Adequately to Reading Intervention  

ERIC Educational Resources Information Center

Dimensions of instruction and assessment were manipulated within a tertiary prevention to examine their effects on word and text reading development. In this article case studies of two children who demonstrated significant and sustained lack of adequate response to treatment are profiled. Results indicated that reducing group size, using…

Knutson, Jennifer S.; Simmons, Deborah C.; Good, Roland, III; McDonagh, Sarah H.

2004-01-01

211

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

ERIC Educational Resources Information Center

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

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

2014-01-01

212

Adequate Motion Simulation and Collision Detection for Soccer Playing Humanoid Robots  

E-print Network

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

Stryk, Oskar von

213

Abstract --The need to determine adequate regulations in the transmission activity in deregulated environments does not  

E-print Network

of the electrical transmission assets transform them into a natural monopoly. These features provide strongAbstract -- The need to determine adequate regulations in the transmission activity in deregulated that are adapted to local market conditions. Relevant issues are transmission tariff schemes and transmission

Dixon, Juan

214

What Is the Cost of an Adequate Vermont High School Education?  

ERIC Educational Resources Information Center

Access to an adequate education has been widely considered an undeniable right since Chief Justice Warren stated in his landmark decision that "Today, education is perhaps the most important function of state and local governments...it is doubtful that any child may reasonably be expected to succeed in life if he is denied the opportunity of an…

Rucker, Frank D.

2010-01-01

215

How Many Schools and Districts Have Not Made Adequate Yearly Progress? Four-Year Trends  

ERIC Educational Resources Information Center

The Center on Education Policy (CEP) analyzed trends over four years in the number of schools and school districts that did not make adequate yearly progress (AYP) in raising student achievement under the No Child Left Behind Act (NCLB). Using data from the Consolidated State Performance Reports submitted to the U.S. Department of Education by all…

Usher, Alexandra

2010-01-01

216

21 CFR 514.117 - Adequate and well-controlled studies.  

Code of Federal Regulations, 2012 CFR

...514.117 Food and Drugs FOOD AND DRUG ADMINISTRATION...important aspect of adequacy. The Food and Drug Administration (FDA...of section 512 of the Federal Food, Drug, and Cosmetic Act...adequately documented natural history of the disease or...

2012-04-01

217

21 CFR 514.117 - Adequate and well-controlled studies.  

Code of Federal Regulations, 2011 CFR

...514.117 Food and Drugs FOOD AND DRUG ADMINISTRATION...important aspect of adequacy. The Food and Drug Administration (FDA...of section 512 of the Federal Food, Drug, and Cosmetic Act...adequately documented natural history of the disease or...

2011-04-01

218

21 CFR 514.117 - Adequate and well-controlled studies.  

Code of Federal Regulations, 2013 CFR

...514.117 Food and Drugs FOOD AND DRUG ADMINISTRATION...important aspect of adequacy. The Food and Drug Administration (FDA...of section 512 of the Federal Food, Drug, and Cosmetic Act...adequately documented natural history of the disease or...

2013-04-01

219

21 CFR 514.117 - Adequate and well-controlled studies.  

...514.117 Food and Drugs FOOD AND DRUG ADMINISTRATION...important aspect of adequacy. The Food and Drug Administration (FDA...of section 512 of the Federal Food, Drug, and Cosmetic Act...adequately documented natural history of the disease or...

2014-04-01

220

21 CFR 514.117 - Adequate and well-controlled studies.  

Code of Federal Regulations, 2010 CFR

...514.117 Food and Drugs FOOD AND DRUG ADMINISTRATION...important aspect of adequacy. The Food and Drug Administration (FDA...of section 512 of the Federal Food, Drug, and Cosmetic Act...adequately documented natural history of the disease or...

2010-04-01

221

Conducting Tests of Hypotheses: The Need for an Adequate Sample Size  

ERIC Educational Resources Information Center

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

Asraf, Ratnawati Mohd; Brewer, James K.

2004-01-01

222

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

E-print Network

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

Ehrhardt, Matthias

223

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

E-print Network

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

Ehrhardt, Matthias

224

Robust mitotic entry is ensured by a latching switch  

PubMed Central

Summary Cell cycle events are driven by Cyclin dependent kinases (CDKs) and by their counter-acting phosphatases. Activation of the Cdk1:Cyclin B complex during mitotic entry is controlled by the Wee1/Myt1 inhibitory kinases and by Cdc25 activatory phosphatase, which are themselves regulated by Cdk1:Cyclin B within two positive circuits. Impairing these two feedbacks with chemical inhibitors induces a transient entry into M phase referred to as mitotic collapse. The pathology of mitotic collapse reveals that the positive circuits play a significant role in maintaining the M phase state. To better understand the function of these feedback loops during G2/M transition, we propose a simple model for mitotic entry in mammalian cells including spatial control over Greatwall kinase phosphorylation. After parameter calibration, the model is able to recapture the complex and non-intuitive molecular dynamics reported by Potapova et al. (Potapova et al., 2011). Moreover, it predicts the temporal patterns of other mitotic regulators which have not yet been experimentally tested and suggests a general design principle of cell cycle control: latching switches buffer the cellular stresses which accompany cell cycle processes to ensure that the transitions are smooth and robust. PMID:24143279

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

2013-01-01

225

Robust mitotic entry is ensured by a latching switch.  

PubMed

Cell cycle events are driven by Cyclin dependent kinases (CDKs) and by their counter-acting phosphatases. Activation of the Cdk1:Cyclin B complex during mitotic entry is controlled by the Wee1/Myt1 inhibitory kinases and by Cdc25 activatory phosphatase, which are themselves regulated by Cdk1:Cyclin B within two positive circuits. Impairing these two feedbacks with chemical inhibitors induces a transient entry into M phase referred to as mitotic collapse. The pathology of mitotic collapse reveals that the positive circuits play a significant role in maintaining the M phase state. To better understand the function of these feedback loops during G2/M transition, we propose a simple model for mitotic entry in mammalian cells including spatial control over Greatwall kinase phosphorylation. After parameter calibration, the model is able to recapture the complex and non-intuitive molecular dynamics reported by Potapova et al. (Potapova et al., 2011). Moreover, it predicts the temporal patterns of other mitotic regulators which have not yet been experimentally tested and suggests a general design principle of cell cycle control: latching switches buffer the cellular stresses which accompany cell cycle processes to ensure that the transitions are smooth and robust. PMID:24143279

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

2013-01-01

226

Health care of youth aging out of foster care.  

PubMed

Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26 years, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met. PMID:23184106

2012-12-01

227

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

PubMed Central

Background South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. Methods The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Results Response rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Conclusion Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential. PMID:23364081

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

2013-01-01

228

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

NASA Astrophysics Data System (ADS)

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

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

2013-12-01

229

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

PubMed Central

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

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

2013-01-01

230

74 FR 43754 - Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care...  

Federal Register 2010, 2011, 2012, 2013

...upgrading, or developing EHR systems to ensure that the technology...diligence to ensure that the EHR systems accurately capture quality data and that, ideally, such systems provide point-of-care decision support that promotes optimal...

2009-08-27

231

Hospice Care  

MedlinePLUS

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

232

Care of patients with ebola virus disease.  

PubMed

Caring for patients with Ebola virus disease requires strict biosafety protocols to eliminate exposure and ensure containment. Training and competency verification were critical to creation of a safe environment for nursing staff involved in the direct care of two patients with Ebola virus disease at Emory University Hospital. J Contin Educ Nurs. 2014;45(11):479-481. PMID:25365183

Smith, Elaine L; Rice, Karen L; Feistritzer, Nancye R; Hill, Carolyn; Vanairsdale, Sharon; Gentry, Janice

2014-11-01

233

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

Microsoft Academic Search

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

Jürgen Schreiber; Mario Brauns

2010-01-01

234

Adequate Nutrition Followed by Revisional Bariatric Surgery to Optimize Homeostatic Eating Control  

Microsoft Academic Search

Terms as treatment failure or ineffective treatment after bariatric surgery are not clearly defined and difficult to handle.\\u000a About one third of all persons who were formerly treated with a Lapband have either mechanical problems or do not lose enough\\u000a weight. The current review argues in favor of adequate nutrition to suppress hunger and optimize satiety together with effective\\u000a but

Dave H. Schweitzer

2008-01-01

235

A non-linear model for farm optimization with adequate and limited water supplies  

Microsoft Academic Search

This paper develops a non-linear optimization model for the determination of optimum cropping pattern, water amount and farm income under adequate and limited water supply conditions. The objective function of the model is based on crop water-benefit functions. The model is solved using Ms Excel Solver package for conditions existing in South-east Anatolian Region of Turkey. The model gives the

Bogachan Benli; Suleyman Kodal

2003-01-01

236

Adequate trust avails, mistaken trust matters: on the moral responsibility of doctors as proxies for patients' trust in biobank research.  

PubMed

In Sweden, most patients are recruited into biobank research by non-researcher doctors. Patients' trust in doctors may therefore be important to their willingness to participate. We suggest a model of trust that makes sense of such transitions of trust between domains and distinguishes adequate trust from mistaken trust. The unique position of doctors implies, we argue, a Kantian imperfect duty to compensate for patients' mistaken trust. There are at least three kinds of mistaken trust, each of which requires a different set of countermeasures. First, trust is mistaken when necessary competence is lacking; the competence must be developed or the illusion dispelled. Second, trust is irrational whenever the patient is mistaken about his actual reasons for trusting. Care must therefore be taken to support the patient's reasoning and moral agency. Third, some patients inappropriately trust doctors to recommend only research that will benefit them directly. Such trust should be counteracted by nurturing a culture where patients expect to be asked occasionally to contribute to the common good. PMID:22681564

Johnsson, Linus; Helgesson, Gert; Hansson, Mats G; Eriksson, Stefan

2013-11-01

237

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

PubMed

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

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

2014-07-01

238

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

SciTech Connect

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

Kennedy, J.L. [Oil & Gas Journal, Houston, TX (United States)

1995-06-01

239

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

PubMed Central

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

2013-01-01

240

Care of the infant of the diabetic mother.  

PubMed

Gestational diabetes mellitus (GDM) from all causes of diabetes is the most common medical complication of pregnancy and is increasing in incidence, particularly as type 2 diabetes continues to increase worldwide. Despite advances in perinatal care, infants of diabetic mothers (IDMs) remain at risk for a multitude of physiologic, metabolic, and congenital complications such as preterm birth, macrosomia, asphyxia, respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia and hyperviscosity, hypertrophic cardiomyopathy, and congenital anomalies, particularly of the central nervous system. Overt type 1 diabetes around conception produces marked risk of embryopathy (neural tube defects, cardiac defects, caudal regression syndrome), whereas later in gestation, severe and unstable type 1 maternal diabetes carries a higher risk of intrauterine growth restriction, asphyxia, and fetal death. IDMs born to mothers with type 2 diabetes are more commonly obese (macrosomic) with milder conditions of the common problems found in IDMs. IDMs from all causes of GDM also are predisposed to later-life risk of obesity, diabetes, and cardiovascular disease. Care of the IDM neonate needs to focus on ensuring adequate cardiorespiratory adaptation at birth, possible birth injuries, maintenance of normal glucose metabolism, and close observation for polycythemia, hyperbilirubinemia, and feeding intolerance. PMID:22094826

Hay, William W

2012-02-01

241

Healthy Child Care America Campaign: You Can Make a Difference in Your Community.  

ERIC Educational Resources Information Center

Child-care and health-care professionals joined efforts in the "Healthy Child Care America" campaign to ensure that children are cared for in environments that are safe and healthy. Goals of the campaign include raising awareness of the importance of quality child care, and involving more people in the nationwide effort to improve quality and…

Huggins, Moniquin

1995-01-01

242

Mobile advanced simulation for primary care pediatricians: Spanish Experience  

E-print Network

Mobile advanced simulation for primary care pediatricians: Spanish Experience Purpose of the study: Advanced simulation uses to be focused on hospital and emergencies personnel. Primary care pediatricians and initiate the adequate treatment. We report the results of the Spanish Society of Primary Care Pediatrics

Manstein, Dietmar J.

243

Utilisation of postnatal care among rural women in Nepal  

Microsoft Academic Search

BACKGROUND: Postnatal care is uncommon in Nepal, and where it is available the quality is often poor. Adequate utilisation of postnatal care can help reduce mortality and morbidity among mothers and their babies. Therefore, our study assessed the utilisation of postnatal care at a rural community level. METHODS: A descriptive, cross-sectional study was carried out in two neighbouring villages in

Sulochana Dhakal; Glyn N Chapman; Padam P Simkhada; Edwin R van Teijlingen; Jane Stephens; Amalraj E Raja

2007-01-01

244

Health Care Reform Act is Constitutional and Necessary  

Microsoft Academic Search

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

Ian C. Bartrum

2011-01-01

245

Care partners for persons with AIDS: Implications for health communication  

Microsoft Academic Search

Societal factors are now converging that signal a need for changes in the way health care is delivered and in the way health care delivery is investigated. It was once adequate to understand health care interaction through an analysis of the physician?patient relationship. However, increased longevities and the increased prevalence of chronic disease are leading to a burgeoning of home?

Katherine Miller; Eric G. Zook

1997-01-01

246

Transitional Care  

ERIC Educational Resources Information Center

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

Naylor, Mary; Keating, Stacen A.

2008-01-01

247

34 CFR 602.18 - Ensuring consistency in decision-making.  

Code of Federal Regulations, 2010 CFR

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

2010-07-01

248

42 CFR 401.713 - Ensuring the privacy and security of data.  

Code of Federal Regulations, 2013 CFR

... Ensuring the privacy and security of data. 401.713 Section 401.713 Public...REQUIREMENTS Availability of Medicare Data for Performance Measurement § 401.713 Ensuring the privacy and security of data. (a) A qualified entity must...

2013-10-01

249

42 CFR 401.713 - Ensuring the privacy and security of data.  

Code of Federal Regulations, 2012 CFR

... Ensuring the privacy and security of data. 401.713 Section 401.713 Public...REQUIREMENTS Availability of Medicare Data for Performance Measurement § 401.713 Ensuring the privacy and security of data. (a) A qualified entity must...

2012-10-01

250

34 CFR 602.18 - Ensuring consistency in decision-making.  

Code of Federal Regulations, 2011 CFR

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

2011-07-01

251

33 CFR 149.334 - Who must ensure compliance with the requirements for unmanned deepwater ports?  

Code of Federal Regulations, 2012 CFR

...ensure compliance with the requirements for unmanned deepwater ports? 149.334 Section...AND EQUIPMENT Lifesaving Equipment Unmanned Deepwater Port Requirements § 149...ensure compliance with the requirements for unmanned deepwater ports? The owner or...

2012-07-01

252

33 CFR 149.334 - Who must ensure compliance with the requirements for unmanned deepwater ports?  

Code of Federal Regulations, 2013 CFR

...ensure compliance with the requirements for unmanned deepwater ports? 149.334 Section...AND EQUIPMENT Lifesaving Equipment Unmanned Deepwater Port Requirements § 149...ensure compliance with the requirements for unmanned deepwater ports? The owner or...

2013-07-01

253

33 CFR 149.334 - Who must ensure compliance with the requirements for unmanned deepwater ports?  

...ensure compliance with the requirements for unmanned deepwater ports? 149.334 Section...AND EQUIPMENT Lifesaving Equipment Unmanned Deepwater Port Requirements § 149...ensure compliance with the requirements for unmanned deepwater ports? The owner or...

2014-07-01

254

33 CFR 149.334 - Who must ensure compliance with the requirements for unmanned deepwater ports?  

Code of Federal Regulations, 2010 CFR

...ensure compliance with the requirements for unmanned deepwater ports? 149.334 Section...AND EQUIPMENT Lifesaving Equipment Unmanned Deepwater Port Requirements § 149...ensure compliance with the requirements for unmanned deepwater ports? The owner or...

2010-07-01

255

33 CFR 149.334 - Who must ensure compliance with the requirements for unmanned deepwater ports?  

Code of Federal Regulations, 2011 CFR

...ensure compliance with the requirements for unmanned deepwater ports? 149.334 Section...AND EQUIPMENT Lifesaving Equipment Unmanned Deepwater Port Requirements § 149...ensure compliance with the requirements for unmanned deepwater ports? The owner or...

2011-07-01

256

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

PubMed Central

Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately. This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common post-operative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and post-operative analgesia following shoulder surgery. PMID:24093051

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

2013-01-01

257

An innovative model of health care delivery: the care management program of the University of Iowa.  

PubMed

The Indigent Patient Care Program (legislatively enacted in 1915) provides comprehensive health care to indigent Iowans without health insurance. The University of Iowa Hospitals and Clinics, a leading academic medical center, was designated as the health care provider for these medically and socially complex patients. The Care Management Program of the University of Iowa (CMPUI) is an innovative care delivery model responsible for total health management of patients enrolled in the indigent program. The CMPUI is a solution to preserve the tripartite missions of an academic medical center while ensuring the preservation of the historic Indigent Patient Care Program in Iowa. PMID:12141016

Muller, Barbara A; Doyle, Cynthia L; Hasselman, Elizabeth; Moore, Pamela S; Powell, Joyce L; Cayner, Jay J

2002-07-01

258

Ethical guidance in the era of managed care: an analysis of the American College of Healthcare Executives' Code of Ethics.  

PubMed

Market competition and the rise of managed care are transforming the healthcare system from a physician-dominated cottage industry into a manager-dominated corporate enterprise. The managed care revolution is also undermining the safe-guards offered by medical ethics and raising serious public concerns. These trends highlight the growing importance of ethical standards for managers. The most comprehensive ethical guidance for health service managers is contained in the American College of Healthcare Executives' (ACHE) Code of Ethics. An analysis of the ACHE Code suggests that it does not adequately address several ethical concerns associated with managed care. The ACHE may wish to develop a supplemental statement regarding ethical issues in managed care. A supplemental statement that provides more specific guidance in the areas of financial incentives to reduce utilization, social mission, consumer/patient information, and the health service manager's responsibility to patients could be extremely valuable in today's complex and rapidly changing environment. More specific ethical guidelines would not ensure individual or organizational compliance. However, they would provide professional standards that could guide decision making and help managers evaluate performance in managed care settings. PMID:11066951

Higgins, W

2000-01-01

259

Feeding and Caring for a Two-Year-Old 4-H Futurity Horse  

E-print Network

This publication explains how to care for a 2-year-old horse and have a successful 4-H futurity horse project. Topics include proper nutrition; regular coat, hoof, and health care; adequate exercise; and consistent training. Activities are included...

Antilley, Teri J.; Sigler, Dennis

2009-05-15

260

Bioethics for clinicians: 6. Advance care planning.  

PubMed Central

Advance rate planning is a process whereby a patient, in consultation with health care providers, family members and important others, makes decisions about his or her future health care. Grounded in the ethical principle of autonomy and the legal doctrine of consent, advance care planning helps to ensure that the norm of consent is respected should the patient become incapable of participating in treatment decisions. Physicians can play an important role by informing patients about advance care planning directing them to appropriate resources, counselling them as they engage in advance care planning and helping them to tailor advance directives to their prognosis. PMID:8976334

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

1996-01-01

261

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

SciTech Connect

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

SIMPSON, B.C.

1999-08-12

262

Combine 1D and 3D color calibration methods for ensuring consistent color reproduction  

Microsoft Academic Search

Printer color calibration is a crucial step to ensure consistent color reproduction. In this paper, we present a color calibration system that can not only ensure the color consistency for a same printer at different times, but also ensure the color consistency for different printers of the same model. We will analyze the most significant sources of color variations in

Yifeng Wu

2003-01-01

263

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

PubMed

Coherent speckle influences the resulting image when narrow spectral line-width and single spatial mode illumination are used, though these are the same light-source properties that provide the best radiance-to-cost ratio. However, a suitable size of the detection pinhole can be chosen to maintain adequate optical sectioning while making the probability density of the speckle noise more normal and reducing its effect. The result is a qualitatively better image with improved contrast, which is easier to read. With theoretical statistics and experimental results, we show that the detection pinhole size is a fundamental parameter for designing imaging systems for use in turbid media. PMID:23224184

Glazowski, Christopher; Rajadhyaksha, Milind

2012-08-01

264

Dexmedetomidine and low-dose ketamine provide adequate sedation for awake fibreoptic intubation  

Microsoft Academic Search

Purpose  We report the use of the alpha2 agonist, dexmedetomidine, with low-dose ketamine as a safe and effective treatment strategy to provide adequate comfort and\\u000a sedation for a patient who fulfilled criteria of a difficult airway and required awake fibreoptic intubation (AFOI).\\u000a \\u000a \\u000a \\u000a Clinical features  A 52-yr-old male with prostate cancer presented for radical prostatectomy. He reported several failed intubations with previous\\u000a surgeries

Corey S. Scher; Melvin C. Gitlin

2003-01-01

265

Does Group Prenatal Care Affect Satisfaction And Prenatal Care Utilization in Iranian Pregnant Women?  

PubMed Central

Background: The need to provide high quality prenatal care services, which take account of women’s views and specifically address their need for information, support and communication, has been advocated and group prenatal care, had been suggested as one of the ways to achieve this objective. The purpose of this study was to examine the impact of group versus individual prenatal care on satisfaction and prenatal care use. Methods: This was a cluster-randomized controlled trial with the health center as the randomization unit that conducted in 2007. Satisfaction was measured through a standardized questionnaire, and the Kotelchuck Adequacy of Prenatal Care Utilization Index was used to measure prenatal care utilization. Results: We recruited 678 women (group prenatal care, (N= 344) and individual prenatal care, (N=334) in the study. Women in group prenatal care model were more satisfied than women in individual prenatal care model in all areas evaluated, including information, communication, co-ordination and quality of care. Group care women were significantly more likely to have adequate prenatal care than individual care women were (OR=1.35 95% CI=1.26–1.44). Conclusions: Group prenatal care was associated with a significant improvement in client satisfaction and prenatal care utilization. This model of care has implications for the planning and provision of prenatal services within public health system, which is moving toward a better quality health care, and increasing use of services. PMID:23113007

Jafari, F; Eftekhar, H; Mohammad, K; Fotouhi, A

2010-01-01

266

Ensuring confidence in radionuclide-based sediment chronologies and bioturbation rates  

USGS Publications Warehouse

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

Crusius, John; Kenna, Timothy C.

2007-01-01

267

Health Care in Europe for Women with Genital Mutilation  

Microsoft Academic Search

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

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

2006-01-01

268

Health care challenges and opportunities in the 1990s.  

PubMed

The 1990s offer both substantial challenges and opportunities for those involved in the delivery of health care. Increasing costs must be managed to ensure that the health of both Americans and America's economy are maintained. Managed care offers the brightest hope for effectively controlling costs while increasing the quality of care. PMID:10116960

Fields, J A; Lilly, F S; Sutton-Bell, N

1991-01-01

269

Tribal Child Care and Development Fund: Guide for New Administrators  

ERIC Educational Resources Information Center

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

Child Care Bureau, 2008

2008-01-01

270

Animal and Range Sciences Department Agricultural Animal Care Training Program  

E-print Network

Animal and Range Sciences Department Agricultural Animal Care Training Program Approved by AACUC May 2003 Goals The goals of the Agricultural Animal Care Training Program are to ensure animal well-being, the validity and effectiveness of research and teaching activities, and the health and safety of animal care

Maxwell, Bruce D.

271

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

PubMed Central

Purpose Optimal training intensity and the adequate exercise level for physical fitness is one of the most important interests of coaches and sports physiologists. The aim of this study was to investigate the validity of the Narita et al target heart rate equation for the adequate exercise training level in sedentary young boys. Methods Forty two sedentary young boys (19.07±1.16 years) undertook a blood lactate transition threshold maximal treadmill test to volitional exhaustion with continuous respiratory gas measurements according to the Craig method. The anaerobic threshold (AT) of the participants then was calculated using the Narita target heart rate equation. Results Hopkin's spreadsheet to obtain confidence limit and the chance of the true difference between gas measurements and Narita target heart rate equation revealed that the Narita equation most likely underestimates the measured anaerobic threshold in sedentary young boys (168.76±15 vs. 130.08±14.36) (Difference ±90% confidence limit: 38.1±18). Intraclass correlation coefficient (ICC) showed a poor agreement between the criterion method and Narita equation (ICC= 0.03). Conclusion According to the results, the Narita equation underestimates the measured AT. It seems that the Narita equation is a good predictor of aerobic not AT which can be investigated in the future studies. PMID:24427475

Siahkouhian, Marefat; Khodadadi, Davar

2013-01-01

272

Adequate Systemic Perfusion Maintained by a CentriMag during Acute Heart Failure  

PubMed Central

Mechanical circulatory support during severe acute heart failure presents options for myocardial recovery or cardiac replacement. Short-term circulatory support with the newest generation of magnetically levitated centrifugal-flow pumps affords several potential advantages. Herein, we present our experience with such a pump—the CentriMag® (Levitronix LLC; Waltham, Mass) centrifugal-flow ventricular assist device—in 4 critically ill patients who were in cardiogenic shock. From November 2007 through March 2008, 3 patients were supported after cardiac surgery, and 1 after chronic heart failure worsened. Two patients were bridged to heart transplantation, and 2 died during support. Perfusion during support was evaluated in terms of serum lactic acid levels and oxygenation values. In all of the patients, the CentriMag's pump flow was adequate, and continuous mechanical ventilation support was provided. Lactic acid levels substantially improved with CentriMag support and were maintained at near-normal levels throughout. At the same time, arterial pH, PO2, and carbon dioxide levels remained within acceptable ranges. No thromboembolic events or mechanical failures occurred. Our experience indicates that short-term use of the CentriMag ventricular assist device during acute heart failure can restore and adequately support circulation until recovery or until the application of definitive therapy. PMID:18941648

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

2008-01-01

273

ASID (HICSIG) position statement: infection control guidelines for patients with influenza-like illnesses, including pandemic (H1N1) influenza 2009, in Australian health care facilities.  

PubMed

Standard and Droplet Precautions are considered adequate to control the transmission of influenza in most health care situations. Vaccination of health care staff, carers and vulnerable patients against seasonal and, eventually, pandemic influenza strains is an essential protective strategy. Management principles include: performance of hand hygiene before and after every patient contact or contact with the patient environment, in accord with the national 5 Moments for Hand Hygiene Standard; disinfection of the patient environment; early identification and isolation of patients with suspected or proven influenza; adoption of a greater minimum distance of patient separation (2 metres) than previously recommended; use of a surgical mask and eye protection for personal protection on entry to infectious areas or within 2 metres of an infectious patient; contact tracing for patient and health care staff and restriction of prophylactic antivirals mainly to those at high risk of severe disease; in high aerosol-risk settings, use of particulate mask, eye protection, impervious long-sleeved gown, and gloves donned in that sequence and removed in reverse sequence, avoiding self-contamination; exclusion of symptomatic staff from the workplace until criteria for non-infectious status are met; reserving negative-pressure ventilation rooms (if available) for intensive care patients, especially those receiving non-invasive ventilation; ensuring that infectious postpartum women wear surgical masks when caring for their newborn infants and practise strict hand hygiene; and implementation of special arrangements for potentially infected newborns who require nursery or intensive care. PMID:19835543

Stuart, Rhonda L; Cheng, Allen C; Marshall, Caroline L; Ferguson, John K

2009-10-19

274

Integrated care pathways and task shifting  

PubMed Central

Delivery of HIV care has evolved over the last 10 years, and nurse specialists are a driving force in developing new pathways to enhance patient care. Despite the continued rise in numbers of people living with HIV, the financial constraints on the NHS have unfortunately resulted in a reduction in service provision. Experienced nurses are integral to patient care management. They not only provide standardized care for stable patients, therefore increasing consultant capacity for the more complex medical patient, but have a degree of flexibility that allows newly diagnosed patients quick access to care and support. With a strong emphasis being placed on an integrated and collaborative multidisciplinary team approach, to ensure patients receive the same standard of care, Scotland's HIV centres follow an integrated care pathway. The nurse oversees the completion of this document and co-ordinates the pathway of care depending on the clinical need. Nurses develop and maintain necessary partnerships between primary care, specialist care, psychological services, social care and third sector support services. The nurse case load continues to expand and diversify. Stable patients may be maintained on therapy but are living with a stigmatized long-term chronic condition and rely on the nurse as a point of contact to access advice and support readily. The more chaotic and vulnerable clients with complex care needs require the nurse to co-ordinate their care, ensuring the appropriate agencies remain involved. Overseeing the transition of care to other units and tracing patients who are lost to follow up is also a necessity, as retention in care is paramount for the continued improvement in clinical outcomes. The contribution that specialist nurses make to the provision of HIV care is valuable and will continue to play a large role in the delivery of such care. PMID:25394004

Panton, Linda

2014-01-01

275

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

Microsoft Academic Search

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

Nicki Pesik; Mark Keim; Tomoko Rie Sampson

1999-01-01

276

Causes for the evolution of case management and the development of a working model in an acute care hospital in Singapore.  

PubMed

Case management is a collaborative process which assesses, plans, implements, co-ordinates, monitors and evaluates options and services to meet an individual's health needs. The case manager performs a key role in ensuring that collaboration and communication between the multi-disciplinary healthcare team and patient is maintained, and that quality clinical outcomes are achieved and the patients reach an optimal level of wellness and function. Patients that can benefit from case management in an acute hospital setting are frequently elderly and have complex medical and care issues arising out of changes in functional status. The components of a successful case management system include identifying a suitable model for implementation and recruiting the correct persons to function as case managers. A defined assessment and recruitment guideline will ensure that appropriate patients are placed on case management. Communication and collaboration with all stakeholders in formulating a patient's plan of care are essential. The subsequent implementation and monitoring of the plan is crucial, as variances that occur must be adequately managed in order to ensure that a satisfactory clinical outcome is achieved without inappropriate expenditure of resources. The barriers to a successful case management programme can result from inappropriate case loads and failure of the other healthcare team members to understand and appreciate the case manager's role and functions. However, this can be overcome by education and using outcome data to demonstrate the effectiveness of case management. PMID:12161881

Tai, H Y

2002-07-01

277

42 CFR 422.206 - Interference with health care professionals' advice to enrollees prohibited.  

Code of Federal Regulations, 2013 CFR

...decisions. (2) Health care professionals must provide...option of no treatment. Health care professionals must ensure...participants throughout the health system in making decisions...available information on these policies as follows:...

2013-10-01

278

42 CFR 422.206 - Interference with health care professionals' advice to enrollees prohibited.  

Code of Federal Regulations, 2012 CFR

...decisions. (2) Health care professionals must provide...option of no treatment. Health care professionals must ensure...participants throughout the health system in making decisions...available information on these policies as follows:...

2012-10-01

279

42 CFR 422.206 - Interference with health care professionals' advice to enrollees prohibited.  

Code of Federal Regulations, 2011 CFR

...decisions. (2) Health care professionals must provide...option of no treatment. Health care professionals must ensure...participants throughout the health system in making decisions...available information on these policies as follows:...

2011-10-01

280

42 CFR 422.206 - Interference with health care professionals' advice to enrollees prohibited.  

Code of Federal Regulations, 2010 CFR

...decisions. (2) Health care professionals must provide...option of no treatment. Health care professionals must ensure...participants throughout the health system in making decisions...available information on these policies as follows:...

2010-10-01

281

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

Cancer.gov

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

282

[Facilitating access to care for most-at-risk populations : The Bamako night sexual health clinic experience (Mali)].  

PubMed

The estimated prevalence of HIV in Mali is 1.3 % of the general population. The epidemic is concentrated in certain groups, particularly men who have sex with men (MSM) and sex workers (SW). Access to care is limited for these populations, notably because of structural obstacles (e.g. marked social rejection ; health care services poorly adapted to the real needs of these people). Innovative strategies must be envisaged to ensure access to care services and retention in care for these populations. As part of a health promotion process, ARCAD-SIDA, a Malian NGO involved in the fight against AIDS since 1995, set up a night sexual health clinic in 2010 as part of a strategy to more adequately respond to the health needs of these populations. This clinic adapts health service timetables to match the lifestyles of the targeted populations, brings services in closer physical proximity to the places in which these populations live, proposes patient-tailored consultations, works to improve the patients' psychosocial skills, and promotes community-based peer mobilization. In an environment which is generally hostile to MSM and SW, ARCAD-SIDA also works in advocacy, targeting political decision-makers, defense forces and journalists. The NGO has also played a key role in ensuring that these populations are taken into account in the national strategy for the fight against HIV. Since opening in 2010, the clinic has helped reach a large number of MSM and SW and has improved retention in care. This innovative strategy has also enabled the NGO to improve its professional practices in terms of an individual-based approach to prevention. Interventions that are better adapted to the needs and environment of the populations for whom they are intented to have a positive effect on access to and use of healthcare services. PMID:25380379

Coulibaly, Alou; Dembelé Keita, Bintou; Henry, Emilie; Trenado, Emmanuel

2014-09-01

283

Barriers to Prenatal Care for Mexican and Mexican American Women  

Microsoft Academic Search

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

Ippolytos Kalofonos; Lawrence A. Palinkas

1999-01-01

284

Palliative Care  

MedlinePLUS

Palliative care specialists are medical professionals who work with your child and the healthcare team to help make your child as comfortable as possible. Palliative care teams are called by different names at various ...

285

Hospice Care  

MedlinePLUS

... comfort as possible. Is hospice care available to nursing home residents? Yes. The services of hospice care programs ... home, a family member's home, a hospital, a nursing home or a hospice facility. The members of the ...

286

Health care in Moscow.  

PubMed Central

In the Russian Federation privatisation is affecting the health care sector as much as it is industry and commerce. That the general public support the transfer of state clinics to the private sector is a mark of their dissatisfaction with the old state run system. Doctors too see better opportunities to practise good medicine and be paid better for doing so. In Moscow the health department has set up a commission to license all clinics providing treatment, which should ensure standards of safety, training, and equipment. The Russian Federation is also trying to establish a medical insurance system to cover its citizens for health care, but in Moscow and elsewhere its implementation has been delayed by arguments and bureaucracy. In the meantime the health of Muscovites remains poor, with a high incidence of birth defects, and illnesses among the young. Images p783-a PMID:8219954

Ryan, M

1993-01-01

287

Is surgery an effective and adequate treatment in advanced Marjolin's ulcer?  

PubMed

Malignancies in scars are generally known as Marjolin's ulcers. Between 1999 and 2004, 15 patients with Marjolin's ulcer were treated in our clinic. All lesions were secondary to burns of various causes. We perform a combined approach and aggressive surgery for treatment of Marjolin's ulcer; excision with safe margin, lymphatic dissection, postoperative radiotherapy, chemotherapy and amputation if needed. We think that the scar tissue acts as a barrier for the tumors, which will enlarge. We believe that, if we release this barrier like scar tissue, the virulent the spread of the tumor will be permitted. In this article, we consider whether or not surgical excision alone as recommended in the treatment of Marjolin's ulcers is adequate and effective. An aggressive combined approach is essential for treatment in early stages with high success rate. But there is no consensus for the treatment of advanced disease and results are generally unsuccessful. PMID:15896503

Aydo?du, Eser; Yildirim, Serkan; Aköz, Tayfun

2005-06-01

288

Adequate bases of phase space master integrals for gg ? h at NNLO and beyond  

NASA Astrophysics Data System (ADS)

We study master integrals needed to compute the Higgs boson production cross section via gluon fusion in the infinite top quark mass limit, using a canonical form of differential equations for master integrals, recently identified by Henn, which makes their solution possible in a straightforward algebraic way. We apply the known criteria to derive such a suitable basis for all the phase space master integrals in afore mentioned process at next-to-next-to-leading order in QCD and demonstrate that the method is applicable to next-to-next-to-next-to-leading order as well by solving a non-planar topology. Furthermore, we discuss in great detail how to find an adequate basis using practical examples. Special emphasis is devoted to master integrals which are coupled by their differential equations.

Höschele, Maik; Hoff, Jens; Ueda, Takahiro

2014-09-01

289

Overcome of Carbon Catabolite Repression of Bioinsecticides Production by Sporeless Bacillus thuringiensis through Adequate Fermentation Technology.  

PubMed

The overcoming of catabolite repression, in bioinsecticides production by sporeless Bacillus thuringiensis strain S22 was investigated into fully controlled 3?L fermenter, using glucose based medium. When applying adequate oxygen profile throughout the fermentation period (75% oxygen saturation), it was possible to partially overcome the catabolite repression, normally occurring at high initial glucose concentrations (30 and 40?g/L glucose). Moreover, toxin production yield by sporeless strain S22 was markedly improved by the adoption of the fed-batch intermittent cultures technology. With 22.5?g/L glucose used into culture medium, toxin production was improved by about 36% when applying fed-batch culture compared to one batch. Consequently, the proposed fed-batch strategy was efficient for the overcome of the carbon catabolite repression. So, it was possible to overproduce insecticidal crystal proteins into highly concentrated medium. PMID:25309756

Ben Khedher, Saoussen; Jaoua, Samir; Zouari, Nabil

2014-01-01

290

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

NASA Astrophysics Data System (ADS)

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

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

2005-04-01

291

Overcome of Carbon Catabolite Repression of Bioinsecticides Production by Sporeless Bacillus thuringiensis through Adequate Fermentation Technology  

PubMed Central

The overcoming of catabolite repression, in bioinsecticides production by sporeless Bacillus thuringiensis strain S22 was investigated into fully controlled 3?L fermenter, using glucose based medium. When applying adequate oxygen profile throughout the fermentation period (75% oxygen saturation), it was possible to partially overcome the catabolite repression, normally occurring at high initial glucose concentrations (30 and 40?g/L glucose). Moreover, toxin production yield by sporeless strain S22 was markedly improved by the adoption of the fed-batch intermittent cultures technology. With 22.5?g/L glucose used into culture medium, toxin production was improved by about 36% when applying fed-batch culture compared to one batch. Consequently, the proposed fed-batch strategy was efficient for the overcome of the carbon catabolite repression. So, it was possible to overproduce insecticidal crystal proteins into highly concentrated medium.

Ben Khedher, Saoussen; Jaoua, Samir; Zouari, Nabil

2014-01-01

292

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

PubMed

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

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

2014-06-01

293

Adequate bases of phase space master integrals for $gg \\to h$ at NNLO and beyond  

E-print Network

We study master integrals needed to compute the Higgs boson production cross section via gluon fusion in the infinite top quark mass limit, using a canonical form of differential equations for master integrals, recently identified by Henn, which makes their solution possible in a straightforward algebraic way. We apply the known criteria to derive such a suitable basis for all the phase space master integrals in afore mentioned process at next-to-next-to-leading order in QCD and demonstrate that the method is applicable to next-to-next-to-next-to-leading order as well by solving a non-planar topology. Furthermore, we discuss in great detail how to find an adequate basis using practical examples. Special emphasis is devoted to master integrals which are coupled by their differential equations.

Höschele, Maik; Ueda, Takahiro

2014-01-01

294

Adequate bases of phase space master integrals for $gg \\to h$ at NNLO and beyond  

E-print Network

We study master integrals needed to compute the Higgs boson production cross section via gluon fusion in the infinite top quark mass limit, using a canonical form of differential equations for master integrals, recently identified by Henn, which makes their solution possible in a straightforward algebraic way. We apply the known criteria to derive such a suitable basis for all the phase space master integrals in afore mentioned process at next-to-next-to-leading order in QCD and demonstrate that the method is applicable to next-to-next-to-next-to-leading order as well by solving a non-planar topology. Furthermore, we discuss in great detail how to find an adequate basis using practical examples. Special emphasis is devoted to master integrals which are coupled by their differential equations.

Maik Höschele; Jens Hoff; Takahiro Ueda

2014-07-15

295

Three monthly doses of palivizumab are not adequate for 5-month protection: a population pharmacokinetic analysis.  

PubMed

Recent guidelines in British Columbia, Canada have suggested that the use of a maximum of 3 monthly doses of palivizumab 15 mg/kg intramuscularly for RSV immunoprophylaxis of high risk infants born prior to the RSV season is adequate to provide protection against severe RSV disease for a 5-month RSV season. Efficacy was established, however, with 2 large, randomized controlled clinical studies using 5 monthly doses of immunoprophylaxis. To evaluate the differences in expected palivizumab exposures between the 2 dosing regimens (3 vs 5 monthly doses across a 5-month period), we used a population pharmacokinetic (PK) model that was developed using palivizumab PK data collected from 22 clinical studies with a total of 1800 subjects. This model adequately described observed palivizumab concentrations from the different pediatric studies and was subsequently used to simulate expected palivizumab serum concentrations for 3 monthly doses compared with 5 monthly doses in children younger than 24 months with chronic lung disease of prematurity and infants younger than 6 months postnatal age who were born at ? 35 weeks gestational age. Results from the population PK model indicated lower serum concentrations of palivizumab during the fourth and fifth months, after an abbreviated 3-monthly-dose regimen when compared with the mean trough concentrations seen with the 5-monthly-dose regimen studied in the pivotal clinical trials in premature infants. Specifically, during the fourth and fifth months, 52% and 85%, respectively, would have levels below the lowest concentration (fifth percentile) in those receiving the 5-monthly-dose regimen. Simulations using this model did not support a 3-monthly-dose regimen to protect against severe RSV disease during the typical 5-month season. PMID:23523663

La Via, William V; Notario, Gerard F; Yu, Xiang-Qing; Sharma, Shringi; Noertersheuser, Peter A; Robbie, Gabriel J

2013-12-01

296

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

PubMed Central

Objectives To describe the psychological needs of adolescent survivors of acute lymphoblastic leukemia (ALL) or brain tumor (BT), we examined: (a) the occurrence of cognitive, behavioral, and emotional concerns identified during a comprehensive psychological evaluation, and (b) the frequency of referrals for psychological follow-up services to address identified concerns. Methods Psychological concerns were identified on measures according to predetermined criteria for 100 adolescent survivors. Referrals for psychological follow-up services were made for concerns previously unidentified in formal assessment or not adequately addressed by current services. Results Most survivors (82%) exhibited at least one concern across domains: behavioral (76%), cognitive (47%), and emotional (19%). Behavioral concerns emerged most often on scales associated with executive dysfunction, inattention, learning, and peer difficulties. CRT was associated with cognitive concerns, ?2(1,N=100)=5.63, p<0.05. Lower income was associated with more cognitive concerns for ALL survivors, t(47)=3.28, p<0.01, and more behavioral concerns for BT survivors, t(48)=2.93, p<0.01. Of survivors with concerns, 38% were referred for psychological follow-up services. Lower-income ALL survivors received more referrals for follow-up, ?2(1,N=41)=8.05, p<0.01. Referred survivors had more concerns across domains than non-referred survivors, ALL: t(39)=2.96, p<0.01, BT: t(39)=3.52, p<0.01. Trends suggest ALL survivors may be at risk for experiencing unaddressed cognitive needs. Conclusions Many adolescent survivors of cancer experience psychological difficulties that are not adequately managed by current services, underscoring the need for long-term surveillance. In addition to prescribing regular psychological evaluations, clinicians should closely monitor whether current support services appropriately meet survivors’ needs, particularly for lower-income survivors and those treated with CRT. PMID:22278930

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

2012-01-01

297

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

PubMed Central

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

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

2005-01-01

298

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

PubMed Central

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

2014-01-01

299

Health care system factors affecting end-of-life care.  

PubMed

The field of palliative care in the United States developed in response to a public health crisis--namely, poor quality of life for patients with serious illness and their families--and most palliative care research to date has been appropriately focused on identifying patient and family needs and identifying gaps in the current health care system and in the education of our health care professionals. Research has also begun to develop and evaluate new interventions and systems to address these care gaps. Preliminary studies suggest modest benefits of an array of programs designed to deliver palliative care services. These benefits include improved pain and other symptoms, increased family satisfaction, and lower hospital costs. Unfortunately, the validity and reliability of these findings are limited by important methodological weaknesses including small sample sizes, poorly described and nongeneralizable interventions, diverse and nonstandardized outcome measures, and poor study designs (i.e., lack of appropriate control groups, nonblinded designs). Comprehensive and rigorous research is needed to evaluate the effect of well-delineated and generalizable palliative care structures and processes on important clinical and use outcomes. Large multisite studies that have adequate power to detect meaningful differences in clinical and use outcomes, and that use well-defined and generalizable structures and evidence-based care processes, well-defined uniform outcome measures, and analyses that link the outcomes of interest to individual components of the interventions, are needed to guide further development of the field. PMID:16499472

Morrison, R Sean

2005-01-01

300

Incentives in primary care and their impact on potentially avoidable hospital admissions.  

PubMed

Financial incentives in primary care have been introduced with the purpose of improving appropriateness of care and containing demand. We usually observe pay-for-performance programs, but alternatives, such as pay-for-participation in improvement activities and pay-for-compliance with clinical guidelines, have also been implemented. Here, we assess the influence of different programs that ensure extra payments to GPs for containing avoidable hospitalisations. Our dataset covers patients and GPs of the Italian region Emilia-Romagna for the year 2005. By separating pay-for-performance from pay-for-participation and pay-for-compliance programs, we estimate the impact of different financial incentives on the probability of avoidable hospitalisations. As dependent variable, we consider two different sets of conditions for which timely and effective primary care should be able to limit the need for hospital admission. The first is based on 27 medical diagnostic related groups that Emilia-Romagna identifies as at risk of inappropriateness in primary care, while the second refers to the internationally recognised ambulatory care-sensitive conditions. We show that pay-for-performance schemes may have a significant effect over aggregate indicators of appropriateness, while the effectiveness of pay-for-participation schemes is adequately captured only by taking into account subpopulations affected by specific diseases. Moreover, the same scheme produces different effects on the two sets of indicators used, with performance improvements limited to the target explicitly addressed by the Italian policy maker. This evidence is consistent with the idea that a "tunnel vision" effect may occur when public authorities monitor specific sets of objectives as proxies for more general improvements in the quality of health care delivered. PMID:20424882

Fiorentini, Gianluca; Iezzi, Elisa; Lippi Bruni, Matteo; Ugolini, Cristina

2011-08-01

301

Exploring workplace violence among home care workers in a consumer-driven home health care program.  

PubMed

Nominal research has examined sexual harassment and workplace violence against home care workers within consumer-driven home care models such as those offered in Oregon. This study examined home care workers' experiences of violence while providing care to consumer employers, the patients who hire and manage home care workers. Focus groups and interviews were conducted in Oregon with 83 home care workers, 99 Oregon Department of Human Services (DHS) employees, and 11 consumer employers. Home care workers reported incidents of workplace physical violence (44%), psychological abuse (65%), sexual harassment (41%), and sexual violence (14%). Further, three themes were identified that may increase the risk of workplace violence: (1) real and perceived barriers to reporting violence; (2) tolerance of violence; and (3) limited training to prevent violence. To ensure worker safety while maintaining quality care, safety policies and training for consumer employers, state DHS employees, and home care workers must be developed. PMID:24053217

Nakaishi, Lindsay; Moss, Helen; Weinstein, Marc; Perrin, Nancy; Rose, Linda; Anger, W Kent; Hanson, Ginger C; Christian, Mervyn; Glass, Nancy

2013-10-01

302

December 2011 EA Report Brown Bagger 1 EAPs and Primary Care Physicians  

E-print Network

December 2011 EA Report Brown Bagger 1 Brown Bagger EAPs and Primary Care Physicians By Harry to visit their primary care physicians, who often are not equipped to provide adequate treatment for depression (Wojcik, 2004). Primary Care Physicians Primary care physicians are more likely than mental health

Kim, Duck O.

303

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

E-print Network

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

Fernández Olivares, Juan

304

Perceptions of jordanian head nurses of variables that influence the quality of nursing care.  

PubMed

The purpose of this research was to study the perceptions of head nurses in Jordan about variables that influence the quality of nursing care in a teaching hospital. Head nurses perceived that nurses "usually" provided high quality nursing care. Time was the most important factor that influenced the quality of nursing care. High quality care required adequate staffing levels. PMID:15326998

Mrayyan, Majd T

2004-01-01

305

Comprehensive care of amyotrophic lateral sclerosis patients: a care model.  

PubMed

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that presents with muscle weakness, causing progressive difficulty in movement, communication, eating and ultimately, breathing, creating a growing dependence on family members and other carers. The ideal way to address the problems associated with the disease, and the decisions that must be taken, is through multidisciplinary teams. The key objectives of these teams are to optimise medical care, facilitate communication between team members, and thus to improve the quality of care. In our centre, we have extensive experience in the care of patients with ALS through an interdisciplinary team whose aim is to ensure proper patient care from the hospital to the home setting. In this article, we describe the components of the team, their roles and our way of working. PMID:23540596

Güell, Maria Rosa; Antón, Antonio; Rojas-García, Ricardo; Puy, Carmen; Pradas, Jesus

2013-12-01

306

Constraining canopy biophysical simulations with daily MODIS reflectance data ensuring pixel-target adequacy  

NASA Astrophysics Data System (ADS)

Modern vegetation models incorporate ecophysiological details that allow for accurate estimates of carbon dioxide uptake, water use and energy exchange, but require knowledge of dynamic structural and biochemical traits. Variations in these traits are controlled by genetic factors as well as growth stage and nutrient and moisture availability, making them difficult to predict and prone to significant error. Here we explore the use of daily MODIS optical reflectance data for constraining key canopy- and leaf-level traits required by forward biophysical models. A multi-objective optimization algorithm is used to invert the PROSAIL canopy radiation transfer model against MODIS optical reflectance observations. PROSAIL accounts for the effects of leaf-level optical properties, foliage distribution and orientation on canopy reflectance across the optical range. Inversions are conducted for several growing seasons for both soybean and maize at multiple sites across the Central US agro-ecosystem. These inversions provide estimates of seasonal variations, and associated uncertainty, of variables such as leaf area index (LAI). The inversion-derived canopy properties are used to examine the ability of MODIS data to characterize seasonal variations in these states relative to field observations. The canopy properties are then used as inputs into the MLCan biophysical model to conduct forward simulations. MLCan characterizes the ecophysiological functioning of a plant canopy at a half-hourly timestep, and has been rigorously validated for both C3 and C4 crops against observations of canopy CO2 uptake, evapotranspiration and sensible heat exchange. By utilizing the inverted canopy states to drive MLCan over several growing seasons, we are able to assess the impact of uncertainty in the MODIS inversion procedure on uncertainties in forward model flux estimates. This work requires the use of instant (non-composited) observations obtained at a daily frequency from both Terra and Aqua platforms. As a whiskbroom imaging instrument, MODIS has a complex viewing geometry which affects its spatial response, i.e. the way the electromagnetic radiation reflected from the surface is ultimately encoded in the remotely-sensed image. A model of this spatial response is used here to ensure that the footprint of the satellite observations matches adequately with the coupled model simulations of the target fields. The relationship between the purity of the remote sensing observation, with respect to the target field, and the quality of the biophysical variable inversion is also investigated.

Drewry, D.; Duveiller, G.

2013-12-01

307

Overview of the Medicare Catastrophic Coverage Act of 1988 and its impact on health-care delivery.  

PubMed

The Medicare Catastrophic Coverage Act of 1988 is described, and its impact on health-care delivery is discussed. The act will expand Medicare coverage of inpatient hospital care and will also provide payment for outpatient prescription drugs and home i.v. therapy. For the prescription drug benefit, deductible and coinsurance payments will be phased in, and Medicare will establish payment limits. A per diem fee schedule will be established to pay for the supplies and services used in home i.v. therapy. Providers of home therapy must have qualifications specified by the act. Pharmacists will have an important role in ensuring that patients understand and comply with their drug therapy once they leave the hospital. As members of the home health-care team, pharmacists will be involved in identifying candidates for home care, instructing patients in the use of sophisticated medical equipment, and monitoring the safety and efficacy of therapy. Medicare beneficiaries will help finance the new coverage by paying a flat premium; in addition, all individuals eligible for Medicare will pay supplemental premiums based on their federal income tax liability. Congress, however, will come under pressure to lower or freeze these premiums. Hospitals and pharmacists should cooperate in urging Congress to provide adequate funding for services specified by the catastrophic coverage act. PMID:2672805

Grealy, M R

1989-07-01

308

Special needs of adult critical care units.  

PubMed

This article has highlighted some of the specific needs of adult critical care units and the role that both the nurse manager and materiel manager play in today's changing health care system and environment. The key to success in meeting the specific needs of critical care patients lies in open communication and collaboration between the materiel management department and the department of nursing. The challenges are many, yet cooperation and an understanding of one another's needs can do much to create successful relationships within critical care settings and ensure optimal patient safety. PMID:10127552

Cardin, S

1993-08-01

309

Proposing a redefinition of pharmaceutical care.  

PubMed

In many clinical practice settings, individual pharmaceutical care practitioners have thousands of patients who may receive their service. However, the pharmaceutical care approach provides virtually no guidance regarding how patients should be identified or prioritized by practicing pharmacists. We believe that pharmacists need to be "officially" accountable to specific patient groups at high risk for drug- or disease-induced morbidity within their practice. Consequently, the current definition of pharmaceutical care and its associated care processes need to be modified to ensure the activities of pharmacists are being focused on high-priority patients on a consistent basis. PMID:22395251

Blackburn, David F; Yakiwchuk, Erin M; Jorgenson, Derek J; Mansell, Kerry D

2012-03-01

310

The Health and Social Care Act 2008.  

PubMed

Several inquiry reports have shown that there is still a need to further improve health and social care and strengthen public confidence in these services. The reports have particularly emphasized the need for stricter regulation of health and adult social care providers and the need to use statutory powers to ensure compliance with quality and safety standards.This article outlines how the provisions of the Health and Social Care Act 2008 aim to address this need to further regulate quality and safety standards in health and social care. PMID:21240085

Griffith, Richard; Tengnah, Cassam

2010-12-01

311

Primary care for adolescents with developmental disabilities.  

PubMed

Disability is a natural part of the human experience. To maximize potential, adolescents with disabilities require multidisciplinary transition planning and life-skill training. Health care professionals can reduce barriers to accessing health care. They can encourage self-determination and connect patients to self-advocacy organizations. They can facilitate smooth transitions to adult health care services. Careful descriptions of a patient's baseline traits and function are critical, not only to assist in person centered planning processes, but to ensure that new caregivers and clinicians have the information they need to recognize changes in function or behavior that can signal illness. PMID:25124203

Kripke, Clarissa Calliope

2014-09-01

312

Ensuring Quality  

ERIC Educational Resources Information Center

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

Erickson, Paul W.

2009-01-01

313

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

PubMed

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

Cantor, N L

2001-01-01

314

End-of-life care issues in advanced dementia  

PubMed Central

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

2013-01-01

315

Cardiac catecholamines in rats fed copper deficient or copper adequate diets containing fructose or starch  

SciTech Connect

The symptoms of copper (Cu) deficiency are known to be more severe when rats are fed a diet with fructose (F) as the principal carbohydrate. Mortality, in males, due to cardiac abnormalities usually occurs after five weeks of a 62% F, 0.6 ppm Cu deficient diet. These effects are not observed if cornstarch (CS) is the carbohydrate (CHO) source. Studies with F containing diets have shown increased catecholamine (C) turnover rates while diets deficient in Cu result in decreased norepinephrine (N) levels in tissues. Dopamine B-hydroxylase (EC 1.14.17.1) is a Cu dependent enzyme which catalyzes the conversion of dopamine (D) to N. An experiment was designed to investigate the effects of CHO and dietary Cu on levels of three C in cardiac tissue. Thirty-two male and female Sprague-Dawley rats were fed Cu deficient or adequate diets with 60% of calories from F or CS for 6 weeks. N, epinephrine (E) and D were measured by HPLC. Statistical analysis indicates that Cu deficiency tends to decrease N levels, while having the reverse effect on E. D did not appear to change. These findings indicate that Cu deficiency but not dietary CHO can affect the concentration of N and E in rat cardiac tissue.

Scholfield, D.J.; Fields, M.; Beal, T.; Lewis, C.G.; Behall, K.M. (Dept. og Agriculture, Beltsville, MD (USA))

1989-02-09

316

Food intake in women two years or more after bariatric surgery meets adequate intake requirements.  

PubMed

Restricted food intake after bariatric surgery can be an important factor both in the long-term control of body weight and in the onset of nutritional deficiencies. The objective of this study was to assess the adequacy of food intake in women two or more years after bariatric surgery according to the excess weight lost. A group of 141 women who underwent banded Roux-en-Y gastric bypass (RYGB) was divided according to the percentage of excess weight they lost (%EWL)<50; 50?75; = 75. The habitual energy and nutrient intakes were determined by a 24-hour recall over two days and the probability of adequate intake was based on the Dietary Reference Intake. The mean total estimated energy requirement (EER) as well as energy, macronutrient and cholesterol intakes did not differ among the groups. Only the %EWL<50 group had an intake equal to their EER, but they presented a higher number of inadequacies, such as low levels of magnesium, folic acid and vitamins C and E. Calcium and dietary fiber intakes were extremely low in all three groups. In conclusion, weight loss after surgery is associated with food habits that favor energy intake over micronutrient intake. PMID:22652372

Novais, Patrícia Fátima Sousa; Rasera, Irineu; Leite, Celso Vieira de Souza; Marin, Flávia Andréia; de Oliveira, Maria Rita Marques

2012-05-01

317

Determination of the need for selenium by chicks fed practical diets adequate in vitamin E  

SciTech Connect

Experiments were conducted to compare the dietary needs for selenium (Se) by chicks fed either purified (amino acid-based) or practical (corn- and soy-based) diets that were adequate with respect to vitamin E (i.e., contained 100 IU/kg) and all other known nutrients with the single exception of Se (i.e., contained only 0.10 ppm Se). Studies were conducted in Ithaca using Single Comb White Leghorn chicks fed the purified basal diet and in Beijing using chicks of the same breed fed either the same purified basal diet or the practical diet formulated to be similar to that used in poultry production in some parts of China and the US. Results showed that each basal diet produced severe depletion of Se-dependent glutathione peroxidase (SeGSHpx) in plasma, liver and pancreas according to the same time-course, but that other consequences of severe uncomplicated Se deficiency were much more severe among chicks fed the purified diet (e.g., growth depression, pancreatic dysfunction as indicated by elevated plasma amylase and abnormal pancreatic histology). Chicks fed the practical Se-deficient diet showed reduced pancreas levels of copper, zinc and molybdenum and elevated plasma levels of iron; they required ca. 0.10 ppm dietary Se to sustain normal SeGSHpx in several tissues and to prevent elevated amylase in plasma. The dietary Se requirement of the chick is, therefore, estimated to be 0.10 ppm.

Combs, G.F. Jr.; Su, Q.; Liu, C.H.; Sinisalo, M.; Combs, S.B.

1986-03-01

318

Accountable care: are you ready?  

PubMed

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

Nguyen, James; Choi, Ben

2011-08-01

319

Faculty of Health and Medical Sciences School of Health & Social Care  

E-print Network

Faculty of Health and Medical Sciences School of Health & Social Care www.surrey.ac.uk/healthandsocialcare Caring for the Acutely Ill Cancer Patient Module Code NUR3189 Credits / Level of Study 15 credits / Level to manage care pathways of the acutely ill cancer patient safely whilst ensuring that individualised care

Doran, Simon J.

320

Infant care practices in rural China and their relation to prenatal care utilisation.  

PubMed

Studies describing postpartum childcare practices and the influence of prenatal care on infant care outcomes in rural China are scarce. This study looked at data for 1479 women who had given birth during the preceding 2 years (median age of the child was 8 months). Data were available from a Knowledge, Attitude and Perception cross-sectional survey collected from 2001 to 2003, after a prenatal care intervention in Anhui County, China, with a response rate of 97%. Prenatal care utilisation was categorised using the Adequacy of Prenatal Care Utilisation index. Logistic regression was used to study the association between prenatal care utilisation and infant care practices. Mothers' uptake of breastfeeding, introduction of milk formula, cereal/porridge, meat and uptake of any immunisation were found to be in accordance with national recommendations. Intermediate prenatal care uptake was positively associated with never breastfeeding and early introduction of cereal/porridge. Inadequate care was positively associated with never breastfeeding, early introduction of milk formula and cereal/porridge, and early start of work after delivery. Initiation to prenatal care after the third month was positively associated with early introduction of milk formula and cereal/porridge. Having no prenatal care was positively associated with never breastfeeding and early introduction of milk formula. Mothers' uptake of infant care practices in this population was largely in accordance with national recommendations. Women with less than adequate utilisation of prenatal care and those who had initiated prenatal care late were less likely to follow recommendations on infant care. PMID:20336564

Nwaru, B I; Wu, Z; Hemminki, E

2011-01-01

321

Relational practice as the key to ensuring quality care for frail older people: discharge planning as a case example  

Microsoft Academic Search

Discharging frail older people from acute hospital settings has been an issue of concern for over 40 years and recent studies suggest that enduring problems remain. This paper explores the experiences of discharge from three different units: an acute surgical ward, an acute medical ward and a specialist ward for older people. Based on extensive data from interviews with older

Sion Williams; Mike Nolan; John Keady

2009-01-01

322

Because you careEmergency Care OR/Anesthesia Critical Care Perinatal Care Home Care Introduction  

E-print Network

Because you careEmergency Care · OR/Anesthesia · Critical Care · Perinatal Care · Home Care practitioners to make efficient decisions in time. In intensive care and anesthesia, the demand for computerised of physiological needs during the patient wake-up from anesthesia or drug intoxication. Knowledge-Based Systems

Dojat, Michel

323

48 CFR 52.222-23 - Notice of Requirement for Affirmative Action To Ensure Equal Employment Opportunity for...  

Code of Federal Regulations, 2011 CFR

... Notice of Requirement for Affirmative Action To Ensure Equal Employment... Notice of Requirement for Affirmative Action To Ensure Equal Employment... Notice of Requirement for Affirmative Action To Ensure Equal...

2011-10-01

324

48 CFR 52.222-23 - Notice of Requirement for Affirmative Action To Ensure Equal Employment Opportunity for...  

Code of Federal Regulations, 2012 CFR

... Notice of Requirement for Affirmative Action To Ensure Equal Employment... Notice of Requirement for Affirmative Action To Ensure Equal Employment... Notice of Requirement for Affirmative Action To Ensure Equal...

2012-10-01

325

48 CFR 52.222-23 - Notice of Requirement for Affirmative Action To Ensure Equal Employment Opportunity for...  

Code of Federal Regulations, 2013 CFR

... Notice of Requirement for Affirmative Action To Ensure Equal Employment... Notice of Requirement for Affirmative Action To Ensure Equal Employment... Notice of Requirement for Affirmative Action To Ensure Equal...

2013-10-01

326

25 CFR 1000.256 - Must the Secretary retain project funds to ensure proper health and safety standards in...  

Code of Federal Regulations, 2013 CFR

...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction...

2013-04-01

327

25 CFR 1000.256 - Must the Secretary retain project funds to ensure proper health and safety standards in...  

Code of Federal Regulations, 2012 CFR

...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction...

2012-04-01

328

25 CFR 1000.256 - Must the Secretary retain project funds to ensure proper health and safety standards in...  

Code of Federal Regulations, 2011 CFR

...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction...

2011-04-01

329

25 CFR 1000.256 - Must the Secretary retain project funds to ensure proper health and safety standards in...  

Code of Federal Regulations, 2010 CFR

...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction...

2010-04-01

330

25 CFR 1000.256 - Must the Secretary retain project funds to ensure proper health and safety standards in...  

...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction projects...project funds to ensure proper health and safety standards in construction...

2014-04-01

331

December 10, 2010 Nurse Bargaining Update: UC's Wage Proposal Ensures Competitive Compensation  

E-print Network

, the proposed wage increases that we presented to the union will help ensure that nurse wages at UC Davis remainDecember 10, 2010 Nurse Bargaining Update: UC's Wage Proposal Ensures Competitive Compensation Our negotiations with CNA for a new nurses' contract continued on December 8 and 9 in San Diego. UC delivered its

Leistikow, Bruce N.

332

24 CFR 81.102 - Verification and enforcement to ensure GSE data integrity.  

...Verification and enforcement to ensure GSE data integrity. 81.102 Section 81.102 Housing...Verification and enforcement to ensure GSE data integrity. (a) Independent verification authority...Secretary may independently verify the accuracy and completeness of the data,...

2014-04-01

333

24 CFR 81.102 - Verification and enforcement to ensure GSE data integrity.  

Code of Federal Regulations, 2012 CFR

...Verification and enforcement to ensure GSE data integrity. 81.102 Section 81.102 Housing...Verification and enforcement to ensure GSE data integrity. (a) Independent verification authority...Secretary may independently verify the accuracy and completeness of the data,...

2012-04-01

334

24 CFR 81.102 - Verification and enforcement to ensure GSE data integrity.  

Code of Federal Regulations, 2011 CFR

...Verification and enforcement to ensure GSE data integrity. 81.102 Section 81.102 Housing...Verification and enforcement to ensure GSE data integrity. (a) Independent verification authority...Secretary may independently verify the accuracy and completeness of the data,...

2011-04-01

335

24 CFR 81.102 - Verification and enforcement to ensure GSE data integrity.  

Code of Federal Regulations, 2013 CFR

...Verification and enforcement to ensure GSE data integrity. 81.102 Section 81.102 Housing...Verification and enforcement to ensure GSE data integrity. (a) Independent verification authority...Secretary may independently verify the accuracy and completeness of the data,...

2013-04-01

336

WHO IS MOST RESPONSIBLE FOR ENSURING THE MEAT WE EAT IS SAFE?  

Microsoft Academic Search

We report results of an analysis of the attribution of relative responsibility across the stages of the food chain for ensuring food safety. Specifically, we identify perceptions of the share of the overall responsibility that each stage in the food chain has to ensure that the meat people cook and eat at home does not cause them to become ill.

Seda Erdem; Dan Rigby; Ada Wossink

2010-01-01

337

RRP: Recruitment and Retention Project enhance and ensure sustainability with University student recruitment; !  

E-print Network

student recruitment; ! ·identify and implement strategies designed to enhance student retention;! ·ensure system level barriers to student success and engagement are removed.! Objectives:! ·increase learnerRRP: Recruitment and Retention Project Mandate:! ·enhance and ensure sustainability with University

Seldin, Jonathan P.

338

24 CFR 903.25 - How does HUD ensure PHA compliance with its plan?  

Code of Federal Regulations, 2010 CFR

... 2010-04-01 false How does HUD ensure PHA compliance with its plan? 903.25 Section...URBAN DEVELOPMENT PUBLIC HOUSING AGENCY PLANS PHA Plans § 903.25 How does HUD ensure PHA compliance with its plan? A PHA must...

2010-04-01

339

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

NASA Technical Reports Server (NTRS)

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

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

1998-01-01

340

Defining an Adequate Sample of Earlywood Vessels for Retrospective Injury Detection in Diffuse-Porous Species  

PubMed Central

Vessels of broad-leaved trees have been analyzed to study how trees deal with various environmental factors. Cambial injury, in particular, has been reported to induce the formation of narrower conduits. Yet, little or no effort has been devoted to the elaboration of vessel sampling strategies for retrospective injury detection based on vessel lumen size reduction. To fill this methodological gap, four wounded individuals each of grey alder (Alnus incana (L.) Moench) and downy birch (Betula pubescens Ehrh.) were harvested in an avalanche path. Earlywood vessel lumina were measured and compared for each tree between the injury ring built during the growing season following wounding and the control ring laid down the previous year. Measurements were performed along a 10 mm wide radial strip, located directly next to the injury. Specifically, this study aimed at (i) investigating the intra-annual duration and local extension of vessel narrowing close to the wound margin and (ii) identifying an adequate sample of earlywood vessels (number and intra-ring location of cells) attesting to cambial injury. Based on the results of this study, we recommend analyzing at least 30 vessels in each ring. Within the 10 mm wide segment of the injury ring, wound-induced reduction in vessel lumen size did not fade with increasing radial and tangential distances, but we nevertheless advise favoring early earlywood vessels located closest to the injury. These findings, derived from two species widespread across subarctic, mountainous, and temperate regions, will assist retrospective injury detection in Alnus, Betula, and other diffuse-porous species as well as future related research on hydraulic implications after wounding. PMID:22761707

Arbellay, Estelle; Corona, Christophe; Stoffel, Markus; Fonti, Patrick; Decaulne, Armelle

2012-01-01

341

When are studies adequate for regulatory purposes? View of one regulated.  

PubMed

The question of adequacy of studies for regulatory purposes has been debated for years. Nine questions need answers to determine adequacy: (1) Does the study deal with a defined problem or a defined segment of it? (2) Do the study data justify the conclusions drawn? (3) Were appropriate statistical analyses used? Is there evidence of bias versus objectivity in the collection or analysis of data? (4) Does the study support, supplement (or complement) or refute information in the literature? Is the study truly new information? (5) Does the study conform to the Interagency Regulatory Liaison Group (IRLG) guidelines for documentation of Epidemiologic Studies? (6) Does the study stand up to peer review? (7) Have other investigators been able to confirm the findings by duplicating the study? (8) Is the study acceptable or can it be made acceptable for publication in a reputable scientific journal? (9) Is the problem of such magnitude or significance that regulation is required? Because there is no such thing as a risk-free environment or absolute safety and there is no definitive "yes" answer to each of the questions, the regulated would hope--yes, insist--that the regulators exercise judgement with great skill in promulgation of rules or regulations. The application of safety factors and the determination of acceptable levels of risk should be social decisions. A discussion of instances where the "regulated" believes that studies have not been adequate, or others habe been ignored, or misinterpreted for regulatory purposes in included.A method of settling controversial questions to eliminate the litigation route is proposed. Judgment which is so often eliminated by regulation needs to find its way back into the regulatory process. The regulated recognize the need for regulations. However, when these regulations are based on less than good scientific judgment, harm will be done to the regulatory process itself in the long run. PMID:7333262

Bundy, M

1981-12-01

342

Defining an adequate sample of earlywood vessels for retrospective injury detection in diffuse-porous species.  

PubMed

Vessels of broad-leaved trees have been analyzed to study how trees deal with various environmental factors. Cambial injury, in particular, has been reported to induce the formation of narrower conduits. Yet, little or no effort has been devoted to the elaboration of vessel sampling strategies for retrospective injury detection based on vessel lumen size reduction. To fill this methodological gap, four wounded individuals each of grey alder (Alnus incana (L.) Moench) and downy birch (Betula pubescens Ehrh.) were harvested in an avalanche path. Earlywood vessel lumina were measured and compared for each tree between the injury ring built during the growing season following wounding and the control ring laid down the previous year. Measurements were performed along a 10 mm wide radial strip, located directly next to the injury. Specifically, this study aimed at (i) investigating the intra-annual duration and local extension of vessel narrowing close to the wound margin and (ii) identifying an adequate sample of earlywood vessels (number and intra-ring location of cells) attesting to cambial injury. Based on the results of this study, we recommend analyzing at least 30 vessels in each ring. Within the 10 mm wide segment of the injury ring, wound-induced reduction in vessel lumen size did not fade with increasing radial and tangential distances, but we nevertheless advise favoring early earlywood vessels located closest to the injury. These findings, derived from two species widespread across subarctic, mountainous, and temperate regions, will assist retrospective injury detection in Alnus, Betula, and other diffuse-porous species as well as future related research on hydraulic implications after wounding. PMID:22761707

Arbellay, Estelle; Corona, Christophe; Stoffel, Markus; Fonti, Patrick; Decaulne, Armelle

2012-01-01

343

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

...ENGINEERING AND TRAFFIC OPERATIONS ENFORCEMENT OF HEAVY VEHICLE USE TAX § 669.13 Effect of failure to certify...adequately obtaining proof-of-payment of the heavy vehicle use tax as a condition of registration notwithstanding the...

2014-04-01

344

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

PubMed

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

Casper, Tim; Kindig, David A

2012-01-01

345

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

PubMed Central

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

Casper, Tim

2012-01-01

346

Factors influencing intensive care nurses' knowledge and attitudes regarding ventilator-associated pneumonia and oral care practice in intubated patients in Croatia.  

PubMed

Adequate oral care in intubated patients may reduce occurrence of ventilator-associated pneumonia. The purpose of this study was to explore knowledge, attitudes, and oral care practice in Croatian intensive care units and influencing factors. Nurses' knowledge is insufficient; however, most of them reported positive attitude toward the importance of oral care. Performed oral hygiene measures are mostly inappropriate. There is a need to improve the knowledge of ventilator-associated pneumonia and oral care. PMID:25278406

Jordan, Ante; Badovinac, Ana; Spalj, Stjepan; Par, Matej; Slaj, Martina; Plan?ak, Darije

2014-10-01

347

Child Care Options MSU Child Development Center  

E-print Network

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

Maxwell, Bruce D.

348

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

NASA Astrophysics Data System (ADS)

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

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

2012-12-01

349

Universal health care in India: Panacea for whom?  

PubMed

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

Qadeer, Imrana

2013-01-01

350

All grown up: moving from pediatric to adult diabetes care.  

PubMed

Transition of care from a child-centered care environment to an adult-centered care environment for pediatric patients with diabetes is needed to ensure continued diabetes care. The transition process should start early and be tailored to the developmental stage of the patient. The typical challenges of adolescence and young adulthood including pubertal changes, parent-child conflict and the potential for high-risk behavior complicate the transition process. Methods of transfer of care are variable and less than optimal. Ongoing study and continued efforts are needed to improve the transition process so that young patients with diabetes receive high quality uninterrupted care. PMID:23531959

Lewis, Katherine

2013-04-01

351

Managed Care  

Microsoft Academic Search

The managed mental health care industry is seen as having established a totalitarian regime, subjugaling patients and therapists and depriving them of freedom and the democratic process. This paper compares the regimes of Mussolini, Hiller, Lenin, and Stalin, and the fictional regimes in Orwell's 1984 and Huxley's Brave New World with managed care. The comparison is made by discussion of

Karen Shore

1996-01-01

352

Compassionate care.  

PubMed

While working as a healthcare assistant caring for patients with dementia, as well as on placements as a nursing student, I have seen how important it is to listen to what a patient is saying and to watch their body language. By taking time to do this, nurses can develop therapeutic relationships with patients, promoting compassionate care. PMID:24617406

Moore, Alison

353

Assessing Child-Care Quality with a Telephone Interview.  

ERIC Educational Resources Information Center

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

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

2001-01-01

354

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

ERIC Educational Resources Information Center

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

Monroe, Helen

355

Racial Differences in Perceived Barriers to Prenatal Care  

Microsoft Academic Search

Objectives: It is well known that black women are less likely to receive adequate prenatal care than white women. This study examines whether there are differences in barriers to prenatal care reported by black and white mothers. Method: Data from the 1988 National Maternal and Infant Health Survey were used to measure relationships between race and reported financial, service, and

Sylva A. Tossounian; Kenneth C. Schoendorf; John L. Kiely

1997-01-01

356

SAN JOSE STATE UNIVERSITY INSTITUTIONAL ANIMAL CARE & USE COMMITTEE  

E-print Network

to animals. On that premise, the PI will be expected to adequately support that the experimental designSAN JOSE STATE UNIVERSITY INSTITUTIONAL ANIMAL CARE & USE COMMITTEE GUIDELINES FOR CONDUCTING A LITERATURE SEARCH FOR ANIMAL CARE AND USE SUBMISSIONS The Federal government requires an Institution's Animal

Su, Xiao

357

Differences in outcome with subspecialty care: Pyloromyotomy in North Carolina  

Microsoft Academic Search

Background\\/Purpose: Proponents of subspecialization in surgery claim that fellowship training improves the quality of care. Others claim that general training is adequate for most routine surgical procedures. The authors questioned whether there were differences in outcomes when general surgeons (GEN) operate on children and infants with common surgical conditions compared with the care of their pediatric surgical (PED) colleagues. Methods:

Thomas Pranikoff; Brendan T. Campbell; Jeffrey Travis; Ronald B. Hirschl

2002-01-01

358

Global Uranium And Thorium Resources: Are They Adequate To Satisfy Demand Over The Next Half Century?  

NASA Astrophysics Data System (ADS)

This presentation will consider the adequacy of global uranium and thorium resources to meet realistic nuclear power demand scenarios over the next half century. It is presented on behalf of, and based on evaluations by, the Uranium Group - a joint initiative of the OECD Nuclear Energy Agency and the International Atomic Energy Agency, of which the author is a Vice Chair. The Uranium Group produces a biennial report on Uranium Resources, Production and Demand based on information from some 40 countries involved in the nuclear fuel cycle, which also briefly reviews thorium resources. Uranium: In 2008, world production of uranium amounted to almost 44,000 tonnes (tU). This supplied approximately three-quarters of world reactor requirements (approx. 59,000 tU), the remainder being met by previously mined uranium (so-called secondary sources). Information on availability of secondary sources - which include uranium from excess inventories, dismantling nuclear warheads, tails and spent fuel reprocessing - is incomplete, but such sources are expected to decrease in market importance after 2013. In 2008, the total world Reasonably Assured plus Inferred Resources of uranium (recoverable at less than 130/kgU) amounted to 5.4 million tonnes. In addition, it is clear that there are vast amounts of uranium recoverable at higher costs in known deposits, plus many as yet undiscovered deposits. The Uranium Group has concluded that the uranium resource base is more than adequate to meet projected high-case requirements for nuclear power for at least half a century. This conclusion does not assume increasing replacement of uranium by fuels from reprocessing current reactor wastes, or by thorium, nor greater reactor efficiencies, which are likely to ameliorate future uranium demand. However, progressively increasing quantities of uranium will need to be mined, against a backdrop of the relatively small number of producing facilities around the world, geopolitical uncertainties and strong opposition to growth of nuclear power in a number of quarters - it is vital that the market provides incentives for exploration and development of environmentally sustainable mining operations. Thorium: World Reasonably Assured plus Inferred Resources of thorium are estimated at over 2.2 million tonnes, in hard rock and heavy mineral sand deposits. At least double this amount is considered to occur in as yet undiscovered thorium deposits. Currently, demand for thorium is insignificant, but even a major shift to thorium-fueled reactors would not make significant inroads into the huge resource base over the next half century.

Lambert, I. B.

2012-04-01

359

Human milk feeding supports adequate growth in infants <= 1250 grams birth weight  

PubMed Central

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

2013-01-01

360

Promoting universal financial protection: how the Thai universal coverage scheme was designed to ensure equity  

PubMed Central

Background Empirical evidence demonstrates that the Thai Universal Coverage Scheme (UCS) has improved equity of health financing and provided a relatively high level of financial risk protection. Several UCS design features contribute to these outcomes: a tax-financed scheme, a comprehensive benefit package and gradual extension of coverage to illnesses that can lead to catastrophic household costs, and capacity of the National Health Security Office (NHSO) to mobilise adequate resources. This study assesses the policy processes related to making decisions on these features. Methods The study employs qualitative methods including reviews of relevant documents, in-depth interviews of 25 key informants, and triangulation amongst information sources. Results Continued political and financial commitments to the UCS, despite political rivalry, played a key role. The Thai Rak Thai (TRT)-led coalition government introduced UCS; staying in power 8 of the 11 years between 2001 and 2011 was long enough to nurture and strengthen the UCS and overcome resistance from various opponents. Prime Minister Surayud’s government, replacing the ousted TRT government, introduced universal renal replacement therapy, which deepened financial risk protection. Commitment to their manifesto and fiscal capacity pushed the TRT to adopt a general tax-financed universal scheme; collecting premiums from people engaged in the informal sector was neither politically palatable nor technically feasible. The relatively stable tenure of NHSO Secretary Generals and the chairs of the Financing and the Benefit Package subcommittees provided a platform for continued deepening of financial risk protection. NHSO exerted monopsonistic purchasing power to control prices, resulting in greater patient access and better systems efficiency than might have been the case with a different design. The approach of proposing an annual per capita budget changed the conventional line-item programme budgeting system by basing negotiations between the Bureau of Budget, the NHSO and other stakeholders on evidence of service utilization and unit costs. Conclusions Future success of Thai UCS requires coverage of effective interventions that address primary and secondary prevention of non-communicable diseases and long-term care policies in view of epidemiologic and demographic transitions. Lessons for other countries include the importance of continued political support, evidence informed decisions, and a capable purchaser organization. PMID:23919275

2013-01-01

361

Care of dementia in Canada: A collaborative care approach with a central role for the primary care physician  

Microsoft Academic Search

A chronic and complex disease such as dementia requires organized and integrated care from all the actors involved. Management of dementia entails ensuring early detection and diagnosis, starting and maintaining the appropriate pharmacological treatment, and most importantly providing ongoing support to the patient and his caregivers as they go through the different stages of the disease, many of which impose

F. Massoud; P. Lysy; H. Bergman

2010-01-01

362

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

PubMed Central

The private sector exerts a significant and critical influence on child health outcomes in developing countries, including the health of poor children. This article reviews the available evidence on private sector utilization and quality of care. It provides a framework for analysing the private sector's influence on child health outcomes. This influence goes beyond service provision by private providers and nongovernmental organizations (NGOs). Pharmacies, drug sellers, private suppliers, and food producers also have an impact on the health of children. Many governments are experimenting with strategies to engage the private sector to improve child health. The article analyses some of the most promising strategies, and suggests that a number of constraints make it hard for policy-makers to emulate these approaches. Few experiences are clearly described, monitored, and evaluated. The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of how to engage the private sector most effectively. The starting point should include the evaluation of the presence and potential of the private sector, including actors such as professional associations, producer organizations, community groups, and patients' organizations. PMID:14997241

Bustreo, Flavia; Harding, April; Axelsson, Henrik

2003-01-01

363

Retention in mental health care of Portuguese-speaking patients  

PubMed Central

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

Goncalves, Marta; Cook, Benjamin; Mulvaney-Day, Norah; Alegria, Margarita; Kinrys, Gustavo

2013-01-01

364

Patients' Experiences with Navigation for Cancer Care  

PubMed Central

Objective We examined how navigation, defined as the assessment and alleviation of barriers to adequate health care, influences patients' perspectives on the quality of their cancer care. Methods We conducted post-study patient interviews from a randomized controlled trial (usual care vs. patient navigation services) from cancer diagnosis through treatment completion. Patients were recruited from 11 primary care, hospital and community oncology practices in New York. We interviewed patients about their expectations and experience of patient navigation or, for non-navigated patients, other sources of assistance. Results Thirty-five patients newly diagnosed with breast or colorectal cancer. Valued aspects of navigation included emotional support, assistance with information needs and problem-solving, and logistical coordination of cancer care. Unmet cancer care needs expressed by patients randomized to usual care consisted of lack of assistance or support with childcare, household responsibilities, coordination of care, and emotional support. Conclusion Cancer patients value navigation. Instrumental benefits were the most important expectations for navigation from navigated and non-navigated patients. Navigated patients received emotional support and assistance with information needs, problem-solving, and logistical aspects of cancer care coordination. Practice Implications Navigation services may help improve cancer care outcomes important to patients by addressing fragmented, confusing, uncoordinated, or inefficient care. PMID:20006459

Carroll, Jennifer K.; Humiston, Sharon G.; Meldrum, Sean C.; Salamone, Charcy M.; Jean-Pierre, Pascal; Epstein, Ronald M.; Fiscella, Kevin

2010-01-01

365

Adequate margins for random setup uncertainties in head-and-neck IMRT  

SciTech Connect

Purpose: To investigate the effect of random setup uncertainties on the highly conformal dose distributions produced by intensity-modulated radiotherapy (IMRT) for clinical head-and-neck cancer patients and to determine adequate margins to account for those uncertainties. Methods and materials: We have implemented in our clinical treatment planning system the possibility of simulating normally distributed patient setup displacements, translations, and rotations. The planning CT data of 8 patients with Stage T1-T3N0M0 oropharyngeal cancer were used. The clinical target volumes of the primary tumor (CTV{sub primary}) and of the lymph nodes (CTV{sub elective}) were expanded by 0.0, 1.5, 3.0, and 5.0 mm in all directions, creating the planning target volumes (PTVs). We performed IMRT dose calculation using our class solution for each PTV margin, resulting in the conventional static plans. Then, the system recalculated the plan for each positioning displacement derived from a normal distribution with {sigma} = 2 mm and {sigma} = 4 mm (standard deviation) for translational deviations and {sigma} = 1 deg for rotational deviations. The dose distributions of the 30 fractions were summed, resulting in the actual plan. The CTV dose coverage of the actual plans was compared with that of the static plans. Results: Random translational deviations of {sigma} = 2 mm and rotational deviations of {sigma} = 1 deg did not affect the CTV{sub primary} volume receiving 95% of the prescribed dose (V{sub 95}) regardless of the PTV margin used. A V{sub 95} reduction of 3% and 1% for a 0.0-mm and 1.5-mm PTV margin, respectively, was observed for {sigma} = 4 mm. The V{sub 95} of the CTV{sub elective} contralateral was approximately 1% and 5% lower than that of the static plan for {sigma} = 2 mm and {sigma} = 4 mm, respectively, and for PTV margins < 5.0 mm. An additional reduction of 1% was observed when rotational deviations were included. The same effect was observed for the CTV{sub elective} ipsilateral but with smaller dose differences than those for the contralateral side. The effect of the random uncertainties on the mean dose to the parotid glands was not significant. The maximal dose to the spinal cord increased by a maximum of 3 Gy. Conclusions: The margins to account for random setup uncertainties, in our clinical IMRT solution, should be 1.5 mm and 3.0 mm in the case of {sigma} = 2 mm and {sigma} = 4 mm, respectively, for the CTV{sub primary}. Larger margins (5.0 mm), however, should be applied to the CTV{sub elective}, if the goal of treatment is a V{sub 95} value of at least 99%.

Astreinidou, Eleftheria [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands)]. E-mail: e.astreinidou@azu.nl; Bel, Arjan [Nucletron B.V., Veenendaal (Netherlands); Raaijmakers, Cornelis P.J. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Terhaard, Chris H.J. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Lagendijk, Jan J.W. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands)

2005-03-01

366

Involving Parents in Their Children's Dental Care.  

ERIC Educational Resources Information Center

Asserts that parent education is vital to good dental hygiene for the whole family. Discusses what Head Start staffers can do to ensure that children's dental needs are being met, particularly in assisting parents with taking responsibility for children's dental hygiene. Covers dental care tips for parents, questions and answers about dental…

Becker, Donna

1998-01-01

367

Beyond equivalence of care in prison pharmacy.  

PubMed

Prison healthcare has undergone a significant transformation over recent times. The main aim of these changes was to ensure prisoners received the same level of care as patients in the community. Prisons are a unique environment to provide healthcare within. Both the environment and the patient group provide a challenge to healthcare delivery. One of the biggest challenges currently being faced by healthcare providers is the misuse and abuse of prescription medication. It seems that the changes that have been made in prison healthcare, to ensure that prisoners receive the same level of care as patients in the community over recent times, have led to an increase in this problem. Prison pharmacy is ideally placed to help reduce the misuse and abuse of prescription medication. This can be achieved by using the skills and knowledge of the pharmacy department to ensure appropriate prescribing of medication liable to misuse and abuse. PMID:24400788

Choudhry, Khurshid; Evans, Nicola

2014-10-01

368

34 CFR 602.18 - Ensuring consistency in decision-making.  

Code of Federal Regulations, 2012 CFR

...POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION THE SECRETARY'S RECOGNITION...mission, and that ensure that the education or training offered by an institution...including any offered through distance education or correspondence...

2012-07-01

369

34 CFR 602.18 - Ensuring consistency in decision-making.  

Code of Federal Regulations, 2013 CFR

...POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION THE SECRETARY'S RECOGNITION...mission, and that ensure that the education or training offered by an institution...including any offered through distance education or correspondence...

2013-07-01

370

Information Technology Services (ITS) Information Technology Services (ITS) ensures that faculty, students, and staff have the  

E-print Network

Information Technology Services (ITS) Information Technology Services (ITS) ensures that faculty, students, and staff have the information technology tools and infrastructure necessary to carry out maximum use of the appropriate information technology tools in their learning, teaching, research

Maroncelli, Mark

371

5 CFR 330.503 - Ensuring agency compliance with the principles of open competition.  

Code of Federal Regulations, 2012 CFR

...OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS RECRUITMENT, SELECTION, AND PLACEMENT (GENERAL) Restrictions To Protect Competitive Principles § 330.503 Ensuring agency compliance with the principles of open competition. OPM will...

2012-01-01

372

28 CFR 115.122 - Policies to ensure referrals of allegations for investigations.  

Code of Federal Regulations, 2012 CFR

...for investigations. 115.122 Section 115.122 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Lockups Responsive Planning § 115.122 Policies to ensure...

2012-07-01

373

75 FR 68297 - Pesticides; Satisfaction of Data Requirements; Procedures To Ensure Protection of Data Submitters...  

Federal Register 2010, 2011, 2012, 2013

...Ensure Protection of Data Submitters' Rights AGENCY: Environmental Protection Agency...of exclusive use and data compensation rights of data submitters. The proposed revisions...D. Protection of Data Submitters' Rights The bulk of the regulations in 40...

2010-11-05

374

The health literacy, self-care, and medication hassles of patients with heart failure and their caregivers  

Microsoft Academic Search

Nearly 90 million Americans lack the necessary health literacy skills to adequately care for themselves in the face of a complex healthcare system and self-care regimens. Patients with heart failure are particularly challenged by meeting with multiple healthcare providers, who may emphasize different self-care strategies, which can be difficult for patients to interpret. Understanding how to effectively care for one's

Aleda M Hess

2009-01-01

375

Recommendations for Long Term Care in an Elderly Medicaid Population.  

ERIC Educational Resources Information Center

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

Travis, Shirley S.; McAuley, William J.

376

Vision Care for the Preschool Child with Handicaps.  

ERIC Educational Resources Information Center

The article provides information about the number and diversity of preschool children with handicaps requiring vision services, such as refractive errors and eye muscle imbalances, and describes a vision care system designed to ensure that these preschool children receive optimal vision care. (Author/CL)

Cress, Pamela; And Others

1984-01-01

377

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

ERIC Educational Resources Information Center

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

Chen, Huey Jen; Boothroyd, Roger A.

2006-01-01

378

Developing a health care strategy: a results-based approach.  

PubMed

In today's corporate environment, health care managers will be evaluated on performance--and forward-thinking companies are already quantifying their health care success. How this performance is defined and measured will differ from company to company, but shaping the definition and aligning it with the overall business strategy ensures success. PMID:10142764

Sperling, K L

1995-01-01

379

UNIVERSITY ANIMAL CARE COMMITTEE UACC Approved: November 2012  

E-print Network

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

Abolmaesumi, Purang

380

Drugs Requiring Application to PharmaCare Special Authority  

E-print Network

OVER Drugs Requiring Application to PharmaCare Special Authority Program Drugs listed may cost and ensures the long-term sustainability of your PBC drug plan. When prescribed a drug below, you.* Regardless of PharmaCare's decision to cover the drug, a copy of the decision must be submitted to PBC

381

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

SciTech Connect

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

Vine, E.

1992-05-01

382

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

SciTech Connect

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

Vine, E.

1992-05-01

383

Daily Care  

MedlinePLUS

... in daily life . Help the person remain as independent as possible. Offer opportunities for choice. Establish a familiar routine . Sign up for our e-Newsletter for care tips and news. ALZConnected ® Connect with our online caregiver community at ...

384

Continuing Care  

MedlinePLUS

... with Alzheimer’s disease and other forms of … Continue reading ? Coordinated Care Lets Alzheimer’s Patients Stay at Home Longer November 1, 2014 Elderly men and women with Alzheimer’s and other serious ...

385

Residential Care  

MedlinePLUS

... to care for residents with behavioral needs and fees. When you visit a facility, ask for their ... types of facilities can include an initial entry fee with subsequent monthly fees or payment may be ...

386

Palliative Care  

MedlinePLUS

... and your child, and are consistent with your personal values and beliefs. Palliative Care Basics Palliative means ... Kansas City Read More September 11, 2014 Funding Process Reaches Next Steps for Spinal Muscular Atrophy Clinical ...

387

Child Care  

MedlinePLUS

... the nation's overall well-being. Disability Expenses and Investments Fertility Health Care Industries Health Insurance HIV/AIDS ... Area Income and Poverty Supplemental Poverty Measure Wealth International Trade The U.S. Census Bureau is the official ...

388

Association between maternal occupational status and utilization of antenatal care  

Microsoft Academic Search

Objectives: Adequate utilization of antenatal care reduces the morbidity of mother and child. How frequent a pregnant woman attends\\u000a antenatal care is dependent on many factors. The aim of this study was to assess the current influence of educational level\\u000a and occupational status on maternal utilization of antenatal care under the conditions of an industrialized country and provision\\u000a of universal

Elisabeth Simoes; Siegfried Kunz; Ralf Münnich; Friedrich Wilhelm Schmahl

2006-01-01

389

Measuring organizational readiness for knowledge translation in chronic care  

Microsoft Academic Search

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

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

2011-01-01

390

Caring Encounters  

ERIC Educational Resources Information Center

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

Gunn, Alyson

2012-01-01

391

Lack of adequate sun protection for children with oculocutaneous albinism in South Africa  

PubMed Central

Background Childhood is a high risk time for ultraviolet induced skin damage as this age group has more time and opportunity to be outdoors in the sun. Children in Africa with the inherited condition oculocutaneous albinism (OCA) are especially vulnerable due to their lack of protective melanin. They are highly susceptible to developing skin lesions that have both cosmetic and health complications, with a high risk of developing skin cancers. The study aimed to explore the adequacy of sun protection strategies of children with albinism in order to inform future provision. Methods Community based participatory research methods were employed to investigate sun protection strategies in 90 pupils with OCA (40 female and 50 male) boarding at a special school educating pupils with visual impairment in a rural area of northern South Africa. Hats worn and sunscreen preparations used were examined during semi-structured face to face interviews conducted in small peer groups. The resident nurse interpreted if necessary and provided additional information on monitoring and treatment of skin lesions. Results Participants with albinism in this study were exposed to high levels of ultraviolet radiation throughout the year and showed skin damage despite wearing protective head gear. All except one pupil possessed at least one hat, with a mean brim width of 5.4 cm. Gender differences in sun avoidance behaviour were documented, with females seeking shade during recreational periods and males playing soccer outside. Although 38% of pupils were using a sunscreen with a sun protection factor (SPF) rating, only 12% had government sponsored tubes of SPF15 cream. Government sponsored sunscreen preparations were only provided if actively sought, involving time consuming trips to regional hospitals, with inadequate availability and insufficient supply. Conclusion Children with albinism living away from home in rural areas appear to have inadequate sun protection strategies. Changes in health policy could address these deficiencies. We recommend providing more detailed health care information, giving advice on appropriate styles of hat to wear and how to assess commercial SPF products. Health promotional material should also be evaluated to determine its effectiveness among user groups. PMID:18590551

Lund, Patricia M; Taylor, Julie S

2008-01-01

392

The Standard One Gram Dose of Vancomycin is not Adequate Prophylaxis for MRSA  

PubMed Central

Introduction The indications for vancomycin prophylaxis to prevent Methicillin-resistant Staphylococcus aureus (MRSA) surgical site infections are increasing. The recommended dose of vancomycin has traditionally been 1 gram intravenous. However, the increasing prevalence of obesity in our population coupled with increasing resistance of MRSA to vancomycin has resulted in recent recommendations for weight-based dosing of vancomycin at 15mg/kg. We hypothesize that the standard one gram dose of vancomycin is inadequate to meet the recently recommended dosage of 15mg/kg. Methods We performed a retrospective chart review on 216 patients who were screened positive for MRSA prior to undergoing elective total joint or spine surgeries between January 2009 to January 2012. All patients were given 1 gram of vancomycin within an hour prior to surgical incision as prophylaxis. Using the revised dosing protocol of 15mg/kg of body weight for vancomycin, proper dosage was calculated for each patient. These values were then compared to the 1 gram dose given to the patients at time of surgery. Patients were assessed as either underdosed (a calculated weight-based dose >1 gram) or overdosed (a calculated weight-based dose <1 gram). Additionally, we used actual case times and pharmacokinetic equations to determine the vancomycin (VAN) levels at the end of the procedures. Results Out of 216 patients who tested positive for MRSA, 149 patients (69%) were determined to be underdosed and 22 patients (10%) patients were determined to be overdosed. The predicted VAN level at the end of procedure was <15 mg/L in 60% of patients with 1 gram dose compared to 12% (p=0.0005) with weight base dose. Six patients developed post-operative MRSA surgical site infections (SSI). Of these six patients; four had strains of MRSA with vancomycin minimum inhibitory concentration of >1.0mg/L. Based on 1g dosing, 5/6 patients with MRSA positive SSIs had wound closure levels of <15 mg/L and all six were <20 mg/L. Conclusion In settings such as hospitals, where the risk for resistant bacteria, especially MRSA, is high, it is becoming increasingly important to accurately dose patients who require vancomycin. In order to avoid incorrect dosing of vancomycin health care providers must use weight-based dosing.

Catanzano, Anthony; Phillips, Michael; Dubrovskaya, Yanina; Hutzler, Lorraine; Bosco, Joseph

2014-01-01

393

Ebola virus disease cases among health care workers not working in ebola treatment units - liberia, june-august, 2014.  

PubMed

West Africa is experiencing the largest Ebola virus disease (Ebola) epidemic in recorded history. Health care workers (HCWs) are at increased risk for Ebola. In Liberia, as of August 14, 2014, a total of 810 cases of Ebola had been reported, including 10 clusters of Ebola cases among HCWs working in facilities that were not Ebola treatment units (non-ETUs). The Liberian Ministry of Health and Social Welfare and CDC investigated these clusters by reviewing surveillance data, interviewing county health officials, HCWs, and contact tracers, and visiting health care facilities. Ninety-seven cases of Ebola (12% of the estimated total) were identified among HCWs; 62 HCW cases (64%) were part of 10 distinct clusters in non-ETU health care facilities, primarily hospitals. Early recognition and diagnosis of Ebola in patients who were the likely source of introduction to the HCWs (i.e., source patients) was missed in four clusters. Inconsistent recognition and triage of cases of Ebola, overcrowding, limitations in layout of physical spaces, lack of training in the use of and adequate supply of personal protective equipment (PPE), and limited supervision to ensure consistent adherence to infection control practices all were observed. Improving infection control infrastructure in non-ETUs is essential for protecting HCWs. Since August, the Liberian Ministry of Health and Social Welfare with a consortium of partners have undertaken collaborative efforts to strengthen infection control infrastructure in non-ETU health facilities. PMID:25412067

Matanock, Almea; Arwady, M Allison; Ayscue, Patrick; Forrester, Joseph D; Gaddis, Bethany; Hunter, Jennifer C; Monroe, Benjamin; Pillai, Satish K; Reed, Christie; Schafer, Ilana J; Massaquoi, Moses; Dahn, Bernice; De Cock, Kevin M

2014-11-21

394

Fetal deaths in Mexican-American, black, and white non-Hispanic women seeking government-funded prenatal care.  

PubMed

Hispanics of Mexican origin constitute the largest minority population in the Southwestern United States, yet little is known about their reproductive health. This study assessed ethnic differentials in fetal mortality at 20 or more weeks gestation and identified the social and behavioral predictors associated with this outcome among low-income Hispanic, black non-Hispanic and white non-Hispanic women. Records were used of 80,431 patients attending federally funded prenatal care clinics in California from 1984 through 1989. The fetal death rate per 1,000 live births and fetal deaths was 7.8 for Hispanic, 8.4 for white non-Hispanic and 20.5 for black non-Hispanic women. These rates indicated favorable reproductive outcomes for Mexican Americans despite their social risk profile. An analysis of stillbirths by gestational age showed that Hispanic women stood a significantly lower risk of short-gestational stillbirths than non-Hispanics. In contrast, Hispanic women had a higher proportion of term stillbirths. Hispanic acculturation was a significant predictor of short-term gestation fetal deaths only. The inability to pay for health care was a strong predictor of fetal deaths for all ethnic groups, underscoring the need to ensure adequate access to maternity care for low-income women. PMID:7836554

Guendelman, S; Chavez, G; Christianson, R

1994-10-01

395

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

ERIC Educational Resources Information Center

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

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

2008-01-01

396

Remifentanil for analgesia-based sedation in the intensive care unit  

Microsoft Academic Search

Providing effective analgesia and adequate sedation is a generally accepted goal of intensive care medicine. Due to its rapid, organ independent and predictable metabolism the short acting opioid remifentanil might be particularly useful for analgesia-based sedation in the intensive care unit (ICU). This hypothesis was tested by two studies in this issue of Critical Care. The study by Breen et

Ralf Kuhlen; Christian Putensen

2004-01-01

397

Rectal cancer delivery of radiotherapy in adequate time and with adequate dose is influenced by treatment center, treatment schedule, and gender and is prognostic parameter for local control: Results of study CAO/ARO/AIO-94  

SciTech Connect

Purpose: The impact of the delivery of radiotherapy (RT) on treatment results in rectal cancer patients is unknown. Methods and Materials: The data from 788 patients with rectal cancer treated within the German CAO/AIO/ARO-94 phase III trial were analyzed concerning the impact of the delivery of RT (adequate RT: minimal radiation RT dose delivered, 4300 cGy for neoadjuvant RT or 4700 cGy for adjuvant RT; completion of RT in <44 days for neoadjuvant RT or <49 days for adjuvant RT) in different centers on the locoregional recurrence rate (LRR) and disease-free survival (DFS) at 5 years. The LRR, DFS, and delivery of RT were analyzed as endpoints in multivariate analysis. Results: A significant difference was found between the centers and the delivery of RT. The overall delivery of RT was a prognostic factor for the LRR (no RT, 29.6% {+-} 7.8%; inadequate RT, 21.2% {+-} 5.6%; adequate RT, 6.8% {+-} 1.4%; p = 0.0001) and DFS (no RT, 55.1% {+-} 9.1%; inadequate RT, 57.4% {+-} 6.3%; adequate RT, 69.1% {+-} 2.3%; p = 0.02). Postoperatively, delivery of RT was a prognostic factor for LRR on multivariate analysis (together with pathologic stage) but not for DFS (independent parameters, pathologic stage and age). Preoperatively, on multivariate analysis, pathologic stage, but not delivery of RT, was an independent prognostic parameter for LRR and DFS (together with adequate chemotherapy). On multivariate analysis, the treatment center, treatment schedule (neoadjuvant vs. adjuvant RT), and gender were prognostic parameters for adequate RT. Conclusion: Delivery of RT should be regarded as a prognostic factor for LRR in rectal cancer and is influenced by the treatment center, treatment schedule, and patient gender.

Fietkau, Rainer [Department of Radiation Therapy, University of Rostock, Rostock (Germany)]. E-mail: rainer.fietkau@med.uni-rostock.de; Roedel, Claus [Departments of Radiation Therapy and Surgery, University of Erlangen, Erlangen (Germany); Hohenberger, Werner [Departments of Radiation Therapy and Surgery, University of Erlangen, Erlangen (Germany); Raab, Rudolf [Department of Surgery, Klinikum Oldenburg, Oldenburg (Germany); Hess, Clemens [Departments of Radiation Therapy and General Surgery, University of Goettingen, Goettingen (Germany); Liersch, Torsten [Departments of Radiation Therapy and General Surgery, University of Goettingen, Goettingen (Germany); Becker, Heinz [Departments of Radiation Therapy and General Surgery, University of Goettingen, Goettingen (Germany); Wittekind, Christian [Institute of Pathology, University of Leipzig, Leipzig (Germany); Hutter, Matthias [Department of Radiation Therapy, Krankenhaus Nordwest Frankfurt, Frankfurt (Germany); Hager, Eva [Department of Radiation Therapy, Krankenhaus Klagenfurt, Klagenfurt (Austria); Karstens, Johann [Department of Radiation Therapy, University of Hannover, Hannover (Germany); Ewald, Hermann [Department of Radiation Therapy, University of Schleswig-Holstein, Campus Kiel, Kiel (Germany); Christen, Norbert [Department of Radiation Therapy, Krankenhaus Dresden-Friedrichstadt, Dresden (Germany); Jagoditsch, Michael [Department of Surgery, Klinikum St. Veit, St. Veit (Austria); Martus, Peter [Institute of Biostatistics and Clinical Epidemiology, Charite Universitary Medicine Berlin, Berlin (Germany); Sauer, Rolf [Departments of Radiation Therapy and Surgery, University of Erlangen, Erlangen (Germany)

2007-03-15

398

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

ERIC Educational Resources Information Center

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

Brown, Kay; Bascetta, Cynthia A.

2009-01-01

399

Active therapy and models of care for adolescents and young adults with cancer.  

PubMed

The reduction in the cancer mortality rate in adolescents and young adults (AYA) with cancer has lagged behind the reduction noted in children and older adults. Studies investigating reasons for this are limited but causes appear to be multifactorial. Host factors such as developmental stage, compliance, and tolerance to therapy; provider factors such as lack of awareness of cancer in AYA and referral patterns; differences in disease biology and treatment strategies; low accrual onto clinical trials; and lack of psychosocial support and education programs for AYA all likely play a role. Recommendations for change from a recent international workshop include education of physicians and patients concerning AYA cancer, improved cooperation between pediatric and adult centers, age-appropriate psychosocial support services, programs to help AYA with issues relevant to them, dedicated AYA hospital space, improved accrual to clinical trials, the use of technology to educate patients and enhance communication between patients and the health care team, and ensuring that resident and fellowship training programs provide adequate education in AYA oncology. The longer term goal is to develop AYA oncology into a distinct subspecialist discipline within oncology. The ideal model of care would incorporate medical care, psychosocial support services, and a physical environment that are age-appropriate. When this is not feasible, the development of "virtual units" connecting patients to the health care team or a combination of physical and virtual models are alternative options. The assessment of outcome measures is necessary to determine whether the interventions implemented result in improved survival and better quality of life, and are cost-effective. PMID:21523752

Ramphal, Raveena; Meyer, Ralph; Schacter, Brent; Rogers, Paul; Pinkerton, Ross

2011-05-15

400

Collaborative communication between psychologists and primary care providers.  

PubMed

Psychologists frequently collaborate in the care of patients managed in primary care. Communication with a patient's primary care team is important to ensure coordination and continuity of care. The communication is far from seamless. Although The Health Information Privacy and Portability Act (HIPPA) is designed to promote sharing of clinical information while protecting patient confidentiality, unique problems arise when mental health records are included. Mental health records are subject to different regulations to protect the patient's confidentiality. Thus, what is communicated and how it will be accomplished are challenges. Further, psychologists and primary care providers often view documentation differently, resulting in different styles of documenting that may also impede coordinated care. Increasingly, health care systems are moving toward electronic medical records, creating greater opportunities for an integrated record. Improved communication through the record can keep other providers abreast of the mental health care being provided as well as suggestions they can use to reinforce the mental health care treatment plan. PMID:19234866

Knowles, Philip

2009-03-01

401

Attracting and retaining nurses in HIV care.  

PubMed

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

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

2014-01-01

402

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

Code of Federal Regulations, 2013 CFR

...adequate veterinary care and animal health program? The sanctuary...American College of Laboratory Animal Medicine document, “The Provision...serum for banking and/or testing shall be obtained as appropriate...the chimpanzee and human and animal safety concerns....

2013-10-01

403

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

Code of Federal Regulations, 2010 CFR

...adequate veterinary care and animal health program? The sanctuary...American College of Laboratory Animal Medicine document, “The Provision...serum for banking and/or testing shall be obtained as appropriate...the chimpanzee and human and animal safety concerns....

2010-10-01

404

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

Code of Federal Regulations, 2011 CFR

...adequate veterinary care and animal health program? The sanctuary...American College of Laboratory Animal Medicine document, “The Provision...serum for banking and/or testing shall be obtained as appropriate...the chimpanzee and human and animal safety concerns....

2011-10-01

405

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

Code of Federal Regulations, 2012 CFR

...adequate veterinary care and animal health program? The sanctuary...American College of Laboratory Animal Medicine document, “The Provision...serum for banking and/or testing shall be obtained as appropriate...the chimpanzee and human and animal safety concerns....

2012-10-01

406

One Patient, Many Places: Managing Health Care Transitions, Part II: Practitioner Skills and Patient and Caregiver Preparation  

Microsoft Academic Search

his series of articles addresses how health care organizations (ie, organized or inte- grated care systems or large provider groups that receive payment under either a capitated or fee-for-service basis) can improve the quality of transitions among care venues for patients with complex care needs. Part I provided an intro- duction and discussed strategies for ensuring ac- countability for patients

Eric A. Coleman; Peter D. Fox

407

TRANSITIONS OF CARE/HANDOVER Purpose: The purpose of this policy is to establish standards within the Graduate Medical  

E-print Network

Page 167 ` TRANSITIONS OF CARE/HANDOVER Purpose: The purpose of this policy is to establish to ensure that Transitions of Care and Handover occur in such a manner that the quality and safety of patient care is not compromised. The term "Transitions of Care" refers to the movement patients make

Oliver, Douglas L.

408

Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework.  

PubMed

Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest it should have been. Priority-setting usually occurred in the context of budget cycles and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicized through circulars and notice boards, but there were no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level in the contexts of low-income countries. Second, it provides guidance to decision-makers on how to improve fairness, legitimacy, and sustainability of the priority-setting process. PMID:20554365

Maluka, Stephen; Kamuzora, Peter; San Sebastiån, Miguel; Byskov, Jens; Olsen, Øystein E; Shayo, Elizabeth; Ndawi, Benedict; Hurtig, Anna-Karin

2010-08-01

409

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

PubMed Central

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

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

2009-01-01

410

Intentional rounding: its role in supporting essential care.  

PubMed

The King's Fund Point of Care (POC) programme aims to identify and test interventions that can improve patients' experiences of care. "Intentional rounding" is one such intervention, which is being trialled by some of the teams working with the King's Fund on the POC programme. This article explains the principles of intentional rounding and how nurses can use it to ensure patients' essential care needs are met. PMID:21887975

Fitzsimons, Beverley; Bartley, Annette; Cornwell, Jocelyn

411

Journal of Mammalian Evolution, Vol. 4, No. 2, 1997 Are Guinea Pigs Rodents? The Importance of Adequate  

E-print Network

of Adequate Models in Molecular Phylogenetics Jack Sullivan1'2 and David L. Swofford1 The monophyly-7554/97/0600-0077$I2.50;0 © 1997 Plenum Publishing Corporation #12;78 Sullivan and Swofford phology [includingthe

Sullivan, Jack

412

Are Substance Use Prevention Programs More Effective in Schools Making Adequate Yearly Progress? A Study of Project ALERT  

ERIC Educational Resources Information Center

This exploratory study sought to determine if a popular school-based drug prevention program might be effective in schools that are making adequate yearly progress (AYP). Thirty-four schools with grades 6 through 8 in 11 states were randomly assigned either to receive Project ALERT (n = 17) or to a control group (n = 17); of these, 10 intervention…

Clark, Heddy Kovach; Ringwalt, Chris L.; Shamblen, Stephen R.; Hanley, Sean M.; Flewelling, Robert L.

2011-01-01

413

Are missing outcome data adequately handled? A review of published randomized controlled trials in major medical journals  

Microsoft Academic Search

Background Randomized controlled trials almost always have some individuals with missing outcomes. Inadequate handling of these missing data in the analysis can cause substantial bias in the treatment effect estimates. We examine how missing outcome data are handled in randomized controlled trials in order to assess whether adequate steps have been taken to reduce nonresponse bias and to identify ways

Angela M Wood; Ian R White; Simon G Thompson

2004-01-01

414

Using Fuzzy Logic to Identify Schools Which May Be Misclassified by the No Child Left Behind Adequate Yearly Progress Policy  

ERIC Educational Resources Information Center

This investigation developed, tested, and prototyped a Fuzzy Inference System (FIS) that would assist decision makers in identifying schools that may have been misclassified by existing Adequate Yearly Progress (AYP) methods. This prototype was then used to evaluate Louisiana elementary schools using published school data for Academic Year 2004. …

Yates, Donald W.

2009-01-01

415

Targeting adequate thermal stability and fire safety in selecting ionic liquid-based electrolytes for energy storage  

E-print Network

1 Targeting adequate thermal stability and fire safety in selecting ionic liquid-based electrolytes electrolyte solutions with nonvolatile and nonflammable ionic liquids instead of actual carbonate mixtures could be safer. However, few definitions of thermal stability of electrolytes based on ionic liquids

Paris-Sud XI, Université de

416

Update with 2009-10 Data and Five-Year Trends: How Many Schools Have Not Made Adequate Yearly Progress?  

ERIC Educational Resources Information Center

Recently, much attention has focused on the number of schools in the nation failing to make adequate yearly progress (AYP) in raising student achievement under the No Child Left Behind Act (NCLB). The Obama Administration has projected a dramatic increase in this number as 2014--the year when 100% of students are expected to score proficient on…

Usher, Alexandra

2011-01-01

417

Predicting the distribution of under-five deaths by cause in countries without adequate vital registration systems  

Microsoft Academic Search

Background The absence of complete vital registration and atypical nature of the locations where epidemiological studies of cause of death in children are conducted make it difficult to know the true distribution of child deaths by cause in developing countries. A credible method is needed for generating valid estimates of this distribution for countries without adequate vital registration systems. Methods

Saul S Morris; Robert E Black; Lana Tomaskovic

2003-01-01

418

Models of care and delivery  

PubMed Central

Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP), or a mixture of the two, depending on the setting. Key factors explaining this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV-related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV-specific visits in a shared care model with GPs. A similar shared-model approach with community clinics for injecting drug-dependent persons is also being implemented. Shared care models require oversight to ensure that primary responsibility is defined for the persons overall health situation, for screening of co-morbidities, defining indication to treat comorbidities, prescription of non-HIV medicines, etc. Intelligent bioinformatics platforms (i.e. generation of alerts if course of care deviates from a prior defined normality) are being developed to assist in providing this oversight and to provide measure of quality. Although consensus exists to assess basic quality indicators of care, a comprehensive set of harmonized indicators are urgently needed to define best practise standards via benchmarking. Such a tool will be central to guide ongoing discussions on restructuring of models, as quality of care should not be compromised in this process. PMID:25394003

Lundgren, Jens

2014-01-01

419

Towards community-based integrated care: trends and issues in Japan's long-term care policy  

PubMed Central

Introduction In 2000, Japan implemented a mandatory long-term care insurance system. With the rapid growth of the system, problems became apparent. Several critical alterations were made to long-term care insurance system, particularly with respect to integrated care. Methods This paper elucidates the policy trends that led to the reforms of the long-term care insurance system, which included new concepts of ‘integrated care’ and ‘community-based care’, an agenda of cost containment and service streamlining, and coordination with medical care. Results Community-based integrated care, as envisaged in the long-term care policy, includes not only the integration of medical care into service provision but also the inclusion of the informal mutual aid, oversight of for-profit providers by an administration that ensures users are not exploited and coordination between systems that cover different geographical areas. Conclusions Japan's experience in community-based care integration suggests that this project requires multi-faceted care integration in local communities. In the future, it will be necessary to conduct empirical assessments of the effectiveness of these measures. PMID:24605073

Morikawa, Mie

2014-01-01

420

Palliative care for children with cancer.  

PubMed

Over the past two decades, paediatric palliative care has emerged as both a primary approach and as its own medical subspecialty, the overall aim of which is to ease suffering for children with life-threatening illness and their families through a concurrent model of care. However, most discussions have been focused on the transition to palliative care when no realistic hope for cure exists. We believe that, because the course of cancer is so unpredictable, this idea is misleading. Indeed, palliative care is increasingly being recognized as being about not just how to cope with the process of dying, but also about how to engage in living when faced with a life-threatening illness. This article will examine our current understanding of several areas of palliative care, with the ultimate message that palliative care is simply a novel term for the total care of a child and family, an approach that should be applied consistently and concurrently regardless of disease status. By improving familiarity with palliative care and building relationships with palliative care specialists, the paediatric oncology clinician will ensure that the best care possible for children and families is provided, regardless of outcome. PMID:23337915

Waldman, Elisha; Wolfe, Joanne

2013-02-01

421

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

Cancer.gov

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

422

Women Veterans Health Care  

MedlinePLUS

... Health Care » Women Veterans Health Care Women Veterans Health Care Womens Health Women Veterans Health Care Home Program ... Breast Cancer Awareness Healthy Aging WVCC Women Veterans Health Care Did you know that women are the fastest ...

423

Dementia - home care  

MedlinePLUS

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

424

Oral health care for hospitalized children.  

PubMed

Oral health care may be the greatest unmet health need of children in the U.S. Half of the children in the U.S. suffer from tooth decay by 8 years of age. The consequences of poor oral health are many, including mouth pain, inability to chew and eat, abscess and soft tissue infection, diminished self-esteem, and impaired school performance. Numerous medical conditions, such as asthma and diabetes, and developmental disabilities, such as cerebral palsy and autism, have associated oral health implications. Oral health care is often neglected by nondental health providers. Nurses are in a unique position to contribute to the improvement of this national health problem by promoting oral health care among hospitalized children and their families. A hospital program for oral health care is proposed, including assessment of teeth and gingiva, ensuring oral care for all, as well as oral health education as part of patient education. PMID:22132567

Blevins, Jo Young

2011-01-01

425

The content of African diets is adequate to achieve optimal efficacy with fixed-dose artemether-lumefantrine: a review of the evidence.  

PubMed

A fixed-dose combination of artemether-lumefantrine (AL, Coartem(R)) has shown high efficacy, good tolerability and cost-effectiveness in adults and children with uncomplicated malaria caused by Plasmodium falciparum. Lumefantrine bioavailability is enhanced by food, particularly fat.As the fat content of sub-Saharan African meals is approximately a third that of Western countries, it raises the question of whether fat consumption by African patients is sufficient for good efficacy. Data from healthy volunteers have indicated that drinking 36 mL soya milk (containing only 1.2 g of fat) results in 90% of the lumefantrine absorption obtained with 500 mL milk (16 g fat). African diets are typically based on a carbohydrate staple (starchy root vegetables, fruit [plantain] or cereals) supplemented by soups, relishes and sauces derived from vegetables, pulses, nuts or fish. The most important sources of dietary fat in African countries are oil crops (e.g. peanuts, soya beans) and cooking oils as red palm, peanut, coconut and sesame oils. Total fat intake in the majority of subSaharan countries is estimated to be in the range 30-60 g/person/day across the whole population (average 43 g/person/day). Breast-feeding of infants up to two years of age is standard, with one study estimating a fat intake of 15-30 g fat/day from breast milk up to the age of 18 months. Weaning foods typically contain low levels of fat, and the transition from breast milk to complete weaning is associated with a marked reduction in dietary fat. Nevertheless, fat intake >10 g/day has been reported in young children post-weaning. A randomized trial in Uganda reported no difference in the efficacy of AL between patients receiving supervised meals with a fixed fat content (~23 g fat) or taking AL unsupervised, suggesting that fat intake at home was sufficient for optimal efficacy. Moreover, randomized trials in African children aged 5-59 months have shown similar high cure rates to those observed in older populations, indicating that food consumption is adequate post-weaning. In conclusion, it appears that only a very small amount of dietary fat is necessary to ensure optimal efficacy with AL and that the fat content of standard meals or breast milk in sub-Saharan Africa is adequate. PMID:19032767

Premji, Zulfiqarali G; Abdulla, Salim; Ogutu, Bernhards; Ndong, Alice; Falade, Catherine O; Sagara, Issaka; Mulure, Nathan; Nwaiwu, Obiyo; Kokwaro, Gilbert

2008-01-01

426

Collaborative Care in NSCLC; the Role of Early Palliative Care  

PubMed Central

The management of non-small cell lung cancer (NSCLC) has evolved into a multidisciplinary team approach that traditionally has involved medical oncology, radiation oncology, and thoracic surgery. However, in the era of personalized medicine the importance of molecular diagnostics requires adequate tissue for histologic subtyping and molecular testing and thus requires the engagement of other subspecialties such as pathology, respirology, and interventional radiology. Unfortunately in 2014, the majority of patients presenting with NSCLC will succumb to their disease and the early integration of palliative care into the treatment strategy will improve the quality of life and end-of-life care of our patients and may in fact improve their overall survival. PMID:25126538

Howe, Marnie; Burkes, Ronald L.

2014-01-01

427

The Challenges of Ensuring Participant Consent in Internet-based Sex Studies: A Case Study of the Men's INTernet Sex (MINTS-I and II) Studies  

PubMed Central

This study documents our experience in designing, testing, and refining human subjects’ consent protocol in 3 of the first NIH-funded online studies of HIV/STI sexual risk behavior in the USA. We considered 4 challenges primary: a) designing recruitment and enrollment procedures to ensure adequate attention to subject considerations; b) obtaining and documenting subjects’ consent; c) establishing investigator credibility through investigator-participant interactions; d) enhancing confidentiality during all aspects of the study. Human consent in online studies appears more relative, continuous, inherent, tenuous, and diverse than in offline studies. Reasons for declining consent appear related to pragmatic concerns not human subjects’ risks. Reordering the consent process, and short, chunked, stepwise, tailored consent procedures may enhance communicating information and documenting consent. PMID:24204104

Rosser, B. R. Simon; Gurak, Laura; Horvath, Keith J.; Oakes, J. Michael; Konstan, Joseph; Danilenko, Gene P.

2013-01-01

428

41 CFR 102-36.255 - What options do we have when unusual circumstances do not allow adequate time for disposal...  

Code of Federal Regulations, 2012 CFR

...do not allow adequate time for disposal through GSA? 102-36.255...do not allow adequate time for disposal through GSA? Contact your...are responsible for any turn in costs and all costs related to transporting the...

2012-01-01

429

41 CFR 102-36.255 - What options do we have when unusual circumstances do not allow adequate time for disposal...  

Code of Federal Regulations, 2010 CFR

...do not allow adequate time for disposal through GSA? 102-36.255...do not allow adequate time for disposal through GSA? Contact your...are responsible for any turn in costs and all costs related to transporting the...

2010-07-01

430

41 CFR 102-36.255 - What options do we have when unusual circumstances do not allow adequate time for disposal...  

Code of Federal Regulations, 2011 CFR

...do not allow adequate time for disposal through GSA? 102-36.255...do not allow adequate time for disposal through GSA? Contact your...are responsible for any turn in costs and all costs related to transporting the...

2011-01-01

431

November 27, 2012 UCSF Statement on Its Animal Care and Research Program  

E-print Network

Welfare Act and the NIH's Public Health Service Policy on Humane Care and Use of Laboratory AnimalsNovember 27, 2012 UCSF Statement on Its Animal Care and Research Program: Barbara French, Vice The University takes very seriously the care and use of the animals it studies, beginning with ensuring

Klein, Ophir

432

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

Code of Federal Regulations, 2013 CFR

...group to provide coordination of care and to ensure continuous assessment...the interdisciplinary plan of care. The interdisciplinary group...registered nurse. (iii) A social worker. (iv) A pastoral...day-to-day provision of hospice care and services. (b)...

2013-10-01

433

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

Code of Federal Regulations, 2010 CFR

...group to provide coordination of care and to ensure continuous assessment...the interdisciplinary plan of care. The interdisciplinary group...registered nurse. (iii) A social worker. (iv) A pastoral...day-to-day provision of hospice care and services. (b)...

2010-10-01

434

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

Code of Federal Regulations, 2011 CFR

...group to provide coordination of care and to ensure continuous assessment...the interdisciplinary plan of care. The interdisciplinary group...registered nurse. (iii) A social worker. (iv) A pastoral...day-to-day provision of hospice care and services. (b)...

2011-10-01

435

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

Code of Federal Regulations, 2012 CFR

...group to provide coordination of care and to ensure continuous assessment...the interdisciplinary plan of care. The interdisciplinary group...registered nurse. (iii) A social worker. (iv) A pastoral...day-to-day provision of hospice care and services. (b)...

2012-10-01

436

Defining and Assessing the Competence of Health Care Professionals in France  

ERIC Educational Resources Information Center

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

Matillon, Yves; LeBoeuf, Dominique; Maisonneuve, Herve

2005-01-01

437

New Faculty WorkshopNew Faculty Workshop Animal Care Services / Research Compliance Services / Sponsored Programs Services  

E-print Network

New Faculty WorkshopNew Faculty Workshop Animal Care Services / Research Compliance ServicesOffice of the Vice President for Research #12;Animal Care ServicesAnimal Care Services · PHONE: 8604862907 · FAX and scholarship to ensure that it meets all regulatory standards involving research with human subjects, animals

Alpay, S. Pamir

438

Washington University/BJH/SLCH Consortium Adult Critical Care Medicine Institutional Resources Policy  

E-print Network

Care programs include: � Neurologic Critical Care � Raj Dhar, MD Program Director The ACGME requires and Neurology. Critical Care Medicine training and experience are modified to meet the needs of each trainee to ensure graduates demonstrate competence in the field of their choice upon completion of training

Kornfeld, S. Kerry

439

Solving California's Child Care Crisis: Research Addressing Regulations and Funding. California Policy Seminar Research Report.  

ERIC Educational Resources Information Center

In 1991, a study was conducted to determine the extent to which the stringency of state regulations ensures high quality in child care settings and the extent to which California's child care staffing crisis can be addressed through regulatory changes. To compare child care quality under different licensing standards, the study examined findings…

Howes, Carollee; Whitebook, Marcy

440

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

PubMed

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

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

2009-01-01

441

Stepped care treatment for depression and anxiety in primary care. a randomized controlled trial  

Microsoft Academic Search

Background  Depressive and anxiety disorders are common in general practice but not always treated adequately. Introducing stepped care\\u000a might improve this. In this randomized trial we examined the effectiveness of such a stepped care model.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The study population consisted of primary care attendees aged 18-65 years with minor or major DSM-IV depressive and\\/or anxiety\\u000a disorders, recruited through screening. We randomized 120

Wike Seekles; Annemieke van Straten; Aartjan Beekman; Harm van Marwijk; Pim Cuijpers

2011-01-01

442

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

PubMed

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

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

2013-10-01

443

Caring Classroom.  

ERIC Educational Resources Information Center

Strategies for creating caring, positive classroom environments from the start include hanging pictures of people from around the world with mirrors to promote reflection, making signs that present concepts about rights, and creating name cards for saving work in progress. Questions for teachers to ask before school begins are included. (SM)

Kreidler, William J.

1996-01-01

444

Just caring.  

PubMed

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

Hussey, Trevor

2012-01-01

445

Prenatal Care.  

ERIC Educational Resources Information Center

This booklet is the first in a series of publications designed to provide parents with useful information about childrearing. Contents are organized into three parts. Part I focuses on the pregnancy, prenatal care, development of the baby, pregnant lifestyles, nutrition, common discomforts, and problems of pregnancy. Part II provides information…

Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Office for Maternal and Child Health Services.

446

Infant Care.  

ERIC Educational Resources Information Center

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

North, A. Frederick

447

INSTRUCTIONS: PLEASE COMPLETE IN FULL. ENSURE THAT YOU HAVE READ AND SIGNED THE DECLARATION FOR  

E-print Network

of years completed Field of Study Grade/Diploma/Degree and year completed High School/GED Commercial, Trade you to do the work adequately? #12;EDUCATION AND TRAINING Name & location of Institution Number or Technical Training Undergraduate/ Professional Other Continuing Education Professional Qualifications

Saskatchewan, University of

448

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

PubMed Central

Those in practice find that the fee-for-service system does not adequately value the contributions made by primary care. The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the Affordable Care Act to test new models of health care delivery to improve the quality of care while lowering costs. All programs coming out of the Innovation Center are tests of new payment and service delivery models. By changing both payment and delivery models and moving to a payment model that rewards physicians for quality of care instead of volume of care, we may be able to achieve the kind of health care patients want to receive and primary care physicians want to provide. PMID:22412007

Baron, Richard J.

2012-01-01

449

42 CFR 457.535 - Cost-sharing protection to ensure enrollment of American Indians and Alaska Natives.  

Code of Federal Regulations, 2011 CFR

...ensure enrollment of American Indians and Alaska Natives. 457.535 Section 457...ensure enrollment of American Indians and Alaska Natives. States may not impose premiums...on children who are American Indians or Alaska Natives, as defined in §...

2011-10-01

450

34 CFR 403.200 - What are the State's responsibilities for ensuring compliance with the comparability requirements?  

Code of Federal Regulations, 2011 CFR

...responsibilities for ensuring compliance with the comparability requirements? 403.200 Section...responsibilities for ensuring compliance with the comparability requirements? (a) The State...demonstrate its compliance with the comparability requirements by filing an...

2011-07-01

451

34 CFR 403.200 - What are the State's responsibilities for ensuring compliance with the comparability requirements?  

Code of Federal Regulations, 2013 CFR

...responsibilities for ensuring compliance with the comparability requirements? 403.200 Section...responsibilities for ensuring compliance with the comparability requirements? (a) The State...demonstrate its compliance with the comparability requirements by filing an...

2013-07-01

452

34 CFR 403.200 - What are the State's responsibilities for ensuring compliance with the comparability requirements?  

Code of Federal Regulations, 2012 CFR

...responsibilities for ensuring compliance with the comparability requirements? 403.200 Section...responsibilities for ensuring compliance with the comparability requirements? (a) The State...demonstrate its compliance with the comparability requirements by filing an...

2012-07-01

453

34 CFR 403.200 - What are the State's responsibilities for ensuring compliance with the comparability requirements?  

Code of Federal Regulations, 2010 CFR

...responsibilities for ensuring compliance with the comparability requirements? 403.200 Section...responsibilities for ensuring compliance with the comparability requirements? (a) The State...demonstrate its compliance with the comparability requirements by filing an...

2010-07-01

454

45 CFR 264.30 - What procedures exist to ensure cooperation with the child support enforcement requirements?  

Code of Federal Regulations, 2012 CFR

...procedures exist to ensure cooperation with the child support enforcement requirements...exist to ensure cooperation with the child support enforcement requirements...established, modified or enforced, to the child support enforcement agency...

2012-10-01

455

45 CFR 264.30 - What procedures exist to ensure cooperation with the child support enforcement requirements?  

Code of Federal Regulations, 2013 CFR

...procedures exist to ensure cooperation with the child support enforcement requirements...exist to ensure cooperation with the child support enforcement requirements...established, modified or enforced, to the child support enforcement agency...

2013-10-01

456

45 CFR 264.30 - What procedures exist to ensure cooperation with the child support enforcement requirements?  

Code of Federal Regulations, 2011 CFR

...procedures exist to ensure cooperation with the child support enforcement requirements...exist to ensure cooperation with the child support enforcement requirements...established, modified or enforced, to the child support enforcement agency...

2011-10-01

457

The Leap of a Provincial SME into the Global Market Using E-commerce: The Success of Adequate Planning  

NASA Astrophysics Data System (ADS)

The leap into the global market is not easy when it involves a provincial family business. This article demonstrates how adequate planning is fundamental in a small and medium-sized enterprise (SME) with the tight budget they have available to them, in order to be able to differentiate themselves in a highly competitive market, taking into accounts the benefits and risks involved. The Information Technology (IT) tools put in place will give the necessary support and allow for the possibility of increasing and improving the infrastructure as the company requires. An adequate strategy for the future to increases sales would be e-marketing techniques as well as the current promotions which contribute to diffusing the brand.

Sainz de Abajo, Beatriz; García Salcines, Enrique; Burón Fernández, F. Javier; López Coronado, Miguel; de Castro Lozano, Carlos

458

A model for determining when an analysis contains sufficient detail to provide adequate NEPA coverage for a proposed action  

SciTech Connect

Neither the National Environmental Policy Act (NEPA) nor its subsequent regulations provide substantive guidance for determining the Level of detail, discussion, and analysis that is sufficient to adequately cover a proposed action. Yet, decisionmakers are routinely confronted with the problem of making such determinations. Experience has shown that no two decisionmakers are Likely to completely agree on the amount of discussion that is sufficient to adequately cover a proposed action. one decisionmaker may determine that a certain Level of analysis is adequate, while another may conclude the exact opposite. Achieving a consensus within the agency and among the public can be problematic. Lacking definitive guidance, decisionmakers and critics alike may point to a universe of potential factors as the basis for defending their claim that an action is or is not adequately covered. Experience indicates that assertions are often based on ambiguous opinions that can be neither proved nor disproved. Lack of definitive guidance slows the decisionmaking process and can result in project delays. Furthermore, it can also Lead to inconsistencies in decisionmaking, inappropriate Levels of NEPA documentation, and increased risk of a project being challenged for inadequate coverage. A more systematic and less subjective approach for making such determinations is obviously needed. A paradigm for reducing the degree of subjectivity inherent in such decisions is presented in the following paper. The model is specifically designed to expedite the decisionmaking process by providing a systematic approach for making these determination. In many cases, agencies may find that using this model can reduce the analysis and size of NEPA documents.

Eccleston, C.H.

1994-11-01

459

Glutathione peroxidase mRNA levels in selenium-deficient, selenium-adequate and high-selenium rats  

SciTech Connect

Glutathione peroxidase (GPX) is an indicator of Se status, but the regulation of GPX is not understood. Se deficiency decreases GPX activity and mRNA levels in rat liver, but the effect of Se status on GPX mRNA levels in other tissues has not been investigated. To study this regulation, male weanling rats were fed Se-deficient, Se-adequate or high-Se diets. At 35 d, liver, kidney, heart, lung, muscle and testes GPX activities were assayed. mRNA levels were determined by northern blotting using a {sup 32}P-labeled 0.7 kb EcoRI fragment of cloned GPX. In Se-adequate rats, GPX enzyme activity was highest in liver and missing in testis; the ranking was L{much gt}K{gt}Lg{ge}H{gt}M{much gt}T. GPX mRNA level was also highest in liver and missing in testis; the ranking was L{much gt}K{gt}H{gt}Lg{ge}M{much gt}T. Se deficiency decreased the GPX mRNA level dramatically in liver, kidney and heart, and reduced it in lung and muscle, but high Se did not raise GPX mRNA levels above Se-adequate levels. These results show that GPX activity differences are due to different levels of GPX mRNA. The reduction of GPX mRNA levels by Se deficiency demonstrates that low Se status down-regulates GPX mRNA in other tissues as well as liver; high-Se status does not up-regulate GPX mRNA above Se-adequate levels. The tissue-to-tissue variation in GPX mRNA level indicates that other factors in addition to Se status regulate GPX expression.

Sunde, R.A.; Schwartz, J.K.; Johnson, A.W.; Foley, N.E. (Univ. of Missouri, Columbia (United States))

1991-03-11

460

Computer Security There are some simple steps that everyone should take to help ensure their identity  

E-print Network

Computer Security There are some simple steps that everyone should take to help ensure their identity remains safe when working on computers. � Memorize all of your passwords. Unless you completely the national crime prevention council web site at: http://www.ncpc.org/training/campus-crime-prevention. Below

Olsen, Stephen L.

461

The Crucial Role of School Nurses: Ensuring Immunization Compliance, Education, and Documentation.  

ERIC Educational Resources Information Center

Discusses the current status of immunizations, the latest immunization recommendations, and the important role of school nurses in ensuring that all students are properly immunized with the correct immunizations at the correct time. An alphabetical listing of immunizations provides specific details. The paper also discusses myths versus facts…

Dychkowski, Linda

2000-01-01

462

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

Code of Federal Regulations, 2013 CFR

...production operations to ensure that each PET drug meets the requirements of the act...identity, strength, quality, or purity of a PET drug. (c) Specifications and processes...identity, strength, quality, and purity of a PET drug. You must demonstrate that any...

2013-04-01

463

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

...production operations to ensure that each PET drug meets the requirements of the act...identity, strength, quality, or purity of a PET drug. (c) Specifications and processes...identity, strength, quality, and purity of a PET drug. You must demonstrate that any...

2014-04-01

464

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

Code of Federal Regulations, 2012 CFR

...production operations to ensure that each PET drug meets the requirements of the act...identity, strength, quality, or purity of a PET drug. (c) Specifications and processes...identity, strength, quality, and purity of a PET drug. You must demonstrate that any...

2012-04-01

465

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

Code of Federal Regulations, 2011 CFR

...production operations to ensure that each PET drug meets the requirements of the act...identity, strength, quality, or purity of a PET drug. (c) Specifications and processes...identity, strength, quality, and purity of a PET drug. You must demonstrate that any...

2011-04-01

466

Assessment of strategy formulation: how to ensure quality in process and outcome  

Microsoft Academic Search

Purpose – Today, industrial firms need to cope with competitive challenges related to innovation, dynamic responses, knowledge sharing, etc. by means of effective and dynamic strategy formulation. In light of these challenges, the purpose of the paper is to present and evaluate an assessment tool for strategy formulation processes that ensures high quality in process and outcome. Design\\/methodology\\/approach – A

Nuran Acur; Linda Englyst

2006-01-01

467

Personnel Preparation: Recurring Challenges and the Need for Action to Ensure Access to General Education  

ERIC Educational Resources Information Center

All teacher preparation programs face serious challenges; however, programs that prepare teachers to work with students with extensive support needs face additional, unique challenges in preparing professionals to facilitate their students' development of functional skills and to ensure their access to the general education curriculum. The purpose…

Delano, Monica E.; Keefe, Liz; Perner, Darlene

2009-01-01

468

28 CFR 115.22 - Policies to ensure referrals of allegations for investigations.  

...Standards for Adult Prisons and Jails Responsive Planning § 115...ensure that an administrative or criminal investigation is completed...sexual harassment in prisons or jails shall have in place a policy...sexual harassment in prisons or jails shall have in place a...

2014-07-01

469

Ensuring Stability of State-dependent Riccati Equation Controllers Via Satis cing  

E-print Network

Ensuring Stability of State-dependent Riccati Equation Controllers Via Satis cing J. Willard Curtis, 84602 fwilly, beardg@ee.byu.edu Abstract Controls based on solutions to the state-dependent Riccati-dependent Riccati equation (SDRE) approach, rst implemented by Cloutier in 2] utilizes a Riccati equation similar

Sontag, Eduardo

470

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

ERIC Educational Resources Information Center

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

Venugopal, B.

1999-01-01

471

Ensuring America's Future by Increasing Latino College Completion: Latino College Completion in 50 States. Executive Summary  

ERIC Educational Resources Information Center

In 2009, Excelencia in Education launched the Ensuring America's Future initiative to inform, organize, and engage leaders in a tactical plan to increase Latino college completion. This initiative included the release of a benchmarking guide for projections of degree attainment disaggregated by race/ethnicity that offered multiple metrics to track…

Santiago, Deborah; Soliz, Megan

2012-01-01

472

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

Microsoft Academic Search

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

H-J von Martens

1999-01-01

473

Nie and Fan THE ARRIVING ON TIME PROBLEM: A DISCRETE ALGORITHM THAT ENSURES  

E-print Network

Nie and Fan THE ARRIVING ON TIME PROBLEM: A DISCRETE ALGORITHM THAT ENSURES CONVERGENCE Yu Nie1 Ph Tel: 530 754 6429 Email: ynie@ucdavis.edu Yueyue Fan Assistant Professor Department of Civil Corresponding author. 1 #12;Nie and Fan Abstract Finding optimal paths in stochastic networks is an important

Fan, Yueyue

474

FIRE SAFETY RESPONSIBILITIES At California State University, Fullerton, the overall responsibility for ensuring the campus has  

E-print Network

FIRE SAFETY RESPONSIBILITIES At California State University, Fullerton, the overall responsibility for ensuring the campus has an effective fire safety program rests with the Vice President for Administration funded groups have responsibility for their own fire safety program. Facilities Planning and Management

de Lijser, Peter

475

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

ERIC Educational Resources Information Center

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

Kritek, William J.

476

Although every reasonable effort is made to ensure accuracy, the information in this document is provided  

E-print Network

in the areas of algorithmic information theory, artificial intelligence, combinatorics, data communications, data structures and data management ·Applications of computers in society - artificial intelligence of The University of Auckland, to ensure that they are aware of and comply with all regulations, requirements

Sun, Jing

477

Although every reasonable effort is made to ensure accuracy, the information in this document is provided  

E-print Network

, artificial intelligence, combinatorics, data communications and networks, distributed computing, graphics and data management ·Applications of computers in society - artificial intelligence, human computer of Auckland, to ensure that they are aware of and comply with all regulations, requirements and policies

Sun, Jing