Development of a master health facility list in Nigeria.

PubMed

Makinde, Olusesan Ayodeji; Azeez, Aderemi; Bamidele, Samson; Oyemakinde, Akin; Oyediran, Kolawole Azeez; Adebayo, Wura; Fapohunda, Bolaji; Abioye, Abimbola; Mullen, Stephanie

2014-01-01

Abstract. Routine Health Information Systems (RHIS) are increasingly transitioning to electronic platforms in several developing countries. Establishment of a Master Facility List (MFL) to standardize the allocation of unique identifiers for health facilities can overcome identification issues and support health facility management. The Nigerian Federal Ministry of Health (FMOH) recently developed a MFL, and we present the process and outcome. The MFL was developed from the ground up, and includes a state code, a local government area (LGA) code, health facility ownership (public or private), the level of care, and an exclusive LGA level health facility serial number, as part of the unique identifier system in Nigeria. To develop the MFL, the LGAs sent the list of all health facilities in their jurisdiction to the state, which in turn collated for all LGAs under them before sending to the FMOH. At the FMOH, a group of RHIS experts verified the list and identifiers for each state. The national MFL consists of 34,423 health facilities uniquely identified. The list has been published and is available for worldwide access; it is currently used for planning and management of health services in Nigeria. Unique identifiers are a basic component of any information system. However, poor planning and execution of implementing this key standard can diminish the success of the RHIS. Development and adherence to standards is the hallmark for a national health information infrastructure. Explicit processes and multi-level stakeholder engagement is necessary to ensuring the success of the effort.

[The Unified National Health System and the third sector: Characterization of non-hospital facilities providing basic health care services in Belo Horizonte, Minas Gerais, Brazil].

PubMed

Canabrava, Claudia Marques; Andrade, Eli Iôla Gurgel; Janones, Fúlvio Alves; Alves, Thiago Andrade; Cherchiglia, Mariangela Leal

2007-01-01

In Brazil, nonprofit or charitable organizations are the oldest and most traditional and institutionalized form of relationship between the third sector and the state. Despite the historical importance of charitable hospital care, little research has been done on the participation of the nonprofit sector in basic health care in the country. This article identifies and describes non-hospital nonprofit facilities providing systematically organized basic health care in Belo Horizonte, Minas Gerais, Brazil, in 2004. The research focused on the facilities registered with the National Council on Social Work, using computer-assisted telephone and semi-structured interviews. Identification and description of these organizations showed that the charitable segment of the third sector conducts organized and systematic basic health care services but is not recognized by the Unified National Health System as a potential partner, even though it receives referrals from basic government services. The study showed spatial and temporal overlapping of government and third-sector services in the same target population.

Systems, supplies, and staff: a mixed-methods study of health care workers' experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015.

PubMed

Curran, Kathryn G; Wells, Emma; Crowe, Samuel J; Narra, Rupa; Oremo, Jared; Boru, Waqo; Githuku, Jane; Obonyo, Mark; De Cock, Kevin M; Montgomery, Joel M; Makayotto, Lyndah; Langat, Daniel; Lowther, Sara A; O'Reilly, Ciara; Gura, Zeinab; Kioko, Jackson

2018-06-11

From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya's 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June-July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers' (HCW) experiences during outbreak response. Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns. Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs' personal passion to help others. The confusion over roles, reporting, and management found in this evaluation highlights a need to

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Health Facilities

MedlinePlus

Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers, and specialized care centers, ... psychiatric care centers. When you choose a health facility, you might want to consider How close it ...

Using health-facility data to assess subnational coverage of maternal and child health indicators, Kenya.

PubMed

Maina, Isabella; Wanjala, Pepela; Soti, David; Kipruto, Hillary; Droti, Benson; Boerma, Ties

2017-10-01

To develop a systematic approach to obtain the best possible national and subnational statistics for maternal and child health coverage indicators from routine health-facility data. Our approach aimed to obtain improved numerators and denominators for calculating coverage at the subnational level from health-facility data. This involved assessing data quality and determining adjustment factors for incomplete reporting by facilities, then estimating local target populations based on interventions with near-universal coverage (first antenatal visit and first dose of pentavalent vaccine). We applied the method to Kenya at the county level, where routine electronic reporting by facilities is in place via the district health information software system. Reporting completeness for facility data were well above 80% in all 47 counties and the consistency of data over time was good. Coverage of the first dose of pentavalent vaccine, adjusted for facility reporting completeness, was used to obtain estimates of the county target populations for maternal and child health indicators. The country and national statistics for the four-year period 2012/13 to 2015/16 showed good consistency with results of the 2014 Kenya demographic and health survey. Our results indicated a stagnation of immunization coverage in almost all counties, a rapid increase of facility-based deliveries and caesarean sections and limited progress in antenatal care coverage. While surveys will continue to be necessary to provide population-based data, web-based information systems for health facility reporting provide an opportunity for more frequent, local monitoring of progress, in maternal and child health.

Mental Health Disorders, Suicide Risk, and Treatment seeking among Formerly Deployed National Guardand Reserve Service Member seen in Non VA Facilities

DTIC Science & Technology

2016-10-01

1 AWARD NUMBER: W81XWH-15-1-0506 TITLE: Mental Health Disorders, Suicide Risk, and Treatment seeking among Formerly Deployed National Guard... Suicide Risk, and Treatment seeking among Formerly Deployed National Guard and Reserve Service Member seen in Non-VA Facilities 5b. GRANT NUMBER W81XWH...and Reserve veterans. The prevalence of current PTSD was 7% (95% CI = 5.7-8.5). Preliminary analyses indicated that PTSD, depression , mental health

The influences of Taiwan's National Health Insurance on women's choice of prenatal care facility: Investigation of differences between rural and non-rural areas

PubMed Central

Chen, Likwang; Chen, Chi-Liang; Yang, Wei-Chih

2008-01-01

Background Taiwan's National Health Insurance (NHI), implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Methods Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI) in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. Results After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998–1999 was about 6.54 times of that in 1990–1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in rural areas. Conclusion We

The influences of Taiwan's National Health Insurance on women's choice of prenatal care facility: Investigation of differences between rural and non-rural areas.

PubMed

Chen, Likwang; Chen, Chi-Liang; Yang, Wei-Chih

2008-03-29

Taiwan's National Health Insurance (NHI), implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI) in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998-1999 was about 6.54 times of that in 1990-1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in rural areas. We concluded that women in rural areas were

Are Health Facility Management Committees in Kenya ready to implement financial management tasks: findings from a nationally representative survey.

PubMed

Waweru, Evelyn; Opwora, Antony; Toda, Mitsuru; Fegan, Greg; Edwards, Tansy; Goodman, Catherine; Molyneux, Sassy

2013-10-10

Community participation in peripheral public health facilities has in many countries focused on including community representatives in Health Facility Management Committees (HFMCs). In Kenya, HFMC roles are being expanded with the phased implementation of the Health Sector Services Fund (HSSF). Under HSSF, HFMCs manage facility funds which are dispersed directly from central level into facility bank accounts. We assessed how prepared HFMCs were to undertake this new role in advance of HSSF roll out, and considered the implications for Kenya and other similar settings. Data were collected through a nationally representative sample of 248 public health centres and dispensaries in 24 districts in 2010. Data collection included surveys with in-charges (n = 248), HFMC members (n = 464) and facility users (n = 698), and record reviews. These data were supplemented by semi-structured interviews with district health managers in each district. Some findings supported preparedness of HFMCs to take on their new roles. Most facilities had bank accounts and HFMCs which met regularly. HFMC members and in-charges generally reported positive relationships, and HFMC members expressed high levels of motivation and job satisfaction. Challenges included users' low awareness of HFMCs, lack of training and clarity in roles among HFMCs, and some indications of strained relations with in-charges. Such challenges are likely to be common to many similar settings, and are therefore important considerations for any health facility based initiatives involving HFMCs. Most HFMCs have the basic requirements to operate. However to manage their own budgets effectively and meet their allocated roles in HSSF implementation, greater emphasis is needed on financial management training, targeted supportive supervision, and greater community awareness and participation. Once new budget management roles are fully established, qualitative and quantitative research on how HFMCs are adapting to

National Facilities study

NASA Technical Reports Server (NTRS)

1994-01-01

This study provides a set of recommendations for improving the effectiveness of our nation's aeronautics and space facilities. The study plan considers current and future government and commercial needs as well as DOD and NASA mission requirements through the year 2023. It addresses shortfalls in existing capabilities, new facility requirements, upgrades, consolidations, and phase-out of existing facilities. If the recommendations are implemented, they will provide world-class capability where it is vital to our country's needs and make us more efficient in meeting future needs.

Are Health Facility Management Committees in Kenya ready to implement financial management tasks: findings from a nationally representative survey

PubMed Central

2013-01-01

Background Community participation in peripheral public health facilities has in many countries focused on including community representatives in Health Facility Management Committees (HFMCs). In Kenya, HFMC roles are being expanded with the phased implementation of the Health Sector Services Fund (HSSF). Under HSSF, HFMCs manage facility funds which are dispersed directly from central level into facility bank accounts. We assessed how prepared HFMCs were to undertake this new role in advance of HSSF roll out, and considered the implications for Kenya and other similar settings. Methods Data were collected through a nationally representative sample of 248 public health centres and dispensaries in 24 districts in 2010. Data collection included surveys with in-charges (n = 248), HFMC members (n = 464) and facility users (n = 698), and record reviews. These data were supplemented by semi-structured interviews with district health managers in each district. Results Some findings supported preparedness of HFMCs to take on their new roles. Most facilities had bank accounts and HFMCs which met regularly. HFMC members and in-charges generally reported positive relationships, and HFMC members expressed high levels of motivation and job satisfaction. Challenges included users’ low awareness of HFMCs, lack of training and clarity in roles among HFMCs, and some indications of strained relations with in-charges. Such challenges are likely to be common to many similar settings, and are therefore important considerations for any health facility based initiatives involving HFMCs. Conclusion Most HFMCs have the basic requirements to operate. However to manage their own budgets effectively and meet their allocated roles in HSSF implementation, greater emphasis is needed on financial management training, targeted supportive supervision, and greater community awareness and participation. Once new budget management roles are fully established, qualitative and quantitative

Evaluation of case management of uncomplicated malaria in Haiti: a national health facility survey, 2012.

PubMed

Landman, Keren Z; Jean, Samuel E; Existe, Alexandre; Akom, Eniko E; Chang, Michelle A; Lemoine, Jean Frantz; Mace, Kimberly E

2015-10-09

Malaria is a public health concern in Haiti, although there are limited data on its burden and case management. National malaria guidelines updated in 2012 recommend treatment with chloroquine and primaquine. In December 2012, a nationally-representative cross-sectional survey of health facilities (HFs) was conducted to determine malaria prevalence among febrile outpatients and malaria case management quality at baseline before scale-up of diagnostics and case management training. Among all 833 HFs nationwide, 30 were selected randomly, in proportion to total HFs per region, for 2-day evaluations. Survey teams inventoried HF material and human resources. Outpatients of all ages were screened for temperature >37.5 °C or history of fever; those without severe symptoms were consented and enrolled. Providers evaluated and treated enrolled patients according to HF standards; the survey teams documented provider-ordered diagnostic tests and treatment decisions. Facility-based test results [microscopy and malaria rapid diagnostic tests (RDTs)] were collected from HF laboratories. Blood smears for gold-standard microscopy, and dried blood spots for polymerase chain reaction (PCR) were obtained. Malaria diagnostic capacity, defined as completing a test for an enrolled patient or having adequate resources for RDTs or microscopy, was present in 11 (37 %) HFs. Among 459 outpatients screened, 257 (56 %) were febrile, of which 193 (75 %) were eligible, and 153 (80 %) were enrolled. Among 39 patients with facility-level malaria test results available on the survey day, 11 (28 %) were positive, of whom 6 (55 %) were treated with an anti-malarial. Twenty-seven (95 %) of the 28 patients testing negative were not treated with an anti-malarial. Of 114 patients without test results available, 35 (31 %) were presumptively treated for malaria. Altogether, 42 patients were treated with an anti-malarial, one (2 %) according to Haiti's 2012 guidelines. Of 140 gold-standard smears, none

The National Submicron Facility.

ERIC Educational Resources Information Center

Wolf, Edward D.

1979-01-01

Describes the activities of the National Submicron Facility which was established at Cornell University in Ithaca, New York to serve as an information resource for the nation's research community in microstructure science and engineering. (HM)

National Study of Changes in Community Access to School Physical Activity Facilities: The School Health Policies and Programs Study

PubMed Central

Evenson, Kelly R.; Wen, Fang; Lee, Sarah M.; Heinrich, Katie M.; Eyler, Amy

2016-01-01

Background A Healthy People 2010 developmental objective (22-12) was set to increase the proportion of the nation’s public and private schools that provide access to their physical activity spaces and facilities for all persons outside of normal school hours. The purpose of this study was to describe the prevalence of indoor and outdoor facilities at schools and the availability of those facilities to the public in 2000 and 2006. Methods In 2000 and 2006, the School Health Policies and Programs Study (SHPPS) was conducted in each state and in randomly selected districts, schools, and classrooms. This analysis focused on the school level questionnaire from a nationally representative sample of public and nonpublic elementary, middle, and high schools (n = 921 in 2000 and n = 984 in 2006). Results No meaningful changes in the prevalence of access to school physical activity facilities were found from 2000 to 2006, for youth or adult community sports teams, classes, or open gym. Conclusions These national data indicate a lack of progress from 2000 and 2006 toward increasing the proportion of the nation’s public and private schools that provide access to their physical activity facilities for all persons outside of normal school hours. PMID:20440007

Quality of the delivery services in health facilities in Northern Ethiopia.

PubMed

Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen

2017-03-09

Substantial improvements have been observed in the coverage of and access to maternal health service, especially in skilled birth attendants, in Ethiopia. However, the quality of care has been lagging behind. Therefore, this study investigated the status of the quality of delivery services in Northern Ethiopia. A facility based survey was conducted from December 2014 to February 2015 in Northern Ethiopia. The quality of delivery service was assessed in 32 health facilities using a facility audit checklist, by reviewing delivery, by conducting in-depth interview and observation, and by conducting exit interviews with eligible mothers. Facilities were considered as 'good quality' if they scored positively on 75% of the quality indicators set in the national guidelines for all the three components; input (materials, infrastructure, and human resource), process (adherence to standard care procedures during intrapartum and immediate postpartum periods) and output (the mothers' satisfaction and utilization of lifesaving procedures). Overall 2 of 32 (6.3%) of the study facilities fulfilled all the three quality components; input, process and output. Two of the three components were assessed as good in 11 of the 32 (34.4%) health facilities. The input quality was the better of the other quality components; which was good in 21 out of the 32 (65.6%) health facilities. The process and output quality was good in only 10 of the 32 (31.3%) facilities. Only 6.3% of the studied health facilities had good quality in all three dimensions of quality measures that was done in accordance to the national delivery service guidelines. The most compromised quality component was the process. Systematic and sustained efforts need to be strengthened to improve all dimensions of quality in order to achieve the desired quality of delivery services and increase the proportion of births occurring in health facilities.

HIV policy implementation in two health and demographic surveillance sites in Uganda: findings from a national policy review, health facility surveys and key informant interviews.

PubMed

McRobie, Ellen; Wringe, Alison; Nakiyingi-Miiro, Jessica; Kiweewa, Francis; Lutalo, Tom; Nakigozi, Gertrude; Todd, Jim; Eaton, Jeffrey William; Zaba, Basia; Church, Kathryn

2017-04-05

Successful HIV testing, care and treatment policy implementation is essential for realising the reductions in morbidity and mortality those policies are designed to target. While adoption of new HIV policies is rapid, less is known about the facility-level implementation of new policies and the factors influencing this. We assessed implementation of national policies about HIV testing, treatment and retention at health facilities serving two health and demographic surveillance sites (HDSS) (10 in Kyamulibwa, 14 in Rakai). Ugandan Ministry of Health HIV policy documents were reviewed in 2013, and pre-determined indicators were extracted relating to the content and nature of guidance on HIV service provision. Facility-level policy implementation was assessed via a structured questionnaire administered to in-charge staff from each health facility. Implementation of policies was classified as wide (≥75% facilities), partial (26-74% facilities) or minimal (≤25% facilities). Semi-structured interviews were conducted with key informants (policy-makers, implementers, researchers) to identify factors influencing implementation; data were analysed using the Framework Method of thematic analysis. Most policies were widely implemented in both HDSS (free testing, free antiretroviral treatment (ART), WHO first-line regimen as standard, Option B+). Both had notable implementation gaps for policies relating to retention on treatment (availability of nutritional supplements, support groups or isoniazid preventive therapy). Rakai implemented more policies relating to provision of antiretroviral treatment than Kyamulibwa and performed better on quality of care indicators, such as frequency of stock-outs. Factors facilitating implementation were donor investment and support, strong scientific evidence, low policy complexity, phased implementation and effective planning. Limited human resources, infrastructure and health management information systems were perceived as major

Health system changes under pay-for-performance: the effects of Rwanda's national programme on facility inputs.

PubMed

Ngo, Diana K L; Sherry, Tisamarie B; Bauhoff, Sebastian

2017-02-01

Pay-for-performance (P4P) programmes have been introduced in numerous developing countries with the goal of increasing the provision and quality of health services through financial incentives. Despite the popularity of P4P, there is limited evidence on how providers achieve performance gains and how P4P affects health system quality by changing structural inputs. We explore these two questions in the context of Rwanda's 2006 national P4P programme by examining the programme's impact on structural quality measures drawn from international and national guidelines. Given the programme's previously documented success at increasing institutional delivery rates, we focus on a set of delivery-specific and more general structural inputs. Using the programme's quasi-randomized roll-out, we apply multivariate regression analysis to short-run facility data from the 2007 Service Provision Assessment. We find positive programme effects on the presence of maternity-related staff, the presence of covered waiting areas and a management indicator and a negative programme effect on delivery statistics monitoring. We find no effects on a set of other delivery-specific physical resources, delivery-specific human resources, delivery-specific operations, general physical resources and general human resources. Using mediation analysis, we find that the positive input differences explain a small and insignificant fraction of P4P's impact on institutional delivery rates. The results suggest that P4P increases provider availability and facility operations but is only weakly linked with short-run structural health system improvements overall. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Terrorism-related risk management for health care facilities.

PubMed

Reid, Daniel J; Reid, William H

2005-01-01

Clinicians should have a basic understanding of the physical and financial risk to mental health facilities related to external threat, such as (but not necessarily limited to) terrorism. Patient care and accessibility to mental health services rest not only on clinical skills, but on a place to practice them and an organized system supported by staff, physical facilities and funding. Clinicians who have some familiarity with the non-clinical requirements for care are in a position to support non-clinical staff in preventing care from being interrupted by external threats or events such as terrorist activity, and/or serving at the interface of facility operations and direct clinical care. Readers should note that this article is an introduction to the topic and cannot address all local, state, and national standards for hospital safety, or insurance providers' individual facility requirements.

National Health Expenditures, 1996

PubMed Central

Levit, Katharine R.; Lazenby, Helen C.; Braden, Bradley R.; Cowan, Cathy A.; Sensenig, Arthur L.; McDonnell, Patricia A.; Stiller, Jean M.; Won, Darleen K.; Martin, Anne B.; Sivarajan, Lekha; Donham, Carolyn S.; Long, Anna M.; Stewart, Madie W.

1997-01-01

The national health expenditures (NHE) series presented in this report for 1960-96 provides a view of the economic history of health care in the United States through spending for health care services and the sources financing that care. In 1996 NHE topped $1 trillion. At the same time, spending grew at the slowest rate, 4.4 percent, ever recorded in the current series. For the first time, this article presents estimates of Medicare managed care payments by type of service, as well as nursing home and home health spending in hospital-based facilities. PMID:10179997

Characteristics of U.S. Mental Health Facilities That Offer Suicide Prevention Services.

PubMed

Kuramoto-Crawford, S Janet; Smith, Kelley E; McKeon, Richard

2016-01-01

This study characterized mental health facilities that offer suicide prevention services or outcome follow-up after discharge. The study analyzed data from 8,459 U.S. mental health facilities that participated in the 2010 National Mental Health Services Survey. Logistic regression analyses were used to compare facilities that offered neither of the prevention services with those that offered both or either service. About one-fifth of mental health facilities reported offering neither suicide prevention services nor outcome follow-up. Approximately one-third offered both, 25% offered suicide prevention services only, and 21% offered only outcome follow-up after discharge. Facilities that offered neither service were less likely than facilities that offered either to offer comprehensive support services or special programs for veterans; to offer substance abuse services; and to be accredited, licensed, or certified. Further examination of facilitators and barriers in implementing suicide prevention services in mental health facilities is warranted.

National Cryo-Electron Microscopy Facility

Cancer.gov

Information about the National Cryo-EM Facility at NCI, created to provide researchers access to the latest cryo-EM technology for high resolution imaging. Includes timeline for installation and how to access the facility.

The National Ignition Facility and Industry

NASA Astrophysics Data System (ADS)

Harri, J. G.; Paisner, J. A.; Lowdermilk, W. H.; Boyes, J. D.; Kumpan, S. A.; Sorem, M. S.

1994-09-01

The mission of the National Ignition Facility is to achieve ignition and gain in inertial confinement fusion targets in the laboratory. The facility will be used for defense applications such as weapons physics and weapons effects testing, and for civilian applications such as fusion energy development and fundamental studies of matter at high temperatures and densities. The National Ignition Facility construction project will require the best of our construction industries and its success will depend on the best products offered by hundreds of the nation's high technology companies. Three-fourths of the construction costs will be invested in industry. This article reviews the design, cost and schedule, and required industrial involvement associated with the construction project.

Thomas Jefferson National Accelerator Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Grames, Joseph; Higinbotham, Douglas; Montgomery, Hugh

The Thomas Jefferson National Accelerator Facility (Jefferson Lab) in Newport News, Virginia, USA, is one of ten national laboratories under the aegis of the Office of Science of the U.S. Department of Energy (DOE). It is managed and operated by Jefferson Science Associates, LLC. The primary facility at Jefferson Lab is the Continuous Electron Beam Accelerator Facility (CEBAF) as shown in an aerial photograph in Figure 1. Jefferson Lab was created in 1984 as CEBAF and started operations for physics in 1995. The accelerator uses superconducting radio-frequency (srf) techniques to generate high-quality beams of electrons with high-intensity, well-controlled polarization. Themore » technology has enabled ancillary facilities to be created. The CEBAF facility is used by an international user community of more than 1200 physicists for a program of exploration and study of nuclear, hadronic matter, the strong interaction and quantum chromodynamics. Additionally, the exceptional quality of the beams facilitates studies of the fundamental symmetries of nature, which complement those of atomic physics on the one hand and of high-energy particle physics on the other. The facility is in the midst of a project to double the energy of the facility and to enhance and expand its experimental facilities. Studies are also pursued with a Free-Electron Laser produced by an energy-recovering linear accelerator.« less

Identifying health facilities outside the enterprise: challenges and strategies for supporting health reform and meaningful use.

PubMed

Dixon, Brian E; Colvard, Cyril; Tierney, William M

2014-06-24

Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records.

Cost of delivering health care services at primary health facilities in Ghana.

PubMed

Dalaba, Maxwell Ayindenaba; Welaga, Paul; Matsubara, Chieko

2017-11-17

There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs) and Community-based Health Planning and Services (CHPS) in Ghana. The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs) from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD) attendance were estimated. The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC). The cost per OPD attendance was higher at CHPS (US$8.79) than at HCs (US$5.16). The average Internally Generated Funds (IGF) recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS) reimbursement was the main source of revenue accounting for over 90% total IGF. The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar studies involving large numbers of primary health facilities in

The Role of Health Extension Workers in Linking Pregnant Women With Health Facilities for Delivery in Rural and Pastoralist Areas of Ethiopia.

PubMed

Jackson, Ruth; Hailemariam, Assefa

2016-09-01

Women's preference to give birth at home is deeply embedded in Ethiopian culture. Many women only go to health facilities if they have complications during birth. Health Extension Workers (HEWs) have been deployed to improve the utilization of maternal health services by bridging the gap between communities and health facilities. This study examined the barriers and facilitators for HEWs as they refer women to mid-level health facilities for birth. A qualitative study was conducted in three regions: Afar Region, Southern Nations Nationalities and People's Region and Tigray Region between March to December 2014. Interviews and focus group discussions were conducted with 45 HEWs, 14 women extension workers (employed by Afar Pastoralist Development Association, Afar Region) and 11 other health workers from health centers, hospitals or health offices. Data analysis was done based on collating the data and identifying key themes. Barriers to health facilities included distance, lack of transportation, sociocultural factors and disrespectful care. Facilitators for facility-based deliveries included liaising with Health Development Army (HDA) leaders to refer women before their expected due date or if labour starts at home; the introduction of ambulance services; and, provision of health services that are culturally more acceptable for women. HEWs can effectively refer more women to give birth in health facilities when the HDA is well established, when health staff provide respectful care, and when ambulance is available at any time.

Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability

PubMed Central

Adair-Rohani, Heather; Zukor, Karen; Bonjour, Sophie; Wilburn, Susan; Kuesel, Annette C; Hebert, Ryan; Fletcher, Elaine R

2013-01-01

ABSTRACT Background: Access to electricity is critical to health care delivery and to the overarching goal of universal health coverage. Data on electricity access in health care facilities are rarely collected and have never been reported systematically in a multi-country study. We conducted a systematic review of available national data on electricity access in health care facilities in sub-Saharan Africa. Methods: We identified publicly-available data from nationally representative facility surveys through a systematic review of articles in PubMed, as well as through websites of development agencies, ministries of health, and national statistics bureaus. To be included in our analysis, data sets had to be collected in or after 2000, be nationally representative of a sub-Saharan African country, cover both public and private health facilities, and include a clear definition of electricity access. Results: We identified 13 health facility surveys from 11 sub-Saharan African countries that met our inclusion criteria. On average, 26% of health facilities in the surveyed countries reported no access to electricity. Only 28% of health care facilities, on average, had reliable electricity among the 8 countries reporting data. Among 9 countries, an average of 7% of facilities relied solely on a generator. Electricity access in health care facilities increased by 1.5% annually in Kenya between 2004 and 2010, and by 4% annually in Rwanda between 2001 and 2007. Conclusions: Energy access for health care facilities in sub-Saharan African countries varies considerably. An urgent need exists to improve the geographic coverage, quality, and frequency of data collection on energy access in health care facilities. Standardized tools should be used to collect data on all sources of power and supply reliability. The United Nations Secretary-General's “Sustainable Energy for All” initiative provides an opportunity to comprehensively monitor energy access in health care

Integrated approach to oral health in aged care facilities using oral health practitioners and teledentistry in rural Queensland.

PubMed

Tynan, Anna; Deeth, Lisa; McKenzie, Debra; Bourke, Carolyn; Stenhouse, Shayne; Pitt, Jacinta; Linneman, Helen

2018-04-16

Residents of residential aged care facilities are at very high risk of developing complex oral diseases and dental problems. Key barriers exist in delivering oral health services to residential aged care facilities, particularly in regional and rural areas. A quality improvement study incorporating pre- and post chart audits and pre- and post consultation with key stakeholders, including staff and residents, expert opinion on cost estimates and field notes were used. One regional and three rural residential aged care facilities situated in a non-metropolitan hospital and health service in Queensland. Number of appointments avoided at an oral health facility Feedback on program experience by staff and residents Compliance with oral health care plan implementation Observations of costs involved to deliver new service. The model developed incorporated a visit by an oral health therapist for screening, education, simple intervention and referral for a teledentistry session if required. Results showed an improvement in implementation of oral health care plans and a minimisation of need for residents to attend an oral health care facility. Potential financial and social cost savings for residents and the facilities were also noted. Screening via the oral health therapist and teledentistry appointment minimises the need for a visit to an oral health facility and subsequent disruption to residents in residential aged care facilities. © 2018 National Rural Health Alliance Ltd.

The National Ignition Facility: Transition to a User Facility

NASA Astrophysics Data System (ADS)

Moses, E. I.; Atherton, J.; Lagin, L.; Larson, D.; Keane, C.; MacGowan, B.; Patterson, R.; Spaeth, M.; Van Wonterghem, B.; Wegner, P.; Kauffman, R.

2016-03-01

The National Ignition Facility (NIF) at Lawrence Livermore National Laboratory (LLNL) has been operational since March 2009 and has been transitioning to a user facility supporting ignition science, high energy density science (HEDS), national security applications, and fundamental science. The facility has achieved its design goal of 1.8 MJ and 500 TW of 3ω light on target, and has performed target experiments with 1.9 MJ at peak powers of 410 TW. The facility is on track to perform over 200 target shots this year in support of all of its user communities. The facility has nearly 60 diagnostic systems operational and has shown flexibility in laser pulse shape and performance to meet the requirements of its multiple users. Progress continues on its goal of demonstrating thermonuclear burn in the laboratory. It has performed over 40 indirect-drive experiments with cryogenic-layered capsules. New platforms are being developed for HEDS and fundamental science. Equation-of-state and material strength experiments have been done on a number of materials with pressures of over 50 MBars obtained in diamond, conditions never previously encountered in the laboratory and similar to those found in planetary interiors. Experiments are also in progress investigating radiation transport, hydrodynamic instabilities, and direct drive implosions. NIF continues to develop as an experimental facility. Advanced Radiographic Capability (ARC) is now being installed on NIF for producing high-energy radiographs of the imploded cores of ignition targets and for short pulse laser-plasma interaction experiments. One NIF beam is planned for conversion to two picosecond beams in 2014. Other new diagnostics such as x-ray Thomson scattering, low energy neutron spectrometer, and multi-layer reflecting x-ray optics are also planned. Incremental improvements in laser performance such as improved optics damage performance, beam balance, and back reflection control are being pursued.

The National Scientific Balloon Facility. [balloon launching capabilities of ground facility

NASA Technical Reports Server (NTRS)

Kubara, R. S.

1974-01-01

The establishment and operation of the National Scientific Balloon Facility are discussed. The balloon launching capabilities are described. The ground support systems, communication facilities, and meteorological services are analyzed.

A National Perspective on Exploring Correlates of Accreditation in Children's Mental Health Care.

PubMed

Lee, Madeline Y

2017-07-01

This study is the first to explore national accreditation rates and the relationship between accreditation status and organizational characteristics and quality indicators in children's mental health. Data from the Substance Abuse and Mental Health Services Administration's (SAMHSA's) National Survey of Mental Health Treatment Facilities (NSMHTF) were used from 8,247 facilities that serve children and/or adolescents. Nearly 60% (n=4,925) of the facilities were accredited by the Council on Accreditation (COA), the Commission on Accreditation of Rehabilitation Facilities (CARF), or The Joint Commission (TJC). Chi-square analyses were conducted to explore relationships. Compared to non-accredited facilities, more accredited facilities reported greater number of admissions, acceptance of government funding and client funds, and implementation of several quality indicators. Policies with incentives for accreditation could influence accreditation rates, and accreditation could influence quality indicators. These results set the foundation for future research about the drivers of the accreditation phenomenon and its impact on children's mental health outcomes.

Non-health care facility anticonvulsant medication errors in the United States.

PubMed

DeDonato, Emily A; Spiller, Henry A; Casavant, Marcel J; Chounthirath, Thitphalak; Hodges, Nichole L; Smith, Gary A

2018-06-01

This study provides an epidemiological description of non-health care facility medication errors involving anticonvulsant drugs. A retrospective analysis of National Poison Data System data was conducted on non-health care facility medication errors involving anticonvulsant drugs reported to US Poison Control Centers from 2000 through 2012. During the study period, 108,446 non-health care facility medication errors involving anticonvulsant pharmaceuticals were reported to US Poison Control Centers, averaging 8342 exposures annually. The annual frequency and rate of errors increased significantly over the study period, by 96.6 and 76.7%, respectively. The rate of exposures resulting in health care facility use increased by 83.3% and the rate of exposures resulting in serious medical outcomes increased by 62.3%. In 2012, newer anticonvulsants, including felbamate, gabapentin, lamotrigine, levetiracetam, other anticonvulsants (excluding barbiturates), other types of gamma aminobutyric acid, oxcarbazepine, topiramate, and zonisamide, accounted for 67.1% of all exposures. The rate of non-health care facility anticonvulsant medication errors reported to Poison Control Centers increased during 2000-2012, resulting in more frequent health care facility use and serious medical outcomes. Newer anticonvulsants, although often considered safer and more easily tolerated, were responsible for much of this trend and should still be administered with caution.

Health Professions Education Facilities in the Non-Profit Sector. 1973.

ERIC Educational Resources Information Center

Health Resources Administration (DHEW/PHS), Bethesda, MD. Bureau of Health Manpower.

In this study of the physical facilities of the nation's health professions schools, all schools of dentistry, medicine, optometry, osteopathy, pharmacy, podiatry, public health, and veterinary medicine, and all parent institutions of the schools, were surveyed in May of 1973. The major goals of this pioneering survey were to assess the nature and…

Frontline staff motivation levels and health care quality in rural and urban primary health facilities: a baseline study in the Greater Accra and Western regions of Ghana.

PubMed

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward

2016-12-01

The population of Ghana is increasingly becoming urbanized with about 70 % of the estimated 26.9 million people living in urban and peri-urban areas. Nonetheless, eight out of the ten regions in Ghana remain predominantly rural where only 32.1 % of the national health sector workforce works. Doctor-patient ratio in a predominantly rural region is about 1:18,257 compared to 1:4,099 in an urban region. These rural-urban inequities significantly account for the inability of Ghana to attain the health related Millennium Development Goals (MDGs) before the end of 2015. To ascertain whether or not rural-urban differences exist in health worker motivation levels and quality of health care in health facilities accredited by the National Health Insurance Authority in Ghana. This is a baseline quantitative study conducted in 2012 among 324 health workers in 64 accredited clinics located in 9 rural and 7 urban districts in Ghana. Ordered logistic regression was performed to determine the relationship between facility geographic location (rural/urban) and staff motivation levels, and quality health care standards. Quality health care and patient safety standards were averagely low in the sampled health facilities. Even though health workers in rural facilities were more de-motivated by poor availability of resources and drugs than their counterparts in urban facilities (p < 0.05), quality of health care and patient safety standards were relatively better in rural facilities. For Ghana to attain the newly formulated sustainable development goals on health, there is the need for health authorities to address the existing rural-urban imbalances in health worker motivation and quality health care standards in primary healthcare facilities. Future studies should compare staff motivation levels and quality standards in accredited and non-accredited health facilities since the current study was limited to health facilities accredited by the National Health Insurance Authority.

[Potential vulnerability to flooding at public health facilities in four northern regions of Peru].

PubMed

Hernández-Vásquez, Akram; Arroyo-Hernández, Hugo; Bendezú-Quispe, Guido; Díaz-Seijas, Deysi; Vilcarromero, Stalin; Rubilar-González, Juan; Gutierrez-Lagos, Edith

2016-03-01

In order to determine the potential vulnerability of public health facilities in four northern regions of Peru to the possible effects of El Niño-Southern Oscillation (ENSO) phenomenon. An exploratory spatial analysis was performed using the geo-referenced points for at-risk areas based on the activation of gullies that were reported by the National Water Authority, and the location of the four regional public health facilities of the Ministry of Health. Concentric areas of influence were simulate from the points of risk towards the public health facilities using radii of 200, 1000 and 1500 meters. The Tumbes region would be the most affected with 37.2% of its health facilities being affected by floods and landslides. The I-2 and I-3 categories of health facilities appeared to be the most affected with 28.9% and 31.6% respectively. Therefore, public health facilities near the risk zones may be affected by the ENSO.

Pediatric Hospital Discharges to Home Health and Postacute Facility Care: A National Study.

PubMed

Berry, Jay G; Hall, Matt; Dumas, Helene; Simpser, Edwin; Whitford, Kathleen; Wilson, Karen M; O'Neill, Margaret; Mittal, Vineeta; Agrawal, Rishi; Dribbon, Michael; Haines, Christopher J; Traul, Christine; Marks, Michelle; O'Brien, Jane

2016-04-01

Acute care hospitals are challenged to provide efficient, high-quality care to children who have medically complex conditions and may require weeks or months for recovery. Although the use of home health care (HHC) and facility-based postacute care (PAC) after discharge is well documented for adults, to our knowledge, little is known for children. To assess the national prevalence of, characteristics of children discharged to, and variation in use across states of HHC and PAC for children. Retrospective analysis of 2,423,031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years from the nationally representative Agency for Healthcare Research and Quality Kids' Inpatient Database. Discharges to HHC (eg, visiting or private-duty home nursing) and PAC (eg, rehabilitation facility) were identified from Centers for Medicare and Medicaid Services Discharge Status Codes. We compared children's characteristics (eg, race/ethnicity and number of chronic conditions) by discharge type using generalized linear regression. The median age of participants was 3 years (interquartile range, 0-13 years), and 45.6% were female. Of 2,423,031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years, 122,673 discharges (5.1%) were to HHC and 26,282 (1.1%) were to PAC facilities. Neonatal care was the most common reason (44.5%, n = 54,589) for acute care hospitalization with discharge to HHC. Nonneonatal respiratory, musculoskeletal, and trauma-related problems, collectively, were the most common reasons for discharge to PAC (42.9%, n = 11,275). When compared with PAC, more discharges to HHC had no chronic condition (34.4% vs 18.0%, P < .001) and fewer discharges to HHC had 4 or more chronic conditions (22.5% vs 37.7%, P < .001). In multivariable analysis, Hispanic children were less likely to use PAC (0.8% vs 1.1%; odds ratio [OR], 0.9 [95% CI, 0.8-0.9]) or HHC (3.3% vs 5.5%; OR, 0.8 [95% CI, 0.7-0.8]) compared with other children. Children with 4 or

The USGS National Wildlife Health Center: Advancing wildlife and ecosystem health

USGS Publications Warehouse

Moede Rogall, Gail; Sleeman, Jonathan M.

2017-01-11

In 1975, the Federal government responded to the need for establishing national expertise in wildlife health by creating the National Wildlife Health Center (NWHC), a facility within the Department of the Interior; the NWHC is the only national center dedicated to wildlife disease detection, control, and prevention. Its mission is to provide national leadership to safeguard wildlife and ecosystem health through active partnerships and exceptional science. Comparisons are often made between the NWHC, which strives to protect the health of our Nation’s wildlife, and the Centers for Disease Control and Prevention (CDC), which strive to protect public health. The NWHC, a science center of the U.S. Geological Survey (USGS) with specialized laboratories, works to safeguard the Nation’s wildlife from diseases by studying the causes and drivers of these threats, and by developing strategies to prevent and manage them. In addition to the main campus, located in Madison, Wisconsin, the NWHC also operates the Honolulu Field Station that addresses wildlife health issues in Hawaii and the Pacific Region.

The National Ignition Facility (NIF) as a User Facility

NASA Astrophysics Data System (ADS)

Keane, Christopher; NIF Team

2013-10-01

The National Ignition Facility (NIF) has made significant progress towards operation as a user facility. Through June 2013, NIF conducted over 1200 experiments in support of ICF, HED science, and development of facility capabilities. The NIF laser has met or achieved all specifications and a wide variety of diagnostic and target fabrication capabilities are in place. A NIF User Group and associated Executive Board have been formed. Two User Group meetings have been conducted since formation of the User Group. NIF experiments in fundamental science have provided important new results. NIF ramp compression experiments have been conducted using diamond and iron, with EOS results obtained at pressures up to approximately 50 Mbar and 8 Mbar, respectively. Initial experiments in supernova hydrodynamics, the fundamental physics of the Rayleigh-Taylor instability, and equation of state in the Gbar pressure regime have also been conducted. This presentation will discuss the fundamental science program at NIF, including the proposal solicitation and scientific review processes and other aspects of user facility operation. This work was performed under the auspices of the Lawrence Livermore National Security, LLC, (LLNS) under Contract No. DE-AC52-07NA27344.

National Ignition Facility project acquisition plan revision 1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clobes, A.R.

The purpose of this National Ignition Facility Acquisition Plan is to describe the overall procurement strategy planned for the National Ignition Facility M Project. It was prepared for the NIP Prood Office by the NIF Procurement Manager.

National Biomedical Tracer Facility: Project definition study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heaton, R.; Peterson, E.; Smith, P.

The Los Alamos National Laboratory is an ideal institution and New Mexico is an ideal location for siting the National Biomedical Tracer Facility (NBTF). The essence of the Los Alamos proposal is the development of two complementary irradiation facilities that combined with our existing radiochemical processing hot cell facilities and waste handling and disposal facilities provide a low cost alternative to other proposals that seek to satisfy the objectives of the NBTF. We propose the construction of a 30 MeV cyclotron facility at the site of the radiochemical facilities, and the construction of a 100 MeV target station at LAMPFmore » to satisfy the requirements and objectives of the NBTF. We do not require any modifications to our existing radiochemical processing hot cell facilities or our waste treatment and disposal facilities to accomplish the objectives of the NBTF. The total capital cost for the facility defined by the project definition study is $15.2 M. This cost estimate includes $9.9 M for the cyclotron and associated facility, $2.0 M for the 100 MeV target station at LAMPF, and $3.3 M for design.« less

National Ignition Facility project acquisition plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Callaghan, R.W.

The purpose of this National Ignition Facility Acquisition Plan is to describe the overall procurement strategy planned for the National Ignition Facility (NIF) Project. The scope of the plan describes the procurement activities and acquisition strategy for the following phases of the NIF Project, each of which receives either plant and capital equipment (PACE) or other project cost (OPC) funds: Title 1 and 2 design and Title 3 engineering (PACE); Optics manufacturing facilitization and pilot production (OPC); Convention facility construction (PACE); Procurement, installation, and acceptance testing of equipment (PACE); and Start-up (OPC). Activities that are part of the base Inertialmore » Confinement Fusion (ICF) Program are not included in this plan. The University of California (UC), operating Lawrence Livermore National Laboratory (LLNL) and Los Alamos National Laboratory, and Lockheed-Martin, which operates Sandia National Laboratory (SNL) and the University of Rochester Laboratory for Laser Energetics (UR-LLE), will conduct the acquisition of needed products and services in support of their assigned responsibilities within the NIF Project structure in accordance with their prime contracts with the Department of Energy (DOE). LLNL, designated as the lead Laboratory, will have responsibility for all procurements required for construction, installation, activation, and startup of the NIF.« less

The National Mental Health Registry (NMHR).

PubMed

Aziz, A A; Salina, A A; Abdul Kadir, A B; Badiah, Y; Cheah, Y C; Nor Hayati, A; Ruzanna, Z Z; Sharifah Suziah, S M; Chee, K Y

2008-09-01

The National Mental Health Registry (NMHR) collects information about patients with mental disorder in Malaysia. This information allows us to estimate the incidence of selected mental disorders, and to evaluate risk factors and treatment in the country. The National Mental Health Registry (NMHR) presented its first report in 2004, a year after its establishment. The report focused on schizophrenia as a pioneer project for the National Mental Health Registry. The development of the registry has progressed with data collected from government-based facilities, the academia and the private sector. The 2003-2005 report was recently published and distributed. Since then the registry has progressed to include suicides and other mental illnesses such as depression. The NMHR Report 2003-2005 provides detailed information about the profile of persons with Schizophrenia who presented for the first time to various psychiatry and mental health providers throughout Malaysia. More detailed description regarding pharmacotherapy is reported and few cross tabulations done in an effort to provide better understanding and more clinically meaningful reports.

An investigation of pre-activity cardiovascular screening procedures in health/fitness facilities--part II: rationale for low adherence with national standards.

PubMed

Springer, Judy B; Eickhoff-Shemek, JoAnn M; Zuberbuehler, Ernest J

2009-01-01

The purpose of this study was to explore the rationale provided by program directors and general managers of health/fitness facilities for low adherence to nationally accepted standards related to pre-activity cardiovascular screening procedures (PACSPs) for members and clients of personal trainers. Qualitative interviews were conducted with the directors/managers in a Midwest region representing 76 facilities who indicated they did not conduct PACSPs for members and clients of personal trainers. Analysis of the rationale provided revealed 6 major clusters: (1) Purpose or need for screening; (2) time and staffing; (3) barrier to participation; (4) personal responsibility for health and actions; (5) legal issues; and (6) company or franchise policy that categorized the reasons for low adherence to PACSPs. These findings highlight the need to increase awareness of the relevance of PACSPs among health/fitness managers, staff members, and current exercise science students as well as engage those in risk management for informed dialogue for consistent application of the standard of care. Copyright 2009 Wiley Periodicals, Inc.

An audit of the use of isolation facilities in a UK National Health Service trust.

PubMed

Damji, S; Barlow, G D; Patterson, L; Nathwani, D

2005-07-01

To aid the ongoing battle against hospital-acquired infection in the UK, all acute National Health Service (NHS) trusts should have audit data about how dedicated isolation beds within the trust are being used. In a previously published audit, we demonstrated that one-third of patients admitted to a dedicated isolation room in Tayside were not thought to be an infection risk by experienced healthcare staff. Since this audit, Tayside's isolation facilities have moved from a small peripheral 'fever' hospital to a large central teaching hospital site. At the time of this move, and using the above audit data, we designed and implemented a guideline for general practitioners and hospital doctors regarding the admission of patients to an isolation bed. The aim of this study was to compare the use of isolation beds before and after the move to the new facilities, which we anticipated would increase the demand for isolation. The results show that by all three criteria used, the utilization of isolation beds has deteriorated following the move, mainly due to the increased admission of general medical 'boarders' and low-risk infection patients. At a time when hospital-acquired infections are increasing, NHS trusts should ensure that dedicated isolation beds are used appropriately.

A National Survey of Mental Health Screening and Assessment Practices in Juvenile Correctional Facilities

ERIC Educational Resources Information Center

Swank, Jacqueline M.; Gagnon, Joseph C.

2017-01-01

Background: Mental health screening and assessment is crucial within juvenile correctional facilities (JC). However, limited information is available about the current screening and assessment procedures specifically within JC. Objective: The purpose of the current study was to obtain information about the mental health screening and assessment…

Provision of Rehabilitation Services in Residential Care Facilities: Evidence From a National Survey.

PubMed

Bhuyan, Soumitra S; Chandak, Aastha; Gupta, Niodita; Wyant, David K; Kim, Jungyoon; Bhatt, Jay; Singh, Ayesha; Gilmore, Sean; Ahn, SangNam; Chang, Cyril F

2017-06-01

To examine the association between organizational factors and provision of rehabilitation services that include physical therapy (PT) and occupational therapy (OT) in residential care facilities (RCFs) in the United States. A cross-sectional, observational study conducted using a national sample from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. U.S. RCFs. RCFs (N=2302; weighted sample, 31,134 RCFs). Not applicable. The association between characteristics of the facilities, director and staff, and residents, and provision of PT and OT services was assessed using multivariate logistic regression analyses. Among all RCFs in the United States, 43.9% provided PT and 40.0% provided OT. Medicaid-certified RCFs, larger-sized RCFs, RCFs with a licensed director, RCFs that used volunteers, and RCFs with higher personal care aide hours per patient per day were more likely to provide both PT and OT, while private, for-profit RCFs were less likely to provide PT and OT. RCFs with a higher percentage of white residents were more likely to provide PT, while RCFs with chain affiliation were more likely to provide OT. Less than half of the RCFs in the United States provide PT and OT, and this provision of therapy services is associated with organizational characteristics of the facilities. Future research should explore the effectiveness of rehabilitation services in RCFs on residents' health outcomes. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Mixed and low-level waste treatment project: Appendix C, Health and safety criteria for the mixed and low-level waste treatment facility at the Idaho National Engineering Laboratory

DOE Office of Scientific and Technical Information (OSTI.GOV)

Neupauer, R.M.; Thurmond, S.M.

This report contains health and safety information relating to the chemicals that have been identified in the mixed waste streams at the Waste Treatment Facility at the Idaho National Engineering Laboratory. Information is summarized in two summary sections--one for health considerations and one for safety considerations. Detailed health and safety information is presented in material safety data sheets (MSDSs) for each chemical.

The Small Area Health Statistics Unit: a national facility for investigating health around point sources of environmental pollution in the United Kingdom.

PubMed Central

Elliott, P; Westlake, A J; Hills, M; Kleinschmidt, I; Rodrigues, L; McGale, P; Marshall, K; Rose, G

1992-01-01

STUDY OBJECTIVE--The Small Area Health Statistics Unit (SAHSU) was established at the London School of Hygiene and Tropical Medicine in response to a recommendation of the enquiry into the increased incidence of childhood leukaemia near Sellafield, the nuclear reprocessing plant in West Cumbria. The aim of this paper was to describe the Unit's methods for the investigation of health around point sources of environmental pollution in the United Kingdom. DESIGN--Routine data currently including deaths and cancer registrations are held in a large national database which uses a post code based retrieval system to locate cases geographically and link them to the underlying census enumeration districts, and hence to their populations at risk. Main outcome measures were comparison of observed/expected ratios (based on national rates) within bands delineated by concentric circles around point sources of environmental pollution located anywhere in Britain. MAIN RESULTS--The system is illustrated by a study of mortality from mesothelioma and asbestosis near the Plymouth naval dockyards during 1981-87. Within a 3 km radius of the docks the mortality rate for mesothelioma was higher than the national rate by a factor of 8.4, and that for asbestosis was higher by a factor of 13.6. CONCLUSIONS--SAHSU is a new national facility which is rapidly able to provide rates of mortality and cancer incidence for arbitrary circles drawn around any point in Britain. The example around Plymouth of mesothelioma and asbestosis demonstrates the ability of the system to detect an unusual excess of disease in a small locality, although in this case the findings are likely to be related to occupational rather than environmental exposure. PMID:1431704

A health maintenance facility for space station freedom

NASA Technical Reports Server (NTRS)

Billica, R. D.; Doarn, C. R.

1991-01-01

We describe a health care facility to be built and used on an orbiting space station in low Earth orbit. This facility, called the health maintenance facility, is based on and modeled after isolated terrestrial medical facilities. It will provide a phased approach to health care for the crews of Space Station Freedom. This paper presents the capabilities of the health maintenance facility. As Freedom is constructed over the next decade there will be an increase in activities, both construction and scientific. The health maintenance facility will evolve with this process until it is a mature, complete, stand-alone health care facility that establishes a foundation to support interplanetary travel. As our experience in space continues to grow so will the commitment to providing health care.

Concentrating Solar Power Projects - National Solar Thermal Power Facility

Science.gov Websites

| Concentrating Solar Power | NREL National Solar Thermal Power Facility Status Date: February 13, 2014 Project Overview Project Name: National Solar Thermal Power Facility Country: India Location Capacity (Net): 1.0 MW Output Type: Steam Rankine Thermal Storage Storage Type: None

National Ignition Facility Laser System Performance

DOE PAGES

Spaeth, Mary L.; Manes, Kenneth R.; Bowers, M.; ...

2017-03-23

The National Ignition Facility (NIF) laser is the culmination of more than 40 years of work at Lawrence Livermore National Laboratory dedicated to the delivery of laser systems capable of driving experiments for the study of high-energy-density physics. Although NIF was designed to support a number of missions, it was clear from the beginning that its biggest challenge was to meet the requirements for pursuit of inertial confinement fusion. Meeting the Project Completion Criteria for NIF in 2009 and for the National Ignition Campaign (NIC) in 2012 included meeting the NIF Functional Requirements and Primary Criteria that were established formore » the project in 1994. Finally, during NIC and as NIF transitioned to a user facility, its goals were expanded to include requirements defined by the broader user community as well as by laser system designers and operators.« less

Availability of herbal medicines and medicinal plants in the primary health facilities of the state of São Paulo, Southeast Brazil: results from the National Program for Access and Quality Improvement in Primary Care.

PubMed

Caccia-Bava, Maria do Carmo Gullaci Guimarães; Bertoni, Bianca Waléria; Pereira, Ana Maria Soares; Martinez, Edson Zangiacomi

2017-05-01

This study aims to describe the availability of herbal medicines and medicinal plants in the primary care facilities in the state of São Paulo, Southeast Brazil, from the results of the first cycle of the National Program for Access and Quality Improvement in Primary Care (PMAQ). The PMAQ uses a national cross-sectional multicenter design, with data from 4,249 health facilities distributed among 645 municipalities of the state of São Paulo. Of these facilities, 467 (11%) had herbal medicines and/or medicinal plants. Among the 645 municipalities, 104 (16.1%) had at least one health facility that provided these drugs. We observed that the availability of herbal medicines is greater in larger cities with better social and economic conditions. Furthermore, we found that use of industrialized herbal medicines prevailed over that of vegetal drugs or compounded herbal medicines.

The association between recreational parks, facilities and childhood obesity: a cross-sectional study of the 2007 National Survey of Children's Health.

PubMed

Alexander, Dayna S; Huber, Larissa R Brunner; Piper, Crystal R; Tanner, Amanda E

2013-05-01

Despite the rising childhood obesity rates, few studies have examined the association between access to recreational parks and facilities and obesity. A cross-sectional study was performed among 42 278 US children who participated in the 2007 National Survey of Children's Health. Access to parks and recreational facilities was self-reported by parents, and body mass index was calculated from parents' self-report of the child's height and weight. Logistic regression was used to obtain ORs and 95% CIs. Since obesity was not a rare occurrence, an OR correction method was used to provide a more reliable estimate of the prevalence ratio (PR). Children with access to parks and facilities had decreased prevalence of obesity as compared to children without access (PR=0.79, 95% CI 0.69 to 0.91). After adjustment for covariates, the magnitude of the association remained unchanged; however, results were no longer statistically significant (PR=0.77, 95% CI 0.55 to 1.07). Race/ethnicity was an effect modifier of the access-obesity relationship (p<0.0001). Among Non-Hispanic White children, there was no strong association (PR=0.89, 95% CI 0.64 to 1.23). However, among Non-Hispanic Black children, those who had access to recreational parks and facilities had 0.40 times the prevalence of obesity as compared to those without access, and this result was statistically significant (95% CI 0.17 to 0.90). This research highlights potential health disparities in childhood obesity due to limited access to recreational parks and facilities. Additional studies are needed to further investigate this association. If confirmed, providing safe, accessible parks and facilities may be one way to combat childhood obesity, particularly among minority children.

Ethiopia's assessment of emergency obstetric and newborn care: setting the gold standard for national facility-based assessments.

PubMed

Keyes, Emily B; Haile-Mariam, Abonesh; Belayneh, Neghist T; Gobezie, Wasihun A; Pearson, Luwei; Abdullah, Muna; Kebede, Henok

2011-10-01

To describe the methods used to implement Ethiopia's 2008 emergency obstetric and newborn care services (EmONC) assessment; highlight how the collaborative process contributed to immediate integration of results into national and subnational planning; and explain how the experience informed the development of a set of tools providing best practices and guidelines for other countries conducting similar assessments. A team of maternal and newborn health experts from the Federal Ministry of Health (FMOH), the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), and the United Nations Population Fund (UNFPA), together with representatives from the Ethiopian Society of Obstetricians and Gynecologists, provided technical guidance for the 18-month process and facilitated demand for and use of the assessment results. Eighty-four trained data collectors administered 9 data collection modules in 806 public and private facilities. Field work and data were managed by a private firm who, together with the core team, implemented a multi-layered plan for data quality. Columbia University's Averting Maternal Death and Disability Program provided technical assistance. Results were published in national and regional reports and in 1-page facility factsheets informing subnational planning activities. Assessment results-which have been published in journal articles-informed water infrastructure improvements, efforts to expand access to magnesium sulfate, and FMOH and UN planning documents. The assessment also established a permanent database for future monitoring of the health system, including geographic locations of surveyed facilities. Ethiopia's assessment was successful largely because of active local leadership, a collaborative process, ample financial and technical support, and rapid integration of results into health system planning. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

National Ignition Facility: Experimental plan

NASA Astrophysics Data System (ADS)

1994-05-01

As part of the Conceptual Design Report (CDR) for the National Ignition Facility (NIF), scientists from Lawrence Livermore National Laboratory (LLNL), Los Alamos National Laboratory (LANL), Sandia National Laboratory (SNL), the University of Rochester's Laboratory for Laser Energetics (UR/LLE), and EG&G formed an NIF Target Diagnostics Working Group. The purpose of the Target Diagnostics Working Group is to prepare conceptual designs of target diagnostics for inclusion in the facility CDR and to determine how these specifications impact the CDR. To accomplish this, a subgroup has directed its efforts at constructing an approximate experimental plan for the ignition campaign of the NIF CDR. The results of this effort are contained in this document, the Experimental Plan for achieving fusion ignition in the NIF. This group initially concentrated on the flow-down requirements of the experimental campaign leading to ignition, which will dominate the initial efforts of the NIF. It is envisaged, however, that before ignition, there will be parallel campaigns supporting weapons physics, weapons effects, and other research. This plan was developed by analyzing the sequence of activities required to finally fire the laser at the level of power and precision necessary to achieve the conditions of an ignition hohlraum target, and to then use our experience in activating and running Nova experiments to estimate the rate of completing these activities.

Health facilities at the district level in Indonesia

PubMed Central

Heywood, Peter; Harahap, Nida P

2009-01-01

Background At Independence the Government of Indonesia inherited a weak and unevenly distributed health system to which much of the population had only limited access. In response, the government decided to increase the number of facilities and to locate them closer to the people. To staff these health facilities the government introduced obligatory government service for all new graduates in medicine, nursing and midwifery. Most of these staff also established private practices in the areas in which they were located. The health information system contains little information on the health care facilities established for private practice by these staff. This article reports on the results of enumerating all health facilities in 15 districts in Java. Methods We enumerated all healthcare facilities, public and private, by type in each of 15 districts in Java. Results The enumeration showed a much higher number of healthcare facilities in each district than is shown in most reports and in the health information system which concentrates on public, multi-provider facilities. Across the 15 districts: 86% of facilities were solo-provider facilities for outpatient services; 13% were multi-provider facilities for outpatient services; and 1% were multi-provider facilities offering both outpatient and inpatient services. Conclusion The relatively good distribution of health facilities in Indonesia was achieved through establishing public health centers at the sub-district level and staffing them through a system of compulsory service for doctors, nurses and midwives. Subsequently, these public sector staff also established solo-provider facilities for their own private practice; these solo-provider facilities, of which those for nurses are almost half, comprise the largest category of outpatient care facilities, most are not included in official statistics. Now that Indonesia no longer has mandatory service for newly graduated doctors, nurses and midwives, it will have

The National Transonic Facility

NASA Technical Reports Server (NTRS)

Holmes, H. K.

1986-01-01

The National Transonic Facility, NTF, is a high Reynolds Number facility where the increase in Reynolds Number is obtained by operating at high pressures and low temperatures. Liquid nitrogen is allowed to vaporize, making gaseous nitrogen the test medium with temperatures extending down to approximately 100 degrees Kelvin. These factors have created unique, new challenges to those developing sensors and instrumentation. Pressure vessels, thermal enclosures or elaborate temperature compensations schemes, are needed for environmental protection and special materials are needed for sensors and model fabrication. The need for a new measurement, model deformation, was also created. An extensive program to develop the unique sensors and instrumentation was initiated. The data acquisition system and systems to measure aerodynamic forces and pressures, model attitude, and model deformation, are discussed.

The NTF as a national facility. [project planning

NASA Technical Reports Server (NTRS)

Nicks, O. W.

1977-01-01

Activities which led to the definition of the National Transonic Facility and the general agreements reached regarding its use and operations are reviewed. Topics discussed include: redefinition of test requirements, development of low cost options, consideration of a single transonic facility using existing hardware if feasible, facility concept recommendations, and acquisition schedule proposals.

Chasm in primary care provision in a universal health system: Findings from a nationally representative survey of health facilities in Malaysia

PubMed Central

Sivasampu, Sheamini; Khoo, Ee Ming; Mohamad Noh, Kamaliah

2017-01-01

Background Malaysia has achieved universal health coverage since 1980s through the expansion of direct public provision, particularly in rural areas. However, no systematic examination of the rural-urban distribution of primary care services and resources has been conducted to date for policy impact evaluation. Methods We conducted a national cross-sectional survey of 316 public and 597 private primary care clinics, selected through proportionate stratified random sampling, from June 2011 through February 2012. Using a questionnaire developed based on the World Health Organization toolkits on monitoring health systems strengthening, we examined the availability of primary care services/resources and the associations between service/resource availability and clinic ownership, locality, and patient load. Data were weighted for all analyses to account for the complex survey design and produce unbiased national estimates. Results Private primary care clinics and doctors outnumbered their public counterparts by factors of 5.6 and 3.9, respectively, but the private clinics were significantly less well-equipped with basic facilities and provided a more limited range of services. Per capita densities of primary care clinics and workforce were higher in urban areas (2.2 clinics and 15.1 providers per 10,000 population in urban areas versus 1.1 clinics and 11.7 providers per 10,000 population in rural areas). Within the public sector, the distribution of health services and resources was unequal and strongly favored the urban clinics. Regression analysis revealed that rural clinics had lower availability of services and resources after adjusting for ownership and patient load, but the associations were not significant except for workforce availability (adjusted odds ratio [OR]: 0.82; 95% confidence interval [CI]: 0.71–0.96). Conclusions Targeted primary care expansion in rural areas could be an effective first step towards achieving universal health coverage, especially in

Chasm in primary care provision in a universal health system: Findings from a nationally representative survey of health facilities in Malaysia.

PubMed

Lim, Huy Ming; Sivasampu, Sheamini; Khoo, Ee Ming; Mohamad Noh, Kamaliah

2017-01-01

Malaysia has achieved universal health coverage since 1980s through the expansion of direct public provision, particularly in rural areas. However, no systematic examination of the rural-urban distribution of primary care services and resources has been conducted to date for policy impact evaluation. We conducted a national cross-sectional survey of 316 public and 597 private primary care clinics, selected through proportionate stratified random sampling, from June 2011 through February 2012. Using a questionnaire developed based on the World Health Organization toolkits on monitoring health systems strengthening, we examined the availability of primary care services/resources and the associations between service/resource availability and clinic ownership, locality, and patient load. Data were weighted for all analyses to account for the complex survey design and produce unbiased national estimates. Private primary care clinics and doctors outnumbered their public counterparts by factors of 5.6 and 3.9, respectively, but the private clinics were significantly less well-equipped with basic facilities and provided a more limited range of services. Per capita densities of primary care clinics and workforce were higher in urban areas (2.2 clinics and 15.1 providers per 10,000 population in urban areas versus 1.1 clinics and 11.7 providers per 10,000 population in rural areas). Within the public sector, the distribution of health services and resources was unequal and strongly favored the urban clinics. Regression analysis revealed that rural clinics had lower availability of services and resources after adjusting for ownership and patient load, but the associations were not significant except for workforce availability (adjusted odds ratio [OR]: 0.82; 95% confidence interval [CI]: 0.71-0.96). Targeted primary care expansion in rural areas could be an effective first step towards achieving universal health coverage, especially in countries with limited healthcare

Buffet test in the National Transonic Facility

NASA Technical Reports Server (NTRS)

Young, Clarence P., Jr.; Hergert, Dennis W.; Butler, Thomas W.; Herring, Fred M.

1992-01-01

A buffet test of a commercial transport model was accomplished in the National Transonic Facility at the NASA Langley Research Center. This aeroelastic test was unprecedented for this wind tunnel and posed a high risk to the facility. This paper presents the test results from a structural dynamics and aeroelastic response point of view and describes the activities required for the safety analysis and risk assessment. The test was conducted in the same manner as a flutter test and employed onboard dynamic instrumentation, real time dynamic data monitoring, automatic, and manual tunnel interlock systems for protecting the model. The procedures and test techniques employed for this test are expected to serve as the basis for future aeroelastic testing in the National Transonic Facility. This test program was a cooperative effort between the Boeing Commercial Airplane Company and the NASA Langley Research Center.

[Quality Indicators of Primary Health Care Facilities in Austria].

PubMed

Semlitsch, Thomas; Abuzahra, Muna; Stigler, Florian; Jeitler, Klaus; Posch, Nicole; Siebenhofer, Andrea

2017-07-11

Background The strengthening of primary health care is one major goal of the current national health reform in Austria. In this context, a new interdisciplinary concept was developed in 2014 that defines structures and requirements for future primary health care facilities. Objective The aim of this project was the development of quality indicators for the evaluation of the scheduled primary health care facilities in Austria, which are in accordance with the new Austrian concept. Methods We used the RAND/NPCRDC method for the development and selection of the quality indicators. We conducted systematic literature searches for existing measures in international databases for quality indicators as well as in bibliographic databases. All retrieved measures were evaluated and rated by an expert panel in a 2-step process regarding relevance and feasibility. Results Overall, the literature searches yielded 281 potentially relevant quality indicators, which were summarized to 65 different quality measures for primary health care. Out of these, the panel rated and accepted 30 measures as relevant and feasible for use in Austria. Five of these indicators were structure measures, 14 were process measures and the remaining 11 were outcome measures. Based on the Austrian primary health care concept, the final set of quality indicators was grouped in the 5 following domains: Access to primary health care (5), quality of care (15), continuity of care (5), coordination of care (4), and safety (1). Conclusion This set of quality measures largely covers the four defined functions of primary health care. It enables standardized evaluation of primary health care facilities in Austria regarding the implementation of the Austrian primary health care concept as well as improvement in healthcare of the population. © Georg Thieme Verlag KG Stuttgart · New York.

Assessing the Contributions of Private Health Facilities in a Pioneer Private-Public Partnership in Childhood Immunization in Nigeria

PubMed Central

Oluoha, Chukwuemeka; Ahaneku, Hycienth

2014-01-01

The vision of Nigeria’s immunization program is to reach and sustain routine immunization coverage of greater than 90% for all vaccines by 2020. In order to achieve this, Abia state embarked on a unique private-public partnership (PPP) between private health facilities and the Abia state ministry of health. The aim of this partnership was to collaborate with private health facilities to provide free childhood immunization services in the state - the first of its kind in Nigeria. This is a retrospective study of the 2011 Abia state, Nigeria monthly immunization data. In the 4 local governments operating the PPP, 45% (79/175) of the health facilities that offered immunization services in 2011 were private health facilities and 55% (96/175) were public health facilities. However, 21% of the immunization services took place in private health facilities while 79% took place in public health facilities. Private health facilities were shown to have a modest contribution to immunization in the 4 local governments involved in the PPP. Efforts should be made to expand PPP in immunization nationally to improve immunization services in Nigeria. PMID:28299112

Health Resources Statistics; Health Manpower and Health Facilities, 1969.

ERIC Educational Resources Information Center

National Center for Health Statistics (DHEW/PHS), Hyattsville, MD.

Intended to provide current statistics on health manpower and inpatient health facilities for the evaluation, planning, and administration of health programs, data were gathered from college and university records, state licensing records, association membership records, and agencies and establishments that provide health services. About 3.7…

National Ignition Facility under fire over ignition failure

NASA Astrophysics Data System (ADS)

Allen, Michael

2016-08-01

The 3.5bn National Ignition Facility (NIF) at the Lawrence Livermore National Laboratory in California is no nearer to igniting a sustainable nuclear fusion burn - four years after its initial target date - according to a report by the US National Nuclear Security Administration (NNSA).

Animal-assisted interventions: A national survey of health and safety policies in hospitals, eldercare facilities, and therapy animal organizations.

PubMed

Linder, Deborah E; Siebens, Hannah C; Mueller, Megan K; Gibbs, Debra M; Freeman, Lisa M

2017-08-01

Animal-assisted intervention (AAI) programs are increasing in popularity, but it is unknown to what extent therapy animal organizations that provide AAI and the hospitals and eldercare facilities they work with implement effective animal health and safety policies to ensure safety of both animals and humans. Our study objective was to survey hospitals, eldercare facilities, and therapy animal organizations on their AAI policies and procedures. A survey of United States hospitals, eldercare facilities, and therapy animal organizations was administered to assess existing health and safety policies related to AAI programs. Forty-five eldercare facilities, 45 hospitals, and 27 therapy animal organizations were surveyed. Health and safety policies varied widely and potentially compromised human and animal safety. For example, 70% of therapy animal organizations potentially put patients at risk by allowing therapy animals eating raw meat diets to visit facilities. In general, hospitals had stricter requirements than eldercare facilities. This information suggests that there are gaps between the policies of facilities and therapy animal organizations compared with recent guidelines for animal visitation in hospitals. Facilities with AAI programs need to review their policies to address recent AAI guidelines to ensure the safety of animals and humans involved. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Public Health Investigation After the Discovery of Ricin in a South Carolina Postal Facility

PubMed Central

Schier, Joshua G.; Patel, Manish M.; Belson, Martin G.; Patel, Amee; Schwartz, Michael; Fitzpatrick, Nicole; Drociuk, Dan; Deitchman, Scott; Meyer, Richard; Litovitz, Toby; Watson, William A.; Rubin, Carol H.; Kiefer, Max

2007-01-01

Objectives. In October 2003, a package containing ricin and a note threatening to poison water supplies was discovered in a South Carolina postal facility, becoming the first potential chemical terrorism event involving ricin in the United States. We examined the comprehensive public health investigation that followed and discuss the lessons learned from it. Methods. An investigation consisting primarily of environmental sampling for ricin contamination, performance of health assessments on affected personnel, and local, regional, and national surveillance for ricin-associated illness. Results. Laboratory analysis of 75 environmental sampling specimens revealed no ricin contamination. Health assessments of 36 affected employees were completed. Local surveillance initially identified 3 suspected cases, and national surveillance identified 399 outliers during the 2-week period after the incident. No confirmed cases of ricin-associated illness were identified. Conclusions. A multifaceted and multidisciplinary approach is required for an effective public health response to a chemical threat such as ricin. The results of all of the described activities were used to determine that the facility was safe to reopen and that no public health threat existed. PMID:17413057

Factors influencing deliveries at health facilities in a rural Maasai Community in Magadi sub-County, Kenya.

PubMed

Karanja, Sarah; Gichuki, Richard; Igunza, Patrick; Muhula, Samuel; Ofware, Peter; Lesiamon, Josephine; Leshore, Lepantas; Kyomuhangi-Igbodipe, Lenny Bazira; Nyagero, Josephat; Binkin, Nancy; Ojakaa, David

2018-01-03

In response to poor maternal, newborn, and child health indicators in Magadi sub-county, the "Boma" model was launched to promote health facility delivery by establishing community health units and training community health volunteers (CHVs) and traditional birth attendants (TBAs) as safe motherhood promoters. As a result, health facility delivery increased from 14% to 24%, still considerably below the national average (61%). We therefore conducted this study to determine factors influencing health facility delivery and describe barriers and motivators to the same. A mixed methods cross-sectional study involving a survey with 200 women who had delivered in the last 24 months, 3 focus group discussions with health providers, chiefs and CHVs and 26 in-depth interviews with mothers, key decision influencers and TBAs. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) using logistic regression were calculated to identify predictive factors for health facility delivery. Thematic analysis was done to describe barriers and motivators to the same. Of the women interviewed, 39% delivered at the health facility. Factors positively associated with health facility deliveries included belonging to the highest wealth quintiles [aOR 4.9 (95%CI 1.5-16.5)], currently not married [aOR 2.4 (95%CI 1.1-5.4)] and living near the health facility [aOR 2.2 (95%CI 1.1 = 4.4)]. High parity [aOR 0.7 (95%CI 0.5-0.9)] was negatively associated with health facility delivery. Barriers to health facility delivery included women not being final decision makers on place of birth, lack of a birth plan, gender of health provider, unfamiliar birthing position, disrespect and/or abuse, distance, attitude of health providers and lack of essential drugs and supplies. Motivators included proximity to health facility, mother's health condition, integration of TBAs into the health system, and health education/advice received. Belonging to the highest wealth quintile, currently not married and

Users Guide for the National Transonic Facility Research Data System

NASA Technical Reports Server (NTRS)

Foster, Jean M.; Adcock, Jerry B.

1996-01-01

The National Transonic Facility is a complex cryogenic wind tunnel facility. This report briefly describes the facility, the data systems, and the instrumentation used to acquire research data. The computational methods and equations are discussed in detail and many references are listed for those who need additional technical information. This report is intended to be a user's guide, not a programmer's guide; therefore, the data reduction code itself is not documented. The purpose of this report is to assist personnel involved in conducting a test in the National Transonic Facility.

Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan.

PubMed

Zaidi, Shehla; Riaz, Atif; Rabbani, Fauziah; Azam, Syed Iqbal; Imran, Syeda Nida; Pradhan, Nouhseen Akber; Khan, Gul Nawaz

2015-11-25

The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan. An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A household survey, a health facility survey, and focus group discussions with client and spouses were used for assessment. Contracted out facilities had a significantly higher utilization as compared to control facilities for antenatal care, delivery, postnatal care, emergency obstetric care, and neonatal illness. Contracted facilities had comparatively better quality of MNCH services but not in all aspects. Better household practices were also seen in the district where contracting involved administrative control over outreach programs. Contracting was also faced with certain drawbacks. Facility utilization was inequitably higher amongst more educated and affluent clients. Contracted out catchments had higher out-of-pocket expenses on MNCH services, driven by steeper transport costs and user charges for additional diagnostics. Contracting out did not influence higher MNCH service coverage rates across the catchment. Physical distances, inadequate transport, and low demand for facility-based care in non-emergency settings were key client-reported barriers. Contracting out MNCH services at government health facilities can improve facility utilization and bring some improvement in  quality of services. However, contracting out of health facilities is insufficient to increase

National Ignition Facility Control and Information System Operational Tools

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marshall, C D; Beeler, R G; Bowers, G A

The National Ignition Facility (NIF) in Livermore, California, is the world's highest-energy laser fusion system and one of the premier large scale scientific projects in the United States. The system is designed to setup and fire a laser shot to a fusion ignition or high energy density target at rates up to a shot every 4 hours. NIF has 192 laser beams delivering up to 1.8 MJ of energy to a {approx}2 mm target that is planned to produce >100 billion atm of pressure and temperatures of >100 million degrees centigrade. NIF is housed in a ten-story building footprint themore » size of three football fields as shown in Fig. 1. Commissioning was recently completed and NIF will be formally dedicated at Lawrence Livermore National Laboratory on May 29, 2009. The control system has 60,000 hardware controls points and employs 2 million lines of control system code. The control room has highly automated equipment setup prior to firing laser system shots. This automation has a data driven implementation that is conducive to dynamic modification and optimization depending on the shot goals defined by the end user experimenters. NIF has extensive facility machine history and infrastructure maintenance workflow tools both under development and deployed. An extensive operational tools suite has been developed to support facility operations including experimental shot setup, machine readiness, machine health and safety, and machine history. The following paragraphs discuss the current state and future upgrades to these four categories of operational tools.« less

Removal site evaluation report for the Isotope Facilities at Oak Ridge National Laboratory, Oak Ridge, Tennessee

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

This removal site evaluation (RmSE) report of the Isotope Facilities at Oak Ridge National Laboratory (ORNL) was prepared to provide the Environmental Restoration Program with information necessary to evaluate whether hazardous and/or radiological contaminants in and around the Isotopes Facility pose a substantial risk to human health or the environment and if remedial site evaluations (RSEs) or removal actions are required. The scope of the project included: (1) a review of historical evidence regarding operations and use of the facility; (2) interviews with facility personnel concerning current and past operating practices; (3) a site inspection; and (4) identification of hazardmore » areas requiring maintenance, removal, or remedial actions. The results of RmSE indicate that no substantial risks exist from contaminants present in the Isotope Facilities because adequate controls and practices exist to protect human health and the environment. The recommended correction from the RmSE are being conducted as maintenance actions; accordingly, this RmSE is considered complete and terminated.« less

Managing facility risk: external threats and health care organizations.

PubMed

Reid, Daniel J; Reid, William H

2014-01-01

Clinicians and clinical administrators should have a basic understanding of physical and financial risk to mental health facilities related to external physical threat, including actions usually viewed as "terrorism" and much more common sources of violence. This article refers to threats from mentally ill persons and those acting out of bizarre or misguided "revenge," extortionists and other outright criminals, and perpetrators usually identified as domestic or international terrorists. The principles apply both to relatively small and contained acts (such as a patient or ex-patient attacking a staff member) and to much larger events (such as bombings and armed attack), and are relevant to facilities both within and outside the U.S. Patient care and accessibility to mental health services rest not only on clinical skills, but also on a place to practice them and an organized system supported by staff, physical facilities, and funding. Clinicians who have some familiarity with the non-clinical requirements for care are in a position to support non-clinical staff in preventing care from being interrupted by external threats or events such as terrorist activity, and/or to serve at the interface of facility operations and direct clinical care. Readers should note that this article is an introduction to the topic and cannot address all local, state and national standards for hospital safety, or insurance providers' individual facility requirements. Copyright © 2014 John Wiley & Sons, Ltd.

77 FR 43095 - Eunice Kennedy Shriver National Institute of Child Health & Human Development; Notice of Closed...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-23

... Chemical Synthesis Facility. Date: July 26, 2012. Time: 1:00 p.m. to 3:30 p.m. Agenda: To review and... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health & Human Development; Notice of Closed Meeting Pursuant to section 10(d...

Awareness of Racial Disparities in Kidney Transplantation among Health Care Providers in Dialysis Facilities.

PubMed

Kim, Joyce J; Basu, Mohua; Plantinga, Laura; Pastan, Stephen O; Mohan, Sumit; Smith, Kayla; Melanson, Taylor; Escoffery, Cam; Patzer, Rachel E

2018-05-07

Despite the important role that health care providers at dialysis facilities have in reducing racial disparities in access to kidney transplantation in the United States, little is known about provider awareness of these disparities. We aimed to evaluate health care providers' awareness of racial disparities in kidney transplant waitlisting and identify factors associated with awareness. We conducted a cross-sectional analysis of a survey of providers from low-waitlisting dialysis facilities ( n =655) across all 18 ESRD networks administered in 2016 in the United States merged with 2014 US Renal Data System and 2014 US Census data. Awareness of national racial disparity in waitlisting was defined as responding "yes" to the question: "Nationally, do you think that African Americans currently have lower waitlisting rates than white patients on average?" The secondary outcome was providers' perceptions of racial difference in waitlisting at their own facilities. Among 655 providers surveyed, 19% were aware of the national racial disparity in waitlisting: 50% (57 of 113) of medical directors, 11% (35 of 327) of nurse managers, and 16% (35 of 215) of other providers. In analyses adjusted for provider and facility characteristics, nurse managers (versus medical directors; odds ratio, 7.33; 95% confidence interval, 3.35 to 16.0) and white providers (versus black providers; odds ratio, 2.64; 95% confidence interval, 1.39 to 5.02) were more likely to be unaware of a national racial disparity in waitlisting. Facilities in the South (versus the Northeast; odds ratio, 3.05; 95% confidence interval, 1.04 to 8.94) and facilities with a low percentage of blacks (versus a high percentage of blacks; odds ratio, 1.86; 95% confidence interval, 1.02 to 3.39) were more likely to be unaware. One quarter of facilities had >5% racial difference in waitlisting within their own facilities, but only 5% were aware of the disparity. Among a limited sample of dialysis facilities with low

Community and facility-level engagement in planning and budgeting for the government health sector--a district perspective from Kenya.

PubMed

O'Meara, Wendy Prudhomme; Tsofa, Benjamin; Molyneux, Sassy; Goodman, Catherine; McKenzie, F Ellis

2011-03-01

Health systems reform processes have increasingly recognized the essential contribution of communities to the success of health programs and development activities in general. Here we examine the experience from Kilifi district in Kenya of implementing annual health sector planning guidelines that included community participation in problem identification, priority setting, and planning. We describe challenges in the implementation of national planning guidelines, how these were met, and how they influenced final plans and budgets. The broad-based community engagement envisaged in the guidelines did not take place due to the delay in roll out of the Ministry of Health-trained community health workers. Instead, community engagement was conducted through facility management committees, though in a minority of facilities, even such committees were not involved. Some overlap was found in the priorities highlighted by facility staff, committee members and national indicators, but there were also many additional issues raised by committee members and not by other groups. The engagement of the community through committees influenced target and priority setting, but the emphasis on national health indicators left many local priorities unaddressed by the final work plans. Moreover, it appears that the final impact on budgets allocated at district and facility level was limited. The experience in Kilifi highlights the feasibility of engaging the community in the health planning process, and the challenges of ensuring that this engagement feeds into consolidated plans and future implementation. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Availability of Youth Services in U.S. Mental Health Treatment Facilities

PubMed Central

Cummings, Janet R.; Case, Brady G.; Ji, Xu; Marcus, Steven C.

2015-01-01

Despite concern about access to mental health (MH) services for youth, little is known about the specialty treatment infrastructure serving this population. We used national data to examine which types of MH treatment facilities (hospital- and community-based) were most likely to offer youth services and which types of communities were most likely to have this infrastructure. Larger (p<0.001) and privately owned (p<0.001) facilities were more likely to offer youth services. Rural counties, counties in which a majority of residents were nonwhite, and/or counties with a higher percentage of uninsured residents were less likely to have a community-based MH treatment facility that served youth (p<0.001). PMID:26467795

Availability of Youth Services in U.S. Mental Health Treatment Facilities.

PubMed

Cummings, Janet R; Case, Brady G; Ji, Xu; Marcus, Steven C

2016-09-01

Despite concern about access to mental health (MH) services for youth, little is known about the specialty treatment infrastructure serving this population. We used national data to examine which types of MH treatment facilities (hospital- and community-based) were most likely to offer youth services and which types of communities were most likely to have this infrastructure. Larger (p < 0.001) and privately owned (p < 0.001) facilities were more likely to offer youth services. Rural counties, counties in which a majority of residents were nonwhite, and/or counties with a higher percentage of uninsured residents were less likely to have a community-based MH treatment facility that served youth (p < 0.001).

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya

PubMed Central

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-01-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility’s bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers’ motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in

Project definition study for the National Biomedical Tracer Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roozen, K.

The University of Alabama at Birmingham (UAB) has conducted a study of the proposed National Biomedical Tracer Facility (NBTF). In collaboration with General Atomics, RUST International, Coleman Research Corporation (CRC), IsoMed, Ernst and Young and the advisory committees, they have examined the issues relevant to the NBTF in terms of facility design, operating philosophy, and a business plan. They have utilized resources within UAB, CRC and Chem-Nuclear to develop recommendations on environmental, safety and health issues. The Institute of Medicine Panel`s Report on Isotopes for Medicine and the Life Sciences took the results of prior workshops further in developing recommendationsmore » for the mission of the NBTF. The IOM panel recommends that the NBTF accelerator have the capacity to accelerate protons to 80 MeV and a minimum of 750 microamperes of current. The panel declined to recommend a cyclotron or a linac. They emphasized a clear focus on research and development for isotope production including target design, separation chemistry and generator development. The facility needs to emphasize education and training in its mission. The facility must focus on radionuclide production for the research and clinical communities. The formation of a public-private partnership resembling the TRIUMF-Nordion model was encouraged. An advisory panel should assist with the NBTF operations and prioritization.« less

Mixed and low-level waste treatment project: Appendix C, Health and safety criteria for the mixed and low-level waste treatment facility at the Idaho National Engineering Laboratory. Part 2, Chemical constituents

DOE Office of Scientific and Technical Information (OSTI.GOV)

Neupauer, R.M.; Thurmond, S.M.

This report contains health and safety information relating to the chemicals that have been identified in the mixed waste streams at the Waste Treatment Facility at the Idaho National Engineering Laboratory. Information is summarized in two summary sections--one for health considerations and one for safety considerations. Detailed health and safety information is presented in material safety data sheets (MSDSs) for each chemical.

National facilities study. Volume 5: Space research and development facilities task group

NASA Technical Reports Server (NTRS)

1994-01-01

With the beginnings of the U.S. space program, there was a pressing need to develop facilities that could support the technology research and development, testing, and operations of evolving space systems. Redundancy in facilities that was once and advantage in providing flexibility and schedule accommodation is instead fast becoming a burden on scarce resources. As a result, there is a clear perception in many sectors that the U.S. has many space R&D facilities that are under-utilized and which are no longer cost-effective to maintain. At the same time, it is clear that the U.S. continues to possess many space R&D facilities which are the best -- or among the best -- in the world. In order to remain world class in key areas, careful assessment of current capabilities and planning for new facilities is needed. The National Facility Study (NFS) was initiated in 1992 to develop a comprehensive and integrated long-term plan for future aerospace facilities that meets current and projected government and commercial needs. In order to assess the nation's capability to support space research and development (R&D), a Space R&D Task Group was formed. The Task Group was co-chaired by NASA and DOD. The Task Group formed four major, technologically- and functionally- oriented working groups: Human and Machine Operations; Information and Communications; Propulsion and Power; and Materials, Structures, and Flight Dynamics. In addition to these groups, three supporting working groups were formed: Systems Engineering and Requirements; Strategy and Policy; and Costing Analysis. The Space R&D Task Group examined several hundred facilities against the template of a baseline mission and requirements model (developed in common with the Space Operations Task Group) and a set of excursions from the baseline. The model and excursions are described in Volume 3 of the NFS final report. In addition, as a part of the effort, the group examined key strategic issues associated with space R

Health Care Facilities Resilient to Climate Change Impacts

PubMed Central

Paterson, Jaclyn; Berry, Peter; Ebi, Kristie; Varangu, Linda

2014-01-01

Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator’s guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change. PMID:25522050

Legionnaires' Disease: a Problem for Health Care Facilities

MedlinePlus

... Clips Legionnaires’ Disease A problem for health care facilities Language: English (US) Español (Spanish) Recommend on Facebook ... drinking. Many people being treated at health care facilities, including long-term care facilities and hospitals, have ...

Malaria diagnostic capacity in health facilities in Ethiopia

PubMed Central

2014-01-01

Background Accurate early diagnosis and prompt treatment is one of the key strategies to control and prevent malaria in Ethiopia where both Plasmodium falciparum and Plasmodium vivax are sympatric and require different treatment regimens. Microscopy is the standard for malaria diagnosis at the health centres and hospitals whereas rapid diagnostic tests are used at community-level health posts. The current study was designed to assess malaria microscopy capacity of health facilities in Oromia Regional State and Dire Dawa Administrative City, Ethiopia. Methods A descriptive cross-sectional study was conducted from February to April 2011 in 122 health facilities, where health professionals were interviewed using a pre-tested, standardized assessment tool and facilities’ laboratory practices were assessed by direct observation. Results Of the 122 assessed facilities, 104 (85%) were health centres and 18 (15%) were hospitals. Out of 94 health facilities reportedly performing blood films, only 34 (36%) used both thin and thick smears for malaria diagnosis. The quality of stained slides was graded in 66 health facilities as excellent, good and poor quality in 11(17%), 31 (47%) and 24 (36%) respectively. Quality assurance guidelines and malaria microscopy standard operating procedures were found in only 13 (11%) facilities and 12 (10%) had involved in external quality assessment activities, and 32 (26%) had supportive supervision within six months of the survey. Only seven (6%) facilities reported at least one staff’s participation in malaria microscopy refresher training during the previous 12 months. Although most facilities, 96 (79%), had binocular microscopes, only eight (7%) had the necessary reagents and supplies to perform malaria microscopy. Treatment guidelines for malaria were available in only 38 (31%) of the surveyed facilities. Febrile patients with negative malaria laboratory test results were managed with artemether-lumefantrine or chloroquine in 51% (53

The National Transonic Facility: A Research Retrospective

NASA Technical Reports Server (NTRS)

Wahls, R. A.

2001-01-01

An overview of the National Transonic Facility (NTF) from a research utilization perspective is provided. The facility was born in the 1970s from an internationally recognized need for a high Reynolds number test capability based on previous experiences with preflight predictions of aerodynamic characteristics and an anticipated need in support of research and development for future aerospace vehicle systems. Selection of the cryogenic concept to meet the need, unique capabilities of the facility, and the eventual research utilization of the facility are discussed. The primary purpose of the paper is to expose the range of investigations that have used the NTF since being declared operational in late 1984; limited research results are included, though many more can be found in the references.

Water safety in healthcare facilities. The Vieste Charter.

PubMed

Bonadonna, L; Cannarozzi de Grazia, M; Capolongo, S; Casini, B; Cristina, M L; Daniele, G; D'Alessandro, D; De Giglio, O; Di Benedetto, A; Di Vittorio, G; Ferretti, E; Frascolla, B; La Rosa, G; La Sala, L; Lopuzzo, M G; Lucentini, L; Montagna, M T; Moscato, U; Pasquarella, C; Prencipe, R; Ricci, M L; Romano Spica, V; Signorelli, C; Veschetti, E

2017-01-01

The Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI) and the Local Health Authority of Foggia, Apulia, Italy, after the National Convention "Safe water in healthcare facilities" held in Vieste-Pugnochiuso on 27-28 May 2016, present the "Vieste Charter", drawn up in collaboration with experts from the National Institute of Health and the Ministry of Health. This paper considers the risk factors that may affect the water safety in healthcare facilities and reports the current regulatory frameworks governing the management of installations and the quality of the water. The Authors promote a careful analysis of the risks that characterize the health facilities, for the control of which specific actions are recommended in various areas, including water safety plans; approval of treatments; healthcare facilities responsibility, installation and maintenance of facilities; multidisciplinary approach; education and research; regional and national coordination; communication.

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya.

PubMed

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-03-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility's bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers' motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in

Health facilities safety in natural disasters: experiences and challenges from South East Europe.

PubMed

Radovic, Vesela; Vitale, Ksenija; Tchounwou, Paul B

2012-05-01

The United Nations named 2010 as a year of natural disasters, and launched a worldwide campaign to improve the safety of schools and hospitals from natural disasters. In the region of South East Europe, Croatia and Serbia have suffered the greatest impacts of natural disasters on their communities and health facilities. In this paper the disaster management approaches of the two countries are compared, with a special emphasis on the existing technological and legislative systems for safety and protection of health facilities and people. Strategic measures that should be taken in future to provide better safety for health facilities and populations, based on the best practices and positive experiences in other countries are recommended. Due to the expected consequences of global climate change in the region and the increased different environmental risks both countries need to refine their disaster preparedness strategies. Also, in the South East Europe, the effects of a natural disaster are amplified in the health sector due to its critical medical infrastructure. Therefore, the principles of environmental security should be implemented in public health policies in the described region, along with principles of disaster management through regional collaborations.

Healthy firms: constraints to growth among private health sector facilities in Ghana and Kenya.

PubMed

Burger, Nicholas E; Kopf, Daniel; Spreng, Connor P; Yoong, Joanne; Sood, Neeraj

2012-01-01

Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business

Healthy Firms: Constraints to Growth among Private Health Sector Facilities in Ghana and Kenya

PubMed Central

Burger, Nicholas E.; Kopf, Daniel; Spreng, Connor P.; Yoong, Joanne; Sood, Neeraj

2012-01-01

Background Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. Methodology/Principal Findings We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. Conclusions/Significance The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have

National Transonic Facility status

NASA Technical Reports Server (NTRS)

Mckinney, L. W.; Bruce, W. E., Jr.; Gloss, B. B.

1989-01-01

The National Transonic Facility (NTF) was operational in a combined checkout and test mode for about 3 years. During this time there were many challenges associated with movement of mechanical components, operation of instrumentation systems, and drying of insulation in the cryogenic environment. Most of these challenges were met to date along with completion of a basic flow calibration and aerodynamic tests of a number of configurations. Some of the major challenges resulting from cryogenic environment are reviewed with regard to hardware systems and data quality. Reynolds number effects on several configurations are also discussed.

National health spending trends in 1996. National Health Accounts Team.

PubMed

Levit, K R; Lazenby, H C; Braden, B R

1998-01-01

The National Health Accounts, produced annually by the Health Care Financing Administration's Office of the Actuary, present estimates for 1960-1996 of nationwide spending for health care and the sources funding that care. This year's estimates set two records: Spending topped $1 trillion for the first time, and expenditure growth slowed to the lowest rate seen in thirty-seven years of measuring health care spending--4.4 percent. The combination of decelerating health spending and a growing economy has kept national health spending as a share of the nation's gross domestic product unchanged for the fourth consecutive year.

Returning HIV-1 viral load results to participant-selected health facilities in national Population-based HIV Impact Assessment (PHIA) household surveys in three sub-Saharan African Countries, 2015 to 2016.

PubMed

Saito, Suzue; Duong, Yen T; Metz, Melissa; Lee, Kiwon; Patel, Hetal; Sleeman, Katrina; Manjengwa, Julius; Ogollah, Francis M; Kasongo, Webster; Mitchell, Rick; Mugurungi, Owen; Chimbwandira, Frank; Moyo, Crispin; Maliwa, Vusumuzi; Mtengo, Helecks; Nkumbula, Tepa; Ndongmo, Clement B; Vere, Nora Skutayi; Chipungu, Geoffrey; Parekh, Bharat S; Justman, Jessica; Voetsch, Andrew C

2017-11-01

Logistical complexities of returning laboratory test results to participants have precluded most population-based HIV surveys conducted in sub-Saharan Africa from doing so. For HIV positive participants, this presents a missed opportunity for engagement into clinical care and improvement in health outcomes. The Population-based HIV Impact Assessment (PHIA) surveys, which measure HIV incidence and the prevalence of viral load (VL) suppression in selected African countries, are returning VL results to health facilities specified by each HIV positive participant within eight weeks of collection. We describe the performance of the specimen and data management systems used to return VL results to PHIA participants in Zimbabwe, Malawi and Zambia. Consenting participants underwent home-based counseling and HIV rapid testing as per national testing guidelines; all confirmed HIV positive participants had VL measured at a central laboratory on either the Roche CAP/CTM or Abbott m2000 platform. On a bi-weekly basis, a dedicated data management team produced logs linking the VL test result with the participants' contact information and preferred health facility; project staff sent test results confidentially via project drivers, national courier systems, or electronically through an adapted short message service (SMS). Participants who provided cell phone numbers received SMS or phone call alerts regarding availability of VL results. From 29,634 households across the three countries, 78,090 total participants 0 to 64 years in Zimbabwe and Malawi and 0 to 59 years in Zambia underwent blood draw and HIV testing. Of the 8391 total HIV positive participants identified, 8313 (99%) had VL tests performed and 8245 (99%) of these were returned to the selected health facilities. Of the 5979 VL results returned in Zimbabwe and Zambia, 85% were returned within the eight-week goal with a median turnaround time of 48 days (IQR: 33 to 61). In Malawi, where exact return dates were

Evaluating malaria case management at public health facilities in two provinces in Angola.

PubMed

Plucinski, Mateusz M; Ferreira, Manzambi; Ferreira, Carolina Miguel; Burns, Jordan; Gaparayi, Patrick; João, Lubaki; da Costa, Olinda; Gill, Parambir; Samutondo, Claudete; Quivinja, Joltim; Mbounga, Eliane; de León, Gabriel Ponce; Halsey, Eric S; Dimbu, Pedro Rafael; Fortes, Filomeno

2017-05-03

Malaria accounts for the largest portion of healthcare demand in Angola. A pillar of malaria control in Angola is the appropriate management of malaria illness, including testing of suspect cases with rapid diagnostic tests (RDTs) and treatment of confirmed cases with artemisinin-based combination therapy (ACT). Periodic systematic evaluations of malaria case management are recommended to measure health facility readiness and adherence to national case management guidelines. Cross-sectional health facility surveys were performed in low-transmission Huambo and high-transmission Uíge Provinces in early 2016. In each province, 45 health facilities were randomly selected from among all public health facilities stratified by level of care. Survey teams performed inventories of malaria commodities and conducted exit interviews and re-examinations, including RDT testing, of a random selection of all patients completing outpatient consultations. Key health facility readiness and case management indicators were calculated adjusting for the cluster sampling design and utilization. Availability of RDTs or microscopy on the day of the survey was 71% (54-83) in Huambo and 85% (67-94) in Uíge. At least one unit dose pack of one formulation of an ACT (usually artemether-lumefantrine) was available in 83% (66-92) of health facilities in Huambo and 79% (61-90) of health facilities in Uíge. Testing rates of suspect malaria cases in Huambo were 30% (23-38) versus 69% (53-81) in Uíge. Overall, 28% (13-49) of patients with uncomplicated malaria, as determined during the re-examination, were appropriately treated with an ACT with the correct dose in Huambo, compared to 60% (42-75) in Uíge. Incorrect case management of suspect malaria cases was associated with lack of healthcare worker training in Huambo and ACT stock-outs in Uíge. The results reveal important differences between provinces. Despite similar availability of testing and ACT, testing and treatment rates were lower in

(NTF) National Transonic Facility Test 213-SFW Flow Control II,

NASA Image and Video Library

2012-11-19

(NTF) National Transonic Facility Test 213-SFW Flow Control II, Fast-MAC Model: The fundamental Aerodynamics Subsonic Transonic-Modular Active Control (Fast-MAC) Model was tested for the 2nd time in the NTF. The objectives were to document the effects of Reynolds numbers on circulation control aerodynamics and to develop and open data set for CFD code validation. Image taken in building 1236, National Transonic Facility

National space test centers - Lewis Research Center Facilities

NASA Technical Reports Server (NTRS)

Roskilly, Ronald R.

1990-01-01

The Lewis Research Center, NASA, presently has a number of test facilities that constitute a significant national space test resource. It is expected this capability will continue to find wide application in work involving this country's future in space. Testing from basic research to applied technology, to systems development, to ground support will be performed, supporting such activities as Space Station Freedom, the Space Exploration Initiative, Mission to Planet Earth, and many others. The major space test facilities at both Cleveland and Lewis' Plum Brook Station are described. Primary emphasis is on space propulsion facilities; other facilities of importance in space power and microgravity are also included.

National Health Information Center

MedlinePlus

... About ODPHP National Health Information Center National Health Information Center The National Health Information Center (NHIC) is ... of interest View the NHO calendar . Federal Health Information Centers and Clearinghouses Federal Health Information Centers and ...

An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania.

PubMed

Kuwawenaruwa, August; Borghi, Josephine; Remme, Michelle; Mtei, Gemini

2017-07-11

There is limited evidence on how health care inputs are distributed from the sub-national level down to health facilities and their potential influence on promoting health equity. To address this gap, this paper assesses equity in the distribution of health care inputs across public primary health facilities at the district level in Tanzania. This is a quantitative assessment of equity in the distribution of health care inputs (staff, drugs, medical supplies and equipment) from district to facility level. The study was carried out in three districts (Kinondoni, Singida Rural and Manyoni district) in Tanzania. These districts were selected because they were implementing primary care reforms. We administered 729 exit surveys with patients seeking out-patient care; and health facility surveys at 69 facilities in early 2014. A total of seventeen indices of input availability were constructed with the collected data. The distribution of inputs was considered in relation to (i) the wealth of patients accessing the facilities, which was taken as a proxy for the wealth of the population in the catchment area; and (ii) facility distance from the district headquarters. We assessed equity in the distribution of inputs through the use of equity ratios, concentration indices and curves. We found a significant pro-rich distribution of clinical staff and nurses per 1000 population. Facilities with the poorest patients (most remote facilities) have fewer staff per 1000 population than those with the least poor patients (least remote facilities): 0.6 staff per 1000 among the poorest, compared to 0.9 among the least poor; 0.7 staff per 1000 among the most remote facilities compared to 0.9 among the least remote. The negative concentration index for support staff suggests a pro-poor distribution of this cadre but the 45 degree dominated the concentration curve. The distribution of vaccines, antibiotics, anti-diarrhoeal, anti-malarials and medical supplies was approximately

Health seeking behaviour and challenges in utilising health facilities in Wakiso district, Uganda.

PubMed

Musoke, David; Boynton, Petra; Butler, Ceri; Musoke, Miph Boses

2014-12-01

The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs. To assess the health seeking practices and challenges in utilising health facilities in a rural community in Wakiso district, Uganda. The study was a cross sectional survey that used a structured questionnaire to collect quantitative data among 234 participants. The sample size was obtained using the formula by Leslie Kish. While 89% of the participants were aware that mobile clinics existed in their community, only 28% had received such services in the past month. The majority of participants (84%) did not know whether community health workers existed in their community. The participants' health seeking behaviour the last time they were sick was associated with age (p = 0.028) and occupation (p = 0.009). The most significant challenges in utilising health services were regular stock-out of drugs, high cost of services and long distance to health facilities. There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy.

Simulations of the National Ignition Facility Opacity Sample

NASA Astrophysics Data System (ADS)

Martin, M. E.; London, R. A.; Heeter, R. F.; Dodd, E. S.; Devolder, B. G.; Opachich, Y. P.; Liedahl, D. A.; Perry, T. S.

2017-10-01

A platform to study the opacity of high temperature materials at the National Ignition Facility has been developed. Experiments to study the opacity of materials relevant to inertial confinement fusion and stellar astrophysics are being conducted. The initial NIF experiments are focused on reaching the same plasma conditions (T >150 eV and Ne >= 7 ×1021 cm-3) , for iron, as those achieved in previous experiments at Sandia National Laboratories' (SNL) Z-facility which have shown discrepancies between opacity theory and experiment. We developed a methodology, using 1D HYDRA simulations, to study the effects of tamper thickness on the conditions of iron-magnesium samples. We heat the sample using an x-ray drive from 2D LASNEX hohlraum simulations. We also use this methodology to predict sample uniformity and expansion for comparison with experimental data. This work was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344. Lawrence Livermore National Security, LLC.

42 CFR 4.4 - Use of Library facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Use of Library facilities. 4.4 Section 4.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS NATIONAL LIBRARY OF MEDICINE § 4.4 Use of Library facilities. (a) General. The Library facilities are available to any...

42 CFR 4.4 - Use of Library facilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Use of Library facilities. 4.4 Section 4.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS NATIONAL LIBRARY OF MEDICINE § 4.4 Use of Library facilities. (a) General. The Library facilities are available to any...

42 CFR 4.4 - Use of Library facilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Use of Library facilities. 4.4 Section 4.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS NATIONAL LIBRARY OF MEDICINE § 4.4 Use of Library facilities. (a) General. The Library facilities are available to any...

42 CFR 4.4 - Use of Library facilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Use of Library facilities. 4.4 Section 4.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS NATIONAL LIBRARY OF MEDICINE § 4.4 Use of Library facilities. (a) General. The Library facilities are available to any...

42 CFR 4.4 - Use of Library facilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Use of Library facilities. 4.4 Section 4.4 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS NATIONAL LIBRARY OF MEDICINE § 4.4 Use of Library facilities. (a) General. The Library facilities are available to any...

Health facility and skilled birth deliveries among poor women with Jamkesmas health insurance in Indonesia: a mixed-methods study.

PubMed

Brooks, Mohamad I; Thabrany, Hasbullah; Fox, Matthew P; Wirtz, Veronika J; Feeley, Frank G; Sabin, Lora L

2017-02-02

The growing momentum for quality and affordable health care for all has given rise to the recent global universal health coverage (UHC) movement. As part of Indonesia's strategy to achieve the goal of UHC, large investments have been made to increase health access for the poor, resulting in the implementation of various health insurance schemes targeted towards the poor and near-poor, including the Jamkesmas program. In the backdrop of Indonesia's aspiration to reach UHC is the high rate of maternal mortality that disproportionally affects poor women. The objective of this study was to evaluate the association of health facility and skilled birth deliveries among poor women with and without Jamkesmas and explore perceived barriers to health insurance membership and maternal health service utilization. We used a mixed-methods design. Utilizing data from the 2012 Indonesian Demographic and Health Survey (n = 45,607), secondary analysis using propensity score matching was performed on key outcomes of interest: health facility delivery (HFD) and skilled birth delivery (SBD). In-depth interviews (n = 51) were conducted in the provinces of Jakarta and Banten among poor women, midwives, and government representatives. Thematic framework analysis was performed on qualitative data to explore perceived barriers. In 2012, 63.0% of women did not have health insurance; 19.1% had Jamkesmas. Poor women with Jamkesmas were 19% (OR = 1.19 [1.03-1.37]) more likely to have HFD and 17% (OR = 1.17 [1.01-1.35]) more likely to have SBD compared to poor women without insurance. Qualitative interviews highlighted key issues, including: lack of proper documentation for health insurance registration; the preference of pregnant women to deliver in their parents' village; the use of traditional birth attendants; distance to health facilities; shortage of qualified health providers; overcrowded health facilities; and lack of health facility accreditation. Poor women with

Telepsychiatry in correctional facilities: using technology to improve access and decrease costs of mental health care in underserved populations.

PubMed

Deslich, Stacie Anne; Thistlethwaite, Timothy; Coustasse, Alberto

2013-01-01

It is unclear if telepsychiatry, a subset of telemedicine, increases access to mental health care for inmates in correctional facilities or decreases costs for clinicians or facility administrators. The purpose of this investigation was to determine how utilization of telepsychiatry affected access to care and costs of providing mental health care in correctional facilities. A literature review complemented by a semistructured interview with a telepsychiatry practitioner. Five electronic databases, the National Bureau of Justice, and the American Psychiatric Association Web sites were searched for this research, and 49 sources were referenced. The literature review examined implementation of telepsychiatry in correctional facilities in Arizona, California, Georgia, Kansas, Ohio, Texas, and West Virginia to determine the effect of telepsychiatry on inmate access to mental health services and the costs of providing mental health care in correctional facilities. Telepsychiatry provided improved access to mental health services for inmates, and this increase in access is through the continuum of mental health care, which has been instrumental in increasing quality of care for inmates. Use of telepsychiatry saved correctional facilities from $12,000 to more than $1 million. The semistructured interview with the telepsychiatry practitioner supported utilization of telepsychiatry to increase access and lower costs of providing mental health care in correctional facilities. Increasing access to mental health care for this underserved group through telepsychiatry may improve living conditions and safety inside correctional facilities. Providers, facilities, and state and federal governments can expect increased savings with utilization of telepsychiatry.

National Biomedical Tracer Facility. Project definition study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schafer, R.

We request a $25 million government-guaranteed, interest-free loan to be repaid over a 30-year period for construction and initial operations of a cyclotron-based National Biomedical Tracer Facility (NBTF) in North Central Texas. The NBTF will be co-located with a linear accelerator-based commercial radioisotope production facility, funded by the private sector at approximately $28 million. In addition, research radioisotope production by the NBTF will be coordinated through an association with an existing U.S. nuclear reactor center that will produce research and commercial radioisotopes through neutron reactions. The combined facilities will provide the full range of technology for radioisotope production and research:more » fast neutrons, thermal neutrons, and particle beams (H{sup -}, H{sup +}, and D{sup +}). The proposed NBTF facility includes an 80 MeV, 1 mA H{sup -} cyclotron that will produce proton-induced (neutron deficient) research isotopes.« less

"Doing" diversity. Holy Cross Health System facilities honor differences in different ways.

PubMed

Burnside, G

1994-12-01

Holy Cross Health System (HCHS), a South Bend, IN-based organization that stretches from coast to coast, has instituted a diversity initiative to take advantage of demographic changes in its facilities' work forces and the communities they are serving. Launched by Holy Cross's corporate headquarters, the program is carried out by the member facilities, each of which had added its own ideas. HCHS's diversity program has three major components: Consciousness-raising among employees. Activities range from "transcultural rounds" for nursing students to fashion shows in which employees wear costumes from their places of national origin. Educating the larger community. HCHS facilities have been urged to increase awareness of diversity among physicians, patients, vendors, and local business and civic leaders. Strategic thinking. The leaders of HCHS facilities have been advised to integrate diversity into their strategic planning. Leaders are familiarizing themselves with the different cultural, ethnic, and religious groups in the community and preparing their facilities to take full advantage of those groups' contributions.

Establishing a national resource: a health informatics collection to maintain the legacy of health informatics development.

PubMed

Ellis, Beverley; Roberts, Jean; Cooper, Helen

2007-01-01

This case study report of the establishment of a national repository of multi-media materials describes the creation process, the challenges faced in putting it into operation and the opportunities for the future. The initial resource has been incorporated under standard library and knowledge management practices. A collaborative action research method was used with active experts in the domain to determine the requirements and priorities for further development. The National Health Informatics Collection (NatHIC) is now accessible and the further issues are being addressed by inclusion in future University and NHS strategic plans. Ultimately the Collection will link with other facilities that contribute to the description and maintenance of effective informatics in support of health globally. The issues raised about the National Health Informatics Collection as established in the UK have resonance with the challenges of capturing the overall historic development of an emerging discipline in any country.

Conceptual design of the National Ignition Facility

NASA Astrophysics Data System (ADS)

Paisner, Jeffrey A.; Boyes, John D.; Kumpan, Steven A.; Lowdermilk, W. Howard; Sorem, Michael S.

1995-12-01

The Secretary of the U.S. Department of Energy (DOE) commissioned a conceptual design report (CDR) for the National Ignition Facility (NIF) in January 1993 as part of a key decision zero (KD0), justification of mission need. Motivated by the progress to date by the inertial confinement fusion (ICF) program in meeting the Nova technical contract goals established by the National Academy of Sciences in 1989, the Secretary requested a design using a solid-state laser driver operating at the third harmonic (0.35 micrometer) of neodymium (Nd) glass. The participating ICF laboratories signed a memorandum of agreement in August 1993, and established a project organization, including a technical team from the Lawrence Livermore National Laboratory (LLNL), Los Alamos National Laboratory (LANL), Sandia National Laboratories (SNL), and the Laboratory for Laser Energetics at the University of Rochester. Since then, we completed the NIF conceptual design, based on standard construction at a generic DOE defense program's site, and issued a 7,000-page, 27-volume CDR in May 1994. Over the course of the conceptual design study, several other key documents were generated, including a facilities requirements document, a conceptual design scope and plan, a target physics design document, a laser design cost basis document, a functional requirements document, an experimental plan for indirect drive ignition, and a preliminary hazards analysis (PHA) document. DOE used the PHA to categorize the NIF as a low-hazard, non-nuclear facility. On October 21, 1994 the Secretary of Energy issued a key decision one (KD1) for the NIF, which approved the project and authorized DOE to request Office of Management and Budget-approval for congressional line-item FY 1996 NIF funding for preliminary engineering design and for National Environmental Policy Act activities. In addition, the Secretary declared Livermore as the preferred site for constructing the NIF. In February 1995, the NIF Project was

[Organization of workplace first aid in health care facilities].

PubMed

Ciavarella, M; Sacco, A; Bosco, Maria Giuseppina; Chinni, V; De Santis, A; Pagnanelli, A

2007-01-01

Laws D.Lgs. 626/94 and D.I. 388/03 attach particular importance to the organization of first aid in the workplace. Like every other enterprise, also hospitals and health care facilities have the obligation, as foreseen by the relevant legislation, to organize and manage first aid in the workplace. To discuss the topic in the light of the guidelines contained in the literature. We used the references contained in the relevant literature and in the regulations concerning organization of first aid in health care facilities. The regulations require the general manager of health care facilities to organize the primary intervention in case of emergencies in all health care facilities (health care or administrative, territorial and hospitals). In health care facilities the particular occupational risks, the general access of the public and the presence of patients who are already assumed to have altered states of health, should be the reason for particular care in guaranteeing the best possible management of a health emergency in the shortest time possible.

Contraception services for incarcerated women: a national survey of correctional health providers.

PubMed

Sufrin, Carolyn B; Creinin, Mitchell D; Chang, Judy C

2009-12-01

Incarcerated women have had limited access to health care prior to their arrest. Although their incarceration presents an opportunity to provide them with health care, their reproductive health needs have been overlooked. We performed a cross-sectional study of a nationally representative sample of 950 correctional health providers who are members of the Academy of Correctional Health Providers. A total of 405 surveys (43%) were returned, and 286 (30%) were eligible for analysis. Most ineligible surveys were from clinicians at male-only facilities. Of eligible respondents, 70% reported some degree of contraception counseling for women at their facilities. Only 11% provided routine counseling prior to release. Seventy percent said that their institution had no formal policy on contraception. Thirty-eight percent of clinicians provided birth control methods at their facilities. Although the most frequently counseled and prescribed method was oral contraceptive pills, only 50% of providers rated their oral contraceptive counseling ability as good or very good. Contraception counseling was associated with working at a juvenile facility, and with screening for sexually transmitted infections. Contraception does not appear to be integrated into the routine delivery of clinical services to incarcerated women. Because the correctional health care system can provide important clinical and public health interventions to traditionally marginalized populations, services for incarcerated women should include access to contraception.

Information for decision making from imperfect national data: tracking major changes in health care use in Kenya using geostatistics.

PubMed

Gething, Peter W; Noor, Abdisalan M; Goodman, Catherine A; Gikandi, Priscilla W; Hay, Simon I; Sharif, Shahnaaz K; Atkinson, Peter M; Snow, Robert W

2007-12-11

Most Ministries of Health across Africa invest substantial resources in some form of health management information system (HMIS) to coordinate the routine acquisition and compilation of monthly treatment and attendance records from health facilities nationwide. Despite the expense of these systems, poor data coverage means they are rarely, if ever, used to generate reliable evidence for decision makers. One critical weakness across Africa is the current lack of capacity to effectively monitor patterns of service use through time so that the impacts of changes in policy or service delivery can be evaluated. Here, we present a new approach that, for the first time, allows national changes in health service use during a time of major health policy change to be tracked reliably using imperfect data from a national HMIS. Monthly attendance records were obtained from the Kenyan HMIS for 1 271 government-run and 402 faith-based outpatient facilities nationwide between 1996 and 2004. A space-time geostatistical model was used to compensate for the large proportion of missing records caused by non-reporting health facilities, allowing robust estimation of monthly and annual use of services by outpatients during this period. We were able to reconstruct robust time series of mean levels of outpatient utilisation of health facilities at the national level and for all six major provinces in Kenya. These plots revealed reliably for the first time a period of steady nationwide decline in the use of health facilities in Kenya between 1996 and 2002, followed by a dramatic increase from 2003. This pattern was consistent across different causes of attendance and was observed independently in each province. The methodological approach presented can compensate for missing records in health information systems to provide robust estimates of national patterns of outpatient service use. This represents the first such use of HMIS data and contributes to the resurrection of these hugely

A national study of prescribed drugs in institutions and community residential facilities for mentally retarded people.

PubMed

Hill, B K; Balow, E A; Bruininks, R H

1985-01-01

The prevalence of psychotropic and nonpsychotropic drug prescriptions in institutions and community residential facilities in 1978-79 was assessed. The data were gathered as an incidental part of a comprehensive national interview study of the characteristics of residential facilities and their residents. The study included 2271 retarded individuals in 236 residential facilities in the US. Facilities were selected through a 2-stage probability sample design in such a way that the probability of a facility's selection was proportionate to its size (number of residents) and so that the distribution of sample facilities across census regions and size classes was in close agreement with the distribution of facilities nationally. Interviews at 75 institutions and 161 private facilities were conducted between September 1978 and April 1979. Demographic information about individual residents, including date of birth, date of admission, previous type of residential placement, age, height, weight, diagnosed degree of retardation, and diagnosis of epilepsy, autism, or mental illness, was obtained from each resident's records. The staff person most familiar with each resident was then identified and interviewed about the resident. Care persons were asked whether and for what purpose drugs were prescribed for each resident. 75.8% of institutionalized residents and 54.3% of community facility residents were reported to be receiving at least 1 type of regularly prescribed medication. Percentages reported for specific drugs should be considered minimums, because drug names were not always elicited if the drug's purpose was known. Drugs not named, but reported to be prescribed for a chronic health condition, epilepsy, a psychiatric problem, for sleeping, or for birth control, were listed with "other" within tentative categories. Multiple regression was used to examine the relationships among drug use and several resident and facility characteristics. The institutionalized and

Status of the National Transonic Facility Characterization

NASA Technical Reports Server (NTRS)

Bobbitt, C., Jr.; Everhart, J.

2001-01-01

This paper describes the current activities at the National Transonic Facility to document the test-section flow and to support tunnel improvements. The paper is divided into sections on the tunnel calibration, flow quality measurements, data quality assurance, and implementation of wall interference corrections.

Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan

PubMed Central

Steinhardt, Laura C; Aman, Iqbal; Pakzad, Iqbalshah; Kumar, Binay; Singh, Lakhwinder P; Peters, David H

2011-01-01

Background User fees for primary care tend to suppress utilization, and many countries are experimenting with fee removal. Studies show that additional inputs are needed after removing fees, although well-documented experiences are lacking. This study presents data on the effects of fee removal on facility quality and utilization in Afghanistan, based on a pilot experiment and subsequent nationwide ban on fees. Methods Data on utilization and observed structural and perceived overall quality of health care were compared from before-and-after facility assessments, patient exit interviews and catchment area household surveys from eight facilities where fees were removed and 14 facilities where fee levels remained constant, as part of a larger health financing pilot study from 2005 to 2007. After a national user fee ban was instituted in 2008, health facility administrative data were analysed to assess subsequent changes in utilization and quality. Results The pilot study analysis indicated that observed and perceived quality increased across facilities but did not differ by fee removal status. Difference-in-difference analysis showed that utilization at facilities previously charging both service and drug fees increased by 400% more after fee removal, prompting additional inputs from service providers, compared with facilities that previously only charged service fees or had no change in fees (P = 0.001). Following the national fee ban, visits for curative care increased significantly (P < 0.001), but institutional deliveries did not. Services typically free before the ban—immunization and antenatal care—had immediate increases in utilization but these were not sustained. Conclusion Both pilot and nationwide data indicated that curative care utilization increased following fee removal, without differential changes in quality. Concerns raised by non-governmental organizations, health workers and community leaders over the effects of lost revenue and increased

Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities - United States, 2016.

PubMed

Marynak, Kristy; VanFrank, Brenna; Tetlow, Sonia; Mahoney, Margaret; Phillips, Elyse; Jamal Mbbs, Ahmed; Schecter, Anna; Tipperman, Doug; Babb, Stephen

2018-05-11

Persons with mental or substance use disorders or both are more than twice as likely to smoke cigarettes as persons without such disorders and are more likely to die from smoking-related illness than from their behavioral health conditions (1,2). However, many persons with behavioral health conditions want to and are able to quit smoking, although they might require more intensive treatment (2,3). Smoking cessation reduces smoking-related disease risk and could improve mental health and drug and alcohol recovery outcomes (1,3,4). To assess tobacco-related policies and practices in mental health and substance abuse treatment facilities (i.e., behavioral health treatment facilities) in the United States (including Puerto Rico), CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed data from the 2016 National Mental Health Services Survey (N-MHSS) and the 2016 National Survey of Substance Abuse Treatment Services (N-SSATS). In 2016, among mental health treatment facilities, 48.9% reported screening patients for tobacco use, 37.6% offered tobacco cessation counseling, 25.2% offered nicotine replacement therapy (NRT), 21.5% offered non-nicotine tobacco cessation medications, and 48.6% prohibited smoking in all indoor and outdoor locations (i.e., smoke-free campus). In 2016, among substance abuse treatment facilities, 64.0% reported screening patients for tobacco use, 47.4% offered tobacco cessation counseling, 26.2% offered NRT, 20.3% offered non-nicotine tobacco cessation medications, and 34.5% had smoke-free campuses. Full integration of tobacco cessation interventions into behavioral health treatment, coupled with implementation of tobacco-free campus policies in behavioral health treatment settings, could decrease tobacco use and tobacco-related disease and could improve behavioral health outcomes among persons with mental and substance use disorders (1-4).

42 CFR 476.76 - Cooperation with health care facilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Cooperation with health care facilities. 476.76 Section 476.76 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... § 476.76 Cooperation with health care facilities. Before implementation of review, a QIO must make a...

Assessing patient safety in Canadian ambulatory surgery facilities: A national survey

PubMed Central

Ahmad, Jamil; Ho, Olivia A; Carman, Wayne W; Thoma, Achilles; Lalonde, Donald H; Lista, Frank

2014-01-01

BACKGROUND: There has been increased interest regarding patient safety and standards of care in Canadian ambulatory surgery facilities where surgical procedures are performed. The Canadian Association for Accreditation of Ambulatory Surgical Facilities (CAAASF) is a national organization formed to establish and maintain standards to ensure that surgical procedures conducted outside of public hospitals are performed safely. OBJECTIVE: To determine how many procedures are performed annually at CAAASF member sites, and to examine complication rates and several key patient safety practices. METHODS: All 69 facilities accredited by the CAAASF were surveyed. The survey focused on procedural data, complication rates and patient safety interventions. RESULTS: In 2010, 40,240 estimated procedures were performed. A total of 263 (0.007%) complications were reported. Sixteen (0.0004%) patients required reoperations in hospital and 19 (0.0004%) patients required transfer to hospital on the day of surgery. There were only two mortalities within 30 days of surgery reported in the past five years. With regard to patient safety practices, 93% used antimicrobial prophylaxis, 100% used strategies to maintain normothermia and 82% used measures for venous thromboembolism prevention. CONCLUSION: The present study is the first to report on the Canadian experience in ambulatory surgery facilities and provides insight into current practices at these facilities. Appropriate accreditation of ambulatory surgery facilities, well-established patient safety-related standards of care, careful patient selection and procedures performed by qualified health care professionals with appropriate certification practicing within the scope of their practice form the basis for safe and effective ambulatory surgery. PMID:25152645

National health expenditures, 1990

PubMed Central

Levit, Katharine R.; Lazenby, Helen C.; Cowan, Cathy A.; Letsch, Suzanne W.

1991-01-01

During 1990, health expenditures as a share of gross national product rose to 12.2 percent, up from 11.6 percent in 1989. This dramatic increase is the second largest increase in the past three decades. The national health expenditure estimates presented in this article document rapidly rising health care costs and provide a context for understanding the health care financing crisis facing the Nation today. The 1990 national health expenditures incorporate the most recently available data. They differ from historical estimates presented in the preceding article. The length of time and complicated process of producing projections required use of 1989 national health expenditures—data available prior to the completion of the 1990 estimates presented here. PMID:10114934

Impacts assessment for the National Ignition Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bay Area Economics

1996-12-01

This report documents the economic and other impacts that will be created by the National Ignition Facility (NIF) construction and ongoing operation, as well as the impacts that may be created by new technologies that may be developed as a result of NIF development and operation.

Accounting for variations in ART program sustainability outcomes in health facilities in Uganda: a comparative case study analysis.

PubMed

Zakumumpa, Henry; Bennett, Sara; Ssengooba, Freddie

2016-10-18

Uganda implemented a national ART scale-up program at public and private health facilities between 2004 and 2009. Little is known about how and why some health facilities have sustained ART programs and why others have not sustained these interventions. The objective of the study was to identify facilitators and barriers to the long-term sustainability of ART programs at six health facilities in Uganda which received donor support to commence ART between 2004 and 2009. A case-study approach was adopted. Six health facilities were purposively selected for in-depth study from a national sample of 195 health facilities across Uganda which participated in an earlier study phase. The six health facilities were placed in three categories of sustainability; High Sustainers (2), Low Sustainers (2) and Non- Sustainers (2). Semi-structured interviews with ART Clinic managers (N = 18) were conducted. Questionnaire data were analyzed (N = 12). Document review augmented respondent data. Based on the data generated, across-case comparative analyses were performed. Data were collected between February and June 2015. Several distinguishing features were found between High Sustainers, and Low and Non-Sustainers' ART program characteristics. High Sustainers had larger ART programs with higher staffing and patient volumes, a broader 'menu' of ART services and more stable program leadership compared to the other cases. High Sustainers associated sustained ART programs with multiple funding streams, robust ART program evaluation systems and having internal and external program champions. Low and Non Sustainers reported similar barriers of shortage and attrition of ART-proficient staff, low capacity for ART program reporting, irregular and insufficient supply of ARV drugs and a lack of alignment between ART scale-up and their for-profit orientation in three of the cases. We found that ART program sustainability was embedded in a complex system involving dynamic interactions

SPHERES National Lab Facility

NASA Technical Reports Server (NTRS)

Benavides, Jose

2014-01-01

SPHERES is a facility of the ISS National Laboratory with three IVA nano-satellites designed and delivered by MIT to research estimation, control, and autonomy algorithms. Since Fall 2010, The SPHERES system is now operationally supported and managed by NASA Ames Research Center (ARC). A SPHERES Program Office was established and is located at NASA Ames Research Center. The SPHERES Program Office coordinates all SPHERES related research and STEM activities on-board the International Space Station (ISS), as well as, current and future payload development. By working aboard ISS under crew supervision, it provides a risk tolerant Test-bed Environment for Distributed Satellite Free-flying Control Algorithms. If anything goes wrong, reset and try again! NASA has made the capability available to other U.S. government agencies, schools, commercial companies and students to expand the pool of ideas for how to test and use these bowling ball-sized droids. For many of the researchers, SPHERES offers the only opportunity to do affordable on-orbit characterization of their technology in the microgravity environment. Future utilization of SPHERES as a facility will grow its capabilities as a platform for science, technology development, and education.

Utilization of outpatient services in refugee settlement health facilities: a comparison by age, gender, and refugee versus host national status

PubMed Central

2011-01-01

Background Comparisons between refugees receiving health care in settlement-based facilities and persons living in host communities have found that refugees have better health outcomes. However, data that compares utilization of health services between refugees and the host population, and across refugee settlements, countries and regions is limited. The paper will address this information gap. The analysis in this paper uses data from the United Nations High Commissioner of Refugees (UNHCR) Health Information System (HIS). Methods Data about settlement populations and the use of outpatient health services were exported from the UNHCR health information system database. Tableau Desktop was used to explore the data. STATA was used for data cleaning and statistical analysis. Differences in various indicators of the use of health services by region, gender, age groups, and status (host national vs. refugee population) were analyzed for statistical significance using generalized estimating equation models that adjusted for correlated data within refugee settlements over time. Results Eighty-one refugee settlements were included in this study and an average population of 1.53 million refugees was receiving outpatient health services between 2008 and 2009. The crude utilization rate among refugees is 2.2 visits per person per year across all settlements. The refugee utilization rate in Asia (3.5) was higher than in Africa on average (1.8). Among refugees, females have a statistically significant higher utilization rate than males (2.4 visits per person per year vs. 2.1). The proportion of new outpatient attributable to refugees is higher than that attributable to host nationals. In the Asian settlements, only 2% outpatient visits, on average, were attributable to host community members. By contrast, in Africa, the proportion of new outpatient (OPD) visits by host nationals was 21% on average; in many Ugandan settlements, the proportion of outpatient visits attributable

Examining national trends in worker health with the National Health Interview Survey.

PubMed

Luckhaupt, Sara E; Sestito, John P

2013-12-01

To describe data from the National Health Interview Survey (NHIS), both the annual core survey and periodic occupational health supplements (OHSs), available for examining national trends in worker health. The NHIS is an annual in-person household survey with a cross-sectional multistage clustered sample design to produce nationally representative health data. The 2010 NHIS included an OHS. Prevalence rates of various health conditions and health behaviors among workers based on multiple years of NHIS core data are available. In addition, the 2010 NHIS-OHS data provide prevalence rates of selected health conditions, work organization factors, and occupational exposures among US workers by industry and occupation. The publicly available NHIS data can be used to identify areas of concern for various industries and for benchmarking data from specific worker groups against national averages.

Operational Philosophy for the Advanced Test Reactor National Scientific User Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

J. Benson; J. Cole; J. Jackson

2013-02-01

In 2007, the Department of Energy (DOE) designated the Advanced Test Reactor (ATR) as a National Scientific User Facility (NSUF). At its core, the ATR NSUF Program combines access to a portion of the available ATR radiation capability, the associated required examination and analysis facilities at the Idaho National Laboratory (INL), and INL staff expertise with novel ideas provided by external contributors (universities, laboratories, and industry). These collaborations define the cutting edge of nuclear technology research in high-temperature and radiation environments, contribute to improved industry performance of current and future light-water reactors (LWRs), and stimulate cooperative research between user groupsmore » conducting basic and applied research. To make possible the broadest access to key national capability, the ATR NSUF formed a partnership program that also makes available access to critical facilities outside of the INL. Finally, the ATR NSUF has established a sample library that allows access to pre-irradiated samples as needed by national research teams.« less

Buffet test in the National Transonic Facility

NASA Technical Reports Server (NTRS)

Young, Clarence P., Jr.; Hergert, Dennis W.; Butler, Thomas W.; Herring, Fred M.

1992-01-01

A buffet test of a commercial transport model was accomplished in the National Transonic Facility at the NASA Langley Research Center. This aeroelastic test was unprecedented for this wind tunnel and posed a high risk for the facility. Presented here are the test results from a structural dynamics and aeroelastic response point of view. The activities required for the safety analysis and risk assessment are described. The test was conducted in the same manner as a flutter test and employed on-board dynamic instrumentation, real time dynamic data monitoring, and automatic and manual tunnel interlock systems for protecting the model.

Health and Safety Management for Small-scale Methane Fermentation Facilities

NASA Astrophysics Data System (ADS)

Yamaoka, Masaru; Yuyama, Yoshito; Nakamura, Masato; Oritate, Fumiko

In this study, we considered health and safety management for small-scale methane fermentation facilities that treat 2-5 ton of biomass daily based on several years operation experience with an approximate capacity of 5 t·d-1. We also took account of existing knowledge, related laws and regulations. There are no qualifications or licenses required for management and operation of small-scale methane fermentation facilities, even though rural sewerage facilities with a relative similar function are required to obtain a legitimate license. Therefore, there are wide variations in health and safety consciousness of the operators of small-scale methane fermentation facilities. The industrial safety and health laws are not applied to the operation of small-scale methane fermentation facilities. However, in order to safely operate a small-scale methane fermentation facility, the occupational safety and health management system that the law recommends should be applied. The aims of this paper are to clarify the risk factors in small-scale methane fermentation facilities and encourage planning, design and operation of facilities based on health and safety management.

The History of Art Therapy at the National Institutes of Health

ERIC Educational Resources Information Center

Robb, Megan

2012-01-01

The National Institutes of Health (NIH) Clinical Research Center is a government facility that has a long history of groundbreaking research. Art therapy research began at NIH in 1958 with Hanna Kwiatkowska, whose work contributed to the foundation of art therapy with families, and with Harriet Wadeson, who conducted psychodynamic art therapy…

Perspectives of frontline health workers on Ghana's National Health Insurance Scheme before and after community engagement interventions.

PubMed

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Rinke de Wit, Tobias F

2016-05-28

Barely a decade after introduction of Ghana's National Health Insurance Scheme (NHIS), significant successes have been recorded in universal access to basic healthcare services. However, sustainability of the scheme is increasingly threatened by concerns on quality of health service delivery in NHIS-accredited health facilities coupled with stakeholders' discontentment with the operational and administrative challenges confronting the NHIS. The study sought to ascertain whether or not Systematic Community Engagement (SCE) interventions have a significant effect on frontline health workers' perspectives on the NHIS and its impact on quality health service delivery. The study is a randomized cluster trial involving clinical and non-clinical frontline health workers (n = 234) interviewed at baseline and follow-up in the Greater Accra and Western regions of Ghana. Individual respondents were chosen from within each intervention and control groupings. Difference-in-difference estimations and propensity score matching were performed to determine impact of SCE on staff perceptions of the NHIS. The main outcome measure of interest was staff perception of the NHIS based on eight (8) factor-analyzed quality service parameters. Staff interviewed in intervention facilities appeared to perceive the NHIS more positively in terms of its impact on "availability and quality of drugs (p < 0.05)" and "workload on health staff/infrastructure" than those interviewed in control facilities (p < 0.1). Delayed reimbursement of service providers remained a key concern to over 70 % of respondents in control and intervention health facilities. Community engagement in quality service assessment is a potential useful strategy towards empowering communities while promoting frontline health workers' interest, goodwill and active participation in Ghana's NHIS.

Predictors of Army National Guard and Reserve members' use of Veteran Health Administration health care after demobilizing from OEF/OIF deployment.

PubMed

Harris, Alex H S; Chen, Cheng; Mohr, Beth A; Adams, Rachel Sayko; Williams, Thomas V; Larson, Mary Jo

2014-10-01

This study described rates and predictors of Army National Guard and Army Reserve members' enrollment in and utilization of Veteran Health Administration (VHA) services in the 365 days following demobilization from an index deployment. We also explored regional and VHA facility variation in serving eligible members in their catchment areas. The sample included 125,434 Army National Guard and 48,423 Army Reserve members who demobilized after a deployment ending between FY 2008 and FY 2011. Demographic, geographic, deployment, and Military Health System eligibility were derived from Defense Enrollment Eligibility Reporting System and "Contingency Tracking System" data. The VHA National Patient Care Databases were used to ascertain VHA utilization and status (e.g., enrollee, TRICARE). Logistic regression models were used to evaluate predictors of VHA utilization as an enrollee in the year following demobilization. Of the study members demobilizing during the observation period, 56.9% of Army National Guard members and 45.7% of Army Reserve members utilized VHA as an enrollee within 12 months. Demographic, regional, health coverage, and deployment-related factors were associated with VHA enrollment and utilization, and significant variation by VHA facility was found. These findings can be useful in the design of specific outreach efforts to improve linkage from the Military Health System to the VHA. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

National Health Care Survey

Cancer.gov

This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.

Treatment-seeking behaviour and social health insurance in Africa: the case of Ghana under the National Health Insurance Scheme.

PubMed

Fenny, Ama P; Asante, Felix A; Enemark, Ulrika; Hansen, Kristian S

2014-10-27

Health insurance is attracting more and more attention as a means for improving health care utilization and protecting households against impoverishment from out-of-pocket expenditures. Currently about 52 percent of the resources for financing health care services come from out of pocket sources or user fees in Africa. Therefore, Ghana serves as in interesting case study as it has successfully expanded coverage of the National Health Insurance Scheme (NHIS). The study aims to establish the treatment-seeking behaviour of households in Ghana under the NHI policy. The study relies on household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah.Out of the 1013 who sought care in the previous 4 weeks, 60% were insured and 71% of them sought care from a formal health facility. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. Overall, compared to the uninsured, the insured are more likely to choose formal health facilities than informal care including self-medication when ill. We discuss the implications of these results as the concept of the NHIS grows widely in Ghana and serves as a good model for other African countries.

Treatment-Seeking Behaviour and Social Health Insurance in Africa: The Case of Ghana Under the National Health Insurance Scheme

PubMed Central

Fenny, Ama P.; Asante, Felix A.; Enemark, Ulrika; Hansen, Kristian S.

2015-01-01

Health insurance is attracting more and more attention as a means for improving health care utilization and protecting households against impoverishment from out-of-pocket expenditures. Currently about 52 percent of the resources for financing health care services come from out of pocket sources or user fees in Africa. Therefore, Ghana serves as in interesting case study as it has successfully expanded coverage of the National Health Insurance Scheme (NHIS). The study aims to establish the treatment-seeking behaviour of households in Ghana under the NHI policy. The study relies on household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah. Out of the 1013 who sought care in the previous 4 weeks, 60% were insured and 71% of them sought care from a formal health facility. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. Overall, compared to the uninsured, the insured are more likely to choose formal health facilities than informal care including self-medication when ill. We discuss the implications of these results as the concept of the NHIS grows widely in Ghana and serves as a good model for other African countries. PMID:25560361

ATR National Scientific User Facility 2013 Annual Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ulrich, Julie A.; Robertson, Sarah

2015-03-01

This is the 2013 Annual Report for the Advanced Test Reactor National Scientific User Facility. This report includes information on university-run research projects along with a description of the program and the capabilities offered researchers.

Health facility delivery in sub-Saharan Africa: successes, challenges, and implications for the 2030 development agenda.

PubMed

Doctor, Henry V; Nkhana-Salimu, Sangwani; Abdulsalam-Anibilowo, Maryam

2018-06-19

Sub-Saharan Africa remains one of the regions with modest health outcomes; and evidenced by high maternal mortality ratios and under-5 mortality rates. There are complications that occur during and following pregnancy and childbirth that can contribute to maternal deaths; most of which are preventable or treatable. Evidence shows that early and regular attendance of antenatal care and delivery in a health facility under the supervision of trained personnel is associated with improved maternal health outcomes. The aim of this study is to assess changes in and determinants of health facility delivery using nationally representative surveys in sub-Saharan Africa. This study also seeks to present renewed evidence on the determinants of health facility delivery within the context of the Agenda for Sustainable Development to generate evidence-based decision making and enable deployment of targeted interventions to improve health facility delivery and maternal and child health outcomes. We used pooled data from 58 Demographic and Health Surveys (DHS) conducted between 1990 and 2015 in 29 sub-Saharan African countries. This yielded a total of 1.1 million births occurring in the 5 years preceding the surveys. Descriptive statistics were used to describe the counts and proportions of women who delivered by place of delivery and their background characteristics at the time of delivery. We used multilevel logistic regression model to estimate the magnitude of association in the form of odds ratios between place of delivery and the predictors. Results show that births among women in the richest wealth quintile were 68% more likely to occur in health facilities than births among women in the lowest wealth quintile. Women with at least primary education were twice more likely to give birth in facilities than women with no formal education. Births from more recent surveys conducted since 2010 were 85% more likely to occur in facilities than births reported in earliest (1990s

National health expenditures, 1989

PubMed Central

Lazenby, Helen C.; Letsch, Suzanne W.

1990-01-01

Spending for health care in the United States grew to $604.1 billion in 1989, an increase of 11.1 percent from the 1988 level. Growth in national health expenditures has been edging upward since 1986, when the annual growth in the health care bill was 7.7 percent. Health care spending continues to command a larger and larger proportion of the resources of the Nation: In 1989, 11.6 percent of the Nation's output, as measured by the gross national product, was consumed by health care, up from 11.2 percent in 1988. PMID:10113559

Formal and informal maternal health care: comparing the service provision of health facilities and village health volunteers in East Sepik Province.

PubMed

O'Keefe, Daniel; Davis, Jessica; Yakuna, Glenda; Van Gemert, Caroline; Morgan, Chris

2011-01-01

Maternal health across Papua New Guinea (PNG) is of extreme public health concern. In response, the National Department of Health explicitly prioritized improving maternal, neonatal and child health services, envisaging increased collaboration between the formal health system and community-based initiatives as one method for achieving this. This study examined the patterns of formal and non-formal service utilization during pregnancy and childbirth in one province. We analysed the activity database of the East Sepik Women and Children's Health Project's Village Health Volunteer (VHV) program, an informal health service in East Sepik Province of PNG, estimating VHV activity and coverage for two maternal health care services (first antenatal care visit and VHV-attended deliveries) and comparing these to the volume and estimated coverage of these services delivered by the formal health system in East Sepik over the years 2007 to 2010. We found a significant increase in women's utilization of VHVs for first antenatal care and for an attended delivery. Reported coverage of these services delivered by the formal health service declined or at best remained static over the same time period. Our data cannot illuminate the causes of an apparent and highly concerning decline in health facility usage for assisted delivery, nor the reasons for increased usage of VHVs. The factors contributing to these trends in service provision require urgent study, to improve our understanding of the drivers of utilization of critical maternal health services. Our study demonstrates that VHVs deliver a substantial proportion of maternal health services in East Sepik. This finding alone highlights the importance of considering this cadre when planning health service improvements and suggests that a national VHV policy that builds on the work of the National Health Plan in defining the most appropriate role for VHVs in maternal health care is long overdue.

Health Habits of Employees in a Large Medical Center: Time Trends and Impact of a Worksite Wellness Facility.

PubMed

Abu Dabrh, Abd Moain; Gorty, Archana; Jenkins, Sarah M; Murad, Mohammad Hassan; Hensrud, Donald D

2016-02-11

Worksite health interventions are not novel but their effect remains subject of debate. We examined employer-based wellness program to determine health habits trends, and compare prevalence estimates to national data. We conducted serial surveys (1996 and 2007-10) to employees of a large medical center that included questions measuring outcomes, including obesity, regular exercise, cardiovascular activity, and smoking status. Logistic regression models were estimated to compare data by membership across years, considering p-values ≤ 0.01 as statistically significant. 3,206 employees responded (Response rates 59-68%). Obesity prevalence increased over time in members and nonmembers of the wellness facility, consistent with national trends. Members had a lower prevalence of cigarette smoking compared to nonmembers (overall year-adjusted odds ratio 0.66, P < 0.001). Further, employees had a lower prevalence of cigarette smoking (9.7 vs. 17.3% in 2010, P < 0.001) compared with national data. Wellness facility membership was associated with increased regular exercise and cardiovascular exercise (P < 0.001) compared to nonmembers. In summary, working in a medical center was associated with a decreased prevalence of cigarette smoking, but not with lower prevalence of obesity. Worksite wellness facility membership was associated with increased exercise and decreased cigarette smoking. Employer-based interventions may be effective in improving some health behaviors.

Health Habits of Employees in a Large Medical Center: Time Trends and Impact of a Worksite Wellness Facility

PubMed Central

Abu Dabrh, Abd Moain; Gorty, Archana; Jenkins, Sarah M.; Murad, Mohammad Hassan; Hensrud, Donald D.

2016-01-01

Worksite health interventions are not novel but their effect remains subject of debate. We examined employer-based wellness program to determine health habits trends, and compare prevalence estimates to national data. We conducted serial surveys (1996 and 2007–10) to employees of a large medical center that included questions measuring outcomes, including obesity, regular exercise, cardiovascular activity, and smoking status. Logistic regression models were estimated to compare data by membership across years, considering p-values ≤ 0.01 as statistically significant. 3,206 employees responded (Response rates 59–68%). Obesity prevalence increased over time in members and nonmembers of the wellness facility, consistent with national trends. Members had a lower prevalence of cigarette smoking compared to nonmembers (overall year-adjusted odds ratio 0.66, P < 0.001). Further, employees had a lower prevalence of cigarette smoking (9.7 vs. 17.3% in 2010, P < 0.001) compared with national data. Wellness facility membership was associated with increased regular exercise and cardiovascular exercise (P < 0.001) compared to nonmembers. In summary, working in a medical center was associated with a decreased prevalence of cigarette smoking, but not with lower prevalence of obesity. Worksite wellness facility membership was associated with increased exercise and decreased cigarette smoking. Employer-based interventions may be effective in improving some health behaviors. PMID:26864205

They receive antenatal care in health facilities, yet do not deliver there: predictors of health facility delivery by women in rural Ghana.

PubMed

Boah, Michael; Mahama, Abraham B; Ayamga, Emmanuel A

2018-05-03

Research has shown that use of antenatal services by pregnant women and delivery in health facilities with skilled birth attendants contribute to better delivery outcomes. However, a gap exists in Ghana between the use of antenatal care provided by health facilities and delivery in health facilities with skilled birth attendants by pregnant women. This study sought to identify the predictors of health facility delivery by women in a rural district in Ghana. This was a cross-sectional study conducted in June 2016. Women who delivered in the past 6 months preceding the study were interviewed. Data on socio-demographic characteristics, use of antenatal care, place of delivery and reasons for home delivery were collected from study participants. Chi-square test and multiple logistic regression analysis were used to assess an association between women's socio-demographic and obstetric characteristics and place of delivery at 95% confidence interval. The study found that 98.8% of women received antenatal care services at least once during their recent pregnancy, and 67.9% attended antenatal care at least four times before delivery. However, 61.9% of the women delivered in a health facility with a skilled attendant. The frequently mentioned reason for home delivery was "unaware of onset of labour and delivery". The odds for delivery at a health facility were reduced among women with four living children [(AOR = 0.07, CI = 0.15-0.36, p = 0.001)], with no exposure to delivery care information [(AOR = 0.06, CI = 0.01-0.34, p = 0.002), who started their first ANC visit from the second trimester of pregnancy[(AOR = 0.003, CI = 0.01-0.15, p < 0.001)] and increased among women who made at least four ANC visits before delivery [(AOR = 17.53, CI = 6.89-44.61, p < 0.001)]. Findings from this study revealed a low rate of delivery at health facilities although visits to antenatal care sessions were high, an indication that there was the

The Taiwan National Health Insurance program and full infant immunization coverage.

PubMed

Chen, Chin-Shyan; Liu, Tsai-Ching

2005-02-01

We compared hospital-born infants and well-baby care use associated with complete immunizations in Taiwan before and after institution of National Health Insurance (NHI). We used logistic regression to analyze data from 1989 and 1996 National Maternal and Infant Health Surveys of 1398 and 3185 1-year-old infants, respectively. Infants born in hospitals were found to receive fewer immunizations than those born elsewhere before NHI but significantly more after NHI. Use of well-baby care correlates strongly and positively with the probability that a child will receive a full course of immunization after NHI. The NHI policy of including hospitals as immunization providers facilitates access to immunization services for children born in those facilities. Through NHI provision of free well-baby care, health planners have stimulated the demand for immunization.

Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.

PubMed

Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen

2015-05-01

Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.

Overview: Development of the National Ignition Facility and the Transition to a User Facility for the Ignition Campaign and High Energy Density Scientific Research

DOE PAGES

Moses, E. I.; Lindl, J. D.; Spaeth, M. L.; ...

2017-03-23

The National Ignition Facility (NIF) at Lawrence Livermore National Laboratory has been operational since March 2009 and has been transitioning to a user facility supporting ignition science, high energy density stockpile science, national security applications, and fundamental science. The facility has achieved its design goal of 1.8 MJ and 500 TW of 3ω light on target, and has performed target experiments with 1.9 MJ at peak powers of 410 TW. The National Ignition Campaign (NIC), established by the U.S. National Nuclear Security Administration in 2005, was responsible for transitioning NIF from a construction project to a national user facility. Besidesmore » the operation and optimization of the use of the NIF laser, the NIC program was responsible for developing capabilities including target fabrication facilities; cryogenic layering capabilities; over 60 optical, X-ray, and nuclear diagnostic systems; experimental platforms; and a wide range of other NIF facility infrastructure. This study provides a summary of some of the key experimental results for NIF to date, an overview of the NIF facility capabilities, and the challenges that were met in achieving these capabilities. Finally, they are covered in more detail in the papers that follow.« less

Overview: Development of the National Ignition Facility and the Transition to a User Facility for the Ignition Campaign and High Energy Density Scientific Research

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moses, E. I.; Lindl, J. D.; Spaeth, M. L.

The National Ignition Facility (NIF) at Lawrence Livermore National Laboratory has been operational since March 2009 and has been transitioning to a user facility supporting ignition science, high energy density stockpile science, national security applications, and fundamental science. The facility has achieved its design goal of 1.8 MJ and 500 TW of 3ω light on target, and has performed target experiments with 1.9 MJ at peak powers of 410 TW. The National Ignition Campaign (NIC), established by the U.S. National Nuclear Security Administration in 2005, was responsible for transitioning NIF from a construction project to a national user facility. Besidesmore » the operation and optimization of the use of the NIF laser, the NIC program was responsible for developing capabilities including target fabrication facilities; cryogenic layering capabilities; over 60 optical, X-ray, and nuclear diagnostic systems; experimental platforms; and a wide range of other NIF facility infrastructure. This study provides a summary of some of the key experimental results for NIF to date, an overview of the NIF facility capabilities, and the challenges that were met in achieving these capabilities. Finally, they are covered in more detail in the papers that follow.« less

TB/HIV Co-Infection Care in Conflict-Affected Settings: A Mapping of Health Facilities in the Goma Area, Democratic Republic of Congo.

PubMed

Kaboru, Berthollet Bwira; Ogwang, Brenda A; Namegabe, Edmond Ntabe; Mbasa, Ndemo; Kabunga, Deka Kambale; Karafuli, Kambale

2013-09-01

HIV/AIDS and Tuberculosis (TB) are major contributors to the burden of disease in sub-Saharan Africa. The two diseases have been described as a harmful synergy as they are biologically and epidemiologically linked. Control of TB/HIV co-infection is an integral and most challenging part of both national TB and national HIV control programmes, especially in contexts of instability where health systems are suffering from political and social strife. This study aimed at assessing the provision of HIV/TB co-infection services in health facilities in the conflict-ridden region of Goma in Democratic Republic of Congo. A cross-sectional survey of health facilities that provide either HIV or TB services or both was carried out. A semi-structured questionnaire was used to collect the data which was analysed using descriptive statistics. Eighty facilities were identified, of which 64 facilities were publicly owned. TB care was more available than HIV care (in 61% vs. 9% of facilities). Twenty-three facilities (29%) offered services to co-infected patients. TB/HIV co-infection rates among patients were unknown in 82% of the facilities. Only 19 facilities (24%) reported some coordination with and support from concerned diseases' control programmes. HIV and TB services are largely fragmented, indicating imbalances and poor coordination by disease control programmes. HIV and TB control appear not to be the focus of health interventions in this crisis affected region, despite the high risks of TB and HIV infection in the setting. Comprehensive public health response to this setting calls for reforms that promote joint TB/HIV co-infection control, including improved leadership by the HIV programmes that accuse weaknesses in this conflict-ridden region.

Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities.

PubMed

Allegranzi, Benedetta; Conway, Laurie; Larson, Elaine; Pittet, Didier

2014-03-01

The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign. Copyright © 2014 World Health Organization. Published by Mosby, Inc. All rights reserved.

Health facility committees and facility management - exploring the nature and depth of their roles in Coast Province, Kenya

PubMed Central

2011-01-01

Background Community participation has been emphasized internationally as a way of enhancing accountability, as well as a means to enhance health goals in terms of coverage, access and effective utilization. In rural health facilities in Kenya, initiatives to increase community accountability have focused on Health Facility Committees (HFCs). In Coast Province the role of HFCs has been expanded with the introduction of direct funding of rural facilities. We explored the nature and depth of managerial engagement of HFCs at the facility level in two rural districts in this Coastal setting, and how this has contributed to community accountability Methods We conducted structured interviews with the health worker in-charge and with patients in 30 health centres and dispensaries. These data were supplemented with in-depth interviews with district managers, and with health workers and HFC members in 12 health centres and dispensaries. In-depth interviews with health workers and HFC members included a participatory exercise to stimulate discussion of the nature and depth of their roles in facility management. Results HFCs were generally functioning well and played an important role in facility operations. The breadth and depth of engagement had reportedly increased after the introduction of direct funding of health facilities which allowed HFCs to manage their own budgets. Although relations with facility staff were generally good, some mistrust was expressed between HFC members and health workers, and between HFC members and the broader community, partially reflecting a lack of clarity in HFC roles. Moreover, over half of exit interviewees were not aware of the HFC's existence. Women and less well-educated respondents were particularly unlikely to know about the HFC. Conclusions There is potential for HFCs to play an active and important role in health facility management, particularly where they have control over some facility level resources. However, to optimise their

Health facility committees and facility management - exploring the nature and depth of their roles in Coast Province, Kenya.

PubMed

Goodman, Catherine; Opwora, Antony; Kabare, Margaret; Molyneux, Sassy

2011-09-22

Community participation has been emphasized internationally as a way of enhancing accountability, as well as a means to enhance health goals in terms of coverage, access and effective utilization. In rural health facilities in Kenya, initiatives to increase community accountability have focused on Health Facility Committees (HFCs). In Coast Province the role of HFCs has been expanded with the introduction of direct funding of rural facilities. We explored the nature and depth of managerial engagement of HFCs at the facility level in two rural districts in this Coastal setting, and how this has contributed to community accountability We conducted structured interviews with the health worker in-charge and with patients in 30 health centres and dispensaries. These data were supplemented with in-depth interviews with district managers, and with health workers and HFC members in 12 health centres and dispensaries. In-depth interviews with health workers and HFC members included a participatory exercise to stimulate discussion of the nature and depth of their roles in facility management. HFCs were generally functioning well and played an important role in facility operations. The breadth and depth of engagement had reportedly increased after the introduction of direct funding of health facilities which allowed HFCs to manage their own budgets. Although relations with facility staff were generally good, some mistrust was expressed between HFC members and health workers, and between HFC members and the broader community, partially reflecting a lack of clarity in HFC roles. Moreover, over half of exit interviewees were not aware of the HFC's existence. Women and less well-educated respondents were particularly unlikely to know about the HFC. There is potential for HFCs to play an active and important role in health facility management, particularly where they have control over some facility level resources. However, to optimise their contribution, efforts are needed to

Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district.

PubMed

Thwala, Siphiwe Bridget Pearl; Blaauw, Duane; Ssengooba, Freddie

2018-01-01

Improving the delivery of emergency obstetric care (EmNOC) remains critical in addressing direct causes of maternal mortality. United Nations (UN) agencies have promoted standard methods for evaluating the availability of EmNOC facilities although modifications have been proposed by others. This study presents an assessment of the preparedness of public health facilities to provide EmNOC using these methods in one South African district with a persistently high maternal mortality ratio. Data collection took place in the final quarter of 2014. Cross-sectional surveys were conducted to classify the 7 hospitals and 8 community health centres (CHCs) in the district as either basic EmNOC (BEmNOC) or comprehensive EmNOC (CEmNOC) facilities using UN EmNOC signal functions. The required density of EmNOC facilities was calculated using UN norms. We also assessed the availability of EmNOC personnel, resuscitation equipment, drugs, fluids, and protocols at each facility. The workload of skilled EmNOC providers at hospitals and CHCs was compared. All 7 hospitals in the district were classified as CEmNOC facilities, but none of the 8 CHCs performed all required signal functions to be classified as BEmNOC facilities. UN norms indicated that 25 EmNOC facilities were required for the district population, 5 of which should be CEmNOCs. None of the facilities had 100% of items on the EmNOC checklists. Hospital midwives delivered an average of 36.4±14.3 deliveries each per month compared to only 7.9±3.2 for CHC midwives (p<0.001). The analysis indicated a shortfall of EmNOC facilities in the district. Full EmNOC services were centralised to hospitals to assure patient safety even though national policy guidelines sanction more decentralisation to CHCs. Studies measuring EmNOC availability need to consider facility opening hours, capacity and staffing in addition to the demonstrated performance of signal functions.

Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district

PubMed Central

Blaauw, Duane; Ssengooba, Freddie

2018-01-01

Background Improving the delivery of emergency obstetric care (EmNOC) remains critical in addressing direct causes of maternal mortality. United Nations (UN) agencies have promoted standard methods for evaluating the availability of EmNOC facilities although modifications have been proposed by others. This study presents an assessment of the preparedness of public health facilities to provide EmNOC using these methods in one South African district with a persistently high maternal mortality ratio. Methods Data collection took place in the final quarter of 2014. Cross-sectional surveys were conducted to classify the 7 hospitals and 8 community health centres (CHCs) in the district as either basic EmNOC (BEmNOC) or comprehensive EmNOC (CEmNOC) facilities using UN EmNOC signal functions. The required density of EmNOC facilities was calculated using UN norms. We also assessed the availability of EmNOC personnel, resuscitation equipment, drugs, fluids, and protocols at each facility. The workload of skilled EmNOC providers at hospitals and CHCs was compared. Results All 7 hospitals in the district were classified as CEmNOC facilities, but none of the 8 CHCs performed all required signal functions to be classified as BEmNOC facilities. UN norms indicated that 25 EmNOC facilities were required for the district population, 5 of which should be CEmNOCs. None of the facilities had 100% of items on the EmNOC checklists. Hospital midwives delivered an average of 36.4±14.3 deliveries each per month compared to only 7.9±3.2 for CHC midwives (p<0.001). Conclusions The analysis indicated a shortfall of EmNOC facilities in the district. Full EmNOC services were centralised to hospitals to assure patient safety even though national policy guidelines sanction more decentralisation to CHCs. Studies measuring EmNOC availability need to consider facility opening hours, capacity and staffing in addition to the demonstrated performance of signal functions. PMID:29596431

Factors influencing women's utilization of public health care services during childbirth in Malawi Public health facility utilization.

PubMed

Machira, Kennedy; Palamuleni, Martin

2017-06-01

Maternal mortality remains a public health challenge claiming many lives at the time of giving birth lives. However, there have been scanty studies investigating factors influencing women's use of public health facilities during childbirth. The aim of the study was to explore the factors associated with women choice of public health facility during childbirth. The study used 2010 Malawi Demographic Health Survey dataset and a binary logistics regression analysis to estimate the determinants influencing women's use of public health facilities at the time they give birth. Of 23020 women respondents, 8454(36.7%) chose to give birth in public health facilities. Multivariate analysis reported that frequency of antenatal care (ANC), birth order, women's education, wealth status and quality of care were the major predictors increasing women's choice to use public health facilities at childbirth. There is need to use multimedia approach to engage women on significance of utilizing public health facilities during childbirth and promote quality of care in facilities if their health outcome is to improve in Malawi.

The first experiments on the national ignition facility

NASA Astrophysics Data System (ADS)

Landen, O. L.; Glenzer, S.; Froula, D.; Dewald, E.; Suter, L. J.; Schneider, M.; Hinkel, D.; Fernandez, J.; Kline, J.; Goldman, S.; Braun, D.; Celliers, P.; Moon, S.; Robey, H.; Lanier, N.; Glendinning, G.; Blue, B.; Wilde, B.; Jones, O.; Schein, J.; Divol, L.; Kalantar, D.; Campbell, K.; Holder, J.; McDonald, J.; Niemann, C.; MacKinnon, A.; Collins, R.; Bradley, D.; Eggert, J.; Hicks, D.; Gregori, G.; Kirkwood, R.; Niemann, C.; Young, B.; Foster, J.; Hansen, F.; Perry, T.; Munro, D.; Baldis, H.; Grim, G.; Heeter, R.; Hegelich, B.; Montgomery, D.; Rochau, G.; Olson, R.; Turner, R.; Workman, J.; Berger, R.; Cohen, B.; Kruer, W.; Langdon, B.; Langer, S.; Meezan, N.; Rose, H.; Still, B.; Williams, E.; Dodd, E.; Edwards, J.; Monteil, M.-C.; Stevenson, M.; Thomas, B.; Coker, R.; Magelssen, G.; Rosen, P.; Stry, P.; Woods, D.; Weber, S.; Alvarez, S.; Armstrong, G.; Bahr, R.; Bourgade, J.-L.; Bower, D.; Celeste, J.; Chrisp, M.; Compton, S.; Cox, J.; Constantin, C.; Costa, R.; Duncan, J.; Ellis, A.; Emig, J.; Gautier, C.; Greenwood, A.; Griffith, R.; Holdner, F.; Holtmeier, G.; Hargrove, D.; James, T.; Kamperschroer, J.; Kimbrough, J.; Landon, M.; Lee, D.; Malone, R.; May, M.; Montelongo, S.; Moody, J.; Ng, E.; Nikitin, A.; Pellinen, D.; Piston, K.; Poole, M.; Rekow, V.; Rhodes, M.; Shepherd, R.; Shiromizu, S.; Voloshin, D.; Warrick, A.; Watts, P.; Weber, F.; Young, P.; Arnold, P.; Atherton, L.; Bardsley, G.; Bonanno, R.; Borger, T.; Bowers, M.; Bryant, R.; Buckman, S.; Burkhart, S.; Cooper, F.; Dixit, S.; Erbert, G.; Eder, D.; Ehrlich, B.; Felker, B.; Fornes, J.; Frieders, G.; Gardner, S.; Gates, C.; Gonzalez, M.; Grace, S.; Hall, T.; Haynam, C.; Heestand, G.; Henesian, M.; Hermann, M.; Hermes, G.; Huber, S.; Jancaitis, K.; Johnson, S.; Kauffman, B.; Kelleher, T.; Kohut, T.; Koniges, A. E.; Labiak, T.; Latray, D.; Lee, A.; Lund, D.; Mahavandi, S.; Manes, K. R.; Marshall, C.; McBride, J.; McCarville, T.; McGrew, L.; Menapace, J.; Mertens, E.; Munro, D.; Murray, J.; Neumann, J.; Newton, M.; Opsahl, P.; Padilla, E.; Parham, T.; Parrish, G.; Petty, C.; Polk, M.; Powell, C.; Reinbachs, I.; Rinnert, R.; Riordan, B.; Ross, G.; Robert, V.; Tobin, M.; Sailors, S.; Saunders, R.; Schmitt, M.; Shaw, M.; Singh, M.; Spaeth, M.; Stephens, A.; Tietbohl, G.; Tuck, J.; van Wonterghem, B.; Vidal, R.; Wegner, P.; Whitman, P.; Williams, K.; Winward, K.; Work, K.; Wallace, R.; Nobile, A.; Bono, M.; Day, B.; Elliott, J.; Hatch, D.; Louis, H.; Manzenares, R.; O'Brien, D.; Papin, P.; Pierce, T.; Rivera, G.; Ruppe, J.; Sandoval, D.; Schmidt, D.; Valdez, L.; Zapata, K.; MacGowan, B.; Eckart, M.; Hsing, W.; Springer, P.; Hammel, B.; Moses, E.; Miller, G.

2006-06-01

A first set of shock propagation, laser-plasma interaction, hohlraum energetics and hydrodynamic experiments have been performed using the first 4 beams of the National Ignition Facility (NIF), in support of indirect drive Inertial Confinement Fusion (ICF) and High Energy Density Physics.

ART Attrition across Health Facilities Implementing Option B+ in Haiti.

PubMed

Myrtil, Martine Pamphile; Puttkammer, Nancy; Gloyd, Stephen; Robinson, Julia; Yuhas, Krista; Domercant, Jean Wysler; Honoré, Jean Guy; Francois, Kesner

2018-01-01

Describing factors related to high attrition is important in order to improve the implementation of the Option B+ strategy in Haiti. We conducted a retrospective cohort study to describe the variability of antiretroviral therapy (ART) retention across health facilities among pregnant and lactating women and assess for differences in ART retention between Option B+ clients and other ART patients. There were 1989 Option B+ clients who initiated ART in 45 health facilities. The percentage of attrition varied from 9% to 81% across the facilities. The largest health facilities had 38% higher risk of attrition (relative risk [RR]: 1.38, 95% confidence interval [CI]: 1.08-1.77, P = .009). Private institutions had 18% less risk of attrition (RR: 0.82, 95% CI: 0.70-0.96, P = .020). Health facilities located in the West department and the South region had lower risk of attrition. Being on treatment in a large or public health facility or a facility located in the North region was a significant risk factor associated with high attrition among Option B+ clients. The implementation of the Option B+ strategy must be reevaluated in order to effectively eliminate mother-to-child HIV transmission.

Use of a Balanced Scorecard in strengthening health systems in developing countries: an analysis based on nationally representative Bangladesh Health Facility Survey.

PubMed

Khan, M Mahmud; Hotchkiss, David R; Dmytraczenko, Tania; Zunaid Ahsan, Karar

2013-01-01

This paper illustrates the importance of collecting facility-based data through regular surveys to supplement the administrative data, especially for developing countries of the world. In Bangladesh, measures based on facility survey indicate that only 70% of very basic medical instruments and 35% of essential drugs were available in health facilities. Less than 2% of officially designated obstetric care facilities actually had required drugs, injections and personnel on-site. Majority of (80%) referral hospitals at the district level were not ready to provide comprehensive emergency obstetric care. Even though the Management Information System reports availability of diagnostic machines in all district-level and sub-district-level facilities, it fails to indicate that 50% of these machines are not functional. In terms of human resources, both physicians and nurses are in short supply at all levels of the healthcare system. The physician-nurse ratio also remains lower than the desirable level of 3.0. Overall job satisfaction index was less than 50 for physicians and 66 for nurses. Patient satisfaction score, however, was high (86) despite the fact that process indicators of service quality were poor. Facility surveys can help strengthen not only the management decision-making process but also the quality of administrative data. Copyright © 2012 John Wiley & Sons, Ltd.

Assessing post-abortion care in health facilities in Afghanistan: a cross-sectional study.

PubMed

Ansari, Nasratullah; Zainullah, Partamin; Kim, Young Mi; Tappis, Hannah; Kols, Adrienne; Currie, Sheena; Haver, Jaime; van Roosmalen, Jos; Broerse, Jacqueline E W; Stekelenburg, Jelle

2015-02-03

Complications of abortion are one of the leading causes of maternal mortality worldwide, along with hemorrhage, sepsis, and hypertensive diseases of pregnancy. In Afghanistan little data exist on the capacity of the health system to provide post-abortion care (PAC). This paper presents findings from a national emergency obstetric and neonatal care needs assessment related to PAC, with the aim of providing insight into the current situation and recommendations for improvement of PAC services. A national Emergency Obstetric and Neonatal Care Needs Assessment was conducted from December 2009 through February 2010 at 78 of the 127 facilities designated to provide emergency obstetric and neonatal care services in Afghanistan. Research tools were adapted from the Averting Maternal Death and Disability Program Needs Assessment Toolkit and national midwifery education assessment tools. Descriptive statistics were used to summarize facility characteristics, and linear regression models were used to assess the factors associated with providers' PAC knowledge and skills. The average number of women receiving PAC in the past year in each facility was 244, with no significant difference across facility types. All facilities had at least one staff member who provided PAC services. Overall, 70% of providers reported having been trained in PAC and 68% felt confident in their ability to perform these services. On average, providers were able to identify 66% of the most common complications of unsafe or incomplete abortion and 57% of the steps to take in examining and managing women with these complications. Providers correctly demonstrated an average of 31% of the tasks required for PAC during a simulated procedure. Training was significantly associated with PAC knowledge and skills in multivariate regression models, but other provider and facility characteristics were not. While designated emergency obstetric facilities in Afghanistan generally have most supplies and equipment for

Going beyond the vertical: leveraging a national HIV quality improvement programme to address other health priorities in Haiti.

PubMed

Joseph, Jean Paul; Jerome, Gregory; Lambert, Wesler; Almazor, Patrick; Cupidon, Colette Eugene; Hirschhorn, Lisa R

2015-07-01

Although the central role of quality to achieve targeted population health goals is widely recognized, how to spread the capacity to measure and improve quality across programmes has not been widely studied. We describe the successful leveraging of expertise and framework of a national HIV quality improvement programme to spread capacity and improve quality across a network of clinics in HIV and other targeted areas of healthcare delivery in rural Haiti.The work was led by Zamni LaSante, a Haitian nongovernment organization and its sister organization, Partners In Health working in partnership with the Haitian Ministry of Health in the Plateau Central and Lower Artibonite regions in 12 public sector facilities.Data included routinely collected organizational assessments of facility quality improvement capacity, national HIV performance measures and Zamni LaSante programme records.We found that facility quality improvement capacity increased with spread from HIV to other areas of inpatient and outpatient care, including tuberculosis (TB), maternal health and inpatient services in all 12 supported healthcare facilities. A significant increase in the quality of HIV care was also seen in most areas, including CD4 monitoring, TB screening, HIV treatment (all P < 0.01) and nutritional assessment and prevention of mother-to-child transmission (both P < .05), with an increase in average facility performance from 39 to 72% (P < .01).In conclusion, using a diagonal approach to leverage a national vertical programme for wider benefit resulted in accelerated change in professional culture and increased capacity to spread quality improvement activities across facilities and areas of healthcare delivery. This led to improvement within and beyond HIV care and contributed to the goal of quality of care for all.

Progress towards implementation of ACT malaria case-management in public health facilities in the Republic of Sudan: a cluster-sample survey

PubMed Central

2012-01-01

Background Effective malaria case-management based on artemisinin-based combination therapy (ACT) and parasitological diagnosis is a major pillar within the 2007-2012 National Malaria Strategic Plan in the Sudan. Three years after the launch of the strategy a health facility survey was undertaken to evaluate case-management practices and readiness of the health facilities and health workers to implement a new malaria case-management strategy. Methods A cross-sectional, cluster sample survey was undertaken at public health facilities in 15 states of Sudan. Data were collected using quality-of-care assessment methods. The main outcomes were the proportions of facilities with ACTs and malaria diagnostics; proportions of health workers exposed to malaria related health systems support activities; and composite and individual indicators of case-management practices for febrile outpatients stratified by age, availability of ACTs and diagnostics, use of malaria diagnostics, and test result. Results We evaluated 244 facilities, 294 health workers and 1,643 consultations for febrile outpatients (425 < 5 years and 1,218 ≥ 5 years). Health facility and health worker readiness was variable: chloroquine was available at only 5% of facilities, 73% stocked recommended artesunate and sulfadoxine/pyrimethamine (AS+SP), 51% had the capacity to perform parasitological diagnosis, 53% of health workers had received in-service training on ACTs, 24% were trained in the use of malaria Rapid Diagnostic Tests, and 19% had received a supervisory visit including malaria case-management. At all health facilities 46% of febrile patients were parasitologically tested and 35% of patients were both, tested and treated according to test result. At facilities where AS+SP and malaria diagnostics were available 66% of febrile patients were tested and 51% were both, tested and treated according to test result. Among test positive patients 64% were treated with AS+SP but 24% were treated with

The National Direct-Drive Program: OMEGA to the National Ignition Facility

DOE PAGES

Regan, S. P.; Goncharov, V. N.; Sangster, T. C.; ...

2017-12-28

The goal of the National Direct-Drive Program is to demonstrate and understand the physics of laser direct drive (LDD). Efforts are underway on OMEGA for the 100-Gbar Campaign to demonstrate and understand the physics for hot-spot conditions and formation relevant for ignition at the 1-MJ scale, and at the National Ignition Facility to develop an understanding of the direct-drive physics at long scale lengths for the MJ Direct-Drive Campaign. For this paper the strategy of the National Direct-Drive Program is described; the requirements for the DT cryogenic fill-tube target being developed for OMEGA are presented; and preliminary LDD implosion measurementsmore » of hydrodynamic mixing seeded by laser imprint, the target-mounting stalk, and microscopic surface debris are reported.« less

The National Direct-Drive Program: OMEGA to the National Ignition Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Regan, S. P.; Goncharov, V. N.; Sangster, T. C.

The goal of the National Direct-Drive Program is to demonstrate and understand the physics of laser direct drive (LDD). Efforts are underway on OMEGA for the 100-Gbar Campaign to demonstrate and understand the physics for hot-spot conditions and formation relevant for ignition at the 1-MJ scale, and at the National Ignition Facility to develop an understanding of the direct-drive physics at long scale lengths for the MJ Direct-Drive Campaign. For this paper the strategy of the National Direct-Drive Program is described; the requirements for the DT cryogenic fill-tube target being developed for OMEGA are presented; and preliminary LDD implosion measurementsmore » of hydrodynamic mixing seeded by laser imprint, the target-mounting stalk, and microscopic surface debris are reported.« less

An Update of the Nation's Long-Term Strategic Needs for NASA's Aeronautics Test Facilities

NASA Technical Reports Server (NTRS)

Anton, Philip S.; Raman, Raj; Osburg, Jan; Kallimani, James G.

2009-01-01

The National Aeronautics and Space Administration's (NASA's) major wind tunnel (WT), propulsion test (PT), and simulation facilities exist to serve NASA's and the nation's aeronautics needs. RAND Corporation researchers conducted a prior study of these facilities from 2002 to 2003, identifying (1) NASA's continuing ability to serve national needs, (2) which facilities appear strategically important from an engineering perspective given the vehicle classes the nation investigates and produces, and (3) management challenges and issues. This documented briefing (DB) is the final report from a new, one-year study (conducted from September 2006 through January 2008), partially updating the prior assessment. The study focuses on updating the list of facilities in the prior study that were deemed to be strategically important (again, from an engineering perspective) in serving those needs. This update also adds a new assessment of national needs for six major aeronautics simulators at NASA and lists those deemed strategically important.

Does health facility service environment matter for the receipt of essential newborn care? Linking health facility and household survey data in Malawi.

PubMed

Carvajal-Aguirre, Liliana; Mehra, Vrinda; Amouzou, Agbessi; Khan, Shane M; Vaz, Lara; Guenther, Tanya; Kalino, Maggie; Zaka, Nabila

2017-12-01

Health facility service environment is an important factor for newborns survival and well-being in general and in particular in high mortality settings such as Malawi where despite high coverage of essential interventions, neonatal mortality remains high. The aim of this study is to assess whether the quality of the health service environment at birth is associated with quality of care received by the newborn. We used data from the Malawi Millennium Development Goals Endline household survey conducted as part of MICS survey program and Service Provision Assessment Survey carried out in 2014. The analysis is based on 6218 facility births that occurred during the past 2 years. Descriptive statistics, bivariate and multivariate random effect models are used to assess the association of health facility service readiness score for normal deliveries and newborn care with newborns receiving appropriate newborn care, defined for this analysis as receiving 5 out of 6 recommended interventions during the first 2 days after birth. Newborns in districts with top facility service readiness score have 1.5 higher odds of receiving appropriate newborn care (adjusted odds ratio (aOR) = 1.52, 95% confidence interval CI = 1.19-1.95, P  = 0.001), as compared to newborns in districts with a lower facility score after adjusting for potential confounders. Newborns in the Northern region were two times more likely to receive 5 newborn care interventions as compared to newborns in the Southern region (aOR = 2.06, 95% CI = 1.50-2.83, P  < 0.001). Living in urban or rural areas did not have an impact on receiving appropriate newborn care. There is need to increase the level of service readiness across all facilities, so that all newborns irrespective of the health facility, district or region of delivery are able to receive all recommended essential interventions. Investments in health systems in Malawi should concentrate on increasing training and availability of

Status of the National Transonic Facility Characterization (Invited)

NASA Technical Reports Server (NTRS)

Bobbitt, C., Jr.; Everhart, J.

2001-01-01

This paper describes the current activities at the National Transonic Facility to document the test-section flow and to support tunnel improvements. The paper is divided into sections on the tunnel calibration, flow quality measurements, data quality assurance, and implementation of wall interference corrections.

The Taiwan National Health Insurance Program and Full Infant Immunization Coverage

PubMed Central

Chen, Chin-Shyan; Liu, Tsai-Ching

2005-01-01

Objectives. We compared hospital-born infants and well-baby care use associated with complete immunizations in Taiwan before and after institution of National Health Insurance (NHI). Methods. We used logistic regression to analyze data from 1989 and 1996 National Maternal and Infant Health Surveys of 1398 and 3185 1-year-old infants, respectively. Results. Infants born in hospitals were found to receive fewer immunizations than those born elsewhere before NHI but significantly more after NHI. Use of well-baby care correlates strongly and positively with the probability that a child will receive a full course of immunization after NHI. Conclusions. The NHI policy of including hospitals as immunization providers facilitates access to immunization services for children born in those facilities. Through NHI provision of free well-baby care, health planners have stimulated the demand for immunization. PMID:15671469

A national facility for biological cryo-electron microscopy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Saibil, Helen R., E-mail: h.saibil@mail.cryst.bbk.ac.uk; Grünewald, Kay; Stuart, David I.

2015-01-01

This review provides a brief update on the use of cryo-electron microscopy for integrated structural biology, along with an overview of the plans for the UK national facility for electron microscopy being built at the Diamond synchrotron. Three-dimensional electron microscopy is an enormously powerful tool for structural biologists. It is now able to provide an understanding of the molecular machinery of cells, disease processes and the actions of pathogenic organisms from atomic detail through to the cellular context. However, cutting-edge research in this field requires very substantial resources for equipment, infrastructure and expertise. Here, a brief overview is provided ofmore » the plans for a UK national three-dimensional electron-microscopy facility for integrated structural biology to enable internationally leading research on the machinery of life. State-of-the-art equipment operated with expert support will be provided, optimized for both atomic-level single-particle analysis of purified macromolecules and complexes and for tomography of cell sections. The access to and organization of the facility will be modelled on the highly successful macromolecular crystallography (MX) synchrotron beamlines, and will be embedded at the Diamond Light Source, facilitating the development of user-friendly workflows providing near-real-time experimental feedback.« less

The national community mental health care project in Vietnam: a review for future guidance.

PubMed

Ng, Chee Hong; Than, Phong Thai; La, Cuong Duc; Van Than, Quang; Van Dieu, Chu

2011-04-01

The aim of this paper is to review the national community mental health care (CMHC) project in Vietnam and recommend improvements to the model based on findings reported at a national workshop of major service providers, and supplemented by information gathered from site visits and discussions with mental health leaders, professionals and stakeholders in the hospital and community mental health services. Since 2000, the CMHC project has been carried out in all 63 provinces with an overall national district coverage of around 64% and a total registry of 145 160 patients. It demonstrates a commitment by the government to integrate mental health into primary health care, in line with the World Health Organization recommendations, and set up a national community mental health network. Free treatment is provided for patients, mostly with schizophrenia (62.83%) and epilepsy (34.78%), at the local community level, and a national monitoring system is well established. However, the limitations include the lack of project funds, human resources and facilities, treatment scope, and linkages with families and community. A revised model of CMHC that builds on the strengths of existing services is proposed. While progress in community mental health care in Vietnam has been significant, many challenges facing the CMHC project need addressing.

TB/HIV Co-Infection Care in Conflict-Affected Settings: A Mapping of Health Facilities in the Goma Area, Democratic Republic of Congo

PubMed Central

Kaboru, Berthollet Bwira; Ogwang, Brenda. A.; Namegabe, Edmond Ntabe; Mbasa, Ndemo; Kabunga, Deka Kambale; Karafuli, Kambale

2013-01-01

Background: HIV/AIDS and Tuberculosis (TB) are major contributors to the burden of disease in sub-Saharan Africa. The two diseases have been described as a harmful synergy as they are biologically and epidemiologically linked. Control of TB/HIV co-infection is an integral and most challenging part of both national TB and national HIV control programmes, especially in contexts of instability where health systems are suffering from political and social strife. This study aimed at assessing the provision of HIV/TB co-infection services in health facilities in the conflict-ridden region of Goma in Democratic Republic of Congo. Methods: A cross-sectional survey of health facilities that provide either HIV or TB services or both was carried out. A semi-structured questionnaire was used to collect the data which was analysed using descriptive statistics. Results: Eighty facilities were identified, of which 64 facilities were publicly owned. TB care was more available than HIV care (in 61% vs. 9% of facilities). Twenty-three facilities (29%) offered services to co-infected patients. TB/HIV co-infection rates among patients were unknown in 82% of the facilities. Only 19 facilities (24%) reported some coordination with and support from concerned diseases’ control programmes. HIV and TB services are largely fragmented, indicating imbalances and poor coordination by disease control programmes. Conclusion: HIV and TB control appear not to be the focus of health interventions in this crisis affected region, despite the high risks of TB and HIV infection in the setting. Comprehensive public health response to this setting calls for reforms that promote joint TB/HIV co-infection control, including improved leadership by the HIV programmes that accuse weaknesses in this conflict-ridden region. PMID:24596866

Recent Developments at the NASA Langley Research Center National Transonic Facility

NASA Technical Reports Server (NTRS)

Paryz, Roman W.

2011-01-01

Several upgrade projects have been completed or are just getting started at the NASA Langley Research Center National Transonic Facility. These projects include a new high capacity semi-span balance, model dynamics damping system, semi-span model check load stand, data acquisition system upgrade, facility automation system upgrade and a facility reliability assessment. This presentation will give a brief synopsis of each of these efforts.

Characteristics and management of presumptive tuberculosis in public health facilities in Malawi, 2014-2016.

PubMed

Ng'ambi, W; Gugsa, S; Tweya, H; Girma, B; Kanyerere, H; Dambe, I; Babaye, Y; Mpunga, J; Phiri, S

2017-12-21

Setting: Public health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services in Malawi. Objectives: Using routinely collected health service delivery data to describe trends in HIV ascertainment and use of the Xpert ® MTB/RIF assay to diagnose TB among HIV-positive presumptive TB cases. Design: This was an implementation study of presumptive TB cases who sought care from 21 facilities between April 2014 and June 2016. Descriptive statistics were used to summarise patient, facility and service level characteristics. Results: Of 28 567 presumptive TB cases analysed, 23 198 (81%) had known HIV status. The proportion of ascertained HIV status in presumptive TB cases increased over the study period. HIV prevalence was 49%, with 73% of HIV-positive presumptive TB cases on antiretroviral therapy. Access to Xpert ranged between 37% and 63% per quarter among HIV-positive presumptive TB patients with smear-negative sputum results. Of 7829 patients with documented Xpert results, 68% were HIV-positive. Conclusion: After the introduction of registers with HIV-related variables, HIV ascertainment among presumptive TB cases increased over time. Access to Xpert was suboptimal among HIV-positive presumptive TB cases. Further collaboration between national TB and HIV programmes may facilitate increased use of Xpert for HIV-positive patients with presumptive TB who seek care in public health facilities.

National health expenditures, 1983

PubMed Central

Gibson, Robert M.; Levit, Katharine R.; Lazenby, Helen; Waldo, Daniel R.

1984-01-01

Although growing more slowly than in recent years, spending for health continued to account for an increasing share of the Nation's gross national product. In 1983, spending for health amounted to 10.8 percent of the gross national product, or $1,459 per person. Public programs financed 40 percent of all personal health care spending. Medicare and Medicaid expended $91 billion in benefits, 29 percent of all spending for personal health. New estimates of spending in calendar year 1983, along with revised measures of the benefits paid by private health insurers, are presented here. PMID:10310949

Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: Evidence from Tanzanian national survey.

PubMed

Bintabara, Deogratius; Mpondo, Bonaventura C T

2018-01-01

Sub-Saharan Africa is experiencing a rapid rise in the burden of non-communicable diseases in both urban and rural areas. Data on health system preparedness to manage hypertension and other non-communicable diseases remains scarce. This study aimed to assess the preparedness of lower-level health facilities for outpatient primary care of hypertension in Tanzania. This study used data from the 2014-2015 Tanzania Service Provision Assessment survey. The facility was considered as prepared for the outpatient primary care of hypertension if reported at least half (≥50%) of the items listed from each of the three domains (staff training and guideline, basic diagnostic equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Data were analyzed using Stata 14. An unadjusted logistic regression model was used to assess the association between outcome and explanatory variables. All variables with a P value < 0.2 were fitted into the multiple logistic regression models using a 5% significance level. Out of 725 health facilities involved in the current study, about 68% were public facilities and 73% located in rural settings. Only 28% of the assessed facilities were considered prepared for the outpatient primary care of hypertension. About 9% and 42% of the assessed facilities reported to have at least one trained staff and guidelines for hypertension respectively. In multivariate analysis, private facilities [AOR = 2.7, 95% CI; 1.2-6.1], urban location [AOR = 2.2, 95% CI; 1.2-4.2], health centers [AOR = 5.2, 95% CI; 3.1-8.7] and the performance of routine management meetings [AOR = 2.6, 95% CI; 1.1-5.9] were significantly associated with preparedness for the outpatient primary care of hypertension. The primary healthcare system in Tanzania is not adequately equipped to cope with the increasing burden of hypertension and other non-communicable diseases. Rural location, public ownership, and absence of

Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: Evidence from Tanzanian national survey

PubMed Central

Mpondo, Bonaventura C. T.

2018-01-01

Introduction Sub-Saharan Africa is experiencing a rapid rise in the burden of non-communicable diseases in both urban and rural areas. Data on health system preparedness to manage hypertension and other non-communicable diseases remains scarce. This study aimed to assess the preparedness of lower-level health facilities for outpatient primary care of hypertension in Tanzania. Methods This study used data from the 2014–2015 Tanzania Service Provision Assessment survey. The facility was considered as prepared for the outpatient primary care of hypertension if reported at least half (≥50%) of the items listed from each of the three domains (staff training and guideline, basic diagnostic equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Data were analyzed using Stata 14. An unadjusted logistic regression model was used to assess the association between outcome and explanatory variables. All variables with a P value < 0.2 were fitted into the multiple logistic regression models using a 5% significance level. Results Out of 725 health facilities involved in the current study, about 68% were public facilities and 73% located in rural settings. Only 28% of the assessed facilities were considered prepared for the outpatient primary care of hypertension. About 9% and 42% of the assessed facilities reported to have at least one trained staff and guidelines for hypertension respectively. In multivariate analysis, private facilities [AOR = 2.7, 95% CI; 1.2–6.1], urban location [AOR = 2.2, 95% CI; 1.2–4.2], health centers [AOR = 5.2, 95% CI; 3.1–8.7] and the performance of routine management meetings [AOR = 2.6, 95% CI; 1.1–5.9] were significantly associated with preparedness for the outpatient primary care of hypertension. Conclusion The primary healthcare system in Tanzania is not adequately equipped to cope with the increasing burden of hypertension and other non-communicable diseases

National Health Expenditures, 1979

PubMed Central

Gibson, Robert M

1980-01-01

Outlays for health care in the nation reached $212.2 billion in calendar year 1979—12.5 percent higher than in 1978, according to preliminary figures compiled by the Health Care Financing Administration. This estimate represented $943 per person in the United States and was equal to 9.0 percent of the Gross National Product. This latest report in the annual series representing national health expenditures provides detailed estimates of health care spending by type of service and method of financing. PMID:10309255

National Institutes of Health-Sponsored Clinical Islet Transplantation Consortium Phase 3 Trial: Manufacture of a Complex Cellular Product at Eight Processing Facilities.

PubMed

Ricordi, Camillo; Goldstein, Julia S; Balamurugan, A N; Szot, Gregory L; Kin, Tatsuya; Liu, Chengyang; Czarniecki, Christine W; Barbaro, Barbara; Bridges, Nancy D; Cano, Jose; Clarke, William R; Eggerman, Thomas L; Hunsicker, Lawrence G; Kaufman, Dixon B; Khan, Aisha; Lafontant, David-Erick; Linetsky, Elina; Luo, Xunrong; Markmann, James F; Naji, Ali; Korsgren, Olle; Oberholzer, Jose; Turgeon, Nicole A; Brandhorst, Daniel; Chen, Xiaojuan; Friberg, Andrew S; Lei, Ji; Wang, Ling-Jia; Wilhelm, Joshua J; Willits, Jamie; Zhang, Xiaomin; Hering, Bernhard J; Posselt, Andrew M; Stock, Peter G; Shapiro, A M James; Chen, Xiaojuan

2016-11-01

Eight manufacturing facilities participating in the National Institutes of Health-sponsored Clinical Islet Transplantation (CIT) Consortium jointly developed and implemented a harmonized process for the manufacture of allogeneic purified human pancreatic islet (PHPI) product evaluated in a phase 3 trial in subjects with type 1 diabetes. Manufacturing was controlled by a common master production batch record, standard operating procedures that included acceptance criteria for deceased donor organ pancreata and critical raw materials, PHPI product specifications, certificate of analysis, and test methods. The process was compliant with Current Good Manufacturing Practices and Current Good Tissue Practices. This report describes the manufacturing process for 75 PHPI clinical lots and summarizes the results, including lot release. The results demonstrate the feasibility of implementing a harmonized process at multiple facilities for the manufacture of a complex cellular product. The quality systems and regulatory and operational strategies developed by the CIT Consortium yielded product lots that met the prespecified characteristics of safety, purity, potency, and identity and were successfully transplanted into 48 subjects. No adverse events attributable to the product and no cases of primary nonfunction were observed. © 2016 by the American Diabetes Association.

Health assessment for Watkins-Johnson Facility, Scotts Valley, California, Region 9. CERCLIS No. CAD980893234. Preliminary report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

The Watkins-Johnson facility is on the National Priorities List. The facility manufactures electronic components. The environmental sampling conducted to date indicates that the contaminants of concern at the site are predominantly VOCs present in ground water, surface water, and soil. The VOCs present in one or more environmental media include trichloroethylene (TCE); 1,2-dichloroethylene (DCE); tetrachloroethylene perchloroethylene (PCE); vinyl chloride; methylene chloride; 1,1,1-trichloroethane (TCA); and Freon 113. The site is considered to be of potential public health concern because of the risk to human health caused by the possibility of exposure to hazardous substances via ingestion of contaminated ground water.

National Transonic Facility model and model support vibration problems

NASA Technical Reports Server (NTRS)

Young, Clarence P., Jr.; Popernack, Thomas G., Jr.; Gloss, Blair B.

1990-01-01

Vibrations of models and model support system were encountered during testing in the National Transonic Facility. Model support system yaw plane vibrations have resulted in model strain gage balance design load limits being reached. These high levels of vibrations resulted in limited aerodynamic testing for several wind tunnel models. The yaw vibration problem was the subject of an intensive experimental and analytical investigation which identified the primary source of the yaw excitation and resulted in attenuation of the yaw oscillations to acceptable levels. This paper presents the principal results of analyses and experimental investigation of the yaw plane vibration problems. Also, an overview of plans for development and installation of a permanent model system dynamic and aeroelastic response measurement and monitoring system for the National Transonic Facility is presented.

Quality of reproductive health services at commune health stations in Viet Nam: implications for national reproductive health care strategy.

PubMed

Ngo, Anh D; Hill, Peter S

2011-05-01

This paper presents a qualitative study conducted in 2009 of provider and patient perceptions of primary level reproductive health services provided by commune health stations (CHSs), and the implications for Viet Nam's 2011-2020 National Strategy for Reproductive Health Care. In the three provinces of Thai Nguyen, Thua Thien Hue, and Vinh Long, we interviewed the heads of CHSs, held focus group discussions with midwives and women patients, and observed facilities. Half the 30 CHSs visited were in poor physical condition; the rest were newly renovated. However, the model of service delivery was largely unchanged from ten years before. Many appeared to fall short in meeting patient expectations in terms of modern medical equipment and technology, range of drug supplies, and levels of staff expertise. As a result, many women were turning to private doctors and public hospitals, at least in urban areas, or seeking medication from pharmacies. To make CHS clinics sustainable, promotion of access to reproductive health services should be undertaken concurrently with quality improvement. A responsive payment scheme must also be developed to generate revenues. Efforts should be made to reduce the unnecessary use of more costly services from private clinics and higher level public facilities. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Trends in antenatal care attendance and health facility delivery following community and health facility systems strengthening interventions in Northern Uganda.

PubMed

Ediau, Michael; Wanyenze, Rhoda K; Machingaidze, Simba; Otim, George; Olwedo, Alex; Iriso, Robert; Tumwesigye, Nazarius M

2013-10-18

Maternal morbidity and mortality remains high in Uganda; largely due to inadequate antenatal care (ANC), low skilled deliveries and poor quality of other maternal health services. In order to address both the demand and quality of ANC and skilled deliveries, we introduced community mobilization and health facility capacity strengthening interventions. Interventions were introduced between January 2010 and September 2011. These included: training health workers, provision of medical supplies, community mobilization using village health teams, music dance and drama groups and male partner access clubs. These activities were implemented at Kitgum Matidi health center III and its catchment area. Routinely collected health facility data on selected outcomes in the year preceding the interventions and after 21 months of implementation of the interventions was reviewed. Trend analysis was performed using excel and statistical significance testing was performed using EPINFO StatCal option. The number of pregnant women attending the first ANC visit significantly increased from 114 to 150 in the first and fourth quarter of 2010 (OR 1.72; 95% CI 1.39-2.12) and to 202 in the third quarter of 2011(OR 11.41; 95% CI 7.97-16.34). The number of pregnant women counselled, tested and given results for HIV during the first ANC attendance significantly rose from 92 (80.7%) to 146 (97.3%) in the first and fourth quarter of 2010 and then to 201 (99.5%) in the third quarter of 2011. The number of male partners counseled, tested and given results together with their wives at first ANC visit rose from 13 (16.7%) in the fourth quarter of 2009 to 130 (89%) in the fourth quarter of 2010 and to 180 (89.6%) in the third quarter of 2011. There was a significant rise in the number of pregnant women delivering in the health facility with provision of mama-kits (delivery kits), from 74 (55.2%) to 149 (99.3%) in the second and fourth quarter of 2010. Combined community and facility systems

A meta-analysis of socio-demographic factors predicting birth in health facility.

PubMed

Berhan, Yifru; Berhan, Asres

2014-09-01

The low proportion of health facility delivery in developing countries is one of the main challenges in achieving the Millennium Development Goal of a global reduction of maternal deaths by 75% by 2015. There are several primary studies which identified socio-demographic and other predictors of birth in health facility. However, there are no efforts to synthesis the findings of these studies. The objective of this meta-analysis was to determine the strength of the association of birth in the health facility with selected sociodemographic factors. A meta-analysis of Mantel-Haenszel odds ratios was conducted by including 24 articles which were reported between 2000 and 2013 from developing countries. A computer-based search was done from MEDLINE, African Journals Online, Google Scholar and HINARI databases. Included studies did compare the women's' health facility delivery in relation to their selected socio-demographic characteristics. The pooled analysis demonstrated association of health facility delivery with living in urban areas (OR = 9.8), secondary and above educational level of the parents (OR = 5.0), middle to high wealth status (OR = 2.3) and first time pregnancy (OR = 2.8). The risk of delivering outside the health facility was not significantly associated with maternal age (teenage vs 20 years and above) and marital status. The distance of pregnant women's residence from the health facility was found to have an inverse relation to the proportion of health facility delivery. Although the present meta-analysis identified several variables which were associated with an increase in health facility delivery, the most important predictor of birth in the health facility amenable to intervention is educational status of the parents to be. Therefore, formal and informal education to women and family members on the importance of health facility delivery needs to be strengthened. Improving the wealth status of the population across the world may not be achieved

Status report on the activities of National Balloon Facility at Hyderabad

NASA Astrophysics Data System (ADS)

Shankarnarayan, Sreenivasan; S, Sreenivasan; Shankarnarayan, Sreenivasan; Manchanda, R. K.; Subba Rao Jonnalagadda, Venkata; Buduru, Suneelkumar

National balloon facility at Hyderabad has been mandated to provide launch support for Indian and International scientific balloon experiments and also perform the necessary research and development in the design and fabrication of plastic balloons. In the last 4 years, since our last report, NBF has launched many successful balloon flights for the astronomy payloads and a large number of high altitude GPS Sonde flights at different places in the country. We have also continued our efforts on qualification of raw materials for zero-failure performance of our balloons and major focus on upgrading of various facilities and load-line instrumentation for launching from remote sites. We foresee a surge of balloon based experimental activity for in-situ measurements in atmospheric sciences and concept validation payloads for future space based instruments. A new centre for research in Environmental Sciences and Payload Engineering (ESPE) has also been set up at the National Balloon Facility campus to develop and conduct research in various aspects of Environmental sciences in collaboration with other groups, with a specific goal to identify, development of advanced technologies leading to an improved understanding of the earth system. The Payload Engineering facility is geared to the Design and Fabrication of Micro and Nano Satellites and will act as Inter -University Centre for payload fabrication. In this paper we present an overview of the present and planned activities in scientific ballooning at National Balloon Facility Hyderabad.

National Transonic Facility Characterization Status

NASA Technical Reports Server (NTRS)

Bobbitt, C., Jr.; Everhart, J.; Foster, J.; Hill, J.; McHatton, R.; Tomek, W.

2000-01-01

This paper describes the current status of the characterization of the National Transonic Facility. The background and strategy for the tunnel characterization, as well as the current status of the four main areas of the characterization (tunnel calibration, flow quality characterization, data quality assurance, and support of the implementation of wall interference corrections) are presented. The target accuracy requirements for tunnel characterization measurements are given, followed by a comparison of the measured tunnel flow quality to these requirements based on current available information. The paper concludes with a summary of which requirements are being met, what areas need improvement, and what additional information is required in follow-on characterization studies.

Preliminary assessment report for Virginia Army National Guard Army Aviation Support Facility, Richmond International Airport, Installation 51230, Sandston, Virginia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dennis, C.B.

This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Virginia Army National Guard (VaARNG) property in Sandston, Virginia. The Army Aviation Support Facility (AASF) is contiguous with the Richmond International Airport. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The PA is designed to characterize the site accurately and determine the need for further action by examining site activities, quantities of hazardous substances present, and potential pathwaysmore » by which contamination could affect public health and the environment. The AASF, originally constructed as an active Air Force interceptor base, provides maintenance support for VaARNG aircraft. Hazardous materials used and stored at the facility include JP-4 jet fuel, diesel fuel, gasoline, liquid propane gas, heating oil, and motor oil.« less

Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities

PubMed Central

Allegranzi, Benedetta; Conway, Laurie; Larson, Elaine; Pittet, Didier

2014-01-01

Background The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. Methods From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Results Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Conclusion Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign. PMID:24581011

76 FR 40751 - National Environmental Policy Act; Wallops Flight Facility; Site-Wide

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-11

..., and to increase the knowledge of the Earth's upper atmosphere and the near space environment. The... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION [Notice (11-062)] National Environmental Policy Act; Wallops Flight Facility; Site- Wide AGENCY: National Aeronautics and Space Administration. ACTION: Notice...

Residents' willingness-to-pay for attributes of rural health care facilities.

PubMed

Allen, James E; Davis, Alison F; Hu, Wuyang; Owusu-Amankwah, Emmanuel

2015-01-01

As today's rural hospitals have struggled with financial sustainability for the past 2 decades, it is critical to understand their value relative to alternatives, such as rural health clinics and private practices. To estimate the willingness-to-pay for specific attributes of rural health care facilities in rural Kentucky to determine which services and operational characteristics are most valued by rural residents. We fitted choice experiment data from 769 respondents in 10 rural Kentucky counties to a conditional logit model and used the results to estimate willingness-to-pay for attributes in several categories, including hours open, types of insurance accepted, and availability of health care professionals and specialized care. Acceptance of Medicaid/Medicare with use of a sliding fee scale versus acceptance of only private insurance was the most valued attribute. Presence of full diagnostic services, an emergency room, and 24-hour/7-day-per-week access were also highly valued. Conversely, the presence of specialized care, such as physical therapy, cancer care, or dialysis, was not valued. In total, respondents were willing to pay $225 more annually to support a hospital relative to a rural health clinic. Rural Kentuckians value the services, convenience, and security that rural hospitals offer, though they are not willing to pay more for specialized care that may be available in larger medical treatment centers. The results also inform which attributes might be added to existing rural health facilities to make them more valuable to local residents. © 2014 National Rural Health Association.

Extending health insurance in Ghana: effects of the National Health Insurance Scheme on maternity care.

PubMed

Brugiavini, Agar; Pace, Noemi

2016-12-01

There is considerable interest in exploring the potential of social health insurance in Africa where a number of countries are currently experimenting with different approaches. Since these schemes have been introduced recently and are continuously evolving, it is important to evaluate their effectiveness in the enhancement of health care utilization and reduction of out-of-pocket expenses for potential policy suggestions. To investigate how the National Health Insurance Schemes (NHIS) in Ghana affects the utilization of maternal health care services and medical out-of-pocket expenses. We used nationally-representative household data from the Ghana Demographic and Health Survey (GDHS). We analyzed the 2014 GDHS focusing on four outcome variables, i.e. antenatal check up, delivery in a health facility, delivery assisted by a trained person and out-of-pocket expenditure. We estimated probit and bivariate probit models to take into account the issue of self selection into the health insurance schemes. The results suggest that, also taking into account the issue of self selection into the health insurance schemes, the NHIS enrollment positively affects the probability of formal antenatal check-ups before delivery, the probability of delivery in an institution and the probability of being assisted during delivery by a trained person. On the contrary, we find that, once the issue of self-selection is taken into account, the NHIS enrollment does not have a significant effect on out-of-pocket expenditure at the extensive margin. Since a greater utilization of health-care services has a strong positive effect on the current and future health status of women and their children, the health-care authorities in Ghana should make every effort to extend this coverage. In particular, since the results of the first step of the bivariate probit regressions suggest that the educational attainment of women is a strong determinant of enrollment, and those with low education and unable

Cleanups In My Community (CIMC) - Federal Facility RCRA Sites, National Layer

EPA Pesticide Factsheets

Federal facilities are properties owned by the federal government. This data layer provides access to Federal facilities that are Resource Conservation and Recovery Act (RCRA) sites as part of the CIMC web service. The Resource Conservation and Recovery Act, among other things, helps ensure that wastes are managed in an environmentally sound manner so as to protect human health and the environment from the potential hazards of waste disposal.In particular, RCRA tightly regulates all hazardous waste from cradle to grave. In general, all generators, transporters, treaters, storers, and disposers of hazardous waste are required to provide information about their activities to state environmental agencies. These agencies, in turn pass on the information to regional and national EPA offices. Accidents or other activities at facilities that treat, store or dispose of hazardous wastes have sometimes led to the release of hazardous waste or hazardous constituents into soil, ground water, surface water, or air. When that happens, the RCRA Corrective Action program is one program that may be used to accomplish the necessary cleanup.In Cleanups in My Community, you can map or list RCRA Corrective Action sites that are currently undergoing corrective action, sites for which a remedy has been selected, sites for which construction has been completed, and sites where the corrective action cleanup is complete. This data layer shows those RCRA sites that are located at Federa

A study of the operation of selected national research facilities

NASA Technical Reports Server (NTRS)

Eisner, M.

1974-01-01

The operation of national research facilities was studied. Conclusions of the study show that a strong resident scientific staff is required for successful facility operation. No unique scheme of scientific management is revealed except for the obvious fact that the management must be responsive to the users needs and requirements. Users groups provide a convenient channel through which these needs and requirements are communicated.

Fostering good governance at peripheral public health facilities: an experience from Nepal.

PubMed

Gurung, G; Tuladhar, S

2013-01-01

The Nepalese primary healthcare system at sub-district level consists of three different levels of health facility to serve the mostly rural population. The Ministry of Health and Population decentralised health services by handing over 1433 health facilities in 28 districts to Health Facility Operation and Management Committees (HFOMCs), which were formed following a public meeting, and consist of 9 to 13 members, representing the health facility in-charge, elected members of the village development committee, dalit (disadvantaged caste) and women members. The purpose was to make this local committee responsible for managing all affairs of the health facility. However, the handing over of the health facilities to HFOMCs was not matched by an equivalent increase in the managerial capacity of the members, which potentially makes this initiative ineffective. The Health Facility Management Strengthening Program was implemented in 13 districts to foster good governance in the health facilities by increasing the capacity of HFOMCs. This effort focuses on capacity building of HFOMCs as a continuous process rather than a one-off event. Training, follow-up and promotional activities were conducted. This article focuses on how good governance at the peripheral public health facilities in Nepal can be fostered through the active engagement and capacity building of HFOMCs. This article used baseline and monitoring data collected during technical support visits to HFOMCs and their members between July 2008 and October 2011. The results show that the Health Facility Management Strengthening Program was quite successful in strengthening local health governance in the health facilities. The level of community engagement in governance improved, that is, the number of effective HFOMC meetings increased, the inclusion of dalit/women members in the decision-making process expanded, resource mobilization was facilitated, and community accountability, as measured by health facility

WASH and gender in health care facilities: The uncharted territory.

PubMed

Kohler, Petra; Renggli, Samuel; Lüthi, Christoph

2017-11-08

Health care facilities in low- and middle-income countries are high-risk settings, and face special challenges to achieving sustainable water, sanitation, and hygiene (WASH) services. Our applied interdisciplinary research conducted in India and Uganda analyzed six dimensions of WASH services in selected health care facilities, including menstrual hygiene management. To be effective, WASH monitoring strategies in health care facilities must include gender sensitive measures. We present a novel strategy, showing that applied gender sensitive multitool assessments are highly productive in assessments of WASH services and facilities from user and provider perspectives. We discuss its potential for applications at scale and as an area of future research.

National health insurance policy in Nepal: challenges for implementation.

PubMed

Mishra, Shiva Raj; Khanal, Pratik; Karki, Deepak Kumar; Kallestrup, Per; Enemark, Ulrika

2015-01-01

The health system in Nepal is characterized by a wide network of health facilities and community workers and volunteers. Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. But the reality is a far cry. Only 61.8% of the Nepalese households have access to health facilities within 30 min, with significant urban (85.9%) and rural (59%) discrepancy. Addressing barriers to health services needs urgent interventions at the population level. Recently (February 2015), the Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme (SHS) after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias. Mechanisms should be built for monitoring unfair pricing and unaffordable copayments, and an overall benefit package be crafted to include coverage of major health services including non-communicable diseases. Regulations should include such issues as accreditation mechanisms for private providers. Health system strengthening should move along with the roll-out of SHS. Improving the efficiency of hospital, motivating the health workers, and using appropriate technology can improve the quality of health services. Also, as currently a constitution drafting is being finalized, careful planning and deliberation is necessary about what insurance structure may suit the proposed future federal structure in Nepal.

Video model deformation system for the National Transonic Facility

NASA Technical Reports Server (NTRS)

Burner, A. W.; Snow, W. L.; Goad, W. K.

1983-01-01

A photogrammetric closed circuit television system to measure model deformation at the National Transonic Facility is described. The photogrammetric approach was chosen because of its inherent rapid data recording of the entire object field. Video cameras are used to acquire data instead of film cameras due to the inaccessibility of cameras which must be housed within the cryogenic, high pressure plenum of this facility. A rudimentary theory section is followed by a description of the video-based system and control measures required to protect cameras from the hostile environment. Preliminary results obtained with the same camera placement as planned for NTF are presented and plans for facility testing with a specially designed test wing are discussed.

Drivers of facility deliveries in Africa and Asia: regional analyses using the demographic and health surveys.

PubMed

Diamond-Smith, Nadia; Sudhinaraset, May

2015-01-16

In the past few decades many countries have worked to increase the number of women delivering in facilities, with the goal of improving maternal and neonatal health outcomes. The purpose of this study is to explore the current situation of facility deliveries in Africa and Asia to understand where and with whom women deliver. Furthermore, we aim to test potential drivers of facility delivery at the individual, household, and community-level. Demographic and Health Survey data collected since 2003 from 43 countries in Africa and Asia is explored to understand the patterns of where women are delivering. We look at patterns by region and wealth quintile and urban/rural status. We then run a series of multi-level models looking at relationships between individual, household and community-level factors and the odds of a woman delivering in a facility. We explore this for Asia and Africa separately. We also look at correlates of delivery with a trained provider, in a public facility, in a private facility, with a doctor and in a hospital. The majority of women deliver in a facility and with a provider; however, about 20% of deliveries are still with no one or a friend/relative or alone. Rates of facility delivery are lower in Asia overall, and a greater proportion of deliveries take place in private facilities in Asia compared to Africa. Most of the individual level factors that have been found in past studies to be associated with delivering in a facility hold true for the multi-country-level analyses, and small differences exist between Asia and Africa. Women who deliver in private facilities differ from women who deliver in public facilities or at home. Most women in Africa and Asia are delivering in a facility, and drivers of facility delivery identified in smaller level or country specific studies hold true in multi-country national level data. More data and research is needed on other drivers, especially at the country-level and relating to the quality of care and

The National Ignition Facility: The world's largest optical system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stolz, C J

2007-10-15

The National Ignition Facility (NIF), a 192-beam fusion laser, is presently under construction at the Lawrence Livermore National Laboratory with an expected completion in 2008. The facility contains 7,456 meter-scale optics for amplification, beam steering, vacuum barriers, focusing, polarization rotation, and wavelength conversion. A multiphase program was put in place to increase the monthly optical manufacturing rate by up to 20x while simultaneously reducing cost by up to 3x through a sub-scale development, full-scale facilitization, and a pilot production phase. Currently 80% of the optics are complete with over 50% installed. In order to manufacture the high quality optics atmore » desired manufacturing rate of over 100 precision optics per month, new more deterministic advanced fabrication technologies had to be employed over those used to manufacture previous fusion lasers.« less

Human health risk characterization of petroleum coke calcining facility emissions.

PubMed

Singh, Davinderjit; Johnson, Giffe T; Harbison, Raymond D

2015-12-01

Calcining processes including handling and storage of raw petroleum coke may result in Particulate Matter (PM) and gaseous emissions. Concerns have been raised over the potential association between particulate and aerosol pollution and adverse respiratory health effects including decrements in lung function. This risk characterization evaluated the exposure concentrations of ambient air pollutants including PM10 and gaseous pollutants from a petroleum coke calciner facility. The ambient air pollutant levels were collected through monitors installed at multiple locations in the vicinity of the facility. The measured and modeled particulate levels in ambient air from the calciner facility were compared to standards protective of public health. The results indicated that exposure levels were, on occasions at sites farther from the facility, higher than the public health limit of 150 μg/m(3) 24-h average for PM10. However, the carbon fraction demonstrated that the contribution from the calciner facility was de minimis. Exposure levels of the modeled SO2, CO, NOx and PM10 concentrations were also below public health air quality standards. These results demonstrate that emissions from calcining processes involving petroleum coke, at facilities that are well controlled, are below regulatory standards and are not expected to produce a public health risk. Copyright © 2015 Elsevier Inc. All rights reserved.

Morbidity profile of elderly outpatients attending selected sub-district Siddha health facilities in Tamil Nadu, India

PubMed Central

Selvaraj, Kalaiselvi; Srinivasan, Manikandan; Duraisamy, Venkatachalam; Ramaswamy, Gomathi; Venugopal, Vinayagamurthy; Chinnakali, Palanivel

2016-01-01

Background: Recently, under National Health Mission alternate systems of Medicine are mainstreamed in public health care system. Effective action plan generation, logistic arrangement and roll out of these alternate systems of Medicine needs understanding on profile of morbidities among attendees who come to these facilities. Objectives: This study was planned to report profile of morbidities, age and sex differentials in specific morbidities among geriatric attendees in secondary level siddha health facilities. Materials and Methods: A facility based cross sectional study was conducted among elderly person (60 years and above) attending Siddha outpatient department (OPD) from two of the randomly selected sub district level siddha facilities in Erode district, Tamil Nadu, India. Information on socio-demographic variables like age, gender, education and clinical profile (diagnosis) were collected from records already maintained in the siddha OPD. Morbidities were summarized in terms of proportions based on age and gender. Age and sex specific differentials on specific morbidities were compared using ‘z’ test. Results: Of 2710 patients who visited these two siddha facilities during the reference period, 763 (28.1%) patients were elderly. Arthritis (45.2%), neuritis (8.8%), diabetes (6.6%), bronchial asthma (5.2%), hemiplegia (3.7%) were the top five morbidities diagnosed and treated among elderly attending the siddha OPD. There was a predilection towards elderly male for morbidities such as bronchial asthma and hemiplegia compared to elderly female. Similarly, higher proportions of lumbar spondylosis, hypertension and fungal skin diseases were reported among aged 80 years or more compared to elderly aged 60-79 years. Conclusion: Elderly constitute more than one fourth of outpatients load from siddha health facilities. Degenerative diseases like arthritis and non-communicable diseases were the common morbidities in this age group. Geriatric clinics and mobile

Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study

PubMed Central

Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris

2018-01-01

Background The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. Objective We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. Methods We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. Results This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was

Physical access to health facilities and contraceptive use in Kenya: evidence from the 2008-2009 Kenya Demographic and Health Survey.

PubMed

Ettarh, Remare R; Kyobutungi, Catherine

2012-09-01

The objective of the study was to determine the spatial variation in modern contraceptive use and unmet need for family planning across the counties of Kenya and to examine whether the spatial patterns were associated with inequalities in physical access to health facilities. Data were obtained from the 2008-2009 Kenya Demographic and Health Survey and linked to the location of health facilities in the country. Multivariate logistic regression was used to examine the influence of distance to the nearest health facility and health facility density, in addition to other covariates, on modern contraceptive use and unmet need. Overall, the prevalence of modern contraceptive use and unmet need among women aged 15-49 in Kenya was 42.1% and 19.7% respectively. Among the respondents who lived more than 5 km from the nearest health facility modern contraceptive use was significantly less likely compared to women resident 5 km or less from the nearest health facility. Women from counties with higher health facility density were 53% more likely to use modern contraceptives compared to women in counties with low health facility density. Distance and health facility density in the county were not significantly associated with unmet need. Physical access to health facilities is an important determinant of modern contraceptive use and unmet need in Kenya. Strategies should be developed in underserved counties to mitigate the challenge of distance to health facilities, such as delivering services by outreach and mobile facilities.

Characteristics and management of presumptive tuberculosis in public health facilities in Malawi, 2014–2016

PubMed Central

Gugsa, S.; Tweya, H.; Girma, B.; Kanyerere, H.; Dambe, I.; Babaye, Y.; Mpunga, J.; Phiri, S.

2017-01-01

Setting: Public health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services in Malawi. Objectives: Using routinely collected health service delivery data to describe trends in HIV ascertainment and use of the Xpert® MTB/RIF assay to diagnose TB among HIV-positive presumptive TB cases. Design: This was an implementation study of presumptive TB cases who sought care from 21 facilities between April 2014 and June 2016. Descriptive statistics were used to summarise patient, facility and service level characteristics. Results: Of 28 567 presumptive TB cases analysed, 23 198 (81%) had known HIV status. The proportion of ascertained HIV status in presumptive TB cases increased over the study period. HIV prevalence was 49%, with 73% of HIV-positive presumptive TB cases on antiretroviral therapy. Access to Xpert ranged between 37% and 63% per quarter among HIV-positive presumptive TB patients with smear-negative sputum results. Of 7829 patients with documented Xpert results, 68% were HIV-positive. Conclusion: After the introduction of registers with HIV-related variables, HIV ascertainment among presumptive TB cases increased over time. Access to Xpert was suboptimal among HIV-positive presumptive TB cases. Further collaboration between national TB and HIV programmes may facilitate increased use of Xpert for HIV-positive patients with presumptive TB who seek care in public health facilities. PMID:29584793

48 CFR 801.602-80 - Legal and technical review-Office of Construction and Facilities Management and National Cemetery...

Code of Federal Regulations, 2012 CFR

2012-10-01

...-Office of Construction and Facilities Management and National Cemetery Administration. 801.602-80 Section... Responsibilities 801.602-80 Legal and technical review-Office of Construction and Facilities Management and National Cemetery Administration. An Office of Construction and Facilities Management or National Cemetery...

48 CFR 801.602-80 - Legal and technical review-Office of Construction and Facilities Management and National Cemetery...

Code of Federal Regulations, 2011 CFR

2011-10-01

...-Office of Construction and Facilities Management and National Cemetery Administration. 801.602-80 Section... Responsibilities 801.602-80 Legal and technical review-Office of Construction and Facilities Management and National Cemetery Administration. An Office of Construction and Facilities Management or National Cemetery...

48 CFR 801.602-80 - Legal and technical review-Office of Construction and Facilities Management and National Cemetery...

Code of Federal Regulations, 2013 CFR

2013-10-01

...-Office of Construction and Facilities Management and National Cemetery Administration. 801.602-80 Section... Responsibilities 801.602-80 Legal and technical review-Office of Construction and Facilities Management and National Cemetery Administration. An Office of Construction and Facilities Management or National Cemetery...

48 CFR 801.602-80 - Legal and technical review-Office of Construction and Facilities Management and National Cemetery...

Code of Federal Regulations, 2014 CFR

2014-10-01

...-Office of Construction and Facilities Management and National Cemetery Administration. 801.602-80 Section... Responsibilities 801.602-80 Legal and technical review-Office of Construction and Facilities Management and National Cemetery Administration. An Office of Construction and Facilities Management or National Cemetery...

Unique governance for a national ministry. Catholic Health Initiatives' board structure empowers laity, supports mission.

PubMed

Poe, J E

1998-01-01

The three original founding healthcare systems and 10 sponsoring religious institutes of Catholic Health Initiatives (CHI) have developed an unprecedented governance model to support their vision of a national Catholic health ministry in the twenty-first century. The new organization spans 22 states; annual revenues exceed $4.7 billion. Religious institutes choose either active or honorary status before consolidating with CHI, depending on their desired involvement in the organization. Currently, nine are active and two are honorary. CHI's civil corporation comprises one representative from each active congregation. These representatives approve major changes in mission or philosophical direction. They control board membership by appointing three to five congregation representatives as sponsorship trustees, who are responsible for approving the remaining members of the Board of Stewardship Trustees. This half-religious, half-lay governing board is responsible for leading CHI. CHI has only two levels of governance, a national board and boards of market-based organizations, for instance a network of facilities with one management structure, or a community board of an individual facility. This avoids multiple administrative layers and approval processes. The organization has a civil identity as CHI and a canonical identity as a public juridic person of pontifical right, called Catholic Health Care Federation (CHCF). The governing board members of CHI, as members of CHCF, serve as the religious sponsors for all CHI health facilities. Some facilities have already been "alienated" (turned over) to CHI by their religious institutes; others will be alienated in the future. CHI's recent consolidation with Sisters of Charity of Nazareth Health System added an 11th sponsor, a sixth geographic region, and two members--one religious and one lay--to the governing board. The governance model assists such growth through the appeal of an equal religious-lay partnership and a

Dialectical Behavior Therapy Training and Desired Resources for Implementation: Results From a National Program Evaluation in the Veterans Health Administration.

PubMed

Landes, Sara J; Matthieu, Monica M; Smith, Brandy N; Trent, Lindsay R; Rodriguez, Allison L; Kemp, Janet; Thompson, Caitlin

2016-08-01

Little is known about nonresearch training experiences of providers who implement evidence-based psychotherapies for suicidal behaviors among veterans. This national program evaluation identified the history of training, training needs, and desired resources of clinicians who work with at-risk veterans in a national health care system. This sequential mixed methods national program evaluation used a post-only survey design to obtain needs assessment data from clinical sites (N = 59) within Veterans Health Administration (VHA) facilities that implemented dialectical behavior therapy (DBT). Data were also collected on resources preferred to support ongoing use of DBT. While only 33% of clinical sites within VHA facilities reported that staff attended a formal DBT intensive training workshop, nearly 97% of participating sites reported having staff who completed self-study using DBT manuals. Mobile apps for therapists and clients and templates for documentation in the electronic health records to support measurement-based care were desired clinical resources. Results indicate that less-intensive training models can aid staff in implementing DBT in real-world health care settings. While more training is requested, a number of VHA facilities have successfully implemented DBT into the continuum of care for veterans at risk for suicide. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

11 CFR 100.56 - Office building or facility for national party committees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... national party committees. A gift, subscription, loan, advance, or deposit of money or anything of value to a national party committee for the purchase or construction of an office building or facility is a...

An Overview Of The National Institute For Occupational Safety And Health (NIOSH) Activity In Nonionizing Radiation

NASA Astrophysics Data System (ADS)

Moss, C. Eugene

1980-10-01

The National Institute for Occupational Safety and Health (NIOSH) is a major component of the Center for Disease Control in the Department of Health, Education, and Welfare (DHEW). Headquarters for NIOSH are located in Rockville, Maryland, with laboratory facilities in Morgantown, West Virginia and Cincinnati, Ohio. NIOSH has approximately 900 employees with about 60% located in Cincinnati.

Recent Enhancements to the National Transonic Facility

NASA Technical Reports Server (NTRS)

Kilgore, W. A.; Balakrishna, S.; Bobbitt, C. W.; Underwood, P.

2003-01-01

The National Transonic Facility continues to make enhancements to provide quality data in a safe, efficient and cost effective method for aerodynamic ground testing. Recent enhancements discussed in this paper include the restoration of reliability and improved performance of the heat exchanger systems resulting in the expansion of the NTF air operations envelope. Additionally, results are presented from a continued effort to reduce model dynamics through the use of a new stiffer balance and sting

The Effect of the Removal of User Fees for Delivery at Public Health Facilities on Institutional Delivery in Urban Kenya.

PubMed

Calhoun, Lisa M; Speizer, Ilene S; Guilkey, David; Bukusi, Elizabeth

2018-03-01

Objectives In 2013, Kenya removed delivery fees at public health facilities in an effort to promote equity in access to health services and address high maternal mortality. This study determines the effect of the policy to remove user fees on institutional delivery in a population-based sample of women from urban Kenya. Methods Longitudinal data were collected from a representative sample of 8500 women from five cities in Kenya in 2010 with a follow-up interview in 2014 (response rate 58.9%). Respondents were asked about their most recent birth since 2008 at baseline and 2012 at endline, including the delivery location. Multinomial logistic regression is used, controlling for the temporal time trend and background characteristics, to determine if births which occurred after the national policy change were more likely to occur at a public facility than at home or a private facility. Results Multivariate findings show that women were significantly more likely to deliver at a public facility as compared to a private facility after the policy. Among the poor, the results show that poor women were significantly more likely to deliver in a public facility compared to home or a private facility after policy change. Conclusions for Practice These findings show Kenya's progress towards achieving universal access to delivery services and meeting its national development targets. The removal of delivery fees in the public sector is leading to increased use of facilities for delivery among the urban poor; this is an important first step in reducing maternal death.

Utilisation of health services and geography: deconstructing regional differences in barriers to facility-based delivery in Nepal.

PubMed

Hodge, Andrew; Byrne, Abbey; Morgan, Alison; Jimenez-Soto, Eliana

2015-03-01

While established that geographical inaccessibility is a key barrier to the utilisation of health services, it remains unknown whether disparities are driven only by limited access to these services, or are also attributable to health behaviour. Significant disparities exist in health outcomes and the coverage of many critical health services between the mountains region of Nepal and the rest of the country, yet the principal factors driving these regional disparities are not well understood. Using national representative data from the 2011 Nepal Demographic and Health Survey, we examine the extent to which observable factors explain the overall differences in the utilisation of maternal health services. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect that differences in measurable characteristics have on the regional coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was 18.6 and 36.3 % in the mountains region and the rest of Nepal, respectively. Between 54.8 and 74.1 % of the regional coverage gap was explained by differences in observed characteristics. Factors influencing health behaviours (proxied by mothers' education, TV viewership and tobacco use, and household wealth) and subjective distance to the health facility were the major factors, contributing between 52.9 and 62.5 % of the disparity. Mothers' birth history was also noteworthy. Policies simultaneously addressing access and health behaviours appear necessary to achieve greater coverage and better health outcomes for women and children in isolated areas.

Human Health and Ecological Risk Assessment for the Operation of the Explosives Waste Treatment Facility at Site 300 of the Lawrence Livermore National Laboratory

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gallegos, G; Daniels, J; Wegrecki, A

2007-10-01

This document contains the human health and ecological risk assessment for the Resource Recovery and Conservation Act (RCRA) permit renewal for the Explosives Waste Treatment Facility (EWTF). Volume 1 is the text of the risk assessment, and Volume 2 (provided on a compact disc) is the supporting modeling data. The EWTF is operated by the Lawrence Livermore National Laboratory (LLNL) at Site 300, which is located in the foothills between the cities of Livermore and Tracy, approximately 17 miles east of Livermore and 8 miles southwest of Tracy. Figure 1 is a map of the San Francisco Bay Area, showingmore » the location of Site 300 and other points of reference. One of the principal activities of Site 300 is to test what are known as 'high explosives' for nuclear weapons. These are the highly energetic materials that provide the force to drive fissionable material to criticality. LLNL scientists develop and test the explosives and the integrated non-nuclear components in support of the United States nuclear stockpile stewardship program as well as in support of conventional weapons and the aircraft, mining, oil exploration, and construction industries. Many Site 300 facilities are used in support of high explosives research. Some facilities are used in the chemical formulation of explosives; others are locations where explosive charges are mechanically pressed; others are locations where the materials are inspected radiographically for such defects as cracks and voids. Finally, some facilities are locations where the machined charges are assembled before they are sent to the onsite test firing facilities, and additional facilities are locations where materials are stored. Wastes generated from high-explosives research are treated by open burning (OB) and open detonation (OD). OB and OD treatments are necessary because they are the safest methods for treating explosives wastes generated at these facilities, and they eliminate the requirement for further handling and

Supportive supervision for medicines management in government health facilities in Kiambu County, Kenya: a health workers' perspective.

PubMed

Agoro, Oscar Otieno; Osuga, Ben Onyango; Adoyo, Maureen

2015-01-01

Effective supportive supervision is widely recognized as essential for optimal management of medicines in government health facilities and also in contributing towards improved access and utilization of health services. This study sought to examine the extent supportive supervision for medicines management in government health facilities from a health worker perspective. A cross-sectional study was done targeting health workers managing medicines in government health facilities in Kiambu County. One hundred and thirty eight respondents took part in the study which explored the quality of supportive supervision from a health worker's perspective, and also examined the factors influencing their contentment with the level of supervision received. A statistical analysis was done using SPSS 21 and Excel 2013. Supervisory visits from all levels of health management were not regularly done, standard checklists were not routinely used, and action plans irregularly developed and followed up. Only 54 (38.6%) respondents were satisfied with the levels of supportive supervision that they received, with satisfaction significantly differing across the professional cadres, χ (2) (12, n = 138) = 29.762, p = .003; across the different tiers of health facilities, r s (138) = 0.341, p < .001; and with the education levels of the respondents, r s (138) = 0.381, p < .001. The study concluded that supportive supervision for medicines management that government health facilities received was still inadequate, and health workers were dissatisfied with the level of supervision that they received. The study recommends a review of the support supervision policy at the county level to address the unearthed inefficiencies and improve supervision for medicines management in government health facilities.

Do service innovations influence the adoption of electronic health records in long-term care organizations? Results from the U.S. National Survey of Residential Care Facilities.

PubMed

Bhuyan, Soumitra S; Zhu, He; Chandak, Aastha; Kim, Jungyoon; Stimpson, Jim P

2014-12-01

Healthcare organizations including residential care facilities (RCFs) are diversifying their services to meet market demands. Service innovations have been linked to the changes in the way that healthcare organizations organize their work. The objective of this study is to explore the relationship between organizational service innovations and Electronic Health Record (EHR) adoption in the RCFs. We used the data from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF adopted EHR or not, and the predictors were the organizational service innovations including provision of skilled nursing care and medication review. We also added facility characteristics as control variables. Weighted multivariate logistic regressions were used to estimate the relationship between service innovation factors and EHR adoption in the RCFs. In 2010, about 17.4% of the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing services to their residents are more likely (OR: 1.42; 95% CI: 1.09-1.87) to adopt EHR. Similarly, RCFs with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00-1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid certification were significantly associated with EHR adoption. Our findings suggest that service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health care organizations, where quality of care and interoperability of patients' records might play a vital role under the current healthcare reform. Future research could examine the relationship between service innovations and use of different EHR functionality in

National health expenditures, 1985

PubMed Central

Waldo, Daniel R.; Levit, Katharine R.; Lazenby, Helen

1986-01-01

Slower price inflation in 1985 translated into slower growth of national health expenditures, but underlying growth in the use of goods and services continued along historic trends. Coupled with somewhat sluggish growth of the gross national product, this adherence to trends pushed the share of our Nation's output accounted for by health spending to 10.7 percent. Some aspects of health spending changed: Falling use of hospital services was offset by rising hospital profits and increased use of other health care services. Other aspects remained the same: Both the public sector and the private sector continued efforts to contain costs, efforts that have affected and will continue to affect not only the providers of care but the users of care as well. PMID:10311775

The US National Transonic Facility, NTF

NASA Technical Reports Server (NTRS)

Bruce, Walter E., Jr.; Gloss, Blair B.

1989-01-01

The construction of the National Transonic Facility was completed in September 1982 and the start-up and checkout of tunnel systems were performed over the next two years. In August 1984, the Operational Readiness Review (ORR) was conducted and the facility was declared operational for final checkout of cryogenic instrumentation and control systems, and for the aerodynamic calibration and testing to commence. Also, the model access system for the cryogenic mode of operation would be placed into operation along with tunnel testing. Since the ORR, a host of operating problems resulting from the cryogenic environment were identified and solved. These range from making mechanical and electrical systems functional to eliminating temperature induced model vibration to coping with the outgassing of moisture from the thermal insulation. Additionally, a series of aerodynamic tests have demonstrated data quality and provided research data on several configurations. Some of the more significant efforts are reviewed since the ORR and the NTF status concerning hardware, instrumentation and process controls systems, operating constraints imposed by the cryogenic environment, and data quality are summarized.

Risk assessment and optimization (ALARA) analysis for the environmental remediation of Brookhaven National Laboratory`s hazardous waste management facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dionne, B.J.; Morris, S.C. III; Baum, J.W.

1998-01-01

The Department of Energy`s (DOE) Office of Environment, Safety, and Health (EH) sought examples of risk-based approaches to environmental restoration to include in their guidance for DOE nuclear facilities. Extensive measurements of radiological contamination in soil and ground water have been made at Brookhaven National Laboratory`s Hazardous Waste Management Facility (HWMF) as part of a Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) remediation process. This provided an ideal opportunity for a case study. This report provides a risk assessment and an {open_quotes}As Low as Reasonably Achievable{close_quotes} (ALARA) analysis for use at other DOE nuclear facilities as an example ofmore » a risk-based decision technique. This document contains the Appendices for the report.« less

Flow Disturbance Measurements in the National Transonic Facility

NASA Technical Reports Server (NTRS)

King, Rudolph A.; Andino, Marlyn Y.; Melton, Latunia; Eppink, Jenna; Kegerise, Michael A.

2013-01-01

Recent flow measurements have been acquired in the National Transonic Facility to assess the test-section unsteady flow environment. The primary purpose of the test is to determine the feasibility of the facility to conduct laminar-flow-control testing and boundary-layer transition-sensitive testing at flight-relevant operating conditions throughout the transonic Mach number range. The facility can operate in two modes, warm and cryogenic test conditions for testing full and semispan-scaled models. Data were acquired for Mach and unit Reynolds numbers ranging from 0.2 less than or equal to M less than or equal to 0.95 and 3.3 × 10(exp 6) less than Re/m less than 220×10(exp 6) collectively at air and cryogenic conditions. Measurements were made in the test section using a survey rake that was populated with 19 probes. Roll polar data at selected conditions were obtained to look at the uniformity of the flow disturbance field in the test section. Data acquired included mean total temperatures, mean and fluctuating static/total pressures, and mean and fluctuating hot-wire measurements. This paper focuses primarily on the unsteady pressure and hot-wire results. Based on the current measurements and previous data, an assessment was made that the facility may be a suitable facility for ground-based demonstrations of laminar-flow technologies at flight-relevant conditions in the cryogenic mode.

A national survey of the impact of rapid scale-up of antiretroviral therapy on health-care workers in Malawi: effects on human resources and survival.

PubMed

Makombe, Simon D; Jahn, Andreas; Tweya, Hannock; Chuka, Stuart; Yu, Joseph Kwong-Leung; Hochgesang, Mindy; Aberle-Grasse, John; Pasulani, Olesi; Schouten, Erik J; Kamoto, Kelita; Harries, Anthony D

2007-11-01

To assess the human resources impact of Malawis rapidly growing antiretroviral therapy (ART) programme and balance this against the survival benefit of health-care workers who have accessed ART themselves. We conducted a national cross-sectional survey of the human resource allocation in all public-sector health facilities providing ART in mid-2006. We also undertook a survival analysis of health-care workers who had accessed ART in public and private facilities by 30 June 2006, using data from the national ART monitoring and evaluation system. By 30 June 2006, 59 581 patients had accessed ART from 95 public and 28 private facilities. The public sites provided ART services on 2.4 days per week on average, requiring 7% of the clinician workforce, 3% of the nursing workforce and 24% of the ward clerk workforce available at the facilities. We identified 1024 health-care workers in the national ART-patient cohort (2% of all ART patients). The probabilities for survival on ART at 6 months, 12 months and 18 months were 85%, 81% and 78%, respectively. An estimated 250 health-care workers lives were saved 12 months after ART initiation. Their combined work-time of more than 1000 staff-days per week was equivalent to the human resources required to provide ART at the national level. A large number of ART patients in Malawi are managed by a small proportion of the health-care workforce. Many health-care workers have accessed ART with good treatment outcomes. Currently, staffing required for ART balances against health-care workers lives saved through treatment, although this may change in the future.

7 CFR 1956.143 - Debt restructuring-hospitals and health care facilities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 103-354 will consider the following criteria for selection: past experience in health care facility... 7 Agriculture 14 2011-01-01 2011-01-01 false Debt restructuring-hospitals and health care... Settlement-Community and Business Programs § 1956.143 Debt restructuring—hospitals and health care facilities...

An equity analysis of utilization of health services in Afghanistan using a national household survey.

PubMed

Kim, Christine; Saeed, Khwaja Mir Ahad; Salehi, Ahmad Shah; Zeng, Wu

2016-12-05

Afghanistan has made great strides in the coverage of health services across the country but coverage of key indicators remains low nationally and whether the poorest households are accessing these services is not well understood. We analyzed the Afghanistan Mortality Survey 2010 on utilization of inpatient and outpatient care, institutional delivery and antenatal care by wealth quintiles. Concentration indexes (CIs) were generated to measure the inequality of using the four services. Additional analyses were conducted to examine factors that explain the health inequalities (e.g. age, gender, education and residence). Among households reporting utilization of health services, public health facilities were used more often for inpatient care, while they were used less for outpatient care. Overall, the utilization of inpatient and outpatient care, and antenatal care was equally distributed among income groups, with CIs of 0.04, 0.03 and 0.08, respectively. However, the poor used more public facilities while the wealthy used more private facilities. There was a substantial inequality in the use of institutional delivery services, with a CI of 0.31. Poorer women had a lower rate of institutional deliveries overall, in both public and private facilities, compared to the wealthy. Location was an important factor in explaining the inequality in the use of health services. The large gap between the rich and poor in access to and utilization of key maternal services, such as institutional delivery, may be a central factor to the high rates of maternal mortality and morbidity and impedes efforts to make progress toward universal health coverage. While poorer households use public health services more often, the use of public facilities for outpatient visits remains half that of private facilities. Pro-poor targeting as well as a better understanding of the private sector's role in increasing equitable coverage of maternal health services is needed. Equity-oriented approaches

Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study.

PubMed

Muinga, Naomi; Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris

2018-04-18

The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a

75 FR 54627 - Best Management Practices for Unused Pharmaceuticals at Health Care Facilities

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-08

... at Health Care Facilities AGENCY: Environmental Protection Agency (EPA). ACTION: Notice. SUMMARY: EPA... Unused Pharmaceuticals at Health Care Facilities. The guidance is targeted at hospitals, medical clinics... drafted a guidance document for health care facilities, which describes: Techniques for reducing or...

The role of civil society in strengthening intercultural maternal health care in local health facilities: Puno, Peru

PubMed Central

Samuel, Jeannie

2016-01-01

Background and objective Peru's Ministry of Health has made efforts to increase the cultural inclusiveness of maternal health services. In 2005, the Ministry adopted an intercultural birthing policy (IBP) that authorizes and encourages the use of culturally acceptable birthing practices in government-run health facilities. However, studies suggest that indigenous women may receive inconsistent benefits from these kinds of policies. This article examines whether a grassroots accountability initiative based on citizen monitoring of local health facilities by indigenous women can help to promote the objectives of the IBP and improve intercultural maternal health care. Design Findings are drawn from a larger qualitative research study completed in 2015 that included fieldwork done between 2010 and 2011. Semi-structured interviews were conducted with 23 women working as citizen monitors in local health facilities in Puno and 30 key informants, including frontline health workers, health officials, and civil society actors in Puno and Lima, and human rights lawyers from the Defensoría del Pueblo Office in Puno. Results Monitors confirmed from their own personal experiences in the 1990s and early 2000s that respect for intercultural aspects of maternal health care, including traditional indigenous birthing practices, were not readily accepted in publicly funded health facilities. It was also common for indigenous women to face discrimination when seeking health service provided by the state. Although the government's adoption of the IBP in 2005 was a positive step, considerable efforts are still needed to ensure high-quality, culturally appropriate maternal health care is consistently available in local health facilities. Conclusions Despite important progress in the past two decades, policies aimed at improving intercultural maternal health care are unevenly implemented in local health facilities. Civil society, in particular indigenous women themselves, can play an

Towards National eHealth Implementation--a comparative study on WHO/ITU National eHealth Strategy Toolkit in Iran.

PubMed

Riazi, Hossein; Jafarpour, Maryam; Bitaraf, Ehsan

2014-01-01

Experiences has shown that utilization of ICT in health sector requires national commitment and planned efforts to make the best use of existing capacity. Establishing the main directions as well as planning the detailed steps needed are key to achieving longer-term goals such as health sector efficiency, reform or more fundamental transformation. Collaboration between the health and ICT sectors, both public and private, is central to this effort. As the major United Nations agencies for health and telecommunications respectively, the World Health Organization (WHO) and the International Telecommunication Union (ITU) have recognized the importance of collaboration for eHealth in their global resolutions, which encourage countries to develop national eHealth strategies; the National eHealth Strategy Toolkit is the proof of these recommendations. In this study a mapping of eHealth components in WHO/ITU National eHealth Strategy Toolkit and our national eHealth vision is presented.

Estimating debt capacity of New York State Health facilities.

PubMed

Hogan, A J

1985-01-01

A measure of the capacity to take on new debt is developed for health facilities. This measure is a function of the current financial position of the facility, future financial market conditions (interest rates and bond/loan maturities), and a policy variable (the debt service coverage ratio) to be set by state health policy makers. The quality of this measure was shown to depend on the quality of current health facility financial accounting data, on the quality of forecasts of interest rates and future cashflow, and on the appropriateness of the criterion debt service coverage ratio. Some of the limitations of the estimate are discussed. Consideration of the debt capacity estimate serves to highlight some crucial issues in imposing capital expenditure limits, namely the interrelationships between financial viability, interest rates and access to capital markets.

National Health Expenditures, 1982

PubMed Central

Gibson, Robert M.; Waldo, Daniel R.; Levit, Katharine R.

1983-01-01

Rapid growth in the share of the nation's gross national product devoted to health expenditure has heightened concern over the survival of government entitlement programs and has led to debate of the desirability of current methods of financing health care. In this article, the authors present the data at the heart of the issue, quantifying spending for various types of health care in 1982 and discussing the sources of funds for that spending. PMID:10310273

Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey

PubMed Central

Horng, L.M.; Unicomb, L.; Alam, M.-U.; Halder, A.K.; Shoab, A.K.; Ghosh, P.K.; Opel, A.; Islam, M.K.; Luby, S.P.

2017-01-01

SUMMARY Background Healthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions. Aim To conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy. Methods The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities. Findings More than 96% of facilities had ‘improved’ water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78–92% of handwashing locations for doctors and nurses, but just 4–30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%). Conclusion Healthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi health-care facilities. PMID:27665311

Quality management standards for facility services in the Italian health care sector.

PubMed

Cesarotti, Vittorio; Di Silvio, Bruna

2006-01-01

Health care, one of the most dynamic sectors in Italy, is studied with a particular focus on outsourcing non-core activities such as facility management (FM) services. The project's goals are to define national standards to balance and control facility service evolution, and to drive FM services towards organisational excellence. The authors, in cooperation with a pool of facility service providers and hospitals managers, studied cleaning services--one of the most critical areas. This article describes the research steps and findings following definition and publication of the Italian standard and its application to an international benchmarking process. The method chosen for developing the Italian standard was to merge technical, strategic and organisational aspects with the goal of standardising the contracting system, giving service providers the chance to improve efficiency and quality, while helping healthcare organisations gain from a better, more reliable and less expensive service. The Italian standard not only improved services but also provided adequate control systems for outsourcing organisations. In this win-win context, it is hoped to continually drive FM services towards organisational excellence. This study is specific to the Italian national healthcare system. However, the strategic dynamics described are common to many other contexts. A systematic method for improving hospital FM services is presented. The authors believe that lessons learned from their Italian case study can be used to better understand and drive similar services in other countries or in other FM service outsourcing sectors.

National Health Expenditures, 1978

PubMed Central

Gibson, Robert M.

1979-01-01

Outlays for health care in the Nation reached $192.4 billion in calendar year 1978--13 percent higher than in 1977, according to preliminary figures compiled by the Health Care Financing Administration. This estimate represented $863 per person in the United States and was equal to 9.1 percent of the GNP. This latest report in the annual series representing national health expenditures provides detailed estimates of health care spending by type of service and method of financing. Revised estimates are presented extending back to 1965. PMID:10309049

78 FR 55751 - National Institutes of Health

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-11

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Eye Institute...: National Institutes of Health, Neuroscience Building, Conference Room D, 6001 Executive Boulevard...: National Institutes of Health, Neuroscience Building, Conference Room D, 6001 Executive Boulevard...

Health system support for childbirth care in Southern Tanzania: results from a health facility census

PubMed Central

2013-01-01

Background Progress towards reaching Millennium Development Goals four (child health) and five (maternal health) is lagging behind, particularly in sub-Saharan Africa, despite increasing efforts to scale up high impact interventions. Increasing the proportion of birth attended by a skilled attendant is a main indicator of progress, but not much is known about the quality of childbirth care delivered by these skilled attendants. With a view to reducing maternal mortality through health systems improvement we describe the care routinely offered in childbirth at dispensaries, health centres and hospitals in five districts in rural Southern Tanzania. We use data from a health facility census assessing 159 facilities in five districts in early 2009. A structural and operational assessment was undertaken based on staff reports using a modular questionnaire assessing staffing, work load, equipment and supplies as well as interventions routinely implemented during childbirth. Results Health centres and dispensaries attended a median of eight and four deliveries every month respectively. Dispensaries had a median of 2.5 (IQR 2–3) health workers including auxiliary staff instead of the recommended four clinical officer and certified nurses. Only 28% of first-line facilities (dispensaries and health centres) reported offering active management in the third stage of labour (AMTSL). Essential childbirth care comprising eight interventions including AMTSL, infection prevention, partograph use including foetal monitoring and newborn care including early breastfeeding, thermal care at birth and prevention of ophthalmia neonatorum was offered by 5% of dispensaries, 38% of health centres and 50% of hospitals consistently. No first-line facility had provided all signal functions for emergency obstetric complications in the previous six months. Conclusions Essential interventions for childbirth care are not routinely implemented in first-line facilities or hospitals. Dispensaries

Recent Productivity Improvements to the National Transonic Facility

NASA Technical Reports Server (NTRS)

Popernack, Thomas G., Jr.; Sydnor, George H.

1998-01-01

Productivity gains have recently been made at the National Transonic Facility wind tunnel at NASA Langley Research Center. A team was assigned to assess and set productivity goals to achieve the desired operating cost and output of the facility. Simulations have been developed to show the sensitivity of selected process productivity improvements in critical areas to reduce overall test cycle times. The improvements consist of an expanded liquid nitrogen storage system, a new fan drive, a new tunnel vent stack heater, replacement of programmable logic controllers, an increased data communications speed, automated test sequencing, and a faster model changeout system. Where possible, quantifiable results of these improvements are presented. Results show that in most cases, improvements meet the productivity gains predicted by the simulations.

National Ignition Facility Target Chamber

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wavrik, R W; Cox, J R; Fleming, P J

2000-10-05

On June 11, 1999 the Department of Energy dedicated the single largest piece of the National Ignition Facility (NIF) at Lawrence Livermore National Laboratory (LLNL) in Livermore, California. The ten (10) meter diameter aluminum target high vacuum chamber will serve as the working end of the largest laser in the world. The output of 192 laser beams will converge at the precise center of the chamber. The laser beams will enter the chamber in two by two arrays to illuminate 10 millimeter long gold cylinders called hohlraums enclosing 2 millimeter capsule containing deuterium, tritium and isotopes of hydrogen. The twomore » isotopes will fuse, thereby creating temperatures and pressures resembling those found only inside stars and in detonated nuclear weapons, but on a minute scale. The NIF Project will serve as an essential facility to insure safety and reliability of our nation's nuclear arsenal as well as demonstrating inertial fusion's contribution to creating electrical power. The paper will discuss the requirements that had to be addressed during the design, fabrication and testing of the target chamber. A team from Sandia National Laboratories (SNL) and LLNL with input from industry performed the configuration and basic design of the target chamber. The method of fabrication and construction of the aluminum target chamber was devised by Pitt-Des Moines, Inc. (PDM). PDM also participated in the design of the chamber in areas such as the Target Chamber Realignment and Adjustment System, which would allow realignment of the sphere laser beams in the event of earth settlement or movement from a seismic event. During the fabrication of the target chamber the sphericity tolerances had to be addressed for the individual plates. Procedures were developed for forming, edge preparation and welding of individual plates. Construction plans were developed to allow the field construction of the target chamber to occur parallel to other NIF construction activities. This was

Health spending and political influence: the case of earmarks and health care facilities.

PubMed

Leider, Jonathon P; Tung, Greg; Castrucci, Brian; Sprague, James B

2015-01-01

Earmarks, otherwise known as Congressionally directed spending requests, are a historically significant means of political influence over budgets. In this brief, we report on the results of a longitudinal study of federal earmarks affecting health care facilities and public health. We analyzed 10 years of earmark for health care facilities and examined the correlates of being in the top 50% of earmark recipients for each year. Having representatives or senators serving on the respective Appropriations committees were shown to have increased odds of being a top earmark recipient, as was being in jurisdictions with greater poverty. However, health-related measures of need were not significantly associated with being a top earmark recipient.

Evaluation of aircraft crash hazard at Los Alamos National Laboratory facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Selvage, R.D.

This report selects a method for use in calculating the frequency of an aircraft crash occurring at selected facilities at the Los Alamos National Laboratory (the Laboratory). The Solomon method was chosen to determine these probabilities. Each variable in the Solomon method is defined and a value for each variable is selected for fourteen facilities at the Laboratory. These values and calculated probabilities are to be used in all safety analysis reports and hazards analyses for the facilities addressed in this report. This report also gives detailed directions to perform aircraft-crash frequency calculations for other facilities. This will ensure thatmore » future aircraft-crash frequency calculations are consistent with calculations in this report.« less

The effect of health-facility admission and skilled birth attendant coverage on maternal survival in India: a case-control analysis.

PubMed

Montgomery, Ann L; Fadel, Shaza; Kumar, Rajesh; Bondy, Sue; Moineddin, Rahim; Jha, Prabhat

2014-01-01

Research in areas of low skilled attendant coverage found that maternal mortality is paradoxically higher in women who seek obstetric care. We estimated the effect of health-facility admission on maternal survival, and how this effect varies with skilled attendant coverage across India. Using unmatched population-based case-control analysis of national datasets, we compared the effect of health-facility admission at any time (antenatal, intrapartum, postpartum) on maternal deaths (cases) to women reporting pregnancies (controls). Probability of maternal death decreased with increasing skilled attendant coverage, among both women who were and were not admitted to a health-facility, however, the risk of death among women who were admitted was higher (at 50% coverage, OR = 2.32, 95% confidence interval 1.85-2.92) than among those women who were not; while at higher levels of coverage, the effect of health-facility admission was attenuated. In a secondary analysis, the probability of maternal death decreased with increasing coverage among both women admitted for delivery or delivered at home but there was no effect of admission for delivery on mortality risk (50% coverage, OR = 1.0, 0.80-1.25), suggesting that poor quality of obstetric care may have attenuated the benefits of facility-based care. Subpopulation analysis of obstetric hemorrhage cases and report of 'excessive bleeding' in controls showed that the probability of maternal death decreased with increasing skilled attendant coverage; but the effect of health-facility admission was attenuated (at 50% coverage, OR = 1.47, 0.95-1.79), suggesting that some of the effect in the main model can be explained by women arriving at facility with complications underway. Finally, highest risk associated with health-facility admission was clustered in women with education ≤ 8 years. The effect of health-facility admission did vary by skilled attendant coverage, and this effect appears to be driven partially by reverse

76 FR 71047 - National Institutes of Health

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-16

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute on...., Chief, Extramural Project Review Branch EPRB, NIAAA, National Institutes of Health, 5365 Fishers Lane... Awards., National Institutes of Health, HHS) Dated: November 8, 2011. Jennifer S. Spaeth, Director...

78 FR 24427 - National Institutes of Health

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-25

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Proposed Collection; 60-Day..., the National Human Genome Research Institute (NHGRI), National Institutes of Health (NIH), will... Genome Research Institute (NHGRI), National Institutes of Health (NIH). Need and Use of Information...

Shielding calculations and verifications for the new Radiation Instrument Calibration Facility at Los Alamos National Laboratory

DOE Office of Scientific and Technical Information (OSTI.GOV)

George, G. L.; Olsher, R. H.; Seagraves, D. T.

2002-01-01

MCNP-4C1 was used to perform the shielding design for the new Central Health Physics Calibration Facility (CHPCF) at Los Alamos National Laboratory (LANL). The problem of shielding the facility was subdivided into three separate components: (1) Transmission; (2) Skyshine; and (3) Maze Streaming/ Transmission. When possible, actual measurements were taken to verify calculation results. The comparison of calculation versus measurement results shows excellent agreement for neutron calculations. For photon comparisons, calculations resulted in conservative estimates of the Effective Dose Equivalent (EDE) compared to measured results. This disagreement in the photon measurements versus calculations is most likely due to several conservativemore » assumptions regarding shield density and composition. For example, reinforcing steel bars (Rebar) in the concrete shield walls were not included in the shield model.« less

Quality of child healthcare at primary healthcare facilities: a national assessment of the Integrated Management of Childhood Illnesses in Afghanistan.

PubMed

Mansoor, Ghulam Farooq; Chikvaidze, Paata; Varkey, Sherin; Higgins-Steele, Ariel; Safi, Najibullah; Mubasher, Adela; Yusufi, Khaksar; Alawi, Sayed Alisha

2017-02-01

To assess quality of the national Integrated Management of Childhood Illness (IMCI) program services provided for sick children at primary health facilities in Afghanistan. Mixed methods including cross-sectional study. Thirteen (of thirty-four) provinces in Afghanistan. Observation of case management and re-examination of 177 sick children, exit interviews with caretakers and review of equipment/supplies at 44 health facilities. Introduction and scale up of Integrated Management of Childhood Illnesses at primary health care facilities. Care of sick children according to IMCI guidelines, health worker skills and essential health system elements. Thirty-two (71%) of the health workers were trained in IMCI and five (11%) received supervision in clinical case management during the past 6 months. On average, 5.4 out of 10 main assessment tasks were performed during cases observed, the index being higher in children seen by trained providers than untrained (6.3 vs 3.5, 95% CI 5.8-6.8 vs 2.9-4.1). In all, 74% of the 104 children who needed oral antibiotics received prescriptions, while 30% received complete and correct advice and 30% were overprescribed, and more so by untrained providers. Home care counseling was associated with provider training status (41.3% by trained and 24.5% by untrained). Essential oral and pre-referral injectable medicine and equipment/supplies were available in 66%, 23%, and 45% of health facilities, respectively. IMCI training improved assessment, rational use of antibiotics and counseling; further investment in IMCI in Afghanistan, continuing provider capacity building and supportive supervision for improved quality of care and counseling for sick children is needed, especially given high burden treatable childhood illness. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Building the national health information infrastructure for personal health, health care services, public health, and research

PubMed Central

Detmer, Don E

2003-01-01

Background Improving health in our nation requires strengthening four major domains of the health care system: personal health management, health care delivery, public health, and health-related research. Many avoidable shortcomings in the health sector that result in poor quality are due to inaccessible data, information, and knowledge. A national health information infrastructure (NHII) offers the connectivity and knowledge management essential to correct these shortcomings. Better health and a better health system are within our reach. Discussion A national health information infrastructure for the United States should address the needs of personal health management, health care delivery, public health, and research. It should also address relevant global dimensions (e.g., standards for sharing data and knowledge across national boundaries). The public and private sectors will need to collaborate to build a robust national health information infrastructure, essentially a 'paperless' health care system, for the United States. The federal government should assume leadership for assuring a national health information infrastructure as recommended by the National Committee on Vital and Health Statistics and the President's Information Technology Advisory Committee. Progress is needed in the areas of funding, incentives, standards, and continued refinement of a privacy (i.e., confidentiality and security) framework to facilitate personal identification for health purposes. Particular attention should be paid to NHII leadership and change management challenges. Summary A national health information infrastructure is a necessary step for improved health in the U.S. It will require a concerted, collaborative effort by both public and private sectors. If you cannot measure it, you cannot improve it. Lord Kelvin PMID:12525262

45 CFR 3.41 - Admission to facilities or grounds.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Admission to facilities or grounds. 3.41 Section 3.41 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CONDUCT OF PERSONS AND TRAFFIC ON THE NATIONAL INSTITUTES OF HEALTH FEDERAL ENCLAVE Facilities and Grounds § 3.41...

45 CFR 3.41 - Admission to facilities or grounds.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Admission to facilities or grounds. 3.41 Section 3.41 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION CONDUCT OF PERSONS AND TRAFFIC ON THE NATIONAL INSTITUTES OF HEALTH FEDERAL ENCLAVE Facilities and Grounds § 3.41...

45 CFR 3.41 - Admission to facilities or grounds.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Admission to facilities or grounds. 3.41 Section 3.41 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CONDUCT OF PERSONS AND TRAFFIC ON THE NATIONAL INSTITUTES OF HEALTH FEDERAL ENCLAVE Facilities and Grounds § 3.41...

45 CFR 3.41 - Admission to facilities or grounds.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Admission to facilities or grounds. 3.41 Section 3.41 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CONDUCT OF PERSONS AND TRAFFIC ON THE NATIONAL INSTITUTES OF HEALTH FEDERAL ENCLAVE Facilities and Grounds § 3.41...

45 CFR 3.41 - Admission to facilities or grounds.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Admission to facilities or grounds. 3.41 Section 3.41 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CONDUCT OF PERSONS AND TRAFFIC ON THE NATIONAL INSTITUTES OF HEALTH FEDERAL ENCLAVE Facilities and Grounds § 3.41...

42 CFR 476.76 - Cooperation with health care facilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Cooperation with health care facilities. 476.76 Section 476.76 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Responsibilities of Quality Improvement Organizations (QIOs) General Provisions § 476.76 Cooperation with health...

Guidelines for Management Information Systems in Canadian Health Care Facilities

PubMed Central

Thompson, Larry E.

1987-01-01

The MIS Guidelines are a comprehensive set of standards for health care facilities for the recording of staffing, financial, workload, patient care and other management information. The Guidelines enable health care facilities to develop management information systems which identify resources, costs and products to more effectively forecast and control costs and utilize resources to their maximum potential as well as provide improved comparability of operations. The MIS Guidelines were produced by the Management Information Systems (MIS) Project, a cooperative effort of the federal and provincial governments, provincial hospital/health associations, under the authority of the Canadian Federal/Provincial Advisory Committee on Institutional and Medical Services. The Guidelines are currently being implemented on a “test” basis in ten health care facilities across Canada and portions integrated in government reporting as finalized.

7 CFR 15b.38 - Health care facilities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 1 2012-01-01 2012-01-01 false Health care facilities. 15b.38 Section 15b.38... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Other Aid, Benefits, or Services § 15b.38 Health care... impaired. A recipient hospital that provides health services or benefits shall establish a procedure for...

7 CFR 15b.38 - Health care facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 1 2010-01-01 2010-01-01 false Health care facilities. 15b.38 Section 15b.38... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Other Aid, Benefits, or Services § 15b.38 Health care... impaired. A recipient hospital that provides health services or benefits shall establish a procedure for...

7 CFR 15b.38 - Health care facilities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 1 2011-01-01 2011-01-01 false Health care facilities. 15b.38 Section 15b.38... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Other Aid, Benefits, or Services § 15b.38 Health care... impaired. A recipient hospital that provides health services or benefits shall establish a procedure for...

7 CFR 15b.38 - Health care facilities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 1 2013-01-01 2013-01-01 false Health care facilities. 15b.38 Section 15b.38... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Other Aid, Benefits, or Services § 15b.38 Health care... impaired. A recipient hospital that provides health services or benefits shall establish a procedure for...

Access to Drugs and Out of Pocket Expenditure in Primary Health Facilities.

PubMed

Thapa, A K; Ghimire, N; Adhikari, S R

2016-09-01

The Government of Nepal promulgated health as a human right via Interim constitution and implemented Free Health Service Program in 2008 as a commitment to universalize basic health care services. So, the aim of this study was to understand reported access to medicine and health care services received by outpatients in public primary facilities. The study followed cross sectional study design. Two hundred and thirty-four For data 234 out patients were interviewed on the day of the field visit in March and October 2014 across 28 primary health facilities of seven purposively selected districts representing three ecological belts and five development regions of the country. Our study revealed that the average number of medicines prescribed per patient was 2.65 per case in primary public health facilities, of which 91.2% were dispensed. Around 86.6% dispensed medicines were appropriately labeled and 84% of outpatients had proper knowledge of dosage and timing of medicine use. Around 55.6% of outpatients purchased some or all prescribed medicines from nearby private facilities which were not available in public facilities. Around 40% of them travelled more than half an hour to reach the facility. The gap in medicines prescribed and dispensed, Out of Pocket expenditure coupled with opportunity cost of travelling, appear as hurdles in access to basic health care services. So increasing free medicines list in public primary facilities with all round the year availability might answer major part of the problem.

Public Health Risks from Mismanagement of Healthcare Wastes in Shinyanga Municipality Health Facilities, Tanzania

PubMed Central

Kuchibanda, Kizito; Mayo, Aloyce W.

2015-01-01

The increase of healthcare facilities in Shinyanga municipality has resulted in an increase of healthcare wastes, which poses serious threats to the environment, health workers, and the general public. This research was conducted to investigate management practices of healthcare wastes in Shinyanga municipality with a view of assessing health risks to health workers and the general public. The study, which was carried out in three hospitals, involved the use of questionnaires, in-depth interview, and observation checklist. The results revealed that healthcare wastes are not quantified or segregated in all the three hospitals. Healthcare wastes at the Shinyanga Regional Referral Hospital are disposed of by on-site incineration and burning and some wastes are disposed off-site. At Kolandoto DDH only on-site burning and land disposal are practiced, while at Kambarage UHC healthcare solid wastes are incinerated, disposed of on land disposal, and burned. Waste management workers do not have formal training in waste management techniques and the hospital administrations pay very little attention to appropriate management of healthcare wastes. In light of this, it is evident that management of healthcare solid wastes is not practiced in accordance with the national and WHO's recommended standards. PMID:26779565

Findings from a hepatitis B birth dose assessment in health facilities in the Philippines: opportunities to engage the private sector.

PubMed

Patel, Minal K; Capeding, Rosario Z; Ducusin, Joyce U; de Quiroz Castro, Maricel; Garcia, Luzviminda C; Hennessey, Karen

2014-09-03

Hepatitis B vaccination in the Philippines was introduced in 1992 to reduce the high burden of chronic hepatitis B virus (HBV) infection in the population; in 2007, a birth dose (HepB-BD) was introduced to decrease perinatal HBV transmission. Timely HepB-BD coverage, defined as doses given within 24h of birth, was 40% nationally in 2011. A first step in improving timely HepB-BD coverage is to ensure that all newborns born in health facilities are vaccinated. In order to assess ways of improving the Philippines' HepB-BD program, we evaluated knowledge, attitudes, and practices surrounding HepB-BD administration in health facilities. Teams visited selected government clinics, government hospitals, and private hospitals in regions with low reported HepB-BD coverage and interviewed immunization and maternity staff. HepB-BD coverage was calculated in each facility for a 3-month period in 2011. Of the 142 health facilities visited, 12 (8%) did not provide HepB-BD; seven were private hospitals and five were government hospitals. Median timely HepB-BD coverage was 90% (IQR 80%-100%) among government clinics, 87% (IQR 50%-97%) among government hospitals, and 50% (IQR 0%-90%) among private hospitals (p=0.02). The private hospitals were least likely to receive supervision (53% vs. 6%-31%, p=0.0005) and to report vaccination data to the national Expanded Programme on Immunization (36% vs. 96%-100%, p<0.0001). Private sector hospitals in the Philippines, which deliver 18% of newborns, had the lowest timely HepB-BD coverage. Multiple avenues exist to engage the private sector in hepatitis B prevention including through existing laws, newborn health initiatives, hospital accreditation processes, and raising awareness of the government's free vaccine program. Copyright © 2013 World Health Organization (WHO). Published by Elsevier Ltd.. All rights reserved.

Status of the national transonic facility

NASA Technical Reports Server (NTRS)

Mckinney, L. W.; Gloss, B. B.

1982-01-01

The National Transonic Facility at NASA Langley Research Center, scheduled for completion in July, 1982, is described with emphasis on model and instrumentation activities, calibration plans and some initial research plans. Performance capabilities include a Mach number range of 0.2-1.2, a pressure range of 1-9 atmospheres, and a temperature range of 77-350 K, which will produce a maximum Reynolds number of 120 million at a Mach number of 1.0, based on a 0.25 m chord. A comprehensive tunnel calibration program is planned, which will cover basic tunnel calibration, data qualities, and data comparisons with other facilites and flights.

Modifications to ART service delivery models by health facilities in Uganda in promotion of intervention sustainability: a mixed methods study.

PubMed

Zakumumpa, Henry; Bennett, Sara; Ssengooba, Freddie

2017-04-04

In November 2015, WHO released new treatment guidelines recommending that all diagnosed as HIV positive be enrolled on antiretroviral therapy (ART). Sustaining and expanding ART scale-up programs in resource-limited settings will require adaptations and modifications to traditional ART delivery models to meet the rapid increase in demand. We identify modifications to ART service delivery models by health facilities in Uganda to sustain ART interventions over a 10-year period (2004-2014). A mixed methods approach involving two study phases was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) in Uganda which were accredited to provide ART between 2004 and 2009 was conducted. The second phase involved semi-structured interviews (n = 18) with ART clinic managers of 6 of the 195 health facilities purposively selected from the first study phase. We adopted a thematic framework consisting of four categories of modifications (format, setting, personnel, and population). The majority of health facilities 185 (95%) reported making modifications to ART interventions between 2004 and 2014. Of the 195 health facilities, 157 (81%) rated the modifications made to ART as "major." Modifications to ART were reported under all the four themes. The quantitative and qualitative findings are integrated and presented under four themes. Format: Reducing the frequency of clinic appointments and pharmacy-only refill programs was identified as important strategies for decongesting ART clinics. Home-based care programs were introduced to reduce provider ART delivery costs. Personnel: Task shifting to non-physician cadre was reported in 181 (93%) of the health facilities. Visits to the ART clinic were rationalized in favor of the sub-population deemed to have more clinical need. Two health facilities focused on patients living nearer the health facilities to align with targets set by external donors. Over the study period

An Application of Business Process Management to Health Care Facilities.

PubMed

Hassan, Mohsen M D

The purpose of this article is to help health care facility managers and personnel identify significant elements of their facilities to address, and steps and actions to follow, when applying business process management to them. The ABPMP (Association of Business Process Management Professionals) life-cycle model of business process management is adopted, and steps from Lean, business process reengineering, and Six Sigma, and actions from operations management are presented to implement it. Managers of health care facilities can find in business process management a more comprehensive approach to improving their facilities than Lean, Six Sigma, business process reengineering, and ad hoc approaches that does not conflict with them because many of their elements can be included under its umbrella. Furthermore, the suggested application of business process management can guide and relieve them from selecting among these approaches, as well as provide them with specific steps and actions that they can follow. This article fills a gap in the literature by presenting a much needed comprehensive application of business process management to health care facilities that has specific steps and actions for implementation.

Can India's primary care facilities deliver? A cross-sectional assessment of the Indian public health system's capacity for basic delivery and newborn services.

PubMed

Sharma, Jigyasa; Leslie, Hannah H; Regan, Mathilda; Nambiar, Devaki; Kruk, Margaret E

2018-06-04

To assess input and process capacity for basic delivery and newborn (intrapartum care hereafter) care in the Indian public health system and to describe differences in facility capacity between rural and urban areas and across states. Cross-sectional study. Data from the nationally representative 2012-2014 District Level Household and Facility Survey, which includes a census of community health centres (CHC) and sample of primary health centres (PHC) across 30 states and union territories in India. 8536 PHCs and 4810 CHCs. We developed a summative index of 33 structural and process capacity items matching the Indian Public Health Standards for PHCs as a metric of minimum facility capacity for intrapartum care. We assessed differences in performance on this index across facility type and location. About 30% of PHCs and 5% of CHCs reported not offering any intrapartum care. Among those offering services, volumes were low: median monthly delivery volume was 8 (IQR=13) in PHCs and 41 (IQR=73) in CHCs. Both PHCs and CHCs failed to meet the national standards for basic intrapartum care capacity. Mean facility capacity was low in PHCs in both urban (0.64) and rural (0.63) areas, while in CHCs, capacity was slightly higher in urban areas (0.77vs0.74). Gaps were most striking in availability of skilled human resources and emergency obstetric services. Poor capacity facilities were more concentrated in the more impoverished states, with 37% of districts from these states receiving scores in the lowest third of the facility capacity index (<0.70), compared with 21% of districts otherwise. Basic intrapartum care capacity in Indian public primary care facilities is weak in both rural and urban areas, especially lacking in the poorest states with worst health outcomes. Improving maternal and newborn health outcomes will require focused attention to quality measurement, accountability mechanisms and quality improvement. Policies to address deficits in skilled providers and

Can India’s primary care facilities deliver? A cross-sectional assessment of the Indian public health system’s capacity for basic delivery and newborn services

PubMed Central

Leslie, Hannah H; Regan, Mathilda; Nambiar, Devaki; Kruk, Margaret E

2018-01-01

Objectives To assess input and process capacity for basic delivery and newborn (intrapartum care hereafter) care in the Indian public health system and to describe differences in facility capacity between rural and urban areas and across states. Design Cross-sectional study. Setting Data from the nationally representative 2012–2014 District Level Household and Facility Survey, which includes a census of community health centres (CHC) and sample of primary health centres (PHC) across 30 states and union territories in India. Participants 8536 PHCs and 4810 CHCs. Outcome measures We developed a summative index of 33 structural and process capacity items matching the Indian Public Health Standards for PHCs as a metric of minimum facility capacity for intrapartum care. We assessed differences in performance on this index across facility type and location. Results About 30% of PHCs and 5% of CHCs reported not offering any intrapartum care. Among those offering services, volumes were low: median monthly delivery volume was 8 (IQR=13) in PHCs and 41 (IQR=73) in CHCs. Both PHCs and CHCs failed to meet the national standards for basic intrapartum care capacity. Mean facility capacity was low in PHCs in both urban (0.64) and rural (0.63) areas, while in CHCs, capacity was slightly higher in urban areas (0.77vs0.74). Gaps were most striking in availability of skilled human resources and emergency obstetric services. Poor capacity facilities were more concentrated in the more impoverished states, with 37% of districts from these states receiving scores in the lowest third of the facility capacity index (<0.70), compared with 21% of districts otherwise. Conclusions Basic intrapartum care capacity in Indian public primary care facilities is weak in both rural and urban areas, especially lacking in the poorest states with worst health outcomes. Improving maternal and newborn health outcomes will require focused attention to quality measurement, accountability mechanisms and

Design and Fabrication of Opacity Targets for the National Ignition Facility

DOE PAGES

Cardenas, Tana; Schmidt, Derek William; Dodd, Evan S.; ...

2017-12-22

Accurate models for opacity of partially ionized atoms are important for modeling and understanding stellar interiors and other high-energy-density phenomena such as inertial confinement fusion. Lawrence Livermore National Laboratory is leading a multilaboratory effort to conduct experiments on the National Ignition Facility (NIF) to try to reproduce recent opacity tests at the Sandia National Laboratory Z-facility. Since 2015, the NIF effort has evolved several hohlraum designs that consist of multiple pieces joined together. The target also has three components attached to the main stalk over a long distance with high tolerances that have resulted in several design iterations. The targetmore » has made use of rapid prototyped features to attach a capsule and collimator under the hohlraum while avoiding interference with the beams. Furthermore, this paper discusses the evolution of the hohlraum and overall target design and the challenges involved with fabricating and assembling these targets.« less

Design and Fabrication of Opacity Targets for the National Ignition Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cardenas, Tana; Schmidt, Derek William; Dodd, Evan S.

Accurate models for opacity of partially ionized atoms are important for modeling and understanding stellar interiors and other high-energy-density phenomena such as inertial confinement fusion. Lawrence Livermore National Laboratory is leading a multilaboratory effort to conduct experiments on the National Ignition Facility (NIF) to try to reproduce recent opacity tests at the Sandia National Laboratory Z-facility. Since 2015, the NIF effort has evolved several hohlraum designs that consist of multiple pieces joined together. The target also has three components attached to the main stalk over a long distance with high tolerances that have resulted in several design iterations. The targetmore » has made use of rapid prototyped features to attach a capsule and collimator under the hohlraum while avoiding interference with the beams. Furthermore, this paper discusses the evolution of the hohlraum and overall target design and the challenges involved with fabricating and assembling these targets.« less

76 FR 40383 - National Institutes of Health

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-08

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Government-Owned Inventions; Availability for Licensing AGENCY: Public Health Service, National Institutes of Health, HHS. ACTION: Notice... the indicated licensing contact at the Office of Technology Transfer, National Institutes of Health...

Outreach on a National Scale: The Critical Role of Facilities

NASA Astrophysics Data System (ADS)

Bartel, B. A.; Charlevoix, D. J.

2015-12-01

Facilities provide infrastructure for science that would not be feasible at a single institution. Facilities are also a resource for development of outreach products and activities that reach a national audience of diverse stakeholders. UNAVCO manages the NSF geodetic facility GAGE (Geodesy Advancing Geosciences and Earthscope). Staff at UNAVCO with expertise in education, outreach, and communication translate the science and supporting infrastructure into materials consumable by a wide array of users including teachers, students, museum attendees, emergency managers, park interpreters, and members of the general public. UNAVCO has the ability to distribute materials to a national and international audience, thereby greatly increasing the impact of the science and increasing the value of the investment by the National Science Foundation. In 2014 and 2015, UNAVCO produced multiple print products focused on the Plate Boundary Observatory (PBO), the geodetic component of EarthScope. Products include a deck of playing cards featuring PBO GPS stations, a poster featuring GPS velocities of the Western United States, and another poster focused on GPS velocities in Alaska. We are distributing these products to a broad audience, including teachers, station permit holders, and community members. The Tectonics of the Western United States poster was distributed this year in the American Geosciences Institute Earth Science Week kit for teachers, reaching 16,000 educators around the country. These posters and the PBO playing cards (PBO-52) were distributed to more than 100 teachers through workshops led by UNAVCO, the EarthScope National Office, the Southern California Earthquake Center (SCEC), and more. Additionally, these cards serve as a way to engage landowners who host these scientific stations on their property. This presentation will address the strategies for creating nationally relevant materials and the tools used for dissemination of materials to a broad audience. We

Cryogenic Balance Technology at the National Transonic Facility

NASA Technical Reports Server (NTRS)

Parker, P. A.

2001-01-01

This paper provides an overview of force measurement at the National Transonic Facility (NTF). The NTF has unique force measurement requirements that dictate an integration of all aspects of balance design, production, and calibration. An overview of current force measurement capabilities is provided along with new balance development efforts. Research activities in the areas of thermal compensation and balance calibration are presented. Also, areas of future research are detailed.

National Health Care Skill Standards.

ERIC Educational Resources Information Center

National Consortium on Health Science and Technology Education, Okemos, MI.

This document presents the National Health Care Skill Standards, which were developed by the National Consortium on Health Science and Technology and West Ed Regional Research Laboratory, in partnership with educators and health care employers. The document begins with an overview of the purpose and benefits of skill standards. Presented next are…

National health expenditures, 1991

PubMed Central

Letsch, Suzanne W.; Lazenby, Helen C.; Levit, Katharine R.; Cowan, Cathy A.

1992-01-01

Spending for health care rose to $751.8 billion in 1991, an increase of 11.4 percent from the 1990 level. National health expenditures as a share of gross domestic product increased to 13.2 percent, up from 12.2 percent in 1990. The health care sector exhibited strong growth, despite slow growth in the overall economy. This combination resulted in the largest increase in the share of the Nation's output consumed by health care in the past three decades. In this article, the authors present estimates of health spending in the United States for 1991. The authors also examine reasons for the unusually large growth in Medicaid expenditures and highlight recent trends in the hospital sector. PMID:10127445

A national study of transitional hospital services in mental health.

PubMed Central

Dorwart, R A; Hoover, C W

1994-01-01

OBJECTIVES. Shifts in care for the seriously mentally ill from inpatient to community-based treatment have highlighted the importance of transitional care. Our objectives were to document the kinds and quantity of transitional services provided by psychiatric hospitals nationally and to assess the impact of hospital type (psychiatric vs general), ownership (public vs private), case mix, and revenue source on provision of these services. METHODS. A national sample of nonfederal inpatient mental health facilities (n = 915) was surveyed in 1988, and data were analyzed by using multiple regression. RESULTS. Half (46%) of the facilities surveyed provided patient follow-up of 1 week or less, and almost all (93%) conducted team review of discharge plans, but 74% provided no case management services. Hospital type was the most consistent predictor of transitional care, with psychiatric hospitals providing more of these services than general hospitals. Severity of illness, level of nonfederal funding, urbanicity, and teaching hospital affiliation were positively associated with provision of case management. CONCLUSIONS. Transitional care services for mentally ill patients leaving the hospital were found to be uneven and often inadequate. Reasons for broad variation in services are discussed. PMID:8059877

National Health Care Skill Standards.

ERIC Educational Resources Information Center

Far West Lab. for Educational Research and Development, San Francisco, CA.

This booklet contains draft national health care skill standards that were proposed during the National Health Care Skill Standards Project on the basis of input from more than 1,000 representatives of key constituencies of the health care field. The project objectives and structure are summarized in the introduction. Part 1 examines the need for…

Improving primary health care facility performance in Ghana: efficiency analysis and fiscal space implications.

PubMed

Novignon, Jacob; Nonvignon, Justice

2017-06-12

Health centers in Ghana play an important role in health care delivery especially in deprived communities. They usually serve as the first line of service and meet basic health care needs. Unfortunately, these facilities are faced with inadequate resources. While health policy makers seek to increase resources committed to primary healthcare, it is important to understand the nature of inefficiencies that exist in these facilities. Therefore, the objectives of this study are threefold; (i) estimate efficiency among primary health facilities (health centers), (ii) examine the potential fiscal space from improved efficiency and (iii) investigate the efficiency disparities in public and private facilities. Data was from the 2015 Access Bottlenecks, Cost and Equity (ABCE) project conducted by the Institute for Health Metrics and Evaluation. The Stochastic Frontier Analysis (SFA) was used to estimate efficiency of health facilities. Efficiency scores were then used to compute potential savings from improved efficiency. Outpatient visits was used as output while number of personnel, hospital beds, expenditure on other capital items and administration were used as inputs. Disparities in efficiency between public and private facilities was estimated using the Nopo matching decomposition procedure. Average efficiency score across all health centers included in the sample was estimated to be 0.51. Also, average efficiency was estimated to be about 0.65 and 0.50 for private and public facilities, respectively. Significant disparities in efficiency were identified across the various administrative regions. With regards to potential fiscal space, we found that, on average, facilities could save about GH₵11,450.70 (US$7633.80) if efficiency was improved. We also found that fiscal space from efficiency gains varies across rural/urban as well as private/public facilities, if best practices are followed. The matching decomposition showed an efficiency gap of 0.29 between private

Referral of children seeking care at private health facilities in Uganda.

PubMed

Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus; Clarke, Siân E; Lal, Sham; Hansen, Kristian S; Magnussen, Pascal; LaRussa, Philip

2017-02-14

In Uganda, referral of sick children seeking care at public health facilities is poor and widely reported. However, studies focusing on the private health sector are scanty. The main objective of this study was to assess referral practices for sick children seeking care at private health facilities in order to explore ways of improving treatment and referral of sick children in this sector. A survey was conducted from August to October 2014 in Mukono district, central Uganda. Data was collected using a structured questionnaire supplemented by Focus Group Discussions and Key Informant interviews with private providers and community members. A total of 241 private health facilities were surveyed; 170 (70.5%) were registered drug shops, 59 (24.5%) private clinics and 12 (5.0%) pharmacies. Overall, 104/241 (43.2%) of the private health facilities reported that they had referred sick children to higher levels of care in the two weeks prior to the survey. The main constraints to follow referral advice as perceived by caretakers were: not appreciating the importance of referral, gender-related decision-making and negotiations at household level, poor quality of care at referral facilities, inadequate finances at household level; while the perception that referral leads to loss of prestige and profit was a major constraint to private providers. In conclusion, the results show that referral of sick children at private health facilities faces many challenges at provider, caretaker, household and community levels. Thus, interventions to address constraints to referral of sick children are urgently needed.

Medicare and Medicaid programs; fire safety requirements for certain health care facilities; amendment. Interim final rule with comment period.

PubMed

2005-03-25

This interim final rule with comment period adopts the substance of the April 15, 2004 temporary interim amendment (TIA) 00-1 (101), Alcohol Based Hand Rub Solutions, an amendment to the 2000 edition of the Life Safety Code, published by the National Fire Protection Association (NFPA). This amendment will allow certain health care facilities to place alcohol-based hand rub dispensers in egress corridors under specified conditions. This interim final rule with comment period also requires that nursing facilities install smoke detectors in resident rooms and public areas if they do not have a sprinkler system installed throughout the facility or a hard-wired smoke detection system in those areas.

Design of the opacity spectrometer for opacity measurements at the National Ignition Facility

DOE PAGES

Ross, P. W.; Heeter, R. F.; Ahmed, M. F.; ...

2016-10-03

Recent experiments at the Sandia National Laboratory Z facility have called into question models used in calculating opacity, of importance for modeling stellar interiors. An effort is being made to reproduce these results at the National Ignition Facility (NIF). These experiments require a new X-ray opacity spectrometer (OpSpec) spanning 540 eV–2100 eV with a resolving power E/ΔE > 700. The design of the OpSpec is presented. Photometric calculations based on expected opacity data are also presented in this paper. First use on NIF is expected in September 2016.

Design of the opacity spectrometer for opacity measurements at the National Ignition Facility.

PubMed

Ross, P W; Heeter, R F; Ahmed, M F; Dodd, E; Huffman, E J; Liedahl, D A; King, J A; Opachich, Y P; Schneider, M B; Perry, T S

2016-11-01

Recent experiments at the Sandia National Laboratory Z facility have called into question models used in calculating opacity, of importance for modeling stellar interiors. An effort is being made to reproduce these results at the National Ignition Facility (NIF). These experiments require a new X-ray opacity spectrometer (OpSpec) spanning 540 eV-2100 eV with a resolving power E/ΔE > 700. The design of the OpSpec is presented. Photometric calculations based on expected opacity data are also presented. First use on NIF is expected in September 2016.

Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo

PubMed Central

2009-01-01

Background Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP). Methods Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities. Results None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC. Conclusions Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for

76 FR 16798 - National Institutes of Health

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-25

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Center for Scientific Review.... Place: National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892 (Telephone Conference..., National Institutes of Health, 6701 Rockledge Drive, Room 4136, MSC 7850, Bethesda, MD 20892, (301) 435...

75 FR 6044 - National Institutes of Health

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-05

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Environmental Health Sciences; Notice of Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act... individual intramural programs and projects conducted by the National Institute of Environmental Health...

The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi

PubMed Central

Manthalu, Gerald; Yi, Deokhee; Farrar, Shelley; Nkhoma, Dominic

2016-01-01

The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P <  0.01) increase in the mean proportion of women who made at least one antenatal care (ANC) visit during pregnancy, a 12% (P < 0.05) increase in average ANC visits and an 11% (P < 0.05) increase in the mean proportion of pregnant women who delivered at the facilities. No effects were found for the proportion of pregnant women who made the first ANC visit in the first trimester and the proportion of women who made postpartum care visits. We conclude that user fee exemption is an important policy for increasing maternal health care utilization. For certain maternal services, however, other determinants may be more important. PMID:27175033

The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi.

PubMed

Manthalu, Gerald; Yi, Deokhee; Farrar, Shelley; Nkhoma, Dominic

2016-11-01

The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P <  0.01) increase in the mean proportion of women who made at least one antenatal care (ANC) visit during pregnancy, a 12% (P < 0.05) increase in average ANC visits and an 11% (P < 0.05) increase in the mean proportion of pregnant women who delivered at the facilities. No effects were found for the proportion of pregnant women who made the first ANC visit in the first trimester and the proportion of women who made postpartum care visits. We conclude that user fee exemption is an important policy for increasing maternal health care utilization. For certain maternal services, however, other determinants may be more important. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Population-based geographic access to parent and satellite National Cancer Institute Cancer Center Facilities.

PubMed

Onega, Tracy; Alford-Teaster, Jennifer; Wang, Fahui

2017-09-01

Satellite facilities of National Cancer Institute (NCI) cancer centers have expanded their regional footprints. This study characterized geographic access to parent and satellite NCI cancer center facilities nationally overall and by sociodemographics. Parent and satellite NCI cancer center facilities, which were geocoded in ArcGIS, were ascertained. Travel times from every census tract in the continental United States and Hawaii to the nearest parent and satellite facilities were calculated. Census-based population attributes were used to characterize measures of geographic access for sociodemographic groups. From the 62 NCI cancer centers providing clinical care in 2014, 76 unique parent locations and 211 satellite locations were mapped. The overall proportion of the population within 60 minutes of a facility was 22% for parent facilities and 32.7% for satellite facilities. When satellites were included for potential access, the proportion of some racial groups for which a satellite was the closest NCI cancer center facility increased notably (Native Americans, 22.6% with parent facilities and 39.7% with satellite facilities; whites, 34.8% with parent facilities and 50.3% with satellite facilities; and Asians, 40.0% with parent facilities and 54.0% with satellite facilities), with less marked increases for Hispanic and black populations. Rural populations of all categories had dramatically low proportions living within 60 minutes of an NCI cancer center facility of any type (1.0%-6.6%). Approximately 14% of the population (n = 43,033,310) lived more than 180 minutes from a parent or satellite facility, and most of these individuals were Native Americans and/or rural residents (37% of Native Americans and 41.7% of isolated rural residents). Racial/ethnic and rural populations showed markedly improved geographic access to NCI cancer center care when satellite facilities were included. Cancer 2017;123:3305-11. © 2017 American Cancer Society. © 2017 American

Implementation of tuberculosis infection control in health facilities in Mukono and Wakiso districts, Uganda

PubMed Central

2013-01-01

Background Tuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings. Understanding the reasons for low level of implementation is critical. The study aim was to assess TBIC practices and barriers to implementation in two districts in Uganda. Methods We conducted a cross-sectional study in 51 health facilities in districts of Mukono and Wakiso. The study included: a facility survey, observations of practices and eight focus group discussions with health workers. Results Quantitative: Only 16 facilities (31%) had a TBIC plan. Five facilities (10%) were screening patients for cough. Two facilities (4%) reported providing masks to patients with cough. Ventilation in the waiting areas was inadequate for TBIC in 43% (22/51) of the facilities. No facility possessed N95 particulate respirators. Qualitative: Barriers that hamper implementation of TBIC elicited included: under-staffing, lack of space for patient separation, lack of funds to purchase masks, and health workers not appreciating the importance of TBIC. Conclusion TBIC measures were not implemented in health facilities in the two Ugandan districts where the survey was done. Health system factors like lack of staff, space and funds are barriers to implement TBIC. Effective implementation of TBIC measures occurs when the fundamental health system building blocks -governance and stewardship, financing, infrastructure, procurement and supply chain management are in place and functioning appropriately. PMID:23915376

Implementation of tuberculosis infection control in health facilities in Mukono and Wakiso districts, Uganda.

PubMed

Buregyeya, Esther; Nuwaha, Fred; Verver, Suzanne; Criel, Bart; Colebunders, Robert; Wanyenze, Rhoda; Kalyango, Joan N; Katamba, Achilles; Mitchell, Ellen Mh

2013-08-01

Tuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings. Understanding the reasons for low level of implementation is critical. The study aim was to assess TBIC practices and barriers to implementation in two districts in Uganda. We conducted a cross-sectional study in 51 health facilities in districts of Mukono and Wakiso. The study included: a facility survey, observations of practices and eight focus group discussions with health workers. Quantitative: Only 16 facilities (31%) had a TBIC plan. Five facilities (10%) were screening patients for cough. Two facilities (4%) reported providing masks to patients with cough. Ventilation in the waiting areas was inadequate for TBIC in 43% (22/51) of the facilities. No facility possessed N95 particulate respirators. Qualitative: Barriers that hamper implementation of TBIC elicited included: under-staffing, lack of space for patient separation, lack of funds to purchase masks, and health workers not appreciating the importance of TBIC. TBIC measures were not implemented in health facilities in the two Ugandan districts where the survey was done. Health system factors like lack of staff, space and funds are barriers to implement TBIC. Effective implementation of TBIC measures occurs when the fundamental health system building blocks--governance and stewardship, financing, infrastructure, procurement and supply chain management are in place and functioning appropriately.

National health expenditures, 1988

PubMed Central

1990-01-01

Every year, analysts in the Health Care Financing Administration present figures on what our Nation spends for health. As the result of a comprehensive re-examination of the definitions, concepts, methods, and data sources used to prepare those figures, this year's report contains new estimates of national health expenditures for calendar years 1960 through 1988. Significant changes have been made to estimates of spending for professional services and to estimates of what consumers pay out of pocket for health care. In the first article, trends in use of and expenditure for various types of goods and services are discussed, as well as trends in the sources of funds used to finance health care. In a companion article, the benchmark process is described in more detail, as are the data sources and methods used to prepare annual estimates of health expenditures. PMID:10113395

Prevalence of pregnancy-related complications and course of labour of surviving women who gave birth in selected health facilities in Rwanda: a health facility-based, cross-sectional study.

PubMed

Semasaka Sengoma, Jean Paul; Krantz, Gunilla; Nzayirambaho, Manasse; Munyanshongore, Cyprien; Edvardsson, Kristina; Mogren, Ingrid

2017-07-09

This study estimated health facility-based prevalence for pre-eclampsia/eclampsia, postpartum haemorrhage and caesarean section (CS) due to prolonged labour/dystocia. The background characteristics of Rwandan pregnant women, the course of labour and the level of healthcare were investigated in relation to pregnancy and delivery outcomes. This is health facility-based study and data were collected in 2014-2015 through structured interviews and medical records (n=817) in Kigali and Northern Province, Rwanda. Frequencies and prevalence were used to describe participants' background factors, labour and delivery-related characteristics. Bivariable and multivariable logistic regression models were performed for different background factors and pregnancy/delivery outcomes. Pre-eclampsia/eclampsia, postpartum haemorrhage and CS due to prolonged labour/dystocia represented 1%, 2.7% and 5.4% of all participants, respectively. In total, 56.4% of the participants were transferred from facilities with low levels to those with higher levels of healthcare, and the majority were transferred from health centres to district hospitals, with CS as the main reason for transfer. Participants who arrived at the health facility with cervical dilation grade of ≤3 cm spent more hours in maternity ward than those who arrived with cervical dilatation grade of ≥4 cm. Risk factors for CS due to prolonged labour or dystocia were poor households, nulliparity and residence far from health facility. The estimated health facility-based prevalence of pregnancy-related complications was relatively low in this sample from Rwanda. CS was the main reason for the transfer of pregnant women from health centres to district hospitals. Upgrading the capacity of health centres in the management of pregnant women in Rwanda may improve maternal and fetal health. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is

76 FR 53685 - National Institutes of Health

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-29

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Submission for OMB Review... data collection projects, the Center for Scientific Review (CSR), National Institutes of Health (NIH... for public comment. The National Institutes of Health may not conduct or sponsor and the respondent is...

The national ignition facility and atomic data

NASA Astrophysics Data System (ADS)

Crandall, David H.

1998-07-01

The National Ignition Facility (NIF) is under construction, capping over 25 years of development of the inertial confinement fusion concept by providing the facility to obtain fusion ignition in the laboratory for the first time. The NIF is a 192 beam glass laser to provide energy controlled in space and time so that a millimeter-scale capsule containing deuterium and tritium can be compressed to fusion conditions. Light transport, conversion of light in frequency, interaction of light with matter in solid and plasma forms, and diagnostics of extreme material conditions on small scale all use atomic data in preparing for use of the NIF. The NIF will provide opportunity to make measurements of atomic data in extreme physical environments related to fusion energy, nuclear weapon detonation, and astrophysics. The first laser beams of NIF should be operational in 2001 and the full facility completed at the end of 2003. NIF is to provide 1.8 megajoule of blue light on fusion targets and is intended to achieve fusion ignition by about the end of 2007. Today's inertial fusion development activities use atomic data to design and predict fusion capsule performance and in non-fusion applications to analyze radiation transport and radiation effects on matter. Conditions investigated involve radiation temperature of hundreds of eV, pressures up to gigabars and time scales of femptoseconds.

Recent progress on the National Ignition Facility advanced radiographic capability

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wegner, P.; Bowers, M.; Chen, H.

2016-01-08

The National Ignition Facility (NIF) is a megajoule (million-joule)-class laser and experimental facility built for Stockpile Stewardship and High Energy Density (HED) science research [1]. Up to several times a day, 192 laser pulses from NIF's 192 laser beamlines converge on a millimeter-scale target located at the center of the facility's 10-meter diameter target chamber. The carefully synchronized pulses, typically a few nanoseconds (billionths of a second) in duration and co-times to better than 20 picoseconds (trillionths of a second), a deliver a combined energy of up to 1.8 megajoules and a peak power of 500 terawatts (trillion watts). Furthermore,more » this drives temperatures inside the target to tens of millions of degrees and pressures to many billion times greater than Earth's atmosphere.« less

Cost analysis and efficiency of sub-district health facilities in two districts in Ghana.

PubMed

Aboagye, Anthony Q Q; Degboe, Arnold N K

2011-01-01

To establish the full costs borne by sub-district health facilities in providing services, we analysed the costs and revenues of 10 sub-district health facilities located in two districts in Ghana. The full costs were obtained by considering staff costs, cost of utilities, cost of using health facility equipment, cost of non-drug consumables, equipment maintenance expenses, amounts spent on training, community information sessions and other outreach activities as well as all other costs incurred in running the facilities. We found that (i) a large proportion of sub-district health facility costs is made up of staff salaries; (ii) at all facilities, internally generated funds (IGFs) are substantially lower than costs incurred in running the facilities; (iii) average IGF is several times higher in one district than the other; (iv) wide variations exist in efficiency indicators and (v) there is some evidence that sub-district health facilities may not necessarily be financially more efficient than hospitals in using financial resources. We suggest that the study should be replicated in other districts; but in the mean time, the health authorities should take note of the conclusions and recommendations of this study. Efforts should also be made to improve record keeping at these facilities. Copyright © 2010 John Wiley & Sons, Ltd.

Guide for users of the National Transonic Facility

NASA Technical Reports Server (NTRS)

Fuller, D. E.; Gloss, B. B.; Nystrom, D.

1981-01-01

The National Transonic Facility (NTF) is a fan-driven, closed-circuit, continuous flow, pressurized wind tunnel. The test section is 2.5 m x 2.5 m and 7.62 m long with a slotted-wall configuration. The NTF will have a Mach number range from 0.2 to 1.2, with Reynolds number up to 120 10 to the sixth power at Mach 1 (based on a reference length of 0.25 m). The pressure range for the facility will be from 1 to about 9 bars (1 ban = 100 kPa), and the temperature can be varied from 340 to 78 K. This report provides potential users of the NTF with the information required for preliminary planning to test programs and for preliminary layout of models and model supports which may be used in such programs.

Innovation within a national health care system.

PubMed

Young, Antony

2017-05-01

Tony is a practicing frontline National Health Service surgeon and director of medical innovation at Anglia Ruskin University and has founded 4 medical-technology start-ups. He has also cofounded the £500 million Anglia Ruskin MedTech Campus, which will become one of the world's largest health innovation spaces. In 2014, he was appointed as national clinical director for innovation at National Health Service England and in February 2016 became the first national clinical lead for innovation. In this role, he provides clinical leadership and support in delivering improved health outcomes in England, drives the uptake of proven innovations across the National Health Service, promotes economic growth through innovation, and helps make the National Health Service the go-to place on the planet for medical innovation. Copyright © 2016 Elsevier Inc. All rights reserved.

Direct facility funding as a response to user fee reduction: implementation and perceived impact among Kenyan health centres and dispensaries

PubMed Central

Opwora, Antony; Kabare, Margaret; Molyneux, Sassy; Goodman, Catherine

2010-01-01

There is increasing pressure for reduction of user fees, but this can have adverse effects by decreasing facility-level funds. To address this, direct facility funding (DFF) was piloted in Coast Province, Kenya, with health facility committees (HFCs) responsible for managing the funds. We evaluated the implementation and perceived impact 2.5 years after DFF introduction. Quantitative data collection at 30 public health centres and dispensaries included a structured interview with the in-charge, record reviews and exit interviews. In addition, in-depth interviews were conducted with the in-charge and HFC members at 12 facilities, and with district staff and other stakeholders. DFF procedures were well established: HFCs met regularly and accounting procedures were broadly followed. DFF made an important contribution to facility cash income, accounting for 47% in health centres and 62% in dispensaries. The main items of expenditure were wages for support staff (32%), travel (21%), and construction and maintenance (18%). DFF was perceived to have a highly positive impact through funding support staff such as cleaners and patient attendants, outreach activities, renovations, patient referrals and increasing HFC activity. This was perceived to have improved health worker motivation, utilization and quality of care. A number of problems were identified. HFC training was reportedly inadequate, and no DFF documentation was available at facility level, leading to confusion. Charging user fees above those specified in the national policy remained common, and understanding of DFF among the broader community was very limited. Finally, relationships between HFCs and health workers were sometimes characterized by mistrust and resentment. Relatively small increases in funding may significantly affect facility performance when the funds are managed at the periphery. Kenya plans to scale up DFF nationwide. Our findings indicate this is warranted, but should include improved training

Direct facility funding as a response to user fee reduction: implementation and perceived impact among Kenyan health centres and dispensaries.

PubMed

Opwora, Antony; Kabare, Margaret; Molyneux, Sassy; Goodman, Catherine

2010-09-01

There is increasing pressure for reduction of user fees, but this can have adverse effects by decreasing facility-level funds. To address this, direct facility funding (DFF) was piloted in Coast Province, Kenya, with health facility committees (HFCs) responsible for managing the funds. We evaluated the implementation and perceived impact 2.5 years after DFF introduction. Quantitative data collection at 30 public health centres and dispensaries included a structured interview with the in-charge, record reviews and exit interviews. In addition, in-depth interviews were conducted with the in-charge and HFC members at 12 facilities, and with district staff and other stakeholders. DFF procedures were well established: HFCs met regularly and accounting procedures were broadly followed. DFF made an important contribution to facility cash income, accounting for 47% in health centres and 62% in dispensaries. The main items of expenditure were wages for support staff (32%), travel (21%), and construction and maintenance (18%). DFF was perceived to have a highly positive impact through funding support staff such as cleaners and patient attendants, outreach activities, renovations, patient referrals and increasing HFC activity. This was perceived to have improved health worker motivation, utilization and quality of care. A number of problems were identified. HFC training was reportedly inadequate, and no DFF documentation was available at facility level, leading to confusion. Charging user fees above those specified in the national policy remained common, and understanding of DFF among the broader community was very limited. Finally, relationships between HFCs and health workers were sometimes characterized by mistrust and resentment. Relatively small increases in funding may significantly affect facility performance when the funds are managed at the periphery. Kenya plans to scale up DFF nationwide. Our findings indicate this is warranted, but should include improved training

Health financing in Malawi: Evidence from National Health Accounts

PubMed Central

2010-01-01

Background National health accounts provide useful information to understand the functioning of a health financing system. This article attempts to present a profile of the health system financing in Malawi using data from NHA. It specifically attempts to document the health financing situation in the country and proposes recommendations relevant for developing a comprehensive health financing policy and strategic plan. Methods Data from three rounds of national health accounts covering the Financial Years 1998/1999 to 2005/2006 was used to describe the flow of funds and their uses in the health system. Analysis was performed in line with the various NHA entities and health system financing functions. Results The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. The country had not met the Abuja of allocating at least 15% of national budget on health. The percentage of total health expenditure from households' direct out-of-pocket payments decreased from 26% in 1998/99 to 12.1% in 2005/2006. Conclusion There is a need to increase government contribution to the total health expenditure to at least the levels of the Abuja Declaration of 15% of the national budget. In addition, the country urgently needs to develop and implement a prepaid health financing system within a comprehensive health financing policy and strategy with a view to assuring universal access to essential health services for all citizens. PMID:21062503

National and sub-national analysis of the health benefits and cost-effectiveness of strategies to reduce maternal mortality in Afghanistan.

PubMed

Carvalho, Natalie; Salehi, Ahmad Shah; Goldie, Sue J

2013-01-01

Afghanistan has one of the highest rates of maternal mortality in the world. We assess the health outcomes and cost-effectiveness of strategies to improve the safety of pregnancy and childbirth in Afghanistan. Using national and sub-national data, we adapted a previously validated model that simulates the natural history of pregnancy and pregnancy-related complications. We incorporated data on antenatal care, family planning, skilled birth attendance and information about access to transport, referral facilities and quality of care. We evaluated single interventions (e.g. family planning) and strategies that combined several interventions packaged as integrated services (transport, intrapartum care). Outcomes included pregnancy-related complications, maternal deaths, maternal mortality ratios, costs and cost-effectiveness ratios. Model-projected reduction in maternal deaths between 1999-2002 and 2007-08 approximated 20%. Increasing family planning was the most effective individual intervention to further reduce maternal mortality; up to 1 in 3 pregnancy-related deaths could be prevented if contraception use approached 60%. Nevertheless, reductions in maternal mortality reached a threshold (∼30% to 40%) without strategies that assured women access to emergency obstetrical care. A stepwise approach that coupled improved family planning with incremental improvements in skilled attendance, transport, referral and appropriate intrapartum care and high-quality facilities prevented 3 of 4 maternal deaths. Such an approach would cost less than US$200 per year of life saved at the national level, well below Afghanistan's per capita gross domestic product (GDP), a common benchmark for cost-effectiveness. Similar results were noted sub-nationally. Our findings reinforce the importance of early intensive efforts to increase family planning for spacing and limiting births and to provide control of fertility choices. While significant improvements in health delivery

Prevalence and predictors of giving birth in health facilities in Bugesera District, Rwanda.

PubMed

Joharifard, Shahrzad; Rulisa, Stephen; Niyonkuru, Francine; Weinhold, Andrew; Sayinzoga, Felix; Wilkinson, Jeffrey; Ostermann, Jan; Thielman, Nathan M

2012-12-05

The proportion of births attended by skilled health personnel is one of two indicators used to measure progress towards Millennium Development Goal 5, which aims for a 75% reduction in global maternal mortality ratios by 2015. Rwanda has one of the highest maternal mortality ratios in the world, estimated between 249-584 maternal deaths per 100,000 live births. The objectives of this study were to quantify secular trends in health facility delivery and to identify factors that affect the uptake of intrapartum healthcare services among women living in rural villages in Bugesera District, Eastern Province, Rwanda. Using census data and probability proportional to size cluster sampling methodology, 30 villages were selected for community-based, cross-sectional surveys of women aged 18-50 who had given birth in the previous three years. Complete obstetric histories and detailed demographic data were elicited from respondents using iPad technology. Geospatial coordinates were used to calculate the path distances between each village and its designated health center and district hospital. Bivariate and multivariate logistic regressions were used to identify factors associated with delivery in health facilities. Analysis of 3106 lifetime deliveries from 859 respondents shows a sharp increase in the percentage of health facility deliveries in recent years. Delivering a penultimate baby at a health facility (OR = 4.681 [3.204 - 6.839]), possessing health insurance (OR = 3.812 [1.795 - 8.097]), managing household finances (OR = 1.897 [1.046 - 3.439]), attending more antenatal care visits (OR = 1.567 [1.163 - 2.112]), delivering more recently (OR = 1.438 [1.120 - 1.847] annually), and living closer to a health center (OR = 0.909 [0.846 - 0.976] per km) were independently associated with facility delivery. The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a health facility, possession of health insurance, greater financial

U.S. National Institutes of Health core consolidation-investing in greater efficiency.

PubMed

Chang, Michael C; Birken, Steven; Grieder, Franziska; Anderson, James

2015-04-01

The U.S. National Institutes of Health (NIH) invests substantial resources in core research facilities (cores) that support research by providing advanced technologies and scientific and technical expertise as a shared resource. In 2010, the NIH issued an initiative to consolidate multiple core facilities into a single, more efficient core. Twenty-six institutions were awarded supplements to consolidate a number of similar core facilities. Although this approach may not work for all core settings, this effort resulted in consolidated cores that were more efficient and of greater benefit to investigators. The improvements in core operations resulted in both increased services and more core users through installation of advanced instrumentation, access to higher levels of management expertise; integration of information management and data systems; and consolidation of billing; purchasing, scheduling, and tracking services. Cost recovery to support core operations also benefitted from the consolidation effort, in some cases severalfold. In conclusion, this program of core consolidation resulted in improvements in the effective operation of core facilities, benefiting both investigators and their supporting institutions.

Planning of public healthcare facility using a location allocation modelling: A case study

NASA Astrophysics Data System (ADS)

Shariff, S. Sarifah Radiah; Moin, Noor Hasnah; Omar, Mohd

2014-09-01

Finding the correct location of any facility and determining the demands which are to be assigned to it is very crucial in public health service. This is to ensure that the public gain maximum benefits. This article analyzes the previous location decisions of public primary healthcare (PHC) facilities in the district of Kuala Langat, Malaysia. With total population of 220214 (in 2010), the PHC in the district is currently served by 28 facilities. The percentages of total population covered (in 2007) within the maximum allowable distance of 3km and 5km are 69.7 percent and 77.8 percent respectively. This is very low compared to the Malaysian National Health Policy of Health for All or 100 percent coverage. The determination of health facility location should be planned carefully to further increase effective primary health service to the nation that is required for economic sustainability.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

PubMed Central

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

Capacity assessment of selected health care facilities for the pilot implementation of Package for Essential Non-communicable Diseases (PEN) intervention in Ghana.

PubMed

Nyarko, Kofi Mensah; Ameme, Donne Kofi; Ocansey, Dennis; Commeh, Efua; Markwei, Mehitabel Tori; Ohene, Sally-Ann

2016-01-01

Non-communicable diseases (NCDs) continue to pose threats to human health and development worldwide. Though preventable, NCDs kill more people annually than all other diseases combined. The four major NCDs namely cardiovascular diseases, chronic respiratory diseases, diabetes and cancers share common modifiable risk factors. In order to prevent and control NCDs, Ghana has adopted the World Health Organisation Package for Essential NCD (WHO-PEN) intervention, to be piloted in selected districts before a nationwide scale-up. We assessed the capacity of these facilities for the implementation of the WHO-PEN pilot. We conducted a cross-sectional health facility-based survey using a multistage sampling technique. We collected data on human resource, equipment, service utilization, medicines availability and health financing through interviews and observation. Descriptive data analysis was performed and expressed in frequencies and relative frequencies. In all, 23 health facilities comprising two regional hospitals, three district hospitals, nine health centres and nine Community-based Health Planning and Services (CHPS) compounds from three regions were surveyed. All the hospitals had medical officers whilst 4 (44.4%) of the health centres had physician assistants. Health financing is mainly by the National Health Insurance Scheme (NHIS). None of the health facilities had spacers and only one health centre had oxygen cylinder, glucometer and nebulizer. Gaps exist in the human resource capacity and service delivery at the primary care levels, the focus of WHO-PEN intervention. Adequately equipping the primary health care level with trained health workers, basic equipment, medications and diagnostics will optimize the performance of WHO-PEN intervention when implemented.

Organizational factors influencing health information technology adoption in long-term-care facilities.

PubMed

Wang, Tiankai; Wang, Yangmei; Moczygemba, Jackie

2014-01-01

Long-term care (LTC) is an important sector of the health care industry. However, the adoption of health information technology (HIT) systems in LTC facilities lags behind that in other sectors of health care. Previous literature has focused on the financial and technical barriers. This study examined the organizational factors associated with HIT adoption in LTC facilities. A survey of 500 LTC facilities in Texas enabled researchers to compile HIT indexes for further statistical analyses. A general linear model was used to study the associations between the clinical/administrative HIT indexes and organizational factors. The empirical outcomes show that the size of an LTC facility has a significant association with HIT adoption. Rural LTC facilities, especially freestanding ones, adopt less HIT than their urban counterparts, whereas freestanding LTC facilities have the lowest HIT adoption overall. There is not enough evidence to support ownership status as a significant factor in HIT adoption. Some implications are proposed, but further research is necessary.

Promoting universal financial protection: contracting faith-based health facilities to expand access--lessons learned from Malawi.

PubMed

Chirwa, Maureen L; Kazanga, Isabel; Faedo, Giulia; Thomas, Stephen

2013-08-19

Public-private collaborations are increasingly being utilized to universalize health care. In Malawi, the Ministry of Health contracts selected health facilities owned by the main faith-based provider, the Christian Health Association of Malawi (CHAM), to deliver care at no fee to the most vulnerable and underserved populations in the country through Service Level Agreements (SLAs). This study examined the features of SLAs and their effectiveness in expanding universal coverage. The study involved a policy analysis focusing on key stakeholders around SLAs as well as a case study approach to analyse how design and implementation of SLAs affect efficiency, equity and sustainability of services delivered by SLAs. The study employed both qualitative and quantitative research methods to address the research questions and was conducted in five CHAM health facilities: Mulanje Mission, Holy Family, and Mtengowanthenga Hospitals, and Mabiri and Nkope Health Centres. National and district level decision makers were interviewed while providers and clients associated with the health facilities were surveyed on their experiences. A total of 155 clients from an expected 175 were recruited in the study. The study findings revealed key aspects of how SLAs were operating, the extent to which their objectives were being attained and why. In general, the findings demonstrated that SLAs had the potential to improve health and universal health care coverage, particularly for the vulnerable and underserved populations. However, the findings show that the performance of SLAs in Malawi were affected by various factors including lack of clear guidelines, non-revised prices, late payment of bills, lack of transparency, poor communication, inadequate human and material resources, and lack of systems to monitor performance of SLAs, amongst others. There was strong consensus and shared interest between the government and CHAM regarding SLAs. It was clear that free services provided by SLAs had

Effects of health-care services and commodities cost on the patients at the primary health facilities in Zaria Metropolis, North Western Nigeria.

PubMed

Adegboyega, O; Abioye, K

2017-08-01

The payment for health-care services is a major problem for many poor patients in developing nations. The aim of the study was to examine the cost of services and commodities and how these affect the patients who utilizes the primary health-care centers in Zaria, North western Nigeria. A descriptive cross-sectional survey of six primary health-care facilities in Zaria metropolis, namely Baban dodo, Tudun Wada, Magajiya PHCs from Zaria local government areas (LGA) and Samaru, Kwata, and Dogarawa PHCs from Sabon Gari LGA, was carried out. The mean age of the respondents was 28.87± 8.63 years, most of them were married (53.3%), Hausa (63.3%), and Muslims (85.7%); also, they were unemployed housewives with daily stipends from their husbands less than 1 dollar/day. The major method for payment for health-care services was out of pocket (98.3%). More than one-third of the clients were not aware of the National Health Insurance Scheme (NHIS) (39%). There was a significant inverse relationship between the monthly income of the clients and the experience of financial stress and a positive association between patients' monthly income and awareness of the NHIS (P < 0.05). The respondents were paying user fees for essential health-care services at the primary health-care centers and this was not convenient for them. There is a need for the LGA health department to intensify the supervision of the activities at the PHCs. Standardization of prices of services and commodities and the implementation of the National Health Act may alleviate the burdens of the poor community members who access PHCs in Nigeria.

78 FR 24760 - National Institutes of Health

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-26

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Prospective Grant of Start... Prevention in Humans AGENCY: National Institutes of Health, HHS. ACTION: Notice. SUMMARY: This is notice, in accordance with 35 U.S.C. 209(c)(1) and 37 CFR 404.7(a)(1)(i), that the National Institutes of Health...

[A guide to good practice for information security in the handling of personal health data by health personnel in ambulatory care facilities].

PubMed

Sánchez-Henarejos, Ana; Fernández-Alemán, José Luis; Toval, Ambrosio; Hernández-Hernández, Isabel; Sánchez-García, Ana Belén; Carrillo de Gea, Juan Manuel

2014-04-01

The appearance of electronic health records has led to the need to strengthen the security of personal health data in order to ensure privacy. Despite the large number of technical security measures and recommendations that exist to protect the security of health data, there is an increase in violations of the privacy of patients' personal data in healthcare organizations, which is in many cases caused by the mistakes or oversights of healthcare professionals. In this paper, we present a guide to good practice for information security in the handling of personal health data by health personnel, drawn from recommendations, regulations and national and international standards. The material presented in this paper can be used in the security audit of health professionals, or as a part of continuing education programs in ambulatory care facilities. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Precision shock tuning on the national ignition facility.

PubMed

Robey, H F; Celliers, P M; Kline, J L; Mackinnon, A J; Boehly, T R; Landen, O L; Eggert, J H; Hicks, D; Le Pape, S; Farley, D R; Bowers, M W; Krauter, K G; Munro, D H; Jones, O S; Milovich, J L; Clark, D; Spears, B K; Town, R P J; Haan, S W; Dixit, S; Schneider, M B; Dewald, E L; Widmann, K; Moody, J D; Döppner, T D; Radousky, H B; Nikroo, A; Kroll, J J; Hamza, A V; Horner, J B; Bhandarkar, S D; Dzenitis, E; Alger, E; Giraldez, E; Castro, C; Moreno, K; Haynam, C; LaFortune, K N; Widmayer, C; Shaw, M; Jancaitis, K; Parham, T; Holunga, D M; Walters, C F; Haid, B; Malsbury, T; Trummer, D; Coffee, K R; Burr, B; Berzins, L V; Choate, C; Brereton, S J; Azevedo, S; Chandrasekaran, H; Glenzer, S; Caggiano, J A; Knauer, J P; Frenje, J A; Casey, D T; Johnson, M Gatu; Séguin, F H; Young, B K; Edwards, M J; Van Wonterghem, B M; Kilkenny, J; MacGowan, B J; Atherton, J; Lindl, J D; Meyerhofer, D D; Moses, E

2012-05-25

Ignition implosions on the National Ignition Facility [J. D. Lindl et al., Phys. Plasmas 11, 339 (2004)] are underway with the goal of compressing deuterium-tritium fuel to a sufficiently high areal density (ρR) to sustain a self-propagating burn wave required for fusion power gain greater than unity. These implosions are driven with a very carefully tailored sequence of four shock waves that must be timed to very high precision to keep the fuel entropy and adiabat low and ρR high. The first series of precision tuning experiments on the National Ignition Facility, which use optical diagnostics to directly measure the strength and timing of all four shocks inside a hohlraum-driven, cryogenic liquid-deuterium-filled capsule interior have now been performed. The results of these experiments are presented demonstrating a significant decrease in adiabat over previously untuned implosions. The impact of the improved shock timing is confirmed in related deuterium-tritium layered capsule implosions, which show the highest fuel compression (ρR~1.0 g/cm(2)) measured to date, exceeding the previous record [V. Goncharov et al., Phys. Rev. Lett. 104, 165001 (2010)] by more than a factor of 3. The experiments also clearly reveal an issue with the 4th shock velocity, which is observed to be 20% slower than predictions from numerical simulation.

Quantifying surgical and anesthetic availability at primary health facilities in Mongolia.

PubMed

Spiegel, David A; Choo, Shelly; Cherian, Meena; Orgoi, Sergelen; Kehrer, Beat; Price, Raymond R; Govind, Salik

2011-02-01

Significant barriers limit the safe and timely provision of surgical and anaesthetic care in low- and middle-income countries. Nearly one-half of Mongolia's population resides in rural areas where the austere geography makes travel for adequate surgical care very difficult. Our goal was to characterize the availability of surgical and anaesthetic services, in terms of infrastructure capability, physical resources (supplies and equipment), and human resources for health at primary level health facilities in Mongolia. A situational analysis of the capacity to deliver emergency and essential surgical care (EESC) was performed in a nonrandom sample of 44 primary health facilities throughout Mongolia. Significant shortfalls were noted in the capacity to deliver surgical and anesthetic services. Deficiencies in infrastructure and supplies were common, and there were no trained surgeons or anaesthesiologists at any of the health facilities sampled. Most procedures were performed by general doctors and paraprofessionals, and occasionally visiting surgeons from higher levels of the health system. While basic interventions such as suturing or abscess drainage were commonly performed, the availability of many essential interventions was absent at a significant number of facilities. This situational analysis of the availability of essential surgical and anesthetic services identified significant deficiencies in infrastructure, supplies, and equipment, as well as a lack of human resources at the primary referral level facilities in Mongolia. Given the significant travel distances to secondary level facilities for the majority of the rural population, there is an urgent need to strengthen the delivery of essential surgical and anaesthetic services at the primary referral level (soum and intersoum). This will require a multidisciplinary, multi-sectoral effort aimed to improve infrastructure, procure and maintain essential equipment and supplies, and train appropriate health

Recommendations for Health Monitoring and Reporting for Zebrafish Research Facilities

PubMed Central

Crim, Marcus J.; Lieggi, Christine

2016-01-01

Abstract The presence of subclinical infection or clinical disease in laboratory zebrafish may have a significant impact on research results, animal health and welfare, and transfer of animals between institutions. As use of zebrafish as a model of disease increases, a harmonized method for monitoring and reporting the health status of animals will facilitate the transfer of animals, allow institutions to exclude diseases that may negatively impact their research programs, and improve animal health and welfare. All zebrafish facilities should implement a health monitoring program. In this study, we review important aspects of a health monitoring program, including choice of agents, samples for testing, available testing methodologies, housing and husbandry, cost, test subjects, and a harmonized method for reporting results. Facilities may use these recommendations to implement their own health monitoring program. PMID:26991393

Sandia National Laboratories Facilities Management and Operations Center Design Standards Manual

DOE Office of Scientific and Technical Information (OSTI.GOV)

Peterson, Timothy L.

2014-09-01

At Sandia National Laboratories in New Mexico (SNL/NM), the design, construction, operation, and maintenance of facilities is guided by industry standards, a graded approach, and the systematic analysis of life cycle benefits received for costs incurred. The design of the physical plant must ensure that the facilities are "fit for use," and provide conditions that effectively, efficiently, and safely support current and future mission needs. In addition, SNL/NM applies sustainable design principles, using an integrated whole-building design approach, from site planning to facility design, construction, and operation to ensure building resource efficiency and the health and productivity of occupants. Themore » safety and health of the workforce and the public, any possible effects on the environment, and compliance with building codes take precedence over project issues, such as performance, cost, and schedule. These design standards generally apply to all disciplines on all SNL/NM projects. Architectural and engineering design must be both functional and cost-effective. Facility design must be tailored to fit its intended function, while emphasizing low-maintenance, energy-efficient, and energy-conscious design. Design facilities that can be maintained easily, with readily accessible equipment areas, low maintenance, and quality systems. To promote an orderly and efficient appearance, architectural features of new facilities must complement and enhance the existing architecture at the site. As an Architectural and Engineering (A/E) professional, you must advise the Project Manager when this approach is prohibitively expensive. You are encouraged to use professional judgment and ingenuity to produce a coordinated interdisciplinary design that is cost-effective, easily contractible or buildable, high-performing, aesthetically pleasing, and compliant with applicable building codes. Close coordination and development of civil, landscape, structural, architectural

Industrial Sanitation and Personal Facilities. Module SH-13. Safety and Health.

ERIC Educational Resources Information Center

Center for Occupational Research and Development, Inc., Waco, TX.

This student module on industrial sanitation and personal facilities is one of 50 modules concerned with job safety and health. This module deals wth many facets of industrial sanitation and the facilities industries should provide so that proper health procedures may be followed. Following the introduction, 14 objectives (each keyed to a page in…

Initial Findings on Hydrodynamic Scaling Extrapolations of National Ignition Facility BigFoot Implosions

NASA Astrophysics Data System (ADS)

Nora, R.; Field, J. E.; Peterson, J. Luc; Spears, B.; Kruse, M.; Humbird, K.; Gaffney, J.; Springer, P. T.; Brandon, S.; Langer, S.

2017-10-01

We present an experimentally corroborated hydrodynamic extrapolation of several recent BigFoot implosions on the National Ignition Facility. An estimate on the value and error of the hydrodynamic scale necessary for ignition (for each individual BigFoot implosion) is found by hydrodynamically scaling a distribution of multi-dimensional HYDRA simulations whose outputs correspond to their experimental observables. The 11-parameter database of simulations, which include arbitrary drive asymmetries, dopant fractions, hydrodynamic scaling parameters, and surface perturbations due to surrogate tent and fill-tube engineering features, was computed on the TRINITY supercomputer at Los Alamos National Laboratory. This simple extrapolation is the first step in providing a rigorous calibration of our workflow to provide an accurate estimate of the efficacy of achieving ignition on the National Ignition Facility. This work performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

Limited Service Availability, Readiness, and Use of Facility-Based Delivery Care in Haiti: A Study Linking Health Facility Data and Population Data

PubMed Central

Wang, Wenjuan; Winner, Michelle; Burgert-Brucker, Clara R

2017-01-01

Background: Understanding the barriers that women in Haiti face to giving birth at a health facility is important for improving coverage of facility delivery and reducing persistently high maternal mortality. We linked health facility survey data and population survey data to assess the role of the obstetric service environment in affecting women's use of facility delivery care. Methods: Data came from the 2012 Haiti Demographic and Health Survey (DHS) and the 2013 Haiti Service Provision Assessment (SPA) survey. DHS clusters and SPA facilities were linked with their geographic coordinate information. The final analysis sample from the DHS comprised 4,921 women who had a live birth in the 5 years preceding the survey. Service availability was measured with the number of facilities providing delivery services within a specified distance from the cluster (within 5 kilometers for urban areas and 10 kilometers for rural areas). We measured facility readiness to provide obstetric care using 37 indicators defined by the World Health Organization. Random-intercept logistic regressions were used to model the variation in individual use of facility-based delivery care and cluster-level service availability and readiness, adjusting for other factors. Results: Overall, 39% of women delivered their most recent birth at a health facility and 61% delivered at home, with disparities by residence (about 60% delivered at a health facility in urban areas vs. 24% in rural areas). About one-fifth (18%) of women in rural areas and one-tenth (12%) of women in nonmetropolitan urban areas lived in clusters where no facility offered delivery care within the specified distances, while nearly all women (99%) in the metropolitan area lived in clusters that had at least 2 such facilities. Urban clusters had better service readiness compared with rural clusters, with a wide range of variation in both areas. Regression models indicated that in both rural and nonmetropolitan urban areas

78 FR 42967 - National Institutes of Health

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-18

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee... Resources Research, National Institutes of Health, HHS) Dated: July 12, 2013. Michelle Trout, Program...

Ignition and Inertial Confinement Fusion at The National Ignition Facility

NASA Astrophysics Data System (ADS)

Moses, Edward I.

2016-10-01

The National Ignition Facility (NIF), the world's largest and most powerful laser system for inertial confinement fusion (ICF) and for studying high-energy-density (HED) science, is now operational at Lawrence Livermore National Laboratory (LLNL). The NIF is now conducting experiments to commission the laser drive, the hohlraum and the capsule and to develop the infrastructure needed to begin the first ignition experiments in FY 2010. Demonstration of ignition and thermonuclear bum in the laboratory is a major NIF goal. NIF will achieve this by concentrating the energy from the 192 beams into a mm3-sized target and igniting a deuterium-tritium mix, liberating more energy than is required to initiate the fusion reaction. NIP's ignition program is a national effort managed via the National Ignition Campaign (NIC). The NIC has two major goals: execution of DT ignition experiments starting in FY20l0 with the goal of demonstrating ignition and a reliable, repeatable ignition platform by the conclusion of the NIC at the end of FY2012. The NIC will also develop the infrastructure and the processes required to operate NIF as a national user facility. The achievement of ignition at NIF will demonstrate the scientific feasibility of ICF and focus worldwide attention on laser fusion as a viable energy option. A laser fusion-based energy concept that builds on NIF, known as LIFE (Laser Inertial Fusion Energy), is currently under development. LIFE is inherently safe and can provide a global carbon-free energy generation solution in the 21st century. This paper describes recent progress on NIF, NIC, and the LIFE concept.

75 FR 71134 - National Institutes of Health

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-22

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Cancer Institute; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act, as amended (5 U....398, Cancer Research Manpower; 93.399, Cancer Control, National Institutes of Health, HHS) Dated...

Determinants of use of health facility for childbirth in rural Hadiya zone, Southern Ethiopia.

PubMed

Asseffa, Netsanet Abera; Bukola, Fawole; Ayodele, Arowojolu

2016-11-16

Maternal mortality remains a major global public health concern despite many international efforts. Facility-based childbirth increases access to appropriate skilled attendance and emergency obstetric care services as the vast majority of obstetric complications occur during delivery. The purpose of the study was to determine the proportion of facility delivery and assess factors influencing utilization of health facility for childbirth. A cross-sectional study was conducted in two rural districts of Hadiya zone, southern Ethiopia. Participants who delivered within three years of the survey were selected by stratified random sampling. Trained interviewers administered a pre-tested semi-structured questionnaire. We employed bivariate analysis and logistic regression to identify determinants of facility-based delivery. Data from 751 participants showed that 26.9% of deliveries were attended in health facilities. In bivariate analysis, maternal age, education, husband's level of education, possession of radio, antenatal care, place of recent ANC attended, planned pregnancy, wealth quintile, parity, birth preparedness and complication readiness, being a model family and distance from the nearest health facility were associated with facility delivery. On multiple logistic regression, age, educational status, antenatal care, distance from the nearest health facility, wealth quintile, being a model family, planned pregnancy and place of recent ANC attended were the determinants of facility-based childbirth. Efforts to improve institutional deliveries in the region must strengthen initiatives that promote female education, opportunities for wealth creation, female empowerment and increased uptake of family planning among others. Service related barriers and cultural influences on the use of health facility for childbirth require further evaluation.

National Health Interview Survey (NHIS)

EPA Pesticide Factsheets