Promoting Early Diagnosis of Hemodynamic Instability during Simulated Hemorrhage with the Use of a Real-time Decision-assist Algorithm

DTIC Science & Technology

2013-01-01

vilian trauma systems and in military casualty care rely on standard vital signs (blood pressure, arterial oxygen saturation , heart rate [HR...acting to maintain blood pressure and arterial oxygen saturation (i.e., standard vital signs are not changing) in the presence of re- duced...assessments in austere environments. Profiles of changes in mean arterial pressure (MAP), cardiac output, and venous oxygen saturation during LBNP have been

Diabetes and the Affordable Care Act

PubMed Central

Schade, David S.

2014-01-01

Abstract The Affordable Care Act—“Obamacare”—is the most important federal medical legislation to be enacted since Medicare. Although the goal of the Affordable Care Act is to improve healthcare coverage, access, and quality for all Americans, people with diabetes are especially poised to benefit from the comprehensive reforms included in the act. Signed into law in 2010, this massive legislation will slowly be enacted over the next 10 years. In the making for at least a decade, it will affect every person in the United States, either directly or indirectly. In this review, we discuss the major changes in healthcare that will take place in the next several years, including (1) who needs to purchase insurance on the Web-based exchange, (2) the cost to individuals and the rebates that they may expect, (3) the rules and regulations for purchasing insurance, (4) the characteristics of the different “metallic” insurance plans that are available, and (5) the states that have agreed to participate. With both tables and figures, we have tried to make the Affordable Care Act both understandable and appreciated. The goal of this comprehensive review is to highlight aspects of the Affordable Care Act that are of importance to practitioners who care for people with diabetes by discussing both the positive and the potentially negative aspects of the program as they relate to diabetes care. PMID:24927108

76 FR 68613 - National Adoption Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-04

... National Adoption Month, 2011 By the President of the United States of America A Proclamation As a Nation... without families. During National Adoption Month, we celebrate the acts of compassion and love that unite... the foster care system. Last year, during National Adoption Month, I signed the International Adoption...

The Patient Protection and Affordable Care Act: The Impact on Urologic Cancer Care

PubMed Central

Keegan, Kirk A.; Penson, David F.

2012-01-01

In March 2010, the Patient Protection and Affordable Care Act as well as its amendments were signed into law. This sweeping legislation was aimed at controlling spiraling healthcare costs and redressing significant disparities in healthcare access and quality. Cancer diagnoses and their treatments constitute a large component of rising healthcare expenditures and, not surprisingly, the legislation will have a significant influence on cancer care in the United States. Because genitourinary malignancies represent an impressive 25% of all cancer diagnoses per year, this legislation could have a profound impact on urologic oncology. To this end, we will present key components of this landmark legislation, including the proposed expansion to Medicaid coverage, the projected role of Accountable Care Organizations, the expected creation of quality reporting systems, the formation of an independent Patient-Centered Outcomes Research Institute, and enhanced regulation on physician-owned practices. We will specifically address the anticipated effect of these changes on urological cancer care. Briefly, the legal ramifications and current barriers to the statutes will be examined. PMID:22819697

Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

PubMed Central

Logani, Sachin; Green, Adam; Gasperino, James

2011-01-01

The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU) are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees) and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform. PMID:22110908

77 FR 23595 - National Equal Pay Day, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-20

... America A Proclamation Working women power America's economy and sustain our middle class. For millions of families across our country, women's wages mean food on the table, decent medical care, and timely mortgage payments. Yet, in 2010--47 years after President John F. Kennedy signed the Equal Pay Act of 1963--women...

Redefining the Core Competencies of Future Healthcare Executives under Healthcare Reform

ERIC Educational Resources Information Center

Love, Dianne B.; Ayadi, M. Femi

2015-01-01

As the healthcare industry has evolved over the years, so too has the administration of healthcare organizations. The signing into law of the Patient Protection and Affordable Care Act (ACA) has brought additional changes to the healthcare industry that will require changes to the healthcare administration curriculum. The movement toward a…

Signing In: Knowledge and Action in Nursery Teaching

ERIC Educational Resources Information Center

Plum, Maja

2018-01-01

Based on fieldwork conducted in two day care centres in Denmark, this paper explores knowledge and action as relational and intertwined phenomena in nursery teaching. Engaging with perspectives from actor network theory, emphasis is put on the socio-material distribution of knowing and acting. That is, how the nursery teacher becomes part of…

The Patient Protection and Affordable Care Act of 2010: impact on otolaryngology practice and research.

PubMed

Sun, Gordon H; Davis, Matthew M

2012-05-01

The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama on March 23, 2010. Since its passage, the PPACA has led to increased health insurance coverage for millions more Americans, and it includes provisions leading to new avenues for clinical and health services research funding. The legislation also favors development of the primary care specialties and general surgery, increased training of midlevel health care providers, and medical training and service in underserved areas of the United States. However, the PPACA does not effectively engage otolaryngologists in quality improvement, despite modifications to the Physician Quality Reporting System. The legislation also levies a tax on cosmetic procedures, affecting both clinicians and patients. This article reviews the sections of the PPACA that are most pertinent to otolaryngologists and explains how these components of the bill will affect otolaryngologic practice and research over the coming decade.

Right-wing conspiracy? Socialist plot? The origins of the Patient Protection and Affordable Care Act.

PubMed

Quadagno, Jill

2014-02-01

On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA). Did the ACA signify a government takeover of the health care system, a first step on the road to socialism, as conservative critics charged? Or was it, rather, a sellout to the right wing, as liberal single-payer advocates proclaimed? The ACA's key provisions, the employer mandate and the individual mandate, were Republican policy ideas, and its fundamental principles were nearly identical to the Health Equity and Access Reform Today Act of 1993 (HEART), a bill promoted by Republican senators to deflect support for President Bill Clinton's Health Security plan. Yet the ACA was also a policy legacy of the Clinton administration in important ways that rarely are acknowledged, notably Medicaid expansion and insurance company regulation. Although the ACA departed from the liberal vision of a single-payer plan and adhered closely to the objectives of those who believed that the health care system should encourage the free market, it included provisions that will make coverage more affordable, reliable, and accessible.

Preparing for the physician payment sunshine act.

PubMed

Dickerson, David M; Naidu, Ramana K

2014-01-01

In March of 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, ushering in an era of health care reform. Section 6002 of the bill, the Physician Payment Sunshine Act, requires manufacturers of drugs, devices, biological therapeutics, and medical supplies to disclose to the Centers for Medicare and Medicaid Services any payments or transfers of value to physicians. These reports are not meant to prohibit relationships between physicians and industry, but rather to generate a searchable public database illustrating the purpose of the payment, the entities involved, and the timing of each occurrence. Although the bill is meant to reveal physician-industry relationships, the question of how society at large and the medical field will interpret these data are unknown. The purpose of this article is to inform physicians of the components of the Physician Payment Sunshine Act. We discuss several resultant challenges and suggest a framework for preparing for transparency reporting and its potential effects.

The new follow-on-biologics law: a section by section analysis of the patent litigation provisions in the Biologics Price Competition and Innovation Act of 2009.

PubMed

Dougherty, Michael P

2010-01-01

An abbreviated pathway for the approval of biosimilar biological products, often called "follow-on biologics," has been enacted into law as part of the health care legislation recently passed by Congress and signed by the President. The subtitle of the health care bill establishing this approval pathway, the Biologics Price Competition and Innovation Act of 2009, includes many provisions governing the identification of patents relevant to a given biosimilar biological product and the assertion of those patents in infringement suits. This article provides a section-by-section analysis of the patent-related provisions of the new approval pathway for biosimilar biological products, and points out several ways in which the new law differs fundamentally from the Hatch-Waxman Act, which provides the approval pathway for generic versions of small molecule drugs.

Effect on motivation, perceived competence, and activation after participation in the ''Ready to Act'' programme for people with screen-detected dysglycaemia: a 1-year randomised controlled trial, Addition-DK.

PubMed

Maindal, Helle Terkildsen; Sandbæk, Annelli; Kirkevold, Marit; Lauritzen, Torsten

2011-05-01

To investigate the reach of the ''Ready to Act'' programme and the 1-year effects on psychological determinants of healthy behaviour: motivation, perceived competence, and activation level. A total of 509 adults with dysglycaemia were recruited from general practioners (GPs) in the intensive arm of the Danish Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION) study, a type 2 diabetes screening programme. The participants were randomised to the ''Ready to Act'' programme added on top of GP care (n = 322) or to GP care (n = 187). The core components of the programme were motivation, action experience, informed decision-making, and social involvement conducted in two one-to-one sessions and eight group-meetings (18 hours). The reach of the programme was measured by the proportion of people who signed up. Outcomes were changes in treatment motivation (Treatment Self-Regulation Questionnaire, TSRQ), perceived competence (Perceived Competence Scale, PCS), and activation in chronic care (Patient Activation Measure, PAM). Effect size was the difference between 1-year changes in the randomisation groups analysed by intention-to-treat. A total of 142 (44%) of 322 signed up and 123 (87%) of these completed. At 1 year, the difference in autonomous motivation for behavioural treatment (TSRQ) between the randomisation groups was 1.0 (95% CI 0.1 to 2.0), and the difference in perceived competence changes in healthy diet (PCS-d) was 1.5 (95% CI 0.2 to 2.7). No differences were observed for activation (PAM) between the groups. Subgroup analysis revealed men to benefit more from the intervention than women. The programme is a promising health-promoting component in prevention and care for people with screen-detected dysglycaemia, as it attracted four of 10 people and had effects on motivation and perceived competence.

The Patient Protection and Affordable Care Act: the impact on urologic cancer care.

PubMed

Keegan, Kirk A; Penson, David F

2013-10-01

In March 2010, the Patient Protection and Affordable Care Act as well as its amendments were signed into law. This sweeping legislation was aimed at controlling spiraling healthcare costs and redressing significant disparities in healthcare access and quality. Cancer diagnoses and their treatments constitute a large component of rising healthcare expenditures and, not surprisingly, the legislation will have a significant influence on cancer care in the USA. Because genitourinary malignancies represent an impressive 25% of all cancer diagnoses per year, this legislation could have a profound impact on urologic oncology. To this end, we will present key components of this landmark legislation, including the proposed expansion to Medicaid coverage, the projected role of Accountable Care Organizations, the expected creation of quality reporting systems, the formation of an independent Patient-Centered Outcomes Research Institute, and enhanced regulation on physician-owned practices. We will specifically address the anticipated effect of these changes on urologic cancer care. Briefly, the legal ramifications and current barriers to the statutes will be examined. Published by Elsevier Inc.

12 CFR 609.910 - Compliance with the Electronic Signatures in Global and National Commerce Act (Public Law 106-229...

Code of Federal Regulations, 2010 CFR

2010-01-01

... Global and National Commerce Act (Public Law 106-229) (E-SIGN). 609.910 Section 609.910 Banks and Banking... with the Electronic Signatures in Global and National Commerce Act (Public Law 106-229) (E-SIGN). (a) General. E-SIGN makes it easier to conduct E-commerce. With some exceptions, E-SIGN permits the use and...

12 CFR 609.910 - Compliance with the Electronic Signatures in Global and National Commerce Act (Public Law 106-229...

Code of Federal Regulations, 2011 CFR

2011-01-01

... Global and National Commerce Act (Public Law 106-229) (E-SIGN). 609.910 Section 609.910 Banks and Banking... with the Electronic Signatures in Global and National Commerce Act (Public Law 106-229) (E-SIGN). (a) General. E-SIGN makes it easier to conduct E-commerce. With some exceptions, E-SIGN permits the use and...

12 CFR 609.910 - Compliance with the Electronic Signatures in Global and National Commerce Act (Public Law 106-229...

Code of Federal Regulations, 2012 CFR

2012-01-01

... Global and National Commerce Act (Public Law 106-229) (E-SIGN). 609.910 Section 609.910 Banks and Banking... with the Electronic Signatures in Global and National Commerce Act (Public Law 106-229) (E-SIGN). (a) General. E-SIGN makes it easier to conduct E-commerce. With some exceptions, E-SIGN permits the use and...

12 CFR 609.910 - Compliance with the Electronic Signatures in Global and National Commerce Act (Public Law 106-229...

Code of Federal Regulations, 2014 CFR

2014-01-01

... Global and National Commerce Act (Public Law 106-229) (E-SIGN). 609.910 Section 609.910 Banks and Banking... with the Electronic Signatures in Global and National Commerce Act (Public Law 106-229) (E-SIGN). (a) General. E-SIGN makes it easier to conduct E-commerce. With some exceptions, E-SIGN permits the use and...

12 CFR 609.910 - Compliance with the Electronic Signatures in Global and National Commerce Act (Public Law 106-229...

Code of Federal Regulations, 2013 CFR

2013-01-01

... Global and National Commerce Act (Public Law 106-229) (E-SIGN). 609.910 Section 609.910 Banks and Banking... with the Electronic Signatures in Global and National Commerce Act (Public Law 106-229) (E-SIGN). (a) General. E-SIGN makes it easier to conduct E-commerce. With some exceptions, E-SIGN permits the use and...

Health Care Reform: Understanding Individuals' Attitudes and Information Sources

PubMed Central

Shue, Carolyn K.; McGeary, Kerry Anne; Reid, Ian; Fan, Maoyong

2014-01-01

Since passage of the Affordable Care Act (ACA) was signed into law by President Barrack Obama, little is known about state-level perceptions of residents on the ACA. Perceptions about the act could potentially affect implementation of the law to the fullest extent. This 3-year survey study explored attitudes about the ACA, the types of information sources that individuals rely on when creating those attitudes, and the predictors of these attitudes among state of Indiana residents. The respondents were split between favorable and unfavorable views of the ACA, yet the majority of respondents strongly supported individual components of the act. National TV news, websites, family members, and individuals' own reading of the ACA legislation were identified as the most influential information sources. After controlling for potential confounders, the respondent's political affiliation, age, sex, and obtaining ACA information from watching national television news were the most important predictors of attitudes about the ACA and its components. These results mirror national-level findings. Implications for implementing health care reform at the state-level are discussed. PMID:25045705

Evolution of US Health Care Reform.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

2017-03-01

Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.

The Influence of Deaf People's Dual Category Status on Sign Language Planning: The British Sign Language (Scotland) Act (2015)

ERIC Educational Resources Information Center

De Meulder, Maartje

2017-01-01

Through the British Sign Language (Scotland) Act, British Sign Language (BSL) was given legal status in Scotland. The main motives for the Act were a desire to put BSL on a similar footing with Gaelic and the fact that in Scotland, BSL signers are the only group whose first language is not English who must rely on disability discrimination…

The Legal Recognition of Sign Languages

ERIC Educational Resources Information Center

De Meulder, Maartje

2015-01-01

This article provides an analytical overview of the different types of explicit legal recognition of sign languages. Five categories are distinguished: constitutional recognition, recognition by means of general language legislation, recognition by means of a sign language law or act, recognition by means of a sign language law or act including…

The Patient Protection and Affordable Care Act: what every provider of gynecologic oncology care should know.

PubMed

Duska, Linda R; Engelhard, Carolyn L

2013-06-01

The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in 2010. While initial implementation of the law began shortly thereafter, the full implementation will take place over the next few years. With respect to cancer care, the act was intended to make care more accessible, affordable, and comprehensive across different parts of the country. For our cancer patients and our practices, the ACA has implications that are both positive and negative. The Medicaid expansion and access to insurance exchanges are intended to increase the number of insured patients and thus improve access to care, but many states have decided to opt out of the Medicaid program and in these states access problems will persist. Screening programs will be put in place for insured patients but may supplant federally funded programs that are currently in place for uninsured patients and may not follow current screening guidelines. Both hospice and home health providers will be asked to provide more services with less funding, and quality measures, including readmission rates, will factor into reimbursement. Insured patients will have access to all phases of clinical trial research. There is a need for us as providers of Gynecologic Oncology care to be active in the implementation of the ACA in order to ensure that our patients and our practices can survive and benefit from the changes in health care reimbursement, with the ultimate goals of improving access to care and quality while reducing unsustainable costs. Copyright © 2013 Elsevier Inc. All rights reserved.

77 FR 15024 - Privacy Act of 1974; Revised System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-14

... Agency customers and employees single sign-on capability and electronic authentication and authorization...Authentication acts as a single sign-on point for USDA Agency applications. This allows a USDA customer to sign onto any USDA applications they have been authorized on via a single sign-on. 2. When a record on its...

"A campaign won as a public issue will stay won": using cartoons and comics to fight national health care reform, 1940s and beyond.

PubMed

Knoblauch, Heidi Katherine

2014-02-01

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. As it went through Congress, the legislation faced forceful resistance. Individuals and organizations opposing the ACA circulated propaganda that varied from photographs of fresh graves or coffins with the caption "Result of ObamaCare" to portrayals of President Obama as the Joker from the Batman movies, captioned with the single word "socialism." The arguments embedded in these images have striking parallels to cartoons circulated by physicians to their patients in earlier fights against national health care. Examining cartoons used in the formative health care reform debates of the 1940s provides a means for tracing the lineage of emotional arguments employed against health care reform.

A Case Report of Clonazepam Dependence

PubMed Central

Kacirova, Ivana; Grundmann, Milan; Silhan, Petr; Brozmanova, Hana

2016-01-01

Abstract Clonazepam is long-acting benzodiazepine agonist used in short-acting benzodiazepine withdrawal; however, recent observations suggest the existence of its abuse. We demonstrate a 40-year-old man with a 20-year history of psychiatric care with recently benzodiazepine dependence (daily intake of ∼60 mg of clonazepam and 10 mg of alprazolam). High serum levels of both drugs were analyzed 3 weeks before admission to hospitalization (clonazepam 543.9 ng/mL, alprazolam 110 ng/mL) and at the time of admission (clonazepam 286.2 ng/mL, alprazolam 140 ng/mL) without any signs of benzodiazepine intoxication. Gradual withdrawal of clonazepam with monitoring of its serum levels and increase of gabapentin dose were used to minimize physical signs and symptoms of clonazepam withdrawal. Alprazolam was discontinued promptly. Clinical consequences of the treatment were controllable tension, intermittent headache, and rarely insomia. It is the first case report showing utilization of therapeutic drug monitoring during withdrawal period in the patient with extreme toleration to severe benzodiazepine dependence. PMID:26945373

Munchausen syndrome by proxy.

PubMed Central

Meadow, R

1982-01-01

Information is presented about 19 children, under age 7 years, from 17 families, whose mothers consistently gave fraudulent clinical histories and fabricated signs so causing them needless harmful medical investigations, hospital admissions, and treatment over periods of time ranging from a few months to 4 years. Episodes of bleeding, neurological abnormality, rashes, fevers, and abnormal urine were commonly simulated. Often the mothers had had previous nursing training and some had a history of fabricating symptoms or signs relating to themselves. Two children died. Of the 17 survivors, 8 were taken into care and the other 9 remained at home after arrangements had been made for their supervision. Study of these children and their families has enabled a list of warning signs to be compiled together with recommendations for dealing with suspected acts. The causes and the relationship of this form of behaviour to other forms of non-accidental injury, iatrogenic injury, and parental-induced illness are discussed. PMID:7065720

Using baldrige performance excellence program approaches in the pursuit of radiation oncology quality care, patient satisfaction, and workforce commitment.

PubMed

Sternick, Edward S

2011-01-01

The Malcolm Baldrige National Quality Improvement Act was signed into law in 1987 to advance US business competitiveness and economic growth. Administered by the National Institute of Standards and Technology, the Act created the Baldrige National Quality Program, recently renamed the Baldrige Performance Excellence Program. The comprehensive analytical approaches referred to as the Baldrige Healthcare Criteria, are very well-suited for the evaluation and sustainable improvement of radiation oncology management and operations. A multidisciplinary self-assessment approach is used for radiotherapy program evaluation and development in order to generate a fact-based, knowledge-driven system for improving quality of care, increasing patient satisfaction, enhancing leadership effectiveness, building employee engagement, and boosting organizational innovation. This methodology also provides a valuable framework for benchmarking an individual radiation oncology practice's operations and results against guidelines defined by accreditation and professional organizations and regulatory agencies.

Use of Warning Signs for Dengue by Pediatric Health Care Staff in Brazil.

PubMed

Sicuro Correa, Luana; Hökerberg, Yara Hahr Marques; Oliveira, Raquel de Vasconcellos Carvalhaes de; Barros, Danielle Martins de Souza; Alexandria, Helenara Abadia Ferreira; Daumas, Regina Paiva; Andrade, Carlos Augusto Ferreira de; Passos, Sonia Regina Lambert; Brasil, Patrícia

2016-01-01

The aim of this study was to describe the use of dengue warning signs by pediatric healthcare staff in the Brazilian public health care system. Cross-sectional study (2012) with physicians, nurses, and nurse technicians assisting children in five health care facilities. Participants reported the use and importance of dengue warning signs in pediatrics clinical practice through a structured questionnaire. Differences in the use of signs (chi-square test) and in the ranking assigned to each of them (Kruskal-Wallis) were assessed according to health care occupation and level of care (p<0.05). The final sample comprised 474 participants (97%), mean age of 37 years (standard deviation = 10.3), mainly females (83.8%), physicians (40.1%) and from tertiary care (75.1%). The majority (91%) reported using warning signs for dengue in pediatrics clinical practice. The most widely used and highly valued signs were major hemorrhages (gastrointestinal, urinary), abdominal pain, and increase in hematocrit concurrent or not with rapid decrease in platelet count. Persistent vomiting as well as other signs of plasma leakage such as respiratory distress and lethargy/restlessness were not identified as having the same degree of importance, especially by nurse technicians and in primary or secondary care. Although most health care staff reported using dengue warning signs, it would be useful to extend the training for identifying easily recognizable signs of plasma leakage that occur regardless of bleeding.

“A Campaign Won as a Public Issue Will Stay Won”: Using Cartoons and Comics to Fight National Health Care Reform, 1940s and Beyond

PubMed Central

Knoblauch, Heidi Katherine

2014-01-01

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. As it went through Congress, the legislation faced forceful resistance. Individuals and organizations opposing the ACA circulated propaganda that varied from photographs of fresh graves or coffins with the caption “Result of ObamaCare” to portrayals of President Obama as the Joker from the Batman movies, captioned with the single word “socialism.” The arguments embedded in these images have striking parallels to cartoons circulated by physicians to their patients in earlier fights against national health care. Examining cartoons used in the formative health care reform debates of the 1940s provides a means for tracing the lineage of emotional arguments employed against health care reform. PMID:24328659

Does Question Wording Predict Support for the Affordable Care Act? An Analysis of Polling During the Implementation Period, 2010-2016.

PubMed

Holl, Kristen; Niederdeppe, Jeff; Schuldt, Jonathon P

2018-07-01

The Patient Protection and Affordable Care Act (ACA) continues to be the subject of fierce political debate in the United States. Drawing on issue framing theory, together with research on wording effects in survey responding, we tested how common differences in the wording of ACA surveys relate to apparent public support for the law. We report on a content analysis of N = 376 U.S. national opinion surveys fielded during a more than six-year period, beginning 23 March 2010 (when President Obama signed the bill into law) and ending 8 November 2016 (Election Day), and use ordinary least squares (OLS) regression models to predict public support for the law as a function of variation in question wording. We coded questions gauging general sentiment toward the law for differences in issue labeling (e.g., Obamacare, Affordable Care Act), whether or not they referenced particular political entities (e.g., President Obama, Congress) or segments of the public (e.g., You, Your Family), various opinion metrics (e.g., Support, Favor), and different response options (e.g., Repeal, Expand) which we used to model aggregate levels of support. The results revealed several key differences in question wording-for example, generic references to the Healthcare Law were employed much more frequently than Obamacare or Affordable Care Act-a number of which reliably predicted aggregate levels of public support. The discussion considers possible explanations for these patterns and reiterates the value of attending to questionnaire design features when interpreting survey data about politically contentious health policy issues.

Gap analysis: transition of health care from Department of Defense to Department of Veterans Affairs.

PubMed

Randall, Marjorie J

2012-01-01

This study examined the effectiveness of Public Law 110-181, "National Defense Authorization Act of Fiscal Year 2008, Title XVI-Wounded Warriors Matter," as it relates to health care for returning Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combat veterans. Specifically, it examined the gap between the time an OEF/OIF combat service member left active service and subsequently obtained health care within the Veteran Affairs (VA) Healthcare System, and which factors influenced or impeded the veteran from obtaining health care sooner. Data were collected from 376 OEF/OIF combat veterans who sought health care at the Nashville or Murfreesboro VA Medical Centers. A questionnaire was designed exclusively for this study. The average time gap for an OEF/OIF combat veteran to transition from Department of Defense to VA health care was 3.83 months (SD 7.17). Twenty-six percent of respondents reported there were factors that impeded them from coming to the VA sooner. Factors included lack of knowledge about VA benefits, transportation/distance, perceptions of losing military career, seeking help as sign of weakness, and VA reputation. The study provided some evidence to support that Department of Defense and VA are meeting mandates for providing seamless transition of health care set forth by "Public Law 110-181, National Defense Authorization Act of Fiscal Year 2008."

Use of Warning Signs for Dengue by Pediatric Health Care Staff in Brazil

PubMed Central

Hökerberg, Yara Hahr Marques; de Oliveira, Raquel de Vasconcellos Carvalhaes; Barros, Danielle Martins de Souza; Alexandria, Helenara Abadia Ferreira; Daumas, Regina Paiva; de Andrade, Carlos Augusto Ferreira; Passos, Sonia Regina Lambert; Brasil, Patrícia

2016-01-01

Objective The aim of this study was to describe the use of dengue warning signs by pediatric healthcare staff in the Brazilian public health care system. Methods Cross-sectional study (2012) with physicians, nurses, and nurse technicians assisting children in five health care facilities. Participants reported the use and importance of dengue warning signs in pediatrics clinical practice through a structured questionnaire. Differences in the use of signs (chi-square test) and in the ranking assigned to each of them (Kruskal-Wallis) were assessed according to health care occupation and level of care (p<0.05). Results The final sample comprised 474 participants (97%), mean age of 37 years (standard deviation = 10.3), mainly females (83.8%), physicians (40.1%) and from tertiary care (75.1%). The majority (91%) reported using warning signs for dengue in pediatrics clinical practice. The most widely used and highly valued signs were major hemorrhages (gastrointestinal, urinary), abdominal pain, and increase in hematocrit concurrent or not with rapid decrease in platelet count. Persistent vomiting as well as other signs of plasma leakage such as respiratory distress and lethargy/restlessness were not identified as having the same degree of importance, especially by nurse technicians and in primary or secondary care. Discussion Although most health care staff reported using dengue warning signs, it would be useful to extend the training for identifying easily recognizable signs of plasma leakage that occur regardless of bleeding. PMID:27716812

[Modifications of vital signs during hygiene care in intensive care patients: an explorative study].

PubMed

Lucchini, Alberto; Giacovelli, Matteo; Elli, Stefano; Gariboldi, Roberto; Pelucchi, Giulia; Bondi, Herman; Brambilla, Daniela

2009-01-01

Hygiene care in critical patients may alter vital signs. Aim of this paper is to measure vital signs and their modifications in critical patients during hygiene care and measure differences with pre and post hygiene values. Vital signs of 6 patients two hours before, during and 90 minutes after hygienic care were measured. During and 2 hours after the end of hygiene a modification of vital signs was observed compared to basic values (mean values during/90 min after, compared to baseline): heart rate +11.20%/ +1.48; systolic blood pressure +22.68%/+1.56; arterial capillary saturimetry -4.31/+0.27, Respiratory frequency +8.10/+2.66, tidal volume +4,04/-7,51, CO2 min/vol +5,34/- 22.33, bladder temperature -0.85/-0.60. Hygiene care in critical care patients may significantly alter vital signs. Therefore a strict haemodinamic and respiratory monitoring is warranted as well as protocols for the management of sedation and of vasoactive support.

[Assessment of the technology of care relations in the health services: perception of the elderly included in the family health strategy in Bambuí, Brazil].

PubMed

Santos, Wagner Jorge dos; Giacomin, Karla Cristina; Firmo, Josélia Oliveira Araújo

2014-08-01

In the health field, technologies of care relations are in the scope of the worker-user encounter, implying intersubjectivity with the development of relationships between subjects, resulting in action. Evaluation studies synthesize knowledge produced on the consequences of using these technologies for society. This anthropological study aims to understand the perception of the elderly regarding the resolution capability and effectiveness of the acts produced in health care relationships in the context of the Family Health Strategy (ESF). The group studied consisted of 57 elderly residents in Bambui, State of Minas Gerais, Brazil. The model of signs, meanings and actions was used for collecting and analyzing data and the semi-structured interview was applied as a research technique. Elderly individuals assess resolution capability and effectiveness of the acts of care in the ESF as negative, with relation to the quality of user and professional interaction. The ESF is not effective and the desired change in the health care model has not occurred in practice. It repeats the centrality of the medical-drug-procedure model that treats the disease rather than the patient, perceiving old age as a disease and illness as being related to aging.

Hot Topics in Primary Care: Management of Opioid-induced Constipation.

PubMed

Johnson, David A; Argoff, Charles E

2015-12-01

Constipation is a common complication of opioid therapy that contributes to substantial patient morbidity, decreased productivity, and opioid nonadherence. Other causes of constipation may occur concomitantly and should be investigated. Although evidence supporting their use is limited, the use of fiber, water, laxatives, and/or exercise is recommended in current guidelines as initial management. Peripherally acting μ-opioid receptor antagonists are important treatment options, are well-tolerated, and improve many signs and symptoms of OIC in patients taking an opioid for chronic noncancer pain.

ESSA: Quick Guides on Top Issues

ERIC Educational Resources Information Center

Aragon, Stephanie; Griffith, Mike; Wixom, Micah Ann; Woods, Julie; Workman, Emily

2016-01-01

The Every Student Succeeds Act (ESSA), signed into law in December 2015, is the latest reauthorization of one of the most influential pieces of federal education legislation, the Elementary and Secondary Education Act (ESEA). The law had not been reauthorized since 2001 when the No Child Left Behind Act (NCLB) was signed, and ESSA is the result of…

Coverage Gains After the Affordable Care Act Among the Uninsured in Minnesota.

PubMed

Call, Kathleen Thiede; Lukanen, Elizabeth; Spencer, Donna; Alarcón, Giovann; Kemmick Pintor, Jessie; Baines Simon, Alisha; Gildemeister, Stefan

2015-11-01

We determined whether and how Minnesotans who were uninsured in 2013 gained health insurance coverage in 2014, 1 year after the Affordable Care Act (ACA) expanded Medicaid coverage and enrollment. Insurance status and enrollment experiences came from the Minnesota Health Insurance Transitions Study (MH-HITS), a follow-up telephone survey of children and adults in Minnesota who had no health insurance in the fall of 2013. ACA had a tempered success in Minnesota. Outreach and enrollment efforts were effective; one half of those previously uninsured gained coverage, although many reported difficulty signing up (nearly 62%). Of the previously uninsured who gained coverage, 44% obtained their coverage through MNsure, Minnesota's insurance marketplace. Most of those who remained uninsured heard of MNsure and went to the Web site. Many still struggled with the enrollment process or reported being deterred by the cost of coverage. Targeting outreach, simplifying the enrollment process, focusing on affordability, and continuing funding for in-person assistance will be important in the future.

Coverage Gains After the Affordable Care Act Among the Uninsured in Minnesota

PubMed Central

Lukanen, Elizabeth; Spencer, Donna; Alarcón, Giovann; Kemmick Pintor, Jessie; Baines Simon, Alisha; Gildemeister, Stefan

2015-01-01

Objectives. We determined whether and how Minnesotans who were uninsured in 2013 gained health insurance coverage in 2014, 1 year after the Affordable Care Act (ACA) expanded Medicaid coverage and enrollment. Methods. Insurance status and enrollment experiences came from the Minnesota Health Insurance Transitions Study (MH-HITS), a follow-up telephone survey of children and adults in Minnesota who had no health insurance in the fall of 2013. Results. ACA had a tempered success in Minnesota. Outreach and enrollment efforts were effective; one half of those previously uninsured gained coverage, although many reported difficulty signing up (nearly 62%). Of the previously uninsured who gained coverage, 44% obtained their coverage through MNsure, Minnesota’s insurance marketplace. Most of those who remained uninsured heard of MNsure and went to the Web site. Many still struggled with the enrollment process or reported being deterred by the cost of coverage. Conclusions. Targeting outreach, simplifying the enrollment process, focusing on affordability, and continuing funding for in-person assistance will be important in the future. PMID:26447912

The Mental Capacity Act--a balance between protection and liberty.

PubMed

Walters, Thomas Paul

The stated aim of the Mental Capacity Act is to provide greater protection to those who may lose their mental capacities, particularly in terms of informed consent, patient affairs, advanced decisions and research. This article attempts to explore this new statute by way of examining the scope to which the Act departs from the previous Common Law. Three key themes are identified within this new Act, which differentiate it from Common Law: patients' best interests, which is paramount to any care or treatment; proxy consent, whereby donees can now be appointed to take charge of medical decisions; and advanced directives, where so-called living wills can be enforced provided that they are specific, written, signed and witnessed. However, upon examining the statute it appears that rather than increasing patient autonomy and self-determination, evidence suggests that power is still being held by the medical profession. Whether patients have full autonomy or not, the main issue could be how to strike an effective and workable balance between protection and liberty.

Lyndon Baines Johnson signs the Wilderness Act into law

Treesearch

Susan A. Fox

2016-01-01

President Lyndon Baines Johnson signed the Wilderness Act into law on Sept. 3, 1964. In this photo, LBJ hands the pen he used to Alice Zahniser while naturalist, author, adventurer, and conservationist Mardy Murie (standing behind her) looks on.

The Assisted Decision-Making (Capacity) Act 2015: what it is and why it matters.

PubMed

Kelly, B D

2017-05-01

Ireland's Assisted Decision-Making (Capacity) Act 2015 was signed by President Higgins in December 2015 and scheduled for commencement in 2016. To explore the content and implications of the 2015 Act. Review of the 2015 Act and related literature. The 2015 Act places the "will and preferences" of persons with impaired mental capacity at the heart of decision-making relating to "personal welfare" (including healthcare) and "property and affairs". Capacity is to be "construed functionally" and interventions must be "for the benefit of the relevant person". The Act outlines three levels of decision-making assistance: "decision-making assistant", "co-decision-maker" (joint decision-maker) and "decision-making representative" (substitute decision-maker). There are procedures relating to "enduring power of attorney" and "advance healthcare directives"; in the case of the latter, a "refusal of treatment" can be legally binding, while a "request for a specific treatment" must "be taken into consideration". The 2015 Act is considerably more workable than the 2013 Bill that preceded it. Key challenges include the subtle decision-making required by patients, healthcare staff, Circuit Court judges and the director of the Decision Support Service; implementation of "advance healthcare directives", especially if they do not form part of a broader model of advance care planning (incorporating the flexibility required for unpredictable future circumstances); and the over-arching issue of logistics, as very many healthcare decisions are currently made in situations where the patient's capacity is impaired. A key challenge will lie in balancing the emphasis on autonomy with principles of beneficence, mutuality and care.

Symptom management in the older adult: 2015 update.

PubMed

Smith, Thomas J

2015-05-01

This article updates the 2002 Jamie von Roenn article about "the palliation of commonly observed symptoms in older patients, including pain, neuropsychiatric, gastrointestinal, and respiratory symptoms." When palliative care was last covered in Clinics in Geriatric Medicine, President George W. Bush had just signed the No Child Left Behind Act, Homeland Security was being established, Michael Jackson won the Artist of the Century Award at the American Music Awards, and gas cost $1.61 a gallon. What has changed in the last decade and a half? Copyright © 2015 Elsevier Inc. All rights reserved.

President Signs STAR Act for Kids' Cancers.

PubMed

2018-06-07

On June 5, President Donald Trump signed the Childhood Cancer Survivorship, Treatment, Access and Research Act, which aims to support pediatric cancer research by expanding the collection of patient biospecimens and records, improving surveillance, and investigating pediatric survivorship. ©2018 American Association for Cancer Research.

Effect of US health policies on health care access for Marshallese migrants.

PubMed

McElfish, Pearl Anna; Hallgren, Emily; Yamada, Seiji

2015-04-01

The Republic of the Marshall Islands is a sovereign nation previously under the administrative control of the United States. Since 1986, the Compacts of Free Association (COFA) between the Republic of the Marshall Islands and the United States allows Marshall Islands citizens to freely enter, lawfully reside, and work in the United States, and provides the United States exclusive military control of the region. When the COFA was signed, COFA migrants were eligible for Medicaid and other safety net programs. However, these migrants were excluded from benefits as a consequence of the Personal Responsibility and Work Opportunity Reconciliation Act. Currently, COFA migrants have limited access to health care benefits in the United States, which perpetuates health inequalities.

Effect of US Health Policies on Health Care Access for Marshallese Migrants

PubMed Central

Hallgren, Emily; Yamada, Seiji

2015-01-01

The Republic of the Marshall Islands is a sovereign nation previously under the administrative control of the United States. Since 1986, the Compacts of Free Association (COFA) between the Republic of the Marshall Islands and the United States allows Marshall Islands citizens to freely enter, lawfully reside, and work in the United States, and provides the United States exclusive military control of the region. When the COFA was signed, COFA migrants were eligible for Medicaid and other safety net programs. However, these migrants were excluded from benefits as a consequence of the Personal Responsibility and Work Opportunity Reconciliation Act. Currently, COFA migrants have limited access to health care benefits in the United States, which perpetuates health inequalities. PMID:25713965

How to improve vital sign data quality for use in clinical decision support systems? A qualitative study in nine Swedish emergency departments.

PubMed

Skyttberg, Niclas; Vicente, Joana; Chen, Rong; Blomqvist, Hans; Koch, Sabine

2016-06-04

Vital sign data are important for clinical decision making in emergency care. Clinical Decision Support Systems (CDSS) have been advocated to increase patient safety and quality of care. However, the efficiency of CDSS depends on the quality of the underlying vital sign data. Therefore, possible factors affecting vital sign data quality need to be understood. This study aims to explore the factors affecting vital sign data quality in Swedish emergency departments and to determine in how far clinicians perceive vital sign data to be fit for use in clinical decision support systems. A further aim of the study is to provide recommendations on how to improve vital sign data quality in emergency departments. Semi-structured interviews were conducted with sixteen physicians and nurses from nine hospitals and vital sign documentation templates were collected and analysed. Follow-up interviews and process observations were done at three of the hospitals to verify the results. Content analysis with constant comparison of the data was used to analyse and categorize the collected data. Factors related to care process and information technology were perceived to affect vital sign data quality. Despite electronic health records (EHRs) being available in all hospitals, these were not always used for vital sign documentation. Only four out of nine sites had a completely digitalized vital sign documentation flow and paper-based triage records were perceived to provide a better mobile workflow support than EHRs. Observed documentation practices resulted in low currency, completeness, and interoperability of the vital signs. To improve vital sign data quality, we propose to standardize the care process, improve the digital documentation support, provide workflow support, ensure interoperability and perform quality control. Vital sign data quality in Swedish emergency departments is currently not fit for use by CDSS. To address both technical and organisational challenges, we propose five steps for vital sign data quality improvement to be implemented in emergency care settings.

SynopSIS: integrating physician sign-out with the electronic medical record.

PubMed

Sarkar, Urmimala; Carter, Jonathan T; Omachi, Theodore A; Vidyarthi, Arpana R; Cucina, Russell; Bokser, Seth; van Eaton, Erik; Blum, Michael

2007-09-01

Safe delivery of care depends on effective communication among all health care providers, especially during transfers of care. The traditional medical chart does not adequately support such communication. We designed a patient-tracking tool that enhances provider communication and supports clinical decision making. To develop a problem-based patient-tracking tool, called Sign-out, Information Retrieval, and Summary (SynopSIS), in order to support patient tracking, transfers of care (ie, sign-outs), and daily rounds. Tertiary-care, university-based teaching hospital. SynopSIS compiles and organizes information from the electronic medical record to support hospital discharge and disposition decisions, daily provider decisions, and overnight or cross-coverage decisions. It reflects the provider's patient-care and daily work-flow needs. We plan to use Web-based surveys, audits of daily use, and interdisciplinary focus groups to evaluate SynopSIS's impact on communication between providers, quality of sign-out, patient continuity of care, and rounding efficiency. We expect SynopSIS to improve care by facilitating communication between care teams, standardizing sign-out, and automating daily review of clinical and laboratory trends. SynopSIS redesigns the clinical chart to better serve provider and patient needs. (c) 2007 Society of Hospital Medicine.

Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis.

PubMed

Arora, V; Johnson, J; Lovinger, D; Humphrey, H J; Meltzer, D O

2005-12-01

The transfer of care for hospitalized patients between inpatient physicians is routinely mediated through written and verbal communication or "sign-out". This study aims to describe how communication failures during this process can lead to patient harm. In interviews employing critical incident technique, first year resident physicians (interns) described (1) any adverse events or near misses due to suboptimal preceding patient sign-out; (2) the worst event due to suboptimal sign-out in which they were involved; and (3) suggestions to improve sign-out. All data were analyzed and categorized using the constant comparative method with independent review by three researchers. Twenty six interns caring for 82 patients were interviewed after receiving sign-out from another intern. Twenty five discrete incidents, all the result of communication failures during the preceding patient sign-out, and 21 worst events were described. Inter-rater agreement for categorization was high (kappa 0.78-1.00). Omitted content (such as medications, active problems, pending tests) or failure-prone communication processes (such as lack of face-to-face discussion) emerged as major categories of failed communication. In nearly all cases these failures led to uncertainty during decisions on patient care. Uncertainty may result in inefficient or suboptimal care such as repeat or unnecessary tests. Interns desired thorough but relevant face-to-face verbal sign-outs that reviewed anticipated issues. They preferred legible, accurate, updated, written sign-out sheets that included standard patient content such as code status or active and anticipated medical problems. Communication failures during sign-out often lead to uncertainty in decisions on patient care. These may result in inefficient or suboptimal care leading to patient harm.

49 CFR 30.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Law No. 100-202 (signed December 22, 1987) [the Continuing Resolution], and section 115 of the Airport and Airways Safety and Capacity Expansion Act of 1987, Public Law No. 100-223 (signed December 30, 1987) [the Airport Safety Act]. These rules are intended to give uniform implementation to these...

The accountable health care act of Massachusetts: mixed results for an experiment in universal health care coverage.

PubMed

Norbash, Alexander; Hindson, David; Heineke, Janelle

2012-10-01

The affordable health care act of Massachusetts, signed into law in 2006, resulted in 98% of Massachusetts residents' having some form of insurance coverage by 2011, the highest coverage rate for residents of any state in the nation. With a strong economy, a low unemployment rate, a robust health care delivery system, an extremely low number of undocumented immigrants, and a low baseline uninsured rate, Massachusetts was well positioned for such an effort. Ingredients included mandates, the creation of separate insurance vehicles directed to both poverty-level and non-poverty-level residents, and the reallocation of the former free care pool. The mandates included consumer mandates and employer mandates; the consumer mandate applies to all Massachusetts residents at the risk of losing personal state tax exemptions, and the employer mandate applies to all Massachusetts businesses with 10 or more employees at the risk of per employee financial penalties. The insurance vehicles were created with premiums allocated on the basis of ability to pay by income classes. Unexpected effects included escalating taxpayer health care costs, with taxpayers shouldering the burden for the newly insured, continuing escalating health care costs at a rate greater than the national average, overburdening primary caregivers as newly insured sought new primary care gatekeepers in a system with primary caregiver shortages, and deprivation of support to the safety-net hospitals as a result of siphoned commonwealth free care pool funds. This exercise demonstrates specific benefits and shortfalls of the Massachusetts health care reform experiment, given the conditions and circumstances found in Massachusetts at the time of implementation. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

76 FR 27325 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-11

... Enhanced Implementation of the ``Learn the Signs. Act Early.'' Campaign in 4 Target Sites,--New--National Center on Birth Defects and Developmental Disabilities (NCBDDD), Centers for Disease Control and Prevention (CDC). Background and Brief Description CDC's ``Learn the Signs Act Early'' campaign is a health...

Crucial factors preceding compulsory psychiatric admission: a qualitative patient-record study.

PubMed

de Jong, Mark H; Oorschot, Margreet; Kamperman, Astrid M; Brussaard, Petra E; Knijff, Esther M; van de Sande, Roland; Van Gool, Arthur R; Mulder, Cornelis L

2017-10-24

Compulsory admissions have a strong effect on psychiatric patients and represent a deprivation of personal liberty. Although the rate of such admissions is tending to rise in several Western countries, there is little qualitative research on the mental health-care process preceding compulsory admission. The objective of the study was to identify crucial factors in the mental health-care process preceding compulsory admission of adult psychiatric patients. This retrospective, qualitative multiple-case study was based on the patient records of patients with severe mental illness, mainly schizophrenia and other psychotic disorders. Twenty two patient records were analyzed. Patients' demographic and clinical characteristics were heterogeneous. All were treated by Flexible Assertive Community Treatment teams (FACT teams) at two mental health institutions in the greater Rotterdam area in the Netherlands and had a compulsory admission in a predefined inclusion period. The data were analyzed according to the Prevention and Recovery System for Monitoring and Analysis (PRISMA) method, assessing acts, events, conditions, and circumstances, failing protective barriers and protective recovery factors. The most important patient factors in the process preceding compulsory admission were psychosis, aggression, lack of insight, care avoidance, and unauthorized reduction or cessation of medication. Neither were health-care professionals as assertive as they could be in managing early signs of relapse and care avoidance of these particular patients. The health-care process preceding compulsory admission is complex, being influenced by acts, events, conditions and circumstances, failing barriers, and protective factors. The most crucial factors are patients' lack of insight and cessation of medication, and health-care professionals' lack of assertiveness.

The prevalence and diagnostic utility of systemic inflammatory response syndrome vital signs in a pediatric emergency department.

PubMed

Scott, Halden F; Deakyne, Sara J; Woods, Jason M; Bajaj, Lalit

2015-04-01

This study sought to determine the prevalence, test characteristics, and severity of illness of pediatric patients with systemic inflammatory response syndrome (SIRS) vital signs among pediatric emergency department (ED) visits. This was a retrospective descriptive cohort study of all visits to the ED of a tertiary academic free-standing pediatric hospital over 1 year. Visits were included if the patient was <18 years of age and did not leave before full evaluation or against medical advice. Exclusion criteria were trauma diagnoses or missing documentation of vital signs. Data were electronically extracted from the medical record. The primary predictor was presence of vital signs meeting pediatric SIRS definitions. Specific vital sign pairs comprising SIRS were evaluated as predictors (temperature-heart rate, temperature-respiratory rate, and temperature-corrected heart rate, in which a formula was used to correct heart rate for degree of temperature elevation). The primary outcome measure was requirement for critical care (receipt of a vasoactive agent or intubation) within 24 hours of ED arrival. There were 56,210 visits during the study period; 40,356 met inclusion criteria. Of these, 6,596 (16.3%) visits had fever >38.5°C, and 6,122 (15.2% of included visits) met SIRS vital sign criteria. Among included visits, those with SIRS vital signs accounted for 92.8% of all visits with fever >38.5°C. Among patients with SIRS vital signs, 4993 (81.6%) were discharged from the ED without intravenous (IV) therapy and without 72-hour readmission. Critical care within the first 24 hours was present in 99 (0.25%) patients: 23 patients with and 76 without SIRS vital signs. Intensive care unit (ICU) admission was present in 126 (2.06%) with SIRS vital signs and 487 (1.42%) without SIRS vital signs. SIRS vital signs were associated with increased risk of critical care within 24 hours (relative risk [RR] = 1.69, 95% confidence interval [CI] = 1.06 to 2.70), ICU admission (RR = 1.45, 95% CI = 1.19 to 1.76), ED laboratory tests (RR = 1.41, 95% CI = 1.37 to 1.45), ED IV medication/fluid administration (RR = 2.54, 95% CI = 2.29 to 2.82), hospital admission (RR = 1.52, 95% CI = 1.42 to 1.63), and 72-hour readmission (RR = 1.31, 95% CI = 1.01 to 1.69). SIRS vital signs were not associated with 30-day in-hospital mortality (RR = 0.37, 95% CI = 0.05 to 2.82). SIRS vital signs had a low sensitivity for critical care requirement (23.2%, 95% CI = 15.3% to 32.8%). The pair of SIRS vital signs with the strongest association with critical care requirement was temperature and corrected heart rate (positive likelihood ratio = 2.74, 95% CI = 1.87 to 4.01). Systemic inflammatory response syndrome vital signs are common among medical pediatric patients presenting to an ED, and critical illness is rare. The majority of patients with SIRS vital signs were discharged without IV therapy and without readmission. Patients with SIRS vital signs had a statistically significant increased risk of critical care requirement, ED IV treatment, ED laboratory tests, admission, and readmission. However, SIRS vital sign criteria did not identify the majority of patients with mortality or need for critical care. SIRS vital signs had low sensitivity for critical illness, making it poorly suited for use in isolation in this setting as a test to detect children requiring sepsis resuscitation. © 2015 by the Society for Academic Emergency Medicine.

Impact of electronic medical record integration of a handoff tool on sign-out in a newborn intensive care unit

PubMed Central

Palma, JP; Sharek, PJ; Longhurst, CA

2016-01-01

Objective To evaluate the impact of integrating a handoff tool into the electronic medical record (EMR) on sign-out accuracy, satisfaction and workflow in a neonatal intensive care unit (NICU). Study Design Prospective surveys of neonatal care providers in an academic children’s hospital 1 month before and 6 months following EMR integration of a standalone Microsoft Access neonatal handoff tool. Result Providers perceived sign-out information to be somewhat or very accurate at a rate of 78% with the standalone handoff tool and 91% with the EMR-integrated tool (P < 0.01). Before integration of neonatal sign-out into the EMR, 35% of providers were satisfied with the process of updating sign-out information and 71% were satisfied with the printed sign-out document; following EMR integration, 92% of providers were satisfied with the process of updating sign-out information (P < 0.01) and 98% were satisfied with the printed sign-out document (P < 0.01). Neonatal care providers reported spending a median of 11 to 15 min/day updating the standalone sign-out and 16 to 20 min/day updating the EMR-integrated sign-out (P = 0.026). The median percentage of total sign-out preparation time dedicated to transcribing information from the EMR was 25 to 49% before and <25% after EMR integration of the handoff tool (P < 0.01). Conclusion Integration of a NICU-specific handoff tool into an EMR resulted in improvements in perceived sign-out accuracy, provider satisfaction and at least one aspect of workflow. PMID:21273990

Teaching Mathematics Vocabulary with an Interactive Signing Math Dictionary

ERIC Educational Resources Information Center

Vesel, Judy; Robillard, Tara

2013-01-01

State frameworks and national standards are explicit about the mathematics content that students must master at each grade level. Although the Individuals with Disabilities Education Act and the No Child Left Behind Act mandate that students who are deaf or hard of hearing and communicate in sign language have access to this content, evidence…

Vital Signs Directed Therapy: Improving Care in an Intensive Care Unit in a Low-Income Country.

PubMed

Baker, Tim; Schell, Carl Otto; Lugazia, Edwin; Blixt, Jonas; Mulungu, Moses; Castegren, Markus; Eriksen, Jaran; Konrad, David

2015-01-01

Global Critical Care is attracting increasing attention. At several million deaths per year, the worldwide burden of critical illness is greater than generally appreciated. Low income countries (LICs) have a disproportionally greater share of critical illness, and yet critical care facilities are scarce in such settings. Routines utilizing abnormal vital signs to identify critical illness and trigger medical interventions have become common in high-income countries but have not been investigated in LICs. The aim of the study was to assess whether the introduction of a vital signs directed therapy protocol improved acute care and reduced mortality in an Intensive Care Unit (ICU) in Tanzania. Prospective, before-and-after interventional study in the ICU of a university hospital in Tanzania. A context-appropriate protocol that defined danger levels of severely abnormal vital signs and stipulated acute treatment responses was implemented in a four week period using sensitisation, training, job aids, supervision and feedback. Acute treatment of danger signs at admission and during care in the ICU and in-hospital mortality were compared pre and post-implementation using regression models. Danger signs from 447 patients were included: 269 pre-implementation and 178 post-implementation. Acute treatment of danger signs was higher post-implementation (at admission: 72.9% vs 23.1%, p<0.001; in ICU: 16.6% vs 2.9%, p<0.001). A danger sign was five times more likely to be treated post-implementation (Prevalence Ratio (PR) 4.9 (2.9-8.3)). Intravenous fluids were given in response to 35.0% of hypotensive episodes post-implementation, as compared to 4.1% pre-implementation (PR 6.4 (2.5-16.2)). In patients admitted with hypotension, mortality was lower post-implementation (69.2% vs 92.3% p = 0.02) giving a numbers-needed-to-treat of 4.3. Overall in-hospital mortality rates were unchanged (49.4% vs 49.8%, p = 0.94). The introduction of a vital signs directed therapy protocol improved the acute treatment of abnormal vital signs in an ICU in a low-income country. Mortality rates were reduced for patients with hypotension at admission but not for all patients.

Examining suicide: imaging's contributions.

PubMed

Church, Elizabeth J

2015-01-01

For many people, the death of hope leads inexorably to the conclusion that the only viable solution, the only way to put an end to unendurable pain, is suicide. What leads a person to commit this final, desperate act, and how might we predict, intervene, and prevent suicide? Health care workers, including radiologic technologists, can play an important role in detecting warning signs in patients and in better understanding what factors may lead to suicide. Although certain forms of suicide such as suicide bombings and assisted suicide are beyond its scope, this article explores medical imaging's contributions to the study of this phenomenon.

Mapping wilderness character in Sequoia and Kings Canyon National Parks

Treesearch

James Tricker; Peter Landres; Gregg Fauth; Paul Hardwick; Alex Eddy

2014-01-01

The Sequoia-Kings Canyon Wilderness was established in September of 1984 when President Ronald Reagan signed the California Wilderness Act (PL 98-425). In March 2009, President Barack Obama signed the Omnibus Public Land Management Act (PL 111-11) designating the John Krebs Wilderness and the Sequoia-Kings Canyon Wilderness Addition (all wholly contained within SEKI)....

Dental plan premiums in the Affordable Care Act marketplaces trended downward from 2014 through 2016.

PubMed

Nasseh, Kamyar; Vujicic, Marko

2017-04-01

Pediatric dental benefits must be offered in the health insurance marketplaces created under the Affordable Care Act. The authors analyzed trends over time in premiums and the number of dental insurers participating in the marketplaces. The authors collected dental benefit plan data from 35 states participating in the federally facilitated marketplaces in 2014, 2015, and 2016. For each county, they counted the number of issuers offering stand-alone dental plans (SADPs) and medical plans with embedded pediatric dental benefits. They also analyzed trends in premiums. From 2014 through 2016, the number of issuers of stand-alone dental plans and medical plans with embedded pediatric dental benefits either did not change or increased in most counties. Average premiums for low-actuarial-value SADPs declined from 2014 through 2016. The increase in the number of issuers of stand-alone dental plans and medical plans with embedded dental benefits may be associated with lower premiums. However, more research is needed to determine if this is the case. Affordable dental plans in the marketplaces could induce people with lower incomes to sign up for dental benefits. Newly insured people could have significant oral health needs and pent-up demand for dental care. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

Foresight and awareness of incipient changes in a patient' clinical conditions--Perspectives of intensive care nurses.

PubMed

Kvande, Monica; Delmar, Charlotte; Lykkeslet, Else; Storli, Sissel Lisa

2015-10-01

The aim of this study was to explore the phenomenon of becoming aware of incipient changes in patient condition from the perspectives and experiences of intensive care nurses. This study involved close observations of and in-depth interviews with 11 experienced intensive care nurses. The text was analysed using a hermeneutic phenomenological method that was inspired by van Manen. This study was undertaken at two different high-technology intensive care units (ICUs) in Norwegian university hospitals. Nurses formed images of individual patients composed of signs (of changes in a patient's condition) that were sensory, measurable, and manifested as the mood of the nurse. The signs may be viewed as separate from and opposed to one another, but they are tightly interwoven and interact with one another. Care situations are powerful stimuli for the patient, and it is of great importance for nurses to become aware of signs in these situations. Nurses also ascribe that following the patient over time is important for becoming aware of signs. An awareness of incipient changes in patient clinical condition requires understanding the ever-changing dynamics of patient condition and dialogic images composed of signs. Care situations and the following of patients through shifts are essential in enabling nurses to detect these signs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Glaucoma-service provision in Scotland: introduction and need for Scottish Intercollegiate Guidelines Network guidelines.

PubMed

Syrogiannis, Andreas; Rotchford, Alan P; Agarwal, Pankaj Kumar; Kumarasamy, Manjula; Montgomery, Donald; Burr, Jennifer; Sanders, Roshini

2015-01-01

To describe the pattern of glaucoma-service delivery in Scotland and identify areas for improvement, taking into account Scottish General Ophthalmic Services (GOS) arrangements and the Eye Care Integration project, and to design Scottish Intercollegiate Guidelines Network (SIGN) guidelines to refine the primary and secondary interface of glaucoma care. A glaucoma-survey questionnaire was sent to all consultant glaucomatologists in Scotland. The design of SIGN guidelines was based on the results of the questionnaire using SIGN methodology. Over 90% of Scottish glaucoma care is triaged and delivered within hospital services. Despite GOS referral, information is variable. There are no consistent discharge practices to the community. These results led to defined research questions that were answered, thus formulating the content of the SIGN guidelines. The guideline covers the assessment of patients in primary care, referral criteria to hospital, discharge criteria from hospital to community, and monitoring of patients at risk of glaucoma. With increasing age and limitations to hospital resources, refining glaucoma pathways between primary and secondary care has become a necessity. Scotland has unique eye care arrangements with both the GOS and Eye Care Integration project. It is hoped that implementation of SIGN guidelines will identify glaucoma at the earliest opportunity and reduce the rate of false-positive referrals to hospital.

Severely deranged vital signs as triggers for acute treatment modifications on an intensive care unit in a low-income country.

PubMed

Schell, Carl Otto; Castegren, Markus; Lugazia, Edwin; Blixt, Jonas; Mulungu, Moses; Konrad, David; Baker, Tim

2015-07-25

Critical care saves lives of the young with reversible disease. Little is known about critical care services in low-income countries. In a setting with a shortage of doctors the actions of the nurse bedside are likely to have a major impact on the outcome of critically ill patients with rapidly changing physiology. Identification of severely deranged vital signs and subsequent treatment modifications are the basis of modern routines in critical care, for example goal directed therapy and rapid response teams. This study assesses how often severely deranged vital signs trigger an acute treatment modification on an Intensive Care Unit (ICU) in Tanzania. A medical records based, observational study. Vital signs (conscious level, respiratory rate, oxygen saturation, heart rate and systolic blood pressure) were collected as repeated point prevalences three times per day in a 1-month period for all adult patients on the ICU. Severely deranged vital signs were identified and treatment modifications within 1 h were noted. Of 615 vital signs studied, 126 (18%) were severely deranged. An acute treatment modification was in total indicated in 53 situations and was carried out three times (6%) (2/32 for hypotension, 0/8 for tachypnoea, 1/6 for tachycardia, 0/4 for unconsciousness and 0/3 for hypoxia). This study suggests that severely deranged vital signs are common and infrequently lead to acute treatment modifications on an ICU in a low-income country. There may be potential to improve outcome if nurses are guided to administer acute treatment modifications by using a vital sign directed approach. A prospective study of a vital sign directed therapy protocol is underway.

Warning Signs After Birth

MedlinePlus

... Home > Pregnancy > Postpartum care > Warning signs after birth Warning signs after birth E-mail to a friend ... breast infection Postpartum bleeding Postpartum depression (PPD) What warning signs should you look for? Call your provider ...

Will my job be safe if I defend my patients? When patient advocacy collides with employment law.

PubMed

Manthous, Constantine A; Moncrieff, Abigail R

2013-10-01

Physicians are moving increasingly from self-employed, private practices to at-will employment relationships. This historic change in the organizational administration of medical services is likely to accelerate as the Affordable Care Act is implemented and as accountable care organizations permeate the medical marketplace. Physicians vow an ascendant oath to safeguard patients' welfare, but as they become employees, they may sign legal contracts that also oblige obedience to the institutions that hire them. What happens when an employer makes a decision that is not in the best interests of patients and the physicians fulfill their Hippocratic obligation to voice dissent on their patients' behalf rather than abiding by their contractual obligation to obey their employer? This article explores the philosophical and legal ramifications of this potential collision of obligations to patients and to employers.

27 CFR 6.102 - Outside signs.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Outside signs. 6.102 Section 6.102 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS âTIED-HOUSEâ Exceptions § 6.102 Outside signs. The act by an industry member of giving or selling outside signs to a retaile...

The Neural Correlates of Highly Iconic Structures and Topographic Discourse in French Sign Language as Observed in Six Hearing Native Signers

ERIC Educational Resources Information Center

Courtin, C.; Herve, P. -Y.; Petit, L.; Zago, L.; Vigneau, M.; Beaucousin, V.; Jobard, G.; Mazoyer, B.; Mellet, E.; Tzourio-Mazoyer, N.

2010-01-01

"Highly iconic" structures in Sign Language enable a narrator to act, switch characters, describe objects, or report actions in four-dimensions. This group of linguistic structures has no real spoken-language equivalent. Topographical descriptions are also achieved in a sign-language specific manner via the use of signing-space and…

27 CFR 6.102 - Outside signs.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Outside signs. 6.102 Section 6.102 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS âTIED-HOUSEâ Exceptions § 6.102 Outside signs. The act by an industry member of giving or selling outside signs to a retaile...

34 CFR 222.3 - How does a local educational agency apply for assistance under section 8002 or 8003 of the Act?

Code of Federal Regulations, 2011 CFR

2011-07-01

... LEA must file a complete and signed application within the time limits required by paragraph (b)(2) of... section 8002 or 8003 of the Act? An LEA must meet the following application requirements to be considered..., the LEA must— (1) File with the Secretary a complete and signed application for payment under section...

34 CFR 222.3 - How does a local educational agency apply for assistance under section 8002 or 8003 of the Act?

Code of Federal Regulations, 2010 CFR

2010-07-01

... LEA must file a complete and signed application within the time limits required by paragraph (b)(2) of... section 8002 or 8003 of the Act? An LEA must meet the following application requirements to be considered..., the LEA must— (1) File with the Secretary a complete and signed application for payment under section...

A Balancing Act

ERIC Educational Resources Information Center

Borenson, Henry

2013-01-01

An operational understanding of the equal sign can hinder learning its relational meaning. After providing examples that illustrate the folly of expecting students who know the operational meaning of the equal sign to intuit the sign's relational meaning, this article provides teachers with strategies that will help them effectively introduce…

17 CFR 230.471 - Signatures to amendments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Signatures to amendments. 230... RULES AND REGULATIONS, SECURITIES ACT OF 1933 Amendments; Withdrawals § 230.471 Signatures to amendments... signed, such document shall be manually signed, or signed using either typed signatures or duplicated or...

Exploring Vital Sign Data Quality in Electronic Health Records with Focus on Emergency Care Warning Scores.

PubMed

Skyttberg, Niclas; Chen, Rong; Blomqvist, Hans; Koch, Sabine

2017-08-30

Computerized clinical decision support and automation of warnings have been advocated to assist clinicians in detecting patients at risk of physiological instability. To provide reliable support such systems are dependent on high-quality vital sign data. Data quality depends on how, when and why the data is captured and/or documented. This study aims to describe the effects on data quality of vital signs by three different types of documentation practices in five Swedish emergency hospitals, and to assess data fitness for calculating warning and triage scores. The study also provides reference data on triage vital signs in Swedish emergency care. We extracted a dataset including vital signs, demographic and administrative data from emergency care visits (n=335027) at five Swedish emergency hospitals during 2013 using either completely paper-based, completely electronic or mixed documentation practices. Descriptive statistics were used to assess fitness for use in emergency care decision support systems aiming to calculate warning and triage scores, and data quality was described in three categories: currency, completeness and correctness. To estimate correctness, two further categories - plausibility and concordance - were used. The study showed an acceptable correctness of the registered vital signs irrespectively of the type of documentation practice. Completeness was high in sites where registrations were routinely entered into the Electronic Health Record (EHR). The currency was only acceptable in sites with a completely electronic documentation practice. Although vital signs that were recorded in completely electronic documentation practices showed plausible results regarding correctness, completeness and currency, the study concludes that vital signs documented in Swedish emergency care EHRs cannot generally be considered fit for use for calculation of triage and warning scores. Low completeness and currency were found if the documentation was not completely electronic.

A new chart to assist with advanced trauma life support.

PubMed

Palmer, I P; Baskett, P J; McCabe, S E

1992-10-01

Many studies have drawn attention to deficiencies in the management of major trauma, both in the UK and elsewhere. One area that has received little attention is the documentation of such cases in the Emergency Room. When outcome may be sub-optimal, documentation assumes greater importance if advances are to be made in the organisation of trauma care. Based upon the American College of Surgeons Advanced Trauma Life Support (ATLS) protocols, the authors have designed a document that records dynamically what happens to the multiply injured victim on arrival in the Emergency Room. It unifies the recording of vital signs, whilst acting as an assessment and resuscitation template. By ensuring no life-threatening illness is missed it is likely to improve patient survival. The document can act as a basis for teaching and a medico-legal record, whilst providing the necessary data for quality assurance and outcome audit.

A qualitative study of sign-out processes between primary and on-call residents: relationships in information exchange, responsibility and accountability.

PubMed

Lee, Soo-Hoon; Fisher, Dale A; Mah, Heidi; Goh, Wei-Ping; Phan, Phillip H

2017-10-01

To review a quality improvement event on the process of sign-outs between the primary and on-call residents. A retrospective qualitative study using semi-structured interviews. A tertiary academic medical center in Singapore with 283 inpatient Medicine beds served by 28 consultants, 29 registrars, 45 residents and 30 interns during the day but 5 residents and 3 interns at night. Residents, registrars and consultants. Quality improvement event on sign-out. Effectiveness of sign-out comprises exchange of patient information, professional responsibility and task accountability. The following process of sign-outs was noted. Primary teams were accountable to the on-call resident by selecting at-risk patients and preparing contingency plans for sign-out. Structured information exchanged included patient history, active problems and plans of care. On-call residents took ownership of at-risk patients by actively asking questions during sign-out and reporting back the agreed care plan. On-call residents were accountable to the primary team by reporting back at-risk patients the next day. A structured information exchange at sign-out increased the on-call resident's ability to care for at-risk patients when it was supported by two-way transfers of responsibility and accountability. © The Author 2017. 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

[Nursing care of pulmonary embolism in out-of-hospital emergencies].

PubMed

Carrión-Martínez, Aurora; Rivera-Caravaca, José Miguel

2016-01-01

Pulmonary embolism is one of the most severe venous thromboembolic diseases, both in mortality and the high number of associated complications and their impact on quality of life. The early hours are critical and proper management during this period can determine future sequels. Therefore, in the outpatient setting, nurses must have adequate knowledge and tools to act quickly and efficiently. In this paper, we present a case of a 77 year-old male in his home that after being discharged from a knee replacement surgery starts with symptoms compatible with pulmonary thromboembolism. A Nursing Care Process is performed, according to the functional patterns of Margory Gordon and a care plan is developed based on NNN taxonomy (NANDA, NOC, NIC). As main nursing diagnosis 'ineffective breathing pattern' is selected and as possible potential complication of the pulmonary embolism the 'pulmonary infarction' is chosen. The results obtained after conducting the care plan are satisfactory, improving the signs and symptoms presented by the patient, hence why we believe it is useful for nurses when facing similar clinical situations. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Proposed Columbia Wind Farm No. 1 : Draft Environmental Impact Statement, Joint NEPA/SEPA.

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

United States. Bonneville Power Administration; Klickitat County

1995-03-01

This Draft Environmental Impact Statement (DEIS) addresses the Columbia Wind Farm {number_sign}1 (Project) proposal for construction and operation of a 25 megawatt (MW) wind power project in the Columbia Hills area southeast of Goldendale in Klickitat County, Washington. The Project would be constructed on private land by Conservation and Renewable Energy System (CARES) (the Applicant). An Environmental Impact Statement is required under both NEPA and SEPA guidelines and is issued under Section 102 (2) (C) of the National Environmental Policy Act (NEPA) at 42 U.S.C. 4321 et seq and under the Washington State Environmental Policy Act (SEPA) as provided bymore » RCW 43.21C.030 (2) (c). Bonneville Power Administration is the NEPA lead agency; Klickitat County is the nominal SEPA lead agency and CARES is the SEPA co-lead agency for this DEIS. The Project site is approximately 395 hectares (975 acres) in size. The Proposed Action would include approximately 91 model AWT-26 wind turbines. Under the No Action Alternative, the Project would not be constructed and existing grazing and agricultural activities on the site would continue.« less

Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team's perspective.

PubMed

Åvik Persson, Helene; Sandgren, Anna; Fürst, Carl-Johan; Ahlström, Gerd; Behm, Lina

2018-06-04

Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team's perspective. The focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey. The analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category "Going into a bubble" illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category "The body begins to shut down" illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death. This study conveys new knowledge concerning the multidisciplinary team's collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons.

23 CFR Appendix C to Subpart A of... - Policy for the Signing and Numbering of Future Interstate Corridors Designated by Section 332 of...

Code of Federal Regulations, 2014 CFR

2014-04-01

... Interstate Corridors Designated by Section 332 of the NHS Designation Act of 1995 or Designated Under 23 U.S... Interstate Corridors Designated by Section 332 of the NHS Designation Act of 1995 or Designated Under 23 U.S... signs along a federally designated future Interstate corridor only after the specific route location has...

23 CFR Appendix C to Subpart A of... - Policy for the Signing and Numbering of Future Interstate Corridors Designated by Section 332 of...

Code of Federal Regulations, 2011 CFR

2011-04-01

... Interstate Corridors Designated by Section 332 of the NHS Designation Act of 1995 or Designated Under 23 U.S... Interstate Corridors Designated by Section 332 of the NHS Designation Act of 1995 or Designated Under 23 U.S... signs along a federally designated future Interstate corridor only after the specific route location has...

23 CFR Appendix C to Subpart A of... - Policy for the Signing and Numbering of Future Interstate Corridors Designated by Section 332 of...

Code of Federal Regulations, 2013 CFR

2013-04-01

... Interstate Corridors Designated by Section 332 of the NHS Designation Act of 1995 or Designated Under 23 U.S... Interstate Corridors Designated by Section 332 of the NHS Designation Act of 1995 or Designated Under 23 U.S... signs along a federally designated future Interstate corridor only after the specific route location has...

Implementing an Effective and Efficient System to Manage the National School Lunch Program in a Private PreK-12 School: An Action Research Study

ERIC Educational Resources Information Center

Rafidi, Jessica A.

2012-01-01

To ensure the health of children in the United States, and to encourage the domestic consumption of nutritious agricultural commodities, President Harry S. Truman signed the National School Lunch Act. The Act, a federally assisted meal program established as a national security measure, was signed on June 4, 1946. Today, the National School Lunch…

Freedom Of Information Act

Science.gov Websites

Web Site Freedom of Information Act Sign In Freedom of Information Act Header Search this site ... Search Freedom of Information Act Introduction to FOIA Making A Request Points of Contact FOIA Reports Reading Room Frequently Asked Questions FOIA Links Privacy Act Requests Freedom Of Information (FOIA) &

Statewide real-time in-flight trauma patient vital signs collection system.

PubMed

Hu, Peter F; Mackenzie, Colin; Dutton, Richard; Sen, Ayan; Xiao, Yan; Handley, Christopher; Ho, Danny; Scalea, Thomas

2008-11-06

Continuous recorded in-flight vital signs monitoring and life-saving interventions linked to outcomes may provide better understanding of pre-hospital triage, care management and patient responses during the 'golden hour' of trauma care. Evaluation of 157 patients' vital signs data collected from our statewide network has identified episodes of physiological decompensation which holds promise for creation of new triage algorithms and enhanced trauma center preparedness.

Promotion in Times of Endangerment: The Sign Language Act in Finland

ERIC Educational Resources Information Center

De Meulder, Maartje

2017-01-01

The development of sign language recognition legislation is a relatively recent phenomenon in the field of language policy. So far only few authors have documented signing communities' aspirations for recognition legislation, how they work with their governments to achieve legislation which most reflects these goals, and whether and why outcomes…

President Signs NASA Transition Authorization Act on This Week @NASA – March 24, 2017

NASA Image and Video Library

2017-03-24

On March 21, President Trump signed the National Aeronautics and Space Administration Transition Authorization Act of 2017. The bipartisan legislation reaffirms Congress’ commitment to the agency and directs it to pursue a balanced portfolio for space exploration and space science, including continued development of the Space Launch System, Orion, Commercial Crew Program; space and planetary science missions, such as the James Webb Space Telescope, Wide-Field Infrared Survey Telescope, and Europa mission; and ongoing operations of the International Space Station and Commercial Resupply Services Program. In a statement, acting NASA Administrator Robert Lightfoot, who attended the signing, along with two astronauts and members of Congress, thanked the president and Congress for supporting the agency and its mission. Also, Spacewalk Outside the Space Station, SpaceX’s Dragon Returns Safely to Earth, Jeff Williams Visits Washington Area, Advanced Woven Thermal Protection, and Lunar and Planetary Science Conference.

Addressing outpatient continuity for ambulatory training: A novel tool for longitudinal primary care sign out.

PubMed

Long, Theodore; Uradu, Andrea; Castillo, Ronald; Brienza, Rebecca

2016-01-01

We created a tool to improve communication among health professional trainees in the ambulatory setting. The tool was devised to both inform practice partner teams about high-risk patients and assign patient follow-up issues to team members. Team members were internal medicine residents and nurse practitioner fellows in the VA Connecticut Healthcare System Center of Excellence in Primary Care Education (CoEPCE), an interprofessional training model in primary care. We used a combination of Likert scale response questions and open ended questions to evaluate trainee attitudes before and after the implementation of the tool, as well as solicited feedback to improve the tool. After using the primary care sign out tool, trainees expressed greater confidence that they could identify high-risk patients that had been cared for by other trainees and that important patient care issues would be followed up by others when they were not in clinic. In terms of areas for improvement, respondents wanted to have the sign out tool posted online. Our sign out tool offers a strategy that others can use to improve communication and knowledge of shared patients within teams comprised of interprofessional trainees.

A flexible system for vital signs monitoring in hospital general care wards based on the integration of UNIX-based workstations, standard networks and portable vital signs monitors.

PubMed

Welch, J P; Sims, N; Ford-Carlton, P; Moon, J B; West, K; Honore, G; Colquitt, N

1991-01-01

The article describes a study conducted on general surgical and thoracic surgical floors of a 1000-bed hospital to assess the impact of a new network for portable patient care devices. This network was developed to address the needs of hospital patients who need constant, multi-parameter, vital signs surveillance, but do not require intensive nursing care. Bedside wall jacks were linked to UNIX-based workstations using standard digital network hardware, creating a flexible system (for general care floors of the hospital) that allowed the number of monitored locations to increase and decrease as patient census and acuity levels varied. It also allowed the general care floors to provide immediate, centralized vital signs monitoring for patients who unexpectedly became unstable, and permitted portable monitors to travel with patients as they were transferred between hospital departments. A disk-based log within the workstation automatically collected performance data, including patient demographics, monitor alarms, and network status for analysis. The log has allowed the developers to evaluate the use and performance of the system.

Anaphylaxis in dogs and cats.

PubMed

Shmuel, Daniella L; Cortes, Yonaira

2013-01-01

To review and summarize current information regarding the pathophysiology and clinical manifestations associated with anaphylaxis in dogs and cats. The etiology, diagnosis, treatment, and prognosis is discussed. Anaphylaxis is a systemic, type I hypersensitivity reaction that often has fatal consequences. Many of the principal clinical manifestations involve organs where mast cell concentrations are highest: the skin, the lungs, and the gastrointestinal tract. Histamine and other deleterious inflammatory mediators promote vascular permeability and smooth muscle contraction; they are readily released from sensitized mast cells and basophils challenged with antigen. Anaphylaxis may be triggered by a variety of antigens including insect and reptile venom, a variety of drugs, vaccines, and food. Anaphylaxis is a clinical diagnosis made from a collection of signs and symptoms. It is most commonly based on pattern recognition. Differential diagnoses include severe asthma, pheocromocytoma, and mastocytosis. Epinephrine is considered the drug of choice for the treatment of anaphylaxis. It acts primarily as a vasopressor in improving hemodynamic recovery. Adjunctive treatments include fluid therapy, H1 and H2 antihistamines, corticosteroids, and bronchodilators; however, these do not substitute for epinephrine. Prognosis depends on the severity of the clinical signs. The clinical signs will vary among species and route of exposure. The most severe clinical reactions are associated when the antigen is administered parenterally. © Veterinary Emergency and Critical Care Society 2013.

[The Present Implementation Status and Problems of Vital-signs Measurement by Community Pharmacists in Home Medical Care in Osaka].

PubMed

Niki, Kazuyuki; Takemura, Miho; Kitagawa, Kyosuke; Shimizu, Ruka; Takahashi, Yuri; Hatabu, Asuka; Uejima, Etsuko

2018-01-01

　While the community-based integrated care systems are in the process of being structured currently, more and more community pharmacists want to learn physical assessment skills. However, no large-scale survey focusing on present implementation status and problems of physical assessment by community pharmacists has been conducted yet. Osaka has the 2nd highest number of community pharmacies in Japan now, and the population aged ≥65 years will be expected to become the 3rd highest in 2025. Thus, Osaka can become a national leading model case for community pharmacists' activity in future home medical care. Therefore, this study aimed to reveal the present implementation status and problems of physical assessment by community pharmacists in Osaka, especially focusing on vital-signs. The questionnaires were sent to all the 3571 insurance pharmacies belonging to the Osaka Pharmaceutical Association and 871 pharmacies responded. Many pharmacists recognized the necessity for vital-signs measurement by pharmacists in home medical care (81.5% of pharmacies that offered home medical care and 75.4% of pharmacies that did not offer one). However, the proportion of pharmacies that conduct vital-signs measurement in home medical care was 18.7%, therefore, it was suggested that the present problem is "many pharmacists cannot conduct vital-signs measurement, although they think it should be conducted". Moreover, the most common reason for not measuring vital-signs was the lack of instruments, such as stethoscopes and sphygmomanometer (43.2%). This is the latest report with a large-scale sample, thus, it can serve as valuable knowledge in considering what pharmacists do for the future.

Screening Newborns | NIH MedlinePlus the Magazine

MedlinePlus

... signed the Newborn and Infant Hearing Screening and Intervention Act, authorizing the coordination and funding of statewide ... hearing loss before they leave the hospital. → Early interventions and treatments (hearing aids, cochlear implants, sign language, ...

76 FR 37979 - Cooperation in USDA Studies and Evaluations, and Full Use of Federal Funds in Nutrition...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-29

... Funds in Nutrition Assistance Programs Nondiscretionary Provisions of the Healthy, Hunger-Free Kids Act... nondiscretionary provisions of the Healthy, Hunger-Free Kids Act of 2010 (HHFK Act). The HHFK Act requires State...: Background The Healthy, Hunger-Free Kids Act of 2010, Public Law 111-296, (the HHFK Act), was signed into law...

32 CFR 806b.11 - When to give Privacy Act Statements (PAS).

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false When to give Privacy Act Statements (PAS). 806b... ADMINISTRATION PRIVACY ACT PROGRAM Collecting Personal Information § 806b.11 When to give Privacy Act Statements... information. Give a copy of the Privacy Act Statement if asked. Do not ask the person to sign the Privacy Act...

32 CFR 806b.11 - When to give Privacy Act Statements (PAS).

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 6 2013-07-01 2013-07-01 false When to give Privacy Act Statements (PAS). 806b... ADMINISTRATION PRIVACY ACT PROGRAM Collecting Personal Information § 806b.11 When to give Privacy Act Statements... information. Give a copy of the Privacy Act Statement if asked. Do not ask the person to sign the Privacy Act...

32 CFR 806b.11 - When to give Privacy Act Statements (PAS).

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false When to give Privacy Act Statements (PAS). 806b... ADMINISTRATION PRIVACY ACT PROGRAM Collecting Personal Information § 806b.11 When to give Privacy Act Statements... information. Give a copy of the Privacy Act Statement if asked. Do not ask the person to sign the Privacy Act...

The Comprehensive Addiction and Recovery Act: Opioid Use Disorder and Midwifery Practice.

PubMed

Murphy, Jeanne; Goodman, Daisy; Johnson, M Christina; Terplan, Mishka

2018-03-01

The federal response to the opioid use disorder crisis has included a mobilization of resources to encourage office-based pharmacotherapy with buprenorphine, an effort culminating in the 2016 Comprehensive Addiction and Recovery Act, signed into law as Public Law 114-198. The Comprehensive Addiction and Recovery Act was designed to increase access to treatment with special emphasis on services for pregnant women and follow-up for infants affected by prenatal substance exposure. In this effort, the Comprehensive Addiction and Recovery Act laudably expands eligibility for obtaining a waiver to prescribe buprenorphine to nurse practitioners and physician assistants. However, certified nurse-midwives and certified midwives, who care for a significant proportion of pregnant and postpartum women and attend a significant proportion of births in the United States, were not included in the Comprehensive Addiction and Recovery Act legislation. In this commentary, we argue that an "all-hands" approach to providing office-based medication-assisted treatment for opioid use disorder is essential to improving access to treatment. Introduced in the House of Representatives in September 2017, the Addiction Treatment Access Improvement Act (H.R. 3692) would allow midwives to apply for the federal waiver to prescribe buprenorphine and is supported by the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives. We support this change and encourage the U.S. Congress to act quickly to allow midwives to prescribe medication-assisted treatment for pregnant women with opioid use disorder.

77 FR 44562 - Public Meeting: Potential Regulatory Implications of the Reduction of Lead in Drinking Water Act...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-30

... Regulatory Implications of the Reduction of Lead in Drinking Water Act of 2011 AGENCY: Environmental... public meeting on August 16, 2012, to discuss and solicit input from States, manufacturers, drinking... Drinking Water Act of 2011 (``the Act''). The Act was signed on January 4, 2011, and will be effective on...

Use of high intensity reflective sheeting in lieu of external lighting of overhead roadway signs : [summary].

DOT National Transportation Integrated Search

2013-06-01

Integral to every road are signs that provide essential information to drivers. The design of signs is the result of careful study from every viewpoint, including sign position, size, shape, color, background, and lettering. Also well studied are veh...

Bender Gestalt Signs and Anti-Social Acting Out Tendencies in Adolescents

ERIC Educational Resources Information Center

Brannigan, Gary G.; Benowity, Martin L.

1975-01-01

This study explores the relationship between performance on the Bender-Gestalt test and antisocial acting out tendencies in adolescents. Results indicate that uneven figure size and exaggerated curvature are the best indicators of antisocial acting out tendencies. (Author)

Effect of handoff skills training for students during the medicine clerkship: a quasi-randomized study.

PubMed

Reyes, Juan A; Greenberg, Larrie; Amdur, Richard; Gehring, James; Lesky, Linda G

2016-03-01

Continuity is critical for safe patient care and its absence is associated with adverse outcomes. Continuity requires handoffs between physicians, but most published studies of educational interventions to improve handoffs have focused primarily on residents, despite interns expected to being proficient. The AAMC core entrustable activities for graduating medical students includes handoffs as a milestone, but no controlled studies with students have assessed the impact of training in handoff skills. The purpose of this study was to assess the impact of an educational intervention to improve third-year medical student handoff skills, the durability of learned skills into the fourth year, and the transfer of skills from the simulated setting to the clinical environment. Trained evaluators used standardized patient cases and an observation tool to assess verbal handoff skills immediately post intervention and during the student's fourth-year acting internship. Students were also observed doing real time sign-outs during their acting internship. Evaluators assessed untrained control students using a standardized case and performing a real-time sign-out. Intervention students mean score demonstrated improvement in handoff skills immediately after the workshop (2.6-3.8; p < 0.0001) that persisted into their fourth year acting internship when compared to baseline performance (3.9-3.5; p = 0.06) and to untrained control students (3.5 vs. 2.5; p < 0.001, d = 1.2). Intervention students evaluated in the clinical setting also scored higher than control students when assessed doing real-time handoffs (3.8 vs. 3.3; p = 0.032, d = 0.71). These findings should be useful to others considering introducing handoff teaching in the undergraduate medical curriculum in preparation for post-graduate medical training. Trial Registration Number NCT02217241.

What The Oregon Health Study Can Tell Us About Expanding Medicaid

PubMed Central

Allen, Heidi; Baicker, Katherine; Finkelstein, Amy; Taubman, Sarah; Wright, Bill J.

2012-01-01

The recently enacted Patient Protection and Affordable Care Act includes a major expansion of Medicaid to low-income adults in 2014. This paper describes the Oregon Health Study, a randomized controlled trial that will be able to shed some light on the likely effects of such expansions. In 2008, Oregon randomly drew names from a waiting list for its previously closed public insurance program. Our analysis of enrollment into this program found that people who signed up for the waiting list and enrolled in the Oregon Medicaid program were likely to have worse health than those who did not. However, actual enrollment was fairly low, partly because many applicants did not meet eligibility standards. PMID:20679654

Readability and Understanding of Informed Consent Among Participants With Low Incomes: A Preliminary Report.

PubMed

Ittenbach, Richard F; Senft, Elizabeth C; Huang, Guixia; Corsmo, Jeremy J; Sieber, Joan E

2015-12-01

With passage and implementation of the Affordable Health Care Act, more vulnerable segments of the U.S. population will now have access to regular health care and increased opportunities to participate in biomedical research. Yet, access to new groups brings with it new responsibilities for investigators, most importantly, reducing burdens for participants. Data collected through this small pilot study suggest several preliminary but potentially important findings when working with adults from low-income populations: First, while all participants read some parts of the consent forms (55%), only a minority reported reading the entire form (45%); second, 73% of participants reported understanding the study very well whereas only 27% reported understanding the study "a little"; third, there was a slight reported advantage of the simplified form over the regular form; however, this difference varied by section. Relatedly, other research has shown a high incidence of persons reading none of the consent form, but signing a statement that they have read and understood the study. Why does this occur? What are we teaching people when we request that they sign a consent form they have chosen not to read? What are the ethical and regulatory implications? Embedded ethics studies such as this one, although pilot and preliminary in nature, offer a number of advantages, such as stimulating additional scientific inquiry as well as challenging established institutional practices. © The Author(s) 2015.

Legal Pathways to the Recognition of Sign Languages: A Comparison of the Catalan and Spanish Sign Language Acts

ERIC Educational Resources Information Center

Quer, Josep

2012-01-01

Despite being minority languages like many others, sign languages have traditionally remained absent from the agendas of policy makers and language planning and policies. In the past two decades, though, this situation has started to change at different paces and to different degrees in several countries. In this article, the author describes the…

77 FR 9943 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-21

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Proposed... 17, 2009, the President signed the American Recovery and Reinvestment Act of 2009 (Recovery Act... employment. The Recovery Act made additional changes to TANF extending supplemental grants through FY 2010...

75 FR 79925 - Semiannual Regulatory Flexibility Agenda

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-20

... (DOCKET NO: R-1370) Legal Authority: 12 USC 1601 et seq Abstract: On May 22, 2009, the Credit Card Accountability Responsibility and Disclosure Act of 2009 (Credit Card Act) was signed into law. Public Law No. 111-24, 123 Stat. 1734 (2009). The Credit Card Act primarily amended the Truth in Lending Act (TILA...

78 FR 34107 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-06

... by the Family Smoking Prevention and Tobacco Control Act AGENCY: Food and Drug Administration, HHS... Smoking Prevention and Tobacco Control Act--(OMB Control Number 0910-0671)--Extension On June 22, 2009, the President signed the Family Smoking Prevention and Tobacco Control Act (the Tobacco Control Act...

Outdoor advertising control practices in Australia, Europe, and Japan

DOT National Transportation Integrated Search

2011-05-01

Although the Highway Beautification Act (HBA) has been credited with reducing the number of nonconforming signs and removing illegal signs throughout the country, the law is controversial and costly to administer. Many have questioned whether it has ...

Testing Consent Order on Refractory Ceramic Fibers

EPA Pesticide Factsheets

This notice announces that EPA has signed signed an enforceable testing consent order under the Toxic Substances Control Act (TSCA), 15 U.S.C. section 2601 at seq., with three of the primary producers of refractory ceramic fibers (RCF).

A flexible system for vital signs monitoring in hospital general care wards based on the integration of UNIX-based workstations, standard networks and portable vital signs monitors.

PubMed Central

Welch, J. P.; Sims, N.; Ford-Carlton, P.; Moon, J. B.; West, K.; Honore, G.; Colquitt, N.

1991-01-01

The article describes a study conducted on general surgical and thoracic surgical floors of a 1000-bed hospital to assess the impact of a new network for portable patient care devices. This network was developed to address the needs of hospital patients who need constant, multi-parameter, vital signs surveillance, but do not require intensive nursing care. Bedside wall jacks were linked to UNIX-based workstations using standard digital network hardware, creating a flexible system (for general care floors of the hospital) that allowed the number of monitored locations to increase and decrease as patient census and acuity levels varied. It also allowed the general care floors to provide immediate, centralized vital signs monitoring for patients who unexpectedly became unstable, and permitted portable monitors to travel with patients as they were transferred between hospital departments. A disk-based log within the workstation automatically collected performance data, including patient demographics, monitor alarms, and network status for analysis. The log has allowed the developers to evaluate the use and performance of the system. PMID:1807720

Grants for nurse practitioner traineeship programs--PHS. Interim final regulations.

PubMed

1984-08-01

These regulations set forth requirements for grants to schools of nursing, medicine, and public health, to public or nonprofit private hospitals, and to other public or nonprofit private entities to meet the costs of traineeships for training nurse practitioners. A trainee must sign a commitment with the Secretary to practice full-time as a nurse practitioner in a primary medical care health manpower shortage area, designated under section 332 of the Public Health Service Act (the Act), for a period equal to 1 month for each month of traineeship support, after completion of the training. If this obligation is not fulfilled, a trainee must pay back traineeship support. The purpose of these regulations is to respond to the comments on the 1980 interim final regulations and to conform 42 CFR Part 57, Subpart AA, with the Paperwork Reduction Act of 1980, Pub. L. 96-511, and with the Omnibus Budget Reconciliation Act of 1981, Pub. L. 97-35, which requires, among other provisions, that the Secretary provide, by regulation, for the waiver or suspension of the repayment obligation under certain conditions. In addition, other minor changes have been made and Office of Management and Budget (OMB) numbers are cited in those sections which have approved reporting and recordkeeping requirements.

TH-D-204-00: The Pursuit of Radiation Oncology Performance Excellence

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

NONE

The Malcolm Baldrige National Quality Improvement Act was signed into law in 1987 to advance U.S. business competitiveness and economic growth. Administered by the National Institute of Standards and Technology NIST, the Act created the Baldrige National Quality Program, now renamed the Baldrige Performance Excellence Program. The comprehensive analytical approaches referred to as the Baldrige Healthcare Criteria, are very well suited for the evaluation and sustainable improvement of radiation oncology management and operations. A multidisciplinary self-assessment approach is used for radiotherapy program evaluation and development in order to generate a fact based knowledge driven system for improving quality of care,more » increasing patient satisfaction, building employee engagement, and boosting organizational innovation. The methodology also provides a valuable framework for benchmarking an individual radiation oncology practice against guidelines defined by accreditation and professional organizations and regulatory agencies. Learning Objectives: To gain knowledge of the Baldrige Performance Excellence Program as it relates to Radiation Oncology. To appreciate the value of a multidisciplinary self-assessment approach in the pursuit of Radiation Oncology quality care, patient satisfaction, and workforce commitment. To acquire a set of useful measurement tools with which an individual Radiation Oncology practice can benchmark its performance against guidelines defined by accreditation and professional organizations and regulatory agencies.« less

TH-D-204-01: The Pursuit of Radiation Oncology Performance Excellence

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

Sternick, E.

The Malcolm Baldrige National Quality Improvement Act was signed into law in 1987 to advance U.S. business competitiveness and economic growth. Administered by the National Institute of Standards and Technology NIST, the Act created the Baldrige National Quality Program, now renamed the Baldrige Performance Excellence Program. The comprehensive analytical approaches referred to as the Baldrige Healthcare Criteria, are very well suited for the evaluation and sustainable improvement of radiation oncology management and operations. A multidisciplinary self-assessment approach is used for radiotherapy program evaluation and development in order to generate a fact based knowledge driven system for improving quality of care,more » increasing patient satisfaction, building employee engagement, and boosting organizational innovation. The methodology also provides a valuable framework for benchmarking an individual radiation oncology practice against guidelines defined by accreditation and professional organizations and regulatory agencies. Learning Objectives: To gain knowledge of the Baldrige Performance Excellence Program as it relates to Radiation Oncology. To appreciate the value of a multidisciplinary self-assessment approach in the pursuit of Radiation Oncology quality care, patient satisfaction, and workforce commitment. To acquire a set of useful measurement tools with which an individual Radiation Oncology practice can benchmark its performance against guidelines defined by accreditation and professional organizations and regulatory agencies.« less

Delegating Informed Consent.

PubMed

Koch, Valerie Gutmann

2017-11-01

Ten years ago, Megan Shinal sought the care of neurosurgeon Steven Toms for the surgical treatment of a recurrent nonmalignant tumor in the pituitary region of her brain. In their twenty-minute meeting, Shinal did not make a final decision about which surgical approach she wished to pursue. Subsequently, she spoke with Tom's physician assistant once by phone and once in person, when she signed the consent form, which did not appear to designate which surgical approach she had chosen. During the operation-a total resection-Toms perforated Shinal's carotid artery, resulting in hemorrhage, stroke, brain injury, and partial blindness. The jury found that Toms had fulfilled his informed-consent obligations prior to performing the resection; however, in June 2017, the Supreme Court of Pennsylvania overturned the decision, relying on the Pennsylvania Medical Care Availability and Reduction of Error Act. The court found that the language of the act is unambiguous in its requirement that "a physician's duty to provide information to a patient sufficient to obtain her informed consent is non-delegable." Presumably, this rule of nondelegation applies beyond the surgical theater to other major treatment decisions. And it is unclear whether it applies to other professionals in a subordinate position to the treating physician, such as residents and fellows. © 2017 The Hastings Center.

77 FR 51811 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-27

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Submission for... signed the American Recovery and Reinvestment Act of 2009 (Recovery Act), which establishes the Emergency... expenditures, or in expenditures related to short-term benefits or subsidized employment. The Recovery Act made...

Engineering study for reducing sign vandalism.

DOT National Transportation Integrated Search

1992-06-01

Sign vandalism has traditionally been a vexing problem for Iowa counties. : The extent of the cost and incidence of these acts have never been fully : ascertained, but a 1990 survey indicated that they cost Iowa counties more : than 1.5 million dolla...

Taiwanese parents' experience of making a "do not resuscitate" decision for their child in pediatric intensive care unit.

PubMed

Liu, Shu-Mei; Lin, Hung-Ru; Lu, Frank L; Lee, Tzu-Ying

2014-03-01

The purpose of this project was to explore the parental experience of making a "do not resuscitate" (DNR) decision for their child who is or was cared for in a pediatric intensive care unit in Taiwan. A descriptive qualitative study was conducted following parental signing of a standard hospital DNR form on behalf of their critically ill child. Sixteen Taiwanese parents of 11 children aged 1 month to 18 years were interviewed. Interviews were recorded, transcribed, analyzed and sorted into themes by the sole interviewer plus other researchers. Three major themes were identified: (a) "convincing points to sign", (b) "feelings immediately after signing", and (c) "post-signing relief or regret". Feelings following signing the DNR form were mixed and included "frustration", "guilt", and "conflicting hope". Parents adjusted their attitudes to thoughts such as "I have done my best," and "the child's life is beyond my control." Some parents whose child had died before the time of the interview expressed among other things "regret not having enough time to be with and talk to my child". Open family visiting hours plus staff sensitivity and communication skills training are needed. To help parents with this difficult signing process, nurses and other professionals in the pediatric intensive care unit need education on initiating the conversation, guiding the parents in expressing their fears, and providing continuing support to parents and children throughout the child's end of life process. Copyright © 2013. Published by Elsevier B.V.

Knowledge of obstetric danger signs and associated factors among pregnant women in Erer district, Somali region, Ethiopia.

PubMed

Maseresha, Nebiyu; Woldemichael, Kifle; Dube, Lamessa

2016-06-06

Knowledge of danger signs of obstetric complications is first step in the appropriate and timely referral to essential obstetric care. Although women's knowledge about the obstetric danger signs is important for improving maternal and child health, little is known about the current knowledge and influencing factors in pastoral community of Ethiopia. This study, therefore, aims to fill this gap by assessing the current level of knowledge and associated factors of pregnant women living in Erer district of Somali region, Ethiopia. A community based, cross-sectional study was conducted from April 7 to 21, 2014. The study involved 666 pregnant women residing in the district. Two-stage sampling technique was used to select the study subjects. Data about women's socio-demographic information, reproductive history, knowledge of the danger signs, exposure to media and interventions were collected by interviewer administered questionnaires. A respondent who spontaneously mentioned at least two of the danger signs during each of the three periods was considered knowledgeable; otherwise not. Descriptive, bivariate, then multivariable logistic regression were done. Six hundred thirty two pregnant women were interviewed with a response rate of 94.9 %. Only 98 (15.5 %) respondents were knowledgeable about obstetric danger signs. Urban residence [AOR = 2.43; 95 % CI (1.40, 4.21)], women who had been pregnant five or more times [AOR = 6.65; 95 % CI (2.48, 17.89)] and antenatal care utilization [AOR = 5.44; 95 % CI (3.26, 9.09)] were associated with being knowledgeable about obstetric danger signs during pregnancy, childbirth and postpartum. A significant proportion of pregnant women in Erer district do not have knowledge of obstetric danger signs. The implication is that lack of recognition may lead to delay in seeking care. Area of residence, gravidity and antenatal care service utilization are independently associated with the knowledge of women on obstetric danger signs in Erer district, a pastoralist community. Thus, intervention programs aiming to improve women's knowledge about obstetric danger signs and symptoms should consider the factors independently associated.

Opportunity and Danger: The Two Sides of the American Recovery and Reinvestment Act

ERIC Educational Resources Information Center

Warner, Carolyn

2009-01-01

The American Recovery and Reinvestment Act (ARRA) is likely the greatest single infusion of federal dollars into education since Congress passed the Elementary and Secondary Education Act in 1965 during Lyndon Johnson's presidency. When President Johnson signed that act, he said its purpose was to give every child in America "all the…

Reflexology: its effects on physiological anxiety signs and sedation needs.

PubMed

Akin Korhan, Esra; Khorshid, Leyla; Uyar, Mehmet

2014-01-01

To investigate whether reflexology has an effect on the physiological signs of anxiety and level of sedation in patients receiving mechanically ventilated support, a single blinded, randomized controlled design with repeated measures was used in the intensive care unit of a university hospital in Turkey. Patients (n = 60) aged between 18 and 70 years and were hospitalized in the intensive care unit and receiving mechanically ventilated support. Participants were randomized to a control group or an intervention group. The latter received 30 minutes of reflexology therapy on their feet, hands, and ears for 5 days. Subjects had vital signs taken immediately before the intervention and at the 10th, 20th, and 30th minutes of the intervention. In the collection of the data, "American Association of Critical-Care Nurses Sedation Assessment Scale" was used. The reflexology therapy group had a significantly lower heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate than the control group. A statistically significant difference was found between the averages of the scores that the patients included in the experimental and control groups received from the agitation, anxiety, sleep, and patient-ventilator synchrony subscales of the American Association of Critical-Care Nurses Sedation Assessment Scale. Reflexology can serve as an effective method of decreasing the physiological signs of anxiety and the required level of sedation in patients receiving mechanically ventilated support. Nurses who have appropriate training and certification may include reflexology in routine care to reduce the physiological signs of anxiety of patients receiving mechanical ventilation.

12 CFR 609.920 - Interpretations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... E-commerce as long as the safeguards of E-SIGN are met and its exceptions recognized. Generally, an... and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ELECTRONIC COMMERCE Interpretations and Definitions § 609.920 Interpretations. (a) E-SIGN preempts most statutes and regulations, including the Act...

12 CFR 609.920 - Interpretations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... E-commerce as long as the safeguards of E-SIGN are met and its exceptions recognized. Generally, an... and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ELECTRONIC COMMERCE Interpretations and Definitions § 609.920 Interpretations. (a) E-SIGN preempts most statutes and regulations, including the Act...

12 CFR 609.920 - Interpretations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... E-commerce as long as the safeguards of E-SIGN are met and its exceptions recognized. Generally, an... and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ELECTRONIC COMMERCE Interpretations and Definitions § 609.920 Interpretations. (a) E-SIGN preempts most statutes and regulations, including the Act...

12 CFR 609.920 - Interpretations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... E-commerce as long as the safeguards of E-SIGN are met and its exceptions recognized. Generally, an... and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ELECTRONIC COMMERCE Interpretations and Definitions § 609.920 Interpretations. (a) E-SIGN preempts most statutes and regulations, including the Act...

12 CFR 609.920 - Interpretations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... E-commerce as long as the safeguards of E-SIGN are met and its exceptions recognized. Generally, an... and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ELECTRONIC COMMERCE Interpretations and Definitions § 609.920 Interpretations. (a) E-SIGN preempts most statutes and regulations, including the Act...

Federal privacy regulations and the provision of Early Hearing Detection and Intervention programs.

PubMed

Houston, K Todd; Behl, Diane D; White, Karl R; Forsman, Irene

2010-08-01

To be successful, Early Hearing Detection and Intervention (EHDI) programs require individually identifiable information about children to be shared among people who are responsible for screening, diagnosis, early intervention, family support, and medical home services. Pediatricians and other stakeholders in the EHDI process often point to federal laws that were passed to ensure privacy and confidentiality in health care and educational programs as major obstacles to achieving efficient and effective EHDI programs. In this article we summarize the provisions of 3 federal laws (the Health Insurance Portability and Accountability Act [HIPAA], the Family Education Rights and Privacy Act [FERPA], and Part C privacy regulations of the Individuals With Disabilities Education Act [IDEA]) that most directly affect information-sharing in EHDI programs. We suggest strategies for sharing the information needed to operate successful EHDI programs while remaining in compliance with these laws, including obtaining signed parental consent to share information between providers, including an option on the individual family services plan for parents to permit sharing of the plan with pediatricians and other providers, and giving copies of all relevant test results to parents to share with providers as they wish.

The neural correlates of highly iconic structures and topographic discourse in French Sign Language as observed in six hearing native signers.

PubMed

Courtin, C; Hervé, P-Y; Petit, L; Zago, L; Vigneau, M; Beaucousin, V; Jobard, G; Mazoyer, B; Mellet, E; Tzourio-Mazoyer, N

2010-09-01

"Highly iconic" structures in Sign Language enable a narrator to act, switch characters, describe objects, or report actions in four-dimensions. This group of linguistic structures has no real spoken-language equivalent. Topographical descriptions are also achieved in a sign-language specific manner via the use of signing-space and spatial-classifier signs. We used functional magnetic resonance imaging (fMRI) to compare the neural correlates of topographic discourse and highly iconic structures in French Sign Language (LSF) in six hearing native signers, children of deaf adults (CODAs), and six LSF-naïve monolinguals. LSF materials consisted of videos of a lecture excerpt signed without spatially organized discourse or highly iconic structures (Lect LSF), a tale signed using highly iconic structures (Tale LSF), and a topographical description using a diagrammatic format and spatial-classifier signs (Topo LSF). We also presented texts in spoken French (Lect French, Tale French, Topo French) to all participants. With both languages, the Topo texts activated several different regions that are involved in mental navigation and spatial working memory. No specific correlate of LSF spatial discourse was evidenced. The same regions were more activated during Tale LSF than Lect LSF in CODAs, but not in monolinguals, in line with the presence of signing-space structure in both conditions. Motion processing areas and parts of the fusiform gyrus and precuneus were more active during Tale LSF in CODAs; no such effect was observed with French or in LSF-naïve monolinguals. These effects may be associated with perspective-taking and acting during personal transfers. 2010 Elsevier Inc. All rights reserved.

75 FR 13702 - Implementation of the Methamphetamine Production Prevention Act of 2008

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-23

... 1117-AB25 Implementation of the Methamphetamine Production Prevention Act of 2008 AGENCY: Drug..., the President signed the Methamphetamine Production Prevention Act of 2008, which clarifies the... Title 21 of the Code of Federal Regulations (CFR), Parts 1300 to 1399. These regulations are designed to...

75 FR 65490 - Agency Information Collection Activities; Proposed Collection; Comment Request; Information...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-25

..., focus groups, surveys, experimental clinical studies, post-marketing surveillance, toxicological and... Products On June 22, 2009, the President signed the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) (Pub. L. 111- 31) into law. The Tobacco Control Act amended the Federal Food, Drug...

75 FR 4568 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-28

... with Amyotrophic Lateral Sclerosis (ALS) in the National ALS Registry--New--Agency for Toxic Substances... signed S. 1382: ALS Registry Act which amended the Public Health Service Act to provide for the establishment of an Amyotrophic Lateral Sclerosis (ALS) Registry. The activities described are part of the...

75 FR 69086 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-10

... Metropolitan Area-based Surveillance Projects for Amyotrophic Lateral Sclerosis (ALS)--New--Agency for Toxic... signed S. 1382: ALS Registry Act which amended the Public Health Service Act to provide for the establishment of an Amyotrophic Lateral Sclerosis (ALS) Registry. The activities described are part of the...

A fundamental conflict of care: Nurses' accounts of balancing patients' sleep with taking vital sign observations at night.

PubMed

Hope, Joanna; Recio-Saucedo, Alejandra; Fogg, Carole; Griffiths, Peter; Smith, Gary B; Westwood, Greta; Schmidt, Paul E

2017-12-21

To explore why adherence to vital sign observations scheduled by an early warning score protocol reduces at night. Regular vital sign observations can reduce avoidable deterioration in hospital. early warning score protocols set the frequency of these observations by the severity of a patient's condition. Vital sign observations are taken less frequently at night, even with an early warning score in place, but no literature has explored why. A qualitative interpretative design informed this study. Seventeen semi-structured interviews with nursing staff working on wards with varying levels of adherence to scheduled vital sign observations. A thematic analysis approach was used. At night, nursing teams found it difficult to balance the competing care goals of supporting sleep with taking vital sign observations. The night-time frequency of these observations was determined by clinical judgement, ward-level expectations of observation timing and the risk of disturbing other patients. Patients with COPD or dementia could be under-monitored, while patients nearing the end of life could be over-monitored. In this study, we found an early warning score algorithm focused on deterioration prevention did not account for long-term management or palliative care trajectories. Nurses were therefore less inclined to wake such patients to take vital sign observations at night. However, the perception of widespread exceptions and lack of evidence regarding optimum frequency risks delegitimising the early warning score approach. This may pose a risk to patient safety, particularly patients with dementia or chronic conditions. Nurses should document exceptions and discuss these with the wider team. Hospitals should monitor why vital sign observations are missed at night, identify which groups are under-monitored and provide guidance on prioritising competing expectations. early warning score protocols should take account of different care trajectories. © 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

Effect of Home Care Nursing on Patients Discharged From Hospital With Self-Reported Signs of Constipation: A Randomized Trial.

PubMed

Konradsen, Hanne; Rasmussen, Marie Louise Thiese; Noiesen, Eline; Trosborg, Ingelise

Constipation is a common health problem in relation to hospitalization. This randomized controlled trial aimed to investigate whether advice from a home care nurse after discharge had an effect on self-reported signs of constipation. A total of 59 patients were included in the study on the basis of their self-reported signs of constipation evaluated using the Constipation Assessment Scale. Advice from the home care nurses was given on the intake of fiber and liquid and mobilization related to scorings on the Constipation Risk Assessment Scale, the administration of laxatives, and referral to a physician when needed. Results showed a tendency toward the visits being effective, but a more complex intervention might be needed.

The nurse response to abnormal vital sign recording in the emergency department.

PubMed

Johnson, Kimberly D; Mueller, Lindsey; Winkelman, Chris

2017-01-01

To examine what occurs after a recorded observation of at least one abnormal vital sign in the emergency department. The aims were to determine how often abnormal vital signs were recorded, what interventions were documented, and what factors were associated with documented follow-up for abnormal vital signs. Monitoring quality of care, and preventing or intervening before harm occurs to patients are central to nurses' roles. Abnormal vital signs have been associated with poor patient outcomes and require follow-up after the observation of abnormal readings to prevent patient harm related to a deteriorating status. This documentation is important to quality and safety of care. Observational, retrospective chart review. Modified Early Warning Score was calculated for all recorded vital signs for 195 charts. Comparisons were made between groups: (1) no abnormal vital signs, (2) abnormal vital sign present, but normal Modified Early Warning Score and (3) critically abnormal Modified Early Warning Score. About 62·1% of charts had an abnormal vital sign documented. Critically abnormal values were present in 14·9%. No documentation was present in 44·6% of abnormal cases. When interventions were documented, it was usually to notify the physician. The timing within the emergency department visit when the abnormalities were observed and the degree of abnormality had significant relationships to the presence of documentation. It is doubtful that nurses do not recognise abnormalities because more severely abnormal vital signs were more likely to have documented follow-up. Perhaps the interruptive nature of the emergency department or the prioritised actions of the nurse impacted documentation within this study. Further research is required to determine why follow-up is not being documented. To ensure safety and quality of patient care, accurate documentation of responses to abnormal vital signs is required. © 2016 John Wiley & Sons Ltd.

Poster: Whistleblower Protection Ombudsman for the EPA OIG

EPA Pesticide Factsheets

The Whistleblower Protection Enhancement Act of 2012 Exit was signed into law on November 27, 2012. The Act strengthens protection for federal employees who blow the whistle on waste, fraud, and abuse in government operations.

Long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide.

PubMed

Price, David; Kaplan, Alan; Jones, Rupert; Freeman, Daryl; Burden, Anne; Gould, Shuna; von Ziegenweidt, Julie; Ali, Muzammil; King, Christine; Thomas, Mike

2015-01-01

Randomized controlled trials indicate that addition of a long-acting muscarinic antagonist (LAMA) such as tiotropium may improve asthma control and reduce exacerbation risk in patients with poorly controlled asthma, but broader clinical studies are needed to investigate the effectiveness of LAMA in real-life asthma care. Medical records of adults with asthma (aged ≥18 years) prescribed tiotropium were obtained from the UK Optimum Patient Care Research Database for the period 2001-2013. Patients diagnosed with chronic obstructive pulmonary disease were excluded, but no other clinical exclusions were applied. Two primary outcomes were compared in the year before (baseline) and the year after (outcome) addition of tiotropium: exacerbations (asthma-related hospital emergency department attendance or inpatient admission, or acute oral corticosteroid course) and acute respiratory events (exacerbation or antibiotic prescription with lower respiratory consultation). Secondary outcomes included lung function test results and short-acting β2 agonist usage. The Wilcoxon signed-rank test was used for variables measured on the interval scale, the marginal homogeneity test for categorized variables, and the paired t-test for lung function indices. Of the 2,042 study patients, 83% were prescribed an inhaled corticosteroid and 68% a long-acting β2 agonist during the baseline year; 67% were prescribed both. Comparing baseline and outcome years, the percentage of patients having at least one exacerbation decreased from 37% to 27% (P<0.001) and the percentage having at least one acute respiratory event decreased from 58% to 47% (P<0.001). There were no significant changes in lung function, and usage of short-acting β2 agonists (in salbutamol/albuterol equivalents) increased from a median (interquartile range) of 274 (110, 548) to 329 (110, 603) μg/day (P=0.01). In this real-life asthma population, addition of LAMA therapy was associated with significant decreases in the incidence of exacerbations and antibiotic prescriptions for lower respiratory tract infections in the following year.

The Every Student Succeeds Act (ESSA): What It Means for Students With Disabilities and Music Educators

ERIC Educational Resources Information Center

Darrow, Alice-Ann

2016-01-01

On December 10, 2015, President Obama signed the Every Student Succeeds Act (ESSA) (P.L. 114-95), legislation which reauthorizes the Elementary and Secondary Education Act of 1965, and replaces the widely criticized No Child Left Behind Act. After various versions were offered, rejected, or revised, the ESSA ultimately passed both chambers of…

The Assistive Technology Act of 2004: What Does It Say and What Does It Mean?

ERIC Educational Resources Information Center

Bausch, Margaret E.; Mittler, Joel E.; Hasselbring, Ted S.; Cross, Donald P.

2005-01-01

On October 25, 2004, President Bush signed into law the reauthorization of the Assistive Technology Act (AT Act). The new law provides a far more optimistic future for assistive technology (AT) and modifies the primary purpose of the previous law. The new AT Act provides "birth to death" legislation and is fundamentally different from…

78 FR 20291 - Fisheries of the United States; Billfish Conservation Act of 2012 Implementing Regulations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-04

.... 121227743-3275-01] RIN 0648-BC86 Fisheries of the United States; Billfish Conservation Act of 2012... request public comment on potential issues related to the implementation of the Billfish Conservation Act... Conservation Act of 2012 (BCA), Public Law 112-183, 16 U.S.C. 1827a, was signed into law on October 5, 2012...

Reinvesting in America's Youth: Lessons from the 2009 Recovery Act Summer Youth Employment Initiative

ERIC Educational Resources Information Center

Bellotti, Jeanne; Rosenberg, Linda; Sattar, Samina; Esposito, Andrea Mraz; Ziegler, Jessica

2010-01-01

On February 17, 2009, President Barack Obama signed the American Recovery and Reinvestment Act into law. Passed in response to the 2008 recession, the Act's purpose was to create jobs, pump money into the economy, and encourage spending. Through the Act, states received $1.2 billion in funding for the workforce investment system to provide…

Design and implementation of a mobile-care system over wireless sensor network for home healthcare applications.

PubMed

Lee, Ren-Guey; Lai, Chien-Chih; Chiang, Shao-Shan; Liu, Hsin-Sheng; Chen, Chun-Chang; Hsieh, Guan-Yu

2006-01-01

According to home healthcare requirement of chronic patients, this paper proposes a mobile-care system integrated with a variety of vital-sign monitoring, where all the front-end vital-sign measuring devices are portable and have the ability of short-range wireless communication. In order to make the system more suitable for home applications, the technology of wireless sensor network is introduced to transmit the captured vital signs to the residential gateway by means of multi-hop relay. Then the residential gateway uploads data to the care server via Internet to carry out patient's condition monitoring and the management of pathological data. Furthermore, the system is added in the alarm mechanism, which the portable care device is able to immediately perceive the critical condition of the patient and to send a warning message to medical and nursing personnels in order to achieve the goal of prompt rescue.

Importance of Rapid Eye Movement Sleep Behavior Disorder to the Primary Care Physician.

PubMed

McCarter, Stuart J; Howell, Michael J

2016-10-01

Sleep disorders and neurodegenerative diseases are commonly encountered in primary care. A common, but underdiagnosed sleep disorder, rapid eye movement sleep behavior disorder (RBD), is highly associated with Parkinson disease and related disorders. Rapid eye movement sleep behavior disorder is common. It is estimated to affect 0.5% of the general population and more than 7% of individuals older than 60 years; however, most cases go unrecognized. Rapid eye movement sleep behavior disorder presents as dream enactment, often with patients thrashing, punching, and kicking while they are sleeping. Physicians can quickly assess for the presence of RBD with high sensitivity and specificity by asking patients the question "Have you ever been told that you act out your dreams, for example by punching or flailing your arms in the air or screaming and shouting in your sleep?" Patients with RBD exhibit subtle signs of neurodegenerative disease, such as mild motor slowing, constipation, or changes in sense of smell. These signs and symptoms may predict development of a neurodegenerative disease within 3 years. Ultimately, most patients with RBD develop a neurodegenerative disease, highlighting the importance of serial neurological examinations to assess for the presence of parkinsonism and/or cognitive impairment and prognostic counseling for these patients. Rapid eye movement sleep behavior disorder is treatable with melatonin (3-6 mg before bed) or clonazepam (0.5-1 mg before bed) and may be the most common, reversible cause of sleep-related injury. Thus, it is important to identify patients at risk of RBD in a primary care setting so that bedroom safety can be addressed and treatment may be initiated. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Knowledge of obstetric danger signs among recently-delivered women in Chamwino district, Tanzania: a cross-sectional study.

PubMed

Bintabara, Deogratius; Mpembeni, Rose N M; Mohamed, Ahmed Abade

2017-08-29

Low knowledge of danger signs has been shown to delay seeking obstetric care which leads to high maternal mortality and morbidity worldwide. In Tanzania about half of pregnant women are informed about obstetric danger signs during antenatal care, but the proportion of those who have full knowledge of these obstetric danger signs is not known. This study assessed the knowledge of obstetric danger signs and its associated factors among recently-delivered women in Chamwino District, Tanzania. A community-based cross-sectional study was conducted in January 2014 in Chamwino District, Tanzania. A woman was considered knowledgeable if she spontaneously mentioned at least five danger signs in any of the three phases of childbirth (pregnancy, childbirth and postpartum) with at least one in each phase. Multistage cluster sampling was used to recruit study participants. Descriptive and bivariate analyses were conducted. Multivariable logistic regression analyses were performed to control for confounding and other important covariates. A total of 428 women were interviewed. The median age (IQR) was 26.5 (22-33) years. Only 25.2% of respondents were knowledgeable about obstetric danger signs during pregnancy, childbirth/labour and postpartum. Significant explanatory variables of being knowledgeable about obstetric danger signs were found to be maternal education (AOR = 1.96; 95% CI: 1.01, 3.82), maternal occupation (AOR = 2.23; 95% CI; 1.10, 4.52), spouse occupation (AOR = 2.10; 95% CI: 1.02, 4.32) and counseling on danger signs (AOR = 3.42; 95% CI: 1.36, 8.62) after controlling for the clustering effect, confounding and important covariates. A low proportion of women was found to be knowledgeable about obstetric danger signs in Chamwino district. Therefore, we recommend the Ministry of Health to design and distribute the maternal health booklets that highlight the obstetric danger signs, and encourage antenatal care providers and community health workers to provide frequent health education about these danger signs for every pregnant woman in order to increase their level of knowledge about obstetric danger signs.

A History of the Atomic Energy Commission

DOE R&D Accomplishments Database

Buck, Alice L.

1983-07-01

This pamphlet traces the history of the US Atomic Energy Commission's twenty-eight year stewardship of the Nation's nuclear energy program, from the signing of the Atomic Energy Act on August 1, 1946 to the signing of the Energy Reorganization Act on October 11, 1974. The Commission's early concentration on the military atom produced sophisticated nuclear weapons for the Nation's defense and made possible the creation of a fleet of nuclear submarines and surface ships. Extensive research in the nuclear sciences resulted in the widespread application of nuclear technology for scientific, medical and industrial purposes, while the passage of the Atomic Energy Act of 1954 made possible the development of a nuclear industry, and enabled the United States to share the new technology with other nations.

New Measurements of the Cosmic Background Radiation Spectrum

DOE R&D Accomplishments Database

Smoot, G. F.; De Amici, G.; Levin, S.; Witebsky, C.

This pamphlet traces the history of the US Atomic Energy Commission's twenty-eight year stewardship of the Nation's nuclear energy program, from the signing of the Atomic Energy Act on August 1, 1946 to the signing of the Energy Reorganization Act on October 11, 1974. The Commission's early concentration on the military atom produced sophisticated nuclear weapons for the Nation's defense and made possible the creation of a fleet of nuclear submarines and surface ships. Extensive research in the nuclear sciences resulted in the widespread application of nuclear technology for scientific, medical and industrial purposes, while the passage of the Atomic Energy Act of 1954 made possible the development of a nuclear industry, and enabled the United States to share the new technology with other nations.

Parkinsonian signs are a risk factor for falls.

PubMed

Dahodwala, Nabila; Nwadiogbu, Chinwe; Fitts, Whitney; Partridge, Helen; Karlawish, Jason

2017-06-01

Parkinsonian signs are common, non-specific findings in older adults and associated with increased rates of dementia and mortality. It is important to understand which motor outcomes are associated with parkinsonian signs. To determine the role of parkinsonian signs on fall rates among older adults. We conducted a longitudinal study of primary care patients from the University of Pennsylvania Health System. Adults over 55 years were assessed at baseline through surveys and a neurological examination. We recorded falls over the following 2 years. Parkinsonian signs were defined as the presence of 2 of 4 cardinal signs. Incident falls were compared between subjects with and without parkinsonian signs, and modified Poisson regression used to adjust for potential confounders in the relationship between parkinsonian signs and falls. 982 subjects with a mean age of 68 (s.d. 8.8) years participated. 29% of participants fell and 12% exhibited parkinsonian signs at baseline. The unadjusted RR for falls among individuals with parkinsonian signs was 1.36 (95% CI 1.05-1.76, p=0.02). After adjusting for age, cognitive function, urinary incontinence, depression, diabetes, stroke and arthritis, individuals with parkinsonian signs were still 38% more likely to fall than those without parkinsonian signs (RR 1.38, 95% CI 1.04-1.82; p=0.03). Falls among those with parkinsonian signs were more likely to lead to injury (53% vs 37%; p=0.04). Parkinsonian signs are a significant, independent risk factor for falls. Early detection of this clinical state is important in order to implement fall prevention programs among primary care patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Ramifications of the Family and Medical Leave Act of 1993.

PubMed

Luecke, R W; Wise, R J; List, M S

1993-08-01

Six months ago, the Family and Medical Leave Act of 1993 was signed into law, and key provisions of the act became effective on August 5, 1993. This article examines the main provisions of the act, explains how employee leaves will be granted in compliance with the act, outlines the consequences of noncompliance with the act, analyzes the operational ramifications of the act, quantifies the financial implications of the act, and discusses the role of the healthcare financial manager in assisting with the formulation of a hospital policy to comply with the act.

78 FR 54069 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, and Eligibility...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-30

... Parts 147, 153, 155, et al. Patient Protection and Affordable Care Act; Program Integrity: Exchange... 147, 153, 155, and 156 [CMS-9957-F] RIN 0938-AR82 Patient Protection and Affordable Care Act; Program... Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as...

Health care system accessibility. Experiences and perceptions of deaf people.

PubMed

Steinberg, Annie G; Barnett, Steven; Meador, Helen E; Wiggins, Erin A; Zazove, Philip

2006-03-01

People who are deaf use health care services differently than the general population; little research has been carried out to understand the reasons. To better understand the health care experiences of deaf people who communicate in American Sign Language. Qualitative analyses of focus group discussions in 3 U.S. cities. Ninety-one deaf adults who communicate primarily in American Sign Language. We collected information about health care communication and perceptions of clinicians' attitudes. We elicited stories of both positive and negative encounters, as well as recommendations for improving health care. Communication difficulties were ubiquitous. Fear, mistrust, and frustration were prominent in participants' descriptions of health care encounters. Positive experiences were characterized by the presence of medically experienced certified interpreters, health care practitioners with sign language skills, and practitioners who made an effort to improve communication. Many participants acknowledged limited knowledge of their legal rights and did not advocate for themselves. Some participants believed that health care practitioners should learn more about sociocultural aspects of deafness. Deaf people report difficulties using health care services. Physicians can facilitate change to improve this. Future research should explore the perspective of clinicians when working with deaf people, ways to improve communication, and the impact of programs that teach deaf people self-advocacy skills and about their legal rights.

The Opioid Epidemic: What Does it Mean for Nurses?

PubMed

Leahy, Laura G

2017-01-01

The United States is facing a major crisis with the current opioid epidemic. Tens of thousands of individuals are dying each year due to abuse and misuse of heroin and prescription opiate drugs. Nurses play an integral role in these aspects of health care and offer solutions by providing education; preventive measures; treatments, including medication-assisted treatments (MATs); and ongoing recovery options for individuals with opioid use disorders. Nurses provide education, issue prescriptions and dispense medications, and provide overall physical and mental health care to patients struggling with this "disease of the brain," and with the signing of the Comprehensive Addiction and Recovery Act, advanced practice RNs will soon be able to include MATs related to buprenorphine as part of their treatment plan. The current article explores the anatomy, physiology, and genetics of addiction and how they relate to the pharmacological MATs used to treat opioid use disorders. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 18-23.]. Copyright 2017, SLACK Incorporated.

[Three contracts signed by the apothecary Nicolas Houel in 1586].

PubMed

Warolin, C

1998-01-01

Nicolas Houel famous apothecary founder of the House of the Christian Charity, near Paris, in the 16th Century, welcomed poor children for six years. The author has found two reception contracts and a settlement act to the Foundation signed by Houel in 1586.

Family physicians' awareness and knowledge of the Genetic Information Non-Discrimination Act (GINA).

PubMed

Laedtke, Amanda L; O'Neill, Suzanne M; Rubinstein, Wendy S; Vogel, Kristen J

2012-04-01

Historically, physicians have expressed concern about their patients' risk of genetic discrimination, which has acted as a barrier to uptake of genetic services. The Genetic Information Nondiscrimination Act of 2008 (GINA) is intended to protect patients against employer and health insurance discrimination. Physicians' awareness and knowledge of GINA has yet to be evaluated. In 2009, we mailed surveys to 1500 randomly selected members of the American Academy of Family Physicians. Questions measured physicians' current knowledge of GINA and their level of concern for genetic discrimination. In total, 401 physicians completed the survey (response rate 26.9%). Approximately half (54.5%) of physicians had no awareness of GINA. Of physicians who reported basic knowledge of GINA, the majority were aware of the protections offered for group health insurance (92.7%), private health insurance (82.9%), and employment (70.7%). Fewer physicians were aware of GINA's limitations regarding life insurance (53.7%) and long-term care insurance (58.8%). Physicians demonstrated highest levels of concern for health insurance, life insurance, and long-term care insurance discrimination, with less concern for employer and family/social discrimination. Level of concern for the risk of genetic discrimination did not correlate significantly with awareness of GINA. Approximately 17 months after GINA was signed into federal law, physicians' knowledge remained limited regarding the existence of this legislation and relevant details. Physicians who are aware of GINA continue to have significant concerns regarding the risk of genetic discrimination. This study reveals the need to further educate physicians about the existence of GINA and the protections offered.

Dedicated Shift Wrap-up Time Does Not Improve Resident Sign-out Volume or Efficiency.

PubMed

Jeanmonod, Rebecca K; Brook, Christopher; Winther, Mark; Pathak, Soma; Boyd, Molly

2010-02-01

Sign-out (SO) is a challenge to the emergency physician. Some training programs have instituted overlapping 9-hour shifts. The residents see patients for eight hours, and have one hour of wrap-up time. This hour helps them complete patient care, leaving fewer patients to sign-out. We examined whether this strategy impacts SO burden. This is a retrospective review of patients evaluated by emergency medicine (EM) residents working 9-hour (eight hours of patient care, one hour wrap-up time) and 12-hour shifts (12 hours patient care, no reserved time for wrap-up). Data were collected by reviewing the clinical tracker. A patient was assigned to the resident who initiated care and dictated the chart. SO was defined as any patient in the ED without disposition at change of shift. Patient turn-around-time (TAT) was also recorded. One-hundred sixty-one postgraduate-year-one resident (PGY1), 264 postgraduate-year-two resident (PGY2), and 193 postgraduate-year-three resident (PGY3) shifts were included. PGY1s signed out 1.9 patients per 12-hour shift. PGY2s signed out 2.3 patients on 12-hour shifts and 1.8 patients on 9-hour shifts. PGY3s signed out 2.1 patients on 12-hour shifts and 2.0 patients on 9-hour shifts. When we controlled for patients seen per hour, SO burden was constant by class regardless of shift length, with PGY2s signing out 18% of patients seen compared to 15% for PGY3s. PGY1s signed out 18% of patients seen. TAT for patients seen by PGY1s and PGY2s was similar, at 189 and 187 minutes, respectively. TAT for patients seen by PGY3s was significantly less at 175 minutes. The additional hour devoted to wrapping up patients in the ED had no affect on SO burden. The SO burden represented a fixed percentage of the total number of patients seen by the residents. PGY3s sign-out a smaller percentage of patients seen compared to other classes, and have faster TATs.

An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care?

PubMed

Ogero, Morris; Ayieko, Philip; Makone, Boniface; Julius, Thomas; Malla, Lucas; Oliwa, Jacquie; Irimu, Grace; English, Mike

2018-06-01

Measurement and correct interpretation of vital signs is part of routine clinical care. Repeated measurement enhances early recognition of deterioration, may help prevent morbidity and mortality and is a standard of care in most countries. To examine documentation of vital signs by clinicians for admissions to paediatric wards in Kenyan hospitals, to describe monitoring frequency by nurses and explore factors influencing frequency. Vital signs information (temperature, respiratory and pulse rate) for the first 48 hours of admission was collected from case records of children admitted with non-surgical conditions to 13 Kenyan county hospitals between September 2013 and April 2016. A mixed effect negative binomial regression model was used to explore whether the severity of illness (indicated by danger signs or severe diagnostic episodes) is associated with increased vital signs observation frequency. We examined 54 800 admission episodes with an overall mortality 6.1%. Nurse to bed ratios were very low (1:10 to 1:41 across hospitals). Admitting clinicians documented all or no vital signs in 57.0% and 8.4% cases respectively. For respiratory and pulse rates there was pronounced even end-digit preference (an indicator of incorrect information) and high frequency recording of specific values ( P  < 0.001) suggesting approximation. Monitoring frequency was explored in 41 738 children. Those with inpatient stays ≥48 hours were expected to have a vital signs count of 18, hospitals varied but most did not achieve this benchmark (median 9, range 2-30). There were clinically small but significant associations between vital signs count and presence of multiple severe illnesses or presence of severe pallor (adjusted relative risk ratio = 1.04, P  < 0.01, 95% confidence interval CI = 1.02-1.06 and 1.05, P  = 0.02, 95% CI = 1.01-1.09, respectively). Data suggest accurate admission measures are sometimes missing especially for pulse and respiratory rates, possibly linked to manual measurement. Monitoring frequency is often low in the high risk population studied probably indicating how quality of nursing care is undermined by considerable human resource shortages.

An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care?

PubMed Central

Ogero, Morris; Ayieko, Philip; Makone, Boniface; Julius, Thomas; Malla, Lucas; Oliwa, Jacquie; Irimu, Grace; English, Mike

2018-01-01

Background Measurement and correct interpretation of vital signs is part of routine clinical care. Repeated measurement enhances early recognition of deterioration, may help prevent morbidity and mortality and is a standard of care in most countries. Objective To examine documentation of vital signs by clinicians for admissions to paediatric wards in Kenyan hospitals, to describe monitoring frequency by nurses and explore factors influencing frequency. Methods Vital signs information (temperature, respiratory and pulse rate) for the first 48 hours of admission was collected from case records of children admitted with non-surgical conditions to 13 Kenyan county hospitals between September 2013 and April 2016. A mixed effect negative binomial regression model was used to explore whether the severity of illness (indicated by danger signs or severe diagnostic episodes) is associated with increased vital signs observation frequency. Results We examined 54 800 admission episodes with an overall mortality 6.1%. Nurse to bed ratios were very low (1:10 to 1:41 across hospitals). Admitting clinicians documented all or no vital signs in 57.0% and 8.4% cases respectively. For respiratory and pulse rates there was pronounced even end-digit preference (an indicator of incorrect information) and high frequency recording of specific values (P < 0.001) suggesting approximation. Monitoring frequency was explored in 41 738 children. Those with inpatient stays ≥48 hours were expected to have a vital signs count of 18, hospitals varied but most did not achieve this benchmark (median 9, range 2-30). There were clinically small but significant associations between vital signs count and presence of multiple severe illnesses or presence of severe pallor (adjusted relative risk ratio = 1.04, P < 0.01, 95% confidence interval CI = 1.02-1.06 and 1.05, P = 0.02, 95% CI = 1.01-1.09, respectively). Conclusions Data suggest accurate admission measures are sometimes missing especially for pulse and respiratory rates, possibly linked to manual measurement. Monitoring frequency is often low in the high risk population studied probably indicating how quality of nursing care is undermined by considerable human resource shortages. PMID:29497504

Delivery of oral health care through the Ryan White CARE Act to people infected with HIV.

PubMed

Schneider, D A; Hardwick, K S; Marconi, K M; Niemcryk, S J; Bowen, G S

1993-01-01

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 was passed by Congress "to improve the quality and availability of care for individuals and families with HIV disease." The act targets those individuals infected with HIV who lack financial resources to pay for care. While provision of oral health care is not mandated by the legislation, many oral health services are supported through five different programs receiving CARE Act funding. Legislative mandates, program guidance materials, grant applications, and other related materials were reviewed to analyze oral health care services supported or proposed through the CARE Act. In fiscal year 1991, an estimated $5.8 million of the total CARE Act funds ($229.6 million) were used for oral health care, and there is evidence that oral health concerns will receive increasing attention by grantees in future years. Opportunities exist for local oral health professionals to become involved in CARE Act programs and in the priority development process. It is possible that CARE Act grantees will serve as catalysts for the development of partnerships between private practitioners and public sector programs--relationships that could lead to improved access and quality of care for people with HIV infection.

Sign my e-petition to make changes to misuse of drugs act.

PubMed

Griffiths, Matt

2012-02-29

My medicines management article (reflections February 8) highlighted legal muddles over the prescription of controlled drugs. The Medicines Act was amended four years ago to allow independent nurse prescribers to prescribe almost all controlled drugs. But the Misuse of Drugs Act needs to amended to make this legally possible.

30 CFR 950.20 - State-Federal Cooperative Agreement.

Code of Federal Regulations, 2012 CFR

2012-07-01

... regulations including 40 CFR part 1500 et seq. (6) The Endangered Species Act, 16 U.S.C. 1531 et seq., and... accordance with the Act. Article II: Effective Date 3. This Agreement shall take effect following signing by... otherwise stated in this Agreement, the Act, 30 CFR part 745, or other applicable laws or regulations...

30 CFR 950.20 - State-Federal Cooperative Agreement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... regulations including 40 CFR part 1500 et seq. (6) The Endangered Species Act, 16 U.S.C. 1531 et seq., and... accordance with the Act. Article II: Effective Date 3. This Agreement shall take effect following signing by... otherwise stated in this Agreement, the Act, 30 CFR part 745, or other applicable laws or regulations...

30 CFR 906.30 - State-Federal cooperative agreement.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Endangered Species Act, 16 U.S.C. 1531 et seq., and implementing regulations including 50 CFR part 402. 5..., in accordance with the Act and the Program. Article II: Effective Date 3. After being signed by the... except as otherwise stated in this Agreement, the Act, 30 CFR 745.13, or other applicable laws. Orders...

30 CFR 906.30 - State-Federal cooperative agreement.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Endangered Species Act, 16 U.S.C. 1531 et seq., and implementing regulations including 50 CFR part 402. 5..., in accordance with the Act and the Program. Article II: Effective Date 3. After being signed by the... except as otherwise stated in this Agreement, the Act, 30 CFR 745.13, or other applicable laws. Orders...

30 CFR 950.20 - State-Federal Cooperative Agreement.

Code of Federal Regulations, 2013 CFR

2013-07-01

... regulations including 40 CFR part 1500 et seq. (6) The Endangered Species Act, 16 U.S.C. 1531 et seq., and... accordance with the Act. Article II: Effective Date 3. This Agreement shall take effect following signing by... otherwise stated in this Agreement, the Act, 30 CFR part 745, or other applicable laws or regulations...

30 CFR 950.20 - State-Federal Cooperative Agreement.

Code of Federal Regulations, 2014 CFR

2014-07-01

... regulations including 40 CFR part 1500 et seq. (6) The Endangered Species Act, 16 U.S.C. 1531 et seq., and... accordance with the Act. Article II: Effective Date 3. This Agreement shall take effect following signing by... otherwise stated in this Agreement, the Act, 30 CFR part 745, or other applicable laws or regulations...

30 CFR 950.20 - State-Federal Cooperative Agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... regulations including 40 CFR part 1500 et seq. (6) The Endangered Species Act, 16 U.S.C. 1531 et seq., and... accordance with the Act. Article II: Effective Date 3. This Agreement shall take effect following signing by... otherwise stated in this Agreement, the Act, 30 CFR part 745, or other applicable laws or regulations...

77 FR 11193 - Proposed Collections; Comment Requests

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-24

... 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently, the Office of the State Small Business... Review collection. On September 27, 2010, President Obama signed into law the Small Business Jobs Act of 2010 (the ``Act''). Title III of the Act created the State Small Business Credit Initiative (SSBCI...

78 FR 16678 - Agency Information Collection Activities; Proposed Collection; Comment Request; Requirements...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-18

... Comprehensive Smokeless Tobacco Health Education Act of 1986, as Amended by the Family Smoking Prevention and... Act of 1986, as Amended by the Family Smoking Prevention and Tobacco Control Act (OMB Control Number 0910-0671)--Extension On June 22, 2009, the President signed the Family Smoking Prevention and Tobacco...

75 FR 3664 - Request for Comments Concerning Regulations Implementing the Comprehensive Smokeless Tobacco...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-22

... June 22, 2009, President Obama signed into law the Family Smoking Prevention and Tobacco Control Act, Pub. L. No. 111-31, 123 Stat. 1776 (2009) (``Family Smoking Prevention Act''). The Family Smoking... Family Smoking Prevention Act also gives the Secretary of the DHHS authority to change the warning...

75 FR 7269 - Agency Information Collection Activities; Proposed Collection; Comment Request; Registration and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-18

... Prevention and Tobacco Control Act (the Tobacco Control Act). DATES: Submit written or electronic comments on... Establishments and Listing of Ingredients in Tobacco Products (OMB Control Number 0910-0650)--Extension On June 22, 2009, the President signed the Tobacco Control Act (Public Law 111-31) into law. The Tobacco...

The Every Student Succeeds Act: Opportunities and Responsibilities. re:VISION

ERIC Educational Resources Information Center

Johnson, Mark

2016-01-01

The "Every Student Succeeds Act" (ESSA) was signed into law by President Barack Obama on December 10, 2015. ESSA reauthorizes the "Elementary and Secondary Education Act" (ESEA), which was first enacted as part of President Lyndon B. Johnson's "War on Poverty." Since 1965, ESEA has represented the federal government's…

I saw the sign: the new federal menu-labeling law and lessons from local experience.

PubMed

Banker, Michelle I

2010-01-01

Following the lead of several state and local governments, Congress recently imposed menu-labeling requirements on chain restaurants as part of the federal health care reform bill signed into law in March 2010. Section 4205 of the Patient Protection and Affordable Care Act requires restaurant chains with 20 or more locations nationwide to display calorie information for standard menu items on menus, menu boards, and drive-thru displays. This paper examines the new federal law in light of existing state and local regulations and considers the arguments for and against mandatory calorie labeling at restaurants as a federal tool for preventing obesity. Specifically, this paper examines the provisions of the new federal law, highlights how it differs from the municipal and state menu-labeling laws already in effect, reviews early studies of the effectiveness of these state and local laws, and considers the propriety of requiring restaurants to disclose calorie information on menus by discussing arguments for and against menu labeling generally and calorie labeling in particular. This paper finds that based on initial studies of state and local menu-labeling regulations, the efficacy of compulsory menu labeling as a tool to combat obesity remains uncertain. Finally, this paper raises practical considerations associated with the new federal law, including implementation issues, potential collateral effects of the law, a survey of legal challenges that may arise, and a discussion of the Food and Drug Administration's competence to enforce a menu-labeling requirement against restaurants.

Course of Disinhibited Social Engagement Disorder From Early Childhood to Early Adolescence.

PubMed

Guyon-Harris, Katherine L; Humphreys, Kathryn L; Fox, Nathan A; Nelson, Charles A; Zeanah, Charles H

2018-05-01

Disinhibited social engagement disorder (DSED) is poorly understood beyond early childhood. The course of DSED signs in a sample of children who experienced severe, early deprivation from early childhood to early adolescence was examined using variable-centered (linear mixed modeling) and person-centered (growth mixture modeling) approaches. The study included 124 children with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 69 community comparison children matched by age and sex. DSED signs were assessed at baseline (mean age 22 months), 30, 42, and 54 months of age, and 8 and 12 years of age using a validated caregiver report of disturbed attachment behavior. Variable-centered analyses based on intent-to-treat groups indicated that signs of DSED decreased sharply for children randomized to foster care and decreased slightly but remained high for children randomized to care as usual. Person-centered analyses showed 4 profiles (i.e., elevated, persistent modest, early decreasing, and minimal). Elevated and persistent modest courses were associated with greater placement disruptions (F 3,99  = 4.29, p = .007, partial eta-squared [η 2 ] = 0.12), older age at placement into foster care (F 3,56  = 3.41, p < .05, partial η 2  = 0.16), and more time in institutional care (F 3,115  = 11.91, p < .001, partial η 2  = 0.24) compared with decreasing and minimal courses. Early and sustained placement into families after deprivation is associated with minimal or decreasing signs of DSED across development. Shortening the amount of time children spend in institutions and preserving placements could help decrease signs of DSED into early adolescence in previously institutionalized children. Copyright © 2018 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Increasing employee awareness of the signs and symptoms of heart attack and the need to use 911 in a State Health Department.

PubMed

Fogle, Crystelle C; Oser, Carrie S; Blades, Lynda L; Harwell, Todd S; Helgerson, Steven D; Gohdes, Dorothy; Spence, Michael R; Dawson, Drew E

2004-07-01

Early recognition of the signs and symptoms of a heart attack can lead to reduced morbidity and mortality. A workplace intervention was conducted among 523 Montana state health department employees in 2003 to increase awareness of the signs and symptoms of heart attack and the need to use 911. All employees received an Act in Time to Heart Attack Signs brochure and wallet card with their paychecks. Act in Time posters were placed in key workplace areas. A weekly e-mail message, including a contest entry opportunity addressing the signs and symptoms of heart attack, was sent to all employees. Baseline and follow-up telephone surveys were conducted to evaluate intervention effectiveness. Awareness of heart attack signs and symptoms and the need to call 911 increased significantly among employees from baseline to follow-up: pain or discomfort in the jaw, neck, or back (awareness increased from 69% to 91%); feeling weak, light-headed, or faint (awareness increased from 79% to 89%); call 911 if someone is having a heart attack or stroke (awareness increased from 84% to 90%). Awareness of chest pain, pain or discomfort in the arms or shoulders, and shortness of breath were more than 90% at baseline and did not increase significantly at follow-up. At baseline, 69% of respondents correctly reported five or more of the signs and symptoms of heart attack; 89% reported correctly at follow-up. This low-cost workplace intervention increased awareness of the signs and symptoms of heart attack and the need to call 911.

78 FR 11814 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-20

...Authentication Service provides public and government businesses single sign-on capability for USDA applications... be collected; (d) ways to minimize the burden of the collection of information on those who are to... (GPEA, Pub. L. 105-277), the Electronic Signatures in Global and National Commerce Act (E-Sign, Pub. L...

Early Warning Signs of Suicide in Service Members Who Engage in Unauthorized Acts of Violence

DTIC Science & Technology

2016-06-01

observable to military law enforcement personnel. Statistical analyses tested for differences in warning signs between cases of suicide, violence, or...indicators, (2) Behavioral Change indicators, (3) Social indicators, and (4) Occupational indicators. Statistical analyses were conducted to test for...6 Coding _________________________________________________________________ 7 Statistical

78 FR 25273 - Determination and Declaration Regarding Emergency Use of in Vitro Diagnostics for Detection of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-30

... Respiratory Protection Devices, and Respiratory Support Devices signed by then Secretary Michael Leavitt on... Act Declaration for Pandemic Influenza Diagnostics, Personal Respiratory Protection Devices, and Respiratory Support Devices signed by then Secretary Michael Leavitt on December 17, 2008. Notice of the EUAs...

Endocytic function is critical for influenza A virus infection via DC-SIGN and L-SIGN

PubMed Central

Gillespie, Leah; Roosendahl, Paula; Ng, Wy Ching; Brooks, Andrew G.; Reading, Patrick C.; Londrigan, Sarah L.

2016-01-01

The ubiquitous presence of cell-surface sialic acid (SIA) has complicated efforts to identify specific transmembrane glycoproteins that function as bone fide entry receptors for influenza A virus (IAV) infection. The C-type lectin receptors (CLRs) DC-SIGN (CD209) and L-SIGN (CD209L) enhance IAV infection however it is not known if they act as attachment factors, passing virions to other unknown receptors for virus entry, or as authentic entry receptors for CLR-mediated virus uptake and infection. Sialic acid-deficient Lec2 Chinese Hamster Ovary (CHO) cell lines were resistant to IAV infection whereas expression of DC-SIGN/L-SIGN restored susceptibility of Lec2 cells to pH- and dynamin-dependent infection. Moreover, Lec2 cells expressing endocytosis-defective DC-SIGN/L-SIGN retained capacity to bind IAV but showed reduced susceptibility to infection. These studies confirm that DC-SIGN and L-SIGN are authentic endocytic receptors for IAV entry and infection. PMID:26763587

Signage as a tool for behavioral change: Direct and indirect routes to understanding the meaning of a sign.

PubMed

Meis, Julia; Kashima, Yoshihisa

2017-01-01

Signs, prompts, and symbols are a common means to change behavior in our society. Understanding the psychological mechanisms by which signage influences behavior is a critical first step to achieve the desired outcome. In the current research, we propose a theoretical model of sign-to-behavior process. The model suggests that when one encounters a sign, it is encoded to construct an action representation (comprehension process), which is then acted on unless its enactment is inhibited (decision process). We test the implications of the model in two studies. In support of our hypothesis, for unfamiliar signs, clarity of purpose predicts perceived effectiveness of a sign; however, for familiar signs, clarity of purpose does not matter. Insights gained from the studies will help to design effective signs. Practical implications of the model are discussed, and future research directions are outlined.

Signage as a tool for behavioral change: Direct and indirect routes to understanding the meaning of a sign

PubMed Central

Kashima, Yoshihisa

2017-01-01

Signs, prompts, and symbols are a common means to change behavior in our society. Understanding the psychological mechanisms by which signage influences behavior is a critical first step to achieve the desired outcome. In the current research, we propose a theoretical model of sign-to-behavior process. The model suggests that when one encounters a sign, it is encoded to construct an action representation (comprehension process), which is then acted on unless its enactment is inhibited (decision process). We test the implications of the model in two studies. In support of our hypothesis, for unfamiliar signs, clarity of purpose predicts perceived effectiveness of a sign; however, for familiar signs, clarity of purpose does not matter. Insights gained from the studies will help to design effective signs. Practical implications of the model are discussed, and future research directions are outlined. PMID:28854203

Ten good reasons to practice ultrasound in critical care.

PubMed

Lichtenstein, Daniel; van Hooland, Simon; Elbers, Paul; Malbrain, Manu L N G

2014-01-01

Over the past decade, critical care ultrasound has gained its place in the armamentarium of monitoring tools. A greater understanding of lung, abdominal, and vascular ultrasound plus easier access to portable machines have revolutionised the bedside assessment of our ICU patients. Because ultrasound is not only a diagnostic test, but can also be seen as a component of the physical exam, it has the potential to become the stethoscope of the 21st century. Critical care ultrasound is a combination of simple protocols, with lung ultrasound being a basic application, allowing assessment of urgent diagnoses in combination with therapeutic decisions. The LUCI (Lung Ultrasound in the Critically Ill) consists of the identification of ten signs: the bat sign (pleural line); lung sliding (seashore sign); the A-lines (horizontal artefact); the quad sign and sinusoid sign indicating pleural effusion; the fractal and tissue-like sign indicating lung consolidation; the B-lines and lung rockets indicating interstitial syndromes; abolished lung sliding with the stratosphere sign suggesting pneumothorax; and the lung point indicating pneumothorax. Two more signs, the lung pulse and the dynamic air bronchogram, are used to distinguish atelectasis from pneumonia. The BLUE protocol (Bedside Lung Ultrasound in Emergency) is a fast protocol (< 3 minutes), also including a vascular (venous) analysis allowing differential diagnosis in patients with acute respiratory failure. With this protocol, it becomes possible to differentiate between pulmonary oedema, pulmonary embolism, pneumonia, chronic obstructive pulmonary disease, asthma, and pneumothorax, each showing specific ultrasound patterns and profiles. The FALLS protocol (Fluid Administration Limited by Lung Sonography) adapts the BLUE protocol to be used in patients with acute circulatory failure. It makes a sequential search for obstructive, cardiogenic, hypovolemic, and distributive shock using simple real-time echocardiography in combination with lung ultrasound, with the appearance of B-lines considered to be the endpoint for fluid therapy. An advantage of lung ultrasound is that the patient is not exposed to radiation, and so the LUCI-FLR project (LUCI favouring limitation of radiation) can be unfolded in trauma patients. Although it has been practiced for 25 years, critical care ultrasound is a relatively young but expanding discipline and can be seen as the stethoscope of the modern intensivist. In this review, the usefulness and advantages of ultrasound in the critical care setting are discussed in ten points. The emphasis is on a holistic approach, with a central role for lung ultrasound.

Vital signs and other observations used to detect deterioration in pregnant women: an analysis of vital sign charts in consultant-led UK maternity units.

PubMed

Smith, G B; Isaacs, R; Andrews, L; Wee, M Y K; van Teijlingen, E; Bick, D E; Hundley, V

2017-05-01

Obstetric early warning systems are recommended for monitoring hospitalised pregnant and postnatal women. We decided to compare: (i) vital sign values used to define physiological normality; (ii) symptoms and signs used to escalate care; (iii) type of chart used; and (iv) presence of explicit instructions for escalating care. One-hundred-and-twenty obstetric early warning charts and escalation protocols were obtained from consultant-led maternity units in the UK and Channel Islands. These data were extracted: values used to determine normality for each maternal vital sign; chart colour-coding; instructions following early warning system triggering; other criteria used as triggers. There was considerable variation in the charts, warning systems and escalation protocols. Of 120 charts, 89.2% used colour; 69.2% used colour-coded escalation systems. Forty-one (34.2%) systems required the calculation of weighted scores. Seventy-five discrete combinations of 'normal' vital sign ranges were found, the most common being: heart rate=50-99beats/min; respiratory rate=11-20breaths/min; blood pressure, systolic=100-149mmHg, diastolic ≤89mmHg; SpO 2 =95-100%; temperature=36.0-37.9°C; and Alert-Voice-Pain-Unresponsive assessment=Alert. Most charts (90.8%) provided instructions about who to contact following triggering, but only 41.7% gave instructions about subsequent observation frequency. The wide range of 'normal' vital sign values in different systems suggests a lack of equity in the processes for detecting deterioration and escalating care in hospitalised pregnant and postnatal women. Agreement regarding 'normal' vital sign ranges is urgently required and would assist the development of a standardised obstetric early warning system and chart. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Legal Structure of Defense Organization.

DTIC Science & Technology

1986-01-15

between the War and Navy Departments in the creation of the Joint Army-Navy Board. That Board, created by a common order signed by the Secretaries of...Order 9877 on "functions of the armed forces" the same day that he signed the National Security Act of 1947. Almost immediately, the differences between...direction of the President," signed a new "Functions Paper" (DoD Directive 5100.1) that, among other changes, altered the designated agent system to

The impact of continuous versus intermittent vital signs monitoring in hospitals: A systematic review and narrative synthesis.

PubMed

Downey, C L; Chapman, S; Randell, R; Brown, J M; Jayne, D G

2018-08-01

Continuous vital signs monitoring on general hospital wards may allow earlier detection of patient deterioration and improve patient outcomes. This systematic review will assess if continuous monitoring is practical outside of the critical care setting, and whether it confers any clinical benefit to patients. MEDLINE ® , MEDLINE ® In-Process, EMBASE, CINAHL and The Cochrane Library were searched for articles that evaluated the clinical or non-clinical outcomes of continuous vital signs monitoring in adults outside of the critical care setting. The protocol was registered with PROSPERO (CRD42017058098). Twenty-four studies met the inclusion criteria and reported outcomes on a total of 40,274 patients and 59 ward staff in nine countries. The majority of studies showed benefits in terms of critical care use and length of hospital stay. Larger studies were more likely to demonstrate clinical benefit, particularly critical care use and length of hospital stay. Three studies showed cost-effectiveness. Barriers to implementation included nursing and patient satisfaction and the burden of false alerts. Continuous vital signs monitoring outside the critical care setting is feasible and may provide a benefit in terms of improved patient outcomes and cost efficiency. Large, well-controlled studies in high-risk populations are required to evaluate the clinical benefit of continuous monitoring systems. Copyright © 2018 Elsevier Ltd. All rights reserved.

The factors that affect the frequency of vital sign monitoring in the emergency department.

PubMed

Johnson, Kimberly D; Winkelman, Chris; Burant, Christopher J; Dolansky, Mary; Totten, Vicken

2014-01-01

Vital signs are an important component of the nursing assessment and are used as early warning signs of changes in a patient's condition; however, little research has been conducted to determine how often vital signs are monitored in the emergency department. Additionally, it has not been determined what personal, social, and environmental factors affect the frequency of vital sign monitoring. The purpose of this study was to examine what factors may influence the time between recording vital signs in the emergency department. We performed a descriptive, retrospective chart review of 202 randomly selected adult ED patients' charts from representative times to capture a variety of ED levels of occupancy in an urban, Midwestern, teaching hospital. Descriptive and hierarchical regression analyses were used. The strongest predictor of the increased time between vital signs from the personal health factors was lower patient acuity (Emergency Severity Index). This relationship remained strong even when social factors and environmental factors were included. Increased length of stay and fewer routes of medications also had significant relationships to the increased time between vital sign monitoring. These findings are clinically important because greater time between vital sign recordings can lead to errors of omission by not detecting changes in vital signs that could reveal changes in the patient's condition. The findings of this study provide direction for future research focusing on determining whether higher frequency of vital signs surveillance contributes to higher quality care and linking quality of care to missing vital signs/inadequate monitoring. Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

ESEA Reauthorization: An Overview of the Every Student Succeeds Act

ERIC Educational Resources Information Center

Sharp, Laurie A.

2016-01-01

On December 10, 2015, the Every Student Succeeds Act of 2015 (ESSA) was signed by President Barack Obama and became the United States' current national education law (United States Department of Education [U.S. DOE], n.d.). The ESSA was a long overdue reauthorization of the Elementary and Secondary Education Act of 1965 (ESEA). Unlike previous…

Will Decentralization Affect Educational Inequity? The Every Student Succeeds Act

ERIC Educational Resources Information Center

Egalite, Anna J.; Fusarelli, Lance D.; Fusarelli, Bonnie C.

2017-01-01

Purpose: In December 2015, President Obama signed the Every Student Succeeds Act, which was a long overdue reauthorization of the Elementary and Secondary Education Act. What is remarkable about this new federal legislation is that it explicitly reverses the decades-long federal effort to more tightly couple the U.S. educational system. While not…

Transition to family practice in Turkey.

PubMed

Güneş, Evrim Didem; Yaman, Hakan

2008-01-01

Turkey's primary health care (PHC) system was established in the beginning of the 1960s and provides preventive and curative basic medical services to the population. This article describes the experience of the Turkish health system, as it tries to adapt to the European health system. It describes the current organization of primary health care and the family medicine model that is in the process of implementation and discusses implications of the transition for family physicians and the challenges faced in meeting the needs for health care staff. In Turkey a trend toward urbanization is evident and more staff positions in rural PHC centers are vacant. Shortages of physicians and an ineffective distribution of doctors are seen as a major problem. Family medicine gained popularity at the beginning of the 1990s, as a specialty with a 3-year postgraduate training program. Medical practitioners who are graduates of a 6-year medical training program and are already working in the PHC system are offered retraining courses. Better working conditions and higher salaries may be important incentives for medical practitioners to sign a contract with the social security institution of Turkey. The lack of well-trained primary care staff is an ongoing challenge. Attempts to retrain medical practitioners to act as family physicians show promising results. Shortness of physician and health professionals and lack of time and resources in primary health care are problems to overcome during this process.

The ACA's 65th Birthday Challenge: Moving from Medicaid to Medicare.

PubMed

Ndumele, Chima D; Sommers, Benjamin D; Trivedi, Amal N

2015-11-01

The Affordable Care Act (ACA) expanded Medicaid to millions of low-income near-elderly Americans, facilitating access to health care services, but did not change income eligibility for Medicaid for those 65 years and older. Therefore, following the ACA's coverage expansion, many newly-insured older enrollees will face a complex insurance transition on their 65th birthday: they will lose Medicaid coverage and transition from Medicaid to Medicare as their primary insurer. This transition in primary health insurance coverage includes changes to benefits, patient cost-sharing, and provider reimbursement, which could have profound consequences on the use of health services and associated health outcomes for low-income seniors. Using data from 2012, we estimate that 1.6 million current Medicaid beneficiaries and an additional 1.6 to 2.9 million low-income individuals who will gain Medicaid coverage under the ACA will be likely to make this transition in the next decade. Primary care physicians and policymakers can help mitigate the potential consequences of this insurance transition by preparing patients for Medicare's more restrictive insurance coverage, encouraging patients to sign up for available low-income subsidies, and understanding how the loss of Medicaid coverage impacts out-of-pocket costs.

26 CFR 1.6055-1 - Information reporting for minimum essential coverage.

Code of Federal Regulations, 2014 CFR

2014-04-01

... section. (2) Affordable Care Act. The term Affordable Care Act refers to the Patient Protection and Affordable Care Act, Public Law 111-148 (124 Stat. 119 (2010)), and the Health Care and Education...(a) of the Affordable Care Act (42 U.S.C. 18021(a)). (10) Reporting entity. A reporting entity is any...

75 FR 60482 - Proposed Extension of Information Collection Request Submitted for Public Comment; Affordable...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

... Collection Request Submitted for Public Comment; Affordable Care Act Enrollment Opportunity Notice Relating to Dependent Coverage; Affordable Care Act Grandfathered Health Plan Disclosure and Recordkeeping Requirement; Affordable Care Act Rescission Notice; Affordable Care Act Patient Protections Notice; Affordable...

On the Crime Object

ERIC Educational Resources Information Center

Akutaev, Rasul M.; Magomedov, Guseyn B.

2016-01-01

The relevance of the research of this problem is caused by the theoretical and practical needs of a specific concept of the crime object as one of the corpus delicti signs essentially the determining and defining its object and objective side, thereby--the nature of socially dangerous act. Besides, being a facultative sign of corpus delicti, the…

76 FR 78621 - Notice of Submission for OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-19

... (TEACH Grant Program) Agreement to Serve. OMB Control Number: 1845-0083. Agency Form Number(s): N/A... College and Higher Education (TEACH) Grant Program under Part A of the Higher Education Act of 1965, as... Education (TEACH) Grant, a student must sign an Agreement to Serve. A new Agreement to Serve must be signed...

Who Are the Remaining Uninsured and Why Haven’t They Signed Up for Coverage?

PubMed

Collins, Sara R; Gunja, Munira Z; Doty, Michelle M; Beutel, Sophie

2016-08-01

The number of uninsured people in the United States has declined by an estimated 20 million since the Affordable Care Act went into effect in 2010. Yet, an estimated 24 million people still lack health insurance. Goal: To examine the characteristics of the remaining uninsured adults and their reasons for not enrolling in marketplace plans or Medicaid. Methods: Analysis of the Commonwealth Fund ACA Tracking Survey, February--April 2016. Key findings and conclusions: There have been notable shifts in the demographic composition of the uninsured since the law's major coverage expansions went into effect in 2014. Latinos have become a growing share of the uninsured, rising from 29 percent in 2013 to 40 percent in 2016. Whites have become a declining share, falling from half the uninsured in 2013 to 41 percent in 2016. The uninsured are very poor: 39 percent of uninsured adults have incomes below the federal poverty level, twice the rate of their overall representation in the adult population. Of uninsured adults who are aware of the marketplaces or who have tried to enroll for coverage, the majority point to affordability concerns as a reason for not signing up.

77 FR 8257 - Sunshine Act Open Commission Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-14

... FEDERAL COMMUNICATIONS COMMISSION Sunshine Act Open Commission Meeting Date: February 8, 2012. The Federal Communications Commission will hold an Open Meeting on the subjects listed below on Wednesday... accessible to people using wheelchairs or other mobility aids. Sign language interpreters, open captioning...

Employment impacts of ARRA funding on TxDOT projects.

DOT National Transportation Integrated Search

2010-10-01

The stimulus package signed by President Obama on March 6, 2009 is known as the American Recovery and : Reinvestment Act (ARRA). This act allocated $48.1 billion to transportation of which $27.5 billion was for : highway projects. Texas was allotted ...

Evaluating physical and behavioral changes in older adults.

PubMed

Walton, J C; Miller, J M

1998-04-01

In older adults, subtle and sometime not so subtle physical or behavior changes can act as early warning signs of changing status. Nonspecific signs and symptoms occurring in older adults such as decline in previous functional capacity, urinary incontinence, anorexia, confusion, or unexplained falls may be signs of infection, medication interaction, dehydration, constipation, or sleep deprivation. Nurses, by critically assessing the situation early, may identify a developing problem. Prompt and early diagnosis of the underlying problem may save costly extended hospitalization or even prevent life-threatening complications.

Development of a prehospital vital signs chart sharing system.

PubMed

Nakada, Taka-aki; Masunaga, Naohisa; Nakao, Shota; Narita, Maiko; Fuse, Takashi; Watanabe, Hiroaki; Mizushima, Yasuaki; Matsuoka, Tetsuya

2016-01-01

Physiological parameters are crucial for the caring of trauma patients. There is a significant loss of prehospital vital signs data of patients during handover between prehospital and in-hospital teams. Effective strategies for reducing the loss remain a challenging research area. We tested whether the newly developed electronic automated prehospital vital signs chart sharing system would increase the amount of prehospital vital signs data shared with a remote trauma center prior to hospital arrival. Fifty trauma patients, transferred to a level I trauma center in Japan, were studied. The primary outcome variable was the number of prehospital vital signs shared with the trauma center prior to hospital arrival. The prehospital vital signs chart sharing system significantly increased the number of prehospital vital signs, including blood pressure, heart rate, and oxygen saturation, shared with the in-hospital team at a remote trauma center prior to patient arrival at the hospital (P < .0001). There were significant differences in prehospital vital signs during ambulance transfer between patients who had severe bleeding and non-severe bleeding within 24 hours after injury onset. Vital signs data collected during ambulance transfer via patient monitors could be automatically converted to easily visible patient charts and effectively shared with the remote trauma center prior to hospital arrival. The prehospital vital signs chart sharing system increased the number of precise vital signs shared prior to patient arrival at the hospital, which can potentially contribute to better trauma care without increasing labor and reduce information loss during clinical handover. Copyright © 2015 Elsevier Inc. All rights reserved.

Machine learning and new vital signs monitoring in civilian en route care: A systematic review of the literature and future implications for the military.

PubMed

Liu, Nehemiah T; Salinas, Jose

2016-11-01

Although air transport medical services are today an integral part of trauma systems in most developed countries, to date, there are no reviews on recent innovations in civilian en route care. The purpose of this systematic review was to identify potential machine learning and new vital signs monitoring technologies in civilian en route care that could help close civilian and military capability gaps in monitoring and the early detection and treatment of various trauma injuries. MEDLINE, the Cochrane Database of Systematic Reviews, and citation review of relevant primary and review articles were searched for studies involving civilian en route care, air medical transport, and technologies from January 2005 to November 2015. Data were abstracted on study design, population, year, sponsors, innovation category, details of technologies, and outcomes. Thirteen observational studies involving civilian medical transport met inclusion criteria. Studies either focused on machine learning and software algorithms (n = 5), new vital signs monitoring (n = 6), or both (n = 2). Innovations involved continuous digital acquisition of physiologic data and parameter extraction. Importantly, all studies (n = 13) demonstrated improved outcomes where applicable and potential use during civilian and military en route care. However, almost all studies required further validation in prospective and/or randomized controlled trials. Potential machine learning technologies and monitoring of novel vital signs such as heart rate variability and complexity in civilian en route care could help enhance en route care for our nation's war fighters. In a complex global environment, they could potentially fill capability gaps such as monitoring and the early detection and treatment of various trauma injuries. However, the impact of these innovations and technologies will require further validation before widespread acceptance and prehospital use. Systematic review, level V.

An assessment of patient sign-outs conducted by University at Buffalo internal medicine residents.

PubMed

Wheat, Deirdre; Co, Christopher; Manochakian, Rami; Rich, Ellen

2012-01-01

Internal medicine residents were surveyed regarding patient sign-outs at shift change. Data were used to design and implement interventions aimed at improving sign-out quality. This quasi-experimental project incorporated the Plan, Do, Study, Act methodology. Residents completed an anonymous electronic survey regarding experiences during sign-outs. Survey questions assessed structure, process, and outcome of sign-outs. Analysis of qualitative and quantitative data was performed; interventions were implemented based on survey findings. A total of 120 surveys (89% response) and 115 surveys (83% response) were completed by residents of 4 postgraduate years in response to the first (2008) and second (2009) survey requests, respectively. Approximately 79% of the respondents to the second survey indicated that postintervention sign-out systems were superior to preintervention systems. Results indicated improvement in specific areas of structure, process, and outcome. Survey-based modifications to existing sign-out systems effected measurable quality improvement in structure, process, and outcome.

A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff.

PubMed

Carter, Wendy; Bick, Debra; Mackintosh, Nicola; Sandall, Jane

2017-02-13

One of the challenges for treating pre-eclampsia and preventing further deterioration is determining how best to enable early detection. If women or their partners and families are able to raise early warnings about potential signs and symptoms of pre-eclampsia in pregnancy, birth and in the postnatal period, women may be able to receive earlier intervention to prevent severe pre-eclampsia from developing. The aim of this study was to improve understanding of factors affecting the ability of women to recognise symptoms and signs of pre-eclampsia/eclampsia and seek appropriate medical help and factors affecting health care professionals' responses to women and their families who 'speak up' about early warning signs and symptoms. A narrative synthesis was conducted of evidence relevant to address the research question. The following electronic data bases were searched for qualitative studies which met inclusion criteria from January 1980 to April 2016; Medline, CINAHL, HMIC, PsycINFO, Embase, BNI, ASSIA, Scopus, Maternity and Infant Care, Web of Science, Google Scholar, Cochrane, JBI and IBSS with the support of an Information Service Consultant. Following thematic analysis, three themes were identified; 1: Women's understanding and knowledge of pre-eclampsia/eclampsia; 2: Factors affecting help seeking behaviour from perspectives of women and their families'; 3: Factors affecting staff response. There was widespread lack of knowledge and understanding of signs and symptoms of pre-eclampsia/eclampsia among women and their families, with some women not exhibiting signs and symptoms of pre-eclampsia or unable to distinguish them from 'normal' pregnancy changes. Women and their families not only need to be made aware of signs and symptoms of pre-eclampsia/eclampsia but also require information on the most effective ways to seek urgent medical assessment and care. Some women did not experience prodromal signs and symptoms, which raises concerns about how women and families can detect early onset, and is an issue which needs further exploration. There is very limited research exploring clinical staff response to women who raise concerns about their health when experiencing symptoms and signs of pre-eclampsia/eclampsia with further research needed if safety and quality of care are to be improved.

Beyond coverage: improving the quality of antenatal care delivery through integrated mentorship and quality improvement at health centers in rural Rwanda.

PubMed

Manzi, Anatole; Nyirazinyoye, Laetitia; Ntaganira, Joseph; Magge, Hema; Bigirimana, Evariste; Mukanzabikeshimana, Leoncie; Hirschhorn, Lisa R; Hedt-Gauthier, Bethany

2018-02-23

Inadequate antenatal care (ANC) can lead to missed diagnosis of danger signs or delayed referral to emergency obstetrical care, contributing to maternal mortality. In developing countries, ANC quality is often limited by skill and knowledge gaps of the health workforce. In 2011, the Mentorship, Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) program was implemented to strengthen providers' ANC performance at 21 rural health centers in Rwanda. We evaluated the effect of MESH-QI on the completeness of danger sign assessments. Completeness of danger sign assessments was measured by expert nurse mentors using standardized observation checklists. Checklists completed from October 2010 to May 2011 (n = 330) were used as baseline measurement and checklists completed between February and November 2012 (12-15 months after the start of MESH-QI implementation) were used for follow-up. We used a mixed-effects linear regression model to assess the effect of the MESH-QI intervention on the danger sign assessment score, controlling for potential confounders and the clustering of effect at the health center level. Complete assessment of all danger signs improved from 2.1% at baseline to 84.2% after MESH-QI (p <  0.001). Similar improvements were found for 20 of 23 other essential ANC screening items. After controlling for potential confounders, the improvement in danger sign assessment score was significant. However, the effect of the MESH-QI was different by intervention district and type of observed ANC visit. In Southern Kayonza District, the increase in the danger sign assessment score was 6.28 (95% CI: 5.59, 6.98) for non-first ANC visits and 5.39 (95% CI: 4.62, 6.15) for first ANC visits. In Kirehe District, the increase in danger sign assessment score was 4.20 (95% CI: 3.59, 4.80) for non-first ANC visits and 3.30 (95% CI: 2.80, 3.81) for first ANC visits. Assessment of critical danger signs improved under MESH-QI, even when controlling for nurse-mentees' education level and previous training in focused ANC. MESH-QI offers an approach to enhance quality of care after traditional training and may be an approach to support newer providers who have not yet attended content-focused courses.

CDC Vital Signs: Alcohol Poisoning Deaths

MedlinePlus

... role of alcohol in injuries and deaths. Doctors, nurses, and other providers can Screen all adult patients ... signs of alcohol poisoning. Talk to your doctor, nurse, or other health care provider if you think ...

Fulfilling Our Promises: The United States and the Helsinki Final Act. A Status Report.

ERIC Educational Resources Information Center

Commission on Security and Cooperation in Europe, Washington, DC.

This report examines compliance by the United States with agreements made in the Helsinki Final Act. The Act was signed in 1975 by leaders of 33 East and West European nations, Canada, and the U.S. It contains numerous cooperative measures aimed at improving East-West relations. This report was prepared by the Commission on Security and…

Ten Years of the Workforce Investment Act (WIA): Interpreting the Research on WIA and Related Programs

ERIC Educational Resources Information Center

Decker, Paul T.; Berk, Jillian A.

2011-01-01

In 1998, President Clinton signed the federal Workforce Investment Act (WIA). Implemented in 2000, WIA replaced the Job Partnership Training Act (JTPA) as the primary federal job training program. Congress viewed WIA as a way to end "business as usual" in the workforce investment system. WIA aimed to transform the employment and training…

Equal Pay: A Thirty-Five Year Perspective.

ERIC Educational Resources Information Center

Castro, Ida L.

Issued on the 35th anniversary of the signing of the Equal Pay Act (1963), this report is a historical analysis of the economic trends affecting women workers from the years leading up to passage of the act through the present. It is divided into three time periods to highlight important developments: Part I--The Early Impact of the Equal Pay Act,…

10 CFR 1008.11 - Appeals of denials of requests pursuant to § 1008.6.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (PRIVACY ACT) Requests for Access or Amendment § 1008.11 Appeals of denials of requests pursuant to § 1008... appeal shall be in writing and must be signed by the individual. The words “PRIVACY ACT APPEAL” should... to be corrected or amended, will be supplied to the appropriate appeal authority by the Privacy Act...

Mastering Resilience in Oncology: Learn to Thrive in the Face of Burnout.

PubMed

Hlubocky, Fay J; Rose, Miko; Epstein, Ronald M

2017-01-01

Oncology clinician burnout has become a noteworthy issue in medical oncology directly affecting the quality of patient care, patient satisfaction, and overall organizational success. Due to the increasing demands on clinical time, productivity, and the evolving medical landscape, the oncology clinician is at significant risk for burnout. Long hours in direct care with seriously ill patients/families, limited control over daily responsibilities, and endless electronic documentation, place considerable professional and personal demands on the oncologist. As a result, the oncology clinician's wellness is adversely impacted. Physical/emotional exhaustion, cynicism, and feelings of ineffectiveness evolve as core signs of burnout. Unaddressed burnout may affect cancer clinician relationships with their patients, the quality of care delivered, and the overall physical and emotional health of the clinician. Oncology clinicians should be encouraged to build upon their strengths, thrive in the face of adversity and stress, and learn to positively adapt to the changing cancer care system. Fostering individual resilience is a key protective factor against the development of and managing burnout. Empowering clinicians at both the individual and organizational level with tailored resilience strategies is crucial to ensuring clinician wellness. Resilience interventions may include: burnout education, work-life balance, adjustment of one's relationship to work, mindful practice, and acceptance of the clinical work environment. Health care organizations must act to provide institutional solutions through the implementation of: team-based oncology care, communication skills training, and effective resiliency training programs in order to mitigate the effects of stress and prevent burnout in oncology.

Health Professions Educational Assistance Act of 1976 (PL 94-484). Amended by Health Services Extension Act of 1977 (PL 95-83, Title III). Fact Sheet.

ERIC Educational Resources Information Center

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

The Health Professions Educational Assistance Act of 1976, signed into law on Oct. 12, 1976, extends health mampower training authorities through fiscal year 1980 with significant changes to meet national needs. The law (PL 94-484), which amends Title VII of the Public Health Service Act and other laws, is designed primarily to produce more…

Better Evidence, Better Choices, Better Schools: State Supports for Evidence-Based School Improvement and the Every Student Succeeds Act. Series on Implementation of the Every Student Succeeds Act

ERIC Educational Resources Information Center

Fleischman, Steve; Scott, Caitlin; Sargrad, Scott

2016-01-01

Signed into law in December 2015, the Every Student Suceeds Act (ESSA) offers state education agencies significant opportunities to use evidence to support the improvement of schools and ensure better outcomes for all students. ESSA replaces the law, regulations, and guidance established through the 2001 No Child Left Behind Act (NCLB), but two…

Cholera Information for Adults

MedlinePlus

... soft spots in the head (fontanelles) Self-Care Guidelines Stay hydrated, preferably with a liquid that contains ... Who's at Risk Signs and Symptoms Self-Care Guidelines When to Seek Medical Care Treatments Your Provider ...

The effect of the quality of vital sign recording on clinical decision making in a regional acute care trauma ward.

PubMed

Keene, Claire M; Kong, Victor Y; Clarke, Damian L; Brysiewicz, Petra

2017-10-01

Recording vital signs is important in the hospital setting and the quality of this documentation influences clinical decision making. The Modified Early Warning Score (MEWS) uses vital signs to categorise the severity of a patient's physiological derangement and illustrates the clinical impact of vital signs in detecting patient deterioration and making management decisions. This descriptive study measured the quality of vital sign recordings in an acute care trauma setting, and used the MEWS to determine the impact the documentation quality had on the detection of physiological derangements and thus, clinical decision making. Vital signs recorded by the nursing staff of all trauma patients in the acute care trauma wards at a regional hospital in South Africa were collected from January 2013 to February 2013. Investigator-measured values taken within 2 hours of the routine observations and baseline patient information were also recorded. A MEWS for each patient was calculated from the routine and investigator-measured observations. Basic descriptive statistics were performed using EXCEL. The details of 181 newly admitted patients were collected. Completion of recordings was 81% for heart rate, 88% for respiratory rate, 98% for blood pressure, 92% for temperature and 41% for GCS. The recorded heart rate was positively correlated with the investigator's measurement (Pearson's correlation coefficient of 0.76); while the respiratory rate did not correlate (Pearson's correlation coefficient of 0.02). In 59% of patients the recorded respiratory rate (RR) was exactly 20 breaths per minute and 27% had a recorded RR of exactly 15. Seven percent of patients had aberrant Glasgow Coma Scale readings above the maximum value of 15. The average MEWS was 2 for both the recorded (MEWS(R)) and investigator (MEWS(I)) vitals, with the range of MEWS(R) 0-7 and MEWS(I) 0-9. Analysis showed 59% of the MEWS(R) underestimated the physiological derangement (scores were lower than the MEWS(I)); 80% of patients had a MEWS(R) requiring 4 hourly checks which was only completed in 2%; 86% of patients had a MEWS(R) of less than three (i.e. not necessitating escalation of care), but 33% of these showed a MEWS(I) greater than three (i.e. actually necessitating escalation of care). Documentation of vital signs aids management decisions, indicating the physiological derangement of a patient and dictating treatment. This study showed that there was a poor quality of vital sign recording in this acute care trauma setting, which led to underestimation of patients' physiological derangement and an inability to detect deteriorating patients. The MEWS could be a powerful tool to empower nurses to become involved in the diagnosis and detection of deteriorating patients, as well as providing a framework to communicate the severity of derangement between health workers. However, it requires a number of strategies to improve the quality of vital sign recording, including continuing education, increasing the numbers of competent staff and administrative changes in vital sign charts. Copyright © 2017. Production and hosting by Elsevier B.V.

Cross-sectional survey of knowledge of obstetric danger signs among women in rural Madagascar.

PubMed

Salem, Ania; Lacour, Oriane; Scaringella, Stefano; Herinianasolo, Josea; Benski, Anne Caroline; Stancanelli, Giovanna; Vassilakos, Pierre; Petignat, Patrick; Schmidt, Nicole Christine

2018-02-05

Antenatal care (ANC) has the potential to identify and manage obstetric complications, educate women about risks during pregnancy and promote skilled birth attendance during childbirth. The aim of this study was to assess women's knowledge of obstetric danger signs and factors associated with this knowledge in Ambanja, Madagascar. It also sought to evaluate whether the participation in a mobile health (mHealth) project that aimed to provide comprehensive ANC to pregnant women in remote areas influenced women's knowledge of obstetric danger signs. From April to October 2015, a non-random, convenience sample of 372 women in their first year postpartum were recruited, including 161 who had participated in the mHealth project. Data were analyzed using bivariate and multivariate logistic regression. Knowledge of at least one danger sign varied from 80.9% of women knowing danger sign(s) in pregnancy, to 51.9%, 50.8% and 53.2% at delivery, postpartum and in the newborn, respectively. Participation in the mHealth intervention, higher household income, and receipt of information about danger signs during pregnancy were associated with knowledge of danger signs during delivery, in bivariate analysis; only higher household income and mHealth project participation were independently associated. Higher educational attainment and receipt of information about danger signs in antenatal care were associated with significantly higher odds of knowing danger sign(s) for the newborn in both bivariate and multivariate analysis. Knowledge of obstetric danger signs is low. Information provision during pregnancy and with mHealth is promising. This trial was retrospectively registered at the International Standard Randomized Controlled Trial Register (identifier ISRCTN15798183 ; August 22, 2015).

Standardized sign-out reduces intern perception of medical errors on the general internal medicine ward.

PubMed

Salerno, Stephen M; Arnett, Michael V; Domanski, Jeremy P

2009-01-01

Prior research on reducing variation in housestaff handoff procedures have depended on proprietary checkout software. Use of low-technology standardization techniques has not been widely studied. We wished to determine if standardizing the process of intern sign-out using low-technology sign-out tools could reduce perception of errors and missing handoff data. We conducted a pre-post prospective study of a cohort of 34 interns on a general internal medicine ward. Night interns coming off duty and day interns reassuming care were surveyed on their perception of erroneous sign-out data, mistakes made by the night intern overnight, and occurrences unanticipated by sign-out. Trainee satisfaction with the sign-out process was assessed with a 5-point Likert survey. There were 399 intern surveys performed 8 weeks before and 6 weeks after the introduction of a standardized sign-out form. The response rate was 95% for the night interns and 70% for the interns reassuming care in the morning. After the standardized form was introduced, night interns were significantly (p < .003) less likely to detect missing sign-out data including missing important diseases, contingency plans, or medications. Standardized sign-out did not significantly alter the frequency of dropped tasks or missed lab and X-ray data as perceived by the night intern. However, the day teams thought there were significantly less perceived errors on the part of the night intern (p = .001) after introduction of the standardized sign-out sheet. There was no difference in mean Likert scores of resident satisfaction with sign-out before and after the intervention. Standardized written sign-out sheets significantly improve the completeness and effectiveness of handoffs between night and day interns. Further research is needed to determine if these process improvements are related to better patient outcomes.

Vital signs: taking the pulse of your managed care contract performance.

PubMed

Waymack, Pamela M; Ward, William J

2005-07-01

Three essential baseline measures of managed care performance that should be reported on a regular basis are: Overall profitability of the organization's managed care portfolio. Payer mix and profitability. Performance of major managed care contracts.

The effect of increased speed limits in the post-MNSL era

DOT National Transportation Integrated Search

1998-02-01

The National Highway System (NHS) Designation Act of 1995 (Public Law 104-59) was signed into law on November 28, 1995. The NHS Act, among other things, established the National Highway System and eliminated the Federal mandate for the National Maxim...

19 CFR 10.761 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Morocco Free Trade Agreement General... applicable to imported goods under the United States-Morocco Free Trade Agreement (the MFTA) signed on June 15, 2004, and under the United States-Morocco Free Trade Agreement Implementation Act (the Act; 118...

19 CFR 10.501 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Singapore Free Trade Agreement General... applicable to imported goods under the United States-Singapore Free Trade Agreement (the SFTA) signed on May 6, 2003, and under the United States-Singapore Free Trade Agreement Implementation Act (the Act; 117...

Definition of Professional Development

ERIC Educational Resources Information Center

Learning Forward, 2015

2015-01-01

President Obama signed into law the Every Student Succeeds Act, the reauthorization of the Elementary and Secondary Education Act, on December 10, 2015. "Learning Forward's focus in this new law is its improved definition of professional learning," said Stephanie Hirsh, executive director of Learning Forward. "We've long advocated…

Effect of Dynamic Light Application on Cognitive Performance and Well-being of Intensive Care Nurses.

PubMed

Simons, Koen S; Boeijen, Enzio R K; Mertens, Marlies C; Rood, Paul; de Jager, Cornelis P C; van den Boogaard, Mark

2018-05-01

Exposure to bright light has alerting effects. In nurses, alertness may be decreased because of shift work and high work pressure, potentially reducing work performance and increasing the risk for medical errors. To determine whether high-intensity dynamic light improves cognitive performance, self-reported depressive signs and symptoms, fatigue, alertness, and well-being in intensive care unit nurses. In a single-center crossover study in an intensive care unit of a teaching hospital in the Netherlands, 10 registered nurses were randomly divided into 2 groups. Each group worked alternately for 3 to 4 days in patients' rooms with dynamic light and 3 to 4 days in control lighting settings. High-intensity dynamic light was administered through ceiling-mounted fluorescent tubes that delivered bluish white light up to 1700 lux during the daytime, versus 300 lux in control settings. Cognitive performance, self-reported depressive signs and symptoms, fatigue, and well-being before and after each period were assessed by using validated cognitive tests and questionnaires. Cognitive performance, self-reported depressive signs and symptoms, and fatigue did not differ significantly between the 2 light settings. Scores of subjective well-being were significantly lower after a period of working in dynamic light. Daytime lighting conditions did not affect intensive care unit nurses' cognitive performance, perceived depressive signs and symptoms, or fatigue. Perceived quality of life, predominantly in the psychological and environmental domains, was lower for nurses working in dynamic light. © 2018 American Association of Critical-Care Nurses.

Experiences of deafblind people about health care.

PubMed

Fernández-Valderas, Carmen; Macías-Seda, Juana; Gil-García, Eugenia

Deafblindness is a disability resulting from the combination of visual and auditory sensory impairments, which can manifest in different levels causing special communication problems. Deafblind people have special needs that derive from difficulties in sensing, understanding, attention and a lack of the skills required to function effectively in society. Deafblindness requires specialized services, personnel specifically trained in its care and special methods for communication. The main objective of this study is to explore the experiences of deafblind people in relation to health care throughout their lives. This study was developed at the St. Angela de la Cruz Centre, belonging to the Association of Parents of Deafblind People in Spain. Phenomenological qualitative study, through semi-structured interviews with deafblind people at the St. Ángela de la Cruz Centre, Salteras (Seville), carried out in 2015, with the help of interpreters in Spanish sign language. Topics covered in the interviews refer to facilities, human resources, time waiting and health care. Coinciding statements were obtained, where the participants point out architectural and educational barriers in health care and stand out better if the professionals know sign language. It can be highlighted that healthcare professionals lack knowledge of all aspects of deafblindness, sign language in particular, and there is a shortage of signs and information for the deafblind. Moreover, alternatives are required to reduce waiting times and improve direct communication with health professionals. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Export bill and scientific exchanges

NASA Astrophysics Data System (ADS)

President Ronald Reagan has signed into law the reauthorization of the Export Administration Act (EAA), first passed in 1979. The amended version of the law, signed July 12, includes a policy statement in support of “vigorous scientific enterprise. . .in accordance with applicable provisions of law. . .by means of publication, teaching, conferences, and other forms of scholarly exchange.”

A Barking Dog That Never Bites? The British Sign Language (Scotland) Bill

ERIC Educational Resources Information Center

De Meulder, Maartje

2015-01-01

This article describes and analyses the pathway to the British Sign Language (Scotland) Bill and the strategies used to reach it. Data collection has been done by means of interviews with key players, analysis of official documents, and participant observation. The article discusses the bill in relation to the Gaelic Language (Scotland) Act 2005…

Knowledge of neonatal danger signs among mothers attending well baby clinic in Nakuru Central District, Kenya: cross sectional descriptive study.

PubMed

Kibaru, Elizabeth Gathoni; Otara, Amos Magembe

2016-10-25

Neonatal mortality has remained high in Kenya despite various efforts being applied to reduce this negative trend. Early detection of neonatal illness is an important step towards improving new born survival. Toward this end there is need for the mothers to be able to identify signs in neonates that signifies severe neonatal illnesses. The objective of the study was to determine the level of knowledge of mothers attending well baby clinics on postnatal neonatal danger signs and determine the associated factors. Cross sectional descriptive study. Purposive sampling of Health care facilities that provide antenatal, delivery and postnatal services were identified. In each of the selected health facility structured questionnaires were administered to mothers with children aged six weeks to nine months attending well baby clinics. Frequencies, Chi square and multivariate logistic regression were determined using the SPSS software (version 20). During the period of study 414 mothers attending well baby clinics were interviewed. Information on neonatal dangers was not provided to 237 (57.2%) of the postnatal mothers during their antenatal clinic attendance by the health care providers. Majority of mothers 350 (84.5%) identified less than three neonatal danger signs. Hotness of the body (fever) was the commonly recognized danger sign by 310 (74.9%) postnatal mothers. Out of 414 mothers 193 (46.6%), 166 (40.1%), 146 (35.3%) and 24 (5.8%) identified difficulty in breathing, poor sucking, jaundice and lethargy/unconsciousness as new born danger signs respectively. Only 46 (11.1%) and 40 (9.7%) identified convulsion and hypothermia as new born danger signs respectively. Education Level, PNC accompaniment by Spouse, Danger signs information to Mother, Explanation of MCH booklet by Care provider during ANC and Mother read MCH Booklet were factors positively associated with improved knowledge of neonatal danger sign. In multivariate logistic regression none of the factors tested were statistically significant in relation to level of knowledge. Knowledge of neonatal danger signs was low among mothers attending well baby clinic despite the information being available in the MCH booklets provided to the mothers during antenatal clinics.

Whole body massage for reducing anxiety and stabilizing vital signs of patients in cardiac care unit

PubMed Central

Adib-Hajbaghery, Mohsen; Abasi, Ali; Rajabi-Beheshtabad, Rahman

2014-01-01

Background: Patients admitted in coronary care units face various stressors. Ambiguity of future life conditions and unawareness of caring methods intensifies the patients’ anxiety and stress. This study was conducted to assess the effects of whole body massage on anxiety and vital signs of patients with acute coronary disorders. Methods: A randomized controlled trial was conducted on 120 patients. Patients were randomly allocated into two groups. The intervention group received a session of whole body massage and the control group received routine care. The levels of State, Trait and overall anxiety and vital signs were assessed in both groups before and after intervention. Independent sample t-test, paired t-test, Chi-square and Fischer exact tests were used for data analysis. Results: The baseline overall mean score of anxiety was 79.43±29.34 in the intervention group and was decreased to 50.38±20.35 after massage therapy (p=0.001). However, no significant changes were occurred in the overall mean anxiety in the control group during the study. The baseline diastolic blood pressure was 77.05±8.12 mmHg and was decreased to 72.18±9.19 mmHg after the intervention (p=0.004). Also, significant decreases were occurred in heart rate and respiration rate of intervention group after massage therapy (p=0.001). However, no significant changes were occurred in vital signs of the control group during the study. Conclusion: The results suggest that whole body massage was effective in reducing anxiety and stabilizing vital signs of patients with acute coronary disorders. PMID:25405113

CDC Vital Signs: Making Health Care Safer

MedlinePlus

... safety efforts happening across the state. Health care facility CEOs/administrators can: Implement systems to alert receiving ... Germs spread between patients and across health care facilities. Antibiotic resistance is a threat. Nightmare germs called ...

The do-not-resuscitate order for terminal cancer patients in mainland China: A retrospective study.

PubMed

Huang, Bo-Yan; Chen, Hui-Ping; Wang, Ying; Deng, Yao-Tiao; Yi, Ting-Wu; Jiang, Yu

2018-05-01

With the development of palliative care, a signed do-not-resuscitate (DNR) order has become increasingly popular worldwide. However, there is no legal guarantee of a signed DNR order for patients with cancer in mainland China. This study aimed to estimate the status of DNR order signing before patient death in the cancer center of a large tertiary affiliated teaching hospital in western China. Patient demographics and disease-related characteristics were also analyzed.This was a retrospective chart analysis. We screened all charts from a large-scale tertiary teaching hospital in China for patients who died of cancer from January 2010 to February 2015. Analysis included a total of 365 records. The details of DNR order forms, patient demographics, and disease-related characteristics were recorded.The DNR order signing rate was 80%. Only 2 patients signed the DNR order themselves, while the majority of DNR orders were signed by patients' surrogates. The median time for signing the DNR order was 1 day before the patients' death. Most DNR decisions were made within the last 3 days before death. The time at which DNR orders were signed was related to disease severity and the rate of disease progression.Our findings indicate that signing a DNR order for patients with terminal cancer has become common in mainland China in recent years. Decisions about a DNR order are usually made by patients' surrogates when patients are severely ill. Palliative care in mainland China still needs to be improved.

Frequency of vital sign assessment and clinical deterioration in an Australian emergency department.

PubMed

Lambe, Katherine; Currey, Judy; Considine, Julie

2016-11-01

Understanding of clinical deterioration of emergency department patients is rapidly evolving. The aim of this study was to investigate the frequency and nature of vital sign collection and clinical deterioration in emergency care. A descriptive exploratory approach was used. Data were collected from the records of 200 randomly selected adults with presenting complaints of abdominal pain, shortness of breath, chest pain and febrile illness from 1 January to 31 December 2014 at a 22 bed emergency department in Melbourne, Australia. When controlled for length of stay, heart rate was the most frequently assessed vital sign per hour (median=0.9) whilst Glasgow Coma Score was the least frequently assessed vital sign per hour (median=0.5). Clinical deterioration (one or more vital signs fulfilling hospital medical emergency team activation criteria during emergency department care) occurred in 14.5% of patients. Of the 5466 vital sign measures, 19.6% were abnormal, 1.9% indicated clinical deterioration. Clinical deterioration occurred in one in seven patients, and one in five vital signs documented were outside of accepted normal ranges. Thus, emergency department physiological status has implications for patient safety and nursing practice, in particular clinical handover for patients requiring hospital admission. Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

The immediate effect of the Same-Sex Marriage Prohibition Act on stigma, discrimination, and engagement on HIV prevention and treatment services in men who have sex with men in Nigeria: analysis of prospective data from the TRUST cohort

PubMed Central

Schwartz, Sheree R; Nowak, Rebecca G; Orazulike, Ifeanyi; Keshinro, Babajide; Ake, Julie; Kennedy, Sara; Njoku, Ogbonnaya; Blattner, William A; Charurat, Manhattan E; Baral, Stefan D

2015-01-01

Summary Background In January, 2014, the Same-Sex Marriage Prohibition Act was signed into law in Nigeria, further criminalising same-sex sexual relationships. We aimed to assess the immediate effect of this prohibition act on stigma, discrimination, and engagement in HIV prevention and treatment services in men who have sex with men (MSM) in Nigeria. Methods The TRUST cohort study uses respondent-driven sampling to assess the feasibility and effectiveness of engagement of MSM in HIV prevention and treatment services at a clinical site located with a community-based organisation trusted by the MSM community. TRUST is a prospective implementation research cohort of MSM (≥16 years) in Abuja, Nigeria. We compared HIV clinical outcomes and stigma, including fear and avoidance of health care, across baseline and quarterly visits before and after implementation of the the Same-Sex Marriage Prohibition Act. Outcomes assessed were measures of stigma and discrimination, loss to follow-up, antiretroviral therapy status, and viral load. We compared outcomes before and after the legislation with χ2 statistics, and estimated incident stigma-related events and loss to follow-up with Poisson regression. Findings Between March 19, 2013, and Aug 7, 2014, 707 MSM participated in baseline study procedures, contributing to 756 before legislation (prelaw) and 420 after legislation (postlaw) visits. Reported history of fear of seeking health care was significantly higher in postlaw visits than in prelaw visits (n=161 [38%] vs n=187 [25%]; p<0.0001), as was avoidance of health care (n=118 [28%] vs n=151 [20%]; p=0.001). In incidence analyses, of 192 MSM with follow-up data and no history of an event at baseline, reported fear of seeking health care was higher in the postlaw than the prelaw period (n=144; incidence rate ratio 2.57, 95% CI 1.29–5.10; p=0.007); loss to follow-up and incident healthcare avoidance were similar across periods. Of the 161 (89%) of 181 HIV-infected MSM with HIV viral loads available, those who had disclosed sexual behaviour with a health-care provider were more often virally suppressed at baseline than those with no previous disclosure (18 [29%] of 62 vs 13 [13%] of 99 men; p=0.013). Interpretation These analyses represent individual-level, quantitative, real-time prospective data for the health-related effects resulting from the enactment of legislation further criminalising same-sex practices. The negative effects of HIV treatment and care in MSM reinforce the unintended consequences of such legislation on global goals of HIV eradication. Strategies to reach MSM less likely to engage in HIV testing and care in highly stigmatised environments are needed to reduce time to HIV diagnosis and treatment. Funding National Institutes of Health. PMID:26125047

The immediate eff ect of the Same-Sex Marriage Prohibition Act on stigma, discrimination, and engagement on HIV prevention and treatment services in men who have sex with men in Nigeria: analysis of prospective data from the TRUST cohort.

PubMed

Schwartz, Sheree R; Nowak, Rebecca G; Orazulike, Ifeanyi; Keshinro, Babajide; Ake, Julie; Kennedy, Sara; Njoku, Ogbonnaya; Blattner, William A; Charurat, Manhattan E; Baral, Stefan D

2015-07-01

In January, 2014, the Same-Sex Marriage Prohibition Act was signed into law in Nigeria, further criminalising same-sex sexual relationships. We aimed to assess the immediate effect of this prohibition act on stigma, discrimination, and engagement in HIV prevention and treatment services in men who have sex with men (MSM) in Nigeria. The TRUST cohort study uses respondent-driven sampling to assess the feasibility and effectiveness of engagement of MSM in HIV prevention and treatment services at a clinical site located with a community-based organisation trusted by the MSM community. TRUST is a prospective implementation research cohort of MSM (≥16 years) in Abuja, Nigeria. We compared HIV clinical outcomes and stigma, including fear and avoidance of health care, across baseline and quarterly visits before and after implementation of the the Same-Sex Marriage Prohibition Act. Outcomes assessed were measures of stigma and discrimination, loss to follow-up, antiretroviral therapy status, and viral load. We compared outcomes before and after the legislation with χ2 statistics, and estimated incident stigma-related events and loss to follow-up with Poisson regression. Between March 19, 2013, and Aug 7, 2014, 707 MSM participated in baseline study procedures, contributing to 756 before legislation (prelaw) and 420 after legislation (postlaw) visits. Reported history of fear of seeking health care was significantly higher in postlaw visits than in prelaw visits (n=161 [38%] vs n=187 [25%]; p<0・0001), as was avoidance of health care (n=118 [28%] vs n=151 [20%]; p=0・001). In incidence analyses, of 192 MSM with follow-up data and no history of an event at baseline, reported fear of seeking health care was higher in the postlaw than the prelaw period (n=144; incidence rate ratio 2・57, 95% CI 1・29–5・10; p=0・007); loss to follow-up and incident healthcare avoidance were similar across periods. Of the 161 (89%) of 181 HIV-infected MSM with HIV viral loads available, those who had disclosed sexual behaviour with a health-care provider were more often virally suppressed at baseline than those with no previous disclosure (18 [29%] of 62 vs 13 [13%] of 99 men; p=0・013). These analyses represent individual-level, quantitative, real-time prospective data for the health-related effects resulting from the enactment of legislation further criminalising same-sex practices. The negative effects of HIV treatment and care in MSM reinforce the unintended consequences of such legislation on global goals of HIV eradication. Strategies to reach MSM less likely to engage in HIV testing and care in highly stigmatised environments are needed to reduce time to HIV diagnosis and treatment. National Institutes of Health.

75 FR 39586 - Agency Information Collection Activities: Submission for the Office of Management and Budget (OMB...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-09

... States who have signed Agreements with NRC under Section 274b. of the Atomic Energy Act (Act)) plus one... protect public health and safety. A copy of the final supporting statement may be viewed free of charge at...

The Genetic Information Nondiscrimination Act (GINA): A Civil Rights Victory

ERIC Educational Resources Information Center

Petruniak, Mark; Krokosky, Alyson; Terry, Sharon F.

2011-01-01

This article discusses the Genetic Information Nondiscrimination Act (GINA) which President George W. Bush officially signed in 2008. The law prohibits employers from making adverse employment decisions based on a person's genetic information, including family health history. It also forbids insurance companies from discriminating against…

75 FR 44810 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-29

... techniques or other forms of information technology, e.g., permitting electronic submission of responses... 4, 2009, President Obama signed the Children's Health Insurance Program Reauthorization Act of 2009... XIX of the Social Security Act (SSA), or child health assistance under a State child health plan under...

7 CFR 65.400 - Labeling.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURAL MARKETING ACT OF 1946 AND THE EGG PRODUCTS INSPECTION ACT (CONTINUED) COUNTRY OF ORIGIN LABELING..., PEANUTS, AND GINSENG General Provisions Country of Origin Notification § 65.400 Labeling. (a) Country of origin declarations can either be in the form of a placard, sign, label, sticker, band, twist tie, pin...

7 CFR 65.400 - Labeling.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURAL MARKETING ACT OF 1946 AND THE EGG PRODUCTS INSPECTION ACT (CONTINUED) COUNTRY OF ORIGIN LABELING..., PEANUTS, AND GINSENG General Provisions Country of Origin Notification § 65.400 Labeling. (a) Country of origin declarations can either be in the form of a placard, sign, label, sticker, band, twist tie, pin...

7 CFR 65.400 - Labeling.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURAL MARKETING ACT OF 1946 AND THE EGG PRODUCTS INSPECTION ACT (CONTINUED) COUNTRY OF ORIGIN LABELING..., PEANUTS, AND GINSENG General Provisions Country of Origin Notification § 65.400 Labeling. (a) Country of origin declarations can either be in the form of a placard, sign, label, sticker, band, twist tie, pin...

19 CFR 10.861 - Scope.

Code of Federal Regulations, 2012 CFR

2012-04-01

... CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman Free Trade Agreement General Provisions... to imported goods under the United States-Oman Free Trade Agreement (the OFTA) signed on January 19, 2006, and under the United States-Oman Free Trade Agreement Implementation Act (the Act; 120 Stat. 1191...

19 CFR 10.861 - Scope.

Code of Federal Regulations, 2013 CFR

2013-04-01

... CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman Free Trade Agreement General Provisions... to imported goods under the United States-Oman Free Trade Agreement (the OFTA) signed on January 19, 2006, and under the United States-Oman Free Trade Agreement Implementation Act (the Act; 120 Stat. 1191...

19 CFR 10.861 - Scope.

Code of Federal Regulations, 2014 CFR

2014-04-01

... CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman Free Trade Agreement General Provisions... to imported goods under the United States-Oman Free Trade Agreement (the OFTA) signed on January 19, 2006, and under the United States-Oman Free Trade Agreement Implementation Act (the Act; 120 Stat. 1191...

19 CFR 10.861 - Scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman Free Trade Agreement General Provisions... to imported goods under the United States-Oman Free Trade Agreement (the OFTA) signed on January 19, 2006, and under the United States-Oman Free Trade Agreement Implementation Act (the Act; 120 Stat. 1191...

Individuals with Disabilities Education Improvement Act of 2004 and IDEA Regulations of 2006: Implications for Educators, Administrators, and Teacher Trainers

ERIC Educational Resources Information Center

Yell, Mitchell L.; Shriner, James G.; Katsiyannis, Antonis

2006-01-01

The Individuals with Disabilities Education Improvement Act of 2004 (hereafter IDEIA) was signed into law by President George W. Bush on December 3, 2004. The law reauthorized and made important changes to the Individuals with Disabilities Education Act (IDEA). On August 3, 2006, the U.S. Department of Education released the Regulations…

The American Recovery and Reinvestment Act of 2009: Selected Funding Streams for Struggling Students and Disconnected Youth

ERIC Educational Resources Information Center

Grant, Elizabeth, Comp.; Johnson, Cassius, Comp.

2009-01-01

On February 17, 2009, President Barack Obama signed the American Recovery and Reinvestment Act, better known as the economic stimulus plan. Congress and the Obama Administration acted in the wake of an economic crisis spurred by a deepening recession. Among its aims in passing the ARRA, Congress moved to help states and local jurisdictions reduce…

Did the Pension Protection Act (PPA) of 2006 Resolve the Pension Crisis in Corporate America?

ERIC Educational Resources Information Center

Luca, John J.

2009-01-01

On August 17, 2006, President George W. Bush signed into law the Pension Protection Act (PL 109-280). The 907-page federal law has been referred to as the most comprehensive reform of the nation's pension law since the enactment of the Employee Retirement Income Security Act (ERISA) of 1974 (Lucas, 2008). This paper will examine the major…

Cancer Patient Perception of the Living Will: Report of a Pilot Survey.

ERIC Educational Resources Information Center

Stephens, Ronald L.; And Others

1991-01-01

Conducted pilot survey of 64 patients with late stage malignancy who had signed living wills. Found that 70.3 percent were grateful for opportunity to sign living will and maintain autonomy over their terminal care, 20.3 percent were either apparently indifferent or unwilling to discuss issue, and 9.4 percent appeared disturbed by their signing of…

Never trust a croup…

PubMed Central

Nickinson, Andrew; Minhas, Jatinder Singh; Bhalla, Minak; Anwuzia-Iwegbu, Charles; Chapman, John

2011-01-01

A 2-year-old girl presented to the James Paget University Hospitals Trust with croup-like symptoms and was later discharged with dexamethasone syrup. The patient re-presented 6 h later following maternal concern with signs of acute respiratory distress. After a period of clinical stability, she acutely decompensated without any prior signs of a life-threatening deterioration. She was managed using nebulised epinephrine and showed signs of clinical improvement. Although improvement persisted, the child showed signs of exhaustion following the preceding events and was later intubed with an endotracheal tube and transferred to the paediatric intensive care unit at Addenbrooke’s University Hospital, Cambridge. Endotracheal aspiration later grew parainfluenza virus, rhinovirus and Staphylococcus aureus and the patient was diagnosed with the exceptionally rare life threatening complications of croup, bacterial tracheitis. The patient was discharged from intensive care 7 days later and has since made a full recovery. PMID:22689599

The value of signs, symptoms and plasma heart-type fatty acid-binding protein (H-FABP) in evaluating patients presenting with symptoms possibly matching acute coronary syndrome: background and methods of a diagnostic study in primary care.

PubMed

Willemsen, Robert T A; Buntinx, Frank; Winkens, Bjorn; Glatz, Jan F; Dinant, Geert Jan

2014-12-12

Chest complaints presented to a general practitioner (GP) are frequently caused by diseases which have advantageous outcomes. However, in some cases, acute coronary syndrome (ACS) is present (1.5-22% of cases). The patient's signs, symptoms and electrocardiography results are insufficient diagnostic tools to distinguish mild disease from ACS. Therefore, most patients presenting chest complaints are referred to secondary care facilities where ACS is then ruled out in a majority of patients (78%). Recently, a point of care test for heart-type fatty acid-binding protein (H-FABP) using a low cut-off value between positive and negative of 4 ng/ml has become available. We aim to study the role of this point of care device in triage of patients presenting chest complaints possibly due to ACS, in primary care. Our research protocol is presented in this article. Results are expected in 2015. Participating GPs will register signs and symptoms in all patients presenting chest complaints possibly due to ACS. Point of care H-FABP testing will also be performed. Our study will be a derivation study to identify signs and symptoms that, combined with point of care H-FABP testing, can be part of an algorithm to either confirm or rule out ACS. The diagnostic value for ACS of this algorithm in general practice will be determined. A safe diagnostic elimination of ACS by application of the algorithm can be of significant clinical relevance. Improved triage and thus reduction of the number of patients with chest complaints without underlying ACS, that are referred to secondary care facilities, could lead to a substantial cost reduction. ClinicalTrials.gov, NCT01826994, accepted April 8th 2013.

Accreditation Association for Ambulatory Health Care

MedlinePlus

... Press Release Archives learn more » For Patients Your health care choices matter. Whether you're anticipating a surgical ... certificate of accreditation is a sign that a health care organization meets or exceeds nationally-recognized Standards. Learn ...

DC-SIGN mediates avian H5N1 influenza virus infection in cis and in trans

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

Wang, S.-F.; Huang, Jason C.; AIDS Prevention and Research Center, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan

2008-09-05

DC-SIGN, a C-type lectin receptor expressed in dendritic cells (DCs), has been identified as a receptor for human immunodeficiency virus type 1, hepatitis C virus, Ebola virus, cytomegalovirus, dengue virus, and the SARS coronavirus. We used H5N1 pseudotyped and reverse-genetics (RG) virus particles to study their ability to bind with DC-SIGN. Electronic microscopy and functional assay results indicate that pseudotyped viruses containing both HA and NA proteins express hemagglutination and are capable of infecting cells expressing {alpha}-2,3-linked sialic acid receptors. Results from a capture assay show that DC-SIGN-expressing cells (including B-THP-1/DC-SIGN and T-THP-1/DC-SIGN) and peripheral blood dendritic cells are capablemore » of transferring H5N1 pseudotyped and RG virus particles to target cells; this action can be blocked by anti-DC-SIGN monoclonal antibodies. In summary, (a) DC-SIGN acts as a capture or attachment molecule for avian H5N1 virus, and (b) DC-SIGN mediates infections in cis and in trans.« less

Prevalence of Heart Failure Signs and Symptoms in a Large Primary Care Population Identified Through the Use of Text and Data Mining of the Electronic Health Record

PubMed Central

Vijayakrishnan, Rajakrishnan; Steinhubl, Steven R.; Ng, Kenney; Sun, Jimeng; Byrd, Roy J.; Daar, Zahra; Williams, Brent A.; deFilippi, Christopher; Ebadollahi, Shahram; Stewart, Walter F.

2014-01-01

Background The electronic health record contains a tremendous amount of data that if appropriately detected can lead to earlier identification of disease states such as heart failure (HF). Using a novel text and data analytic tool we explored the longitudinal EHR of over 50,000 primary care patients to identify the documentation of the signs and symptoms of HF in the years preceding its diagnosis. Methods and Results Retrospective analysis consisting of 4,644 incident HF cases and 45,981 group-matched controls. Documentation of Framingham HF signs and symptoms within encounter notes were carried out using a previously validated natural language processing procedure. A total of 892,805 affirmed criteria were documented over an average observation period of 3.4 years. Among eventual HF cases, 85% had at least one criterion within a year prior to their HF diagnosis (as did 55% of controls). Substantial variability in the prevalence of individual signs and symptoms were found in both cases and controls. Conclusions HF signs and symptoms are frequently documented in a primary care population as identified through automated text and data mining of EHRs. Their frequent identification demonstrates the rich data available within EHRs that will allow for future work on automated criterion identification to help develop predictive models for HF. PMID:24709663

The DISAM Journal of International Security Assistance Management. Volume 32, Number 1, July 2010

DTIC Science & Technology

2010-07-01

Brasilia for the signing ceremony. However, the venue was rescheduled because Jobim is accompanying Brazilian President Luiz Inácio Lula da Silva to...heath care providers, midwives, pharmacists, and nurses . They worked closely with MBLT-3 to make today happen, said a U.S. Army Special Forces Medic...More medical professionals are arriving, and all are highly motivated. We had critical care nurses show up; and after they signed in, they put

7 CFR 1484.31 - Who acts on behalf of each Cooperator?

Code of Federal Regulations, 2011 CFR

2011-01-01

... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS PROGRAMS TO HELP DEVELOP FOREIGN MARKETS FOR AGRICULTURAL COMMODITIES Program Operations § 1484.31 Who acts on behalf of each Cooperator? The Cooperator shall designate at least two individuals in its organization to sign program agreements...

75 FR 25859 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-10

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention [30Day-10-08BH... signed H.R. 4986: National Defense Authorization Act for Fiscal Year 2008 which requires ATSDR to develop... history on base, occupational history, and information on several risk factors (e.g., socio-economic...

ESEA Briefing Book

ERIC Educational Resources Information Center

Petrilli, Michael J.; Finn, Chester E., Jr.

2011-01-01

President Obama and congressional leaders have vowed to take action this year on the Elementary and Secondary Education Act (ESEA), most recently reauthorized and rebranded as the No Child Left Behind Act of 2001. While most observers remain skeptical that everyone will actually see a signing ceremony in 2011, it does appear likely that at least…

Endangerment and Cause or Contribute Findings for Greenhouse Gases under the Clean Air Act

EPA Pesticide Factsheets

Read the Endangerment and Cause or Contribute Findings for Greenhouse Gases under the Clean Air Act, signed by the Administrator on December 7, 2009. The final findings were published in the Federal Register under Docket ID No. EPA-HQ-OAR-2009-0171.

Disability Services Offices for Students with Disabilities: A Campus Resource

ERIC Educational Resources Information Center

Cory, Rebecca C.

2011-01-01

Section 504 of the 1973 Rehabilitation Act and the Americans with Disabilities Act (ADA) are often the starting places for conversations about students with disabilities in higher education. Section 504 and the ADA provide mandates for protection from discrimination and provision of reasonable disability accommodations (e.g., sign language…

76 FR 40738 - Agency Information Collection Activities: Proposed Collection; Comment Request; Standard Flood...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-11

... Community Development and Regulatory Improvement Act of 1994 was signed into law. Section 303 (a) of this... requirement for federally regulated lending institutions to determine whether a building or mobile home... Regulatory Improvement Act of 1994. The establishment of the Standard Flood Hazard Determination form has...

75 FR 34802 - Notice and Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-18

... (telephone: (202) 493-6292), or Ms. Kimberly Toone, Office of Information Technology, RAD-20, Federal... Paperwork Reduction Act of 1995 (PRA), Public Law 104-13, Section 2, 109 Stat. 163 (1995) (codified as... the Rail Safety Improvement Act of 2008, signed into law by President George W. Bush on October 16...

75 FR 28621 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-21

... state and metropolitan area-based surveillance projects for Amyotrophic Lateral Sclerosis (ALS)--New... Description On October 10, 2008, President Bush signed S. 1382: ALS Registry Act which amended the Public Health Service Act to provide for the establishment of an Amyotrophic Lateral Sclerosis (ALS) Registry...

Great Expectations: Understanding the New Title I.

ERIC Educational Resources Information Center

Manasevit, Leigh M.; Cowan, Kristen Tosh

On October 20, 1994, President Clinton signed into law the Improving America's Schools Act of 1994. This statute contains amendments to the Elementary and Secondary Education Act of 1965, including the reauthorization of Chapter 1, as the newly entitled Title I. The reauthorized Title I drastically restructures the direction of former remedial…

Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics?

PubMed

Ellegård, Lina Maria; Dietrichson, Jens; Anell, Anders

2018-01-01

Antibiotic resistance is a major threat to public health worldwide. As the healthcare sector's use of antibiotics is an important contributor to the development of resistance, it is crucial that physicians only prescribe antibiotics when needed and that they choose narrow-spectrum antibiotics, which act on fewer bacteria types, when possible. Inappropriate use of antibiotics is nonetheless widespread, not least for respiratory tract infections (RTI), a common reason for antibiotics prescriptions. We examine if pay-for-performance (P4P) presents a way to influence primary care physicians' choice of antibiotics. During 2006-2013, 8 Swedish healthcare authorities adopted P4P to make physicians select narrow-spectrum antibiotics more often in the treatment of children with RTI. Exploiting register data on all purchases of RTI antibiotics in a difference-in-differences analysis, we find that P4P significantly increased the share of narrow-spectrum antibiotics. There are no signs that physicians gamed the system by issuing more prescriptions overall. © 2017 The Authors Health Economics Published by John Wiley & Sons Ltd.

Nursing care of children after a traumatic incident.

PubMed

Mulvihill, Deanna

2007-01-01

The objective of this study was to describe the nursing interventions with children and their parents to reduce the impact of a traumatic incident. A traumatic incident can be a natural disaster, a plane or car accident, or child abuse. The author has conducted an interdisciplinary integrative review of the research literature on the health impact of childhood trauma. This research is summarized and the results are synthesized and presented in a diagram that demonstrates the strong relationships that trauma has to both short and long-term health status. The impact of post-traumatic stress disorder (PTSD) and interventions to reduce its impact are described. Predictability and continuity in nursing care grounded in both routine and personnel are important. Nurses can teach self-soothing techniques and coping skills prior to using exploratory dialogue to assist the child and the parent in reviewing the traumatic incident. Nurses can also act as advocates for unsafe situations and practices, such as corporal punishment. Assessment of children for history of trauma is indicated, especially children who exhibit signs of short-term health effects. Areas for health education and future research are also presented.

Evaluating Effects of Language Recognition on Language Rights and the Vitality of New Zealand Sign Language

ERIC Educational Resources Information Center

McKee, Rachel Locker; Manning, Victoria

2015-01-01

Status planning through legislation made New Zealand Sign Language (NZSL) an official language in 2006. But this strong symbolic action did not create resources or mechanisms to further the aims of the act. In this article we discuss the extent to which legal recognition and ensuing language-planning activities by state and community have affected…

Understanding Stroke - Know Stroke • Know the Signs • Act in Time

MedlinePlus

... other racial or ethnic group in the United States. "I didn't know a thing about stroke before I had one," she says. "Now, I make sure that all my family knows the signs of stroke, so they can get help if they need it." Stroke occurs when blood flow to your brain is stopped, either by blockage ...

Determinants of knowledge of critical danger signs, safe childbirth and immediate newborn care practices among auxiliary midwives: a cross sectional survey in Myanmar.

PubMed

Than, Kyu Kyu; Morgan, Alison; Pham, Minh Duc; Beeson, James G; Luchters, Stanley

2017-07-05

The re-emergence of community-based health workers such as the auxiliary midwives (AMWs) in Myanmar, who are local female volunteers, has been an important strategy to address global health workforce shortages. The Myanmar government recommends one AMW for every village. The aim of this study is to investigate the current knowledge of critical danger signs and practices for safe childbirth and immediate newborn care of AMWs to inform potential task shifting of additional healthcare responsibilities. A cross-sectional survey was conducted from July 2015 to June 2016 in three hard-to-reach areas in Myanmar. Face-to-face interviews were conducted using a pretested questionnaire. Among 262 AMWs participating in the study, only 8% of AMWs were able to identify at least 80% of 20 critical danger signs. Factors associated with greater knowledge of critical danger signs included older age over 35 years (adjusted OR (AOR) 2.19, 95% CI 0.99 to 4.83), having received refresher training within the last year (AOR 2.20, 95% CI 1.21 to 4.01) and receiving adequate supervision (AOR 5.04, 95% CI 2.74 to 9.29). Those who employed all six safe childbirth and immediate newborn care practices were more likely to report greater knowledge of danger signs (AOR 2.81, 95% CI 1.50 to 5.26), adequate work supervision (AOR 3.18 95% CI 1.62 to 6.24) and less education (AOR 0.44, 95% CI 0.23 to 0.88). The low level of knowledge of critical danger signs and reported practices for safe childbirth identified suggest that an evaluation of the current AMW training and supervision programme needs to be revisited to ensure that existing practices, including recognition of danger signs, meet quality care standards before new interventions are introduced or new responsibilities given to AMWs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The cost and utilisation patterns of a pilot sign language interpreter service for primary health care services in South Africa

PubMed Central

Heap, Marion; Sinanovic, Edina

2017-01-01

Background The World Health Organisation estimates disabling hearing loss to be around 5.3%, while a study of hearing impairment and auditory pathology in Limpopo, South Africa found a prevalence of nearly 9%. Although Sign Language Interpreters (SLIs) improve the communication challenges in health care, they are unaffordable for many signing Deaf people and people with disabling hearing loss. On the other hand, there are no legal provisions in place to ensure the provision of SLIs in the health sector in most countries including South Africa. To advocate for funding of such initiatives, reliable cost estimates are essential and such data is scarce. To bridge this gap, this study estimated the costs of providing such a service within a South African District health service based on estimates obtained from a pilot-project that initiated the first South African Sign Language Interpreter (SASLI) service in health-care. Methods The ingredients method was used to calculate the unit cost per SASLI-assisted visit from a provider perspective. The unit costs per SASLI-assisted visit were then used in estimating the costs of scaling up this service to the District Health Services. The average annual SASLI utilisation rate per person was calculated on Stata v.12 using the projects’ registry from 2008–2013. Sensitivity analyses were carried out to determine the effect of changing the discount rate and personnel costs. Results Average Sign Language Interpreter services’ utilisation rates increased from 1.66 to 3.58 per person per year, with a median of 2 visits, from 2008–2013. The cost per visit was US$189.38 in 2013 whilst the estimated costs of scaling up this service ranged from US$14.2million to US$76.5million in the Cape Metropole District. These cost estimates represented 2.3%-12.2% of the budget for the Western Cape District Health Services for 2013. Conclusions In the presence of Sign Language Interpreters, Deaf Sign language users utilise health care service to a similar extent as the hearing population. However, this service requires significant capital investment by government to enable access to healthcare for the Deaf. PMID:29272272

The cost and utilisation patterns of a pilot sign language interpreter service for primary health care services in South Africa.

PubMed

Zulu, Tryphine; Heap, Marion; Sinanovic, Edina

2017-01-01

The World Health Organisation estimates disabling hearing loss to be around 5.3%, while a study of hearing impairment and auditory pathology in Limpopo, South Africa found a prevalence of nearly 9%. Although Sign Language Interpreters (SLIs) improve the communication challenges in health care, they are unaffordable for many signing Deaf people and people with disabling hearing loss. On the other hand, there are no legal provisions in place to ensure the provision of SLIs in the health sector in most countries including South Africa. To advocate for funding of such initiatives, reliable cost estimates are essential and such data is scarce. To bridge this gap, this study estimated the costs of providing such a service within a South African District health service based on estimates obtained from a pilot-project that initiated the first South African Sign Language Interpreter (SASLI) service in health-care. The ingredients method was used to calculate the unit cost per SASLI-assisted visit from a provider perspective. The unit costs per SASLI-assisted visit were then used in estimating the costs of scaling up this service to the District Health Services. The average annual SASLI utilisation rate per person was calculated on Stata v.12 using the projects' registry from 2008-2013. Sensitivity analyses were carried out to determine the effect of changing the discount rate and personnel costs. Average Sign Language Interpreter services' utilisation rates increased from 1.66 to 3.58 per person per year, with a median of 2 visits, from 2008-2013. The cost per visit was US$189.38 in 2013 whilst the estimated costs of scaling up this service ranged from US$14.2million to US$76.5million in the Cape Metropole District. These cost estimates represented 2.3%-12.2% of the budget for the Western Cape District Health Services for 2013. In the presence of Sign Language Interpreters, Deaf Sign language users utilise health care service to a similar extent as the hearing population. However, this service requires significant capital investment by government to enable access to healthcare for the Deaf.

Affective and Neuroendocrine Effects of Withdrawal from Chronic, Long-Acting Opiate Administration

PubMed Central

Hamilton, Kathryn L.; Harris, Andrew C.; Gewirtz, Jonathan C.

2013-01-01

Although the long-acting opiate methadone is commonly used to treat drug addiction, relatively little is known about effects of withdrawal from this drug in preclinical models. The current study examined affective, neuroendocrine, and somatic signs of withdrawal from the longer-acting methadone derivative l-alpha-acetylmethydol (LAAM) in rats. Anxiety-like behavior during both spontaneous and antagonist-precipitated withdrawal was measured by potentiation of the startle reflex. Withdrawal elevated corticosterone and somatic signs and blunted circadian variations in baseline startle responding. In addition, fear to an explicit, Pavlovian conditioned stimulus (fear-potentiated startle) was enhanced. These data suggest that anxiety-like behavior as measured using potentiated startle responding does not emerge spontaneously during withdrawal from chronic opiate exposure – in contrast to withdrawal from acute drug exposure – but rather is manifested as exaggerated fear in response to explicit threat cues. PMID:24076207

Development of a South African integrated syndromic respiratory disease guideline for primary care.

PubMed

English, René G; Bateman, Eric D; Zwarenstein, Merrick F; Fairall, Lara R; Bheekie, Angeni; Bachmann, Max O; Majara, Bosielo; Ottmani, Salah-Eddine; Scherpbier, Robert W

2008-09-01

The Practical Approach to Lung Health in South Africa (PALSA) initiative aimed to develop an integrated symptom- and sign-based (syndromic) respiratory disease guideline for nurse care practitioners working in primary care in a developing country. A multidisciplinary team developed the guideline after reviewing local barriers to respiratory health care provision, relevant health care policies, existing respiratory guidelines, and literature. Guideline drafts were evaluated by means of focus group discussions. Existing evidence-based guideline development methodologies were tailored for development of the guideline. A locally-applicable guideline based on syndromic diagnostic algorithms was developed for the management of patients 15 years and older who presented to primary care facilities with cough or difficulty breathing. PALSA has developed a guideline that integrates and presents diagnostic and management recommendations for priority respiratory diseases in adults using a symptom- and sign-based algorithmic guideline for nurses in developing countries.

KSC-05PD-0801

NASA Technical Reports Server (NTRS)

2005-01-01

KENNEDY SPACE CENTER, FLA. Members of the Economic Development Commission (EDC) of Floridas Space Coast were on hand to witness the signing of a three-year agreement for economic development cooperation in support of existing and future missions of NASA at KSC. Lynda Weatherman (third from left), president and CEO of the EDC, and Jim Kennedy (center) , director of Kennedy Space Center, signed the Space Act Agreement. At far right is Lisa Malone, director of External Relations and Business Development at KSC. Standing with them are members of the NASA External Relations directorate who helped facilitate the Space Act Agreement are, from left, James Ball, Kim Agee, John Hudiberg, David Pierce, Jessica Livingston and Trudy McCarthy.

In pursuit of high-value healthcare: the case for improving quality and achieving equity in a time of healthcare transformation.

PubMed

Betancourt, Joseph R

2014-01-01

The passage of the Patient Protection and Affordable Care Act and current efforts in payment reform signal the beginning of a significant transformation for the US healthcare system. As we embark on this transformation, disparities have emerged as the hallmark of low-value healthcare--care that does not meet quality standards, is inefficient, and is usually of high cost. A new set of structures is being developed to facilitate increased access to care that is cost-effective and high in quality--otherwise known as high-value healthcare. Addressing disparities and achieving equity are the perfect target areas for recouping value, and doing so will pave the way for high-value healthcare. As healthcare leaders make difficult choices, they should consider the realities of healthcare equity. First, racial and ethnic disparities in healthcare persist and are a clear sign of poor-quality, low-value healthcare. Second, the root causes of these disparities are complex, but a well-developed set of evidence-based approaches is available to help leaders address healthcare inequity. Third, evidence suggests that being inattentive to the root causes of disparities adversely affects efficiency and an organization's bottom line. Finally, if healthcare organizations are progressive, thoughtful, and prepared for success in such an environment, a new healthcare system that offers accessible, high-value, equitable, culturally competent, and high-quality care to all is well within reach.

Therapeutic touch: influence on vital signs of newborns.

PubMed

Ramada, Nadia Christina Oliveira; Almeida, Fabiane de Amorim; Cunha, Mariana Lucas da Rocha

2013-12-01

To compare vital signs before and after the therapeutic touch observed in hospitalized newborns in neonatal intensive care unit. This was a quasi-experimental study performed at a neonatal intensive care unit of a municipal hospital, in the city of São Paulo (SP), Brazil. The sample included 40 newborns submitted to the therapeutic touch after a painful procedure. We evaluated the vital signs, such as heart and respiratory rates, temperature and pain intensity, before and after the therapeutic touch. The majority of newborns were male (n=28; 70%), pre-term (n=19; 52%) and born from vaginal delivery (n=27; 67%). Respiratory distress was the main reason for hospital admission (n=16; 40%). There was a drop in all vital signs after therapeutic touch, particularly in pain score, which had a considerable reduction in the mean values, from 3.37 (SD=1.31) to 0 (SD=0.0). All differences found were statistically significant by the Wilcoxon test (p<0.05). The results showed that therapeutic touch promotes relaxation of the baby, favoring reduction in vital signs and, consequently in the basal metabolism rate.

Music and Sign Language to Promote Infant and Toddler Communication and Enhance Parent-Child Interaction

ERIC Educational Resources Information Center

Colwell, Cynthia; Memmott, Jenny; Meeker-Miller, Anne

2014-01-01

The purpose of this study was to determine the efficacy of using music and/or sign language to promote early communication in infants and toddlers (6-20 months) and to enhance parent-child interactions. Three groups used for this study were pairs of participants (care-giver(s) and child) assigned to each group: 1) Music Alone 2) Sign Language…

Criminal Provisions of the Clean Air Act Amendments of 1990 and their Interface with the United States Sentencing Guidelines

DTIC Science & Technology

1991-09-30

it appears no other thing to me than a foul and pestilent congregation of vapors." Hamlet , Act II, Scene 229 "We will not turn our backs or look the... Shakespeare Selected Plays 210 (1981). (30) Remarks on Signing the Bill Amending the Clean Air Act, 26 Weekly Comp. Pres. Doc. 1823 (Nov. 15, 1990). (31

Danger signs of neonatal illnesses: perceptions of caregivers and health workers in northern India.

PubMed Central

Awasthi, Shally; Verma, Tuhina; Agarwal, Monica

2006-01-01

OBJECTIVE: To assess household practices that can affect neonatal health, from the perspective of caregivers and health workers; to identify signs in neonates leading either to recognition of illness or health-care seeking; and to ascertain the proportion of caregivers who recognize the individual items of the integrated management of neonatal and childhood illnesses (IMNCI) programme. METHODS: The study was carried out in a rural community in Sarojininagar Block, Uttar Pradesh, India, using qualitative and quantitative research designs. Study participants were mothers, grandmothers, grandfathers, fathers or "nannies" (other female relatives) caring for infants younger than 6 months of age and recognized health-care providers serving the area. Focus group discussions (n = 7), key informant interviews (n = 35) and structured interviews (n = 210) were conducted with these participants. FINDINGS: Many household practices were observed which could adversely affect maternal and neonatal health. Among 200 caregivers, 70.5% reported home deliveries conducted by local untrained nurses or relatives, and most mothers initiated breastfeeding only on day 3. More than half of the caregivers recognized fever, irritability, weakness, abdominal distension/vomiting, slow breathing and diarrhoea as danger signs in neonates. Seventy-nine (39.5%) of the caregivers had seen a sick neonate in the family in the past 2 years, with 30.38% in whom illness manifested as continuous crying. Health care was sought for 46 (23%) neonates. Traditional medicines were used for treatment of bulging fontanelle, chest in-drawing and rapid breathing. CONCLUSION: Because there is no universal recognition of danger signs in neonates, and potentially harmful antenatal and birthing practices are followed, there is a need to give priority to implementing IMNCI, and possible incorporation of continuous crying as an additional danger sign. PMID:17128362

Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients.

PubMed

Wen, Kuei-Yen; Lin, Ya-Chin; Cheng, Ju-Feng; Chou, Pei-Chun; Wei, Chih-Hsin; Chen, Yun-Fang; Sun, Jia-Ling

2013-09-01

Discussing end-of-life care with patients is often considered taboo, and signing a do-not-resuscitate (DNR) order is difficult for most patients, especially in Chinese culture. This study investigated distributions and details related to the signing of DNR orders, as well as the completeness of various DNR order forms. Retrospective chart reviews were performed. We screened all charts from a teaching hospital in Taiwan for patients who died of cancer during the period from January 2010 to December 2011. A total of 829 patient records were included in the analysis. The details of the DNR order forms were recorded. The DNR order signing rate was 99.8%. The percentage of DNR orders signed by patients themselves (DNR-P) was 22.6%, while the percentage of orders signed by surrogates (DNR-S) was 77.2%. The percentage of signed DNR forms that were completely filled out was 78.4%. The percentage of DNR-S forms that were completed was 81.7%, while the percentage of DNR-P forms that were completely filled out was only 67.6%. Almost all the cancer patients had a signed DNR order, but for the majority of them, the order was signed by a surrogate. Negative attitudes of discussing death from medical professionals and/or the family members of patients may account for the higher number of signed DNR-S orders than DNR-P orders. Moreover, early obtainment of signed DNR orders should be sought, as getting the orders earlier could promote the quality of end-of-life care, especially in non-oncology wards.

The semiotics of medical image Segmentation.

PubMed

Baxter, John S H; Gibson, Eli; Eagleson, Roy; Peters, Terry M

2018-02-01

As the interaction between clinicians and computational processes increases in complexity, more nuanced mechanisms are required to describe how their communication is mediated. Medical image segmentation in particular affords a large number of distinct loci for interaction which can act on a deep, knowledge-driven level which complicates the naive interpretation of the computer as a symbol processing machine. Using the perspective of the computer as dialogue partner, we can motivate the semiotic understanding of medical image segmentation. Taking advantage of Peircean semiotic traditions and new philosophical inquiry into the structure and quality of metaphors, we can construct a unified framework for the interpretation of medical image segmentation as a sign exchange in which each sign acts as an interface metaphor. This allows for a notion of finite semiosis, described through a schematic medium, that can rigorously describe how clinicians and computers interpret the signs mediating their interaction. Altogether, this framework provides a unified approach to the understanding and development of medical image segmentation interfaces. Copyright © 2017 Elsevier B.V. All rights reserved.

How Do Health Care Providers Diagnose Primary Ovarian Insufficiency (POI)?

MedlinePlus

... Share Facebook Twitter Pinterest Email Print How do health care providers diagnose POI? The key signs of POI ... having periods for 4 months or longer, her health care provider may take these steps to diagnose the ...

CDC Vital Signs: Making Health Care Safer -- Think Sepsis. Time Matters.

MedlinePlus

... Press Kit Read the MMWR Science Clips Making Health Care Safer Think sepsis. Time matters. Language: English (US) ... the antibiotic type, dose, and duration are correct. Health care facility CEOs/administrators can Make infection control a ...

45 CFR 155.20 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT... Care Act of 2010 (Pub. L. 111-148), as amended by the Health Care and Education Reconciliation Act of.... Catastrophic plan means a health plan described in section 1302(e) of the Affordable Care Act. Code means the...

75 FR 70160 - Affordable Care Act; Federal External Review Process; Request for Information

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

...-9986-NC] DEPARTMENT OF LABOR Employee Benefits Security Administration 29 CFR Part 2590 Affordable Care... Affordable Care Act, and its implementing regulations. DATES: Submit written or electronic comments by... processes under the Affordable Care Act; those comments are being collected and evaluated on a separate...

Task Shifting: The Use of Laypersons for Acquisition of Vital Signs Data for Clinical Decision Making in the Emergency Room Following Traumatic Injury.

PubMed

Haac, Bryce E; Gallaher, Jared R; Mabedi, Charles; Geyer, Andrew J; Charles, Anthony G

2017-12-01

In resource-limited settings, identification of successful and sustainable task-shifting interventions is important for improving care. To determine whether the training of lay people to take vital signs as trauma clerks is an effective and sustainable method to increase availability of vital signs in the initial evaluation of trauma patients. We conducted a quasi-experimental study of patients presenting with traumatic injury pre- and post-intervention. The study was conducted at Kamuzu Central Hospital, a tertiary care referral hospital, in Lilongwe, Malawi. All adult (age ≥ 18 years) trauma patients presenting to emergency department over a six-month period from January to June prior to intervention (2011), immediately post-intervention (2012), 1 year post-intervention (2013) and 2 years post-intervention (2014). Lay people were trained to take and record vital signs. The number of patients with recorded vital signs pre- and post-intervention and sustainability of the intervention as determined by time-series analysis. Availability of vital signs on initial evaluation of trauma patients increased significantly post-intervention. The percentage of patients with at least one vital sign recorded increased from 23.5 to 92.1%, and the percentage of patients with all vital signs recorded increased from 4.1 to 91.4%. Availability of Glasgow Coma Scale also increased from 40.3 to 88.6%. Increased documentation of vital signs continued at 1 year and 2 years post-intervention. However, the percentage of documented vital signs did decrease slightly after the US-trained medical student and surgeon who trained the trauma clerks were no longer available in country, except for Glasgow Coma Scale. Patients who died during emergency department evaluation were significantly less likely to have vital signs recorded. The training of lay people to collect vital signs and Glasgow Coma Scale is an effective and sustainable method of task shifting in a resource-limited setting.

Warning Signs of Youth Violence. Just the Facts: Answers to Your Questions about Psychological Health

ERIC Educational Resources Information Center

American Psychological Association (APA), 2002

2002-01-01

Violence. It's the act of purposefully hurting someone. And it's a major issue facing today's young adults. This fact sheet answers questions that those aged 12-24 might ask about violence. This age group faces the highest risk of being the victim of violence. Questions regard the causes of youth violence, warning signs, what to do if someone…

Health insurance issuers implementing medical loss ratio (MLR) requirements under the Patient Protection and Affordable Care Act. Interim final rule with request for comments.

PubMed

2010-12-01

This document contains the interim final regulation implementing medical loss ratio (MLR) requirements for health insurance issuers under the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (Affordable Care Act).

30 CFR 913.30 - State-Federal cooperative agreement.

Code of Federal Regulations, 2012 CFR

2012-07-01

... seq., and implementing regulations, including 40 CFR part 1500. 4. The Endangered Species Act, as... section 523(c) of the Surface Mining Control and Reclamation Act (SMCRA), 30 U.S.C. 1273(c), which allows... administer this Agreement on behalf of the Secretary. Article II: Effective Date After being signed by the...

30 CFR 913.30 - State-Federal cooperative agreement.

Code of Federal Regulations, 2014 CFR

2014-07-01

... seq., and implementing regulations, including 40 CFR part 1500. 4. The Endangered Species Act, as... section 523(c) of the Surface Mining Control and Reclamation Act (SMCRA), 30 U.S.C. 1273(c), which allows... administer this Agreement on behalf of the Secretary. Article II: Effective Date After being signed by the...

30 CFR 913.30 - State-Federal cooperative agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... seq., and implementing regulations, including 40 CFR part 1500. 4. The Endangered Species Act, as... section 523(c) of the Surface Mining Control and Reclamation Act (SMCRA), 30 U.S.C. 1273(c), which allows... administer this Agreement on behalf of the Secretary. Article II: Effective Date After being signed by the...

30 CFR 913.30 - State-Federal cooperative agreement.

Code of Federal Regulations, 2013 CFR

2013-07-01

... seq., and implementing regulations, including 40 CFR part 1500. 4. The Endangered Species Act, as... section 523(c) of the Surface Mining Control and Reclamation Act (SMCRA), 30 U.S.C. 1273(c), which allows... administer this Agreement on behalf of the Secretary. Article II: Effective Date After being signed by the...

30 CFR 913.30 - State-Federal cooperative agreement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... seq., and implementing regulations, including 40 CFR part 1500. 4. The Endangered Species Act, as... section 523(c) of the Surface Mining Control and Reclamation Act (SMCRA), 30 U.S.C. 1273(c), which allows... administer this Agreement on behalf of the Secretary. Article II: Effective Date After being signed by the...

78 FR 60755 - Hazardous Materials: Enhanced Enforcement Procedures-Resumption of Transportation

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-02

.... Summary of MAP-21 and Final Rule V. Summary Review of Amendments VI. Regulatory Analyses and Notices A.... Executive Summary On July 6, 2012, the President signed the Moving Ahead for Progress in the 21st Century Act, or the MAP-21, which included the Hazardous Materials Transportation Safety Improvement Act of...

78 FR 53712 - Surface Transportation Project Delivery Program Application Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-30

... the 21st Century Act (MAP-21), which converted the Surface Transportation Project Delivery Pilot... signed into law the Moving Ahead for Progress in the 21st Century Act (MAP-21), Public Law 112-141, 126... days from the date of MAP-21's enactment (October 1, 2012)--the regulations concerning the information...

78 FR 30258 - Hazardous Materials: Enhanced Enforcement Procedures-Resumption of Transportation

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-22

... 21st Century Act, or the MAP-21, which included the Hazardous Materials Transportation Safety... 6, 2012, the President signed the Moving Ahead for Progress in the 21st Century Act, or the MAP-21... This NPRM In MAP-21 Congress directed the Secretary to address certain transportation matters related...

12 CFR 226.17 - General disclosure requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... identity under § 226.18(a). For private education loan disclosures made in compliance with § 226.47, the... applicable provisions of the Electronic Signatures in Global and National Commerce Act (E-Sign Act) (15 U.S.C...) must be separate from the other disclosures under § 226.18, except for private education loan...

Factors Influencing Improved Student Achievement in Virginia

ERIC Educational Resources Information Center

Linehan, Patrick D.

2012-01-01

At the beginning of the last decade, Congress passed and President George W. Bush signed the No Child Left Behind (NCLB) Act of 2002. Key provisions of this act focused on holding schools accountable to ensure that all students met state established standards. In Virginia, the state Standards of Learning (SOL) assessments form the basis of…

43 CFR 2611.2 - Period of segregation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Period of segregation. 2611.2 Section 2611..., DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) CAREY ACT GRANTS Segregation Under the Carey Act: Procedures § 2611.2 Period of segregation. (a) The States are allowed 10 years from the date of the signing...

78 FR 9922 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

... (ALS) in the National ALS Registry--Revision--(0923-0041, Expiration 7/ 31/2013)--Agency for Toxic... Brief Description On October 10, 2008, President Bush signed S. 1382: ALS Registry Act which amended the Public Health Service Act to provide for the establishment of an Amyotrophic Lateral Sclerosis (ALS...

77 FR 33562 - Unblocking of Specially Designated Nationals and Blocked Persons Pursuant to the Foreign...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-06

... 3, 1999, the Kingpin Act was signed into law by the President of the United States. The Kingpin Act provides a statutory framework for the President to impose sanctions against significant foreign narcotics.... jurisdiction, owned or controlled by significant foreign narcotics traffickers as identified by the President...

77 FR 41479 - Unblocking of Specially Designated Nationals and Blocked Persons Pursuant to the Foreign...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-13

..., 1999, the Kingpin Act was signed into law by the President of the United States. The Kingpin Act provides a statutory framework for the President to impose sanctions against significant foreign narcotics.... jurisdiction, owned or controlled by significant foreign narcotics traffickers as identified by the President...

P.L. 110-140, "Energy Independence and Security Act of 2007", 2007

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

None

2007-12-19

The Energy Independence and Security Act of 2007 (EISA), signed into law on December 19, 2007, set forth an agenda for improving U.S. energy security across the entire economy. While industrial energy efficiency is specifically called out in Title IV, Subtitle D, other EISA provisions also apply to AMO activities.

50 CFR 300.90 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Fraser River Sockeye and Pink Salmon Fisheries § 300.90 Purpose and scope. This subpart implements the Pacific Salmon Treaty Act of 1985 (16 U.S.C. 3631-3644) (Act) and is intended to supplement, not conflict... Government of the United States of America and the Government of Canada Concerning Pacific Salmon, signed at...

50 CFR 300.90 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Fraser River Sockeye and Pink Salmon Fisheries § 300.90 Purpose and scope. This subpart implements the Pacific Salmon Treaty Act of 1985 (16 U.S.C. 3631-3644) (Act) and is intended to supplement, not conflict... Government of the United States of America and the Government of Canada Concerning Pacific Salmon, signed at...

3 CFR 9075 - Proclamation 9075 of December 31, 2013. National Stalking Awareness Month, 2014

Code of Federal Regulations, 2014 CFR

2014-01-01

... violence, and sexual assault. It amended the Clery Act to require colleges to report crime statistics on..., putting victims at risk of sexual assault, physical abuse, or homicide. My Administration remains.... Last March, I was proud to sign the Violence Against Women Reauthorization Act. Every time we renew...

Nurse practitioner perceptions of barriers and facilitators in providing health care for deaf American Sign Language users: A qualitative socio-ecological approach.

PubMed

Pendergrass, Kathy M; Nemeth, Lynne; Newman, Susan D; Jenkins, Carolyn M; Jones, Elaine G

2017-06-01

Nurse practitioners (NPs), as well as all healthcare clinicians, have a legal and ethical responsibility to provide health care for deaf American Sign Language (ASL) users equal to that of other patients, including effective communication, autonomy, and confidentiality. However, very little is known about the feasibility to provide equitable health care. The purpose of this study was to examine NP perceptions of barriers and facilitators in providing health care for deaf ASL users. Semistructured interviews in a qualitative design using a socio-ecological model (SEM). Barriers were identified at all levels of the SEM. NPs preferred interpreters to facilitate the visit, but were unaware of their role in assuring effective communication is achieved. A professional sign language interpreter was considered a last resort when all other means of communication failed. Gesturing, note-writing, lip-reading, and use of a familial interpreter were all considered facilitators. Interventions are needed at all levels of the SEM. Resources are needed to provide awareness of deaf communication issues and legal requirements for caring for deaf signers for practicing and student NPs. Protocols need to be developed and present in all healthcare facilities for hiring interpreters as well as quick access to contact information for these interpreters. ©2017 American Association of Nurse Practitioners.

[Research and Implementation of Vital Signs Monitoring System Based on Cloud Platform].

PubMed

Yu, Man; Tan, Anzu; Huang, Jianqi

2018-05-30

Through analyzing the existing problems in the current mode, the vital signs monitoring information system based on cloud platform is designed and developed. The system's aim is to assist nurse carry out vital signs nursing work effectively and accurately. The system collects, uploads and analyzes patient's vital signs data by PDA which connecting medical inspection equipments. Clinical application proved that the system can effectively improve the quality and efficiency of medical care and may reduce medical expenses. It is alse an important practice result to build a medical cloud platform.

Adding navigation, artificial audition and vital sign monitoring capabilities to a telepresence mobile robot for remote home care applications.

PubMed

Laniel, Sebastien; Letourneau, Dominic; Labbe, Mathieu; Grondin, Francois; Polgar, Janice; Michaud, Francois

2017-07-01

A telepresence mobile robot is a remote-controlled, wheeled device with wireless internet connectivity for bidirectional audio, video and data transmission. In health care, a telepresence robot could be used to have a clinician or a caregiver assist seniors in their homes without having to travel to these locations. Many mobile telepresence robotic platforms have recently been introduced on the market, bringing mobility to telecommunication and vital sign monitoring at reasonable costs. What is missing for making them effective remote telepresence systems for home care assistance are capabilities specifically needed to assist the remote operator in controlling the robot and perceiving the environment through the robot's sensors or, in other words, minimizing cognitive load and maximizing situation awareness. This paper describes our approach adding navigation, artificial audition and vital sign monitoring capabilities to a commercially available telepresence mobile robot. This requires the use of a robot control architecture to integrate the autonomous and teleoperation capabilities of the platform.

Evaluation of Patient Handoff Methods on an Inpatient Teaching Service

PubMed Central

Craig, Steven R.; Smith, Hayden L.; Downen, A. Matthew; Yost, W. John

2012-01-01

Background The patient handoff process can be a highly variable and unstructured period at risk for communication errors. The morning sign-in process used by resident physicians at teaching hospitals typically involves less rigorous handoff protocols than the resident evening sign-out process. Little research has been conducted on best practices for handoffs during morning sign-in exchanges between resident physicians. Research must evaluate optimal protocols for the resident morning sign-in process. Methods Three morning handoff protocols consisting of written, electronic, and face-to-face methods were implemented over 3 study phases during an academic year. Study participants included all interns covering the internal medicine inpatient teaching service at a tertiary hospital. Study measures entailed intern survey-based interviews analyzed for failures in handoff protocols with or without missed pertinent information. Descriptive and comparative analyses examined study phase differences. Results A scheduled face-to-face handoff process had the fewest protocol deviations and demonstrated best communication of essential patient care information between cross-covering teams compared to written and electronic sign-in protocols. Conclusion Intern patient handoffs were more reliable when the sign-in protocol included scheduled face-to-face meetings. This method provided the best communication of patient care information and allowed for open exchanges of information. PMID:23267259

Multi-parameter vital sign database to assist in alarm optimization for general care units.

PubMed

Welch, James; Kanter, Benjamin; Skora, Brooke; McCombie, Scott; Henry, Isaac; McCombie, Devin; Kennedy, Rosemary; Soller, Babs

2016-12-01

Continual vital sign assessment on the general care, medical-surgical floor is expected to provide early indication of patient deterioration and increase the effectiveness of rapid response teams. However, there is concern that continual, multi-parameter vital sign monitoring will produce alarm fatigue. The objective of this study was the development of a methodology to help care teams optimize alarm settings. An on-body wireless monitoring system was used to continually assess heart rate, respiratory rate, SpO 2 and noninvasive blood pressure in the general ward of ten hospitals between April 1, 2014 and January 19, 2015. These data, 94,575 h for 3430 patients are contained in a large database, accessible with cloud computing tools. Simulation scenarios assessed the total alarm rate as a function of threshold and annunciation delay (s). The total alarm rate of ten alarms/patient/day predicted from the cloud-hosted database was the same as the total alarm rate for a 10 day evaluation (1550 h for 36 patients) in an independent hospital. Plots of vital sign distributions in the cloud-hosted database were similar to other large databases published by different authors. The cloud-hosted database can be used to run simulations for various alarm thresholds and annunciation delays to predict the total alarm burden experienced by nursing staff. This methodology might, in the future, be used to help reduce alarm fatigue without sacrificing the ability to continually monitor all vital signs.

Surgeon Reimbursements in Maxillofacial Trauma Surgery: Effect of the Affordable Care Act in Ohio.

PubMed

Khansa, Ibrahim; Khansa, Lara; Pearson, Gregory D

2016-02-01

Surgical treatment of maxillofacial injuries has historically been associated with low reimbursements, mainly because of the high proportion of uninsured patients. The Affordable Care Act, implemented in January of 2014, aimed to reduce the number of uninsured. If the Affordable Care Act achieves this goal, surgeons may benefit from improved reimbursement rates. The authors' purpose was to evaluate the effects of the Affordable Care Act on payor distribution and surgeon reimbursements for maxillofacial trauma surgery at their institution. A review of all patients undergoing surgery for maxillofacial trauma between January of 2012 and December of 2014 was conducted. Insurance status, and amounts billed and collected by the surgeon, were recorded. Patients treated before implementation of the Affordable Care Act were compared to those treated after. Five hundred twenty-three patients were analyzed. Three hundred thirty-four underwent surgery before implementation of the Affordable Care Act, and 189 patients underwent surgery after. After implementation of the Affordable Care Act, the proportion of uninsured decreased (27.2 percent to 11.1 percent; p < 0.001) and the proportion of patients on Medicaid increased (7.8 percent to 25.4 percent; p < 0.001). Overall surgeon reimbursement rate increased from 14.3 percent to 19.8 percent (p < 0.001). After implementation of the Affordable Care Act, we observed a significant reduction in the proportion of maxillofacial trauma patients who were uninsured. Surgeons' overall reimbursement rate increased. These trends should be followed over a longer term to determine the full effect of the Affordable Care Act.

39 CFR 776.8 - Scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... trails, or boardwalks, including signs, the primary purposes of which are public education... Architectural Barriers Act or postal accessibility standards; (3) Any facility construction project deemed...

Applying the plan-do-study-act model to increase the use of kangaroo care.

PubMed

Stikes, Reetta; Barbier, Denise

2013-01-01

To increase the rate of participation in kangaroo care within a level III neonatal intensive care unit. Preterm birth typically results in initial separation of mother and infant which may disrupt the bonding process. Nurses within the neonatal intensive care unit can introduce strategies that will assist parents in overcoming fears and developing relationships with their infants. Kangaroo care is a method of skin-to-skin holding that has been shown to enhance the mother-infant relationship while also improving infant outcomes. However, kangaroo care has been used inconsistently within neonatal intensive care unit settings. The Plan-Do-Study-Act Model was used as a framework for this project. Plan-Do-Study-Act Model uses four cyclical steps for continuous quality improvement. Based upon Plan-Do-Study-Act Model, education was planned, surveys were developed and strategies implemented to overcome barriers. Four months post-implementation, the use of kangaroo care increased by 31%. Staff surveys demonstrated a decrease in the perceived barriers to kangaroo care as well as an increase in kangaroo care. Application of Plan-Do-Study-Act Model was successful in meeting the goal of increasing the use of kangaroo care. The use of the Plan-Do-Study-Act Model framework encourages learning, reflection and validation throughout implementation. Plan-Do-Study-Act Model is a strategy that can promote the effective use of innovative practices in nursing. © 2013 Blackwell Publishing Ltd.

[Evaluation of the actions increasing health accessibility for deaf pregnant patients].

PubMed

Equy, V; Derore, A; Vassort, N; Mongourdin, B; Sergent, F

2012-10-01

Deafness concerns about 7% of the French population. In this context, the clinic of obstetrics and gynecology of Grenoble teaching hospital established two adaptation actions in the pregnant signing-deaf patient's management: a partnership with French Sign Language interpreters from the deaf patient reception and care unit, and sign language training for nine professionals. The aim of this study is to evaluate this patient management and to propose some potential improvements. This descriptive study is made through information from both numeric and paper files of 22 deaf pregnant patients. A significant adaptation of patient management during scheduled consultations and hospitalisation in the clinic is observed, whereas adaptation rate is weak for emergency situations. The patient management adaptation turns out to be perfectible, through the anticipation of the entire pregnancy consultation schedule. In emergency situations, the creation of a sign language interpreter on-call duty would greatly improve the health care access of these patients. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Kangaroo care with twins: a case study in which one infant did not respond as expected.

PubMed

Jarrell, Julia R; Ludington-Hoe, Susan M; Abouelfettoh, Amel

2009-01-01

The purposes were to relate responses (including unacceptable ones) of twins to shared kangaroo care (KC), to provide explanations for the unexpected responses, and to offer suggestions for safe nursing practice. A descriptive, evaluative case study was conducted. Both twins received KC while their vital signs and maternal breast temperatures were manually recorded every 30 seconds. Descriptive statistics were computed. Identical twins, born to a 19-year-old African-American primigravada, were 34 3/7 weeks postconceptional age with weights of 1,760 and 1,480 g, respectively, when tested. Preterm labor resulted in spontaneous vaginal birth at 30 weeks gestation. Infant heart and respiratory rates, oxygen saturations, abdominal temperatures, and maternal breast temperatures. Infant A's vital signs exceeded acceptable clinical limits during shared KC; vital signs returned to normal range once Infant A was returned to the incubator. Infant B's vital signs approximated clinically acceptable ranges throughout the session. Breast temperatures did not differ. Individuality mandates vigilant assessment of infant responses to shared KC.

The Feasibility of Digital Pen and Paper Technology for Vital Sign Data Capture in Acute Care Settings

PubMed Central

Dykes, Patricia C.; Benoit, Angela; Chang, Frank; Gallagher, Joan; Li, Qi; Spurr, Cindy; McGrath, E. Jan; Kilroy, Susan M.; Prater, Marita

2006-01-01

The transition from paper to electronic documentation systems in acute care settings is often gradual and characterized by a period in which paper and electronic processes coexist. Intermediate technologies are needed to “bridge” the gap between paper and electronic systems as a means to improve work flow efficiency through data acquisition at the point of care in structured formats to inform decision support and facilitate reuse. The purpose of this paper is to report on the findings of a study conducted on three acute care units at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston, MA to evaluate the feasibility of digital pen and paper technology as a means to capture vital sign data in the context of acute care workflows and to make data available in a flow sheet in the electronic medical record. PMID:17238337

The feasibility of digital pen and paper technology for vital sign data capture in acute care settings.

PubMed

Dykes, Patricia C; Benoit, Angela; Chang, Frank; Gallagher, Joan; Li, Qi; Spurr, Cindy; McGrath, E Jan; Kilroy, Susan M; Prater, Marita

2006-01-01

The transition from paper to electronic documentation systems in acute care settings is often gradual and characterized by a period in which paper and electronic processes coexist. Intermediate technologies are needed to "bridge" the gap between paper and electronic systems as a means to improve work flow efficiency through data acquisition at the point of care in structured formats to inform decision support and facilitate reuse. The purpose of this paper is to report on the findings of a study conducted on three acute care units at Brigham and Women's Hospital and Massachusetts General Hospital in Boston, MA to evaluate the feasibility of digital pen and paper technology as a means to capture vital sign data in the context of acute care workflows and to make data available in a flow sheet in the electronic medical record.

Autism: Why Act Early?

MedlinePlus

... Emergency Preparedness & Response Environmental Health Healthy Living Injury, Violence & Safety Life Stages & Populations Travelers’ Health Workplace Safety & Health Features Media Sign up for Features Get Email Updates To ...

Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective longitudinal cohort study

PubMed Central

Hui, David; dos Santos, Renata; Chisholm, Gary; Bansal, Swati; Crovador, Camila Souza; Bruera, Eduardo

2014-01-01

Background We recently reported 5 highly specific physical signs associated with death within 3 days among cancer patients that may aid the diagnosis of impending death. In this study, we examined the frequency and onset of an additional 52 bedside physical signs and their diagnostic performance for impending death. Methods We enrolled 357 consecutive patients with advanced cancer admitted to acute palliative care units at two tertiary care cancer centers. We systematically documented 52 physical signs every 12 hours from admission to death or discharge. We examined the frequency and median time of onset of each sign from death backwards, and calculated their likelihood ratios (LRs) associated with death in 3 days. Results 203/357 (57%) patients died at the end of the admission. We identified 8 physical signs that were highly diagnostic of impending death. These signs occurred in 5-78% of patients in the last 3 days of life, had a late onset, and had a high specificity (>95%) and high positive LR for death within 3 days, including non-reactive pupils (positive LR 16.7, 95% confidence interval 14.9-18.6), decreased response to verbal stimuli (8.3, 7.7-9), decreased response to visual stimuli (6.7, 6.3-7.1), inability to close eyelids (13.6, 11.7-15.5), drooping of nasolabial fold (8.3, 7.7-8.9), hyperextension of neck (7.3, 6.7-8), grunting of vocal cords (11.8, 10.3-13.4), and upper gastrointestinal bleed (10.3, 9.5-11.1). Conclusion We identified 8 highly specific physical signs associated with death within 3 days in cancer patients. These signs may inform the diagnosis of impending death. PMID:25676895

Sign Lowering and Phonetic Reduction in American Sign Language.

PubMed

Tyrone, Martha E; Mauk, Claude E

2010-04-01

This study examines sign lowering as a form of phonetic reduction in American Sign Language. Phonetic reduction occurs in the course of normal language production, when instead of producing a carefully articulated form of a word, the language user produces a less clearly articulated form. When signs are produced in context by native signers, they often differ from the citation forms of signs. In some cases, phonetic reduction is manifested as a sign being produced at a lower location than in the citation form. Sign lowering has been documented previously, but this is the first study to examine it in phonetic detail. The data presented here are tokens of the sign WONDER, as produced by six native signers, in two phonetic contexts and at three signing rates, which were captured by optoelectronic motion capture. The results indicate that sign lowering occurred for all signers, according to the factors we manipulated. Sign production was affected by several phonetic factors that also influence speech production, namely, production rate, phonetic context, and position within an utterance. In addition, we have discovered interesting variations in sign production, which could underlie distinctions in signing style, analogous to accent or voice quality in speech.

Structured physical exercise improves neuropsychiatric symptoms in acute dementia care: a hospital-based RCT.

PubMed

Fleiner, Tim; Dauth, Hannah; Gersie, Marleen; Zijlstra, Wiebren; Haussermann, Peter

2017-08-29

The primary objective of this trial is to investigate the effects of a short-term exercise program on neuropsychiatric signs and symptoms in acute hospital dementia care. Within a hospital-based randomized controlled trial, the intervention group conducted a 2-week exercise program with four 20-min exercise sessions on 3 days per week. The control group conducted a social stimulation program. Effects on neuropsychiatric signs and symptoms were measured via the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change, the Neuropsychiatric Inventory, and the Cohen-Mansfield Agitation Inventory. The antipsychotic and sedative dosage was quantified by olanzapine and diazepam equivalents. Eighty-five patients were randomized via minimization to an intervention group (IG) and a control group (CG). Seventy patients (82%) (mean age 80 years, 33 females, mean Mini Mental State Examination score 18.3 points) completed the trial. As compared to the CG (n = 35), the IG (n = 35) showed significantly reduced neuropsychiatric signs and symptoms. Especially, agitated behavior and lability improved. There were no between-group differences concerning antipsychotic and benzodiazepine medication. This exercise program is easily applicable in hospital dementia care and significantly reduces neuropsychiatric signs and symptoms in patients suffering from predominantly moderate stages of dementia. German Clinical Trial Register DRKS00006740 . Registered 28 October 2014.

Two hundred and thirteen cases of marijuana toxicoses in dogs.

PubMed

Janczyk, Pawel; Donaldson, Caroline W; Gwaltney, Sharon

2004-02-01

Marijuana (Cannabis sativa) is a commonly used recreational drug among humans; animals may be exposed following ingestion or accidental inhalation of smoke. From January 1998 to January 2002, 213 incidences were recorded of dogs that developed clinical signs following oral exposure to marijuana, with 99% having neurologic signs, and 30% exhibiting gastrointestional signs. The marijuana ingested ranged from 1/2 to 90 g. The lowest dose at which signs occurred was 84.7 mg/kg and the highest reported dose was 26.8 g/kg. Onset of signs ranged from 5 min to 96 h, with most signs occurring within 1 to 3 h after ingestion. The signs lasted from 30 min to 96 h. Management consisted of decontamination, sedation (with diazepam as drug of choice), fluid therapy, thermoregulation and general supportive care. All followed animals made full recoveries.

Space Policy Directive - 1 Signing

NASA Image and Video Library

2017-12-11

Vice President Mike Pence speaks before President Donald Trump signs Space Policy Directive - 1, directing NASA to return to the moon, alongside President Donald Trump. left, Acting NASA Administrator Robert Lightfoot, second left, NASA astronaut Peggy Whitson, third from left, NASA astronaut Christina Koch, right, and members of the Senate, Congress, and commercial space companies in the Roosevelt room of the White House in Washington, Monday, Dec. 11, 2017. Photo Credit: (NASA/Aubrey Gemignani)

CDC Vital Signs: Child Injury

MedlinePlus

... first aid training). Health care systems can Use technology, such as electronic medical records, to improve the speed and quality of care for injured children, and to monitor the number and severity of ...

75 FR 76732 - Sunshine Act Notices

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-09

... Federal Election Account Individuals who plan to attend and require special assistance, such as sign language interpretation or other reasonable accommodations, should contact Shawn Woodhead Werth, Commission...

"No Child Left Behind": Expanding the Promise. Guide to President Bush's FY 2006 Education Agenda

ERIC Educational Resources Information Center

US Department of Education, 2005

2005-01-01

Three years ago, President George W. Bush signed into law the No Child Left Behind Act (NCLB), which reauthorized the Elementary and Secondary Education Act (ESEA). The new law reflected an unprecedented, bipartisan commitment to ensuring that all students, regardless of background, have the opportunity to obtain a quality education and reach…

12 CFR 205.4 - General disclosure requirements; jointly offered services.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Signatures in Global and National Commerce Act (E-Sign Act) (15 U.S.C. 7001 et seq.). A financial institution.... A financial institution may combine the required disclosures into a single statement for a consumer... with the requirements that this part imposes on any or all of them. An institution need make only the...

ServiceNation: A Call to Higher Education

ERIC Educational Resources Information Center

Jacoby, Barbara

2009-01-01

The Serve America Act was signed into law in April 2009. The Act provides for many opportunities to serve and learn for pre-college youth, college students and graduates, and even baby boomers. It dramatically increases intensive service opportunities by setting AmeriCorps on a path from 75,000 positions annually to 250,000 by 2017, focusing that…

Update on the Federal Stimulus Package and Funding to Higher Education. Report 09-19

ERIC Educational Resources Information Center

Jones, Jessika

2009-01-01

On February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act of 2009 (ARRA). The Act commits $100 billion to education, with $8.5 billion allocated to California. Education programs to receive funding through ARRA include Local Education Agency Title I Grants, Educational Technology Grants, IDEA Grants, Federal…

Investing Wisely and Quickly: Use of ARRA Funds in America's Great City Schools

ERIC Educational Resources Information Center

Naik, Manish; Yorkman, Michell; Casserly, Michael

2010-01-01

President Obama signed the American Recovery and Reinvestment Act of 2009 (the Recovery Act or ARRA) into law on February 17, 2009. This federal stimulus package provided an unprecedented infusion of new education aid for the nation's schools--more than $100 billion. To determine how the unprecedented federal infusion of education funding was…

Implementation of the Service Contract Act of 1965.

DTIC Science & Technology

1980-12-01

67 A. BACKGROUND ------------------------------------------ 67 B. RESULTS ----------------------------------------------- 69 C. A...the contractor liable for any resulting cost to the United States; authority for the Secretary of Labor to list and withhold awarding further contracts...contracts subject to the Act. As a result of these Hearings, a proposed amendment to the SCA was introduced, passed and signed into law by President

Out of the Woods: The Making of the Maine Indian Claims Settlement Act

ERIC Educational Resources Information Center

Kotlowski, Dean J.

2006-01-01

"Maine appears out of the woods," the editor of the "Lewiston Evening Journal" opined, after President Jimmy Carter signed the Maine Indian Claims Settlement Act in 1980. That sigh of relief was heartfelt. During the 1970s, two Native American tribes, the Passamaquoddies and Penobscots, had sparked a long, statewide nightmare…

Learning from the Past: What ESSA Has the Chance to Get Right

ERIC Educational Resources Information Center

Dennis, Danielle V.

2017-01-01

Signed into law by President Barack Obama in December 2015, the Every Student Succeeds Act (ESSA) replaces No Child Left Behind (NCLB), the 2001 reauthorization of the Elementary and Secondary Education Act. NCLB and its Reading First mandate brought punitive accountability models and scripted core curricula into schools. Based on the language of…

Establishment of effective control factors to achieve federal enforcement consistency with the Highway Beautification Act : a final report submitted to Florida Department of Transportation, Right of Way Division.

DOT National Transportation Integrated Search

2017-10-01

The Highway Beautification Act, which was enforced in 1965, aims to establish an efficient outdoor advertising control (OAC) program for erection and maintenance of the outdoor advertising signs, displays and devices, which are located in a close pro...

Leadership Behaviors for Continuous School Improvement

ERIC Educational Resources Information Center

Williams, Florence S.

2011-01-01

In an effort to improve student achievement in our nation's public schools, former President George W. Bush signed into law the No Child Left Behind (NCLB) Act of 2001. The NCLB Act requires that each State Department of Education establishes a set of standards for student achievement with a grading system for making adequate yearly progress (AYP)…

An Ongoing Experiment: State Councils, the Humanities, and the American Public

ERIC Educational Resources Information Center

Lynn, Elizabeth; Levine, Peter

2013-01-01

In 1965, President Johnson signed the National Foundation on the Arts and Humanities Act, giving birth to the National Endowment for the Humanities and the National Endowment for the Arts. The act declared, "Democracy demands wisdom and vision in its citizens. It must therefore foster and support a form of education, and access to the arts…

78 FR 36638 - Unblocking of Specially Designated Nationals and Blocked Persons Pursuant to the Foreign...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-18

... December 3, 1999, the Kingpin Act was signed into law by the President of the United States. The Kingpin Act provides a statutory framework for the President to impose sanctions against significant foreign... by the President. In addition, the Secretary of the Treasury consults with the Attorney General, the...

Coordinating Postsecondary Education and the Public Workforce System in Workforce Planning. Policy Insights

ERIC Educational Resources Information Center

Bransberger, Peace

2015-01-01

In July 2014, President Obama signed into law the Workforce Innovation and Opportunity Act (WIOA), a major restructuring and modernization of U.S. workforce development programs originally created through the Workforce Investment Act of 1998 (WIA), which had been awaiting reauthorization for more than a decade. This brief provides an overview of…

Therapeutic touch: influence on vital signs of newborns

PubMed Central

Ramada, Nadia Christina Oliveira; Almeida, Fabiane de Amorim; Cunha, Mariana Lucas da Rocha

2013-01-01

ABSTRACT Objective>: To compare vital signs before and after the therapeutic touch observed in hospitalized newborns in neonatal intensive care unit. Methods: This was a quasi-experimental study performed at a neonatal intensive care unit of a municipal hospital, in the city of São Paulo (SP), Brazil. The sample included 40 newborns submitted to the therapeutic touch after a painful procedure. We evaluated the vital signs, such as heart and respiratory rates, temperature and pain intensity, before and after the therapeutic touch. Results: The majority of newborns were male (n=28; 70%), pre-term (n=19; 52%) and born from vaginal delivery (n=27; 67%). Respiratory distress was the main reason for hospital admission (n=16; 40%). There was a drop in all vital signs after therapeutic touch, particularly in pain score, which had a considerable reduction in the mean values, from 3.37 (SD=1.31) to 0 (SD=0.0). All differences found were statistically significant by the Wilcoxon test (p<0.05). Conclusion: The results showed that therapeutic touch promotes relaxation of the baby, favoring reduction in vital signs and, consequently in the basal metabolism rate. PMID:24488378

Modelling physiological deterioration in post-operative patient vital-sign data.

PubMed

Pimentel, Marco A F; Clifton, David A; Clifton, Lei; Watkinson, Peter J; Tarassenko, Lionel

2013-08-01

Patients who undergo upper-gastrointestinal surgery have a high incidence of post-operative complications, often requiring admission to the intensive care unit several days after surgery. A dataset comprising observational vital-sign data from 171 post-operative patients taking part in a two-phase clinical trial at the Oxford Cancer Centre, was used to explore the trajectory of patients' vital-sign changes during their stay in the post-operative ward using both univariate and multivariate analyses. A model of normality based vital-sign data from patients who had a "normal" recovery was constructed using a kernel density estimate, and tested with "abnormal" data from patients who deteriorated sufficiently to be re-admitted to the intensive care unit. The vital-sign distributions from "normal" patients were found to vary over time from admission to the post-operative ward to their discharge home, but no significant changes in their distributions were observed from halfway through their stay on the ward to the time of discharge. The model of normality identified patient deterioration when tested with unseen "abnormal" data, suggesting that such techniques may be used to provide early warning of adverse physiological events.

Signs and Symptoms of Early Pregnancy Loss

PubMed Central

Sapra, Katherine J.; Joseph, K.S.; Galea, Sandro; Bates, Lisa M.; Louis, Germaine M. Buck; Ananth, Cande V.

2016-01-01

Approximately one-third of pregnancies end in loss; however, the natural history of early pregnancy loss, including signs and symptoms preceding loss, has yet to be fully described and its underlying mechanisms fully understood. We searched PubMed/MEDLINE and Embase to identify articles with prospective ascertainment of signs and symptoms, including vaginal bleeding, nausea, and vomiting, of pregnancy loss < 20 weeks gestation in spontaneous conceptions to ascertain existing literature on symptomatology of pregnancy loss. Two preconception and 16 pregnancy cohort studies that ascertained information on bleeding and/or nausea/vomiting prior to pregnancy loss ascertainment were included. Data from these studies indicated increased risk of loss with vaginal bleeding and decreased risk of loss with nausea/vomiting, though these studies were mostly comprised of pregnancies surviving into late first trimester. While such associations are biologically plausible, these study designs are subject to bias, given recruitment of women at later gestational ages and reliance on women presenting to care. Reporting symptoms to clinicians and over long periods may introduce reporting error. Data gaps remain regarding (1) relationships between signs and symptoms and losses occurring very early, prior to care entry; (2) empirical testing of whether relationships between signs and symptoms and loss differ across gestational age; (3) whether similar relationships between signs and symptoms and loss are observed in populations using assisted reproductive technologies; (4) the patterning of multiple signs and symptoms in relation to loss; and (5) how hormonal and physiologic adaptions to early pregnancy relate to symptomatology and pregnancy loss. PMID:27342274

Signs and Symptoms of Early Pregnancy Loss.

PubMed

Sapra, Katherine J; Joseph, K S; Galea, Sandro; Bates, Lisa M; Louis, Germaine M Buck; Ananth, Cande V

2017-04-01

Approximately one-third of pregnancies end in loss; however, the natural history of early pregnancy loss, including signs and symptoms preceding loss, has yet to be fully described and its underlying mechanisms fully understood. We searched PubMed/MEDLINE and Embase to identify articles with prospective ascertainment of signs and symptoms, including vaginal bleeding, nausea, and vomiting, of pregnancy loss < 20 weeks gestation in spontaneous conceptions to ascertain existing literature on symptomatology of pregnancy loss. Two preconception and 16 pregnancy cohort studies that ascertained information on bleeding and/or nausea/vomiting prior to pregnancy loss ascertainment were included. Data from these studies indicated increased risk of loss with vaginal bleeding and decreased risk of loss with nausea/vomiting, though these studies were mostly comprised of pregnancies surviving into late first trimester. While such associations are biologically plausible, these study designs are subject to bias, given recruitment of women at later gestational ages and reliance on women presenting to care. Reporting symptoms to clinicians and over long periods may introduce reporting error. Data gaps remain regarding (1) relationships between signs and symptoms and losses occurring very early, prior to care entry; (2) empirical testing of whether relationships between signs and symptoms and loss differ across gestational age; (3) whether similar relationships between signs and symptoms and loss are observed in populations using assisted reproductive technologies; (4) the patterning of multiple signs and symptoms in relation to loss; and (5) how hormonal and physiologic adaptions to early pregnancy relate to symptomatology and pregnancy loss.

Visualization of the inferoposterior thoracic wall (VIP) and boomerang signs-novel sonographic signs of right pleural effusion.

PubMed

Lau, James Siu Ki; Yuen, Chi Kit; Mok, Ka Leung; Yan, Wing Wa; Kan, Pui Gay

2017-11-15

This study is to present the diagnostic values of the novel sonographic visualization of the inferoposterior thoracic wall (VIP) and boomerang signs in detecting right pleural effusion by sonologists with little to no experience in ultrasound. A prospective analysis of a convenience sample of patients who were assessed by junior intensive care physicians was performed. The patients all underwent computed tomography (CT) of the chest or abdomen with lung bases as part of their care regardless of indication; the results were interpreted by radiologists and were considered the gold standard. Sonography was performed to assess for the presence of the VIP and boomerang signs. Sonographic and chest radiographic findings were compared against CT results. 73 patients were enrolled. The sensitivity and specificity for the VIP sign were 0.85 (95% confidence interval [CI], 0.67-0.94) and 0.86 (95% CI, 0.70-0.95). The sensitivity and specificity for the boomerang sign were 0.78 (95% CI, 0.60-0.90) and 0.87 (95% CI, 0.71-0.95). However, the sensitivity and specificity for the traditional approach of detecting an anechoic collection above the diaphragm to indicate pleural effusion were only 0.54 (95% CI, 0.37-0.71) and 0.86 (95% CI, 0.80-0.99). Despite inexperience in sonography, the novel VIP and boomerang signs show high diagnostic values in detecting right pleural effusion compared to the traditional methods. Copyright © 2017 Elsevier Inc. All rights reserved.

Capitation: strategies for success with managed care contracts.

PubMed

Kuklierus, A

1997-01-01

With enrollments in HMOs increasing at double digit rates, independent practice associations, integrated medical groups, hospitals and specialty networks are experiencing a substantial increase in the share of their business paid for through capitation. Experience has shown that once one contract is signed, many are sure to follow. Providers must make sure each contract signed is financially sound for the organization. Then they must be able to manage and monitor contracts long after the ink is dry. This column provides a brief overview ad list of pointers for organizations moving into the managed care arena.

The Care Manager's Dilemma: Balancing Human Rights with Risk Management under the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003

ERIC Educational Resources Information Center

Prebble, Kate; Diesfeld, Kate; Frey, Rosemary; Sutton, Daniel; Honey, Michelle; Vickery, Russell; McKenna, Brian

2013-01-01

In New Zealand, the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 provides diversion for persons with an intellectual disability who have been charged with, or convicted of, a criminal offence. This unique Act moves the responsibility for such "care recipients" from the criminal justice system to a disability…

A single activity with a practice quality improvement project for faculty and a quality improvement project for residents.

PubMed

Kim, Hyun; Malatesta, Theresa M; Simone, Nicole L; Den, Robert B; McAna, John; Dicker, Adam P; Bar Ad, Voichita

2016-01-01

The Next Accreditation System (NAS) requires radiation oncology residents to do a formal quality improvement project during their residency. The American Board of Radiology (ABR) Maintenance of Certification (MOC) program requires certified physicians to complete a Practice Quality Improvement (PQI) project approximately every 3 years. The purpose of our project was to develop a clinical transition of care policy via a process that resulted in quality improvement project credit for residents and PQI credit for participating faculty. Approval for project implementation was obtained from the ABR MOC committee. The PQI project consisted of an initial survey to assess resident perception on resident transition of care in our department, formal sign-out training, and 2 postintervention surveys after 1 and 11 months. The primary endpoint was the percentage of questions with ≤1 unfavorable responses. Sign-test was used to determine response difference from neutral. One hundred percent of surveyed residents completed the preintervention (n = 6), postintervention 1 (n = 7), and postintervention 2 (n = 8) surveys. In the preintervention, postintervention 1, and postintervention 2 surveys, 71.4%, 57.1%, and 57.1% of questions were answered with ≤1 unfavorable response, respectively. The number of questions with ≥75% favorable response was 7 (50%), 7 (50%), and 11 (78.5%) in the preintervention, postintervention 1, and postintervention 2 surveys, respectively (P = .13). A written sign-out template and monthly protected sign-out meetings were instituted. One resident and 3 attending physicians received credit for Accreditation Council of Graduate Medical Education NAS quality improvement and ABR MOC PQI projects, respectively. This project shows the feasibility of a combined attending and resident physician effort to improve patient care and fulfill his or her respective ABR MOC PQI and Accreditation Council of Graduate Medical Education NAS requirements. Attending and resident physicians can tailor collaborative projects to fulfill MOC and NAS requirements unique to their subspecialty. Written sign-out templates and protected sign-out time may improve transition of care. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

75 FR 32480 - Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-08

... Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title VI Native American Programs Purpose of Notice: Availability of funding opportunity announcement. Funding Opportunity Title/Program Name: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title...

For PSOs, it's ... ready, set, go!

PubMed

Weissenstein, E

1997-11-24

With the signing of the federal balanced-budget act earlier this year, the long-awaited era of the provider-sponsored organization is here. The legislation contained a provision giving the green light for Medicare PSOs, an option sought for years by hospitals and other providers. If the rhetoric about PSOs is to be believed, the organizations are the next generation of managed-care plans, ones that are locally controlled and operated by providers, not remote insurance companies. To many in the industry, this idea has become the last best hope for provider-directed healthcare. The government is scheduled to issue the rules for PSO financial solvency and operation this spring so providers can begin forming their organizations. But before they can accomplish anything, PSOs must be sold to consumers and to regulators. In this issue, we examine the marketing and financing of a new breed of healthcare organization.

Acoustical criteria for hospital patient rooms: Resolving competing requirements

NASA Astrophysics Data System (ADS)

Brooks, Bennett M.

2003-10-01

The acoustical criteria for patient rooms in hospitals, nursing homes, and rehabilitation facilities may be based on several needs. One important requirement is that noise levels in the room be conducive to restful sleep. Also, caregivers must have easy auditory and visual access to the patients, and be able to hear vital sign monitor alarms. This often means that patient rooms are located near central nurse stations and that patient room doors are left open. Further, the recently published federal privacy standards developed by the U.S. Department of Health and Human Services (HSS) under the Health Insurance Portability and Accountability Act (HIPAA) require that ``appropriate physical safeguards'' be put in place to protect the confidentiality of patient health information. The simultaneous and competing requirements for speech privacy, caregiver access, and good sleeping conditions present a serious acoustical challenge to health care facility designers. Specific facility design issues and potential solution strategies are presented.

Precautionary policies in local government: green chemistry and safer alternatives.

PubMed

Raphael, Debbie O; Geiger, Chris A

2011-01-01

Local governments like the City and County of San Francisco have shouldered the burden of toxic chemicals released into the environment through the substantial costs of health care, environmental cleanup, and infrastructure to purify drinking water, manage wastewater, and manage solid waste. Cities can no longer afford to wait for federal regulation to prevent toxic chemicals from appearing in products used locally. San Francisco's Precautionary Principle Policy calls on the City to act on early warning signs of harm and to use the best available science to identify safer alternatives. Under its umbrella, a wide array of policy tools have been utilized including financial incentives through procurement contracts, certification and promotion of safer business practices, requirements for information disclosure, and bans and restrictions on the sale of products when safer alternatives are readily available. These policies can often become the models for regional, state, and national change.

Adaptation of neurological practice and policy to a changing US health-care landscape.

PubMed

Gorelick, Philip B

2016-04-01

Health care in the USA is undergoing a drastic transformation under the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act is driving major health-care policy changes by connecting payment for traditional health-care services to value-based care initiatives and emphasising population health and innovative mechanisms to deliver care. Under the Patient Protection and Affordable Care Act, neurological practice will need to adapt and transform. Therefore, neurological policy should consider employing a new framework for neurological residency training, developing interdisciplinary team approaches to neurological subspecialty care, and strengthening the primary care-neurological specialty care interface to avoid redundancies and other medical waste. Additionally, neurological policy will need to support a more robust review of diagnostic and care pathway use to reduce avoidable expenditures, and test and implement bundled payments for key neurological diagnoses. In view of an anticipated 19% shortage of US neurologists in the next 10 years, development of new neurological policy under the Patient Protection and Affordable Care Act is paramount. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Retrospective Case Series of Surgical Implant Generation Network (SIGN) Placement at the Afghan National Police Hospital, Kabul, Afghanistan.

PubMed

Ertl, Christian W; Royal, David; Arzoiey, Humayoon Abdul; Shefa, Azizullah; Sultani, Salim; Mosafa, Mohammed Omar; Sadat, Safiullah; Zirkle, Lewis

2016-01-01

In Afghanistan, adequate and cost-effective medical care for even routine conditions is lacking; especially for complex injuries like long-bone fractures. The Surgical Implant Generation Network (SIGN) intramedullary nail is used for treatment of long-bone fractures from blunt injuries and does not require imaging. We are reporting for the first time results of the SIGN intramedullary nail at the Afghan National Police Hospital, a tertiary care facility in Kabul. 71 records from the SIGN Online Surgical Database were reviewed for gender, age, date of injury, implant date, patient's home of record, and type/ mechanism of injury. Mean age was 26.7 years, all but one being male; time from injury to implant ranged 1 to 401 days, with mean of 40.6 days. Long-bone fractures from motor vehicle accidents remained constant, and war injuries peaked in summer. Follow-up is limited because of security and financial burdens of travel. However, personal communication with Afghan National Police Hospital surgeons suggests that patients included in the current study have not experienced any adverse outcomes. While it remains to be seen if the SIGN Online Surgical Database will facilitate more comprehensive outcome studies, our results provide support for the efficacy of SIGN nails in treating long-bone fractures from war injuries. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Point-of-Care Ultrasound: Sonographic Posterior Fat Pad Sign: A Case Report and Brief Literature Review.

PubMed

Okumura, Yoshito; Maldonado, Nestor; Lennon, Kyle; McCarty, Bryan; Underwood, Philipp; Nelson, Mathew

2017-07-01

Diagnosis of elbow fracture can sometimes be difficult with plain radiography due to overlapping bones, growth plates, and maturing bones in the pediatric population. The radiographic posterior fat pad (PFP) sign is one of the frequently referenced indirect signs of an occult elbow fracture. This sign can be falsely negative if the sign is subtle, and can be falsely positive when the position of the elbow is not flexed at 90 degrees. We discuss a case in which sonographic PFP sign helped to diagnose an elbow fracture. A 57-year-old female presented to the emergency department (ED) after a fall on an outstretched hand. The point-of-care ultrasound (POCUS) was completed identifying an elevated PFP and an anechoic joint fluid collection with innumerous floating hyperechogenic spicules visualized in the olecranon fossa. Diagnosis of a radial head fracture was later confirmed by plain radiograph. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The increase in use and availability of POCUS in the ED makes this a very practical application. Our ability to rapidly perform the ultrasound of the elbow may allow us a more rapid diagnosis of pathology, as well as provide a way to further triage our patients. With time, it may even allow us to avoid routine use of plain radiography. Copyright © 2017 Elsevier Inc. All rights reserved.

Working with the Mental Capacity Act: findings from specialist palliative and neurological care settings.

PubMed

Wilson, Eleanor; Seymour, Jane E; Perkins, Paul

2010-06-01

Since October 2007 staff across health and social care services in England and Wales have been guided by the Mental Capacity Act (2005) in the provision of care for those who may lack capacity to make some decisions for themselves. This paper reports on the findings from a study with 26 staff members working in three palliative and three neurological care centres. Semistructured interviews were used to gain an understanding of their knowledge of the Mental Capacity Act, the issue of capacity itself and the documentation processes associated with the introduction of the Act and in line with advance care planning. Within this setting advance care planning is a key part of care provision and the mental capacity of service users is a regular issue. Findings show that staff generally had a good understanding of issues around capacity but felt unclear about some of the terminology related to the Mental Capacity Act, impacting on their confidence to discuss issues with service users and complete the documentation. Many felt the Act and its associated documentation had aided record-keeping in an area staff already delivered well in practice. Advance care planning in the context of the Mental Capacity Act is not as well embedded in practice as providers would like and consideration needs to be given to how and when staff should approach these issues with service users.

The Meaning of Signs:

PubMed Central

Stein, Claudia

2006-01-01

This article reconstructs the diagnostic act of the French pox in the French-disease hospital of sixteenth-century Augsburg. It focuses on how the participants in the clinical encounter imagined the configuration of the pox and its localization in the human body. Of central importance for answering this question is the early modern conception of physical signs. It has been argued that it was due to a specific understanding of bodily signs and their relationship to a disease and its causes, that disease definition and classification in the early modern period showed a high degree of flexibility and fluidity. This paper looks at how the sixteenth-century theoretical conception of physical signs not only shaped the diagnosis and treatment of the pox but also reflected the overall organization of institutions. PMID:17242549

Translations on Eastern Europe Political, Sociological, and Military Affairs, Number 1424

DTIC Science & Technology

1977-07-28

at hand. The international atmosphere, however, has been marked already for quite a while by the sign of preparations for that so far only...while others still have not been touched since the signing of the Final Act. A deliberate approach is needed particularly in this period which is...injurious activity, the actions of psychopaths and other mentally ill persons are not always innocuous and harmless. If their aberrant convictions about

77 FR 26046 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-02

... for OMB Review; Comment Request; Affordable Care Act Internal Claims and Appeals and External Review...) titled, ``Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non... provisions of the Affordable Care Act pertaining to internal claims and appeals, and the external review...

76 FR 20352 - Notice of Intent To Award Affordable Care Act (ACA) Funding

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-12

... Intent To Award Affordable Care Act (ACA) Funding Notice of Intent to award Affordable Care Act (ACA) funding to two Emerging Infections Program (EIP) grantees, the Connecticut Department of Public Health and... grantees' Fiscal Year (FY) 2011 non-competitive continuation applications under funding opportunity CI05...

76 FR 20354 - Notice of Intent To Award Supplemental Affordable Care Act Funding

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-12

... Intent To Award Supplemental Affordable Care Act Funding Notice of Intent to award supplemental Affordable Care Act funding to support enhancement of an existing laboratory fellowship training program through funding opportunity CDC-RFA-HM10-1001, ``APHL--CDC Partnership for Quality Laboratory Practice...

Patient Protection and Affordable Care Act; program integrity: Exchange, SHOP, and eligibility appeals. Final rule.

PubMed

2013-08-30

This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, this final rule outlines Exchange standards with respect to eligibility appeals, agents and brokers, privacy and security, issuer direct enrollment, and the handling of consumer cases. It also sets forth standards with respect to a State's operation of the Exchange and Small Business Health Options Program (SHOP). It generally is finalizing previously proposed policies without change.

GAO audit not apt to find pervasive fraud in CARE Act.

PubMed

1999-12-24

After hearing a series of news reports suggesting financial improprieties in programs run by Ryan White CARE Act recipients, a General Accounting Office (GAO) review of the program was made. A preliminary GAO report found only a few cases of fraud in the administration of funding stemming from the CARE Act, but that the potential for fraud is very real because of the lack of safeguards. These findings are considered important since the House Commerce Committee is expected to conduct oversight hearings into further authorization of the CARE Act early in 2000.

Patient Protection and Affordable Care Act; establishment of exchanges and qualified health plans; Small Business Health Options Program. Final rule.

PubMed

2013-06-04

This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act) related to the Small Business Health Options Program (SHOP). Specifically, this final rule amends existing regulations regarding triggering events and special enrollment periods for qualified employees and their dependents and implements a transitional policy regarding employees' choice of qualified health plans (QHPs) in the SHOP.

Whose Choice? Developing a Unifying Ethical Framework for Conscience Laws in Health Care.

PubMed

Brown, Benjamin P; Hasselbacher, Lee; Chor, Julie

2016-08-01

Since abortion became legal nationwide, federal and state "conscience clauses" have been established to define the context in which health professionals may decline to participate in contested services. Patients and health care providers may act according to conscience in making health care decisions and in deciding whether to abstain from or to participate in contested services. Historically, however, conscience clauses largely have equated conscience in health care with provider abstinence from such services. We propose a framework to analyze the ethical implications of conscience laws. There is a rich literature on the exercise of conscience in the clinical encounter. This essay addresses the need to ensure that policy, too, is grounded in an ethical framework. We argue that the ideal law meets three standards: it protects patients' exercise of conscience, it safeguards health care providers' rights of conscience, and it does not contradict standards of ethical conduct established by professional societies. We have chosen Illinois as a test of our framework because it has one of the nation's broadest conscience clauses and because an amendment to ensure that women receive consistent access to contested services has just passed in the state legislature. Without such an amendment, Illinois law fails all three standards of our framework. If signed by the governor, the amended law will provide protections for patients' positive claims of conscience. We recommend further protections for providers' positive claims as well. Enacting such changes would offer a model for how ethics-based analysis could be applied to similar policies nationwide.

Anticipating the effect of the Patient Protection and Affordable Care Act for patients with urologic cancer.

PubMed

Ellimoottil, Chandy; Miller, David C

2014-02-01

The Affordable Care Act seeks to overhaul the US health care system by providing insurance for more Americans, improving the quality of health care delivery, and reducing health care expenditures. Although the law's intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the Affordable Care Act, including the proposed insurance expansion, payment and delivery system reforms (e.g., bundled payments and Accountable Care Organizations), and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may affect patients with urologic cancers.

Social Media as a New Vital Sign: Commentary

PubMed Central

2018-01-01

Mobile technologies, such as wireless glucometers and mobile health apps, are increasingly being integrated into health and medical care. Because patients openly share real-time information about their health behaviors and outcomes on social media, social media data may also be used as a tool for monitoring patient care. This commentary describes how recent advances in computer science, psychology, and medicine enable social media data to become a new health “vital sign,” as well as actionable steps that public health officials, health systems, and clinics can take to integrate social data into both public and population health as well as into individual patient care. Barriers that first need to be addressed, including privacy concerns, legal and ethical responsibilities, and infrastructure support, are discussed. PMID:29712631

Detecting Vital Signs with Wearable Wireless Sensors

PubMed Central

Yilmaz, Tuba; Foster, Robert; Hao, Yang

2010-01-01

The emergence of wireless technologies and advancements in on-body sensor design can enable change in the conventional health-care system, replacing it with wearable health-care systems, centred on the individual. Wearable monitoring systems can provide continuous physiological data, as well as better information regarding the general health of individuals. Thus, such vital-sign monitoring systems will reduce health-care costs by disease prevention and enhance the quality of life with disease management. In this paper, recent progress in non-invasive monitoring technologies for chronic disease management is reviewed. In particular, devices and techniques for monitoring blood pressure, blood glucose levels, cardiac activity and respiratory activity are discussed; in addition, on-body propagation issues for multiple sensors are presented. PMID:22163501

A resolution celebrating the 50th anniversary of the signing of Public Law 87-788, an Act commonly known as the McIntire-Stennis Cooperative Forestry Act.

THOMAS, 112th Congress

Sen. Cochran, Thad [R-MS

2012-09-22

Senate - 09/22/2012 Submitted in the Senate, considered, and agreed to without amendment and with a preamble by Unanimous Consent. (All Actions) Tracker: This bill has the status Agreed to in SenateHere are the steps for Status of Legislation:

No Child Left Behind: The Mathematics of Guaranteed Failure. NCLB: Failed Schools--Or Failed Law?

ERIC Educational Resources Information Center

Rose, Lowell C.

2004-01-01

The signing of the No Child Left Behind Act on January 8, 2002, moved the federal effort to influence K-12 schooling to a new and higher level--more aggressive, focused, and directive. The act requires that school districts and schools demonstrate adequate yearly progress (AYP) toward a particular goal: universal student achievement of standards…

12 CFR 205.4 - General disclosure requirements; jointly offered services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Commerce Act (E-Sign Act)(15 U.S.C. 7001 et seq.). A financial institution may use commonly accepted or... combine the required disclosures into a single statement for a consumer who holds more than one account at... imposes on any or all of them. An institution need make only the disclosures required by §§ 205.7 and 205...

77 FR 25 - Amendments to Regulations on Citizen Petitions, Petitions for Stay of Action, and Submission of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-03

... FD&C Act). Section 505(q) of the FD&C Act also includes certification and verification requirements... petition unless the submission is in writing and signed and contains a specific verification (section 505(q... Sec. 10.31(c) and (d) would codify the certification and verification requirements of section 505(q)(1...

The Homestead Act of 1862. Teaching with Documents.

ERIC Educational Resources Information Center

National Archives and Records Administration, Washington, DC.

On January 1, 1863, Daniel Freeman, a Union Army scout convinced a land office clerk in St. Louis (Missouri) to open the office shortly after midnight so that Freeman could file a land claim. In doing so, Freeman became one of the first to take advantage of the opportunities provided by the Homestead Act, a law signed by President Abraham Lincoln…

Preventing Hate Crime and Profiling Hate Crime Offenders.

ERIC Educational Resources Information Center

Anderson, James F.; Dyson, Laronistine; Brooks, Willie, Jr.

2002-01-01

Despite the Hate Crime Statistics Act, signed into law in 1990 to make hate crimes a federal offense, these types of crimes appear to be continuing in the new millennium. Provides hate crime statistics for 1996-98, presents theories on the cause and spread of hate, asserts that a general profile of those with a propensity to act on hate can be…

Bilingual Writing as an Act of Identity: Sign-Making in Multiple Scripts

ERIC Educational Resources Information Center

Kabuto, Bobbie

2010-01-01

This article explores early bilingual script writing as an act of identity. Using multiple theoretical perspectives related to social semiotics and social constructivist perspectives on identity and writing, the research presented in this article is based on a case study of an early biliterate learner of Japanese and English from the ages of 3-7.…

75 FR 10821 - Proposed Information Collection Request Submitted for Public Comment and Recommendations...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-09

... Reemployment Rights Act (USERRA), Public Law 103-353, 108 Stat. 3150 was signed into law. Contained in Title 38..., Public Law 105-339, 112 Stat. 3182, contained in Title 5 U.S.C. 3330a-3330(b), authorizes the Secretary... Veterans' Benefits Improvement Act of 2008 requires VETS to include in its USERRA Annual Report to Congress...

78 FR 72751 - Unblocking of Specially Designated Nationals and Blocked Persons Pursuant to the Foreign...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-03

... SERVICIO AEREO LEO LOPEZ, S.A. DE C.V., Chihuahua, Chihuahua, Mexico; Fernando De Borja 509, Chihuahua... REZA, Jorge Luis, c/o SERVICIO AEREO LEO LOPEZ, S.A. DE C.V., Chihuahua, Chihuahua, Mexico; Calle... 3, 1999, the Kingpin Act was signed into law by the President of the United States. The Kingpin Act...

Implementing the Every Student Succeeds Act: Toward a Coherent, Aligned Assessment System

ERIC Educational Resources Information Center

Brown, Catherine; Boser, Ulrich; Sargrad, Scott; Marchitello, Max

2016-01-01

In December 2015, President Barack Obama signed the Every Student Succeeds Act (ESSA), which replaced No Child Left Behind (NCLB), as the nation's major law governing public schools. ESSA retains the requirement that states test all students in reading and math in grades three through eight and once in high school, as well as the requirement that…

Impacts of the FOCUS Act on Governance in Tennessee Higher Education Institutions

ERIC Educational Resources Information Center

Barber, Jennifer H.; Chesley, Colin G.; Flora, Bethany H.

2016-01-01

With the final passage of the Focus on College and University Success (FOCUS) Act which was signed into law on April 19, 2016, state universities within Tennessee are heading for major transitions in governance structure and autonomy. With changes moving at a speed atypical of higher education, these six soon-to-be former Tennessee Board of…

76 FR 69702 - Sunshine Act Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-09

... planning Approval of School Discipline Report--Findings and Recommendations Review of Concept Papers... services of a sign language interpreter should contact Pamela Dunston at (202) 376-8105 or at signlanguage...

12 CFR 390.339 - Pension plans.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., an opinion signed by an enrolled actuary (as defined by the Employee Retirement Income Security Act... plan's experience and expectations, and represent the actuary's best estimate of the plan's projected...

12 CFR 390.339 - Pension plans.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., an opinion signed by an enrolled actuary (as defined by the Employee Retirement Income Security Act... plan's experience and expectations, and represent the actuary's best estimate of the plan's projected...

12 CFR 390.339 - Pension plans.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., an opinion signed by an enrolled actuary (as defined by the Employee Retirement Income Security Act... plan's experience and expectations, and represent the actuary's best estimate of the plan's projected...

Lupus Nephritis

MedlinePlus

... can be a sign of lupus nephritis. What tests do health care professionals use to diagnose lupus nephritis? Lupus nephritis ... and blood tests and a kidney biopsy. Urine Test Your health care professional uses a urine sample to look for ...

Overcoming the problem of diagnostic heterogeneity in applying measurement-based care in clinical practice: the concept of psychiatric vital signs.

PubMed

Zimmerman, Mark; Young, Diane; Chelminski, Iwona; Dalrymple, Kristy; Galione, Janine N

2012-02-01

Measurement-based care refers to the use of standardized scales to measure the outcome of psychiatric treatment. Diagnostic heterogeneity poses a challenge toward the adoption of a measurement-based care approach toward outcome evaluation in clinical practice. In the present article, we propose adopting the concept of psychiatric vital signs to facilitate measurement-based care. Medical vital signs are measures of basic physiologic functions that are routinely determined in medical settings. Vital signs are often a primary outcome measure, and they are also often adjunctive measurements. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined the frequency of depression and anxiety in a diagnostically heterogeneous group of psychiatric outpatients to determine the appropriateness of considering their measurement as psychiatric vital signs. Three thousand psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV supplemented with items from the Schedule for Affective Disorders and Schizophrenia. We determined the frequency of depression and anxiety evaluated according to the Schedule for Affective Disorders and Schizophrenia items. In the entire sample of 3000 patients, 79.3% (n = 2378) reported clinically significant depression of at least mild severity, 64.4% (n = 1932) reported anxiety of at least mild severity, and 87.4% (n = 2621) reported either anxiety or depression. In all 10 diagnostic categories examined, most patients had clinically significant anxiety or depression of at least mild severity. These findings support the routine assessment of anxiety and depression in clinical practice because almost all patients will have these problems as part of their initial presentation. Even for those patients without depression or anxiety, the case could be made that the measurement of depression and anxiety is relevant and analogous to measuring certain physiologic parameters in medical practice such as blood pressure and body temperature regardless of the reason for the visit. Copyright © 2012 Elsevier Inc. All rights reserved.

Disparities in adult awareness of heart attack warning signs and symptoms--14 states, 2005.

PubMed

2008-02-22

In 2005, approximately 920,000 persons in the United States had a myocardial infarction (i.e., heart attack); in 2004, approximately 157,000 heart attacks were fatal. One study indicated that approximately half of cardiac deaths occur within 1 hour of symptom onset, before patients reach a hospital. Timely access to emergency cardiac care, receipt of advanced treatment, and potential for surviving a heart attack all depend on 1) early recognition of warning signs and symptoms of a heart attack by persons who are having a heart attack and bystanders and 2) immediately calling 9-1-1. Healthy People 2010 includes an objective to increase from 46% to 50% the proportion of adults aged > or =20 years who are aware of the early warning signs and symptoms of a heart attack and the importance of accessing rapid emergency care by calling 9-1-1 (objective 12-2). To update estimates of public awareness of heart attack warning signs and symptoms and knowledge of the importance of calling 9-1-1, CDC analyzed 2005 Behavioral Risk Factor Surveillance System (BRFSS) data from the 14 states that included questions on signs and symptoms of a heart attack. This report describes the results of that analysis, which indicated that although the awareness of certain individual warning signs was as high as 93% (i.e., for shortness of breath), awareness of all five warning signs was 31%, underscoring the need for public health measures to increase public awareness of heart attack warning signs and symptoms. In addition, disparities in awareness were observed by race/ethnicity, sex, and level of education, suggesting that new public health measures should target populations with the lowest levels of awareness.

Nike-Footed Health Workers deal with the problems of adolescent pregnancy.

PubMed

Perino, S S

1992-01-01

Working principally to prevent repeat teen pregnancy, improve birth outcomes to teen mothers, and build adolescent parenting skills, the Nike (sneaker)-Footed Health Worker Project (NFHW) draws trainees from the target population of parenting adolescents. The young mothers will participate in an education project that, after 1 year, will return them to serve the same population from which they were drawn. The Nike-Footed Health Worker Project is designed to allow adolescent mothers to complete high school while they are simultaneously trained in the principles of basic pre- and postnatal care, child development, nutrition, and counseling. After fully understanding and signing a contract detailing the expectations and requirements of the course, trainees will begin the project and receive a base salary in the form of a student loan. Eligible for merit wage increases, they are obligated to use their salaries to make pre-set contributions to the project for housing, food, and child care expenses. After graduating from the 12-month residential project, the NFHWs will be prepared to serve their community. Working out of local clinics and hospitals, they will bring basic care to the homes of pregnant teenagers. Acting as the advocates and counselors of adolescents, the NFHWs will help to prepare the expectant mothers for the arrival of their infant. Following the child's birth, the NFHWs will continue to work with the mother and her primary health care providers as the new mother learns the art of parenting. The NFHW will also ensure that the child has received the appropriate well-baby care (immunizations and so forth) and that the mother has received needed postnatal care and counseling about contraception.

Nike-Footed Health Workers deal with the problems of adolescent pregnancy.

PubMed Central

Perino, S S

1992-01-01

Working principally to prevent repeat teen pregnancy, improve birth outcomes to teen mothers, and build adolescent parenting skills, the Nike (sneaker)-Footed Health Worker Project (NFHW) draws trainees from the target population of parenting adolescents. The young mothers will participate in an education project that, after 1 year, will return them to serve the same population from which they were drawn. The Nike-Footed Health Worker Project is designed to allow adolescent mothers to complete high school while they are simultaneously trained in the principles of basic pre- and postnatal care, child development, nutrition, and counseling. After fully understanding and signing a contract detailing the expectations and requirements of the course, trainees will begin the project and receive a base salary in the form of a student loan. Eligible for merit wage increases, they are obligated to use their salaries to make pre-set contributions to the project for housing, food, and child care expenses. After graduating from the 12-month residential project, the NFHWs will be prepared to serve their community. Working out of local clinics and hospitals, they will bring basic care to the homes of pregnant teenagers. Acting as the advocates and counselors of adolescents, the NFHWs will help to prepare the expectant mothers for the arrival of their infant. Following the child's birth, the NFHWs will continue to work with the mother and her primary health care providers as the new mother learns the art of parenting. The NFHW will also ensure that the child has received the appropriate well-baby care (immunizations and so forth) and that the mother has received needed postnatal care and counseling about contraception. PMID:1561305

The Illegal Immigration Reform and Immigrant Responsibility Act of 1996: an overview.

PubMed

Fragomen, A T

1997-01-01

"On September 30, 1996, President Clinton signed the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (1996 Act), Pub. L. No. 104-208, 110 Stat. 3009. After an intense lobbying effort by the business community, most provisions relating to legal immigration were omitted from the final bill. Instead, the 1996 Act focuses on illegal immigration reform and includes some of the toughest measures ever taken against illegal immigration." Aspects considered include border enforcement, penalities against alien smuggling and document fraud, deportation and exclusion proceedings, employer sanctions, welfare provisions, and changes to existing refugee and asylum procedures. excerpt

76 FR 41263 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH10-1004

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-13

... Intent To Award Affordable Care Act (ACA) Funding, EH10-1004 Notice of Intent to award Affordable Care Act (ACA) funding to National Association for Public Health Statistics and Information Systems... under funding opportunity EH10-1004, ``National Environmental Public Health Tracking Program.'' AGENCY...

76 FR 59703 - Notice of Intent To Award Affordable Care Act (ACA) Funding, RFA-TP-08-001

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-27

... Intent To Award Affordable Care Act (ACA) Funding, RFA- TP-08-001 AGENCY: Centers for Disease Control and... of Intent to award Affordable Care Act (ACA) funding to Preparedness and Emergency Response Research... continuation application under Funding Opportunity Announcement RFA-TP- 08-001, ``Preparedness and Emergency...

76 FR 41929 - Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-15

... 153 Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment; Proposed Rule #0;#0;Federal Register / Vol. 76 , No. 136 / Friday, July 15, 2011...] RIN 0938-AR07 Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk...

78 FR 33233 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-04

... would affect the ability of employers to offer stand-alone pediatric dental coverage in the FF- SHOP... Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Small... rule. SUMMARY: This final rule implements provisions of the Patient Protection and Affordable Care Act...

78 FR 13575 - Coverage of Certain Preventive Services Under the Affordable Care Act; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-28

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 54 [REG-120391-10] RIN 1545-BJ60 Coverage of Certain Preventive Services Under the Affordable Care Act; Correction AGENCY: Internal Revenue... Protection and Affordable Care Act, as amended, and incorporated into the Employee Retirement Income Security...

45 CFR 147.140 - Preservation of right to maintain existing coverage.

Code of Federal Regulations, 2014 CFR

2014-10-01

... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... grandfathered health plan within the meaning of section 1251 of the Patient Protection and Affordable Care Act... Affordable Care Act, do not apply to grandfathered health plans. In addition, the provisions of PHS Act...

45 CFR 147.140 - Preservation of right to maintain existing coverage.

Code of Federal Regulations, 2013 CFR

2013-10-01

... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... grandfathered health plan within the meaning of section 1251 of the Patient Protection and Affordable Care Act... Affordable Care Act, do not apply to grandfathered health plans. In addition, the provisions of PHS Act...

45 CFR 147.140 - Preservation of right to maintain existing coverage.

Code of Federal Regulations, 2012 CFR

2012-10-01

... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... grandfathered health plan within the meaning of section 1251 of the Patient Protection and Affordable Care Act... Affordable Care Act, do not apply to grandfathered health plans. In addition, the provisions of PHS Act...

78 FR 19917 - Medicaid Program; Increased Federal Medical Assistance Percentage Changes Under the Affordable...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-02

... 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the... Care and Education Reconciliation Act of 2010 (Pub. L. 111-152, enacted on March 30, 2010), and... Care Act that expand access to health coverage through improvements in Medicaid and the Children's...

Child Behavior Disorders

MedlinePlus

... a death in the family may cause a child to act out. Behavior disorders are more serious. ... The behavior is also not appropriate for the child's age. Warning signs can include Harming or threatening ...

77 FR 20690 - Northeast Corridor Safety Committee; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-05

... security initiatives, aging electric traction infrastructure, the Americans with Disabilities Act... disabilities. Sign and oral interpretation can be made available if requested 10 calendar days before the...

SIGN Act of 2011

THOMAS, 112th Congress

Sen. Toomey, Pat [R-PA

2011-12-16

Senate - 12/16/2011 Read twice and referred to the Committee on Commerce, Science, and Transportation. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

78 FR 13405 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-27

...This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state- specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

Patient Protection and Affordable Care Act; health insurance market rules. Final rule.

PubMed

2013-02-27

This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

The Psychotherapist and the Sign Language Interpreter

ERIC Educational Resources Information Center

de Bruin, Ed; Brugmans, Petra

2006-01-01

Specialized psychotherapy for deaf people in the Dutch and Western European mental health systems is still a rather young specialism. A key policy principle in Dutch mental health care for the deaf is that they should receive treatment in the language most accessible to them, which is usually Dutch Sign Language (Nederlandse Gebarentaal or NGT).…

The Sign Language Situation in Mali

ERIC Educational Resources Information Center

Nyst, Victoria

2015-01-01

This article gives a first overview of the sign language situation in Mali and its capital, Bamako, located in the West African Sahel. Mali is a highly multilingual country with a significant incidence of deafness, for which meningitis appears to be the main cause, coupled with limited access to adequate health care. In comparison to neighboring…

7 CFR 500.11 - Vehicular and pedestrian traffic.

Code of Federal Regulations, 2011 CFR

2011-01-01

... established roads, shall drive in a careful and safe manner at all times, and shall comply with the signals and directions of the Security Staff and all posted traffic signs. (b) The blocking of entrances... locations or in locations reserved for other persons, or contrary to the direction of posted signs, is...

7 CFR 500.11 - Vehicular and pedestrian traffic.

Code of Federal Regulations, 2010 CFR

2010-01-01

... established roads, shall drive in a careful and safe manner at all times, and shall comply with the signals and directions of the Security Staff and all posted traffic signs. (b) The blocking of entrances... locations or in locations reserved for other persons, or contrary to the direction of posted signs, is...

7 CFR 500.11 - Vehicular and pedestrian traffic.

Code of Federal Regulations, 2013 CFR

2013-01-01

... established roads, shall drive in a careful and safe manner at all times, and shall comply with the signals and directions of the Security Staff and all posted traffic signs. (b) The blocking of entrances... locations or in locations reserved for other persons, or contrary to the direction of posted signs, is...

7 CFR 500.11 - Vehicular and pedestrian traffic.

Code of Federal Regulations, 2012 CFR

2012-01-01

... established roads, shall drive in a careful and safe manner at all times, and shall comply with the signals and directions of the Security Staff and all posted traffic signs. (b) The blocking of entrances... locations or in locations reserved for other persons, or contrary to the direction of posted signs, is...

7 CFR 500.11 - Vehicular and pedestrian traffic.

Code of Federal Regulations, 2014 CFR

2014-01-01

... established roads, shall drive in a careful and safe manner at all times, and shall comply with the signals and directions of the Security Staff and all posted traffic signs. (b) The blocking of entrances... locations or in locations reserved for other persons, or contrary to the direction of posted signs, is...

Algorithmic tools for interpreting vital signs.

PubMed

Rathbun, Melina C; Ruth-Sahd, Lisa A

2009-07-01

Today's complex world of nursing practice challenges nurse educators to develop teaching methods that promote critical thinking skills and foster quick problem solving in the novice nurse. Traditional pedagogies previously used in the classroom and clinical setting are no longer adequate to prepare nursing students for entry into practice. In addition, educators have expressed frustration when encouraging students to apply newly learned theoretical content to direct the care of assigned patients in the clinical setting. This article presents algorithms as an innovative teaching strategy to guide novice student nurses in the interpretation and decision making related to vital sign assessment in an acute care setting.

45 CFR 156.280 - Segregation of funds for abortion services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS... its essential health benefits, as described in section 1302(b) of the Affordable Care Act, for any... may discriminate against any individual health care provider or health care facility because of its...

45 CFR 156.280 - Segregation of funds for abortion services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS... its essential health benefits, as described in section 1302(b) of the Affordable Care Act, for any... may discriminate against any individual health care provider or health care facility because of its...

76 FR 63601 - Sunshine Act Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-13

... School Discipline briefing report Approval of Scope of Discovery Plan for VRA Report V. Management and... of a sign language interpreter should contact Pamela Dunston at (202) 376-8105 or at signlanguage...

Final Determination - signed October 16, 1985

EPA Pesticide Factsheets

Fianl Determination of the U.S. EPA's Assistant Administrator for External Affairs concerning the Bayou Aux Carpes site in Jefferson Parish, Louisiana pursuant to Section 404(c) of the Clean Water Act.

Early warnings, weak signals and learning from healthcare disasters.

PubMed

Macrae, Carl

2014-06-01

In the wake of healthcare disasters, such as the appalling failures of care uncovered in Mid Staffordshire, inquiries and investigations often point to a litany of early warnings and weak signals that were missed, misunderstood or discounted by the professionals and organisations charged with monitoring the safety and quality of care. Some of the most urgent challenges facing those responsible for improving and regulating patient safety are therefore how to identify, interpret, integrate and act on the early warnings and weak signals of emerging risks-before those risks contribute to a disastrous failure of care. These challenges are fundamentally organisational and cultural: they relate to what information is routinely noticed, communicated and attended to within and between healthcare organisations-and, most critically, what is assumed and ignored. Analysing these organisational and cultural challenges suggests three practical ways that healthcare organisations and their regulators can improve safety and address emerging risks. First, engage in practices that actively produce and amplify fleeting signs of ignorance. Second, work to continually define and update a set of specific fears of failure. And third, routinely uncover and publicly circulate knowledge on the sources of systemic risks to patient safety and the improvements required to address them. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Alarm signs and antibiotic prescription in febrile children in primary care: an observational cohort study

PubMed Central

Elshout, Gijs; van Ierland, Yvette; Bohnen, Arthur M; de Wilde, Marcel; Oostenbrink, Rianne; Moll, Henriëtte A; Berger, Marjolein Y

2013-01-01

Background Although fever in children is often self-limiting, antibiotics are frequently prescribed for febrile illnesses. GPs may consider treating serious infections by prescribing antibiotics. Aim To examine whether alarm signs and/or symptoms for serious infections are related to antibiotic prescription in febrile children in primary care. Design and setting Observational cohort study involving five GP out-of-hours services. Method Clinical information was registered and manually recoded. Children (<16 years) with fever having a face-to-face contact with a GP were included. Children who were already using antibiotics or referred to secondary care were excluded. The relation between alarm signs and/or symptoms for serious infections and antibiotic prescription was tested using multivariate logistic regression. Results Of the 8676 included patients (median age 2.4 years), antibiotics were prescribed in 3167 contacts (36.5%). Patient characteristics and alarm signs and/or symptoms positively related to antibiotic prescription were: increasing age (odds ratio [OR] = 1.03; 95% confidence interval [95% CI] = 1.02 to 1.05), temperature measured by GP (OR = 1.72; 95% CI = 1.59 to 1.86), ill appearance (OR = 3.93; 95% CI = 2.85 to 5.42), being inconsolable (OR = 2.27; 95% CI = 1.58 to 3.22), shortness of breath (OR = 2.58; 95% CI = 1.88 to 3.56), duration of fever (OR = 1.31; 95% CI = 1.26 to 1.35). Negative associations were found for neurological signs (OR = 0.45; 95% CI = 0.27 to 0.76), signs of urinary tract infection (OR = 0.63; 95% CI = 0.49 to 0.82), and vomiting and diarrhoea (OR = 0.65; 95% CI = 0.57 to 0.74). These variables explained 19% of the antibiotic prescriptions. Conclusion Antibiotics are often prescribed for febrile children. These data suggest that treatment of a supposed serious bacterial infection is a consideration of GPs. However, the relatively low explained variation indicates that other considerations are also involved. PMID:23834880

The CRADLE vital signs alert: qualitative evaluation of a novel device designed for use in pregnancy by healthcare workers in low-resource settings.

PubMed

Nathan, Hannah L; Boene, Helena; Munguambe, Khatia; Sevene, Esperança; Akeju, David; Adetoro, Olalekan O; Charanthimath, Umesh; Bellad, Mrutyunjaya B; de Greeff, Annemarie; Anthony, John; Hall, David R; Steyn, Wilhelm; Vidler, Marianne; von Dadelszen, Peter; Chappell, Lucy C; Sandall, Jane; Shennan, Andrew H

2018-01-05

Vital signs measurement can identify pregnant and postpartum women who require urgent treatment or referral. In low-resource settings, healthcare workers have limited access to accurate vital signs measuring devices suitable for their environment and training. The CRADLE Vital Signs Alert (VSA) is a novel device measuring blood pressure and pulse that is accurate in pregnancy and designed for low-resource settings. Its traffic light early warning system alerts healthcare workers to the need for escalation of care for women with hypertension, haemorrhage or sepsis. This study evaluated the usability and acceptability of the CRADLE VSA device. Evaluation was conducted in community and primary care settings in India, Mozambique and Nigeria and tertiary hospitals in South Africa. Purposeful sampling was used to convene 155 interviews and six focus groups with healthcare workers using the device (n = 205) and pregnant women and their family members (n = 41). Interviews and focus groups were conducted in the local language and audio-recorded, transcribed and translated into English for analysis. Thematic analysis was undertaken using an a priori thematic framework, as well as an inductive approach. Most healthcare workers perceived the CRADLE device to be easy to use and accurate. The traffic lights early warning system was unanimously reported positively, giving healthcare workers confidence with decision-making and a sense of professionalism. However, a minority in South Africa described manual inflation as tiring, particularly when measuring vital signs in obese and hypertensive women (n = 4) and a few South African healthcare workers distrusted the device's accuracy (n = 7). Unanimously, pregnant women liked the CRADLE device. The traffic light early warning system gave women and their families a better understanding of the importance of vital signs in pregnancy and during the postpartum period. The CRADLE device was well accepted by healthcare workers from a range of countries and levels of facility, including those with no previous vital signs measurement experience. The device motivated women to attend primary care and encouraged them to accept treatment and referral.

Making sense of children's sexual behavior in child care: An analysis of adult responses in special investigation reports.

PubMed

Martin, Karin A

2014-10-01

This paper investigates how adults respond to sexual behavior among children in child care. Culturally, childhood sexuality is variously understood as natural curiosity, a sign of sexual abuse, or a symptom of a sex-offender in the making. Given these competing cultural meanings, how are sexual-like behaviors by children managed by the adults who care for them? An analysis of qualitative data from Special Investigation Reports by childcare licensing consultants in the state of Michigan is used to examine how parents, child care providers, and child care licensing consultants manage and respond to sexual behavior between children in the context of child care. How sexual behavior is responded to depends primarily on who is doing the responding - parent, childcare provider, or state licensing consultant - rather than what type of behavior is being responded to. Parents respond to a wide range of behaviors between children as if they are incidents of sexual abuse. Childcare providers respond to many of those same incidents as misbehavior. Licensing consultants understand these incidents as violation of rules of supervision, but they were also the only group to ever ask if children's sexual behavior was potentially a sign of a child having been sexually abused in another setting. Providers and parents need more education about what kinds of sexual behavior to be concerned about and what kind to understand as common. More education that sexuality that is "rare" and persistent could be a sign of sexual abuse is needed by all parties. Copyright © 2014 Elsevier Ltd. All rights reserved.

Making the Most of the "American Recovery and Reinvestment Act of 2009": A Guide for Asset-Building Leaders

ERIC Educational Resources Information Center

Lind, Christianne; Schmid, William

2009-01-01

To address the economic crisis facing the nation, President Barack Obama signed the American Recovery and Reinvestment Act (ARRA) into law on February 17, 2009. ARRA provides $787 billion in new funding; of this amount, more than $16 billion can be used to support asset-building programs and services for the individuals and communities most…

Education Spending in the American Recovery and Reinvestment Act: Stimulating the Status Quo. WebMemo. No. 2868

ERIC Educational Resources Information Center

Burke, Lindsey

2010-01-01

The American Recovery and Reinvestment Act (ARRA), signed in February 2009, included nearly $100 billion in new funding for the Department of Education (DOE). Over $36 billion of it remains unspent, and bills in both the House and Senate are calling for even more funding for teacher jobs. It is unlikely that billions more in federal spending will…

Making the Most of the American Recovery and Reinvestment Act of 2009: A Guide for Full-Service School Leaders and Community Partners

ERIC Educational Resources Information Center

Gaughen, Katherine; Stewart, Nichole H.; LaVallee, Robert; Zvara, Alexandra

2009-01-01

To address the economic crisis facing the country, the President signed the American Recovery and Reinvestment Act (ARRA) into law on February 17, 2009. The ARRA offers numerous opportunities for full-service school leaders and may provide the necessary funding to prevent significant decreases in operating budgets. One of the largest investments…

42 CFR 405.1205 - Notifying beneficiaries of hospital discharge appeal rights.

Code of Federal Regulations, 2011 CFR

2011-10-01

...” is defined as any facility providing care at the inpatient hospital level, whether that care is short... basis, limited to specialty care or providing a broader spectrum of services. This definition includes... beneficiary refuses to sign the notice. The hospital may annotate its notice to indicate the refusal, and the...

42 CFR 422.620 - Notifying enrollees of hospital discharge appeal rights.

Code of Federal Regulations, 2011 CFR

2011-10-01

... facility providing care at the inpatient hospital level, whether that care is short term or long term... specialty care or providing a broader spectrum of services. This definition also includes critical access... enrollee refuses to sign the notice. The hospital may annotate its notice to indicate the refusal, and the...

42 CFR 405.1205 - Notifying beneficiaries of hospital discharge appeal rights.

Code of Federal Regulations, 2010 CFR

2010-10-01

...” is defined as any facility providing care at the inpatient hospital level, whether that care is short... basis, limited to specialty care or providing a broader spectrum of services. This definition includes... beneficiary refuses to sign the notice. The hospital may annotate its notice to indicate the refusal, and the...

42 CFR 422.620 - Notifying enrollees of hospital discharge appeal rights.

Code of Federal Regulations, 2010 CFR

2010-10-01

... facility providing care at the inpatient hospital level, whether that care is short term or long term... specialty care or providing a broader spectrum of services. This definition also includes critical access... enrollee refuses to sign the notice. The hospital may annotate its notice to indicate the refusal, and the...

78 FR 73441 - Grants to States for Construction or Acquisition of State Homes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-06

... of State home facilities that furnish domiciliary, nursing home, or adult day health care to veterans... States of State home facilities that furnish domiciliary, nursing home, or adult day health care to... Providers Grant and Per Diem Program; and 64.026, Veterans State Adult Day Health Care. Signing Authority...

Benefits for Infants and Toddlers in Health Care Reform

ERIC Educational Resources Information Center

Cole, Patricia

2010-01-01

Routine health care can spell the difference between a strong beginning and a fragile start. After much public and Congressional debate, President Obama signed into law landmark health care reform legislation. Although many provisions will not go into effect this year, several important changes could benefit children within a few months. The…

Presidential Signing Statements Act of 2009

THOMAS, 111th Congress

Rep. Jones, Walter B., Jr. [R-NC-3

2009-01-06

House - 02/09/2009 Referred to the Subcommittee on the Constitution, Civil Rights, and Civil Liberties. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Final Rule (signed September 26, 2016)

EPA Pesticide Factsheets

New Listings of Substitutes; Changes of Listing Status; and Reinterpretation of Unacceptability for Closed Cell Foam Products under the SNAP Program; and Revision of Clean Air Act Section 608 Venting Prohibition for Propane.

78 FR 32237 - Draft Initial Comprehensive Plan and Draft Programmatic Environmental Assessment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-29

... Resources and Ecosystems Sustainability, Tourist Opportunities, and Revived Economies of the Gulf States Act..., Congress passed and the President signed the Resources and Ecosystems Sustainability, Tourist Opportunities...

77 FR 32081 - Sunshine Act Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-31

..., filing of petitions and applications and agency #0;statements of organization and functions are examples... require the services of a sign language interpreter should contact Pamela Dunston at (202) 376-8105 or at...

Final Determination - signed August 31, 2008

EPA Pesticide Factsheets

Final Determination of the U.S. EPA’s Assistant Administrator for Water pursuant to Section 404(c) of the Clean Water Act concerning the proposed Yazoo Backwater area pumps project, Issaquena county, Mississippi.

Design of a real-time and continua-based framework for care guideline recommendations.

PubMed

Lin, Yu-Feng; Shie, Hsin-Han; Yang, Yi-Ching; Tseng, Vincent S

2014-04-16

Telehealth is an important issue in the medical and healthcare domains. Although a number of systems have been developed to meet the demands of emerging telehealth services, the following problems still remain to be addressed: (1) most systems do not monitor/predict the vital signs states so that they are able to send alarms to caregivers in real-time; (2) most systems do not focus on reducing the amount of work that caregivers need to do, and provide patients with remote care; and (3) most systems do not recommend guidelines for caregivers. This study thus proposes a framework for a real-time and Continua-based Care Guideline Recommendation System (Cagurs) which utilizes mobile device platforms to provide caregivers of chronic patients with real-time care guideline recommendations, and that enables vital signs data to be transmitted between different devices automatically, using the Continua standard. Moreover, the proposed system adopts the episode mining approach to monitor/predict anomalous conditions of patients, and then offers related recommended care guidelines to caregivers so that they can offer preventive care in a timely manner.

Design of a Real-Time and Continua-Based Framework for Care Guideline Recommendations

PubMed Central

Lin, Yu-Feng; Shie, Hsin-Han; Yang, Yi-Ching; Tseng, Vincent S.

2014-01-01

Telehealth is an important issue in the medical and healthcare domains. Although a number of systems have been developed to meet the demands of emerging telehealth services, the following problems still remain to be addressed: (1) most systems do not monitor/predict the vital signs states so that they are able to send alarms to caregivers in real-time; (2) most systems do not focus on reducing the amount of work that caregivers need to do, and provide patients with remote care; and (3) most systems do not recommend guidelines for caregivers. This study thus proposes a framework for a real-time and Continua-based Care Guideline Recommendation System (Cagurs) which utilizes mobile device platforms to provide caregivers of chronic patients with real-time care guideline recommendations, and that enables vital signs data to be transmitted between different devices automatically, using the Continua standard. Moreover, the proposed system adopts the episode mining approach to monitor/predict anomalous conditions of patients, and then offers related recommended care guidelines to caregivers so that they can offer preventive care in a timely manner. PMID:24743843

Do infants influence their quality of care? Infants' communicative gestures predict caregivers' responsiveness.

PubMed

Vallotton, Claire D

2009-12-01

Infants' effects on adults are a little studied but important aspect of development. What do infants do that increases caregiver responsiveness in childcare environments? Infants' communicative behaviors (i.e. smiling, crying) affect mothers' responsiveness; and preschool children's language abilities affect teachers' responses in the classroom setting. However, the effects of infants' intentional communications on either parents' or non-parental caregivers' responsiveness have not been examined. Using longitudinal video data from an infant classroom where infant signing was used along with conventional gestures (i.e. pointing), this study examines whether infants' use of gestures and signs elicited greater responsiveness from caregivers during daily interactions. Controlling child age and individual child effects, infants' gestures and signs used specifically to respond to caregivers elicited more responsiveness from caregivers during routine interactions. Understanding the effects of infants' behaviors on caregivers is critical for helping caregivers understand and improve their own behavior towards children in their care.

Automatic Pre-Hospital Vital Signs Waveform and Trend Data Capture Fills Quality Management, Triage and Outcome Prediction Gaps

PubMed Central

Mackenzie, Colin F; Hu, Peter; Sen, Ayan; Dutton, Rick; Seebode, Steve; Floccare, Doug; Scalea, Tom

2008-01-01

Trauma Triage errors are frequent and costly. What happens in pre-hospital care remains anecdotal because of the dual responsibility of treatment (resuscitation and stabilization) and documentation in a time-critical environment. Continuous pre-hospital vital signs waveforms and numerical trends were automatically collected in our study. Abnormalities of pulse oximeter oxygen saturation (< 95%) and validated heart rate (> 100/min) showed better prediction of injury severity, need for immediate blood transfusion, intra-abdominal surgery, tracheal intubation and chest tube insertion than Trauma Registry data or Pre-hospital provider estimations. Automated means of data collection introduced the potential for more accurate and objective reporting of patient vital signs helping in evaluating quality of care and establishing performance indicators and benchmarks. Addition of novel and existing non-invasive monitors and waveform analyses could make the pulse oximeter the decision aid of choice to improve trauma patient triage. PMID:18999022

The patient protection and affordable care act: what does it mean for mental health services for older adults?

PubMed

Sorrell, Jeanne M

2012-11-01

The U.S. Supreme Court recently upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA). It is important to think about how this act will affect mental health services for older adults. The act has the potential to improve health outcomes across all income and age groups. There are specific provisions that are expected to improve care for individuals with mental illness, but there is little information about how these provisions will affect older adults with mental illness. As we move toward implementation of the PPACA, psychiatric nurses need to be aware of myths surrounding the act and to think about changes in the health care system, such as collaborative models of care, that may help identify and overcome barriers to treatment of older adults with mental illness. Copyright 2012, SLACK Incorporated.

Effect of lavender aromatherapy on vital signs and perceived quality of sleep in the intermediate care unit: a pilot study.

PubMed

Lytle, Jamie; Mwatha, Catherine; Davis, Karen K

2014-01-01

Sleep deprivation in hospitalized patients is common and can have serious detrimental effects on recovery from illness. Lavender aromatherapy has improved sleep in a variety of clinical settings, but the effect has not been tested in the intermediate care unit. To determine the effect of inhalation of 100% lavender oil on patients' vital signs and perceived quality of sleep in an intermediate care unit. A randomized controlled pilot study was conducted in 50 patients. Control patients received usual care. The treatment group had 3 mL of 100% pure lavender oil in a glass jar in place at the bedside from 10 pm until 6 am. Vital signs were recorded at intervals throughout the night. At 6 am all patients completed the Richard Campbell Sleep Questionnaire to assess quality of sleep. Blood pressure was significantly lower between midnight and 4 am in the treatment group than in the control group (P = .03) According to the overall mean change score in blood pressure between the baseline and 6 am measurements, the treatment group had a decrease in blood pressure and the control group had an increase; however, the difference between the 2 groups was not significant (P = .12). Mean overall sleep score was higher in the intervention group (48.25) than in the control group (40.10), but the difference was not significant. Lavender aromatherapy may be an effective way to improve sleep in an intermediate care unit.

Understanding the role of emotion in sense-making: a semiotic psychoanalytic oriented perspective.

PubMed

Salvatore, Sergio; Venuleo, Claudia

2008-03-01

We propose a model of emotion grounded on Ignacio Matte Blanco's theory of the unconscious. According to this conceptualization, emotion is a generalized representation of the social context actors are involved in. We discuss how this model can help to better understand the sensemaking processes. For this purpose we present a hierarchical model of sensemaking based on the distinction between significance--the content of the sign--and sense--the psychological value of the act of producing the sign in the given contingence of the social exchange. According to this model, emotion categorization produces the frame of sense regulating the interpretation of the sense of the signs, therefore creating the psychological value of the sensemaking.

Quantifying risk of adverse clinical events with one set of vital signs among primary care patients with hypertension.

PubMed

Tierney, William M; Brunt, Margaret; Kesterson, Joseph; Zhou, Xiao-Hua; L'Italien, Gil; Lapuerta, Pablo

2004-01-01

Hypertension is often uncontrolled. One reason might be physicians' reticence to modify therapy in response to single office measurements of vital signs. Using electronic records from an inner-city primary care practice, we extracted information about vital signs, diagnoses, test results, and drug therapy available on the first primary care visit in 1993 for patients with hypertension. We then identified multivariable predictors of subsequent vascular complications in the ensuing 5 years. Of 5,825 patients (mean age 57 years) previously treated for hypertension for 5.6 years, 7% developed myocardial infarctions, 17% had strokes, 24% developed ischemic heart disease, 22% had heart failure, 12% developed renal insufficiency, and 13% died in 5 years. Controlling for other clinical data, a 10-mmHg increase in systolic blood pressure was associated with 13% increased risk (95% confidence interval [CI], 6%-21%) of renal insufficiency, 9% (95% CI, 3%-15%) increased risk of ischemic heart disease, 7% (95% CI, 3%-11%) increased risk of stroke, and 6% (95% CI, 2%-9%) increased risk of first stroke or myocardial infarction. A 10-mmHg elevation in mean blood pressure predicted a 12% (95% CI, 5%-20%) increased risk of heart failure. An increase in heart rate of 10 beats per minute predicted a 16% (95% CI, 2%-5%) increased risk of death. Diastolic blood pressure predicted only a 13% (95% CI, 4%-23%) increased risk of first stroke. Vital signs-especially systolic blood pressure-recorded routinely during a single primary care visit had significant prognostic value for multiple adverse clinical events among patients treated for hypertension and should not be ignored by clinicians.

Final Determination - signed March 21, 1988

EPA Pesticide Factsheets

Information about final determination of the U.S. EPA's Assistant Administrator for water, concerning wetlands owned by the Russo Development Corporation in Carlstadt, New Jersey pursuant to section 404(c) of the Clean Water Act.

46 CFR 310.52 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., are required by the Act to sign an agreement committing them to service obligations following the date of graduation. The terms of the service obligation contract are set forth in § 310.58 of this subpart. ...

Testing Consent Agreement for N-methylpyrrolidone

EPA Pesticide Factsheets

EPA has signed an Enforceable Consent Agreement (ECA) pursuant to the Toxic Substances Control Act (TSCA), 15 U.S.C. 2601 et seq., with Arco Chemical Company, BASF Corporation, and International Specialty Products Company.

Final Determination - signed November 23, 1990

EPA Pesticide Factsheets

Final determination of the U.S. EPA’s Assistant Administrator for Water pursuant to section 404(c) of the Clean Water Act concerning the Two Forks water supply impoundments in Jefferson and Douglas counties, Colorado.

1400323

NASA Image and Video Library

2014-05-02

DALE THOMAS, LEFT, MARSHALL AA FOR TECHNICAL WORK AND JAMES LACKEY, RIGHT, ACTING DIRECTOR FOR AMRDEC SIGNED AN AGREEMENT ON MAY 2, 2014 TO ENGAGE IN RESEARCH & DEVELOPMENT EFFORTS THAT ADVANCE THE STATE OF THE ART IN ADDITIVE MANUFACTURING

Final Determination - signed March 1, 1990

EPA Pesticide Factsheets

Final Determination of the U.S. Environmental Protection Agency's Assistant Administrator for Water pursuant to Section 404(c) of the Clean Water Act concerning the proposed Big River water supply impoundment in Kent county, RI.

HEW Proposals Open Door for Ms. Jock

ERIC Educational Resources Information Center

Klopfer, Susan

1974-01-01

Discusses the increased demand for women's sports programs as reflected in student publications following the signing of Title 9 of the Education Amendments Act which prohibits sex bias in federally financed education programs. (RB)

Cardiorespiratory dynamics measured from continuous ECG monitoring improves detection of deterioration in acute care patients: A retrospective cohort study

PubMed Central

Clark, Matthew T.; Calland, James Forrest; Enfield, Kyle B.; Voss, John D.; Lake, Douglas E.; Moorman, J. Randall

2017-01-01

Background Charted vital signs and laboratory results represent intermittent samples of a patient’s dynamic physiologic state and have been used to calculate early warning scores to identify patients at risk of clinical deterioration. We hypothesized that the addition of cardiorespiratory dynamics measured from continuous electrocardiography (ECG) monitoring to intermittently sampled data improves the predictive validity of models trained to detect clinical deterioration prior to intensive care unit (ICU) transfer or unanticipated death. Methods and findings We analyzed 63 patient-years of ECG data from 8,105 acute care patient admissions at a tertiary care academic medical center. We developed models to predict deterioration resulting in ICU transfer or unanticipated death within the next 24 hours using either vital signs, laboratory results, or cardiorespiratory dynamics from continuous ECG monitoring and also evaluated models using all available data sources. We calculated the predictive validity (C-statistic), the net reclassification improvement, and the probability of achieving the difference in likelihood ratio χ2 for the additional degrees of freedom. The primary outcome occurred 755 times in 586 admissions (7%). We analyzed 395 clinical deteriorations with continuous ECG data in the 24 hours prior to an event. Using only continuous ECG measures resulted in a C-statistic of 0.65, similar to models using only laboratory results and vital signs (0.63 and 0.69 respectively). Addition of continuous ECG measures to models using conventional measurements improved the C-statistic by 0.01 and 0.07; a model integrating all data sources had a C-statistic of 0.73 with categorical net reclassification improvement of 0.09 for a change of 1 decile in risk. The difference in likelihood ratio χ2 between integrated models with and without cardiorespiratory dynamics was 2158 (p value: <0.001). Conclusions Cardiorespiratory dynamics from continuous ECG monitoring detect clinical deterioration in acute care patients and improve performance of conventional models that use only laboratory results and vital signs. PMID:28771487

Cardiorespiratory dynamics measured from continuous ECG monitoring improves detection of deterioration in acute care patients: A retrospective cohort study.

PubMed

Moss, Travis J; Clark, Matthew T; Calland, James Forrest; Enfield, Kyle B; Voss, John D; Lake, Douglas E; Moorman, J Randall

2017-01-01

Charted vital signs and laboratory results represent intermittent samples of a patient's dynamic physiologic state and have been used to calculate early warning scores to identify patients at risk of clinical deterioration. We hypothesized that the addition of cardiorespiratory dynamics measured from continuous electrocardiography (ECG) monitoring to intermittently sampled data improves the predictive validity of models trained to detect clinical deterioration prior to intensive care unit (ICU) transfer or unanticipated death. We analyzed 63 patient-years of ECG data from 8,105 acute care patient admissions at a tertiary care academic medical center. We developed models to predict deterioration resulting in ICU transfer or unanticipated death within the next 24 hours using either vital signs, laboratory results, or cardiorespiratory dynamics from continuous ECG monitoring and also evaluated models using all available data sources. We calculated the predictive validity (C-statistic), the net reclassification improvement, and the probability of achieving the difference in likelihood ratio χ2 for the additional degrees of freedom. The primary outcome occurred 755 times in 586 admissions (7%). We analyzed 395 clinical deteriorations with continuous ECG data in the 24 hours prior to an event. Using only continuous ECG measures resulted in a C-statistic of 0.65, similar to models using only laboratory results and vital signs (0.63 and 0.69 respectively). Addition of continuous ECG measures to models using conventional measurements improved the C-statistic by 0.01 and 0.07; a model integrating all data sources had a C-statistic of 0.73 with categorical net reclassification improvement of 0.09 for a change of 1 decile in risk. The difference in likelihood ratio χ2 between integrated models with and without cardiorespiratory dynamics was 2158 (p value: <0.001). Cardiorespiratory dynamics from continuous ECG monitoring detect clinical deterioration in acute care patients and improve performance of conventional models that use only laboratory results and vital signs.

Sign-Supported Dutch in Children with Severe Speech and Language Impairments: A Multiple Case Study

ERIC Educational Resources Information Center

Wijkamp, Inge; Gerritsen, Betsy; Bonder, Freke; Haisma, Hinke; van der Schans, Cees

2010-01-01

In the Netherlands, many educators and care providers working at special schools for children with severe speech and language impairments (SSLI) use sign-supported Dutch (SSD) to facilitate communication. Anecdotal experiences suggest positive results, but empirical evidence is lacking. In this multiple case study the changes that occur in the way…

Measuring Adult Literacy in Health Care: Performance of the Newest Vital Sign

ERIC Educational Resources Information Center

Osborn, Chandra Y.; Weiss, Barry D.; Davis, Terry C.; Skripkauskas, Silvia; Rodrigue, Christopher; Bass, Pat F., III; Wolf, Michael S.

2007-01-01

Objective: To compare performance of the newest vital sign (NVS) with existing literacy measures. Methods: We administered the NVS and REALM to 129 patients, and NVS and S-TOFHLA to 119 patients all in public clinics. Results: The NVS demonstrated high sensitivity for detecting limited literacy and moderate specificity (area under the receiver…

76 FR 56767 - Request for Information Regarding State Flexibility To Establish a Basic Health Program Under the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-14

... essential health benefits described in section 1302(b) of the Affordable Care Act to eligible individuals in... Affordable Care Act; (2) covers at least the essential health benefits described in section 1302(b) of the Affordable Care Act; and (3) in the case of a plan that provides health insurance coverage offered by a...

Patient Protection and Affordable Care Act; establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges. Final rule.

PubMed

2014-02-24

The U.S. Office of Personnel Management (OPM) is issuing a final rule implementing modifications to the Multi-State Plan (MSP) Program based on the experience of the Program to date. OPM established the MSP Program pursuant to the Affordable Care Act. This rule clarifies the approach used to enforce the applicable standards of the Affordable Care Act with respect to health insurance issuers that contract with OPM to offer MSP options; amends MSP standards related to coverage area, benefits, and certain contracting provisions under section 1334 of the Affordable Care Act; and makes non-substantive technical changes.

Patient Protection and Affordable Care Act; standards related to essential health benefits, actuarial value and accreditation. Final rule.

PubMed

2013-02-25

This final rule sets forth standards for health insurance issuers consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Specifically, this final rule outlines Exchange and issuer standards related to coverage of essential health benefits and actuarial value. This rule also finalizes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges and amends regulations providing an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans.

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

PubMed

2015-08-17

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.

Comparison of automated and manual vital sign collection at hospital wards.

PubMed

Wood, Jeffrey; Finkelstein, Joseph

2013-01-01

Using a cross-over study design, vital signs were collected from 60 patients by 6 nurses. Each nurse was randomly assigned for manual vital sign collection in 5 patients and for automated data collection in other 5 patients. The mean time taken for vital signs information to be available in EMR was significantly (p <0.004) lower after automated data collection (158.7±67.0) than after the manual collection (4079.8±7091.8 s). The nursing satisfaction score of collecting vital signs was significantly lower (p<0.007) for the manual way (10.3±3.9) than for the automated way (16.5±3.4). We found that 30% of vital sign records were transmitted to EMR with at least one error after manual data collection whereas there wasno transmission error with automated data collection. Allparticipating nurses stated that the automated vital sign collection can improve their efficiency and save their time for direct patient care.

Propagation of 3-D Beams Using a Finite-Difference Algorithm: Practical Considerations

DTIC Science & Technology

2011-05-22

electric-discharge laser ,” J. Appl. Phys. 49(3), 1012–1027 (1978). [6] Sziklas, E. A. and Siegman , A. E., “Mode calculations in unstable resonators with...flowing saturable gain .2. fast fourier-transform method,” Applied Optics 14(8), 1874–1889 (1975). [7] Siegman , A. E., [ Lasers ], University Science...Signed// ALAN H. PAXTON, DR-III Project Manager //Signed// MICHAEL F. SHEEHAN, DR-III, DAF Acting Chief, Laser Division This report is published in

Control of Supercavitation Flow and Stability of Supercavitating Motion of Bodies

DTIC Science & Technology

2001-02-01

sign opposite to a sign of angle Vf - accidental deflection of the model Sgn M = -Sgn i. 4.3. EQUATIONS OF THE SCM DYNAMICS The most effective method of...the motion stability in interactive regime "researcher - computer" [ 16]. The complete mathematical model of the SCM motion includes a set of equations ...of solid body dynamics, equations to calculate the unsteady cavity shape and relations to calculate the acting forces. A set of dynamic equations of

Emergency Care of the Snakebite Victim.

ERIC Educational Resources Information Center

Ballard, Carol N.

1994-01-01

Describes emergency care of snakebite victims, including noting signs and symptoms of venomous snakebites, keeping the victim calm, and seeking immediate medical attention. Provides information on variables that affect the amount of injected venom and how to distinguish nonpoisonous from poisonous snakes. (LP)

What Is Bipolar Disorder? A Guide to Hope and Recovery for African Americans

MedlinePlus

... Violence Signs of a Healthy Workplace Clifford Beers Society Social Self-Directed Care Program Take a Screen Mental ... Campus Minority Mental Health Workplace Wellness Clifford Beers Society Social Self-Directed Care Program Take a Screen Mental ...

Advance care treatment plan (ACT-Plan) for African American family caregivers: a pilot study.

PubMed

Bonner, Gloria J; Wang, Edward; Wilkie, Diana J; Ferrans, Carol E; Dancy, Barbara; Watkins, Yashika

2014-01-01

Research is limited on end-of-life treatment decisions made by African American family caregivers. In a pilot study, we examined the feasibility of implementing an advance care treatment plan (ACT-Plan), a group-based education intervention, with African American dementia caregivers. Theoretically based, the ACT-Plan included strategies to enhance knowledge, self-efficacy, and behavioral skills to make end-of-life treatment plans in advance. Cardiopulmonary resuscitation, mechanical ventilation, and tube feeding were end-of-life treatments discussed in the ACT-Plan. In a four-week pre/posttest two-group design at urban adult day care centers, 68 caregivers were assigned to the ACT-Plan or attention-control health promotion conditions. Findings strongly suggest that the ACT-Plan intervention is feasible and appropriate for African American caregivers. Self-efficacy and knowledge about dementia, cardiopulmonary resuscitation, mechanical ventilation, and tube feeding increased for ACT-Plan participants but not for the attention-control. More ACT-Plan than attention-control participants developed advance care plans for demented relatives. Findings warrant a randomized efficacy trial.

Sign-out snapshot: cross-sectional evaluation of written sign-outs among specialties

PubMed Central

Schoenfeld, Amy R.; Al-Damluji, Mohammed Salim; Horwitz, Leora I.

2013-01-01

Background Sign-out is the process (written, verbal, or both) by which one clinical team transmits information about patients to another team. Poor quality sign-outs are associated with adverse events and delayed treatment. How different specialties approach written sign-outs is unknown. Objective To compare written sign-out practices across specialties and to determine consistency of content, format, and timeliness. Methods The authors evaluated all non-Intensive Care Unit written sign-outs from five inpatient specialties on January 18, 2012, at Yale-New Haven Hospital, focusing on content elements, format style, and whether the sign-outs had been updated within 24 hours. In our institution, all specialties used a single standardized sign-out template, which was built into the electronic medical record. Results The final cohort included 457 sign-outs: 313 medicine, 64 general surgery, 36 pediatrics, 30 obstetrics, and 14 gynecology. Though nearly all sign-outs (96%) had been updated within 24 hours, they frequently lacked key information. Hospital course prevalence ranged from 57% (gynecology) to 100% (pediatrics) (p<0.001). Clinical condition prevalence ranged from 34% (surgery) to 72% (pediatrics) (p=0.005). Conclusion Specialties have varied sign-out practices, and thus structured templates alone do not guarantee inclusion of critical content. Sign-outs across specialties often lacked complex clinical information such clinical condition, anticipatory guidance, and overnight tasks. PMID:23996093

76 FR 66931 - Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-28

... health care expenditures. The ADLSs were first announced in the May 19, 2011 Federal Register (76 FR... Affordable Care Act (Pub. L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010... Medicaid Innovation (Innovation Center) for the purpose of examining new ways of delivering health care and...

48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care Contract...

48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care Contract...

48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care Contract...

48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care Contract...

48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care Contract...

The importance of comprehensive agricultural education in land-grant institutions: a historical perspective.

PubMed

Grant, P M; Field, T G; Green, R D; Rollin, B E

2000-06-01

Any thorough examination of the present and future of agricultural education must certainly begin with a look into its past. Since the creation of the United States, many leading American philosophers have viewed a strong agrarian culture as the bedrock of American vigor. These same philosophers repeatedly noted the significance of comprehensive agricultural education to a nation rich in agricultural wealth. The signing of the Agricultural Colleges Act legitimized the concept of formal education in the agricultural sciences and provided funding for such education. The Act, which came to be known as the Morrill Act, after one of its primary authors, stressed the importance of comprehensive education. In fact, the inclusion of liberal studies was specifically mentioned in the Morrill Act and was defended repeatedly by Morrill himself. Comprehensive education prevented graduating technically trained students who were lacking in the basic outcomes of education--critical, comprehensive problem solving, cohesive thought, and effective communication. However, throughout history, the demands of a growing population coupled with rapid advancements in scientific knowledge led to a gradual move away from comprehensive education in agricultural sciences toward increasing specialization, resulting in more narrowly trained students. Today's agricultural students are technically well versed but often lack the skill and knowledge required for cohesive thought and critical problem solving. Addressing the multitude of challenges facing leaders in the future of agriculture requires much more than technical skill. These challenges require quick, yet careful thinkers and communicators who can respond to changing market structure and consumer demand in a dynamic way. Students who are a product of a conscious move toward amalgamation of burgeoning scientific knowledge and technical prowess with an integrative education emphasizing relationships between disciplines would better serve tomorrow's agriculture.

Mixed messages

PubMed Central

Chen, Christopher B.; Hall, Kevin; Tsuyuki, Ross T.

2014-01-01

Background: More than 5 years ago, the Blueprint for Pharmacy developed a plan for transitioning pharmacy practice toward more patient-centred care. Much of the strategy for change involves communicating the new vision. Objective: To evaluate the communication of the Vision for Pharmacy by the organizations and corporations that signed the Blueprint for Pharmacy’s Commitment to Act. Methods: The list of 88 signatories of the Commitment to Act was obtained from the Blueprint for Pharmacy document. The website of each of these signatories was searched for all references to the Blueprint for Pharmacy or Vision for Pharmacy. Each of the identified references was then analyzed using summative content analysis. Results: A total of 934 references were identified from the webpages of the 88 signatories. Of these references, 549 were merely links to the Blueprint for Pharmacy’s website, 350 of the references provided some detailed information about the Blueprint for Pharmacy and only 35 references provided any specific plans to transition pharmacy practice. Conclusion: Widespread proliferation of the Vision for Pharmacy has not been achieved. One possible explanation for this is that communication of the vision by the signatories has been incomplete. To ensure the success of future communications, change leaders must develop strategies that consider how individual pharmacists and pharmacies understand the message. PMID:24660012

Mixed messages: The Blueprint for Pharmacy and a communication gap.

PubMed

Rosenthal, Meagen; Chen, Christopher B; Hall, Kevin; Tsuyuki, Ross T

2014-03-01

More than 5 years ago, the Blueprint for Pharmacy developed a plan for transitioning pharmacy practice toward more patient-centred care. Much of the strategy for change involves communicating the new vision. To evaluate the communication of the Vision for Pharmacy by the organizations and corporations that signed the Blueprint for Pharmacy's Commitment to Act. The list of 88 signatories of the Commitment to Act was obtained from the Blueprint for Pharmacy document. The website of each of these signatories was searched for all references to the Blueprint for Pharmacy or Vision for Pharmacy. Each of the identified references was then analyzed using summative content analysis. A total of 934 references were identified from the webpages of the 88 signatories. Of these references, 549 were merely links to the Blueprint for Pharmacy's website, 350 of the references provided some detailed information about the Blueprint for Pharmacy and only 35 references provided any specific plans to transition pharmacy practice. Widespread proliferation of the Vision for Pharmacy has not been achieved. One possible explanation for this is that communication of the vision by the signatories has been incomplete. To ensure the success of future communications, change leaders must develop strategies that consider how individual pharmacists and pharmacies understand the message.

[The Status, Change and Health Issues of Inpatients' Sixth Vital Sign in a Medical Center].

PubMed

Lin, Li-Ying; Huang, Ya-Hui; Hung, Chung-Lung; Chen, Ya-Mei; Kuo, Ching-Ju; Ku, Yan-Chiou

2017-04-01

Hospitalized patients generally have elevated levels of emotional distress. Gaining a better under-standing of the problem of emotional distress among hospitalized patients is conducive to providing appropriate emotional care and promoting their recovery. To analyze the scores for the "sixth vital sign" (i.e., emotional distress), diversification, and the health-related problems of hospitalized patients at a medical center in Taiwan. The results may offer an important reference for providing effective emotional care to hospitalized patients. A retrospective descriptive research design was used. Data were collected from all of the 27,885 inpatients that were registered at the target hospital in 2013. Further, a total of 245,814 attendance records were assessed to extract the data that were relevant to emotional distress. The findings revealed that 58.3% of hospitalized patients had earned a sixth vital sign score ≥ 1 and that 0.8% of these patients had earned a score ≥ 4. On the whole, the sixth vital sign scores of hospitalized patients were found to decrease progressively with the number of hospitalization days except for hematology and oncology, neurosurgery, and plastic surgery patients. The highest emotional distress scores were found among family medicine, dermatology, and plastic surgery patients. Moreover, emotional distress scores were significantly higher in patients who had health problems that involved pain, anxiety, or sleep disorder. The present study suggests that improving the emotional care of hematology, oncology, neurosurgery, family medicine, dermatology, and plastic surgery patients and of patients with health problems involving pain, anxiety, or sleep disorder may significantly improve the quality of inpatient holistic healthcare. Only 0.8% of the subjects in the present study had an emotional distress score ≥ 4, which is significantly lower than the level reported in other similar studies. Our findings suggest that related education and training for nursing staffs may improve their assessment and care practices in caring for patients with emotional distress. Furthermore, using more appropriate words, methods, and environments to evaluate the emotional distress of patients holds the potential to improve assessment and care for these patients.

Obstetric danger signs and factors affecting health seeking behaviour among the Kassena-Nankani of Northern Ghana: a qualitative study.

PubMed

Aborigo, Raymond A; Moyer, Cheryl A; Gupta, Mira; Adongo, Philip B; Williams, John; Hodgson, Abraham; Allote, Pascale; Engmann, Cyril M

2014-09-01

Improving community members' knowledge of obstetric danger signs is one strategy for increasing the use of skilled care during pregnancy and the puerperium. This study explored knowledge of obstetric danger signs among a range of community members, examined the sources of their information, and the perceived factors that affect health seeking behaviour in rural northern Ghana. We conducted 72 in-depth interviews and 18 focus groups with community members. All interactions were audio taped, transcribed verbatim and analysed using NVivo 9.0. Community members demonstrated knowledge of a wide range of obstetric danger signs, including excessive bleeding, stomach aches, waist pains, vomiting and fever. Pregnant women learn about danger signs from a range of providers, and regular contact with formal providers typically coincided with increased knowledge of danger signs. Traditional remedies for problems in obstetrics are plentiful and cultural beliefs often restrict the use of allopathic medicine. Increasing knowledge of obstetric danger signs is necessary but not sufficient to overcome cultural preferences for traditional treatments for pregnancy danger signs.

42 CFR 600.5 - Definitions and use of terms.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Care Act of 2010 (Pub. L. 111-148) as amended by the Health Care and Education Reconciliation Act of... care providers means an entity capable of meeting the provision and administration of standard health... not limited to: Accountable Care Organizations, Independent Physician Associations, or a large health...

29 CFR 825.114 - Inpatient care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

29 CFR 825.114 - Inpatient care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

29 CFR 825.114 - Inpatient care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

29 CFR 825.114 - Inpatient care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

29 CFR 825.114 - Inpatient care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 7--Medical Emergencies. Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers medical emergencies. The objectives for the chapter are for students to be able to describe the causes, signs, and symptoms for specified medical emergencies and to describe emergency care for them. Informative…

Simulation Training in Health Care

DTIC Science & Technology

2015-06-01

Harvey simulates cardiac and lung disease , including blood pressure, breathing, pulses, heart sounds, and murmurs. A significant step toward the...fluoroscopy, cardiovascu- lar and pulmonary disease diagnosis and treatment, anesthesia, patient -centered programs, basic vital signs emergency care, infant...effectiveness. However, in health care, ethical considerations and the quantification of the expenses of clinician “learning” on patients is a challenge to

Sow the Seeds of Victory! Posters from the Food Administration during World War I. The Constitution Community: The Emergence of Modern America (1890-1930).

ERIC Educational Resources Information Center

Simmons, Linda

From the outbreak of World War I in Europe until the signing of the Versailles Treaty, President Woodrow Wilson's administration proposed and implemented an extraordinary number of programs that affected people in their everyday activities. In August 1917 Congress passed the Food and Fuel Control Act, also known as the Lever Act, which gave the…

23 CFR Appendix C to Subpart A of... - Policy for the Signing and Numbering of Future Interstate Corridors Designated by Section 332 of...

Code of Federal Regulations, 2010 CFR

2010-04-01

... Interstate Corridors Designated by Section 332 of the NHS Designation Act of 1995 or Designated Under 23 U.S... Corridors Designated by Section 332 of the NHS Designation Act of 1995 or Designated Under 23 U.S.C. 139(b... federally designated future Interstate corridor only after the specific route location has been established...

Partisanship and Ideology in the ESEA Reauthorization in the 106th and 107th Congresses: Foundations for the New Political Landscape of Federal Education Policy

ERIC Educational Resources Information Center

DeBray, Elizabeth H.

2005-01-01

In January 2002, Republican President George W. Bush signed into law the No Child Left Behind (NCLB) Act, the reauthorized Elementary and Secondary Education Act (ESEA) of 1965. The most conservative congressional Republicans, who opposed the bill's extensive new testing mandates and absence of school voucher provisions, were largely left out in…

Transfusion reaction identification and management at the bedside.

PubMed

Crookston, Kendall P; Koenig, Sara C; Reyes, Michael D

2015-01-01

Blood product transfusion is one of the most common invasive procedures performed in the health care setting. In contrast to pharmaceuticals, blood is actually a liquid transplant. Transfusion complications consequently encompass complex biological processes and infectious possibilities. Changes in vital signs are regularly seen during transfusion. Knowledge of common transfusion reaction signs and symptoms enables the clinical team to differentiate a normal patient response from a life-threatening reaction. Direct care nurses responsible for this procedure play a vital role in its success. Understanding the possible complications of transfusion and how to quickly recognize reactions at the bedside helps ensure the best patient outcomes.

Emergency Department Use and Risk Factors among Deaf American Sign Language Users

PubMed Central

McKee, Michael M.; Winters, Paul C.; Sen, Ananda; Zazove, Philip; Fiscella, Kevin

2015-01-01

Background Deaf American Sign Language (ASL) users comprise a linguistic minority population with poor health care access due to communication barriers and low health literacy. Potentially, these health care barriers could increase Emergency Department (ED) use. Objective To compare ED use between deaf and non-deaf patients. Method A retrospective cohort from medical records. The sample was derived from 400 randomly selected charts (200 deaf ASL users and 200 hearing English speakers) from an outpatient primary care health center with a high volume of deaf patients. Abstracted data included patient demographics, insurance, health behavior, and ED use in the past 36 months. Results Deaf patients were more likely to be never smokers and be insured through Medicaid. In an adjusted analysis, deaf individuals were significantly more likely to use the ED (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.11–3.51) over the prior 36 months. Conclusion Deaf American Sign Language users appear to be at greater odds for elevated ED utilization when compared to the general hearing population. Efforts to further understand the drivers for increased ED utilization among deaf ASL users are much needed. PMID:26166160

General practice recruitment for people at risk of schizophrenia: the Buckingham experience.

PubMed

Falloon, I R

2000-11-01

The process of detecting people at high risk of schizophrenia from a community sample is a major challenge for prevention of psychotic disorders. The aim of this paper is to describe early detection procedures that can be implemented in primary care settings. A selected literature review is supplemented by experiences and data obtained during the Buckingham Integrated Mental Health Care Project. General medical practitioners have been favoured as the agents most likely to prove helpful in detecting the key risk factors that predict the onset of schizophrenic disorders, as well as in recognising the earliest signs and symptoms of these conditions. However, the practical problems of screening for multiple and subtle risk factors in general practice are substantial, and general practitioners (GPs) often have difficulty recognising the earliest signs of a psychotic episode. A range of strategies to assist GPs detect early signs of psychosis in their patients are considered. It is feasible to implement primary care setting early detection procedures for people at risk of schizophrenia. Implementation is aided by the use of a brief screening questionnaire, training sessions and case supervision; and increased collaboration with mental health services and other community agencies.