Non Traditional Superintendent: A Case Study of the Transition from Military to Public School Superintendent

ERIC Educational Resources Information Center

Hernandez, Luiza Miera

2010-01-01

In June of 2006, Urban School District appointed the individual who is the focus of this study, a retired Air Force Two Star Major General, as its new superintendent. Although the appointment represents the first nontraditional superintendent to lead Urban School District, it was one of several such appointments to large, urban school districts…

78 FR 41923 - National Advisory Committee on Institutional Quality and Integrity; Notice of Committee Membership

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-12

... role of the committee? The Committee was established under Section 114 of the HEA, and is composed of... recommendation of the majority leader of the U.S. House of Representatives and three of whom are appointed on the recommendation of the minority leader of the U.S. House of Representatives; and Six members are appointed by the...

VRA Extension and Increases in the GI Bill Rates. Hearing before the Subcommittee on Education, Training and Employment of the Committee on Veterans' Affairs, House of Representatives, Ninety-Eighth Congress, First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Veterans' Affairs.

These Congressional hearings contain testimony pertaining to the extension and modification of two federal programs for veterans, the Veterans' Readjustment Appointment Act (VRA) and the GI Bill. During the testimony, witnesses reviewed the effectiveness of VRA appointments. (A VRA is a noncompetitive appointment to a federal civilian job that…

21 CFR 10.95 - Participation in outside standard-setting activities.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., professional societies, and academic institutions. (4) An FDA employee appointed as the liaison representative... associations, professional societies, and academic institutions. (5) An FDA employee appointed as the liaison... validation of analytical methods for regulatory use, drafting uniform laws and regulations, and the...

The estimated cost of "no-shows" in an academic pediatric neurology clinic.

PubMed

Guzek, Lindsay M; Gentry, Shelley D; Golomb, Meredith R

2015-02-01

Missed appointments ("no-shows") represent an important source of lost revenue for academic medical centers. The goal of this study was to examine the costs of "no-shows" at an academic pediatric neurology outpatient clinic. This was a retrospective cohort study of patients who missed appointments at an academic pediatric neurology outpatient clinic during 1 academic year. Revenue lost was estimated based on average reimbursement for different insurance types and visit types. The yearly "no-show" rate was 26%. Yearly revenue lost from missed appointments was $257,724.57, and monthly losses ranged from $15,652.33 in October 2013 to $27,042.44 in January 2014. The yearly revenue lost from missed appointments at the academic pediatric neurology clinic represents funds that could have been used to improve patient access and care. Further work is needed to develop strategies to decrease the no-show rate to decrease lost revenue and improve patient care and access. Copyright © 2015 Elsevier Inc. All rights reserved.

12 CFR 1291.4 - Advisory Councils.

Code of Federal Regulations, 2010 CFR

2010-01-01

... meet with representatives of the Bank's board of directors at least quarterly to provide advice on ways...' AFFORDABLE HOUSING PROGRAM § 1291.4 Advisory Councils. (a) Appointment. (1) Each Bank's board of directors... responses. (3) The Bank's board of directors shall appoint Advisory Council members from a diverse range of...

CASA Fact Sheet.

ERIC Educational Resources Information Center

National Court Appointed Special Advocate Association, Seattle WA.

Each year nearly 400,000 children in the United States are thrust into court through no fault of their own. Often these children also become victims of the United States' overburdened child welfare system. A Court Appointed Special Advocate (CASA) volunteer is a trained citizen who is appointed by a judge to represent the best interests of a child…

50 CFR 270.8 - Nomination and appointment of Council members.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 9 2011-10-01 2011-10-01 false Nomination and appointment of Council members. 270.8 Section 270.8 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC... represented on the Council are engaged in business in two or more states, but within the geographic area of...

50 CFR 270.8 - Nomination and appointment of Council members.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 11 2013-10-01 2013-10-01 false Nomination and appointment of Council members. 270.8 Section 270.8 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC... represented on the Council are engaged in business in two or more states, but within the geographic area of...

29 CFR 417.19 - Assistant Secretary's representative.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 2 2012-07-01 2012-07-01 false Assistant Secretary's representative. 417.19 Section 417.19... Union To Take Appropriate Remedial Action Following Subpart A Procedures § 417.19 Assistant Secretary's representative. The Assistant Secretary shall appoint a representative or representatives whose functions shall...

Predictors of missed appointments in patients referred for congenital or pediatric cardiac magnetic resonance.

PubMed

Lu, Jimmy C; Lowery, Ray; Yu, Sunkyung; Ghadimi Mahani, Maryam; Agarwal, Prachi P; Dorfman, Adam L

2017-07-01

Congenital cardiac magnetic resonance is a limited resource because of scanner and physician availability. Missed appointments decrease scheduling efficiency, have financial implications and represent missed care opportunities. To characterize the rate of missed appointments and identify modifiable predictors. This single-center retrospective study included all patients with outpatient congenital or pediatric cardiac MR appointments from Jan. 1, 2014, through Dec. 31, 2015. We identified missed appointments (no-shows or same-day cancellations) from the electronic medical record. We obtained demographic and clinical factors from the medical record and assessed socioeconomic factors by U.S. Census block data by patient ZIP code. Statistically significant variables (P<0.05) were included into a multivariable analysis. Of 795 outpatients (median age 18.5 years, interquartile range 13.4-27.1 years) referred for congenital cardiac MR, a total of 91 patients (11.4%) missed appointments; 28 (3.5%) missed multiple appointments. Reason for missed appointment could be identified in only 38 patients (42%), but of these, 28 (74%) were preventable or could have been identified prior to the appointment. In multivariable analysis, independent predictors of missed appointments were referral by a non-cardiologist (adjusted odds ratio [AOR] 5.8, P=0.0002), referral for research (AOR 3.6, P=0.01), having public insurance (AOR 2.1, P=0.004), and having scheduled cardiac MR from November to April (AOR 1.8, P=0.01). Demographic factors can identify patients at higher risk for missing appointments. These data may inform initiatives to limit missed appointments, such as targeted education of referring providers and patients. Further data are needed to evaluate the efficacy of potential interventions.

ACHP | News | President Bush Names New ACHP Member

Science.gov Websites

Announces Gov. Mark Sanford's Appointment to the Advisory Council on Historic Preservation WASHINGTON, D.C . - President George W. Bush is appointing Gov. Mark Sanford of South Carolina to the Advisory Council on Historic Preservation (ACHP) as the agency's representative for the nation's governors. Sanford will

77 FR 7132 - Request for Applicants for the Appointment to the United States-India CEO Forum

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-10

... appointment or reappointment as representatives to the U.S. Section of the Forum's private sector Committee....-India CEO Forum, consisting of both private and public sector members, brings together leaders of the... comprising private sector members. The Committee will be composed of two Sections, each consisting of 10-12...

Designated Airworthiness Representatives

DOT National Transportation Integrated Search

1985-10-01

This advisory circular (AC) contains information and guidance concerning the : selection and appointment of Designated Airworthiness Representatives (DAR's) and identifies the specific functions which may be delegated to DAR's as authorized by the Fe...

Primary care appointment availability and nonphysician providers one year after Medicaid expansion.

PubMed

Tipirneni, Renuka; Rhodes, Karin V; Hayward, Rodney A; Lichtenstein, Richard L; Choi, HwaJung; Reamer, Elyse N; Davis, Matthew M

2016-06-01

With insurance enrollment greater than expected under the Affordable Care Act, uncertainty about the availability and timeliness of healthcare services for newly insured individuals has increased. We examined primary care appointment availability and wait times for new Medicaid and privately insured patients before and after Medicaid expansion in Michigan. Simulated patient ("secret shopper") study. Extended follow-up of a previously reported simulated patient ("secret shopper") study assessing accessibility of routine new patient appointments in a stratified proportionate random sample of Michigan primary care practices before versus 4, 8, and 12 months after Medicaid expansion. During the study period, approximately 600,000 adults enrolled in Michigan's Medicaid expansion program, representing 57% of the previously uninsured nonelderly adult population. One year after expansion, we found that appointment availability remained increased by 6 percentage points for new Medicaid patients (95% CI, 1.6-11.1) and decreased by 2 percentage points for new privately insured patients (95% CI, -0.5 to -3.8). Over the same period, the proportion of appointments scheduled with nonphysician providers (nurse practitioners or physician assistants) increased from 8% to 21% of Medicaid appointments (95% CI, 5.6-20.2) and from 11% to 19% of private-insurance appointments (95% CI, 1.3-14.1). Median wait times remained stable for new Medicaid patients and increased slightly for new privately insured patients, both remaining within 2 weeks. During the first year following Medicaid expansion in Michigan, appointment availability for new Medicaid patients increased, a greater proportion of appointments could be obtained with nonphysician providers, and wait times remained within 2 weeks.

Multidisciplinary Cleft Palate Program at BC Children's Hospital: Are We Meeting the Standards of Care?

PubMed

Dahiya, Anita; Courtemanche, Rebecca; Courtemanche, Douglas J

2018-05-01

To characterize current Cleft Palate Program (CPP) practices and evaluate the timeliness of appointments with respect to patient age and diagnosis based on American Cleft Palate-Craniofacial Association (ACPA) population guidelines and CPP patient-specific recommendations. A retrospective review of CPP patient appointments from November 6, 2012, to March 31, 2015, was done. Data were analyzed using descriptive and inferential statistics. The study was conducted using data from the CPP at BC Children's Hospital. A total of 1214 appointments were considered in the analysis, including syndromic and nonsyndromic patients of 0 to 27 years of age. Percentage of patients meeting follow-up targets by ACPA standards and CPP team recommendations. Our results showed patients 5 years and younger or nonsyndromic were more likely to be seen on time ( P < .001). No relationship between the timeliness of an appointment and specific patient diagnoses or distance to clinic was found. With the exception of nursing (97% of appointments were on time), all disciplines had less than 45% of appointments on time with 51% of appointments meeting ACPA guidelines for timeliness and 32% of all appointments meeting CPP recommendations. Timely care for the cleft/craniofacial patient populations represents a challenge for the CPP. Although half of patients may meet the general ACPA guidelines, only 32% of patients are meeting the CPP patient-specific recommendations. To provide better patient care, future adjustments are needed, which may include improved resource allotment and program support.

When They Can't Talk, Lives Are Lost : What Public Officials Need to Know About Interoperability

DOT National Transportation Integrated Search

2003-02-01

This publication was developed to facilitate education and discussion among and between elected and appointed officials, their representative associations, and public safety representatives on public safety wireless communications interoperability. T...

76 FR 72204 - Renewal of Advisory Committee Charter

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-22

.... II. Structure The Committee shall consist of 17 members appointed by the Bank's Board of Directors on..., services, and State government, with not less than three members being representative of the small business... members being representative of the [[Page 72205

75 FR 79961 - Temporary Suspension of Certain Oil Spill Response Time Requirements To Support Deepwater Horizon...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-21

... appointment to view the docket is 202-566-0276. FOR FURTHER INFORMATION CONTACT: If you have questions on this... included individuals; an organization that represents companies that own, operate or charter tankers, ships... representing State environmental and health agencies; and a trade association representing companies involved...

Use of Six Sigma Methodology to Reduce Appointment Lead-Time in Obstetrics Outpatient Department.

PubMed

Ortiz Barrios, Miguel A; Felizzola Jiménez, Heriberto

2016-10-01

This paper focuses on the issue of longer appointment lead-time in the obstetrics outpatient department of a maternal-child hospital in Colombia. Because of extended appointment lead-time, women with high-risk pregnancy could develop severe complications in their health status and put their babies at risk. This problem was detected through a project selection process explained in this article and to solve it, Six Sigma methodology has been used. First, the process was defined through a SIPOC diagram to identify its input and output variables. Second, six sigma performance indicators were calculated to establish the process baseline. Then, a fishbone diagram was used to determine the possible causes of the problem. These causes were validated with the aid of correlation analysis and other statistical tools. Later, improvement strategies were designed to reduce appointment lead-time in this department. Project results evidenced that average appointment lead-time reduced from 6,89 days to 4,08 days and the deviation standard dropped from 1,57 days to 1,24 days. In this way, the hospital will serve pregnant women faster, which represents a risk reduction of perinatal and maternal mortality.

77 FR 9210 - International Pacific Halibut Commission Appointments

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-16

... duties, Commissioners represent the interests of the United States and all of its stakeholders in the... Pacific Halibut Commission (IPHC). This action is necessary to ensure that the interests of the United States and all of its stakeholders in the Pacific halibut fishery are adequately represented. The...

Preservation of the capacity to appoint a proxy decision maker: implications for dementia research.

PubMed

Kim, Scott Y H; Karlawish, Jason H; Kim, H Myra; Wall, Ian F; Bozoki, Andrea C; Appelbaum, Paul S

2011-02-01

Research involving persons with impaired decision-making capacity (such as persons with Alzheimer disease [AD]) remains ethically challenging, especially when the research involves significant risk. If individuals incapable of consenting to research studies were able to appoint a research proxy, it would allow for an appointed surrogate (rather than a de facto surrogate) to represent the subject. To assess the extent to which persons with AD retain their capacity to appoint a research proxy. Interview study. Academic research. One hundred eighty-eight persons with AD were interviewed for their capacity to appoint a proxy for research and to provide consent to 2 hypothetical research scenarios, a lower-risk randomized clinical trial testing a new drug (drug RCT) and a higher-risk randomized clinical trial testing neurosurgical cell implants using a sham control condition (neurosurgical RCT). Categorical capacity status for each subject was determined by independent videotaped reviews of capacity interviews by 5 experienced psychiatrists. Categorical capacity determinations for the capacity to appoint a research proxy, capacity to consent to a drug RCT, and capacity to consent to a neurosurgical RCT. Data showed that 37.7% (40 of 106) of those deemed incapable of consenting to the drug RCT and 54.8% (86 of 157) of those deemed incapable of consenting to the neurosurgical RCT were found capable of appointing a research proxy. Only 7 of 186 (3.8%) were deemed capable of consenting to the neurosurgical RCT by all 5 psychiatrists. A substantial proportion of persons with AD who were thought incapable of consenting to lower-risk or higher-risk studies have preserved capacity for appointing a research proxy. Because few persons are found to be unequivocally capable of providing independent consent to higher-risk AD research, providing for an appointed surrogate even after the onset of AD, which might best be done in the early stages of the illness, may help address key ethical challenges to AD research.

Court Appointed Volunteers for Abused and Neglected Children.

PubMed

Justin, Renate G.

2002-02-01

A court appointed special advocate (CASA) volunteer is a trained citizen who is appointed by a judge to represent the best interests of an abused and neglected child in court. An independent voice, the volunteer gathers information and reports to the court. The CASA volunteer works in close cooperation with other professionals, physicians, lawyers, social workers, and teachers to find the most suitable permanent placement for a victimized child, whether it be a foster home, parental home, or adoptive home. Another function for CASA volunteers is to be supportive to the child during a time of uncertainty in his or her life and to help the youngster adjust to new and changing situations; the CASA volunteer may be the only consistent adult presence during this difficult period of transition.

NOAA appoints members to Marine Protected Areas Federal Advisory Committee

Science.gov Websites

constituencies they represent are: Brian Baird, former assistant secretary for ocean and coastal policy , Portland, Oregon (conservation) Ryan Orgera, Ph.D., legislative representative, Coastal States Organization conserve and manage our coastal and marine resources. Join us on Twitter, Facebook, Instagram and our other

Learning, Labour and Union Learning Representatives: Promoting Workplace Learning

ERIC Educational Resources Information Center

Ball, Malcolm

2011-01-01

The initiative by the Trades Union Congress (TUC) and affiliated trade unions in the UK to appoint trade union learning representatives (ULRs), to promote learning among their members, is a significant development in adult learning. Understandably, the initiative has attracted the attention of academic researchers, but primarily from the…

Tribal Colleges and Universities. Executive Order.

ERIC Educational Resources Information Center

Bush, George W.

This Executive Order establishes the President's Board of Advisors on Tribal Colleges and Universities (Board) within the Department of Education. The Board shall consist of not more than 15 members appointed by the President. The Board shall include representatives of tribal colleges and may also include representatives of other education…

20 CFR 1001.140 - Administration of DVOP.

Code of Federal Regulations, 2010 CFR

2010-04-01

... of the DVOP program, including monitoring of the appointment of DVOP specialists. (c) DVOP specialists shall be in addition to and shall not supplant local veterans' employment representatives assigned...

Nomenclature for Aeronautics

NASA Technical Reports Server (NTRS)

1927-01-01

This nomenclature for aeronautics was prepared by a Special Conference on Aeronautical Nomenclature by the executive committee of the National Advisory Committee for Aeronautics at a meeting held on August 19, 1924, at which meeting Dr. Joseph S. Ames was appointed chairman of the conference. The conference was composed of representatives of the National Advisory Committee for Aeronautics and specially appointed representatives officially designated by the Army Air Service, the Bureau of Aeronautics of the Navy Department, the Bureau of Standards, the American Society of Mechanical Engineers, the Society of Automotive Engineers, and the Aeronautical Chamber of Commerce. The purpose of the committee in the preparation and publication of this report is to secure uniformity in the official documents of the government and, as far as possible, in technical and other commercial publications

31 CFR 353.60 - Payment to representative of an estate.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Payment to representative of an estate. 353.60 Section 353.60 Money and Finance: Treasury Regulations Relating to Money and Finance... appointed by a court, other proof of qualification. Except in the case of corporate fiduciaries, the...

32 CFR Appendix B to Part 153 - Acknowledgment of Limited Legal Representation (Sample)

Code of Federal Regulations, 2010 CFR

2010-07-01

... represented by legal counsel. 2. I acknowledge and understand that the appointment of military counsel for the... me in an initial detention hearing to be conducted outside the United States pursuant to 18 U.S.C...) wish to be represented by ______, military counsel __ (initials). 6. I understand that the legal...

Family attitudes, actions, decisions and experiences following implementation of deemed consent and the Human Transplantation (Wales) Act 2013: mixed-method study protocol

PubMed Central

Noyes, Jane; Morgan, Karen; Walton, Phillip; Roberts, Abigail; Mclaughlin, Leah; Stephens, Michael

2017-01-01

Introduction The Human Transplantation (Wales) Act 2013 (the Act) introduced a ‘soft opt-out’ system of organ donation on 1 December 2015. Citizens are encouraged to make their organ donation decision known during their lifetime. In order to work, the Act and media campaign need to create a context, whereby organ donation becomes the norm, and create a mechanism for people to behave as intended (formally register their decision; consider appointing a representative; convey their donation decision to their families and friends or do nothing—deemed consent). In addition, family members/appointed representatives need to be able to put their own views aside to support the decision of their loved one. The aim of this study is to evaluate initial implementation, outcomes and impact on families and appointed representatives who were approached about organ donation during the first 18 months. Methods and analysis Prospective mixed-method coproductive study undertaken with National Health Service Blood and Transplant (NHSBT), and multiple patient/public representatives. The study is designed to collect information on all cases who meet specified criteria (≥18 years, deceased person voluntarily resident in Wales and died in Wales or England) whose family were approached between 1 December 2015 and 31 June 2017). Data for analysis include: NHSBT routinely collected anonymised audit data on all cases; Specialist Nurse in Organ Donation (SNOD) completed anonymised form for all cases documenting their perception of the families’ understanding of the Act, media campaign and outcome of the donation approach; questionnaires and depth interviews with any family member or appointed representative (minimum 50 cases). Additional focus groups and interviews with SNODs. Anonymised donation outcomes and registration activity reports for Wales provide additional context. Ethics and dissemination Approved by NHSBT Research, Innovation and Technology Advisory Group on 23 October 2015; Wales Research Ethics Committee 5 (IRAS190066; Rec Reference 15/WA/0414) on 25 November 2015 and NHSBT R&D Committee (NHSBT ID: AP-15–02) on 24 November 2015. Registration The protocol is registered on the Health and Care Research Wales Clinical Research Portfolio. Study ID number 34396, www.ukctg.nihr.ac.uk PMID:29025839

Family attitudes, actions, decisions and experiences following implementation of deemed consent and the Human Transplantation (Wales) Act 2013: mixed-method study protocol.

PubMed

Noyes, Jane; Morgan, Karen; Walton, Phillip; Roberts, Abigail; Mclaughlin, Leah; Stephens, Michael

2017-10-12

The Human Transplantation (Wales) Act 2013 (the Act) introduced a 'soft opt-out' system of organ donation on 1 December 2015. Citizens are encouraged to make their organ donation decision known during their lifetime. In order to work, the Act and media campaign need to create a context, whereby organ donation becomes the norm, and create a mechanism for people to behave as intended (formally register their decision; consider appointing a representative; convey their donation decision to their families and friends or do nothing-deemed consent). In addition, family members/appointed representatives need to be able to put their own views aside to support the decision of their loved one. The aim of this study is to evaluate initial implementation, outcomes and impact on families and appointed representatives who were approached about organ donation during the first 18 months. Prospective mixed-method coproductive study undertaken with National Health Service Blood and Transplant (NHSBT), and multiple patient/public representatives. The study is designed to collect information on all cases who meet specified criteria (≥18 years, deceased person voluntarily resident in Wales and died in Wales or England) whose family were approached between 1 December 2015 and 31 June 2017). Data for analysis include: NHSBT routinely collected anonymised audit data on all cases; Specialist Nurse in Organ Donation (SNOD) completed anonymised form for all cases documenting their perception of the families' understanding of the Act, media campaign and outcome of the donation approach; questionnaires and depth interviews with any family member or appointed representative (minimum 50 cases). Additional focus groups and interviews with SNODs. Anonymised donation outcomes and registration activity reports for Wales provide additional context. Approved by NHSBT Research, Innovation and Technology Advisory Group on 23 October 2015; Wales Research Ethics Committee 5 (IRAS190066; Rec Reference 15/WA/0414) on 25 November 2015 and NHSBT R&D Committee (NHSBT ID: AP-15-02) on 24 November 2015. The protocol is registered on the Health and Care Research Wales Clinical Research Portfolio. Study ID number 34396, www.ukctg.nihr.ac.uk. © 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.

[Clinical and Sociodemographic Characteristics That Affect the Recommendation for Assignment of A Legal Representative in Patients With Bipolar Disorder].

PubMed

Akıncı, Erhan; Öncü, Fatih; Ger, Can; Sabuncuoğlu, Mustafa; Kırmızı, Anıl; Eradamlar, Nezih

2017-01-01

In this study, we aimed to evaluate the clinical and sociodemographic characteristics of patients with bipolar disorder who had been sent to the Forensic Psychiatry Unit by the court in order to determine factors that affected the decision to appoint a legal representative. The reports of health council, follow-up outpatient, and hospitalization files of a total of 78 patients with bipolar disorder who had been sent to the Department of Forensic Psychiatry Outpatient Clinic of Bakirköy Mental Health and Neurological Diseases Education and Research Hospital between 1st June 2009-31st December 2011 were examined. Patients had been sent by the court in order to determine whether a legal representative was required. Seventy patients meeting enough to sociodemographic and clinical form were separated as appointment group of legal representative or not and decision variables were compared statistically. Forty-six patients (66%) were recommended assignment of a legal representative. In the patients with bipolar disorder for whom a legal representative was recommended, the presence of other first axis comorbidity, the presence of psychotic episodes, delusions of persecution and reference, hallucinations, the total number of manic and mixed episodes, incidence of alcohol and substance abuse, lifetime total number of attacks, and the total number and duration of hospitalizations were found to be significantly higher. The probability of assignment of a legal representative was increased 11-fold by the presence of first axis comorbidity, 1.3-fold by the number of manic episodes, and 2.2-fold by the number of mixed episodes were specified. In the practice of forensic psychiatry, clinicians should focus on the course of the disease, especially the number and frequency of manic or mixed episodes, total number of episodes and hospitalizations, duration of hospitalizations, alcohol and substance use, the presence of episodes accompanied by psychosis with paranoid delusions and hallucinations, and the presence of the other first axis comorbidity in the patient with bipolar disorder for assessment of the decision to appoint a legal representative.

37 CFR 1.31 - Applicant may be represented by one or more patent practitioners or joint inventors.

Code of Federal Regulations, 2010 CFR

2010-07-01

... PATENT CASES National Processing Provisions Prosecution of Application and Appointment of Attorney Or Agent § 1.31 Applicant may be represented by one or more patent practitioners or joint inventors. An... by one or more patent practitioners or joint inventors. 1.31 Section 1.31 Patents, Trademarks, and...

20 CFR 266.4 - Information considered in selecting a representative payee.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., including the type of relationship, e.g., family or legal guardianship; degree of relationship, if the... payee unless such appointment poses no substantial conflict of interest and unless the creditor is: (1...

Real-time measurement of quality during the compaction of subgrade soils.

DOT National Transportation Integrated Search

2012-12-01

Conventional quality control of subgrade soils during their compaction is usually performed by monitoring moisture content and dry density at a few discrete locations. However, randomly selected points do not adequately represent the entire compacted...

Postoperative pain after endodontic retreatment: single- versus two-visit treatment.

PubMed

Yoldas, Oguz; Topuz, Aysin; Isçi, A Sehnaz; Oztunc, Haluk

2004-10-01

The purpose of this clinical study was to determine the effect of 1- or 2-visit root canal treatment on the postoperative pain in the retreatment cases. Two hundred eighteen cases that required retreatment were included in the study. Obturated and unfilled canal space and the status of periapical tissues were evaluated according to the PAI index. The patients were subcategorized in regard to the presence or the absence of preoperative pain. Approximately half of each category was treated in 1 appointment. After removing the previous root canal obturation materials and biomechanic preparation of root canals, the teeth in the 1-visit group were obturated at the first appointment by using AH 26 sealer and laterally compacted gutta-percha, and those in the 2-visit group were medicated with calcium hydroxide-chlorhexidine combination and then closed with a temporary filling material. One week after the initial appointment, patients were asked about the occurrence of postoperative pain. The level of discomfort was rated as no pain, mild pain, moderate pain, or severe pain (flare-up). Data were statistically analyzed using the chi-squared and Fischer exact tests. Eight patients from the 1-visit group and 2 patients from the 2-visit group had flare-ups. There was a statistical difference between the groups (P <.05). Two-visit root canal treatment was more effective in completely eliminating pain than 1-visit treatment of previously symptomatic teeth (P <.05). Two-visit endodontic treatment with intracanal medication was found to be effective in reducing postoperative pain of previously symptomatic teeth and decreased the number of flare-ups in all retreatment cases.

41 CFR 102-33.25 - What are our responsibilities under this part?

Code of Federal Regulations, 2010 CFR

2010-07-01

..., GSA) a Senior Aviation Management Official (SAMO), who will be your agency's primary member of the...) Appoint representatives of the agency as members of ICAP subcommittees and working groups; and (h) Ensure...

76 FR 38679 - Notice of Call for Nominations for Appointment of Primary and Alternate Representatives, Santa...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

... information explaining the nominee's qualifications (e.g., resume, curriculum vitae). Nomination application...-7100; by written request from the Santa Rosa and San Jacinto Mountains National Monument Manager at the...

Randomized trial of a novel game-based appointment system for a university hospital venereology unit: study protocol.

PubMed

Gabarron, Elia; Serrano, J Artur; Fernandez-Luque, Luis; Wynn, Rolf; Schopf, Thomas

2015-04-08

Chlamydia is the most common reportable sexually transmitted disease (STD) in Norway, and its incidence in the two northernmost counties has been disclosed to be nearly the double of the Norwegian average. The latest publicly available rates showed that 85.6% of the new cases were diagnosed in people under 29 years old. The information and communication technologies are among the most powerful influences in the lives of young people. The Internet can potentially represent a way to educate on sexual health and encourage young people, and especially youth, to be tested for STDs. If hospital websites include an easy and anonymous system for scheduling appointments with the clinic, it is possible that this could lead to an increase in the number of people tested for STDs. The purpose of the study is to assess the impact of a game-based appointment system on the frequency of consultations at a venereology unit and on the use of an educational web app. An A/B testing methodology is used. Users from the city of Tromsø, in North Norway, will be randomized to one of the two versions of the game-style web app on sexual health at www.sjekkdeg.no. Group A will have access to educational content only, while group B will have, in addition, access to a game-based appointment system with automatic prioritization. After one year of the trial, it will be analyzed if the game-based appointment system increases the number of consultations at the venereology unit and if health professionals deem the system useful. This study will explore if facilitating the access to health services for youth through the use of a game-based appointment system integrated in a game-style web app on sexual health education can have an impact on appointment rates. The trial is registered at clinicaltrials.org under the identifier ClinicalTrials.gov NCT:02128620.

Socioeconomic and Demographic Predictors of Missed Opportunities to Provide Advanced Imaging Services.

PubMed

Glover, McKinley; Daye, Dania; Khalilzadeh, Omid; Pianykh, Oleg; Rosenthal, Daniel I; Brink, James A; Flores, Efrén J

2017-11-01

The extent to which racial and socioeconomic disparities exist in accessing clinically appropriate, advanced diagnostic imaging has not been well studied. This study assesses the relationship between demographic and socioeconomic factors and the incidence of imaging missed care opportunities (IMCOs). We performed a retrospective review of outpatient CT and MRI appointments at a quaternary academic medical center and affiliated outpatient facilities during a 12-month period. Missed appointments not rescheduled in advance were classified as IMCOs. Appropriateness criteria scores and demographics were also obtained. Univariate and multivariate analyses were performed to determine if demographic and socioeconomic factors were predictive of IMCOs. Overall, 57,847 patients met inclusion criteria, representing 89,943 scheduled unique imaging appointments of which 5,840 (6.1%) were IMCOs; 0.8% of IMCO appointments had low appropriateness scores compared with 1.2% of completed appointments (P < .01). Appointments covered by commercial insurance (5.2%) had a significantly lower rate of IMCOs than other payers: Medicare = 6.3%, Medicaid = 14.5%, self-pay = 12.0% (P < .05). The following factors were independent predictors of a patient having ≥ 1 IMCO: noncommercial insurance [odds ratio (OR) = 1.7-2.6], African American (OR = 1.8), Hispanic (OR = 1.2), other race (OR = 1.1), language other than English or Spanish (OR = 1.2), male gender (OR = 1.2), age ≥ 65 (OR = 0.71), and median household income of patient home zip code <$50,000 (OR = 1.4). Race and socioeconomic status are independent predictors of IMCOs. In efforts to enhance patient engagement, radiologists should be aware of the impact of race and socioeconomic status on access to clinically appropriate advanced diagnostic imaging. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Increased compactibility of acetames after roll compaction.

PubMed

Kuntz, Theresia; Schubert, Martin A; Kleinebudde, Peter

2011-01-01

A common technique for manufacturing granules in a continuous way is the combination of roll compaction and subsequent milling. Roll compaction can considerably impact tableting performance of a material. The purpose of this study was to investigate the influence of roll compaction/dry granulation on the compaction behavior of acetames, a class of active pharmaceutical substances, which are mainly used for the treatment of central nervous diseases. Some representatives of acetames were roll compacted and then compressed into tablets. Compactibility of granules was compared with the compaction behavior of the directly compressed drug powders. In contrast to many other materials, the roll compaction step induced an increase in compactibility for all investigated acetames. Specific surface areas of the untreated and the roll compacted drugs were determined by nitrogen adsorption. The raise in compactibility observed was accompanied by an increase in specific surface area during roll compaction. Copyright © 2010 Elsevier B.V. All rights reserved.

AIP appoints New CEO

NASA Astrophysics Data System (ADS)

The American Institute of Physics (AIP) has announced the appointment of a new chief executive officer, Kenneth W. Ford, who is to succeed H. William Koch when Koch retires on March 28, 1987. Koch has held the position since 1966.AIP is a not-for-profit scientific organization made up of 10 member societies, including AGU, that represent more than 90,000 scientists. Its main activities include scientific publishing and marketing of 76 primary physics journals, including translations of foreign journals, books, conference proceedings, and the magazine Physics Today. AIP also is involved with electronic abstracting and other scientific communications and has active programs in education, public information, manpower statistics, and the history of physics.

20 CFR 404.1703 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... other association, including but not limited to partnerships, corporations, for-profit organizations, and not-for-profit organizations. Legal guardian or court-appointed representative means a court... representation, we determine past-due benefits before any applicable reduction under section 1127 of the Act (for...

20 CFR 404.1703 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... other association, including but not limited to partnerships, corporations, for-profit organizations, and not-for-profit organizations. Legal guardian or court-appointed representative means a court... representation, we determine past-due benefits before any applicable reduction under section 1127 of the Act (for...

77 FR 2257 - Adoption of Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-17

... good communication of emerging revisions to those within the agency charged with making policy... must comply with ethics requirements similar to those applicable to regular government employees... appointed as ``representatives'' and are not subject to ethics requirements.\\15\\ Once a committee is formed...

Targeting zero non-attendance in healthcare clinics.

PubMed

Chan, Ka C; Chan, David B

2012-01-01

Non-attendance represents a significant cost to many health systems, resulting in inefficiency, wasted resources, poorer service delivery and lengthened waiting queues. Past studies have considered extensively the reasons for non-attendance and have generally concluded that the use of reminder systems is effective. Despite this, there will always be a certain level of non-attendance arising from unforeseeable and unpreventable circumstances, such as illness or accidents, leading to unfilled appointments. This paper reviews current approaches to the non-attendance problem, and presents a high-level approach to fill last minute appointments arising out of unforeseeable non-attendance. However, no single approach will work for all clinics and implementation of these ideas must occur at a local level. These approaches include use of social networks, such as Twitter and Facebook, as a communication tool in order to notify prospective patients when last-minute appointments become available. In addition, teleconsultation using video-conferencing technologies would be suitable for certain last-minute appointments where travel time would otherwise be inhibiting. Developments of new and innovative technologies and the increasing power of social media, means that zero non-attendance is now an achievable target. We hope that this will lead to more evidence-based evaluations from the implementation of these strategies in various settings at a local level.

20 CFR 416.1503 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... business, firm, or other association, including but not limited to partnerships, corporations, for-profit organizations, and not-for-profit organizations. Legal guardian or court-appointed representative means a court... representation, we first determine the SSI past-due benefits before any applicable reduction for reimbursement to...

20 CFR 416.1503 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... business, firm, or other association, including but not limited to partnerships, corporations, for-profit organizations, and not-for-profit organizations. Legal guardian or court-appointed representative means a court... representation, we first determine the SSI past-due benefits before any applicable reduction for reimbursement to...

Local Government In-Service Training; An Annotated Bibliography.

ERIC Educational Resources Information Center

Stout, Ronald M., Ed.

This bibliography on inservice training is divided into four major categories: (1) Local Government Training in General; (2) Training Generalist Officials and Administrators; (3) Training Personnel in Functional Fields; (4) Bibliographies. Coverage includes elected representatives and executives; appointed managers, executives, and supervisors;…

77 FR 47826 - Inland Waterways Users Board; Request for Nominations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-10

... above commodity categories. d. Nomination. Reflecting preceding selection criteria, the current.... Mark R. Pointon, (703) 428-6438. SUPPLEMENTARY INFORMATION: The selection, service, and appointment of... substance of those provisions is as follows: a. Selection. Representative organizations are to be selected...

Disruptive Forces

ERIC Educational Resources Information Center

O'Banion, Terry

2009-01-01

More than 6,500 trustees serve the nation's community colleges. The overwhelming majority of these trustees are exceptional community leaders, elected and appointed to champion the community college mission for the community and students they represent. These local trustees serve the greater good, and as the guardians of their local community…

Social Work Agonistes

ERIC Educational Resources Information Center

Stoesz, David

2008-01-01

Social work should be founded on a powerful network of diverse practitioners applying the social sciences to advance social welfare today. Instead, social work education operates under the guise of identity politics, reserving its highest appointments for the politically correct and members of under-represented groups, with little concern for…

President's Child Safety Partnership. Final Report.

ERIC Educational Resources Information Center

President's Commission on Child Safety Partnership, Washington, DC.

This report presents the findings and recommendations from the President's Child Safety Partnership, a group of citizens representing business, private nonprofit groups, the government, and private individuals appointed by President Reagan to gather accurate information about the nature and extent of violence against children and to identify…

USSR Report, International Affairs

DTIC Science & Technology

1986-10-23

TÄSS—The Presidium of the USSR Supreme Soviet appointed Yevgeniy Makeyev the Soviet Union’s permanent representative to the U.N. Office and other...international organizations in Geneva. Yevgeniy Makeyev worked as head of the second European Department of the Ministry of Foreign Affairs of the

5 CFR 330.205 - Agency RPL applications.

Code of Federal Regulations, 2013 CFR

2013-01-01

... register for positions at the same representative rate and work schedule (full-time, part-time, seasonal... grades or pay levels, appointment type (permanent or time-limited), occupations (e.g., position classification series or career groups), and minimum number of hours of work per week, as applicable. ...

20 CFR 416.1500 - Introduction.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Introduction. 416.1500 Section 416.1500 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Representation of Parties § 416.1500 Introduction. You may appoint someone to represent you in any...

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

Pavlou, A. T.; Betzler, B. R.; Burke, T. P.

Uncertainties in the composition and fabrication of fuel compacts for the Fort St. Vrain (FSV) high temperature gas reactor have been studied by performing eigenvalue sensitivity studies that represent the key uncertainties for the FSV neutronic analysis. The uncertainties for the TRISO fuel kernels were addressed by developing a suite of models for an 'average' FSV fuel compact that models the fuel as (1) a mixture of two different TRISO fuel particles representing fissile and fertile kernels, (2) a mixture of four different TRISO fuel particles representing small and large fissile kernels and small and large fertile kernels and (3)more » a stochastic mixture of the four types of fuel particles where every kernel has its diameter sampled from a continuous probability density function. All of the discrete diameter and continuous diameter fuel models were constrained to have the same fuel loadings and packing fractions. For the non-stochastic discrete diameter cases, the MCNP compact model arranged the TRISO fuel particles on a hexagonal honeycomb lattice. This lattice-based fuel compact was compared to a stochastic compact where the locations (and kernel diameters for the continuous diameter cases) of the fuel particles were randomly sampled. Partial core configurations were modeled by stacking compacts into fuel columns containing graphite. The differences in eigenvalues between the lattice-based and stochastic models were small but the runtime of the lattice-based fuel model was roughly 20 times shorter than with the stochastic-based fuel model. (authors)« less

Assessing Ongoing Electronic Resource Purchases: Linking Tools to Synchronize Staff Workflows

ERIC Educational Resources Information Center

Carroll, Jeffrey D.; Major, Colleen; O'Neal, Nada; Tofanelli, John

2012-01-01

Ongoing electronic resource purchases represent a substantial proportion of collections budgets. Recognizing the necessity of systematic ongoing assessment with full selector engagement, Columbia University Libraries appointed an Electronic Resources Assessment Working Group to promote the inclusion of such resources within our current culture of…

28 CFR 549.43 - Involuntary psychiatric treatment and medication.

Code of Federal Regulations, 2010 CFR

2010-07-01

... treatment for the mental illness and less restrictive alternatives (e.g., seclusion or physical restraint... institution mental health division administrator shall appoint a staff representative. Witnesses should be called if they have information relevant to the inmate's mental condition and/or need for medication, and...

45 CFR 1607.3 - Composition.

Code of Federal Regulations, 2010 CFR

2010-10-01

... percent (60%) of a governing body shall be attorney members. (1) A majority of the members of the governing body shall be attorney members appointed by the governing body(ies) of one or more State, county or municipal bar associations, the membership of which represents a majority of attorneys practicing...

13 CFR 303.6 - EDA-funded CEDS process.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PLANNING INVESTMENTS AND COMPREHENSIVE ECONOMIC DEVELOPMENT STRATEGIES § 303.6 EDA-funded CEDS process. If EDA awards Investment Assistance to a Planning Organization to develop, revise or replace a CEDS, the... must appoint a Strategy Committee. The Strategy Committee must represent the main economic interests of...

The integration of a Podiatrist into an orthopaedic department: a cost-consequences analysis.

PubMed

Walsh, Tom P; Ferris, Linda R; Cullen, Nancy C; Brown, Christopher H; Loughry, Cathy J; McCaffrey, Nikki M

2017-01-01

The aim of this study was to evaluate the cost-consequences of a podiatry-led triage clinic provided in an orthopaedic department relative to usual care for non-urgent foot and ankle complaints in an Australian tertiary care hospital. All new, non-urgent foot and ankle patients seen in an outpatient orthopaedic department were included in this study. The patients seen between 2014 and 2015 by Orthopaedic Surgeons were considered 'usual care', the patients seen between 2015 and 2016 by a Podiatrist were considered the 'Podiatry Triage Clinic'. Data on new and review patient appointments; the number of new patients / session; the number of appointments / patient; the number of patients discharged; the surgical conversion rate; staff time; and imaging use were collected. A cost-consequences analysis, undertaken from a healthcare provider perspective (hospital) estimated the incremental resource use, costs and effects of the Podiatry Triage Clinic relative to usual care over a 12-month period. The Orthopaedic Surgeons and Podiatrist consulted with 72 and 212 new patients during the usual care and triage periods, respectively. The Podiatrist consulted with more new patients / session, mean (SD) of 3.6 (1.0) versus 0.7 (0.8), p  < 0.001 and utilised less appointments / patient than the Orthopaedic Surgeons, mean (SD) of 1.3 (0.6) versus 1.9 (1.1), p  < 0.001. The percentage of patients discharged without surgery was similar in the Podiatry Triage Clinic and usual care, 80.3% and 87.5% p  = 0.135, respectively, but the surgical conversion rate was higher in the Podiatry Triage Clinic, 76.1% versus 12.5% p  < 0.001. The total integrated appointment cost for the 12-month usual care period was $32,744, which represented a cost of $454.78 / patient. The total appointment and imaging cost during the triage period was $19,999, representing $94.34 / patient. Further analysis, suggests that the projected annual saving of integrating a Podiatry Triage Clinic versus an orthopaedic clinic alone is $50,441. The integration of a Podiatrist into an orthopaedic department significantly increases the number of patients seen, is cost-effective, improves the surgical conversion rate and improves the utilisation of Orthopaedic Surgeons.

76 FR 34253 - Exemptions From Certain Prohibited Transaction Restrictions

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-13

... Plan. (b) In the event that the same Independent Fiduciary is appointed to represent the interests of... preceding conditions are not exclusive, and that other circumstances may develop which cause the Independent... Interest as determined by a qualified, independent appraiser, in an updated appraisal on the date of Sale...

23 CFR 260.109 - Selection.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Selection. 260.109 Section 260.109 Highways FEDERAL... PROGRAMS Fellowship and Scholarship Grants § 260.109 Selection. (a) Candidates shall be rated by a selection panel appointed by the Director of the NHI. Members of the panel shall represent the highway...

Employment Training Panel Report to the Legislature.

ERIC Educational Resources Information Center

California State Employment Training Panel, Sacramento.

The Employment Training Panel consists of seven representatives of business and labor who were appointed by the Governor of California and the state's legislature to administer funds transferred from the state unemployment insurance fund for job training. The panel is authorized to contract with employers and schools to conduct training that puts…

78 FR 67339 - Fisheries of the Gulf of Mexico; Southeast Data, Assessment, and Review (SEDAR); Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-12

... Caribbean Fishery Management Councils, in conjunction with NOAA Fisheries and the Atlantic and Gulf States... are appointed by the Gulf of Mexico, South Atlantic, and Caribbean Fishery Management Councils and...; constituency representatives including fishermen, environmentalists, and non-governmental organizations (NGOs...

78 FR 8111 - Fisheries of the Gulf of Mexico; Southeast Data, Assessment, and Review (SEDAR); Public Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-05

... Gulf of Mexico, South Atlantic, and Caribbean Fishery Management Councils, in conjunction with NOAA... SEDAR Workshops are appointed by the Gulf of Mexico, South Atlantic, and Caribbean Fishery Management...; constituency representatives including fishermen, environmentalists, and non-governmental organizations (NGOs...

76 FR 34061 - Fisheries of the South Atlantic; Southeast Data, Assessment, and Review (SEDAR); Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-10

...: The Gulf of Mexico, South Atlantic, and Caribbean Fishery Management Councils, in conjunction with... Workshops are appointed by the Gulf of Mexico, South Atlantic, and Caribbean Fishery Management Councils and...; constituency representatives including fishermen, environmentalists, and NGO's; International experts; and...

38 CFR 1.465 - Incompetent and deceased patients.

Code of Federal Regulations, 2010 CFR

2010-07-01

... vital statistics or permitting inquiry into the cause of death. (2) Consent by personal representative... Sickle Cell Anemia § 1.465 Incompetent and deceased patients. (a) Incompetent patients other than minors... of this part may be given by a court appointed legal guardian. (b) Deceased patients—(1) Vital...

77 FR 20881 - Unified Carrier Registration Plan Board of Directors; Request for Nominations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-06

... Carrier Industry to the Board of Directors. SUMMARY: FMCSA solicits nominations and applications for... persons to serve as representatives of the motor carrier industry. The Agency will appoint five members from the motor carrier industry. The UCR Plan is responsible for the administration of the UCR...

7 CFR 1207.322 - Nominations and appointment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... representative of the potato, potato product, and seed potato import industry; (4) Does the association speak for... by importers of potatoes, potato products and/or seed potatoes. The number of importer members on the... organizations of potato, potato products and/or seed potato importers to assist in nominating importers for...

7 CFR 1207.322 - Nominations and appointment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... representative of the potato, potato product, and seed potato import industry; (4) Does the association speak for... by importers of potatoes, potato products and/or seed potatoes. The number of importer members on the... organizations of potato, potato products and/or seed potato importers to assist in nominating importers for...

20 CFR 725.507 - Guardian for minor or incompetent.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Guardian for minor or incompetent. 725.507... for minor or incompetent. An adjudication officer may require that a legal guardian or representative be appointed to receive benefit payments payable to any person who is mentally incompetent or a minor...

Working with Advocates

ERIC Educational Resources Information Center

Doan, Kim

2010-01-01

Court appointed special advocates (CASAs) are volunteers who represent abused and neglected children in the court system. David Soukup, a judge in Washington State, created the first CASA program in 1977 to gather more information about the children whose cases were appearing before him. The likelihood of meeting a CASA may be equal to the…

48 CFR 809.470 - Fact-finding procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Fact-finding procedures....470 Fact-finding procedures. The provisions of this section constitute the procedures to be used to... appoint a designee to conduct the fact-finding. OGC shall represent VA at any fact-finding hearing and may...

The Coffe Report, 1969.

ERIC Educational Resources Information Center

British Columbia Univ., Vancouver. Faculty of Education.

This report contains the findings of a seven-member faculty commission (to which a student representative was later added) appointed in early 1968 to make proposals for the future development of the Faculty of Education. The introductory chapter places the commission's work in historical perspective, points up priorities, and discusses some issues…

37 CFR 41.108 - Lead counsel.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 37 Patents, Trademarks, and Copyrights 1 2012-07-01 2012-07-01 false Lead counsel. 41.108 Section... COMMERCE PRACTICE BEFORE THE BOARD OF PATENT APPEALS AND INTERFERENCES Contested Cases § 41.108 Lead counsel. (a) A party may be represented by counsel. The Board may require a party to appoint a lead...

37 CFR 41.108 - Lead counsel.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 37 Patents, Trademarks, and Copyrights 1 2011-07-01 2011-07-01 false Lead counsel. 41.108 Section... COMMERCE PRACTICE BEFORE THE BOARD OF PATENT APPEALS AND INTERFERENCES Contested Cases § 41.108 Lead counsel. (a) A party may be represented by counsel. The Board may require a party to appoint a lead...

37 CFR 41.108 - Lead counsel.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Lead counsel. 41.108 Section... COMMERCE PRACTICE BEFORE THE BOARD OF PATENT APPEALS AND INTERFERENCES Contested Cases § 41.108 Lead counsel. (a) A party may be represented by counsel. The Board may require a party to appoint a lead...

A decision support system for quality of life in head and neck oncology patients.

PubMed

Gonçalves, Joaquim J; Rocha, Alvaro M

2012-02-16

The assessment of Quality of Life (QoL) is a Medical goal; it is used in clinical research, medical practice, health-related economic studies and in planning health management measures and strategies. The objective of this project is to develop an informational platform to achieve a patient self-assessment with standardized QoL measuring instruments, through friendly software, easy for the user to adapt, which should aid the study of QoL, by promoting the creation of databases and accelerating its statistical treatment and yet generating subsequent useful results in graphical format for the physician analyzes in an appointment immediately after the answers collection. First, a software platform was designed and developed in an action-research process with patients, physicians and nurses. The computerized patient self-assessment with standardized QoL measuring instruments was compared with traditional one, to verify if its use did not influence the patient's answers. For that, the Wilcoxon and t-Student tests were applied. After, we adopted and adapted the mathematic Rash model to make possible the use of QoL measure in the routine appointments. The results show that the computerized patient self-assessment does not influence the patient's answers and can be used as a suitable tool in the routine appointment, because indicates problems which are more difficult to identify in a traditional appointment, improving thus the physician's decisions. The possibility of representing graphically useful results that physician needs to analyze in the appointment, immediately after the answer collection, in an useful time, makes this QoL assessment platform a diagnosis instrument ready to be used routinely in clinical practice.

Ulysses - An ESA/NASA cooperative programme

NASA Technical Reports Server (NTRS)

Meeks, W.; Eaton, D.

1990-01-01

Cooperation between ESA and NASA is discussed, noting that the Memorandum of Understanding lays the framework for this relationship, defining the responsibilities of ESA and NASA and providing for appointment of leadership and managers for the project. Members of NASA's Jet Propulsion Laboratory and ESA's ESTEC staff have been appointed to leadership positions within the project and ultimate control of the project rests with the Joint Working Group consisting of two project managers and two project scientists, equally representing both organizations. Coordination of time scales and overall mission design is discussed, including launch cooperation, public relations, and funding of scientific investigations such as Ulysses. Practical difficulties of managing an international project are discussed such as differing documentation requirements and communication techniques, and assurance of equality on projects.

5 CFR 316.402 - Procedures for making temporary appointments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... appointments. Such appointments are not VRA appointments and do not lead to conversion to career-conditional appointment; (3) Career-conditional appointment under § 315.601, 315.604, 315.605, 315.606, 315.607, 315.608... the General Accounting Office; (6) Appointment under 28 U.S.C. 602 for current and former employees of...

High power pulsed sources based on fiber amplifiers

NASA Astrophysics Data System (ADS)

Canat, Guillaume; Jaouën, Yves; Mollier, Jean-Claude; Bouzinac, Jean-Pierre; Cariou, Jean-Pierre

2017-11-01

Cladding-pumped rare-earth-doped fiber laser technologies are currently among the best sources for high power applications. Theses extremely compact and robust sources appoint them as good candidate for aeronautical and space applications. The double-clad (DC) fiber converts the poor beamquality of high-power large-area pump diodes from the 1st cladding to laser light at another wavelength guided in an active single-mode core. High-power coherent MOPA (Master Oscillator Power Amplifier) sources (several 10W CW or several 100W in pulsed regime) will soon be achieved. Unfortunately it also brings nonlinear effects which quickly impairs output signal distortions. Stimulated Brillouin scattering (SBS) and optical parametric amplification (OPA) have been shown to be strong limitations. Based on amplifier modeling and experiments we discuss the performances of these sources.

Anticrack inclusion model for compaction bands in sandstone

NASA Astrophysics Data System (ADS)

Sternlof, Kurt R.; Rudnicki, John W.; Pollard, David D.

2005-11-01

Detailed observations of compaction bands exposed in the Aztec Sandstone of southeastern Nevada indicate that these thin, tabular, bounded features of localized porosity loss initiated at pervasive grain-scale flaws, which collapsed in response to compressive tectonic loading. From many of these Griffith-type flaws, an apparently self-sustaining progression of collapse propagated outward to form bands of compacted grains a few centimeters thick and tens of meters in planar extent. These compaction bands can be idealized as highly eccentric ellipsoidal bodies that have accommodated uniform uniaxial plastic strain parallel to their short dimension within a surrounding elastic material. They thus can be represented mechanically as contractile Eshelby inclusions, which generate near-tip compressive stress concentrations consistent with self-sustaining, in-plane propagation. The combination of extreme aspect ratio (˜10-4) and significant uniaxial plastic strain (˜10%) also justifies an approximation of the bands as anticracks: sharp boundaries across which a continuous distribution of closing mode displacement discontinuity has been accommodated. This anticrack interpretation of compaction bands is analogous to that of pressure solution surfaces, except that porosity loss takes the place of material dissolution. We find that displacement discontinuity boundary element modeling of compaction bands as anticracks within a two-dimensional linear elastic continuum can accurately represent the perturbed external stress fields they induce.

The Civic Participation of Visible Minorities in Canadian Society: Framework and Issues for Research and Analysis.

ERIC Educational Resources Information Center

Bancroft, George W.; And Others

This exploratory study examines the issues connected with the civic participation of minority groups in Canada. Civic participation is service, either through appointment or election, on public boards and commissions other than those representing the participant's own ethnocultural group. Information was gathered from a literature review,…

Assessing Research Self-Efficacy in Physician-Scientists: The Clinical Research APPraisal Inventory

ERIC Educational Resources Information Center

Mullikin, Elizabeth A.; Bakken, Lori L.; Betz, Nancy E.

2007-01-01

Between 1980 and 1993, only 19% of medical school graduates chose faculty appointments with research responsibilities. Women and minorities represent only a small fraction of these, despite their growing numbers. The authors' goal is to study the effects of human agency, particularly self-efficacy, on the career development of physician…

17 CFR 240.24c-1 - Access to nonpublic information.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Act; (4) The Securities Investor Protection Corporation or any trustee or counsel for a trustee appointed pursuant to Section 5(b) of the Securities Investor Protection Act of 1970; (5) A trustee in... representative of any of the above persons. (c) Nothing contained in this section shall affect: (1) The...

"They Call Me Headmaster": Malawian and Australian Women Leaders

ERIC Educational Resources Information Center

Whitehead, Kay; Andretzke, Elaine; Binali, Valesi

2018-01-01

This article explores commonalities in the lives and work of women head teachers in Malawian secondary schools and women principals in Australian Lutheran schools. In both Australia and Malawi women are under-represented in school leadership and often appointed to complex schools and communities. We commence with a brief discussion of Malawi and…

25 CFR 90.33 - Watchers and challengers.

Code of Federal Regulations, 2010 CFR

2010-04-01

... TRIBE Elections § 90.33 Watchers and challengers. Any candidate or political party may name a person to... watcher and challenger shall be appointed in writing by the candidate or political party he or she represents. The watchers and challengers shall have the right to be present in the polling place but outside...

State Education Activities to Support Mission Growth. NGA Center for Best Practices. Issue Brief

ERIC Educational Resources Information Center

Butler, Tara A.

2009-01-01

The National Governors Association Center for Best Practices (NGA Center) leads a Mission Growth Working Group, which consists of states that are significantly impacted by the growth of military bases. The group includes state representatives appointed by the governors of Alabama, Colorado, Florida, Georgia, Hawaii, Kansas, Kentucky, Louisiana,…

37 CFR 41.108 - Lead counsel.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 37 Patents, Trademarks, and Copyrights 1 2013-07-01 2013-07-01 false Lead counsel. 41.108 Section... COMMERCE PRACTICE BEFORE THE PATENT TRIAL AND APPEAL BOARD Contested Cases § 41.108 Lead counsel. (a) A party may be represented by counsel. The Board may require a party to appoint a lead counsel. If counsel...

37 CFR 41.108 - Lead counsel.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 37 Patents, Trademarks, and Copyrights 1 2014-07-01 2014-07-01 false Lead counsel. 41.108 Section... COMMERCE PRACTICE BEFORE THE PATENT TRIAL AND APPEAL BOARD Contested Cases § 41.108 Lead counsel. (a) A party may be represented by counsel. The Board may require a party to appoint a lead counsel. If counsel...

Formation of compact HII regions possibly triggered by cloud-cloud collision

NASA Astrophysics Data System (ADS)

Ohama, Akio; Torii, Kazufumi; Hasegawa, Keisuke; Fukui, Yasuo

2015-08-01

Compact HII regions are ionized by young high-mass star(s) and ~1000 compact HII regions are cataloged in the Galaxy (Urquhart et al. MNRAS 443, 1555-1586 (2014)). Compact HII regions are one of the major populations of Galactic HII regions. The molecular environments around compact HII regions are however not well understood due to lack of extensive molecular surveys. In order to better understand formation of exciting stars and compact HII regions, we have carried out a systematic study of molecular clouds toward compact HII regions by using the 12CO datasets obtained with the JCMT and NANTEN2 telescopes for l = 10 - 56, and present here the first results.In one of the present samples, RCW166, we have discovered that the HII region is associated with two molecular clouds whose velocity separation is ~10 km s-1 the two clouds show complimentary spatial distributions, where one of the clouds have a cavity-like distribution apparently embracing the other. We present an interpretation that the two clouds collided with each other and the cavity-like distribution represents a hole created by the collision in the larger cloud as modeled by Habe and Ohta (1992). Similar molecular distributions are often found in the other compact HII regions in the present study.A recent study by Torii et al. (2015, arXiv:1503.00070) indicates that the Spitzer bubble RCW120 was formed by cloud-cloud collision where the inside of the cavity is fully ionized by the exiting stars. RCW166, on the other hand, shows that only a small part of the cavity, the compact HII region, is ionized. We thus suggest that RCW166 represents an evolutionary stage corresponding to an earlier phase of RCW120 in the collision scenario.

Getting patients in the door: medical appointment reminder preferences.

PubMed

Crutchfield, Trisha M; Kistler, Christine E

2017-01-01

Between 23% and 34% of outpatient appointments are missed annually. Patients who frequently miss medical appointments have poorer health outcomes and are less likely to use preventive health care services. Missed appointments result in unnecessary costs and organizational inefficiencies. Appointment reminders may help reduce missed appointments; particular types may be more effective than other types. We used a survey with a discrete choice experiment (DCE) to learn why individuals miss appointments and to assess appointment reminder preferences. We enrolled a national sample of adults from an online survey panel to complete demographic and appointment habit questions as well as a 16-task DCE designed in Sawtooth Software's Discover tool. We assessed preferences for four reminder attributes - initial reminder type, arrival of initial reminder, reminder content, and number of reminders. We derived utilities and importance scores. We surveyed 251 adults nationally, with a mean age of 43 (range 18-83) years: 51% female, 84% White, and 8% African American. Twenty-three percent of individuals missed one or more appointments in the past 12 months. Two primary reasons given for missing an appointment include transportation problems (28%) and forgetfulness (26%). Participants indicated the initial reminder type (21%) was the most important attribute, followed by the number of reminders (10%). Overall, individuals indicated a preference for a single reminder, arriving via email, phone call, or text message, delivered less than 2 weeks prior to an appointment. Preferences for reminder content were less clear. The number of missed appointments and reasons for missing appointments are consistent with prior research. Patient-centered appointment reminders may improve appointment attendance by addressing some of the reasons individuals report missing appointments and by meeting patients' needs. Future research is necessary to determine if preferred reminders used in practice will result in improved appointment attendance in clinical settings.

Well behaved anisotropic compact star models in general relativity

NASA Astrophysics Data System (ADS)

Jasim, M. K.; Maurya, S. K.; Gupta, Y. K.; Dayanandan, B.

2016-11-01

Anisotropic compact star models have been constructed by assuming a particular form of a metric function e^{λ}. We solved the Einstein field equations for determining the metric function e^{ν}. For this purpose we have assumed a physically valid expression of radial pressure (pr). The obtained anisotropic compact star model is representing the realistic compact objects such as PSR 1937 +21. We have done an extensive study about physical parameters for anisotropic models and found that these parameters are well behaved throughout inside the star. Along with these we have also determined the equation of state for compact star which gives the radial pressure is purely the function of density i.e. pr=f(ρ).

Analysis of laboratory compaction methods of roller compacted concrete

NASA Astrophysics Data System (ADS)

Trtík, Tomáš; Chylík, Roman; Bílý, Petr; Fládr, Josef

2017-09-01

Roller-Compacted Concrete (RCC) is an ordinary concrete poured and compacted with machines typically used for laying of asphalt road layers. One of the problems connected with this technology is preparation of representative samples in the laboratory. The aim of this work was to analyse two methods of preparation of RCC laboratory samples with bulk density as the comparative parameter. The first method used dynamic compaction by pneumatic hammer. The second method of compaction had a static character. The specimens were loaded by precisely defined force in laboratory loading machine to create the same conditions as during static rolling (in the Czech Republic, only static rolling is commonly used). Bulk densities obtained by the two compaction methods were compared with core drills extracted from real RCC structure. The results have shown that the samples produced by pneumatic hammer tend to overestimate the bulk density of the material. For both compaction methods, immediate bearing index test was performed to verify the quality of compaction. A fundamental difference between static and dynamic compaction was identified. In static compaction, initial resistance to penetration of the mandrel was higher, after exceeding certain limit the resistance was constant. This means that the samples were well compacted just on the surface. Specimens made by pneumatic hammer actively resisted throughout the test, the whole volume was uniformly compacted.

Is Dental Students' Clinical Productivity Associated with Their Personality Profile?

PubMed

Rodriguez, Kristan D; Bartoloni, Joseph A; Hendricson, William D

2017-12-01

The aim of this study was to assess the relationship between personality preferences of incoming fourth-year dental students at the University of Texas Health Science Center at San Antonio as measured by the Keirsey Temperament Sorter II and their third-year clinical productivity and percentage of broken appointments. All 105 incoming fourth-year dental students in 2016 were invited to participate in the study, and 92 students completed the temperament questionnaire, for a response rate of 87.5%. Those students' clinical activity during their third year was measured by production points and percentage of broken appointments extracted from the electronic health record. The results showed that the majority of the respondents were extroverts rather than introverts and that the extroverts had significantly higher production points and significantly fewer broken appointments than the introverts. The most common personality preferences were sensing and judging. More than two-thirds of the respondents represented the Guardian temperament, one of four categories on the temperament measure. These findings help highlight the traits that may contribute to success in clinical training during dental school and support the notion that clinical success may be influenced by certain personality characteristics as well as the technical and specialized skills of dentistry.

THE ARS-MISSOURI SOIL STRENGTH PROFILE SENSOR: CURRENT STATUS AND FUTURE PROSPECTS

USDA-ARS?s Scientific Manuscript database

Soil compaction that is induced by tillage and traction is an ongoing concern in crop production, and also has environmental consequences. Although cone penetrometers provide standardized compaction measurements, the pointwise data collected makes it difficult to obtain enough data to represent with...

Getting patients in the door: medical appointment reminder preferences

PubMed Central

Crutchfield, Trisha M; Kistler, Christine E

2017-01-01

Purpose Between 23% and 34% of outpatient appointments are missed annually. Patients who frequently miss medical appointments have poorer health outcomes and are less likely to use preventive health care services. Missed appointments result in unnecessary costs and organizational inefficiencies. Appointment reminders may help reduce missed appointments; particular types may be more effective than other types. We used a survey with a discrete choice experiment (DCE) to learn why individuals miss appointments and to assess appointment reminder preferences. Methods We enrolled a national sample of adults from an online survey panel to complete demographic and appointment habit questions as well as a 16-task DCE designed in Sawtooth Software’s Discover tool. We assessed preferences for four reminder attributes – initial reminder type, arrival of initial reminder, reminder content, and number of reminders. We derived utilities and importance scores. Results We surveyed 251 adults nationally, with a mean age of 43 (range 18–83) years: 51% female, 84% White, and 8% African American. Twenty-three percent of individuals missed one or more appointments in the past 12 months. Two primary reasons given for missing an appointment include transportation problems (28%) and forgetfulness (26%). Participants indicated the initial reminder type (21%) was the most important attribute, followed by the number of reminders (10%). Overall, individuals indicated a preference for a single reminder, arriving via email, phone call, or text message, delivered less than 2 weeks prior to an appointment. Preferences for reminder content were less clear. Conclusion The number of missed appointments and reasons for missing appointments are consistent with prior research. Patient-centered appointment reminders may improve appointment attendance by addressing some of the reasons individuals report missing appointments and by meeting patients’ needs. Future research is necessary to determine if preferred reminders used in practice will result in improved appointment attendance in clinical settings. PMID:28182131

Partnership, Efficiency, and Effectiveness--AUA Annual Lecture 2015

ERIC Educational Resources Information Center

Diamond, Ian

2016-01-01

Professor Sir Ian Diamond is Principal and Vice-Chancellor of the University of Aberdeen, an appointment he has held since 1 April 2010. He was previously Chief Executive of the Economic and Social Research Council. He was also Chair of the Research Councils UK Executive Group (2004-2009) the umbrella body that represents all seven UK Research…

77 FR 66180 - Notice of Vacancies on the U.S. Section of the U.S.-Iraq Business Dialogue

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-02

... to facilitate private sector business growth in Iraq and to strengthen trade and investment ties... Section. Each Section consists of members from the private sector, representing the views and interests of the private sector business community. Each Party appoints the members to its respective Section. The...

78 FR 72640 - Notice of Vacancies on the U.S. Section of the U.S.-Iraq Business Dialogue

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-03

... to facilitate private sector business growth in Iraq and to strengthen trade and investment ties... Section. Each Section consists of members from the private sector, representing the views and interests of the private sector business community. Each Party appoints the members to its respective Section. The...

42 CFR 35.44 - Delivery to legal representative; to other claimants if value is $1,000 or less.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT Disposal of Money... charge has neither notice nor other knowledge of the appointment or qualification of a legal... of the persons specified above if the officer in charge has neither notice nor other knowledge that a...

The effect of care coordination on pediatric dental patient attendance.

PubMed

Casaverde, Nina B; Douglass, Joanna M

2007-01-01

The objectives of this retrospective study were to determine if care coordination improved appointment-keeping behavior, and identify factors associated with patient attendance at an urban Medicaid dental clinic. Children with sedation appointments received care coordination comprising telephone reminders, education regarding the appointment, and were mailed reminders or home visits if necessary. Collected chart audit data included age, behavior, appointment history and caries status. After several months, care coordination services were extended to routine, nonsedation appointments. Sedation and routine appointment controls were matched by appointment date and selected from the previous year. Attendance information was obtained from appointment and patient records. Sixty-one sedation appointments and 698 routine appointments were analyzed along with 61 and 931 control appointments, respectively. Sedation patients with care coordination had an attendance rate of 59% compared to 53% in the control group (P>.05). Routine patients with care coordination had an attendance rate of 70% compared to 62% in the control group (P<.001).) Data trends suggest that the children least likely to attend their appointments are those with: (1) high caries scores; (2) poor behavior; (3) long wait times between appointments; (4) multiple missed appointments; and (5) lack of a serviceable phone. Care coordination can improve attendance at an urban Medicaid dental clinic, but improvements are modest. Prospective studies are needed to better delineate which interventions and which patient predictors result in the most improvement in attendance-keeping behavior.

Appointment Wait Time, Primary Care Provider Status, and Patient Demographics are Associated With Nonattendance at Outpatient Gastroenterology Clinic.

PubMed

Shrestha, Manish P; Hu, Chengcheng; Taleban, Sasha

2016-09-22

We intended to identify the factors associated with missed appointments at a gastroenterology (GI) clinic in an academic setting. Missed clinic appointments reduce clinic efficiency, waste resources, and increase costs. Limited data exist on subspecialty clinic attendance. We performed a case-control study using data from the electronic health record of patients scheduled for an appointment at the adult GI clinic at the Banner University Medical Center between March and October of 2014. Patients who missed their appointment during the study period served as cases. Controls were randomly selected from patients who completed their appointment during the study period. Analysis included univariate and multivariate logistic regression analysis. Of 2331 scheduled clinic appointments, 195 (8.4%) were missed appointments. Longer waiting time from referral to scheduled appointment was significantly associated with missed appointment (AOR=1.014; 95% CI, 1.01-1.02; P<0.001). Patients with primary care providers (PCPs) were less likely to miss their appointment than those without PCPs (AOR=0.35; 95% CI, 0.18-0.66; P=0.001). Among patient demographic characteristics, ethnicity and marital status were associated with missed appointment. Wait time, ethnicity, marital status, and PCP status were associated with missed GI clinic appointments. Further investigations are needed to assess the effects of intervention strategies directed at reducing appointment wait time and increasing PCP-based care.

Nursing regulation, the nurse licensure compact, and nurse administrators: working together for patient safety.

PubMed

Poe, Laura

2008-01-01

Maintaining the concept of states rights, boards of nursing responded to the need for removal of barriers in meeting nursing manpower needs. One mechanism to accomplish this end was the development of the Nurse Licensure Compact, a multistate nurse license structured in much the same way as driver's license compacts. Representatives of State Boards of Nursing developed model compact structure and rules which allow nurses licensed in their state of residence to practice in other participating states without having to obtain additional licenses. Monitoring of nurse licensure and disciplinary information is facilitated through Nursys (nurse system). Nurses, nurse administrators, and the public benefit from the experiences of the 23 states that have implemented the Nurse Licensure Compact.

Appointment length, psychiatrists' communication behaviors, and medication management appointment adherence.

PubMed

Cruz, Mario; Roter, Debra L; Cruz, Robyn F; Wieland, Melissa; Larson, Susan; Cooper, Lisa A; Pincus, Harold Alan

2013-09-01

The authors explored the relationship between critical elements of medication management appointments (appointment length, patient-centered talk, and positive nonverbal affect among providers) and patient appointment adherence. The authors used an exploratory, cross-sectional design employing quantitative analysis of 83 unique audio recordings of split treatment medication management appointments for 46 African-American and 37 white patients with 24 psychiatrists at four ambulatory mental health clinics. All patients had a diagnosis of depression. Data collected included demographic information; Patient Health Questionnaire-9 scores for depression severity; psychiatrist verbal and nonverbal communication behaviors during medication management appointments, identified by the Roter Interaction Analysis System during analysis of audio recordings; and appointment adherence. Bivariate analyses were employed to identify covariates that might influence appointment adherence. Generalized estimating equations (GEEs) were employed to assess the relationship between appointment length, psychiatrist patient-centered talk, and positive voice tone ratings and patient appointment adherence, while adjusting for covariates and the clustering of observations within psychiatrists. Wald chi square analyses were used to test whether all or some variables significantly influenced appointment adherence. GEE revealed a significant relationship between positive voice tone ratings and appointment adherence (p=.03). Chi square analyses confirmed the hypothesis of a positive and significant relationship between appointment adherence and positive voice tone ratings (p=.03) but not longer visit length and more patient-centered communication. The nonverbal conveyance of positive affect was associated with greater adherence to medication management appointments by depressed patients. These findings potentially have important implications for communication skills training and adherence research.

Patients' Perspective on the Value of Medication Management Appointments.

PubMed

Cruz, Mario; Cruz, Robyn Flaum; Pincus, Harold Alan

2015-05-20

There is ongoing concern that psychiatric medication management appointments add little value to care. The present study attempted to address this concern by capturing depressed patients' views and opinions about the value of psychiatric medication management appointments. Seventy-eight semi-structured interviews were performed with white and African American depressed patients post medication management appointments. These interviews tapped patients' views and opinions about the value of attending medication management appointments. An iterative thematic analysis was performed. Patients reported greater appointment value when appointments included obtaining medications, discussing the need for medication changes or dose adjustments, and discussing the impact of medications on their illness. Additionally, greater appointment value was perceived by patients when there were non-medical conversations about life issues, immediate outcomes from the appointment such as motivation to continue in care, and specific qualities of providers that were appealing to patients. Patients' perceived value of psychiatric medication management appointments is complex. Though important patient outcomes are obtaining medicine and perceiving improvement in their mental health, there are other valued appointment and provider factors. Some of these other valued factors embedded within medication management appointments could have therapeutic properties. These findings have implications for future clinical research and service delivery.

Pediatric Return Appointment Adherence for Child Welfare-Involved Children in Los Angeles California.

PubMed

Schneiderman, Janet U; Smith, Caitlin; Arnold-Clark, Janet S; Fuentes, Jorge; Kennedy, Andrea K

2016-02-01

This study of primarily Latino caregivers and Latino child welfare-involved children had the following aims: (1) explore the return appointment adherence patterns at a pediatric medical clinic; and (2) determine the relationship of adherence to return appointments and caregiver, child, and clinic variables. The sample consisted of caregivers of child welfare-involved children who were asked to make a pediatric outpatient clinic return appointment (N = 87). Predictors included caregiver demographics, child medical diagnoses and age, and clinic/convenience factors including distance from the clinic to caregiver's home, days until the return appointment, reminder telephone call, Latino provider, and additional specialty appointment. Predictors were examined using χ(2) and t tests of significance. Thirty-nine percent of all caregivers were nonadherent in returning for pediatric appointments. When return appointments were scheduled longer after the initial appointment, caregivers were less likely to bring children back for medical care. The 39 % missed return appointment rate in this study is higher than other similar pediatric populations. Better coordination between pediatricians and caregivers in partnership with child welfare case workers is needed to ensure consistent follow-up regarding health problems, especially when appointments are not scheduled soon after the initial appointment.

Qualitative Study of Foster Caregivers’ Views on Adherence to Pediatric Appointments

PubMed Central

Schneiderman, Janet U.; Kennedy, Andrea K.; Sayegh, Caitlin S.

2016-01-01

The current study is a qualitative investigation of how foster caregivers, primarily Latinos, view adherence to pediatric appointments with the purpose of identifying how the child welfare system, pediatric clinics, and pediatric health providers serving foster children might promote appointment attendance. Participants in the study had a return appointment at an outpatient pediatric clinic that only served children in the child welfare system. Twenty-eight caregivers (13 related and 15 unrelated) participated in telephone interviews after the date of their scheduled pediatric appointment (32% missed their return appointment). Semistructured interview guides included general questions about what promotes attending the pediatric appointment, what makes it difficult to attend the pediatric appointment, and how pediatric care affects the foster child. Analysis of qualitative data using content analysis identified three themes: (a) multiple methods to attend appointments, which included caregivers’ organizational and problem-solving skills; (b) positive health care experiences, which consisted of caregivers’ personal relationships with providers and staff members and clinic organization; and (c) necessity of pediatric care, which included recognition of the need for health care, especially timely immunizations. All caregivers also reported that appointments reminders would be helpful. Unrelated caregivers more often said that appointment attendance was facilitated by clinic organization compared to related caregivers. Nonadherent caregivers mentioned their need to solve problems to attend appointments or reschedule appointments more than attenders. In summary, caregivers said they valued regular pediatric health care to treat their child’s chronic conditions and prevent illnesses, but they acknowledged that their home lives were hectic and attending scheduled appointments was sometimes difficult. Foster caregivers in this study identified the ideal pediatric clinic environment that encourages adherence to health care appointments. This environment is an organized clinic with easy access including parking, engaged pediatric health providers, ability to reschedule appointments when necessary, and an individualized and consistent appointment reminder system. PMID:27291938

5 CFR 9901.511 - Appointing authorities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Appointing authorities. (a) Competitive and excepted appointing authorities. The Secretary may continue to use excepted and competitive appointing authorities under chapter 33 of title 5, U.S. Code... competitive service or permanent, time-limited, or temporary appointments in the excepted service, as...

A comparative survey of missed initial and follow-up appointments to psychiatric specialties in the United kingdom.

PubMed

Mitchell, Alex J; Selmes, Thomas

2007-06-01

Missed appointments are common in psychiatry. Nonattendance at the initial appointment may have different prognostic significance than nonattendance at subsequent appointments. This study examined the frequency of missed appointments among 9,511 initial outpatient appointments and 7,700 follow-up appointments across ten psychiatric subspecialties in a publicly funded mental health service in the United Kingdom. The pooled missed appointment rate was 15.9%, higher than in previous studies on primary and secondary care attendance in the United Kingdom. Nonattendance was lowest on Fridays, in winter months, and in geriatric psychiatry and highest for substance abuse services and in community psychiatry. In most services, attendance improved after the initial appointment, but in psychosomatic medicine and geriatric psychiatry this pattern was reversed. There was a low rate of missed appointments in geriatric psychiatry, rehabilitation psychiatry, cognitive-behavioral therapy, and psychosocial medicine. A high nonattendance rate was found among persons with drug and alcohol difficulties and to a lesser extent in general adult psychiatry. Future studies should consider initial and follow-up appointments as distinct.

Impact of same-day appointments on patient satisfaction with general practice appointment systems.

PubMed

Sampson, Fiona; Pickin, Mark; O'Cathain, Alicia; Goodall, Stephen; Salisbury, Chris

2008-09-01

Following recent concerns about patients' inability to book appointments in advance, this study examined the relationship between the proportion of GP appointments reserved for same-day booking, and patient satisfaction with appointment systems. In a survey of 12,825 patients in 47 practices, it was found that a 10% increase in the proportion of same-day appointments was associated with an 8% reduction in the proportion of patients satisfied. Practices should be wary of increasing the level of same-day appointments to meet access targets.

A Search for X-ray Emission in Isolated Compact Triplets

NASA Technical Reports Server (NTRS)

Brown, Beth A.; Williams, Barbara

2006-01-01

We describe preliminary results of an exploratory search for diffuse X-ray emission in a sample of the poorest galaxy groups, i.e., isolated compact triplets of galaxies. These systems represent the simplest forms of galaxy clustering while manifesting all the complexities inherent in other groups. We have selected 20 compact triplets for this initial study. The component galaxies are expected to interact with each other and with the group's intergalactic medium, if present, in complex ways that trigger high-energy processes.

5 CFR 330.1106 - Appointment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... receive noncompetitive appointments to the competitive service under the authority of Public Law 105-274... excepted appointments made under section 11203(b) of Public Law 105-33 to competitive service appointments under Public Law 105-274. For employees appointed before October 21, 1998, the conversion will be...

5 CFR 330.1106 - Appointment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... receive noncompetitive appointments to the competitive service under the authority of Public Law 105-274... excepted appointments made under section 11203(b) of Public Law 105-33 to competitive service appointments under Public Law 105-274. For employees appointed before October 21, 1998, the conversion will be...

5 CFR 301.203 - Duration of appointment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Duration of appointment. 301.203 Section... EMPLOYMENT Overseas Limited Appointment § 301.203 Duration of appointment. (a) An appointment under this subpart is of indefinite duration unless otherwise limited. (b) An agency may make an overseas limited...

A Black Educator in the Segregated South. Kentucky's Rufus B. Atwood.

ERIC Educational Resources Information Center

Smith, Gerald L.

This book reviews the career of Rufus Ballard Atwood, who served as president of Kentucky State University from 1929 to 1962. The book describes how he was often chosen by whites to represent the African American community on boards and commissions and how these appointments gave him access to the state's political and educational power structure.…

Career Education at O.S.S.D. A Study of Needs and Plan of Action for Career Education at Oregon State School for the Deaf.

ERIC Educational Resources Information Center

McKinlay, Bruce; And Others

Recognizing a need for improvement in their vocational education offerings, the administration of the program for the deaf appointed a study team representing backgrounds including education of the deaf, manpower research, public administration, and occupational analysis. This report presents their specific analysis and recommendations for a…

Report of the Planning Commission for a New University at Boca Raton.

ERIC Educational Resources Information Center

Florida State Dept. of Education, Tallahassee.

Following the decision to establish a new university at Boca Raton, the Board of Control of Florida's Board of Education appointed a committee to revise, refine and develop plans for the new institution and to make preliminary estimates of space requirements and costs. The plans and proposals in this report represent a thorough study by the…

Practising Democracy: Business Community Representatives in the Control of English and Welsh Schools.

ERIC Educational Resources Information Center

Thody, Angela

The 1986 Education Act required that business community members in England and Wales be appointed to the governing boards of local public schools. Since the passage of the law, the idea of sponsored governors has developed. Sponsored governors receive financial supported from their companies to serve on the boards. A survey of employees of three…

Pre-Service Education for Nurses' Aides in Hospitals, Nursing Homes, Home Health Agencies.

ERIC Educational Resources Information Center

Colorado State Dept. of Public Health, Denver. Public Health Nursing Section.

The guide was developed on the basis of advice from a widely representative committee appointed by the Colorado State Department of Public Health. The materials were tested in a course in an urban center and a course in a rural center. The initial portion of the manual presents: (1) guidelines for organizing preparatory nurse aide courses, (2)…

Optical Spectrum of the Compact Planetary Nebula IC 5117

NASA Technical Reports Server (NTRS)

Hyung, Siek; Aller, Lawrence H.; Feibelman, Walter A.; Lee, Seong-Jae; Fisher, Richard R. (Technical Monitor)

2001-01-01

High resolution spectroscopic data of the very compact planetary nebula IC 5117 are obtained in the optical wavelengths, 3700A - 10050A, with the Hamilton Echelle Spectrograph at Lick Observatory, and which have been analyzed along with the International Ultraviolet Explorer (IUE) UV archive data. Although a diagnostic diagram shows significant density and temperature fluctuations, our analysis indicates that the nebular gas may be represented by a homogeneous shell of extremely high density gas, N(sub epsilon) approx. 90 000 /cu cm. The average electron temperatures, e.g. indicated by the [OIII] diagnostics, are around 12 000 K. We construct a photoionization model to represent most of the observed line intensities, and the physical condition of this compact nebulosity. Based on the semi-empirical ionization correction approach, and model indications, we derived the elemental abundances: He, C, N, O, Ne, and Ar appear to be normal or marginally depleted compared to the average planetary nebula, while the remaining elements, S, Cl, and K appear to be enhanced. IC 5117 is perhaps a very young compact planetary nebula, slightly more evolved than the other well-known compact planetary nebula IC 4997. The central stellar temperature is likely to be around 120 000 K, evolved from a C-rich AGB progenitor.

5 CFR 8.2 - Appointment of United States citizens.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Appointment of United States citizens. 8... APPOINTMENTS TO OVERSEAS POSITIONS (RULE VIII) § 8.2 Appointment of United States citizens. United States... appointments for United States citizens recruited within the continental limits of the United States whenever...

5 CFR 8.2 - Appointment of United States citizens.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Appointment of United States citizens. 8... APPOINTMENTS TO OVERSEAS POSITIONS (RULE VIII) § 8.2 Appointment of United States citizens. United States... appointments for United States citizens recruited within the continental limits of the United States whenever...

5 CFR 8.2 - Appointment of United States citizens.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Appointment of United States citizens. 8... APPOINTMENTS TO OVERSEAS POSITIONS (RULE VIII) § 8.2 Appointment of United States citizens. United States... appointments for United States citizens recruited within the continental limits of the United States whenever...

5 CFR 8.2 - Appointment of United States citizens.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Appointment of United States citizens. 8... APPOINTMENTS TO OVERSEAS POSITIONS (RULE VIII) § 8.2 Appointment of United States citizens. United States... appointments for United States citizens recruited within the continental limits of the United States whenever...

Managing patient demand: a qualitative study of appointment making in general practice.

PubMed

Gallagher, M; Pearson, P; Drinkwater, C; Guy, J

2001-04-01

Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. A qualitative study using participant observation. Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria.

Managing patient demand: a qualitative study of appointment making in general practice.

PubMed Central

Gallagher, M; Pearson, P; Drinkwater, C; Guy, J

2001-01-01

BACKGROUND: Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. AIM: To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. DESIGN OF STUDY: A qualitative study using participant observation. SETTING: Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. METHOD: Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. RESULTS: Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. CONCLUSION: Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria. PMID:11458480

Poor appointment-keeping behaviour among repeat blood donors and its relationship to the intent to donate again.

PubMed

Mousavi, S A; Hermundstad, B; Kjustad Frøyland, E M; Llohn, A H; Knutsen, T R

2014-08-01

Anecdotal evidence suggests that missed donation appointments among repeat whole-blood donors are associated with decreased likelihood of future blood donation. This study sought to examine the relationship between missed donation appointments and intention to donate again among repeat whole-blood donors and to examine whether demographic variables are related to appointment-keeping behaviour. During the period February-June 2013, telephone interviews were conducted with repeat donors who either did not show up for or cancelled their donation appointments on the day of the appointment. We asked them whether or not they wanted to schedule appointments for subsequent donations. Rates of missed donation appointments varied by age, but not gender. Although a statistically significant difference between male and female donors was not found with regard to willingness to donate again, female donors were more likely than male donors to call and cancel their appointment. Finally, compared with repeat donors who called and cancelled their appointment, no-show donors were 2.5 times less likely to schedule appointments for subsequent donations (P < 0.001). The results demonstrate that poor appointment-keeping behaviour, and in particular no-show behaviour, is significantly associated with decreased likelihood of future blood donation among repeat whole-blood donors. © 2014 The Authors. Transfusion Medicine © 2014 British Blood Transfusion Society.

Perinatal Health Belief Scales: A Cost Effective Technique for Predicting Prenatal Appointment Keeping Rates amongst Pregnant Teenagers.

ERIC Educational Resources Information Center

Wells, Robert D.; And Others

Prenatal appointment keeping is an important predictor of birth outcomes, yet many pregnant adolescents miss an excessive number of appointments. Since effective strategies for increasing appointment keeping require costly staff time, methods to predict relative risk for noncompliance with appointments might help delineate a circumscribed…

75 FR 74748 - Senior Executive Service; Appointment of Members to the Performance Review Board

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-01

... Compensation--appointment expires on 09/30/11 SOL Katherine E. Bissell, Associate Solicitor for Civil Rights and Labor Management--appointment expires on 09/30/11 SOL Michael D. Felsen, Regional Solicitor, Boston--appointment expires on 09/30/12 SOL Deborah Greenfield, Deputy Solicitor--appointment expires on...

5 CFR 316.302 - Selection of term employees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... appointments not excepted VRA appointments and do not lead to conversion to career-conditional appointment; (3) Career-conditional appointment under § 315.601, 315.604, 315.605, 315.606, 315.607, 315.608, 315.609, 315... Accounting Office; (6) Appointment under 28 U.S.C. 602 for current and former employees of the Administrative...

Shear-enhanced compaction in viscoplastic rocks

NASA Astrophysics Data System (ADS)

Yarushina, V. M.; Podladchikov, Y. Y.

2012-04-01

The phenomenon of mutual influence of compaction and shear deformation was repeatedly reported in the literature over the past years. Dilatancy and shear-enhanced compaction of porous rocks were experimentally observed during both rate-independent and rate-dependent inelastic deformation. Plastic pore collapse was preceding the onset of dilatancy and shear-enhanced compaction. Effective bulk viscosity is commonly used to describe compaction driven fluid flow in porous rocks. Experimental data suggest that bulk viscosity of a fluid saturated rock might be a function of both the effective pressure and the shear stress. Dilatancy and shear-enhanced compaction can alter the transport properties of rocks through their influence on permeability and compaction length scale. Recent investigations show that shear stresses in deep mantle rocks can be responsible for spontaneous development of localized melt-rich bands and segregation of small amounts of melt from the solid rock matrix through shear channeling instability. Usually it is assumed that effective viscosity is a function of porosity only. Thus coupling between compaction and shear deformation is ignored. Spherical model which considers a hollow sphere subjected to homogeneous tractions on the outer boundary as a representative elementary volume succeeded in predicting the volumetric compaction behavior of porous rocks and metals to a hydrostatic pressure in a wide range of porosities. Following the success of this simple model we propose a cylindrical model of void compaction and decompaction due to the non-hydrostatic load. The infinite viscoplastic layer with a cylindrical hole is considered as a representative volume element. The remote boundary of the volume is subjected to a homogeneous non-hydrostatic load such that plane strain conditions are fulfilled through the volume. At some critical values of remote stresses plastic zone develops around the hole. The dependence of the effective bulk viscosity on the properties of individual components as well as on the stress state is examined. We show that bulk viscosity is a function of porosity, effective pressure and shear stress. Decreasing porosity tends to increase bulk viscosity whereas increasing shear stress and increasing effective pressure reduce it.

[Analysis of economic cost of missed outpatient appointments].

PubMed

Jabalera Mesa, M L; Morales Asencio, J M; Rivas Ruiz, F; Porras González, M H

To estimate the economic costs of missed Outpatient appointments by the Costa del Sol Health Agency (ASCS). An analysis was performed on the costs arising from missed outpatient appointments (first appointment and examinations) of each of the specialities in the Centres belonging to the ASCS. A formula was used to determine the unit cost per appointment and per centre and speciality. This involved the direct imputation of the controllable costs and the indirect imputation of the service costs, together with an estimated cost of re-appointments based on a previous case-control study. The cost of missed appointments per centre in the Costa del Sol Hospital was €2,475,640, with a failure rate of 14.2% (256,377 appointments). In the Benalmádena High Resolution Hospital it was €515,936, with an absence rate of 12.2% (44,848 appointments), and in the Mijas High Resolution Centre, a cost of €395,342 with an absence rate of the 13.5% (99,536 appointments). The mean extra cost of a re-appointment was €12.95. The specialities with a higher medium cost were Digestive Diseases, Internal Medicine, and Rehabilitation. The economic cost of patients not turning up for scheduled appointments in the ASCS was greater than 3 million Euros for a non-attendance rate of the 13.8%, with Mijas High Resolution Centre being the centre that showed the lowest mean unitary cost per medical appointment. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Hanford Environmental Dose Reconstruction Project monthly report, November 1992

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

Cannon, S.D.; Finch, S.M.

1992-12-31

The objective of the Hanford Environmental Dose Reconstruction (HEDR) Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The TSP consists of experts in environmental pathways, epidemiology, surface-water transport, ground-water transport, statistics, demography, agriculture, meteorology, nuclear engineering, radiation dosimetry, and cultural anthropology. Included are appointed members representing the states of Oregon, Washington. and Idaho, a representative of Native American tribes, and an individual representing the public. The project is divided into the following technical tasks: Source terms; environmental transport; environmental monitoring data; demography, food consumption and agriculture; environmentalmore » pathways and dose estimates.« less

Hanford Environmental Dose Reconstruction Project monthly report, November 1992

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

Cannon, S.D.; Finch, S.M.

1992-01-01

The objective of the Hanford Environmental Dose Reconstruction (HEDR) Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The TSP consists of experts in environmental pathways, epidemiology, surface-water transport, ground-water transport, statistics, demography, agriculture, meteorology, nuclear engineering, radiation dosimetry, and cultural anthropology. Included are appointed members representing the states of Oregon, Washington. and Idaho, a representative of Native American tribes, and an individual representing the public. The project is divided into the following technical tasks: Source terms; environmental transport; environmental monitoring data; demography, food consumption and agriculture; environmentalmore » pathways and dose estimates.« less

Homeless patients' perceptions about using cell phones to manage medications and attend appointments.

PubMed

Moczygemba, Leticia R; Cox, Lauren S; Marks, Samantha A; Robinson, Margaret A; Goode, Jean-Venable R; Jafari, Nellie

2017-06-01

The objectives of this study were to (1) describe homeless persons' access and use of cell phones and their perceptions about using cell phone alerts to help manage medications and attend health care appointments and (2) identify demographic characteristics, medication use and appointment history and perceptions associated with interest in receiving cell phone alerts to manage medications and appointments. A cross-sectional survey was conducted in 2013 at a homeless clinic in Virginia. The questionnaire comprised items about cell phone usage, ownership and functions such as text messaging. Participants reported medication use and appointment history, perceptions about cell phone alerts and interest in receiving alerts to manage medications and appointments. Descriptive statistics for all variables are reported. Logistic regression was used to examine predictors of interest in using a cell phone to manage medications and appointments. A total of 290 participants completed the survey; 89% had a cell phone. Seventy-seven percent were interested in appointment reminders, whereas 66%, 60% and 54% were interested in refill reminders, medication taking reminders and medication information messages respectively. Those who believed reminders were helpful were more likely to be interested in medication taking, refill and appointment reminder messages compared to those who did not believe reminders were helpful. A history of running out of medicine and forgetting appointments were predictors of interest in refill and appointment reminders. Mobile technology is a feasible method for communicating medication and appointment information to those experiencing or at risk for homelessness. © 2016 Royal Pharmaceutical Society.

Whose interests do lay people represent? Towards an understanding of the role of lay people as members of committees

PubMed Central

Hogg, Christine; Williamson, Charlotte

2008-01-01

Increasingly, lay people are appointed as members to health service committees. The term ‘lay’ is used loosely and the reasons for involving lay people are seldom clearly defined. This paper argues that the different roles that lay people play need to be explicitly defined in order for their contributions to be realized. Although lay members of health service committees are generally assumed to be working for patients’ interests, our observations lead us to think that some lay people tend to support professionals’ or managers’ interests rather than patients’ interests as patients would define them. We suggest that lay people fall into three broad categories: supporters of dominant (professional) interests, supporters of challenging (managerial) interests and supporters of repressed (patient) interests. These alignments should be taken into account in appointments to health service bodies. Further research is needed on the alignments and roles of lay members. PMID:11286594

Access to transportation for Chittenden County Vermont older adults.

PubMed

Hadley Strout, Emily; Fox, Leah; Castro, Alejandro; Haroun, Pishoy; Leavitt, Blake; Ross, Cordelia; Sayan, Mutlay; Delaney, Thomas; Platzer, Alyson; Hutchins, Jeanne; Carney, Jan K

2016-08-01

Aging often leads to decreased independence and mobility, which can be detrimental to health and well-being. The growing population of older adults will create a greater need for reliable transportation. Explore whether and how lack of transportation has compromised areas of daily lives in older adults. 1221 surveys with 36 questions assessing transportation access, usage, and impact on activities were distributed to Chittenden County, Vermont older adults; 252 met criteria for analysis. Older adults reported overwhelming difficulty getting to activities considered important, with 69 % of participants delaying medical appointments due to transportation barriers. Although family and friends represent a primary method of transportation, older adults reported difficulty asking them for help. Lack of accessible transportation leads to missed healthcare appointments and social isolation, which may have detrimental effects on older adults' quality of life. Many older adults face significant transportation challenges that negatively affect their health and well-being.

75 FR 16874 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-02

... she did not work on any day claimed and did not receive income such as vacation pay or pay for time.... Annual time Burden hours responses (Minutes) ID-5I 9,100 15 2,275 ID-5R(SUP) 1,200 10 200 ID-49R 5 15 3... provides representative payees with a booklet at the time of their appointment. The booklet, RRB Form RB-5...

20 CFR 422.515 - Forms used for withdrawal, reconsideration and other appeals, and appointment of representative.

Code of Federal Regulations, 2014 CFR

2014-04-01

... under title XVIII of the act, or (c) entitlement to black lung benefits under title IV of the Federal... to act for him in a claim or related matter.) SSA-1763—Request for Termination of Supplementary... attorney authorized by a claimant to act for him in a claim or related matter.) HA-520—Request for Review...

20 CFR 422.515 - Forms used for withdrawal, reconsideration and other appeals, and appointment of representative.

Code of Federal Regulations, 2012 CFR

2012-04-01

... under title XVIII of the act, or (c) entitlement to black lung benefits under title IV of the Federal... to act for him in a claim or related matter.) SSA-1763—Request for Termination of Supplementary... attorney authorized by a claimant to act for him in a claim or related matter.) HA-520—Request for Review...

20 CFR 422.515 - Forms used for withdrawal, reconsideration and other appeals, and appointment of representative.

Code of Federal Regulations, 2011 CFR

2011-04-01

... under title XVIII of the act, or (c) entitlement to black lung benefits under title IV of the Federal... to act for him in a claim or related matter.) SSA-1763—Request for Termination of Supplementary... attorney authorized by a claimant to act for him in a claim or related matter.) HA-520—Request for Review...

20 CFR 422.515 - Forms used for withdrawal, reconsideration and other appeals, and appointment of representative.

Code of Federal Regulations, 2013 CFR

2013-04-01

... under title XVIII of the act, or (c) entitlement to black lung benefits under title IV of the Federal... to act for him in a claim or related matter.) SSA-1763—Request for Termination of Supplementary... attorney authorized by a claimant to act for him in a claim or related matter.) HA-520—Request for Review...

[Book review] Illustrations of the birds of California, Texas, Oregon, British and Russian America

USGS Publications Warehouse

Banks, Richard C.

1993-01-01

John Cassin was one of the leading American ornithologists of the 19th century. Appointed Honorary Curator of Birds at the Academy of Natural Sciences of Philadelphia in 1842, he built and studied the collections of that institution (although engaged full time in business) until his death in 1869. This book represents perhaps his most important and least well known endeavor.

Identifying demographic variables related to failed dental appointments in a university hospital-based residency program.

PubMed

Mathu-Muju, Kavita R; Li, Hsin-Fang; Hicks, James; Nash, David A; Kaplan, Alan; Bush, Heather M

2014-01-01

The objective of this study was to identify characteristics of pediatric patients who failed to keep the majority of their scheduled dental appointments in a pediatric dental clinic staffed by pediatric dental residents and faculty members. The electronic records of all patients appointed over a continuous 54 month period were analyzed. Appointment history and demographic variables were collected. The rate of failed appointments was calculated by dividing the number of failed appointments with the total number of appointments scheduled for the patient. There were 7,591 patients in the analyzable dataset scheduled with a total of 48,932 appointments. Factors associated with an increased rate of failed appointments included self-paying for dental care, having a resident versus a faculty member as the provider, rural residence, and adolescent aged patients. Multivariable regression models indicated self-paying patients had higher odds and rates of failed appointments than patients with Medicaid and private insurance. Access to care for children may be improved by increasing the availability of private and public insurance. The establishment of a dental home and its relationship to a child receiving continuous care in an institutional setting depends upon establishing a relationship with a specific dentist.

Initial data for high-compactness black hole-neutron star binaries

NASA Astrophysics Data System (ADS)

Henriksson, Katherine; Foucart, François; Kidder, Lawrence E.; Teukolsky, Saul A.

2016-05-01

For highly compact neutron stars, constructing numerical initial data for black hole-neutron star binary evolutions is very difficult. We describe improvements to an earlier method that enable it to handle these more challenging cases. These improvements were found by invoking a general relaxation principle that may be helpful in improving robustness in other initial data solvers. We examine the case of a 6:1 mass ratio system in inspiral close to merger, where the star is governed by a polytropic {{Γ }}=2, an SLy, or an LS220 equation of state (EOS). In particular, we are able to obtain a solution with a realistic LS220 EOS for a star with compactness 0.26 and mass 1.98 M ⊙, which is representative of the highest reliably determined neutron star masses. For the SLy EOS, we can obtain solutions with a comparable compactness of 0.25, while for a family of polytropic equations of state, we obtain solutions with compactness up to 0.21, the largest compactness that is stable in this family. These compactness values are significantly higher than any previously published results.

Measurements of elastic moduli of pharmaceutical compacts: a new methodology using double compaction on a compaction simulator.

PubMed

Mazel, Vincent; Busignies, Virginie; Diarra, Harona; Tchoreloff, Pierre

2012-06-01

The elastic properties of pharmaceutical powders play an important role during the compaction process. The elastic behavior can be represented by Young's modulus (E) and Poisson's ratio (v). However, during the compaction, the density of the powder bed changes and the moduli must be determined as a function of the porosity. This study proposes a new methodology to determine E and v as a function of the porosity using double compaction in an instrumented compaction simulator. Precompression is used to form the compact, and the elastic properties are measured during the beginning of the main compaction. By measuring the axial and radial pressure and the powder bed thickness, E and v can be determined as a function of the porosity. Two excipients were studied, microcrystalline cellulose (MCC) and anhydrous calcium phosphate (aCP). The values of E measured are comparable to those obtained using the classical three-point bending test. Poisson's ratio was found to be close to 0.24 for aCP with only small variations with the porosity, and to increase with a decreasing porosity for MCC (0.23-0.38). The classical approximation of a value of 0.3 for ν of pharmaceutical powders should therefore be taken with caution. Copyright © 2012 Wiley Periodicals, Inc.

16 CFR 1018.17 - Appointments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Appointments. 1018.17 Section 1018.17 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL ADVISORY COMMITTEE MANAGEMENT Establishment of Advisory Committees § 1018.17 Appointments. (a) The Chairman shall appoint as members to advisory...

76 FR 66332 - Appointments to Performance Review Boards for Senior Executive Service

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-26

... NUCLEAR REGULATORY COMMISSION [NRC-2011-0249] Appointments to Performance Review Boards for Senior Executive Service AGENCY: U.S. Nuclear Regulatory Commission. ACTION: Appointment to Performance Review... the following appointments to the NRC Performance Review Boards. The following individuals are...

Do general practice patients with and without appointment differ? Cross-sectional study.

PubMed

Riedl, Bernhard; Kehrer, Simon; Werner, Christoph U; Schneider, Antonius; Linde, Klaus

2018-06-23

Even in practices with a comprehensive appointment system a minority of patients walks in without prior notice, sometimes causing problems for practice service quality. We aimed to explore differences between patients consulting primary care practices with and without appointment. Consecutive patients visiting five primary care practices without an appointment and following patients with an appointment were asked to fill in a four-page questionnaire addressing socio-demographic characteristics, the reason for encounter, urgency of seeing a physician, depressive, somatic and anxiety symptoms, personality traits, and satisfaction with the practice. Physicians also documented the reason for encounter and assessed the urgency. Data were analyzed using univariate and multivariate methods. Two hundred fifty-one patients without and 250 patients with appointment participated. Patients without appointment were significantly younger (mean age 44 vs. 50 years) and reported less often chronic diseases (29% vs. 45%). Also, reasons for encounter differed (e.g., 27% vs. 16% with a respiratory problem). Patients' ratings of urgency did not differ between groups (p = 0.46), but physicians rated urgency higher among patients without appointment (p < 0.001). In logistic regression analyses younger age, male gender, absence of chronic disease, positive screening for at least one mental disorder, low values on the personality trait openness for experience, a high urgency rating by the physician, and a respiratory or musculoskeletal problem as reason for encounter were significantly associated with a higher likelihood of being a patient without appointment. In this study, younger age and a high urgency rating by physicians were the variables most consistently associated with the likelihood of being a patient without appointment. Overall, differences between patients seeking general practices with a comprehensive appointment system without prior notice and patients with appointments were relatively minor.

Appointment attendance at a remote rural dental training facility in Australia.

PubMed

Lalloo, Ratilal; McDonald, Jenny M

2013-08-02

Non-attended appointments have impacts on the operations of dental clinics. These impacts vary from lost productivity, loss of income and loss of clinical teaching hours. Appointment data were analysed to assess the percentage of completed, failed to attend (FTA) and cancelled appointments at an Australian remote rural student dental clinic training facility. The demographic and time characteristics of FTA and cancelled appointments were analysed using simple and multivariate multinomial regression analysis, to inform interventions that may be necessary. Over the 2-year study period a total of 3,042 appointments were made. The percentage of FTA was 21.3% (N = 648) and cancelled appointments 13.7% (N = 418). The odds of an FTA were in excess of 4 times higher in patients aged 19-25 years (OR = 4.1; 95% CI = 2.3-7.3) and 26-35 years (OR = 4.4; 95% CI = 2.5-7.9) compared to patients 65 years and older. The odds of an FTA was 2.3 (95% CI = 1.8-3.1) times higher in public patients compared to private patients. The odds of a cancellation was 1.7 (95% CI = 1.1-2.6) times higher on a Friday compared to a Monday and 1.8 (95% CI = 1.1-2.9) times higher on the last appointment of the day compared to the first appointment. For cancelled appointments, 71.3% were cancelled on the day of the appointment and 16.6% on the day before. Non-attended appointments (FTA or cancelled) were common at this remote rural dental clinic training facility. Efforts to reduce these need to be implemented; including telephonic reminders, educating the community on the importance of attending their appointments, block booking school children and double booking or arranging alternative activities for the students at times when non-attendance is common.

32 CFR 154.15 - Military appointment, enlistment, and induction.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Military appointment, enlistment, and induction... Requirements § 154.15 Military appointment, enlistment, and induction. (a) General. The appointment, enlistment... tendered to immigrant alien health professionals, chaplains, and attorneys. (e) Mobilization of military...

Naval Sea Systems Command Did Not Properly Apply Guidance Regarding Contracting Officers Representatives

DTIC Science & Technology

2016-03-18

Contract _______________________________ 10 PCO and ACO Did Not Ensure Appointment of COR ________________________________________ 12 NAVSEA Did Not Properly...sample was selected, NAVSEA had issued work for 36 availabilities on the contract—obligating $102.5M. { The procuring contracting officer ( PCO ) at...Responsibilities,” Section 1.602-2, “Responsibilities,” May 29, 2014. 3 The contracting officers for the contract reviewed are the PCO at NAVSEA

Russian Foreign Policy in Historical and Current Context: A Reassessment

DTIC Science & Technology

2015-01-01

concerns did not slow the growth of Russian trade with the European Union or Russian tourism to Western European countries. Moreover, before the...Russia’s economic interests. Crimea’s primary economic activities have been tourism and hosting the Russian (and Ukrainian) Black Sea fleets. As incomes...age benefits.41 Following the Beslan hostage crisis, elected gover - nors were replaced by appointed representatives. (And although this was

The Use of a Learning Management System (LMS) to Serve as the Virtual Common Space of a Network for the Scholarship of Teaching and Learning (SoTL) in an Academic Department

ERIC Educational Resources Information Center

Bradley, Nicolette; Jadeski, Lorraine; Newton, Genevieve; Ritchie, Kerry; Merrett, Scott; Bettger, William

2013-01-01

Traditionally, undergraduate curriculum committees, consisting of appointed faculty and student representatives, have served as the sole departmental vehicle for investigating, discussing and promoting the scholarship of teaching and learning (SoTL) within an academic department. However, with the universal demand for greater accountability on all…

Studying Variance in the Galactic Ultra-compact Binary Population

NASA Astrophysics Data System (ADS)

Larson, Shane L.; Breivik, Katelyn

2017-01-01

In the years preceding LISA, Milky Way compact binary population simulations can be used to inform the science capabilities of the mission. Galactic population simulation efforts generally focus on high fidelity models that require extensive computational power to produce a single simulated population for each model. Each simulated population represents an incomplete sample of the functions governing compact binary evolution, thus introducing variance from one simulation to another. We present a rapid Monte Carlo population simulation technique that can simulate thousands of populations on week-long timescales, thus allowing a full exploration of the variance associated with a binary stellar evolution model.

Measuring Chemotherapy Appointment Duration and Variation Using Real-Time Location Systems.

PubMed

Barysauskas, Constance M; Hudgins, Gina; Gill, Katie Kupferberg; Camuso, Kristen M; Bagley, Janet; Rozanski, Sheila; Kadish, Sarah

Clinical schedules drive resource utilization, cost, and patient wait time. Accurate appointment duration allocation ensures appropriate staffing ratios to daily caseloads and maximizes scarce resources. Dana-Farber Cancer Institute (DFCI) infusion appointment duration is adjusted by regimen using a consensus method of experts including pharmacists, nurses, and administrators. Using real-time location system (RTLS), we examined the accuracy of observed appointment duration compared with the scheduled duration. Appointment duration was calculated using RTLS at DFCI between August 1, 2013, and September 30, 2013. Duration was defined as the total time a patient occupied an infusion chair. The top 10 administered infusion regimens were investigated (n = 805). Median observed appointment durations were statistically different than the scheduled durations. Appointment durations were shorter than scheduled 98% (C), 95% (I), and 75% (F) of the time and longer than scheduled 77% (A) and 76% (G) of the time. Fifty-six percent of the longer than scheduled (A) appointments were at least 30 minute longer. RTLS provides reliable and unbiased data to improve schedule accuracy. Replacing consensus with system-based data may improve clinic flow, relieve staff stress, and increase patient satisfaction. Further investigation is warranted to elucidate factors that impact variation in appointment duration.

38 CFR 17.100 - Refusal of treatment by unnecessarily breaking appointments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... and satisfactory reasons are advanced for breaking the appointment and circumstances were such that... unnecessarily breaking appointments. 17.100 Section 17.100 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Breaking Appointments § 17.100 Refusal of treatment by unnecessarily breaking...

5 CFR 2.2 - Appointments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Appointments. 2.2 Section 2.2... SYSTEM (RULE II) § 2.2 Appointments. (a) OPM shall establish and administer a career-conditional...) Persons whose appointments are required by statute to be made on a permanent basis; (2) Employees serving...

5 CFR 2.2 - Appointments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Appointments. 2.2 Section 2.2... SYSTEM (RULE II) § 2.2 Appointments. (a) OPM shall establish and administer a career-conditional...) Persons whose appointments are required by statute to be made on a permanent basis; (2) Employees serving...

5 CFR 2.2 - Appointments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Appointments. 2.2 Section 2.2... SYSTEM (RULE II) § 2.2 Appointments. (a) OPM shall establish and administer a career-conditional...) Persons whose appointments are required by statute to be made on a permanent basis; (2) Employees serving...

Rules of Appointment at Franklin Pierce College.

ERIC Educational Resources Information Center

Franklyn Pierce Coll., Rindge, NH.

This memorandum sets forth the regulations and procedures affecting appointments to the instructional faculty of Franklin Pierce College. Part A: General Provisions, includes information on faculty ranks, the procedure of appointment, the regular review, and normal retirement. Part B deals with the terms and conditions of appointment, including…

5 CFR 930.204 - Appointments and conditions of employment.

Code of Federal Regulations, 2013 CFR

2013-01-01

.... 930.204 Section 930.204 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL...) Administrative Law Judge Program § 930.204 Appointments and conditions of employment. (a) Appointment. An agency may appoint an individual to an administrative law judge position only with prior approval of OPM...

5 CFR 930.204 - Appointments and conditions of employment.

Code of Federal Regulations, 2012 CFR

2012-01-01

.... 930.204 Section 930.204 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL...) Administrative Law Judge Program § 930.204 Appointments and conditions of employment. (a) Appointment. An agency may appoint an individual to an administrative law judge position only with prior approval of OPM...

5 CFR 315.705 - Employees serving under transitional or veterans recruitment appointments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... veterans recruitment appointments. 315.705 Section 315.705 Administrative Personnel OFFICE OF PERSONNEL... veterans recruitment appointments. (a) Agency action. (1) An agency shall convert the employment of an... substantially continuous service under a veterans recruitment appointment or under a combination of transitional...

Hanford Environmental Dose Reconstruction Project monthly report

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

McMakin, A.H., Cannon, S.D.; Finch, S.M.

1992-09-01

The objective of the Hanford Environmental Dose Reconstruction MDR) Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The TSP consists of experts in envirorunental pathways. epidemiology, surface-water transport, ground-water transport, statistics, demography, agriculture, meteorology, nuclear engineering. radiation dosimetry. and cultural anthropology. Included are appointed members representing the states of Oregon, Washington, and Idaho, a representative of Native American tribes, and an individual representing the public. The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed from release to impact onmore » humans (dose estimates): Source Terms; Environmental Transport; Environmental Monitoring Data Demography, Food Consumption, and Agriculture; and Environmental Pathways and Dose Estimates.« less

Automated detection of follow-up appointments using text mining of discharge records.

PubMed

Ruud, Kari L; Johnson, Matthew G; Liesinger, Juliette T; Grafft, Carrie A; Naessens, James M

2010-06-01

To determine whether text mining can accurately detect specific follow-up appointment criteria in free-text hospital discharge records. Cross-sectional study. Mayo Clinic Rochester hospitals. Inpatients discharged from general medicine services in 2006 (n = 6481). Textual hospital dismissal summaries were manually reviewed to determine whether the records contained specific follow-up appointment arrangement elements: date, time and either physician or location for an appointment. The data set was evaluated for the same criteria using SAS Text Miner software. The two assessments were compared to determine the accuracy of text mining for detecting records containing follow-up appointment arrangements. Agreement of text-mined appointment findings with gold standard (manual abstraction) including sensitivity, specificity, positive predictive and negative predictive values (PPV and NPV). About 55.2% (3576) of discharge records contained all criteria for follow-up appointment arrangements according to the manual review, 3.2% (113) of which were missed through text mining. Text mining incorrectly identified 3.7% (107) follow-up appointments that were not considered valid through manual review. Therefore, the text mining analysis concurred with the manual review in 96.6% of the appointment findings. Overall sensitivity and specificity were 96.8 and 96.3%, respectively; and PPV and NPV were 97.0 and 96.1%, respectively. of individual appointment criteria resulted in accuracy rates of 93.5% for date, 97.4% for time, 97.5% for physician and 82.9% for location. Text mining of unstructured hospital dismissal summaries can accurately detect documentation of follow-up appointment arrangement elements, thus saving considerable resources for performance assessment and quality-related research.

5 CFR 316.402 - Procedures for making temporary appointments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... an individual who is qualified for the position and who is eligible for: (1) Reinstatement under... appointments. Such appointments are not VRA appointments and do not lead to conversion to career-conditional... any position for which the individual is qualified. Reappointment must be for a minimum of 120 days...

5 CFR 315.607 - Noncompetitive appointment of present and former Peace Corps personnel.

Code of Federal Regulations, 2011 CFR

2011-01-01

... this period. (c) Conditions. Any law, Executive order, or regulation which disqualifies an applicant for appointment in the competitive service also disqualifies an applicant for appointment under this section. (d) Acquisition of competitive status. A person appointed under paragraph (a) of this section...

5 CFR 930.204 - Appointments and conditions of employment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... served under 5 U.S.C. 3105, passed an OPM administrative law judge competitive examination, and meets the...) Administrative Law Judge Program § 930.204 Appointments and conditions of employment. (a) Appointment. An agency may appoint an individual to an administrative law judge position only with prior approval of OPM...

5 CFR 930.204 - Appointments and conditions of employment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... served under 5 U.S.C. 3105, passed an OPM administrative law judge competitive examination, and meets the...) Administrative Law Judge Program § 930.204 Appointments and conditions of employment. (a) Appointment. An agency may appoint an individual to an administrative law judge position only with prior approval of OPM...

5 CFR 315.607 - Noncompetitive appointment of present and former Peace Corps personnel.

Code of Federal Regulations, 2010 CFR

2010-01-01

... this period. (c) Conditions. Any law, Executive order, or regulation which disqualifies an applicant for appointment in the competitive service also disqualifies an applicant for appointment under this section. (d) Acquisition of competitive status. A person appointed under paragraph (a) of this section...

5 CFR 531.211 - Setting pay for a newly appointed employee.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Setting pay for a newly appointed employee. 531.211 Section 531.211 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE... Position Changes § 531.211 Setting pay for a newly appointed employee. (a) First appointment. An agency...

Lydia Finney appointed WIST program initiator - Argonne Today

Science.gov Websites

Home Mission People Work/Life Connections Focal Point Inside Argonne Argonne Public Website Argonne Today Argonne Today Mission People Work/Life Connections Focal Point Lydia Finney appointed WIST program initiator Home People Lydia Finney appointed WIST program initiator Lydia Finney appointed WIST

4 CFR 3.1 - Appointment, promotion, and assignment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 4 Accounts 1 2010-01-01 2010-01-01 false Appointment, promotion, and assignment. 3.1 Section 3.1 Accounts GOVERNMENT ACCOUNTABILITY OFFICE PERSONNEL SYSTEM EMPLOYMENT § 3.1 Appointment, promotion, and assignment. Employees of GAO shall be appointed, promoted and assigned solely on the basis of merit and...

5 CFR 531.211 - Setting pay for a newly appointed employee.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Setting pay for a newly appointed employee. 531.211 Section 531.211 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE... Position Changes § 531.211 Setting pay for a newly appointed employee. (a) First appointment. An agency...

[Reiter disease or reactive arthritis?].

PubMed

Eppinger, S; Schmitt, J; Meurer, M

2006-04-01

There is an ongoing international discussion on whether the condition reactive arthritis should be named after a former Nazi functionary. The German dermatological community should participate in this debate. In 1916, Hans Reiter described a disease with the symptoms urethritis, conjunctivitis, and arthritis, which was later named after him. After becoming titular professor in May 1918, Reiter was appointed director of the regional public health department Mecklenburg-Schwerin in 1926. At the same time he taught social hygiene at the University of Rostock, where he was appointed full professor in 1928. In 1931, Hans Reiter became a member of the National Socialist German Workers Party (NSDAP). In July 1932 he was elected representative of the NSDAP to the seventh assembly of Mecklenburg-Schwerin. After becoming its acting director in July 1933, Reiter was appointed president of the Reich public health department in Berlin on October 1, 1933. Both his excellent professional qualifications, as well as his National Socialist attitudes, were considered key criteria for taking over this important position. As the president of the Reich public health department, Reiter was said to have known about the conduct of experiments with typhus-fever at the concentration camp Buchenwald in which 250 humans died. From the end of the Second World War until 1947, Reiter was imprisoned in the Nuremberg Prison for War Criminals, but never convicted of a crime.

Appointment systems are essential for improving chronic disease care in resource-poor settings: learning from experiences with HIV patients in Africa.

PubMed

Chalker, John C; Wagner, Anita K; Tomson, Göran; Johnson, Keith; Wahlström, Rolf; Ross-Degnan, Dennis

2013-09-01

Lessons learned from treating patients with HIV infection can inform care systems for other chronic conditions. For antiretroviral treatment, attending appointments on time correlates with medication adherence; however, HIV clinics in East Africa, where attendance rates vary widely, rarely include systems to schedule appointments or to track missed appointments or patient follow-up. An introduction of low-cost, paper-based patient appointment and tracking systems led to an improvement in timely clinic attendance rates and tracking missing patients. An effective appointment system is critical to managing patients with chronic conditions and can be introduced in resource-limited settings, possibly without having to add staff.

Biventricular non-compaction hypertrophic cardiomyopathy in association with congenital complete heart block and type I mitochondrial complex deficiency.

PubMed

Dhar, Ranjana; Reardon, William; McMahon, Colin J

2015-06-01

We report a baby girl with an antenatal diagnosis of biventricular non-compaction and complete heart block detected at 22 weeks' gestation. Postnatal echocardiography confirmed severe biventricular non-compaction hypertrophic cardiomyopathy, multiple muscular ventricular septal defects, and mild-moderate pulmonary valve stenosis. Skeletal muscle biopsy confirmed complex 1 mitochondrial respiratory chain deficiency. An epicardial VVI pacemaker was implanted on day 3 of life and revised at 7 years of age. She remains stable at 8 years of age following pacing and medical treatment with carvedilol, aspirin, co-enzyme Q10, and carnitine. This represents the first report of biventricular non-compaction hypertrophic phenotype in association with congenital complete heart block and complex 1 mitochondrial respiratory chain deficiency in a child.

Transportation barriers to accessing health care for urban children.

PubMed

Yang, Serena; Zarr, Robert L; Kass-Hout, Taha A; Kourosh, Atoosa; Kelly, Nancy R

2006-11-01

The Texas Children's Hospital Residents' Primary Care Group Clinic provides primary care to urban low-income children. The objective of this cross-sectional study was to investigate the impact of transportation problems on a family's ability to keep an appointment. One hundred eighty-three caregivers of children with an appointment were interviewed. Caregivers who kept their appointment were compared with those who did not with respect to demographic and transportation-related characteristics. Logistic regression modeling predicted caregivers with the following characteristics were more likely not to keep an appointment: not using a car to the last kept appointment, not keeping an appointment in the past due to transportation problems, having more than two people in the household, and not keeping an appointment in the past due to reasons other than transportation problems. Future research should focus on developing interventions to help low-income urban families overcome non-financial access barriers, including transportation problems.

5 CFR 316.302 - Selection of term employees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... requirements of parts 332 and 333 of this chapter, to an individual who is qualified for the position and who... appointments not excepted VRA appointments and do not lead to conversion to career-conditional appointment; (3... qualifies. Combined service under the original term appointment and reappointment must not exceed the 4-year...

42 CFR 21.32 - Boards; appointment of; powers and duties.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Boards; appointment of; powers and duties. 21.32 Section 21.32 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL COMMISSIONED OFFICERS Appointment § 21.32 Boards; appointment of; powers and duties. The Surgeon General shall...

42 CFR 21.32 - Boards; appointment of; powers and duties.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Boards; appointment of; powers and duties. 21.32 Section 21.32 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL COMMISSIONED OFFICERS Appointment § 21.32 Boards; appointment of; powers and duties. The Surgeon General shall...

42 CFR 21.32 - Boards; appointment of; powers and duties.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Boards; appointment of; powers and duties. 21.32 Section 21.32 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL COMMISSIONED OFFICERS Appointment § 21.32 Boards; appointment of; powers and duties. The Surgeon General shall...

22 CFR 501.2 - Eligibility for appointment as Foreign Service Officer.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SERVICE OFFICERS § 501.2 Eligibility for appointment as Foreign Service Officer. Cross-reference: The regulations governing eligibility for appointment as a Foreign Service Officer are codified in part 11 of this... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Eligibility for appointment as Foreign Service...

78 FR 69491 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-19

... Change Relating to Market Maker Appointment Cost Rebalances November 13, 2013. Pursuant to Section 19(b... its rules regarding Market-Maker appointment cost rebalances. The text of the proposed rule change is... amend its rules regarding Market-Maker appointment cost rebalances. Appointments to act as a Market...

78 FR 69918 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-21

... fulfillment of market- making obligations in their appointments. The Exchange believes the elimination of an...-appointments. RMMs only qualify for defined benefits in exchange for fulfillment of market- making obligations... appointments, which are similar to the market-making obligations within appointments imposed by other exchanges...

75 FR 38566 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-02

...- Demutualization Trading Permits, Tier Appointment and Bandwidth Packets June 25, 2010. Pursuant to Section 19(b)(1...-demutualization Trading Permits, tier appointment and bandwidth packets. The text of the proposed rule change is..., tier appointment and bandwidth packets. These post-demutualization Trading Permits, tier appointment...

10 CFR 10.26 - Appointment of Hearing Examiner.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Appointment of Hearing Examiner. 10.26 Section 10.26... RESTRICTED DATA OR NATIONAL SECURITY INFORMATION OR AN EMPLOYMENT CLEARANCE Procedures § 10.26 Appointment of Hearing Examiner. The appointment of a Hearing Examiner, pursuant to § 10.24 of this part, shall be from a...

10 CFR 10.26 - Appointment of Hearing Examiner.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Appointment of Hearing Examiner. 10.26 Section 10.26... RESTRICTED DATA OR NATIONAL SECURITY INFORMATION OR AN EMPLOYMENT CLEARANCE Procedures § 10.26 Appointment of Hearing Examiner. The appointment of a Hearing Examiner, pursuant to § 10.24 of this part, shall be from a...

10 CFR 10.26 - Appointment of Hearing Examiner.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Appointment of Hearing Examiner. 10.26 Section 10.26... RESTRICTED DATA OR NATIONAL SECURITY INFORMATION OR AN EMPLOYMENT CLEARANCE Procedures § 10.26 Appointment of Hearing Examiner. The appointment of a Hearing Examiner, pursuant to § 10.24 of this part, shall be from a...

10 CFR 10.26 - Appointment of Hearing Examiner.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Appointment of Hearing Examiner. 10.26 Section 10.26... RESTRICTED DATA OR NATIONAL SECURITY INFORMATION OR AN EMPLOYMENT CLEARANCE Procedures § 10.26 Appointment of Hearing Examiner. The appointment of a Hearing Examiner, pursuant to § 10.24 of this part, shall be from a...

10 CFR 10.26 - Appointment of Hearing Examiner.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Appointment of Hearing Examiner. 10.26 Section 10.26... RESTRICTED DATA OR NATIONAL SECURITY INFORMATION OR AN EMPLOYMENT CLEARANCE Procedures § 10.26 Appointment of Hearing Examiner. The appointment of a Hearing Examiner, pursuant to § 10.24 of this part, shall be from a...

42 CFR 21.32 - Boards; appointment of; powers and duties.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Boards; appointment of; powers and duties. 21.32 Section 21.32 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL COMMISSIONED OFFICERS Appointment § 21.32 Boards; appointment of; powers and duties. The Surgeon General shall...

42 CFR 21.32 - Boards; appointment of; powers and duties.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Boards; appointment of; powers and duties. 21.32 Section 21.32 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL COMMISSIONED OFFICERS Appointment § 21.32 Boards; appointment of; powers and duties. The Surgeon General shall...

Electronic Medical Records and Same Day Patient Tracing Improves Clinic Efficiency and Adherence to Appointments in a Community Based HIV/AIDS Care Program, in Uganda

PubMed Central

Alamo, Stella T.; Wagner, Glenn J.; Sunday, Pamela; Wanyenze, Rhoda K.; Ouma, Joseph; Kamya, Moses; Colebunders, Robert; Wabwire-Mangen, Fred

2013-01-01

Patients who miss clinic appointments make unscheduled visits which compromise the ability to plan for and deliver quality care. We implemented Electronic Medical Records (EMR) and same day patient tracing to minimize missed appointments in a community-based HIV clinic in Kampala. Missed, early, on-schedule appointments and waiting times were evaluated before (pre-EMR) and 6 months after implementation of EMR and patient tracing (post-EMR). Reasons for missed appointments were documented pre and post-EMR. The mean daily number of missed appointments significantly reduced from 21 pre-EMR to 8 post-EMR. The main reason for missed appointments was forgetting (37%) but reduced significantly by 30% post-EMR. Loss to follow-up (LTFU) also significantly decreased from 10.9 to 4.8% The total median waiting time to see providers significantly decreased from 291 to 94 min. Our findings suggest that EMR and same day patient tracing can significantly reduce missed appointments, and LTFU and improve clinic efficiency. PMID:21739285

Depression and literacy are important factors for missed appointments.

PubMed

Miller-Matero, Lisa Renee; Clark, Kalin Burkhardt; Brescacin, Carly; Dubaybo, Hala; Willens, David E

2016-09-01

Multiple variables are related to missed clinic appointments. However, the prevalence of missed appointments is still high suggesting other factors may play a role. The purpose of this study was to investigate the relationship between missed appointments and multiple variables simultaneously across a health care system, including patient demographics, psychiatric symptoms, cognitive functioning and literacy status. Chart reviews were conducted on 147 consecutive patients who were seen by a primary care psychologist over a six month period and completed measures to determine levels of depression, anxiety, sleep, cognitive functioning and health literacy. Demographic information and rates of missed appointments were also collected from charts. The average rate of missed appointments was 15.38%. In univariate analyses, factors related to higher rates of missed appointments included younger age (p = .03), lower income (p = .05), probable depression (p = .05), sleep difficulty (p = .05) and limited reading ability (p = .003). There were trends for a higher rate of missed appointments for patients identifying as black (p = .06), government insurance (p = .06) and limited math ability (p = .06). In a multivariate model, probable depression (p = .02) and limited reading ability (p = .003) were the only independent predictors. Depression and literacy status may be the most important factors associated with missed appointments. Implications are discussed including regular screening for depression and literacy status as well as interventions that can be utilized to help improve the rate of missed appointments.

Dynamic allocation of same-day requests in multi-physician primary care practices in the presence of prescheduled appointments.

PubMed

Balasubramanian, Hari; Biehl, Sebastian; Dai, Longjie; Muriel, Ana

2014-03-01

Appointments in primary care are of two types: 1) prescheduled appointments, which are booked in advance of a given workday; and 2) same-day appointments, which are booked as calls come during the workday. The challenge for practices is to provide preferred time slots for prescheduled appointments and yet see as many same-day patients as possible during regular work hours. It is also important, to the extent possible, to match same-day patients with their own providers (so as to maximize continuity of care). In this paper, we present a mathematical framework (a stochastic dynamic program) for same-day patient allocation in multi-physician practices in which calls for same-day appointments come in dynamically over a workday. Allocation decisions have to be made in the presence of prescheduled appointments and without complete demand information. The objective is to maximize a weighted measure that includes the number of same-day patients seen during regular work hours as well as the continuity provided to these patients. Our experimental design is motivated by empirical data we collected at a 3-provider family medicine practice in Massachusetts. Our results show that the location of prescheduled appointments - i.e. where in the day these appointments are booked - has a significant impact on the number of same-day patients a practice can see during regular work hours, as well as the continuity the practice is able to provide. We find that a 2-Blocks policy which books prescheduled appointments in two clusters - early morning and early afternoon - works very well. We also provide a simple, easily implementable policy for schedulers to assign incoming same-day requests to appointment slots. Our results show that this policy provides near-optimal same-day assignments in a variety of settings.

Factors Associated With Missed and Cancelled Colonoscopy Appointments at Veterans Health Administration Facilities.

PubMed

Partin, Melissa R; Gravely, Amy; Gellad, Ziad F; Nugent, Sean; Burgess, James F; Shaukat, Aasma; Nelson, David B

2016-02-01

Cancelled and missed colonoscopy appointments waste resources, increase colonoscopy delays, and can adversely affect patient outcomes. We examined individual and organizational factors associated with missed and cancelled colonoscopy appointments in Veteran Health Administration facilities. From 69 facilities meeting inclusion criteria, we identified 27,994 patients with colonoscopy appointments scheduled for follow-up, on the basis of positive fecal occult blood test results, between August 16, 2009 and September 30, 2011. We identified factors associated with colonoscopy appointment status (completed, cancelled, or missed) by using hierarchical multinomial regression. Individual factors examined included age, race, sex, marital status, residence, drive time to nearest specialty care facility, limited life expectancy, comorbidities, colonoscopy in the past decade, referring facility type, referral month, and appointment lead time. Organizational factors included facility region, complexity, appointment reminders, scheduling, and prep education practices. Missed appointments were associated with limited life expectancy (odds ratio [OR], 2.74; P = .0004), no personal history of polyps (OR, 2.74; P < .0001), high facility complexity (OR, 2.69; P = .007), dual diagnosis of psychiatric disorders and substance abuse (OR, 1.82; P < .0001), and opt-out scheduling (OR, 1.57; P = .02). Cancelled appointments were associated with age (OR, 1.61; P = .0005 for 85 years or older and OR, 1.44; P < .0001 for 65-84 years old), no history of polyps (OR, 1.51; P < .0001), and opt-out scheduling (OR, 1.26; P = .04). Additional predictors of both outcomes included race, marital status, and lead time. Several factors within Veterans Health Administration clinic control can be targeted to reduce missed and cancelled colonoscopy appointments. Specifically, developing systems to minimize referrals for patients with limited life expectancy could reduce missed appointments, and use of opt-in scheduling and reductions in appointment lead time could improve both outcomes. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Determination of specific gravity of municipal solid waste.

PubMed

Yesiller, Nazli; Hanson, James L; Cox, Jason T; Noce, Danielle E

2014-05-01

This investigation was conducted to evaluate experimental determination of specific gravity (Gs) of municipal solid waste (MSW). Water pycnometry, typically used for testing soils was adapted for testing MSW using a large flask with 2000 mL capacity and specimens with 100-350 g masses. Tests were conducted on manufactured waste samples prepared using US waste constituent components; fresh wastes obtained prior and subsequent to compaction at an MSW landfill; and wastes obtained from various depths at the same landfill. Factors that influence specific gravity were investigated including waste particle size, compaction, and combined decomposition and stress history. The measured average specific gravities were 1.377 and 1.530 for as-prepared/uncompacted and compacted manufactured wastes, respectively; 1.072 and 1.258 for uncompacted and compacted fresh wastes, respectively; and 2.201 for old wastes. The average organic content and degree of decomposition were 77.2% and 0%, respectively for fresh wastes and 22.8% and 88.3%, respectively for old wastes. The Gs increased with decreasing particle size, compaction, and increasing waste age. For fresh wastes, reductions in particle size and compaction caused occluded intraparticle pores to be exposed and waste particles to be deformed resulting in increases in specific gravity. For old wastes, the high Gs resulted from loss of biodegradable components that have low Gs as well as potential access to previously occluded pores and deformation of particles due to both degradation processes and applied mechanical stresses. The Gs was correlated to the degree of decomposition with a linear relationship. Unlike soils, the Gs for MSW was not unique, but varied in a landfill environment due both to physical/mechanical processes and biochemical processes. Specific gravity testing is recommended to be conducted not only using representative waste composition, but also using representative compaction, stress, and degradation states. Copyright © 2014 Elsevier Ltd. All rights reserved.

DOD Rapid Innovation Program: Some Technologies Have Transitioned to Military Users, but Steps Can Be Taken to Improve Program Metrics and Outcomes

DTIC Science & Technology

2015-05-01

Abbreviations ASD /R&E Assistant Secretary of Defense for Research and Engineering BAA Broad Agency Announcement DOD Department of Defense...solicitation of proposals; • merit-based selection of the most promising cost-effective proposals for funding through contracts, cooperative ...representatives appointed by the military service acquisition executives, Assistant Secretary of Defense for Research and Engineering ( ASD /R&E), and

DOE’s Management and Oversight of the Nuclear Weapons Complex

DTIC Science & Technology

1990-03-22

and Economic Development Division Before the Department of Energy Defense Nuclear Facilities Panel Committee on Armed Services House of Representatives...and newly created DOE offices. The Defense Nuclear Facilities Safety Board, whose board members were appointed this past year, was created to provide 6...mandated Defense Nuclear Facilities Safety Board. Continuing dialogue between DOE and the Board can also serve to enhance DOE’s ability to respond more

The Army War College Review: Student Publications. Volume 2, Number 2. May 2016

DTIC Science & Technology

2016-05-01

Character Development of U.S. Army Leaders – The Laissez - Fair Approach,” Military Review Online, September-October 2013, 30-39, http://usacac.army.mil/CAC2...intellectual work with professionals invested in U.S. national security, Landpower, strategic leadership , global security studies, and the advancement of...assumed the leadership chair of the Arctic Council for two years. President Obama appointed a well-qualified Special Representative for the Arctic

Bahrain: Reform, Security, and U.S. Policy

DTIC Science & Technology

2012-10-05

occurred long ago had the king’s reforms not been enacted. Al Khalifa family members have consistently held at least half of all ministerial slots...including all strategic ministry positions. Even before the 2011 unrest that has seen most senior Shiites in government resign, there were only 4 Shiite...Council of Representatives (COR)5 and the all -appointed Shura (Consultative) Council were to be of equal size (40 seats each). Together, they constitute a

Sub-Saharan Africa Report.

DTIC Science & Technology

1987-04-21

south of the Save River, In the .north, the MNR benefited in 1982 from-its absorption >of groups. of Africa Livre fighters operating out of Malawi (AC...Vol 23 Nos 15, 16). One of the Africa Livre leaders was businessman Gimo; ;Phiri, ’who became the MNR’s chief representative in Malawi, operating...Zambezia province for health reasons. The president of the republic has meanwhile appointed (Hermano Gildo Queda Gamito) as BPD chair- man, Antonio

Appointment breaking: causes and solutions.

PubMed

Bean, A G; Talaga, J

1992-12-01

From a review of research on health care appointment breaking, the authors find that patient demographic characteristics, psychosocial problems, previous appointment keeping, health beliefs, and situational factors predict no-show behavior. Suggestions are offered for designing the marketing mix to increase patient appointment keeping. Methods for mitigating the negative effects of no-shows on health care providers are described.

The Interaction of Publications and Appointments: New Evidence on Academic Economists in Germany

ERIC Educational Resources Information Center

Beckmann, Klaus; Schneider, Andrea

2013-01-01

Using a new panel data set comprising publication and appointment data for 889 German academic economists over a quarter of a century, we confirm the familiar hypothesis that publications are important for professorial appointments, but find only a small negative effect of appointments on subsequent research productivity, in particular if one…

13 CFR 120.950 - SBA and CDC must appoint agents.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false SBA and CDC must appoint agents... Development Company Loan Program (504) Debenture Sales and Service Agents § 120.950 SBA and CDC must appoint agents. SBA and the CDC must appoint the following agents to facilitate the sale and service of the...

13 CFR 120.950 - SBA and CDC must appoint agents.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false SBA and CDC must appoint agents... Development Company Loan Program (504) Debenture Sales and Service Agents § 120.950 SBA and CDC must appoint agents. SBA and the CDC must appoint the following agents to facilitate the sale and service of the...

13 CFR 120.950 - SBA and CDC must appoint agents.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA and CDC must appoint agents... Development Company Loan Program (504) Debenture Sales and Service Agents § 120.950 SBA and CDC must appoint agents. SBA and the CDC must appoint the following agents to facilitate the sale and service of the...

13 CFR 120.950 - SBA and CDC must appoint agents.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false SBA and CDC must appoint agents... Development Company Loan Program (504) Debenture Sales and Service Agents § 120.950 SBA and CDC must appoint agents. SBA and the CDC must appoint the following agents to facilitate the sale and service of the...

13 CFR 120.950 - SBA and CDC must appoint agents.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false SBA and CDC must appoint agents... Development Company Loan Program (504) Debenture Sales and Service Agents § 120.950 SBA and CDC must appoint agents. SBA and the CDC must appoint the following agents to facilitate the sale and service of the...

Improving Health Care Accessibility: Strategies and Recommendations.

PubMed

Almorsy, Lamia; Khalifa, Mohamed

2016-01-01

Access time refers to the interval between requesting and actual outpatient appointment. It reflects healthcare accessibility and has a great influence on patient treatment and satisfaction. King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia studied the accessibility to outpatient services in order to develop useful strategies and recommendations for improvement. Utilized, unutilized and no-show appointments were analyzed. It is crucial to manage no-shows and short notice appointment cancellations by preparing a waiting list for those patients who can be called in to an appointment on the same day using an open access policy. An overlapping appointment scheduling model can be useful to minimize patient waiting time and doctor idle time in addition to the sensible use of appointment overbooking that can significantly improve productivity.

Rotation invariant deep binary hashing for fast image retrieval

NASA Astrophysics Data System (ADS)

Dai, Lai; Liu, Jianming; Jiang, Aiwen

2017-07-01

In this paper, we study how to compactly represent image's characteristics for fast image retrieval. We propose supervised rotation invariant compact discriminative binary descriptors through combining convolutional neural network with hashing. In the proposed network, binary codes are learned by employing a hidden layer for representing latent concepts that dominate on class labels. A loss function is proposed to minimize the difference between binary descriptors that describe reference image and the rotated one. Compared with some other supervised methods, the proposed network doesn't have to require pair-wised inputs for binary code learning. Experimental results show that our method is effective and achieves state-of-the-art results on the CIFAR-10 and MNIST datasets.

A compact, inexpensive infrared laser system for continuous-wave optical stimulation of the rat prostate cavernous nerves

NASA Astrophysics Data System (ADS)

Perkins, William C.; Lagoda, Gwen A.; Burnett, Arthur L.; Fried, Nathaniel M.

2014-03-01

Optical nerve stimulation (ONS) has been commonly performed in the laboratory using high-power, pulsed, infrared (IR) lasers including Holmium:YAG, diode, and Thulium fiber lasers. However, the relatively high cost of these lasers in comparison with conventional electrical nerve stimulation (ENS) equipment may represent a significant barrier to widespread adoption of ONS. Optical stimulation of the prostate cavernous nerves (CN's) has recently been reported using lower cost, continuous-wave (CW), all-fiber-based diode lasers. This preliminary study describes further miniaturization and cost reduction of the ONS system in the form of a compact, lightweight, cordless, and inexpensive IR laser. A 140-mW, 1560-nm diode laser was integrated with a green aiming beam and delivery optics into a compact ONS system. Surface and subsurface ONS was performed in a total of 5 rats, in vivo, with measurement of an intracavernous pressure (ICP) response during CW laser irradiation for 30 s with a spot diameter of 0.7 mm. Short-term, CW ONS of the prostate CN's is feasible using a compact, inexpensive, batterypowered IR laser diode system. This ONS system may represent an alternative to ENS for laboratory studies, and with further development, a handheld option for ONS in the clinic to identify and preserve the CN's during prostate cancer surgery.

48 CFR 245.7001 - Selection, appointment, and termination.

Code of Federal Regulations, 2010 CFR

2010-10-01

... REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CONTRACT MANAGEMENT GOVERNMENT PROPERTY Appointment of Property... officers, the appointment authority shall consider experience, training, education, business acumen, judgment, character, and ethics. ...

42 CFR 21.51 - Appointment of officers having specialized training or experience in administration and management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Appointment of officers having specialized training or experience in administration and management. 21.51 Section 21.51 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL COMMISSIONED OFFICERS Appointment § 21.51 Appointment of officers having specialized training...

Appointment-keeping behavior of Medicaid-enrolled pediatric dental patients in eastern Iowa.

PubMed

Iben, P; Kanellis, M J; Warren, J

2000-01-01

The purpose of this prospective study was to assess the appointment-keeping behavior of Medicaid-enrolled pediatric dental patients in three Eastern Iowa practices. During the month of October 1998, a tally was kept of all patient appointments at a private pediatric dental office, a public health dental clinic, and a university-based pediatric dentistry clinic. Patients were categorized as either Medicaid or non-Medicaid. Appointment behavior categories were defined as: On time; Failure; Late-notice Cancellation (less than 24 hours notice); and Tardy (greater than 10 minutes). The data was entered in SPSS and analyzed using the chi square statistic. Statistical significance was P < 0.05. A total of 1,406 appointments were recorded for all three sites. Overall, patients on Iowa Medicaid had higher appointment failure, late-notice cancellation, and tardiness rates than non-Medicaid patients at all three clinics. However, these differences were only statistically significant for the private office and the university-based clinic. Failed appointment rates for Medicaid patients were much higher at the private office (38%) than at the other two sites. Consistent with anecdotal reports from dentists, Medicaid patients had higher rates of broken appointments than did non-Medicaid patients, particularly in a private practice setting.

Predicting appointment misses in hospitals using data analytics

PubMed Central

Karpagam, Sylvia; Ma, Nang Laik

2017-01-01

Background There is growing attention over the last few years about non-attendance in hospitals and its clinical and economic consequences. There have been several studies documenting the various aspects of non-attendance in hospitals. Project Predicting Appoint Misses (PAM) was started with the intention of being able to predict the type of patients that would not come for appointments after making bookings. Methods Historic hospital appointment data merged with “distance from hospital” variable was used to run Logistic Regression, Support Vector Machine and Recursive Partitioning to decide the contributing variables to missed appointments. Results Variables that are “class”, “time”, “demographics” related have an effect on the target variable, however, prediction models may not perform effectively due to very subtle influence on the target variable. Previously assumed major contributors like “age”, “distance” did not have a major effect on the target variable. Conclusions With the given data it will be very difficult to make any moderate/strong prediction of the Appointment misses. That being said with the help of the cut off we are able to capture all of the “appointment misses” in addition to also capturing the actualized appointments. PMID:28567409

A Pilot Study of Reasons and Risk Factors for "No-Shows" in a Pediatric Neurology Clinic.

PubMed

Guzek, Lindsay M; Fadel, William F; Golomb, Meredith R

2015-09-01

Missed clinic appointments lead to decreased patient access, worse patient outcomes, and increased healthcare costs. The goal of this pilot study was to identify reasons for and risk factors associated with missed pediatric neurology outpatient appointments ("no-shows"). This was a prospective cohort study of patients scheduled for 1 week of clinic. Data on patient clinical and demographic information were collected by record review; data on reasons for missed appointments were collected by phone interviews. Univariate and multivariate analyses were conducted using chi-square tests and multiple logistic regression to assess risk factors for missed appointments. Fifty-nine (25%) of 236 scheduled patients were no-shows. Scheduling conflicts (25.9%) and forgetting (20.4%) were the most common reasons for missed appointments. When controlling for confounding factors in the logistic regression, Medicaid (odds ratio 2.36), distance from clinic, and time since appointment was scheduled were associated with missed appointments. Further work in this area is needed. © The Author(s) 2014.

Hanford Environmental Dose Reconstruction Project

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

McMakin, A.H.; Cannon, S.D.; Finch, S.M.

1992-07-01

The objective of the Hanford Environmental Dose Reconstruction (HEDR) Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The TSP consists of experts in environmental pathways, epidemiology, surface-water transport, ground-water transport, statistics, demography, agriculture, meteorology, nuclear engineering, radiation dosimetry, and cultural anthropology. Included are appointed technical members representing the states of Oregon, Washington, and Idaho, a representative of Native American tribes, and an individual representing the public. The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed from release to impactmore » on humans (dose estimates): Source terms, environmental transport, environmental monitoring data, demography, food consumption, and agriculture, and environmental pathways and dose estimates. Progress is discussed.« less

Hanford Environmental Dose Reconstruction Project. Monthly report

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

McMakin, A.H.; Cannon, S.D.; Finch, S.M.

1992-07-01

The objective of the Hanford Environmental Dose Reconstruction (HEDR) Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The TSP consists of experts in environmental pathways, epidemiology, surface-water transport, ground-water transport, statistics, demography, agriculture, meteorology, nuclear engineering, radiation dosimetry, and cultural anthropology. Included are appointed technical members representing the states of Oregon, Washington, and Idaho, a representative of Native American tribes, and an individual representing the public. The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed from release to impactmore » on humans (dose estimates): Source terms, environmental transport, environmental monitoring data, demography, food consumption, and agriculture, and environmental pathways and dose estimates. Progress is discussed.« less

Predicting appointment breaking.

PubMed

Bean, A G; Talaga, J

1995-01-01

The goal of physician referral services is to schedule appointments, but if too many patients fail to show up, the value of the service will be compromised. The authors found that appointment breaking can be predicted by the number of days to the scheduled appointment, the doctor's specialty, and the patient's age and gender. They also offer specific suggestions for modifying the marketing mix to reduce the incidence of no-shows.

43 CFR 30.121 - May a judge appoint a master in a probate case?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false May a judge appoint a master in a probate... PROBATE HEARINGS PROCEDURES Judicial Authority and Duties § 30.121 May a judge appoint a master in a probate case? (a) In the exercise of any authority under this part, a judge may appoint a master to do all...

43 CFR 30.121 - May a judge appoint a master in a probate case?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false May a judge appoint a master in a probate... PROBATE HEARINGS PROCEDURES Judicial Authority and Duties § 30.121 May a judge appoint a master in a probate case? (a) In the exercise of any authority under this part, a judge may appoint a master to do all...

43 CFR 30.121 - May a judge appoint a master in a probate case?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true May a judge appoint a master in a probate... PROBATE HEARINGS PROCEDURES Judicial Authority and Duties § 30.121 May a judge appoint a master in a probate case? (a) In the exercise of any authority under this part, a judge may appoint a master to do all...

43 CFR 30.121 - May a judge appoint a master in a probate case?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false May a judge appoint a master in a probate... PROBATE HEARINGS PROCEDURES Judicial Authority and Duties § 30.121 May a judge appoint a master in a probate case? (a) In the exercise of any authority under this part, a judge may appoint a master to do all...

43 CFR 30.121 - May a judge appoint a master in a probate case?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false May a judge appoint a master in a probate... PROBATE HEARINGS PROCEDURES Judicial Authority and Duties § 30.121 May a judge appoint a master in a probate case? (a) In the exercise of any authority under this part, a judge may appoint a master to do all...

26 CFR 20.2056(b)-6 - Marital deduction; life insurance or annuity payments with power of appointment in surviving spouse.

Code of Federal Regulations, 2010 CFR

2010-04-01

... payments with power of appointment in surviving spouse. 20.2056(b)-6 Section 20.2056(b)-6 Internal Revenue... insurance or annuity payments with power of appointment in surviving spouse. (a) In general. Section 2056(b... after the decedent's death. (3) The surviving spouse must have the power to appoint all or a specific...

Reduction of missed appointments at an urban primary care clinic: a randomised controlled study.

PubMed

Perron, Noelle Junod; Dao, Melissa Dominicé; Kossovsky, Michel P; Miserez, Valerie; Chuard, Carmen; Calmy, Alexandra; Gaspoz, Jean-Michel

2010-10-25

Missed appointments are known to interfere with appropriate care and to misspend medical and administrative resources. The aim of this study was to test the effectiveness of a sequential intervention reminding patients of their upcoming appointment and to identify the profile of patients missing their appointments. We conducted a randomised controlled study in an urban primary care clinic at the Geneva University Hospitals serving a majority of vulnerable patients. All patients booked in a primary care or HIV clinic at the Geneva University Hospitals were sent a reminder 48 hrs prior to their appointment according to the following sequential intervention: 1. Phone call (fixed or mobile) reminder; 2. If no phone response: a Short Message Service (SMS) reminder; 3. If no available mobile phone number: a postal reminder. The rate of missed appointment, the cost of the intervention, and the profile of patients missing their appointment were recorded. 2123 patients were included: 1052 in the intervention group, 1071 in the control group. Only 61.7% patients had a mobile phone recorded at the clinic. The sequential intervention significantly reduced the rate of missed appointments: 11.4% (n = 122) in the control group and 7.8% (n = 82) in the intervention group (p < 0.005), and allowed to reallocate 28% of cancelled appointments. It also proved to be cost effective in providing a total net benefit of 1846. - EUR/3 months. A satisfaction survey conducted with 241 patients showed that 93% of them were not bothered by the reminders and 78% considered them to be useful. By multivariate analysis, the following characteristics were significant predictors of missed appointments: younger age (OR per additional decade 0.82; CI 0.71-0.94), male gender (OR 1.72; CI 1.18-2.50), follow-up appointment >1 year (OR 2.2; CI: 1.15-4.2), substance abuse (2.09, CI 1.21-3.61), and being an asylum seeker (OR 2.73: CI 1.22-6.09). A practical reminder system can significantly increase patient attendance at medical outpatient clinics. An intervention focused on specific patient characteristics could further increase the effectiveness of appointment reminders.

Reduction of missed appointments at an urban primary care clinic: a randomised controlled study

PubMed Central

2010-01-01

Background Missed appointments are known to interfere with appropriate care and to misspend medical and administrative resources. The aim of this study was to test the effectiveness of a sequential intervention reminding patients of their upcoming appointment and to identify the profile of patients missing their appointments. Methods We conducted a randomised controlled study in an urban primary care clinic at the Geneva University Hospitals serving a majority of vulnerable patients. All patients booked in a primary care or HIV clinic at the Geneva University Hospitals were sent a reminder 48 hrs prior to their appointment according to the following sequential intervention: 1. Phone call (fixed or mobile) reminder; 2. If no phone response: a Short Message Service (SMS) reminder; 3. If no available mobile phone number: a postal reminder. The rate of missed appointment, the cost of the intervention, and the profile of patients missing their appointment were recorded. Results 2123 patients were included: 1052 in the intervention group, 1071 in the control group. Only 61.7% patients had a mobile phone recorded at the clinic. The sequential intervention significantly reduced the rate of missed appointments: 11.4% (n = 122) in the control group and 7.8% (n = 82) in the intervention group (p < 0.005), and allowed to reallocate 28% of cancelled appointments. It also proved to be cost effective in providing a total net benefit of 1846. - EUR/3 months. A satisfaction survey conducted with 241 patients showed that 93% of them were not bothered by the reminders and 78% considered them to be useful. By multivariate analysis, the following characteristics were significant predictors of missed appointments: younger age (OR per additional decade 0.82; CI 0.71-0.94), male gender (OR 1.72; CI 1.18-2.50), follow-up appointment >1year (OR 2.2; CI: 1.15-4.2), substance abuse (2.09, CI 1.21-3.61), and being an asylum seeker (OR 2.73: CI 1.22-6.09). Conclusion A practical reminder system can significantly increase patient attendance at medical outpatient clinics. An intervention focused on specific patient characteristics could further increase the effectiveness of appointment reminders. PMID:20973950

Closing the Referral Loop: an Analysis of Primary Care Referrals to Specialists in a Large Health System.

PubMed

Patel, Malhar P; Schettini, Priscille; O'Leary, Colin P; Bosworth, Hayden B; Anderson, John B; Shah, Kevin P

2018-05-01

Ideally, a referral from a primary care physician (PCP) to a specialist results in a completed specialty appointment with results available to the PCP. This is defined as "closing the referral loop." As health systems grow more complex, regulatory bodies increase vigilance, and reimbursement shifts towards value, closing the referral loop becomes a patient safety, regulatory, and financial imperative. To assess the ability of a large health system to close the referral loop, we used electronic medical record (EMR)-generated data to analyze referrals from a large primary care network to 20 high-volume specialties between July 1, 2015 and June 30, 2016. The primary metric was documented specialist appointment completion rate. Explanatory analyses included documented appointment scheduling rate, individual clinic differences, appointment wait times, and geographic distance to appointments. Of the 103,737 analyzed referral scheduling attempts, only 36,072 (34.8%) resulted in documented complete appointments. Low documented appointment scheduling rates (38.9% of scheduling attempts lacked appointment dates), individual clinic differences in closing the referral loop, and significant differences in wait times and distances to specialists between complete and incomplete appointments drove this gap. Other notable findings include high variation in wait times among specialties and correlation between high wait times and low documented appointment completion rates. The rate of closing the referral loop in this health system is low. Low appointment scheduling rates, individual clinic differences, and patient access issues of wait times and geographic proximity explain much of the gap. This problem is likely common among large health systems with complex provider networks and referral scheduling. Strategies that improve scheduling, decrease variation among clinics, and improve patient access will likely improve rates of closing the referral loop. More research is necessary to determine the impact of these changes and other potential driving factors.

Modifying factors of the health belief model associated with missed clinic appointments among individuals with sickle cell disease.

PubMed

Cronin, Robert M; Hankins, Jane S; Byrd, Jeannie; Pernell, Brandi M; Kassim, Adetola; Adams-Graves, Patricia; Thompson, Alexis A; Kalinyak, Karen; DeBaun, Michael R; Treadwell, Marsha

2018-03-29

Outpatient care is critical in the management of chronic diseases, including sickle cell disease (SCD). Risk factors for poor adherence with clinic appointments in SCD are poorly defined. This exploratory study evaluated associations between modifying variables from the Health Belief Model and missed appointments. We surveyed adults with SCD (n = 211) and caregivers of children with SCD (n = 331) between October 2014 and March 2016 in six centres across the U.S. The survey tool utilized the framework of the Health Belief Model, and included: social determinants, psychosocial variables, social support, health literacy and spirituality. A majority of adults (87%) and caregivers of children (65%) reported they missed a clinic appointment. Children (as reported by caregivers) were less likely to miss appointments than adults (OR:0.22; 95% CI:(0.13,0.39)). In adults, financial insecurity (OR:4.49; 95% CI:(1.20, 20.7)), health literacy (OR:4.64; 95% CI:(1.33, 16.15)), and age (OR:0.95; 95% CI:(0.91,0.99)) were significantly associated with missed appointments. In all participants, lower spirituality was associated with missed appointments (OR:1.83; 95%CI:(1.13, 2.94)). The most common reason for missing an appointment was forgetfulness (adults: 31%, children: 26%). A majority thought reminders would help (adults: 83%, children: 71%) using phone calls (adults: 62%, children: 61%) or text messages (adults: 56%, children: 51%). Our findings demonstrate that modifying components of the Health Belief Model, including age, financial security, health literacy, spirituality, and lacking cues to action like reminders, are important in missed appointments and addressing these factors could improve appointment-keeping for adults and children with SCD.

Comparison of silver release predictions using PARFUME with results from the AGR-2 irradiation experiment

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

Collin, Blaise P.; Demkowicz, Paul A.; Baldwin, Charles A.

2016-11-01

The PARFUME (PARticle FUel ModEl) code was used to predict silver release from tristructural isotropic (TRISO) coated fuel particles and compacts during the second irradiation experiment (AGR-2) of the Advanced Gas Reactor Fuel Development and Qualification program. The PARFUME model for the AGR-2 experiment used the fuel compact volume average temperature for each of the 559 days of irradiation to calculate the release of fission product silver from a representative particle for a select number of AGR-2 compacts and individual fuel particles containing either mixed uranium carbide/oxide (UCO) or 100% uranium dioxide (UO2) kernels. Post-irradiation examination (PIE) measurements were performedmore » to provide data on release of silver from these compacts and individual fuel particles. The available experimental fractional releases of silver were compared to their corresponding PARFUME predictions. Preliminary comparisons show that PARFUME under-predicts the PIE results in UCO compacts and is in reasonable agreement with experimental data for UO2 compacts. The accuracy of PARFUME predictions is impacted by the code limitations in the modeling of the temporal and spatial distributions of the temperature across the compacts. Nevertheless, the comparisons on silver release lie within the same order of magnitude.« less

33 CFR 40.1 - Program for appointing cadets.

Code of Federal Regulations, 2010 CFR

2010-07-01

... appointed by the Superintendent of the Coast Guard Academy, which reviews each applicant's personal... appointment. Applications must be submitted online at http://www.uscga.edu using Coast Guard forms CGA-14, CGA...

Factors Associated With Adherence to 14-Day Office Appointments After Heart Failure Discharge.

PubMed

Distelhorst, Karen; Claussen, Renee; Dion, Kelly; Bena, James F; Morrison, Shannon L; Walker, Donna; Tai, Hua-Li; Albert, Nancy M

2018-06-01

Follow-up within 14 days after hospital discharge for heart failure (HF) may prevent 30-day hospital readmission, but adherence varies. The purpose of this study was to determine predictors of nonadherence to scheduled appointments. A medical record review included patients hospitalized for decompensated HF at 3 health system hospitals who had a scheduled 14-day office appointment. Patient demographics, and social, HF, and hospital factors were studied for association with appointment adherence. Multivariable modeling was used to determine the odds of missing scheduled appointments. Of 701 cases, mean (standard deviation) age was 73.5 (13.8) years, 46.4% were female and 38.9% were nonwhite. Appointment nonadherence was 16.2%. In multivariate analyses, 4 factors predicted missed appointments: drug use history (odds ratio [OR], 3.95; 95% confidence interval [CI], 1.70-9.20; P < .001), nonwhite race (OR, 1.85; 95% CI, 1.08-3.16; P = .024), pulmonary disease (OR, 1.80; 95% CI, 1.12-2.87; P = .014), and anemia (OR, 1.58; 95% CI, 1.01-2.46; P = .044). Scheduling appointments postdischarge vs predischarge was not associated with missed appointments (OR, 0.72; 95% CI, 0.45-1.15; P = .17). Findings may help practitioners identify patients who are likely to miss a follow-up visit; all 4 predictors were easily retrievable from medical records during hospitalization. Copyright © 2018 Elsevier Inc. All rights reserved.

Impact of Appointment Waiting Time on Attendance Rates at a Clinical Cancer Genetics Service.

PubMed

Shaw, Tarryn; Metras, Julie; Ting, Zoe Ang Li; Courtney, Eliza; Li, Shao-Tzu; Ngeow, Joanne

2018-05-24

The increase in demand for clinical cancer genetics services has impacted the ability to provide services timeously. Given limited resources, this often results in extended appointment waiting times. Over the last 3 years, the Cancer Genetics Service at the National Cancer Centre Singapore has continued to experience a steady increase in demand for its service. Nevertheless, significant no-show rates have been reported. This study sought to determine whether an association exists between appointment waiting times and attendance rates. Data was gathered for all participants meeting inclusion criteria. Attendance rates and appointment waiting times were calculated. The relationship between mean waiting times for those who did and did not attend their scheduled appointments was evaluated using Welch's t test and linear regression model. The results showed a significant difference in mean appointment waiting times between patients who did and did not attend (32.66 versus 43.50 days respectively; p < 0.0001). Furthermore, patients who waited for longer than 37 days were significantly less likely to attend. No-show rates increased as the waiting time increased, at a rate of 19.60% per 20 days and 21.40% per 30 days. In conclusion, appointment waiting time is a significant predictor for patient attendance. Strategies to ensure patients receive an appointment within the necessary timeframe at the desired setting are important to ensure that individuals at increased cancer risk attend their appointments in order to manage their cancer risks effectively.

An Effective Outpatient Appointment System for General Leonard Wood Army Community Hospital

DTIC Science & Technology

1990-07-13

collection, donated many hours. She asked patients about the appointment system and personally observed clinic personnel. Additionally, as a consumer ...appointment system which must satisfy both the demands 0of external ( patients ) and internal (physicians) customers . At the o0 C 0 same time, the...its health care environment. A variable that can effect patient flow is centralization or decentralization of the registration and appointment system

A quality improvement intervention to increase access to pediatric subspecialty practice.

PubMed

Heptulla, Rubina A; Choi, Steven J; Belamarich, Peter F

2013-02-01

To improve access to new pediatric endocrinology appointments in an urban academic hospital faculty-based practice. Three strategies were implemented to increase the number of appointment slots: new patient appointments were protected from conversion to follow-up appointments; all physicians, including senior faculty, were scheduled to see 3 to 4 new patients per session; and sessions devoted exclusively to follow-up appointments were added based on demand. The main outcomes for this quality improvement activity were waiting times for new and follow-up appointments, monthly visit volume, the per-provider visit volume, differences in the proportion of new visits, and clinic arrival rates pre- and postintervention. Thirteen months after the intervention, average wait for a new patient appointment decreased from 11.4 to 1.7 weeks (P < .001) and follow-up appointment wait time decreased from 8.2 to 2.9 weeks (P < .001). Mean monthly total visit volume increased from 284 to 366 patient visits (P < .01) and mean monthly visit volume per provider increased from 36.8 to 41.0 patients (P = .08). New patients were 27% of the visit volume and 35% after the intervention. Access to our pediatric specialty care clinic was improved without increasing the number of providers by improved scheduling.

Lead Time to Appointment and No-Show Rates for New and Follow-up Patients in an Ambulatory Clinic.

PubMed

Drewek, Rupali; Mirea, Lucia; Adelson, P David

High rates of no-shows in outpatient clinics are problematic for revenue and for quality of patient care. Longer lead time to appointment has variably been implicated as a risk factor for no-shows, but the evidence within pediatric clinics is inconclusive. The goal of this study was to estimate no-show rates and test for association between appointment lead time and no-show rates for new and follow-up patients. Analyses included 534 new and 1920 follow-up patients from pulmonology and gastroenterology clinics at a freestanding children's hospital. The overall rate of no-shows was lower for visits scheduled within 0 to 30 days compared with 30 days or more (23% compared with 47%, P < .0001). Patient type significantly modified the association of appointment lead time; the rate of no-shows was higher (30%) among new patients compared with (21%) follow-up patients with appointments scheduled within 30 days (P = .004). For appointments scheduled 30 or more days' lead time, no-show rates were statistically similar for new patients (46%) and follow-up patients (0.48%). Time to appointment is a risk factor associated with no-shows, and further study is needed to identify and implement effective approaches to reduce appointment lead time, especially for new patients in pediatric subspecialties.

Chemotherapy appointment scheduling under uncertainty using mean-risk stochastic integer programming.

PubMed

Alvarado, Michelle; Ntaimo, Lewis

2018-03-01

Oncology clinics are often burdened with scheduling large volumes of cancer patients for chemotherapy treatments under limited resources such as the number of nurses and chairs. These cancer patients require a series of appointments over several weeks or months and the timing of these appointments is critical to the treatment's effectiveness. Additionally, the appointment duration, the acuity levels of each appointment, and the availability of clinic nurses are uncertain. The timing constraints, stochastic parameters, rising treatment costs, and increased demand of outpatient oncology clinic services motivate the need for efficient appointment schedules and clinic operations. In this paper, we develop three mean-risk stochastic integer programming (SIP) models, referred to as SIP-CHEMO, for the problem of scheduling individual chemotherapy patient appointments and resources. These mean-risk models are presented and an algorithm is devised to improve computational speed. Computational results were conducted using a simulation model and results indicate that the risk-averse SIP-CHEMO model with the expected excess mean-risk measure can decrease patient waiting times and nurse overtime when compared to deterministic scheduling algorithms by 42 % and 27 %, respectively.

Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data

PubMed Central

Cowling, Thomas E; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem

2016-01-01

Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department. Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Conclusions Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear. PMID:26306608

A National Model for Diabetes Prevention and Treatment Program in Civilian and Military Beneficiary Populations (FY07)

DTIC Science & Technology

2013-09-24

examination was performed by one of the investigators (medical doctors) or certified nurse practitioners. Prior to initiating the intervention...3 days before their scheduled appointment. If a patient did not show or cancelled their appointment without rescheduling , the study team...additionally tried to reach them by phone to identify the reason for missing an appointment and to attempt to reschedule another appointment. It was

Accessibility and Barriers to Oncology Appointments at 40 National Cancer Institute-Designated Comprehensive Cancer Centers: Results of a Mystery Shopper Project.

PubMed

Hamlyn, Geoffrey S; Hutchins, Kathryn E; Johnston, Abby L; Thomas, Rishonda T; Tian, James; Kamal, Arif H

2016-10-01

Patients turn to National Cancer Institute (NCI) -designated comprehensive cancer centers because of perceived better quality and more timely access to care. However, recent studies have found that patients at various institutions may struggle to gain access to an appointment or obtain consistent information from attendants. Our study employs a mystery shopper format to identify and quantify barriers faced by patients seeking to make a first consultation appointment across a homogenous sample of 40 NCI-designated comprehensive cancer centers. Five mystery shoppers used a standardized call script to inquire about first available appointment times and service offerings. When inquiring about a date for a first available appointment, 29% of callers were unable to secure an estimated date without registering into the center's database, 51% were able to secure an estimated date, and 20% were provided with an actual date. Of estimated or actual dates for a first available appointment, 74% were greater than 1 week away. There was no statistically significant variation between appointment availability across insurance type or US region. Our study highlights the difficulty of accessing information about appointment availability. Although not statistically significant, inquiries regarding first available appointments for Medicaid patients resulted in longer estimated or actual wait times than those for patients with private insurance, and Medicaid shoppers noted qualitative differences. Although our study was limited by small sample size and imperfect analytic methods, our results suggest the need for more efficient and accessible care for patients at our nation's top cancer centers.

25 CFR 23.13 - Payment for appointed counsel in involuntary Indian child custody proceedings in state courts.

Code of Federal Regulations, 2011 CFR

2011-04-01

... fees and expenses to be paid appointed counsel in state juvenile delinquency proceedings; and (2... appointed counsel in state juvenile delinquency proceedings. (e) The Area Director shall authorize the...

25 CFR 23.13 - Payment for appointed counsel in involuntary Indian child custody proceedings in state courts.

Code of Federal Regulations, 2014 CFR

2014-04-01

... fees and expenses to be paid appointed counsel in state juvenile delinquency proceedings; and (2... appointed counsel in state juvenile delinquency proceedings. (e) The Area Director shall authorize the...

25 CFR 23.13 - Payment for appointed counsel in involuntary Indian child custody proceedings in state courts.

Code of Federal Regulations, 2010 CFR

2010-04-01

... fees and expenses to be paid appointed counsel in state juvenile delinquency proceedings; and (2... appointed counsel in state juvenile delinquency proceedings. (e) The Area Director shall authorize the...

25 CFR 23.13 - Payment for appointed counsel in involuntary Indian child custody proceedings in state courts.

Code of Federal Regulations, 2012 CFR

2012-04-01

... fees and expenses to be paid appointed counsel in state juvenile delinquency proceedings; and (2... appointed counsel in state juvenile delinquency proceedings. (e) The Area Director shall authorize the...

25 CFR 23.13 - Payment for appointed counsel in involuntary Indian child custody proceedings in state courts.

Code of Federal Regulations, 2013 CFR

2013-04-01

... fees and expenses to be paid appointed counsel in state juvenile delinquency proceedings; and (2... appointed counsel in state juvenile delinquency proceedings. (e) The Area Director shall authorize the...

Email for the coordination of healthcare appointments and attendance reminders.

PubMed

Atherton, Helen; Sawmynaden, Prescilla; Meyer, Barbara; Car, Josip

2012-08-15

Email is a popular and commonly-used method of communication, but its use in health care is not routine. Where email communication has been utilised in health care, its purposes have included the coordination of healthcare appointments and attendance reminders, but the effects of using email in this way are not known. This review considers the use of email for the coordination of healthcare appointments and reminders for attendance; particularly scheduling, rescheduling and cancelling healthcare appointments, and providing prompts/reminders for attendance at appointments. To assess the effects of using email for the coordination of healthcare appointments and attendance reminders, compared to other forms of coordinating appointments and reminders, on outcomes for health professionals, patients and carers, and health services, including harms. We searched: the Cochrane Consumers and Communication Review Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980 to January 2010), PsycINFO (OvidSP) (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February 2010),and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists and contacting authors. Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies of interventions that use email for scheduling health appointments, for reminders for a scheduled health appointment or for ongoing coordination of health appointments and that took the form of 1) unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered. Two review authors independently assessed the titles and abstracts of retrieved citations. No studies were identified for inclusion. Consequently, no data collection or analysis was possible. No studies met the inclusion criteria, therefore there are no results to report on the use of email for the coordination of healthcare appointments and attendance reminders. No conclusions on the effects of using email for the coordination of healthcare appointments and attendance reminders could be made and thus no recommendations for practice can be stipulated. Given the significant theoretical opportunities that email presents, there is a need for rigorous studies addressing the review question, but this may involve addressing barriers concerning trial development and implementation.

Analytical study on the suitability of using bentonite coated gravel as a landfill liner material

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

Roberts, Anel A.; Shimaoka, Takayuki

2008-12-15

This study investigates the feasibility of using bentonite coated gravel (BCG) as a liner material for waste landfills. BCG has proven to be a very effective capping material/method for the remediation of contaminated sediments in aquatic environments. The concept of BCG is similar to that of peanuts/almonds covered with chocolate; each aggregate particle has been covered with the clayey material. Laboratory tests were aimed at evaluating regulated and non-regulated factors for liner materials, i.e., permeability and strength. Tests included X-ray diffraction, methylene blue absorption, compaction, free swelling, permeability, 1D consolidation, triaxial compression and cone penetration. The compactive efforts used formore » this study were the reduced Proctor, standard Proctor, intermediate Proctor, modified Proctor and super modified Proctor. The compactive energy corresponding to each effort, respectively, is as follows: 355.5, 592.3, 1196.3, 2693.3, and 5386.4 kJ/m{sup 3}. Results revealed that even though aggregate content represents 70% of the weight of the material, hydraulic conductivities as low as 6 x 10{sup -10} cm/s can be achieved when proper compactive efforts are used. Compressibility is very low for this material even at low (or no) compactive efforts. Results also demonstrated how higher compactive efforts can lower the permeability of BCG; however, over-compaction creates fractures in the aggregate core of BCG that could increase permeability. Moreover, higher compactive efforts create higher swelling pressures that could compromise the performance of a barrier constructed using BCG. As a result of this study, moderate compactive efforts, i.e., intermediate Proctor or modified Proctor, are recommended for constructing a BCG barrier. Using moderate compactive efforts, very low hydraulic conductivities, good workability and good trafficability are easily attainable.« less

Analytical study on the suitability of using bentonite coated gravel as a landfill liner material.

PubMed

Roberts, Anel A; Shimaoka, Takayuki

2008-12-01

This study investigates the feasibility of using bentonite coated gravel (BCG) as a liner material for waste landfills. BCG has proven to be a very effective capping material/method for the remediation of contaminated sediments in aquatic environments. The concept of BCG is similar to that of peanuts/almonds covered with chocolate; each aggregate particle has been covered with the clayey material. Laboratory tests were aimed at evaluating regulated and non-regulated factors for liner materials, i.e., permeability and strength. Tests included X-ray diffraction, methylene blue absorption, compaction, free swelling, permeability, 1D consolidation, triaxial compression and cone penetration. The compactive efforts used for this study were the reduced Proctor, standard Proctor, intermediate Proctor, modified Proctor and super modified Proctor. The compactive energy corresponding to each effort, respectively, is as follows: 355.5, 592.3, 1196.3, 2693.3, and 5386.4 kJ/m(3). Results revealed that even though aggregate content represents 70% of the weight of the material, hydraulic conductivities as low as 6 x 10(-10)cm/s can be achieved when proper compactive efforts are used. Compressibility is very low for this material even at low (or no) compactive efforts. Results also demonstrated how higher compactive efforts can lower the permeability of BCG; however, over-compaction creates fractures in the aggregate core of BCG that could increase permeability. Moreover, higher compactive efforts create higher swelling pressures that could compromise the performance of a barrier constructed using BCG. As a result of this study, moderate compactive efforts, i.e., intermediate Proctor or modified Proctor, are recommended for constructing a BCG barrier. Using moderate compactive efforts, very low hydraulic conductivities, good workability and good trafficability are easily attainable.

A Study to Determine the Optimal Patient Appointment System for the Fitzsimons Army Medical Center Outpatient Clinic

DTIC Science & Technology

1988-06-01

General Outpatient Clinic Patient Appointment System c. The survey was reviewed by FAMC’s Chief of Biostatistics to ensure content validity. 3. Approval of...efficient solution. Certain characteristics of the Fitzsimons General Outpatient Clinic made it ideal for conversion. In proportion to the low number of...OUTPATIENT CLINIC . [] Agree [] Disagree CENTRALIZED APPOINTMENT SYSTEM 6. BETWEEN 18 MAY AND 30 NOVEMBER 1987 APPOINTMENTS WERE MADE THROUGH THE

Quantitative Analysis of the Contributing Factors Affecting Specialty Care No-Show Rates at Brooke Army Medical Center

DTIC Science & Technology

2007-03-30

2002). In the Vein Treatment Surgery Center in Texas, failure to properly cancel cosmetic appointments will result in forfeiture of the patients’ $100...appointments. This problem affects more than just the United States. Missed appointments cost the National Healthcare System ( NHS ) in England a...significant amount of money last year. Official figures from the NHS showed 5.7 million appointments were missed in 2004-2005 (Carvel, 2006). When patients

Effectiveness and cost-effectiveness of fining non-attendance at public hospitals: a randomised controlled trial from Danish outpatient clinics.

PubMed

Blæhr, Emely Ek; Væggemose, Ulla; Søgaard, Rikke

2018-04-13

Fines have been proposed as means for reducing non-attendance in healthcare. The empirical evidence of the effect of fines is however limited. The objective of this study is to investigate the effectiveness and cost-effectiveness of fining non-attendance at outpatient clinics. 1:1 randomised controlled trial of appointments for an outpatient clinic, posted to Danish addresses, between 1 May 2015 and 30 November 2015. Only first appointment for users was included. Healthcare professionals and investigators were masked. A fine of DKK250 (€34) was issued for non-attendance. Users were informed about the fine in case of non-attendance by the appointment letter, and were able to reschedule or cancel until the appointment. A central administration office administered the fine system. The main outcome measures were non-attendance of non-cancelled appointments, fine policy administration costs, net of productivity consequences and probability of fining non-attendance being cost-effective over no fining for a range of hypothetical values of reduced non-attendance. All of the 6746 appointments included were analysed. Of the 3333 appointments randomised to the fine policy, 130 (5%) of non-cancelled appointments were unattended, and of the 3413 appointments randomised to no-fine policy, 131 (5%) were unattended. The cost per appointment of non-attendance was estimated at DKK 56 (SE 5) in the fine group and DKK47 (SE 4) in the no-fine group, leading to a non-statistically significant difference of DKK10 (95% CI -9 to 22) per appointment attributable to the fine policy. The probability of cost-effectiveness remained around 50%, irrespective of increased values of reduced non-attendance or various alternative assumptions used for sensitivity analyses. At a baseline level of around 5%, fining non-attendance does not seem to further reduce non-attendance. Future studies should focus on other means for reduction of non-attendance such as nudging or negative reinforcement. ISRCTN61925912. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effectiveness and cost-effectiveness of fining non-attendance at public hospitals: a randomised controlled trial from Danish outpatient clinics

PubMed Central

Væggemose, Ulla; Søgaard, Rikke

2018-01-01

Objectives Fines have been proposed as means for reducing non-attendance in healthcare. The empirical evidence of the effect of fines is however limited. The objective of this study is to investigate the effectiveness and cost-effectiveness of fining non-attendance at outpatient clinics. Design, participants and setting 1:1 randomised controlled trial of appointments for an outpatient clinic, posted to Danish addresses, between 1 May 2015 and 30 November 2015. Only first appointment for users was included. Healthcare professionals and investigators were masked. Intervention A fine of DKK250 (€34) was issued for non-attendance. Users were informed about the fine in case of non-attendance by the appointment letter, and were able to reschedule or cancel until the appointment. A central administration office administered the fine system. Main outcome measures The main outcome measures were non-attendance of non-cancelled appointments, fine policy administration costs, net of productivity consequences and probability of fining non-attendance being cost-effective over no fining for a range of hypothetical values of reduced non-attendance. Results All of the 6746 appointments included were analysed. Of the 3333 appointments randomised to the fine policy, 130 (5%) of non-cancelled appointments were unattended, and of the 3413 appointments randomised to no-fine policy, 131 (5%) were unattended. The cost per appointment of non-attendance was estimated at DKK 56 (SE 5) in the fine group and DKK47 (SE 4) in the no-fine group, leading to a non-statistically significant difference of DKK10 (95% CI –9 to 22) per appointment attributable to the fine policy. The probability of cost-effectiveness remained around 50%, irrespective of increased values of reduced non-attendance or various alternative assumptions used for sensitivity analyses. Conclusions At a baseline level of around 5%, fining non-attendance does not seem to further reduce non-attendance. Future studies should focus on other means for reduction of non-attendance such as nudging or negative reinforcement. Trial registration number ISRCTN61925912. PMID:29654019

5 CFR 2.2 - Appointments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE RULES APPOINTMENT THROUGH THE COMPETITIVE... appointment system for positions subject to competitive examinations which will permit adjustment of the... system for stabilizing the Federal work force. A competitive status shall be acquired by a career...

5 CFR 2.2 - Appointments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE RULES APPOINTMENT THROUGH THE COMPETITIVE... appointment system for positions subject to competitive examinations which will permit adjustment of the... system for stabilizing the Federal work force. A competitive status shall be acquired by a career...

Comparison of Access to Eye Care Appointments Between Patients With Medicaid and Those With Private Health Care Insurance.

PubMed

Lee, Yoon H; Chen, Andrew X; Varadaraj, Varshini; Hong, Gloria H; Chen, Yimin; Friedman, David S; Stein, Joshua D; Kourgialis, Nicholas; Ehrlich, Joshua R

2018-04-19

Although low-income populations have more eye problems, whether they face greater difficulty obtaining eye care appointments is unknown. To compare rates of obtaining eye care appointments and appointment wait times for those with Medicaid vs those with private insurance. In this prospective, cohort study conducted from January 1, 2017, to July 1, 2017, researchers made telephone calls to a randomly selected sample of vision care professionals in Michigan and Maryland stratified by neighborhood (urban vs rural) and professional type (ophthalmologist vs optometrist) to request the first available appointment. Appointments were sought for an adult needing a diabetic eye examination and a child requesting a routine eye examination for a failed vision screening. Researchers called each practice twice, once requesting an appointment for a patient with Medicaid and the other time for a patient with Blue Cross Blue Shield (BCBS) insurance, and asked whether the insurance was accepted and, if so, when the earliest available appointment could be scheduled. Rate of successfully made appointments and mean wait time for the first available appointment. A total of 603 telephone calls were made to 330 eye care professionals (414 calls [68.7%] to male and 189 calls [31.3%] to female eye care professionals). The sample consisted of ophthalmologists (303 [50.2%]) and optometrists (300 [49.8%]) located in Maryland (322 [53.4%]) and Michigan (281 [46.6%]). The rates of successfully obtaining appointments among callers were 61.5% (95% CI, 56.0%-67.0%) for adults with Medicaid and 79.3% (95% CI, 74.7%-83.9%) for adults with BCBS (P < .001) and 45.4% (95% CI, 39.8%-51.0%) for children with Medicaid and 62.5% (95% CI, 57.1%-68.0%) for children with BCBS (P < .001). Mean wait time did not vary significantly between the BCBS and Medicaid groups for both adults and children. Adults with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (odds ratio [OR], 0.41; 95% CI, 0.28-0.59; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Maryland (OR, 2.40; 95% CI, 1.49-3.87; P < .001) or with an optometrist vs an ophthalmologist (OR, 1.91; 95% CI, 1.31-2.79; P < .001). Children with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (OR, 0.41; 95% CI, 0.28-0.60; P < .001) but had increased odds of obtaining an appointment if they were located in Michigan vs Marlyand (OR, 1.68; 95% CI, 1.04-2.73; P = .03) or with an optometrist vs an ophthalmologist (OR, 8.00; 95% CI, 5.37-11.90; P < .001). Callers were less successful in trying to obtain eye care appointments with Medicaid than with BCBS, suggesting a disparity in access to eye care based on insurance status, although confounding factors may have contributed to this finding. Improving access to eye care professionals for those with Medicaid may improve health outcomes and decrease health care spending in the long term.

A pragmatic trial to improve adherence with scheduled appointments in an inner-city pain clinic by human phone calls in the patient's preferred language.

PubMed

Andreae, Michael H; Nair, Singh; Gabry, Jonah S; Goodrich, Ben; Hall, Charles; Shaparin, Naum

2017-11-01

We investigated if human reminder phone calls in the patient's preferred language increase adherence with scheduled appointments in an inner-city chronic pain clinic. We hypothesized that language and cultural incongruence is the underlying mechanism to explain poor attendance at clinic appointments in underserved Hispanic populations. Pragmatic randomized controlled clinical trial SETTING: Innercity academic chronic pain clinic with a diverse, predominantly African-American and Hispanic population PATIENTS: All (n=963) adult patients with a scheduled first appointment between October 2014 and October 2015 at the Montefiore Pain Center in the Bronx, New York were enrolled. Patients were randomized to receive a human reminder call in their preferred language before their appointment, or no contact. We recorded patients' demographic characteristics and as primary outcome attendance as scheduled, failure to attend and/or cancellation calls. We fit Bayesian and classical multinomial logistic regression models to test if the intervention improved adherence with scheduled appointments. Among the 953 predominantly African American and Hispanic/Latino patients, 475 patients were randomly selected to receive a language-congruent, human reminder call, while 478 were assigned to receive no prior contact, (after we excluded 10 patients, scheduled for repeat appointments). In the experimental group, 275 patients adhered to their scheduled appointment, while 84 cancelled and 116 failed to attend. In the control group, 249 patients adhered to their scheduled appointment, 31 cancelled and 198 failed to attend. Human phone reminders in the preferred language increased adherence (RR 1.89, CI95% [1.42, 1.42], (p<0.01). The intervention seemed particularly effective in Hispanic patients, supporting our hypothesis of cultural congruence as possible underlying mechanism. Human reminder phone calls prior in the patient's preferred language increased adherence with scheduled appointments. The intervention facilitated access to much needed care in an ethnically diverse, resource poor population, presumably by overcoming language barriers. Copyright © 2017 Elsevier Inc. All rights reserved.

Appointment reminder systems are effective but not optimal: results of a systematic review and evidence synthesis employing realist principles

PubMed Central

McLean, Sionnadh Mairi; Booth, Andrew; Gee, Melanie; Salway, Sarah; Cobb, Mark; Bhanbhro, Sadiq; Nancarrow, Susan A

2016-01-01

Missed appointments are an avoidable cost and resource inefficiency which impact upon the health of the patient and treatment outcomes. Health care services are increasingly utilizing reminder systems to manage these negative effects. This study explores the effectiveness of reminder systems for promoting attendance, cancellations, and rescheduling of appointments across all health care settings and for particular patient groups and the contextual factors which indicate that reminders are being employed sub-optimally. We used three inter-related reviews of quantitative and qualitative evidence. Firstly, using pre-existing models and theories, we developed a conceptual framework to inform our understanding of the contexts and mechanisms which influence reminder effectiveness. Secondly, we performed a review following Centre for Reviews and Dissemination guidelines to investigate the effectiveness of different methods of reminding patients to attend health service appointments. Finally, to supplement the effectiveness information, we completed a review informed by realist principles to identify factors likely to influence non-attendance behaviors and the effectiveness of reminders. We found consistent evidence that all types of reminder systems are effective at improving appointment attendance across a range of health care settings and patient populations. Reminder systems may also increase cancellation and rescheduling of unwanted appointments. “Reminder plus”, which provides additional information beyond the reminder function may be more effective than simple reminders (ie, date, time, place) at reducing non-attendance at appointments in particular circumstances. We identified six areas of inefficiency which indicate that reminder systems are being used sub-optimally. Unless otherwise indicated, all patients should receive a reminder to facilitate attendance at their health care appointment. The choice of reminder system should be tailored to the individual service. To optimize appointment and reminder systems, health care services need supportive administrative processes to enhance attendance, cancellation, rescheduling, and re-allocation of appointments to other patients. PMID:27110102

Understanding repeated non-attendance in health services: a pilot analysis of administrative data and full study protocol for a national retrospective cohort.

PubMed

Williamson, Andrea E; Ellis, David A; Wilson, Philip; McQueenie, Ross; McConnachie, Alex

2017-02-14

Understanding the causes of low engagement in healthcare is a pre-requisite for improving health services' contribution to tackling health inequalities. Low engagement includes missing healthcare appointments. Serially (having a pattern of) missing general practice (GP) appointments may provide a risk marker for vulnerability and poorer health outcomes. A proof of concept pilot using GP appointment data and a focus group with GPs informed the development of missed appointment categories: patients can be classified based on the number of appointments missed each year. The full study, using a retrospective cohort design, will link routine health service and education data to determine the relationship between GP appointment attendance, health outcomes, healthcare usage, preventive health activity and social circumstances taking a life course approach and using data from the whole journey in the National Health Service (NHS) healthcare. 172 practices will be recruited (∼900 000 patients) across Scotland. The statistical analysis will focus on 2 key areas: factors that predict patients who serially miss appointments, and serial missed appointments as a predictor of future patient outcomes. Regression models will help understand how missed appointment patterns are associated with patient and practice characteristics. We shall identify key factors associated with serial missed appointments and potential interactions that might predict them. The results of the project will inform debates concerning how best to reduce non-attendance and increase patient engagement within healthcare systems. Significant non-academic beneficiaries include governments, policymakers and medical practitioners. Results will be disseminated via a combination of academic outputs (papers, conferences), social media and through collaborative public health/policy fora. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Appointment reminder systems are effective but not optimal: results of a systematic review and evidence synthesis employing realist principles.

PubMed

McLean, Sionnadh Mairi; Booth, Andrew; Gee, Melanie; Salway, Sarah; Cobb, Mark; Bhanbhro, Sadiq; Nancarrow, Susan A

2016-01-01

Missed appointments are an avoidable cost and resource inefficiency which impact upon the health of the patient and treatment outcomes. Health care services are increasingly utilizing reminder systems to manage these negative effects. This study explores the effectiveness of reminder systems for promoting attendance, cancellations, and rescheduling of appointments across all health care settings and for particular patient groups and the contextual factors which indicate that reminders are being employed sub-optimally. We used three inter-related reviews of quantitative and qualitative evidence. Firstly, using pre-existing models and theories, we developed a conceptual framework to inform our understanding of the contexts and mechanisms which influence reminder effectiveness. Secondly, we performed a review following Centre for Reviews and Dissemination guidelines to investigate the effectiveness of different methods of reminding patients to attend health service appointments. Finally, to supplement the effectiveness information, we completed a review informed by realist principles to identify factors likely to influence non-attendance behaviors and the effectiveness of reminders. We found consistent evidence that all types of reminder systems are effective at improving appointment attendance across a range of health care settings and patient populations. Reminder systems may also increase cancellation and rescheduling of unwanted appointments. "Reminder plus", which provides additional information beyond the reminder function may be more effective than simple reminders (ie, date, time, place) at reducing non-attendance at appointments in particular circumstances. We identified six areas of inefficiency which indicate that reminder systems are being used sub-optimally. Unless otherwise indicated, all patients should receive a reminder to facilitate attendance at their health care appointment. The choice of reminder system should be tailored to the individual service. To optimize appointment and reminder systems, health care services need supportive administrative processes to enhance attendance, cancellation, rescheduling, and re-allocation of appointments to other patients.

How many surgery appointments should be offered to avoid undesirable numbers of 'extras'?

PubMed

Kendrick, T; Kerry, S

1999-04-01

Patients seen as 'extras' (or 'fit-ins') are usually given less time for their problems than those in pre-booked appointments. Consequently, long queues of 'extras' should be avoided. To determine whether a predictable relationship exists between the number of available appointments at the start of the day and the number of extra patients who must be fitted in. This might be used to help plan a practice appointment system. Numbers of available appointments at the start of the day and numbers of 'extras' seen were recorded prospectively in 1995 and 1997 in one group general practice. Minimum numbers of available appointments at the start of the day, below which undesirably large numbers of extra patients could be predicted, were determined using logistic regression applied to the 1995 data. Predictive values of the minimum numbers calculated for 1995, in terms of predicting undesirable numbers of 'extras', were then determined when applied to the 1997 data. Numbers of extra patients seen correlated negatively with available appointments at the start of the day for all days of the week, with coefficients ranging from -0.66 to -0.80. Minimum numbers of available appointments below which undesirably large numbers of extras could be predicted were 26 for Mondays and four for the other week-days. When applied to 1997 data, these minimum numbers gave positive and negative predictive values of 76% and 82% respectively, similar to their values for 1995, despite increases in patient attendance and changes in the day-to-day pattern of surgery provision between the two years. A predictable relationship exists between the number of available appointments at the start of the day and the number of extras who must be fitted in, which may be used to help plan the appointment system for some years ahead, at least in this relatively stable suburban practice.

Text-messaging versus telephone reminders to reduce missed appointments in an academic primary care clinic: a randomized controlled trial

PubMed Central

2013-01-01

Background Telephone or text-message reminders have been shown to significantly reduce the rate of missed appointments in different medical settings. Since text-messaging is less resource-demanding, we tested the hypothesis that text-message reminders would be as effective as telephone reminders in an academic primary care clinic. Methods A randomized controlled non-inferiority trial was conducted in the academic primary care division of the Geneva University Hospitals between November 2010 and April 2011. Patients registered for an appointment at the clinic, and for whom a cell phone number was available, were randomly selected to receive a text-message or a telephone call reminder 24 hours before the planned appointment. Patients were included each time they had an appointment. The main outcome was the rate of unexplained missed appointments. Appointments were not missed if they were cancelled or re-scheduled before or independently from the intervention. We defined non-inferiority as a difference below 2% in the rate of missed appointments and powered the study accordingly. A satisfaction survey was conducted among a random sample of 900 patients (response rate 41%). Results 6450 patients were included, 3285 in the text-message group and 3165 in the telephone group. The rate of missed appointments was similar in the text-message group (11.7%, 95% CI: 10.6-12.8) and in the telephone group (10.2%, 95% CI: 9.2-11.3 p = 0.07). However, only text message reminders were cost-effective. No patient reported any disturbance by any type of reminder in the satisfaction survey. Three quarters of surveyed patients recommended its regular implementation in the clinic. Conclusions Text-message reminders are equivalent to telephone reminders in reducing the proportion of missed appointments in an academic primary care clinic and are more cost-effective. Both types of reminders are well accepted by patients. PMID:23557331

Audiologist-patient communication profiles in hearing rehabilitation appointments.

PubMed

Meyer, Carly; Barr, Caitlin; Khan, Asaduzzaman; Hickson, Louise

2017-08-01

To profile the communication between audiologists and patients in initial appointments on a biomedical-psychosocial continuum; and explore the associations between these profiles and 1) characteristics of the appointment and 2) patients' decisions to pursue hearing aids. Sixty-three initial hearing assessment appointments were filmed and audiologist-patient communication was coded using the Roter Interaction Analysis System. A hierarchical cluster analysis was conducted to profile audiologist-patient communication, after which regression modelling and Chi-squared analyses were conducted. Two distinct audiologist-patient communication profiles were identified during both the history taking phase (46=biopsychosocial profile, 15=psychosocial profile) and diagnosis and management planning phase (45=expanded biomedical profile, 11=narrowly biomedical profile). Longer appointments were significantly more likely to be associated with an expanded biomedical interaction during the diagnosis and management planning phase. No significant associations were found between audiologist-patient communication profile and patients' decisions to pursue hearing aids. Initial audiology consultations appear to remain clinician-centred. Three quarters of appointments began with a biopsychosocial interaction; however, 80% ended with an expanded biomedical interaction. Findings suggest that audiologists could consider modifying their communication in initial appointments to more holistically address the needs of patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Methods of appointment and qualifications of club doctors and physiotherapists in English professional football: some problems and issues.

PubMed

Waddington, I; Roderick, M; Naik, R

2001-02-01

To examine the methods of appointment, experience, and qualifications of club doctors and physiotherapists in professional football. Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned. In almost all clubs, methods of appointment of doctors are informal and reflect poor employment practice: posts are rarely advertised and many doctors are appointed on the basis of personal contacts and without interview. Few club doctors had prior experience or qualifications in sports medicine and very few have a written job description. The club doctor is often not consulted about the appointment of the physiotherapist; physiotherapists are usually appointed informally, often without interview, and often by the manager without involving anyone who is qualified in medicine or physiotherapy. Half of all clubs do not have a qualified (chartered) physiotherapist; such unqualified physiotherapists are in a weak position to resist threats to their clinical autonomy, particularly those arising from managers' attempts to influence clinical decisions. Almost all aspects of the appointment of club doctors and physiotherapists need careful re-examination.

5 CFR 300.704 - Considering individuals for appointment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Considering individuals for appointment. 300.704 Section 300.704 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT (GENERAL) Statutory Bar to Appointment of Persons Who Fail To Register Under Selective...

75 FR 63472 - SES Performance Review Board-Appointment of Members

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-15

... EQUAL EMPLOYMENT OPPORTUNITY COMMISSION SES Performance Review Board--Appointment of Members AGENCY: Equal Employment Opportunity Commission. ACTION: Notice. SUMMARY: Notice is hereby given of the appointment of members to the Performance Review Board of the Equal Employment Opportunity Commission. FOR...

5 CFR 731.104 - Appointments subject to investigation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Appointments subject to investigation. 731.104 Section 731.104 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) SUITABILITY Scope § 731.104 Appointments subject to investigation. (a) To...

5 CFR 731.104 - Appointments subject to investigation.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Appointments subject to investigation. 731.104 Section 731.104 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) SUITABILITY Scope § 731.104 Appointments subject to investigation. (a) To...

5 CFR 731.104 - Appointments subject to investigation.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Appointments subject to investigation. 731.104 Section 731.104 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) SUITABILITY Scope § 731.104 Appointments subject to investigation. (a) To...

5 CFR 731.104 - Appointments subject to investigation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Appointments subject to investigation. 731.104 Section 731.104 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) SUITABILITY Scope § 731.104 Appointments subject to investigation. (a) To...

5 CFR 731.104 - Appointments subject to investigation.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Appointments subject to investigation. 731.104 Section 731.104 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) SUITABILITY Scope § 731.104 Appointments subject to investigation. (a) To...

An Investigation into Patient Non-Attendance and Use of a Short-Message Reminder System at a University Dental Clinic.

PubMed

Storrs, Mark J; Ramov, Helen M; Lalloo, Ratilal

2016-01-01

Non-attended appointments in health care facilities create inefficiencies and loss of clinical productivity: clinical teaching hours are reduced, impacting students' ability to meet the competencies necessary for professional registration. The aim of this study was to assess demographic and time-related factors for patient non-attendance at a dental school clinic in Australia. Appointment data were extracted from the patient management system for the years 2011 and 2012. Data included the status of appointment (attended, cancelled, or failed to attend [FTA]) and an array of demographic and time-related factors. Multinomial logistic regression was conducted to assess relationships between these factors and appointment status. Attendance rates were also compared by year following implementation of a short message service (SMS) reminder at the beginning of 2012. The results showed that, of 58,622 appointments booked with students during 2011 and 2012, 68% of patients attended, 23% cancelled, and 9% were FTA. The percentage of non-attended (cancelled or FTA) appointments differed by demographic and time-related factors. Females were 7% less likely to be FTA, those aged 16-24 years were five times more likely to be FTA, and early morning appointments were 18% less likely to be cancelled and FTA. With the SMS reminder system, the odds of a cancellation were 15% higher, but FTAs were 14% lower (both were statistically significant differences). This study found that failing to attend an appointment was significantly related to a number of factors. Clinical scheduling and reminder systems may need to take these factors into account to decrease the number of teaching hours lost due to patients' missing their appointments.

The Impact of Medicaid Coverage and Reimbursement on Access to Diagnostic Mammography

PubMed Central

Schuur, Jeremiah D.; Shah, Akash; Wu, Zheyang; Forman, Howard P.; Gross, Cary P.

2013-01-01

BACKGROUND Women of low socioeconomic status are at risk for delayed evaluation of abnormal mammograms and later stage presentations of breast cancer. Medicaid reimbursement for clinical services is lower than Medicare reimbursement, yet it is unclear whether low Medicaid reimbursement is a barrier to accessing mammography. The objective of the current study was to determine the association between reported insurance type (Medicaid vs Medicare), Medicaid reimbursement rate, and access to diagnostic mammography (DM). METHODS Standardized patients (SPs) called 521 mammography facilities in defined geographic regions of 11 states in 2005. Facilities were divided between high, middle, and low reimbursing states based on the state’s relative Medicaid-to-Medicare reimbursement rate for DM. SPs contacted each facility twice to schedule a DM using the same clinical vignette but switching insurance status (Medicaid vs Medicare). The authors measured the proportion of SPs who were offered 1) any appointment and 2) a timely appointment, defined as a third available appointment within 20 business days. RESULTS SPs with Medicaid were less likely to receive an appointment than SPs with Medicare (91% vs 99.1%; difference, 8.1%; 95% confidence interval, 5.3%–10.9% [P < .001]). Among facilities that offered appointments to both callers, the proportion of timely appointments did not differ between Medicaid (93.7%) and Medicare (92.9%; P = .51). States’ Medicaid reimbursement rates for DM were not associated with the percentage of SPs with Medicaid who were offered any appointment (P = .50) or a timely appointment (P = .69). CONCLUSIONS Callers with Medicaid were offered appointments for DM less frequently than callers with Medicare, although both were widely accepted. State Medicaid reimbursement rates did not affect access to mammography. PMID:19728371

Children's missed healthcare appointments: professional and organisational responses.

PubMed

Appleton, Jane; Powell, Catherine; Coombes, Lindsey

2016-09-01

This National Society for the Prevention of Cruelty to Children (NSPCC) funded UK study sought to examine organisational and professional responses to children's missed healthcare appointments. The study comprised two parts: phase I was a web-based scoping and systematic analysis of UK National Health Service healthcare organisations' internal policies on missed appointments. Phase II involved a case study of how missed appointments were managed within one hospital trust, including interviews with hospital-based staff, review of organisational data and examination of policies and 'systems' in place. Policies accessed were of variable quality when benchmarked against a predetermined set of evidence-based standards. Additional material (eg, board minutes) gleaned through the searches found an apparent disconnect between nationally determined safeguarding requirements and strategies to reduce the cost pressures arising from missed appointments. Findings from the case study included the continuing use of the adult-centric term 'did not attend' (DNA), the challenges that may be inherent in attending appointments (with concomitant sympathy for parents) and a need to further explore general practitioner responses to DNA notifications, particularly given the acknowledged association between missed appointments and child maltreatment. The web-based scoping exercise yielded a small number of organisational policies. These were of variable quality when rated against predetermined standards. Other material gathered through the search strategy found evidence that 'missed appointment' strategies aimed at reducing costs did not always acknowledge the discrete needs of children. The case study findings contribute to an understanding of the complexities and challenges of responding to a missed appointment and the importance of taking a child-centred approach. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Characteristics of HIV patients who missed their scheduled appointments

PubMed Central

Nagata, Delsa; Gutierrez, Eliana Battaggia

2016-01-01

ABSTRACT OBJECTIVE To analyze whether sociodemographic characteristics, consultations and care in special services are associated with scheduled infectious diseases appointments missed by people living with HIV. METHODS This cross-sectional and analytical study included 3,075 people living with HIV who had at least one scheduled appointment with an infectologist at a specialized health unit in 2007. A secondary data base from the Hospital Management & Information System was used. The outcome variable was missing a scheduled medical appointment. The independent variables were sex, age, appointments in specialized and available disciplines, hospitalizations at the Central Institute of the Clinical Hospital at the Faculdade de Medicina of the Universidade de São Paulo, antiretroviral treatment and change of infectologist. Crude and multiple association analysis were performed among the variables, with a statistical significance of p ≤ 0.05. RESULTS More than a third (38.9%) of the patients missed at least one of their scheduled infectious diseases appointments; 70.0% of the patients were male. The rate of missed appointments was 13.9%, albeit with no observed association between sex and absences. Age was inversely associated to missed appointment. Not undertaking anti-retroviral treatment, having unscheduled infectious diseases consultations or social services care and being hospitalized at the Central Institute were directly associated to missed appointments. CONCLUSIONS The Hospital Management & Information System proved to be a useful tool for developing indicators related to the quality of health care of people living with HIV. Other informational systems, which are often developed for administrative purposes, can also be useful for local and regional management and for evaluating the quality of care provided for patients living with HIV. PMID:26786472

Impact of Delayed Time to Advanced Imaging on Missed Appointments Across Different Demographic and Socioeconomic Factors.

PubMed

Daye, Dania; Carrodeguas, Emmanuel; Glover, McKinley; Guerrier, Claude Emmanuel; Harvey, H Benjamin; Flores, Efrén J

2018-05-01

The aim of this study was to investigate the impact of wait days (WDs) on missed outpatient MRI appointments across different demographic and socioeconomic factors. An institutional review board-approved retrospective study was conducted among adult patients scheduled for outpatient MRI during a 12-month period. Scheduling data and demographic information were obtained. Imaging missed appointments were defined as missed scheduled imaging encounters. WDs were defined as the number of days from study order to appointment. Multivariate logistic regression was applied to assess the contribution of race and socioeconomic factors to missed appointments. Linear regression was performed to assess the relationship between missed appointment rates and WDs stratified by race, income, and patient insurance groups with analysis of covariance statistics. A total of 42,727 patients met the inclusion criteria. Mean WDs were 7.95 days. Multivariate regression showed increased odds ratio for missed appointments for patients with increased WDs (7-21 days: odds ratio [OR], 1.39; >21 days: OR, 1.77), African American patients (OR, 1.71), Hispanic patients (OR, 1.30), patients with noncommercial insurance (OR, 2.00-2.55), and those with imaging performed at the main hospital campus (OR, 1.51). Missed appointment rate linearly increased with WDs, with analysis of covariance revealing underrepresented minorities and Medicaid insurance as significant effect modifiers. Increased WDs for advanced imaging significantly increases the likelihood of missed appointments. This effect is most pronounced among underrepresented minorities and patients with lower socioeconomic status. Efforts to reduce WDs may improve equity in access to and utilization of advanced diagnostic imaging for all patients. Copyright © 2018. Published by Elsevier Inc.

5 CFR 3.3 - Conversion of appointments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Conversion of appointments. 3.3 Section 3.3 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE RULES NONCOMPETITIVE ACQUISITION OF STATUS (RULE III) § 3.3 Conversion of appointments. Any person who acquires a competitive...

5 CFR 3.3 - Conversion of appointments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Conversion of appointments. 3.3 Section 3.3 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE RULES NONCOMPETITIVE ACQUISITION OF STATUS (RULE III) § 3.3 Conversion of appointments. Any person who acquires a competitive...

5 CFR 3.3 - Conversion of appointments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Conversion of appointments. 3.3 Section 3.3 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE RULES NONCOMPETITIVE ACQUISITION OF STATUS (RULE III) § 3.3 Conversion of appointments. Any person who acquires a competitive...

5 CFR 3.3 - Conversion of appointments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Conversion of appointments. 3.3 Section 3.3 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE RULES NONCOMPETITIVE ACQUISITION OF STATUS (RULE III) § 3.3 Conversion of appointments. Any person who acquires a competitive...

5 CFR 3.3 - Conversion of appointments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Conversion of appointments. 3.3 Section 3.3 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE RULES NONCOMPETITIVE ACQUISITION OF STATUS (RULE III) § 3.3 Conversion of appointments. Any person who acquires a competitive...

43 CFR 3861.5 - Appointment and employment of mineral surveyors.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Appointment and employment of mineral...) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MINERAL PATENT APPLICATIONS Surveys and Plats § 3861.5 Appointment and employment of mineral surveyors. ...

43 CFR 3861.5 - Appointment and employment of mineral surveyors.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Appointment and employment of mineral...) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MINERAL PATENT APPLICATIONS Surveys and Plats § 3861.5 Appointment and employment of mineral surveyors. ...

43 CFR 3861.5 - Appointment and employment of mineral surveyors.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Appointment and employment of mineral...) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MINERAL PATENT APPLICATIONS Surveys and Plats § 3861.5 Appointment and employment of mineral surveyors. ...

43 CFR 3861.5 - Appointment and employment of mineral surveyors.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Appointment and employment of mineral...) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MINERAL PATENT APPLICATIONS Surveys and Plats § 3861.5 Appointment and employment of mineral surveyors. ...

48 CFR 2901.603-3 - Appointment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... all warrants above the micro-purchase threshold. In addition, appointments may be made for specific... functions. (a) Purchase Cards (micro-purchase threshold). Purchase cardholders will be appointed in accordance with the DOL Guidelines for Purchase Card Use and the Agency/Office procedures approved by the HCA...

The relative ease of obtaining a dermatologic appointment in Boston: how methods drive results.

PubMed

Weingold, David Howard; Lack, Michael Dweight; Yanowitz, Karen Leslie

2009-06-01

Recent reports have indicated long wait times for dermatologic appointments even for changing moles. Our objective was to determine the wait time for a person willing to make multiple calls and accept an appointment from any dermatologist at any satellite location for a changing mole from a dermatologist who advertised in a Boston, MA, telephone book. We telephoned each practice listed in a Boston, MA, telephone book. Patients making one call to each dermatologic practice on average obtained an appointment in 18 days. Patients calling two practices were offered an appointment on average in 7 days. Patients calling 3 practices were also offered an appointment in 1 week. We only telephoned practices listed in a Boston, MA, telephone book and we only surveyed one urban area. These results suggest that a reasonable concerned patient who was willing to make multiple calls to different providers in Boston, MA, can be seen in a timely fashion.

Why do those who request smoking treatment fail to attend the first appointment?

PubMed Central

Gariti, Peter; Levin, Sarah; Whittingham, Thomas; Barou, Daniela; Xie, Hu; Kampman, Kyle M.; Lynch, Kevin; Halbert, Chanita Hughes; Alterman, Arthur

2008-01-01

As part of a larger trial of pharmacological and counseling interventions for light smokers, we performed a telephone-screening interview followed by a scheduled time for an in-person eligibility appointment. 202 of the 407 who screened positive and expressed interest in participation failed to attend the first scheduled appointment. This paper examines person, study and study site characteristics that differentiated those who did follow through from those who did not. The study also examined the self-reported quit rates of both groups 12 weeks later, the time of the study termination. Analyses suggested that non-attendees were more likely to be younger, unemployed, and African American. The most frequently cited reasons for missing the eligibility appointment were work/family obligations, inconvenient appointment times, and personal schedule problems. Those who kept the initial appointment were more likely to report smoking abstinence at 12 weeks. The study has implications for increasing the utilization of potentially effective treatments for smokers. PMID:17931823

Compact high-flux two-stage solar collectors based on tailored edge-ray concentrators

NASA Astrophysics Data System (ADS)

Friedman, Robert P.; Gordon, Jeffrey M.; Ries, Harald

1995-08-01

Using the recently-invented tailored edge-ray concentrator (TERC) approach for the design of compact two-stage high-flux solar collectors--a focusing primary reflector and a nonimaging TERC secondary reflector--we present: 1) a new primary reflector shape based on the TERC approach and a secondary TERC tailored to its particular flux map, such that more compact concentrators emerge at flux concentration levels in excess of 90% of the thermodynamic limit; and 2) calculations and raytrace simulations result which demonstrate the V-cone approximations to a wide variety of TERCs attain the concentration of the TERC to within a few percent, and hence represent practical secondary concentrators that may be superior to corresponding compound parabolic concentrator or trumpet secondaries.

The impact of representative payee services on medication adherence among unstably housed people living with HIV/AIDS.

PubMed

Hawk, Mary; McLaughlin, Jamie; Farmartino, Christina; King, Miranda; Davis, Dana

2016-01-01

Rates of viral suppression among people living with HIV/AIDS remain low, especially within marginalized populations such as people who are unstably housed. Representative payee is a service in which the US Social Security Administration appoints an individual or an organization to provide financial management for vulnerable individuals who are unable to manage their finances including housing payments. Little or no published research examines the association between financial management services such as representative payee and HIV clinical adherence. We conducted a pilot study with 18 unstably housed participants living with HIV/AIDS to examine the impact of representative payee services on viral suppression. Of the 11 participants who were not virally suppressed at baseline, 9 (81.8%) of them had achieved viral suppression at six-month follow-up (p = .004). Our findings suggest that providing unstably housed people living with HIV/AIDS with representative payee services may help them to improve their housing stability and clinical adherence. Additional research is needed to fully explore correlations between representative payee services and viral suppression.

Accessing primary care: a simulated patient study.

PubMed

Campbell, John L; Carter, Mary; Davey, Antoinette; Roberts, Martin J; Elliott, Marc N; Roland, Martin

2013-03-01

Simulated patient, or so-called 'mystery-shopper', studies are a controversial, but potentially useful, approach to take when conducting health services research. To investigate the construct validity of survey questions relating to access to primary care included in the English GP Patient Survey. Observational study in 41 general practices in rural, urban, and inner-city settings in the UK. Between May 2010 and March 2011, researchers telephoned practices at monthly intervals, simulating patients requesting routine, but prompt, appointments. Seven measures of access and appointment availability, measured from the mystery-shopper contacts, were related to seven measures of practice performance from the GP Patient Survey. Practices with lower access scores in the GP Patient Survey had poorer access and appointment availability for five out of seven items measured directly, when compared with practices that had higher scores. Scores on items from the national survey that related to appointment availability were significantly associated with direct measures of appointment availability. Patient-satisfaction levels and the likelihood that patients would recommend their practice were related to the availability of appointments. Patients' reports of ease of telephone access in the national survey were unrelated to three out of four measures of practice call handling, but were related to the time taken to resolve an appointment request, suggesting responders' possible confusion in answering this question. Items relating to the accessibility of care in a the English GP patient survey have construct validity. Patients' satisfaction with their practice is not related to practice call handling, but is related to appointment availability.

28 CFR 32.43 - Appointment and assignment of Hearing Officers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Appointment and assignment of Hearing Officers. 32.43 Section 32.43 Judicial Administration DEPARTMENT OF JUSTICE PUBLIC SAFETY OFFICERS' DEATH, DISABILITY, AND EDUCATIONAL ASSISTANCE BENEFIT CLAIMS Hearing Officer Determinations § 32.43 Appointment and...

77 FR 20890 - Proposed Information Collection (Appointment of Veterans Service Organization/or Individuals as...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-06

... comments for information needed to determine whether claimant appointed a veterans service organization or... use of other forms of information technology. Titles: Appointment of Veterans Service Organization as... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0321] Proposed Information Collection...

76 FR 75566 - Appointments to Performance Review Boards for Senior Executive Service

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-02

... NUCLEAR REGULATORY COMMISSION [NRC-2011-0249] Appointments to Performance Review Boards for Senior... for Senior Executive Service. SUMMARY: This notice announces a change in the membership of the Senior... appointing and awarding authorities on performance appraisal ratings and performance awards for Senior...

76 FR 26707 - Appointments to Performance Review Board for Senior Executive Service

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-09

... Review Board for Senior Executive Service AGENCY: Committee for Purchase From People Who Are Blind or Severely Disabled. ACTION: Appointment of Performance Review Board for Senior Executive Service. SUMMARY... appointing and awarding authorities on performance appraisal ratings and performance awards for Senior...

5 CFR 301.302 - Overseas appointing procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Overseas appointing procedures. 301.302 Section 301.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS OVERSEAS... employees for local hire appointments in the overseas area is made on the basis of the ability, knowledge...

5 CFR 301.302 - Overseas appointing procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Overseas appointing procedures. 301.302 Section 301.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS OVERSEAS... employees for local hire appointments in the overseas area is made on the basis of the ability, knowledge...

5 CFR 301.302 - Overseas appointing procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Overseas appointing procedures. 301.302 Section 301.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS OVERSEAS... employees for local hire appointments in the overseas area is made on the basis of the ability, knowledge...

5 CFR 301.302 - Overseas appointing procedures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Overseas appointing procedures. 301.302 Section 301.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS OVERSEAS... employees for local hire appointments in the overseas area is made on the basis of the ability, knowledge...

Plant Scientists and the Productivity Effects of Extension Appointments

ERIC Educational Resources Information Center

Foltz, Jeremy D.; Gee, Vanity K.; Barham, Bradford L.

2011-01-01

This article analyzes the primary scholarship activities of agricultural college plant science faculty with and without Extension appointments using survey data from all 1862 land-grant institutions. The evidence suggests that differences between Extension professors and others without Extension appointments are small for minor Extension…

40 CFR 18.10 - Appointment of Special Research Consultants for Environmental Protection.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Appointment of Special Research... PROTECTION AGENCY GENERAL ENVIRONMENTAL PROTECTION RESEARCH FELLOWSHIPS AND SPECIAL RESEARCH CONSULTANTS FOR ENVIRONMENTAL PROTECTION § 18.10 Appointment of Special Research Consultants for Environmental Protection. (a...

5 CFR 301.302 - Overseas appointing procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Overseas appointing procedures. 301.302 Section 301.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS OVERSEAS... employees for local hire appointments in the overseas area is made on the basis of the ability, knowledge...

28 CFR 32.43 - Appointment and assignment of Hearing Officers.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Appointment and assignment of Hearing Officers. 32.43 Section 32.43 Judicial Administration DEPARTMENT OF JUSTICE PUBLIC SAFETY OFFICERS' DEATH, DISABILITY, AND EDUCATIONAL ASSISTANCE BENEFIT CLAIMS Hearing Officer Determinations § 32.43 Appointment and...

78 FR 3325 - Appointing Authority for Military Commissions

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-16

... DEPARTMENT OF DEFENSE Office of the Secretary 32 CFR Part 18 Appointing Authority for Military... concerning the Appointing Authority for Military Commissions. This rule pertains to a military function of... informational purposes only. As a result of the enactment of Military Commissions Act of 2009, the Deputy...

42 CFR 136.42 - Appointment actions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Appointment actions. 136.42 Section 136.42 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Preference in Employment § 136.42 Appointment actions. (a...

Evaluation of screening tests for colorectal cancer.

PubMed

Bolt, R J

1980-12-01

The following guidelines are proposed for the asymptomatic patient representing for routine examination. Instruct the patient to eat All Bran cereal or a similar product for breakfast for three consecutive days prior to the day of appointment. At the time of appointment the stool obtained from rectal examination or from a spontaneous bowel movement is checked for occult blood using the guaiac method. If the findings are negative, no further tests are recommended. If positive, the patient is given complete dietary instructions in a non-meat, high-residue diet with avoidance of beets, horseradish, vitamins, or aspirin-containing compounds. The patient is then given six Hemoccult or Quikcult slides and is instructed to prepare two fecal slides from each stool specimen daily for three days. If these are all negative when tested, no further studies are necessary. If one or more are positive, however, sigmoidoscopic examination and colon and upper gastrointestinal radiography should be carried out in that order. Evidence that early lesions (Duke A or B) are detected and the cure rate improved with this procedure is quite convincing.

34 CFR 303.421 - Appointment of an impartial person.

Code of Federal Regulations, 2010 CFR

2010-07-01

... must be appointed to implement the complaint resolution process in this subpart. The person must— (1... a timely resolution of the complaint. (ii) Provide a record of the proceedings, including a written... appointed to implement the complaint resolution process— (i) Is not an employee of any agency or other...

5 CFR 316.403 - Designation of provisional appointments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Designation of provisional appointments. 316.403 Section 316.403 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS TEMPORARY AND TERM EMPLOYMENT Temporary Limited Employment § 316.403 Designation of provisional appointments. (a) Conditions for designation. A...

49 CFR 604.34 - Chief Counsel decisions and appointment of a PO.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Chief Counsel decisions and appointment of a PO. 604.34 Section 604.34 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CHARTER SERVICE Decisions by FTA and Appointment of a...

5 CFR 317.703 - Guaranteed reinstatement: Presidential appointees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... appointee who was appointed by the President to a civil service position outside the SES without a break in service, and who left the Presidential appointment for reasons other than misconduct, neglect of duty, or... break in service between the two appointments, the individual continues to be entitled to be reinstated...

78 FR 75948 - Senior Executive Service; Appointment of Members to the Performance Review Board

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-13

... Resources Center--Sydney T. Rose Executive Secretary--Director, Executive Resources--Kim L.H. Green... H. Moore, Deputy Assistant Secretary for Operations and Analysis--appointment expires on 09/30/16..., New York--appointment expires on 09/30/16 OLMS Stephen J. Willertz, Director, Office of Enforcement...

5 CFR 532.403 - New appointments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false New appointments. 532.403 Section 532.403 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PREVAILING RATE SYSTEMS Pay Administration § 532.403 New appointments. (a) Except as provided in paragraphs (b) and (c) of this section, a...

38 CFR 17.164 - Patient responsibility in making and keeping dental appointments.

Code of Federal Regulations, 2013 CFR

2013-07-01

... making and keeping dental appointments. 17.164 Section 17.164 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.164 Patient responsibility in making and keeping dental appointments. Any veteran eligible for dental treatment on a one-time completion basis only and...

38 CFR 17.164 - Patient responsibility in making and keeping dental appointments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... making and keeping dental appointments. 17.164 Section 17.164 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.164 Patient responsibility in making and keeping dental appointments. Any veteran eligible for dental treatment on a one-time completion basis only and...

38 CFR 17.164 - Patient responsibility in making and keeping dental appointments.

Code of Federal Regulations, 2012 CFR

2012-07-01

... making and keeping dental appointments. 17.164 Section 17.164 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.164 Patient responsibility in making and keeping dental appointments. Any veteran eligible for dental treatment on a one-time completion basis only and...

38 CFR 17.164 - Patient responsibility in making and keeping dental appointments.

Code of Federal Regulations, 2011 CFR

2011-07-01

... making and keeping dental appointments. 17.164 Section 17.164 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.164 Patient responsibility in making and keeping dental appointments. Any veteran eligible for dental treatment on a one-time completion basis only and...

38 CFR 17.164 - Patient responsibility in making and keeping dental appointments.

Code of Federal Regulations, 2014 CFR

2014-07-01

... making and keeping dental appointments. 17.164 Section 17.164 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.164 Patient responsibility in making and keeping dental appointments. Any veteran eligible for dental treatment on a one-time completion basis only and...

5 CFR 315.605 - Appointment of former ACTION volunteers.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Appointment of former ACTION volunteers... Authorities § 315.605 Appointment of former ACTION volunteers. (a) Agency authority. An agency in the... Director of ACTION certifies as having served satisfactorily as a volunteer or volunteer leader under the...

5 CFR 315.605 - Appointment of former ACTION volunteers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Appointment of former ACTION volunteers... Authorities § 315.605 Appointment of former ACTION volunteers. (a) Agency authority. An agency in the... Director of ACTION certifies as having served satisfactorily as a volunteer or volunteer leader under the...

5 CFR 315.605 - Appointment of former ACTION volunteers.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Appointment of former ACTION volunteers... Authorities § 315.605 Appointment of former ACTION volunteers. (a) Agency authority. An agency in the... Director of ACTION certifies as having served satisfactorily as a volunteer or volunteer leader under the...

5 CFR 315.605 - Appointment of former ACTION volunteers.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Appointment of former ACTION volunteers... Authorities § 315.605 Appointment of former ACTION volunteers. (a) Agency authority. An agency in the... Director of ACTION certifies as having served satisfactorily as a volunteer or volunteer leader under the...

10 CFR 7.18 - Appointment, compensation, and expense reimbursement of advisory committee members, staffs, and...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Appointment, compensation, and expense reimbursement of advisory committee members, staffs, and consultants. 7.18 Section 7.18 Energy NUCLEAR REGULATORY COMMISSION ADVISORY COMMITTEES § 7.18 Appointment, compensation, and expense reimbursement of advisory committee...

10 CFR 7.18 - Appointment, compensation, and expense reimbursement of advisory committee members, staffs, and...

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Appointment, compensation, and expense reimbursement of advisory committee members, staffs, and consultants. 7.18 Section 7.18 Energy NUCLEAR REGULATORY COMMISSION ADVISORY COMMITTEES § 7.18 Appointment, compensation, and expense reimbursement of advisory committee...

10 CFR 7.18 - Appointment, compensation, and expense reimbursement of advisory committee members, staffs, and...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Appointment, compensation, and expense reimbursement of advisory committee members, staffs, and consultants. 7.18 Section 7.18 Energy NUCLEAR REGULATORY COMMISSION ADVISORY COMMITTEES § 7.18 Appointment, compensation, and expense reimbursement of advisory committee...

5 CFR 315.605 - Appointment of former ACTION volunteers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Appointment of former ACTION volunteers... Authorities § 315.605 Appointment of former ACTION volunteers. (a) Agency authority. An agency in the... Director of ACTION certifies as having served satisfactorily as a volunteer or volunteer leader under the...

76 FR 38326 - Qualification Requirements (General)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

... paragraph (b) of section 338.101 by citing section 213.3102(bb) as the authority for appointing non....3102(bb) was established to cover the appointment of non-citizens and is a more appropriate citation... service appointment of a non- citizen to a competitive service position when no qualified U.S. citizens or...

42 CFR 61.36 - Selection and appointment of service fellows.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Selection and appointment of service fellows. 61.36 Section 61.36 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING FELLOWSHIPS Service Fellowships § 61.36 Selection and appointment of service fellows...

42 CFR 61.36 - Selection and appointment of service fellows.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Selection and appointment of service fellows. 61.36 Section 61.36 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING FELLOWSHIPS Service Fellowships § 61.36 Selection and appointment of service fellows...

42 CFR 61.36 - Selection and appointment of service fellows.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Selection and appointment of service fellows. 61.36 Section 61.36 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING FELLOWSHIPS Service Fellowships § 61.36 Selection and appointment of service fellows...

42 CFR 61.36 - Selection and appointment of service fellows.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Selection and appointment of service fellows. 61.36 Section 61.36 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING FELLOWSHIPS Service Fellowships § 61.36 Selection and appointment of service fellows...

42 CFR 61.36 - Selection and appointment of service fellows.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Selection and appointment of service fellows. 61.36 Section 61.36 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING FELLOWSHIPS Service Fellowships § 61.36 Selection and appointment of service fellows...

5 CFR 315.603 - Appointment based on former incumbency of a position brought into the competitive service.

Code of Federal Regulations, 2010 CFR

2010-01-01

... OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS CAREER AND CAREER-CONDITIONAL EMPLOYMENT Career or Career-Conditional Appointment Under Special Authorities § 315.603 Appointment based on former... type of case from this requirement. (b) Review of disapproved recommendations. Agencies shall establish...

5 CFR 315.610 - Noncompetitive appointment of certain National Guard technicians.

Code of Federal Regulations, 2010 CFR

2010-01-01

... National Guard technicians. 315.610 Section 315.610 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... technicians. (a) An agency may appoint noncompetitively a National Guard technician who— (1) Was involuntarily... 3 years as a technician; (3) Meets the qualifications requirements of the job: and (4) Is appointed...

10 CFR 7.18 - Appointment, compensation, and expense reimbursement of advisory committee members, staffs, and...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Appointment, compensation, and expense reimbursement of advisory committee members, staffs, and consultants. 7.18 Section 7.18 Energy NUCLEAR REGULATORY COMMISSION ADVISORY COMMITTEES § 7.18 Appointment, compensation, and expense reimbursement of advisory committee...

10 CFR 7.18 - Appointment, compensation, and expense reimbursement of advisory committee members, staffs, and...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Appointment, compensation, and expense reimbursement of advisory committee members, staffs, and consultants. 7.18 Section 7.18 Energy NUCLEAR REGULATORY COMMISSION ADVISORY COMMITTEES § 7.18 Appointment, compensation, and expense reimbursement of advisory committee...

42 CFR 136.42 - Appointment actions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Appointment actions. 136.42 Section 136.42 Public... OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Preference in Employment § 136.42 Appointment actions. (a..., promotion, or any other personnel action intended to fill a vacancy. (b) Preference eligibles may be given a...

10 CFR 1045.33 - Appointment of restricted data management official.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Appointment of restricted data management official. 1045... DECLASSIFICATION Generation and Review of Documents Containing Restricted Data and Formerly Restricted Data § 1045.33 Appointment of restricted data management official. (a) Each agency with access to RD or FRD shall...

42 CFR 136a.42 - Appointment actions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Appointment actions. 136a.42 Section 136a.42 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Preference in Employment § 136a.42 Appointment actions. (a...

News Music: Here comes science that rocks Student trip: Two views of the future of CERN Classroom: Researchers can motivate pupils Appointment: AstraZeneca trust appoints new director Multimedia: Physics Education comes to YouTube Competition: Students compete in European Union Science Olympiad 2010 Physics roadshow: Pupils see wonders of physics

NASA Astrophysics Data System (ADS)

2010-07-01

Music: Here comes science that rocks Student trip: Two views of the future of CERN Classroom: Researchers can motivate pupils Appointment: AstraZeneca trust appoints new director Multimedia: Physics Education comes to YouTube Competition: Students compete in European Union Science Olympiad 2010 Physics roadshow: Pupils see wonders of physics

The effect of GP telephone triage on numbers seeking same-day appointments.

PubMed

Jiwa, Moyez; Mathers, Nigel; Campbell, Mike

2002-05-01

Telephone consultations with general practitioners (GPs) have not been shown to be an effective way to reduce the demandfor face-to face appointments during the surgery hours. This study aims to determine if GP telephone triage can effectively reduce the demandforface-to -face consultations for patients seeking same-day appointments in general practice. We report an interrupted time series, twoyears before and one year after introduction of GP-led telephone triage. Demand for face-to face appointments with a GPwas reduced by 39% (95% CI = 29 to 51%, P < 0.001). more than 92% of the telephone calls lasted less thanfive minutes. The telephone bill increased by 26%. For a substantial proportion of patients seeking same-day appointments telephone consultations were an acceptable alternative service.

A single appointment protocol to create a partially edentulous CAD/CAM guided surgical template: a clinical report.

PubMed

Marchack, Christopher B; Charles, Allan; Pettersson, Andreas

2011-12-01

The traditional technique for creating a CAD/CAM surgical template with a NobelGuide protocol is to fabricate a radiographic template that depicts the planned tooth position first. Multiple appointments are needed for the fabrication of the radiographic template with Cone Beam Computed Tomography (CBCT) before the surgical procedure can start. An alternative technique is described for fabricating a radiographic template at the initial examination appointment and capturing the necessary DICOM data to plan and fabricate a CAD/CAM surgical template in a 1-appointment protocol, thereby saving the patient and clinician time and reducing the need for multiple appointments. Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

Application of the transtheoretical model of behaviour change for identifying older clients' readiness for hearing rehabilitation during history-taking in audiology appointments.

PubMed

Ekberg, Katie; Grenness, Caitlin; Hickson, Louise

2016-07-01

The transtheoretical model (TTM) of behaviour change focuses on clients' readiness for adopting new health behaviours. This study explores how clients' readiness for change can be identified through their interactions with audiologists during history-taking in initial appointments; and whether clients' readiness has consequences for the rehabilitation decisions they make within the initial appointment. Conversation analysis (CA) was used to examine video-recorded initial audiology appointments with older adults with hearing impairment. The data corpus involved 62 recorded appointments with 26 audiologists and their older adult clients (aged 55+ years). Companions were present in 17 appointments. Clients' readiness for change could be observed through their interaction with the audiologist. Analysis demonstrated that the way clients described their hearing in the history-taking phase had systematic consequences for how they responded to rehabilitation recommendations (in particular, hearing aids) in the management phase of the appointment. In particular, clients identified as being in a pre-contemplation stage-of-change were more likely to display resistance to a recommendation of hearing aids (80% declined). The transtheoretical model of behaviour change can be useful for helping audiologists individualize management planning to be congruent with individual clients' needs, attitudes, desires, and psychological readiness for action in order to optimize clients' hearing outcomes.

Bayesian processing of context-dependent text: reasons for appointments can improve detection of influenza.

PubMed

Alemi, Farrokh; Torii, Manabu; Atherton, Martin J; Pattie, David C; Cox, Kenneth L

2012-01-01

This article aims to examine whether words listed in reasons for appointments could effectively predict laboratory-verified influenza cases in syndromic surveillance systems. Data were collected from the Armed Forces Health Longitudinal Technological Application medical record system. We used 2 algorithms to combine the impact of words within reasons for appointments: Dependent (DBSt) and Independent (IBSt) Bayesian System. We used receiver operating characteristic curves to compare the accuracy of these 2 methods of processing reasons for appointments against current and previous lists of diagnoses used in the Department of Defense's syndromic surveillance system. We examined 13,096 cases, where the results of influenza tests were available. Each reason for an appointment had an average of 3.5 words (standard deviation = 2.2 words). There was no difference in performance of the 2 algorithms. The area under the curve for IBSt was 0.58 and for DBSt was 0.56. The difference was not statistically significant (McNemar statistic = 0.0054; P = 0.07). These data suggest that reasons for appointments can improve the accuracy of lists of diagnoses in predicting laboratory-verified influenza cases. This study recommends further exploration of the DBSt algorithm and reasons for appointments in predicting likely influenza cases.

Availability of Outpatient Mental Health Care by Pediatricians and Child Psychiatrists in Five U.S. Cities.

PubMed

Cama, Shireen; Malowney, Monica; Smith, Anna Jo Bodurtha; Spottswood, Margaret; Cheng, Elisa; Ostrowsky, Louis; Rengifo, Jose; Boyd, J Wesley

2017-10-01

The authors sought to assess the availability of outpatient mental health care through pediatrician and child psychiatrist offices in the United States and to characterize differences in appointment availability by location, provider type, and insurance across five cities. To do so, the authors posed as parents of a 12-year-old child with depression, gave a predetermined insurance type, and asked to make the first available appointment with the specified provider. They called the offices of 601 individual pediatricians and 312 child psychiatrists located in five U.S. cities and listed as in-network by Blue Cross Blue Shield, one of the largest private insurers in the United States. Appointments were obtained with 40% of the pediatricians and 17% of the child psychiatrists. The mean wait time for psychiatry appointments was 30 days longer than for pediatric appointments. Providers were less likely to have available appointments for children on Medicaid, which is public insurance for low-income people. The most common reason for being unable to make an appointment was that the listed phone number was incorrect. Pediatricians were twice as likely to see new patients and to see them sooner than child psychiatrists. Increasing the number of both types of providers may be necessary to increase access to mental health care for children.

Methods of appointment and qualifications of club doctors and physiotherapists in English professional football: some problems and issues

PubMed Central

Waddington, I; Roderick, M; Naik, R

2001-01-01

Objective—To examine the methods of appointment, experience, and qualifications of club doctors and physiotherapists in professional football. Methods—Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned. Results—In almost all clubs, methods of appointment of doctors are informal and reflect poor employment practice: posts are rarely advertised and many doctors are appointed on the basis of personal contacts and without interview. Few club doctors had prior experience or qualifications in sports medicine and very few have a written job description. The club doctor is often not consulted about the appointment of the physiotherapist; physiotherapists are usually appointed informally, often without interview, and often by the manager without involving anyone who is qualified in medicine or physiotherapy. Half of all clubs do not have a qualified (chartered) physiotherapist; such unqualified physiotherapists are in a weak position to resist threats to their clinical autonomy, particularly those arising from managers' attempts to influence clinical decisions. Conclusions—Almost all aspects of the appointment of club doctors and physiotherapists need careful re-examination. Key Words: football clubs; doctors; physiotherapists; qualifications PMID:11157462

COSMIC probes into compact binary formation and evolution

NASA Astrophysics Data System (ADS)

Breivik, Katelyn

2018-01-01

The population of compact binaries in the galaxy represents the final state of all binaries that have lived up to the present epoch. Compact binaries present a unique opportunity to probe binary evolution since many of the interactions binaries experience can be imprinted on the compact binary population. By combining binary evolution simulations with catalogs of observable compact binary systems, we can distill the dominant physical processes that govern binary star evolution, as well as predict the abundance and variety of their end products.The next decades herald a previously unseen opportunity to study compact binaries. Multi-messenger observations from telescopes across all wavelengths and gravitational-wave observatories spanning several decades of frequency will give an unprecedented view into the structure of these systems and the composition of their components. Observations will not always be coincident and in some cases may be separated by several years, providing an avenue for simulations to better constrain binary evolution models in preparation for future observations.I will present the results of three population synthesis studies of compact binary populations carried out with the Compact Object Synthesis and Monte Carlo Investigation Code (COSMIC). I will first show how binary-black-hole formation channels can be understood with LISA observations. I will then show how the population of double white dwarfs observed with LISA and Gaia could provide a detailed view of mass transfer and accretion. Finally, I will show that Gaia could discover thousands black holes in the Milky Way through astrometric observations, yielding view into black-hole astrophysics that is complementary to and independent from both X-ray and gravitational-wave astronomy.

Who attends out-of-hours general practice appointments? Analysis of a patient cohort accessing new out-of-hours units.

PubMed

Kelly, Shona J; Piercy, Hilary; Ibbotson, Rachel; Fowler Davis, Sally V

2018-06-09

This report describes the patients who used additional out-of-hours (OOH) appointments offered through a UK scheme intended to increase patient access to primary care by extending OOH provision. Cohort study and survey data. OOH appointments offered in four units in one region in England (October 2015 to November 2016). Unidentifiable data on all patients were abstracted from a bespoke appointment system and the responses to a patient opinion questionnaire about this service. Descriptive analysis of the appointment data was conducted. Multivariate analysis of the opinion survey data examined the characteristics of the patients who would have gone to the emergency department (ED) had the OOH appointments not been available. There were 24 448 appointments for 19 701 different patients resulting in 29 629 service outcomes. Women dominated the uptake and patients from the poorest fifth of the population used nearly 40% of appointments. The patient survey found OOH appointments were extremely popular-93% selecting 'extremely likely' or 'likely' to recommend the service. Multivariate analysis of patient opinion survey data on whether ED would have been an alternative to the OOH service found that men, young children, people of Asian heritage and the most deprived were more likely to have gone to ED without this service. The users of the OOH service were substantially different from in-hours service users with a large proportion of children under age 5, and the poor, which support the idea that there may be unmet need as the poor have the least flexible working conditions. These results demonstrate the need for equality impact assessment in planning service improvements associated with policy implementation. It suggests that OOH need to take account of patients expectations about convenience of appointments and how patients use services for urgent care needs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Nurse-led Multidisciplinary Heart Failure Group Clinic Appointments: Methods, Materials and Outcomes Used in the Clinical Trial

PubMed Central

Smith, C. E.; Piamjariyakul, U.; Dalton, K. M.; Russell, C.; Wick, J.; Ellerbeck, E.F.

2015-01-01

Background The Self-Management and Care of Heart Failure through Group Clinics Trial (SMAC-HF) evaluated the effects of multidisciplinary group clinic appointments on self-care skills and rehospitalizations in high risk heart failure (HF) patients. Objective The purpose of this article is to: (1) describe key SMAC-HF group clinic interactive learning strategies; (2) describe resources and materials used in the group clinic appointment; and (3) present results supporting this patient-centered group intervention. Methods This clinical trial included 198 HF patients (randomized to either group clinical appointments or to standard care). Data were collected from 72 group clinic appointments via patients’: (1) group clinic session evaluations; (2) HF Self-Care Behaviors Skills; (3) HF related discouragement and quality of life scores and (4) HF related reshopitalizations during the 12 month follow-up. Also the costs of delivery of the group clinical appointments were tabulated. Results Overall, patients rated group appointments as 4.8 out of 5 on the “helpfulness” in managing HF score. The statistical model showed a 33% decrease in the rate of rehospitalizations (incidence rate ratio (IRR) = 0.67) associated with the intervention over the 12-month follow-up period when compared with control patients (χ2(1) = 3.9, p = 0.04). The total cost for implementing five group appointments was $243.58 per patient. Conclusion The intervention was associated with improvements in HF self-care knowledge and home care behavior skills and managing their for HF care. In turn, better self-care was associated with reductions in HF related hospitalizations. PMID:25774836

Accessing primary care: a simulated patient study

PubMed Central

Campbell, John L; Carter, Mary; Davey, Antoinette; Roberts, Martin J; Elliott, Marc N; Roland, Martin

2013-01-01

Background Simulated patient, or so-called ‘mystery-shopper’, studies are a controversial, but potentially useful, approach to take when conducting health services research. Aim To investigate the construct validity of survey questions relating to access to primary care included in the English GP Patient Survey. Design and setting Observational study in 41 general practices in rural, urban, and inner-city settings in the UK. Method Between May 2010 and March 2011, researchers telephoned practices at monthly intervals, simulating patients requesting routine, but prompt, appointments. Seven measures of access and appointment availability, measured from the mystery-shopper contacts, were related to seven measures of practice performance from the GP Patient Survey. Results Practices with lower access scores in the GP Patient Survey had poorer access and appointment availability for five out of seven items measured directly, when compared with practices that had higher scores. Scores on items from the national survey that related to appointment availability were significantly associated with direct measures of appointment availability. Patient-satisfaction levels and the likelihood that patients would recommend their practice were related to the availability of appointments. Patients’ reports of ease of telephone access in the national survey were unrelated to three out of four measures of practice call handling, but were related to the time taken to resolve an appointment request, suggesting responders’ possible confusion in answering this question. Conclusion Items relating to the accessibility of care in a the English GP patient survey have construct validity. Patients’ satisfaction with their practice is not related to practice call handling, but is related to appointment availability. PMID:23561783

What Are Women Told When Requesting Family Planning Services at Clinics Associated with Catholic Hospitals? A Mystery Caller Study.

PubMed

Guiahi, Maryam; Teal, Stephanie B; Swartz, Maryke; Huynh, Sandy; Schiller, Georgia; Sheeder, Jeanelle

2017-12-01

Catholic Church directives restrict family planning service provision at Catholic health care institutions. It is unclear whether obstetrics and gynecology clinics that are owned by or have business affiliations with Catholic hospitals offer family planning appointments. Mystery callers phoned 144 clinics nationwide that were found on Catholic hospital websites between December 2014 and February 2016, and requested appointments for birth control generally, copper IUD services specifically, tubal ligation and abortion. Chi-square and Fisher's exact tests assessed potential correlates of appointment availability, and multivariable logistic regressions were computed if bivariate testing suggested multiple correlates. Although 95% of clinics would schedule birth control appointments, smaller proportions would schedule appointments for copper IUDs (68%) or tubal ligation (58%); only 2% would schedule an abortion. Smaller proportions of Catholic-owned than of Catholic-affiliated clinics would schedule appointments for birth control (84% vs. 100%), copper IUDs (4% vs. 97%) and tubal ligation (29% vs. 72%); for birth control and copper IUD services, no other clinic characteristics were related to appointment availability. Multivariable analysis confirmed that tubal ligation appointments were less likely to be offered at Catholic-owned than at Catholic-affiliated clinics (odds ratio. 0.1); location and association with one of the top 10 Catholic health care systems also were significant. Adherence to church directives is inconsistent at Catholic-associated clinics. Women visiting such clinics who want highly effective methods may need to rely on less effective methods or delay method uptake while seeking services elsewhere. Copyright © 2017 by the Guttmacher Institute.

Nurse-Led Multidisciplinary Heart Failure Group Clinic Appointments: Methods, Materials, and Outcomes Used in the Clinical Trial.

PubMed

Smith, Carol E; Piamjariyakul, Ubolrat; Dalton, Kathleen M; Russell, Christy; Wick, Jo; Ellerbeck, Edward F

2015-01-01

The Self-management and Care of Heart Failure through Group Clinics Trial evaluated the effects of multidisciplinary group clinic appointments on self-care skills and rehospitalizations in high-risk heart failure (HF) patients. The purpose of this article is to (1) describe key Self-management and Care of Heart Failure through Group Clinics Trial group clinic interactive learning strategies, (2) describe resources and materials used in the group clinic appointment, and (3) present results supporting this patient-centered group intervention. This clinical trial included 198 HF patients (randomized to either group clinical appointments or to standard care). Data were collected from 72 group clinic appointments via patients' (1) group clinic session evaluations, (2) HF self-care behaviors skills, (3) HF-related discouragement and quality of life scores, and (4) HF-related reshopitalizations during the 12-month follow-up. Also, the costs of delivery of the group clinical appointments were tabulated. Overall, patients rated group appointments as 4.8 of 5 on the "helpfulness" in managing HF score. The statistical model showed a 33% decrease in the rate of rehospitalizations (incidence rate ratio, 0.67) associated with the intervention over the 12-month follow-up period when compared with control patients (χ(2)1=3.9, P=.04). The total cost for implementing 5 group appointments was $243.58 per patient. The intervention was associated with improvements in HF self-care knowledge and home care behavior skills and managing their for HF care. In turn, better self-care was associated with reductions in HF-related hospitalizations.

Hanford Environmental Dose Reconstruction Project. Monthly report, December 1991

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

Finch, S.M.; McMakin, A.H.

1991-12-31

The objective of the Hanford Environmental Dose Reconstruction Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The project is being managed and conducted by the Pacific Northwest Laboratory (PNL) under the direction of an independent Technical Steering Panel (TSP). The TSP consists of experts in environmental pathways, epidemiology, surface-water transport, ground-water transport, statistics, demography, agriculture, meteorology, nuclear engineering, radiation dosimetry, and cultural anthropology. Included are appointed technical members representing the states of Oregon and Washington, a representative of Native American tribes, and an individual representing the public.more » The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed, from release to impact on human (dose estimates): Source Terms; Environmental Transport; Environmental Monitoring Data; Demographics, Agriculture, Food Habits and; Environmental Pathways and Dose Estimates.« less

Hanford Environmental Dose Reconstruction Project

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

Finch, S.M.; McMakin, A.H.

1991-01-01

The objective of the Hanford Environmental Dose Reconstruction Project is to estimate the radiation doses that individuals and populations could have received from nuclear operations at Hanford since 1944. The project is being managed and conducted by the Pacific Northwest Laboratory (PNL) under the direction of an independent Technical Steering Panel (TSP). The TSP consists of experts in environmental pathways, epidemiology, surface-water transport, ground-water transport, statistics, demography, agriculture, meteorology, nuclear engineering, radiation dosimetry, and cultural anthropology. Included are appointed technical members representing the states of Oregon and Washington, a representative of Native American tribes, and an individual representing the public.more » The project is divided into the following technical tasks. These tasks correspond to the path radionuclides followed, from release to impact on human (dose estimates): Source Terms; Environmental Transport; Environmental Monitoring Data; Demographics, Agriculture, Food Habits and; Environmental Pathways and Dose Estimates.« less

EBCOG Hospital Recognition: where do we stand?

PubMed Central

Wladimiroff, J.; Hornnes, P.

2010-01-01

Hospital Recognition for general Ob/Gyn training programmes was started by EBCOG (European Board & College of Obstetrics & Gynaecology) in 1996 and for subspecialty Ob/Gyn training programmes in 2005, the latter jointly with the four European scientific organisations representing the subspecialties. So far, 85 Audits/Visits have been conducted by EBCOG for general Ob/Gyn training and a good start has been made for subspecialty training, in particular Gynaecological Oncology. EBCOG Visits are conducted by two EBCOG representatives and one trainee appointed by ENTOG (European Network for Trainees in Obstetrics & Gynaecology) for general Ob/Gyn training programmes and by two subspecialty specialists and an EBCOG representative for subspecialty programmes. Each Visit lasts one day. Accredition is granted by the EBCOG Executive Board depending on the Visiting report. Ultimately, EBCOG would like to see the introduction of an auditing and accreditation system for general and subspecialty Ob/Gyn training programmes in each country in Europe PMID:25206968

An interesting case of cryptogenic stroke in a young man due to left ventricular non-compaction: role of cardiac MRI in the accurate diagnosis.

PubMed

Kannan, Arun; Das, Anindita; Janardhanan, Rajesh

2014-06-24

A 28-year-old man arrived for an outpatient cardiac MRI (CMR) study to evaluate cardiac structure. At the age of 24 the patient presented with acute onset expressive aphasia and was diagnosed with ischaemic stroke. Echocardiography at that time was reported as 'apical wall thickening consistent with apical hypertrophic cardiomyopathy'. CMR revealed a moderately dilated left ventricle with abnormal appearance of the left ventricular (LV) apical segments. Further evaluation was consistent with a diagnosis of LV non-compaction (LVNC) cardiomyopathy with a ratio of non-compacted to compacted myocardium measuring 3. There was extensive delayed hyperenhancement signal involving multiple segments representing a significant myocardial scar which is shown to have a prognostic role. Our patient, with no significant cerebrovascular risk factors, would likely have had an embolic stroke. This case demonstrates the role of CMR in accurately diagnosing LVNC in a patient with young stroke where prior echocardiography was non-diagnostic. 2014 BMJ Publishing Group Ltd.

A class of compact dwarf galaxies from disruptive processes in galaxy clusters.

PubMed

Drinkwater, M J; Gregg, M D; Hilker, M; Bekki, K; Couch, W J; Ferguson, H C; Jones, J B; Phillipps, S

2003-05-29

Dwarf galaxies have attracted increased attention in recent years, because of their susceptibility to galaxy transformation processes within rich galaxy clusters. Direct evidence for these processes, however, has been difficult to obtain, with a small number of diffuse light trails and intra-cluster stars being the only signs of galaxy disruption. Furthermore, our current knowledge of dwarf galaxy populations may be very incomplete, because traditional galaxy surveys are insensitive to extremely diffuse or compact galaxies. Aware of these concerns, we recently undertook an all-object survey of the Fornax galaxy cluster. This revealed a new population of compact members, overlooked in previous conventional surveys. Here we demonstrate that these 'ultra-compact' dwarf galaxies are structurally and dynamically distinct from both globular star clusters and known types of dwarf galaxy, and thus represent a new class of dwarf galaxy. Our data are consistent with the interpretation that these are the remnant nuclei of disrupted dwarf galaxies, making them an easily observed tracer of galaxy disruption.

Compact Neutral Hydrogen Clouds: Searching for Undiscovered Dwarf Galaxies and Gas Associated with an Algol-type Variable Star

NASA Astrophysics Data System (ADS)

Grcevich, Jana; Berger, Sabrina; Putman, Mary E.; Eli Goldston Peek, Joshua

2016-01-01

Several interesting compact neutral hydrogen clouds were found in the GALFA-HI (Galactic Arecibo L-Band Feed Array HI) survey which may represent undiscovered dwarf galaxy candidates. The continuation of this search is motivated by successful discoveries of Local Volume dwarfs in the GALFA-HI DR1. We identify additional potential dwarf galaxies from the GALFA-HI DR1 Compact Cloud Catalog which are indentified as having unexpected velocities given their other characteristics via the bayesian analysis software BayesDB. We also present preliminary results of a by-eye search for dwarf galaxies in the GALFA-HI DR2, which provides additional sky coverage. Interestingly, one particularly compact cloud discovered during our dwarf galaxy search is spatially coincident with an Algol-type variable star. Although the association is tentative, Algol-type variables are thought to have undergone significant gas loss and it is possible this gas may be observable in HI.

Compaction of Railway Ballast During Tamping Process: a Parametric Study

NASA Astrophysics Data System (ADS)

Saussine, G.; Azéma, E.; Perales, R.; Radjaï, F.

2009-06-01

We characterize an industrial process currently used on railway track: tamping operation. This process is employed in order to restore the geometry of railway track distorted by train traffics. The main goal is to compact the granular material under the sleepers supporting the railroad squeezing and vibrations. We focus on different phases of the tamping process, namely the penetration of tamping tines into the ballast and squeezing of ballast between tines. Our numerical simulations of three-dimensional discrete polyhedral grains allow us to investigate the influence of vibration frequency on the compaction level at the end of the process, the role of velocity of tamping tines during penetration phase and the mechanism of compaction of a confined granular layer under horizontal vibrations. For each tamping phase, an optimal frequency is proposed, and an analysis of the full process on the samples representing a portion of the railway track enables us to access the influence of various parameters required to optimize the process.

75 FR 12561 - Request for Applicants for Appointment to the Advisory Committee on Commercial Operations of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-16

... Appointment to the Advisory Committee on Commercial Operations of Customs and Border Protection (COAC) AGENCY... Management; request for applicants for appointment to the Advisory Committee on Commercial Operations of... individuals who are interested in serving on the Advisory Committee on Commercial Operations of Customs and...

38 CFR 17.100 - Refusal of treatment by unnecessarily breaking appointments.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Refusal of treatment by... VETERANS AFFAIRS MEDICAL Breaking Appointments § 17.100 Refusal of treatment by unnecessarily breaking... informed that breaking an additional appointment will be deemed to be a refusal to accept VA treatment. If...

22 CFR 11.30 - Senior Foreign Service officer career candidate and limited non-career appointments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Senior Foreign Service officer career candidate... PERSONNEL APPOINTMENT OF FOREIGN SERVICE OFFICERS § 11.30 Senior Foreign Service officer career candidate and limited non-career appointments. (a) General considerations. (1) Career officers at the Senior...

76 FR 43991 - Amendment of Department of Defense Federal Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-22

... adviser to the chair. Board members appointed by the Secretary of Defense, who are not full-time or permanent part-time Federal employees, shall be appointed as experts and consultants under the authority of... shall renew their appointments on an annual basis. With the exception of travel and per diem for...

77 FR 4284 - Renewal of Department of Defense Federal Advisory Committees

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-27

... appointed by the Secretary of Defense, who are not full-time or permanent part-time federal employees, shall... compensation, except for travel and per diem for official Board-related travel. Each Board member is appointed...- time or part-time government employees, shall be appointed to serve as experts and consultants under...

31 CFR 224.8 - When must a surety corporation appoint a new process agent?

Code of Federal Regulations, 2010 CFR

2010-07-01

... appoint a new process agent? 224.8 Section 224.8 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE FEDERAL PROCESS AGENTS OF SURETY CORPORATIONS § 224.8 When must a surety corporation appoint a new process...

31 CFR 224.4 - When must a surety corporation appoint a process agent?

Code of Federal Regulations, 2010 CFR

2010-07-01

... appoint a process agent? 224.4 Section 224.4 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE FEDERAL PROCESS AGENTS OF SURETY CORPORATIONS § 224.4 When must a surety corporation appoint a process agent? A...

25 CFR 5.2 - Appointment actions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Appointment actions. 5.2 Section 5.2 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR PROCEDURES AND PRACTICE PREFERENCE IN EMPLOYMENT § 5.2 Appointment actions. (a) Preference will be afforded a person meeting any one of the standards of § 5.1...

42 CFR 136a.42 - Appointment actions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Appointment actions. 136a.42 Section 136a.42 Public... OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Preference in Employment § 136a.42 Appointment actions. (a..., promotion, or any other personnel action intended to fill a vacancy. (b) Preference eligibles may be given a...

25 CFR 5.2 - Appointment actions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Appointment actions. 5.2 Section 5.2 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR PROCEDURES AND PRACTICE PREFERENCE IN EMPLOYMENT § 5.2 Appointment actions. (a) Preference will be afforded a person meeting any one of the standards of § 5.1...

Oral Exam System at Teacher Appointments in Turkey

ERIC Educational Resources Information Center

Colak, Ismail; Demir, Selcuk Besir

2017-01-01

Many systems have been developed on teacher selection and appointments procedures throughout history in Turkey. Latest teacher appointments and selection systems in Turkey is Oral Exam Evaluation. This new system is discussed in detail in this study. Basically, the study is to analysis what the positive and negative reflections of the system might…

76 FR 16737 - Renewal of Department of Defense Federal Advisory Committees

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-25

... part-time government employees, shall be appointed to serve as experts and consultants under the... to DoD policy, shall be a full-time or permanent part-time DoD employee, and shall be appointed in...-time federal officers or employees, shall be appointed as experts and consultants under the authority...

One-appointment endodontic therapy: biological considerations.

PubMed

Lin, Louis M; Lin, Jarshen; Rosenberg, Paul A

2007-11-01

The authors conducted a literature review to present the best available biological evidence concerning one-appointment endodontic therapy for asymptomatic teeth with apical periodontitis. Because of recent advances in technology, such as rotary engines and nickel-titanium instruments, some practitioners are performing one-appointment endodontic therapy for asymptomatic teeth with apical periodontitis. The authors reviewed the literature, which revealed only a small number of randomized, controlled clinical trials that have been conducted on one-appointment versus multiple-appointment endodontic therapy. As the apical canal preparation is enlarged, a greater percentage of bacteria is eradicated from infected root canals. In addition, sufficiently large apical root canal enlargement facilitates the delivery of antimicrobial irrigant to the apical portion of the canal. However, an association between positive or negative preobturation root canal culture results and the outcome of endodontic treatment has not been well-established. The best available evidence, based on a systematic literature review, indicates that one-appointment endodontic therapy may be feasible in selected cases of apical periodontitis in asymptomatic teeth. However, additional randomized, controlled clinical trials are required.

Compacting de Bruijn graphs from sequencing data quickly and in low memory.

PubMed

Chikhi, Rayan; Limasset, Antoine; Medvedev, Paul

2016-06-15

As the quantity of data per sequencing experiment increases, the challenges of fragment assembly are becoming increasingly computational. The de Bruijn graph is a widely used data structure in fragment assembly algorithms, used to represent the information from a set of reads. Compaction is an important data reduction step in most de Bruijn graph based algorithms where long simple paths are compacted into single vertices. Compaction has recently become the bottleneck in assembly pipelines, and improving its running time and memory usage is an important problem. We present an algorithm and a tool bcalm 2 for the compaction of de Bruijn graphs. bcalm 2 is a parallel algorithm that distributes the input based on a minimizer hashing technique, allowing for good balance of memory usage throughout its execution. For human sequencing data, bcalm 2 reduces the computational burden of compacting the de Bruijn graph to roughly an hour and 3 GB of memory. We also applied bcalm 2 to the 22 Gbp loblolly pine and 20 Gbp white spruce sequencing datasets. Compacted graphs were constructed from raw reads in less than 2 days and 40 GB of memory on a single machine. Hence, bcalm 2 is at least an order of magnitude more efficient than other available methods. Source code of bcalm 2 is freely available at: https://github.com/GATB/bcalm rayan.chikhi@univ-lille1.fr. © The Author 2016. Published by Oxford University Press.

75 FR 7648 - Agency Information Collection Activities: Emergency Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-22

..., recipients, and representative payees: Braille and Microsoft Word files (on data compact discs). Current...) Braille, or (5) Microsoft Word. This call did not require OMB clearance. However, there may be respondents...

Appointment Template Redesign in a Women's Health Clinic Using Clinical Constraints to Improve Service Quality and Efficiency.

PubMed

Huang, Y; Verduzco, S

2015-01-01

Patient wait time is a critical element of access to care that has long been recognized as a major problem in modern outpatient health care delivery systems. It impacts patient and medical staff productivity, stress, quality and efficiency of medical care, as well as health-care cost and availability. This study was conducted in a Women's Health Clinic. The objective was to improve clinic service quality by redesigning patient appointment template using the clinical constraints. The proposed scheduling template consisted of two key elements: the redesign of appointment types and the determination of the length of time slots using defined constraints. The re-classification technique was used for the redesign of appointment visit types to capture service variation for scheduling purposes. Then, the appointment length was determined by incorporating clinic constraints or goals, such as patient wait time, physician idle time, overtime, finish time, lunch hours, when the last appointment was scheduled, and the desired number of appointment slots, to converge the optimal length of appointment slots for each visit type. The redesigned template was implemented and the results indicated a 73% reduction in average patient waiting from the reported 40 to 11 minutes. The patient no-show rate was reduced by 4% from 24% to 20%. The morning section on average finished about 11:50 am. The clinic day was finished around 4:45 pm. Provider average idle time was estimated to be about 5 minutes, which can be used for charting/documenting patients. This study provided an alternative method of redesigning appointment scheduling templates using only the clinical constraints rather than the traditional way that required an objective function. This paper also documented the employed methods step by step in a real clinic setting. The implementation results concluded a significant improvement on patient wait time and no-show rate.

Coordinating clinic and surgery appointments to meet access service levels for elective surgery.

PubMed

Kazemian, Pooyan; Sir, Mustafa Y; Van Oyen, Mark P; Lovely, Jenna K; Larson, David W; Pasupathy, Kalyan S

2017-02-01

Providing timely access to surgery is crucial for patients with high acuity diseases like cancer. We present a methodological framework to make efficient use of scarce resources including surgeons, operating rooms, and clinic appointment slots with a goal of coordinating clinic and surgery appointments so that patients with different acuity levels can see a surgeon in the clinic and schedule their surgery within a maximum wait time target that is clinically safe for them. We propose six heuristic scheduling policies with two underlying ideas behind them: (1) proactively book a tentative surgery day along with the clinic appointment at the time an appointment request is received, and (2) intelligently space out clinic and surgery appointments such that if the patient does not need his/her surgery appointment there is sufficient time to offer it to another patient. A 2-stage stochastic discrete-event simulation approach is employed to evaluate the six scheduling policies. In the first stage of the simulation, the heuristic policies are compared in terms of the average operating room (OR) overtime per day. The second stage involves fine-tuning the most-effective policy. A case study of the division of colorectal surgery (CRS) at the Mayo Clinic confirms that all six policies outperform the current scheduling protocol by a large margin. Numerical results demonstrate that the final policy, which we refer to as Coordinated Appointment Scheduling Policy considering Indication and Resources (CASPIR), performs 52% better than the current scheduling policy in terms of the average OR overtime per day under the same access service level. In conclusion, surgical divisions desiring stratified patient urgency classes should consider using scheduling policies that take the surgical availability of surgeons, patients' demographics and indication of disease into consideration when scheduling a clinic consultation appointment. Copyright © 2016 Elsevier Inc. All rights reserved.

Impact of injection therapy on retinal patients with diabetic macular edema or retinal vein occlusion.

PubMed

Sivaprasad, Sobha; Oyetunde, Sesan

2016-01-01

An important factor in the choice of therapy is the impact it has on the patient's quality of life. This survey aimed to understand treatment burden, treatment-related anxiety and worry, and practical issues such as appointment attendance and work absence in patients receiving injection therapy for diabetic macular edema (DME) or retinal vein occlusion (RVO). A European sample of 131 retinal patients completed a detailed questionnaire to elucidate the impact of injection therapy on individuals with DME or RVO. RVO and DME greatly impact a patient's quality of life. An intensive injection regimen and the requirements for multiple hospital visits place a large practical burden on the patient. Each intravitreal injection appointment (including travel time) was reported to take an average of 4.5 hours, with a total appointment burden over 6 months of 13.5 hours and 20 hours for RVO and DME patients, respectively. This creates a significant burden on patient time and may make appointment attendance difficult. Indeed, 53% of working patients needed to take at least 1 day off work per appointment and 71% of patients required a carer's assistance at the time of the injection appointment, ~6.3 hours per injection. In addition to practical issues, three-quarters of patients reported experiencing anxiety about their most recent injection treatment, with 54% of patients reporting that they were anxious for at least 2 days prior to the injection. Patients' most desired improvement to their treatment regimen was to have fewer injections and to require fewer appointments, to achieve the same visual results. Patients' quality of life is clearly very affected by having to manage an intensive intravitreal injection regimen, with a considerable treatment burden having a large negative effect. Reducing the appointment burden to achieve the same visual outcomes and the provision of additional support for patients to attend appointments would greatly benefit those receiving intravitreal injection therapies for DME and RVO.

Appointment Template Redesign in a Women’s Health Clinic Using Clinical Constraints to Improve Service Quality and Efficiency

PubMed Central

Verduzco, S.

2015-01-01

Summary Background Patient wait time is a critical element of access to care that has long been recognized as a major problem in modern outpatient health care delivery systems. It impacts patient and medical staff productivity, stress, quality and efficiency of medical care, as well as health-care cost and availability. Objectives This study was conducted in a Women’s Health Clinic. The objective was to improve clinic service quality by redesigning patient appointment template using the clinical constraints. Methods The proposed scheduling template consisted of two key elements: the redesign of appointment types and the determination of the length of time slots using defined constraints. The re-classification technique was used for the redesign of appointment visit types to capture service variation for scheduling purposes. Then, the appointment length was determined by incorporating clinic constraints or goals, such as patient wait time, physician idle time, overtime, finish time, lunch hours, when the last appointment was scheduled, and the desired number of appointment slots, to converge the optimal length of appointment slots for each visit type. Results The redesigned template was implemented and the results indicated a 73% reduction in average patient waiting from the reported 40 to 11 minutes. The patient no-show rate was reduced by 4% from 24% to 20%. The morning section on average finished about 11:50 am. The clinic day was finished around 4:45 pm. Provider average idle time was estimated to be about 5 minutes, which can be used for charting/documenting patients. Conclusions This study provided an alternative method of redesigning appointment scheduling templates using only the clinical constraints rather than the traditional way that required an objective function. This paper also documented the employed methods step by step in a real clinic setting. The implementation results concluded a significant improvement on patient wait time and no-show rate. PMID:26171075

The effect of fines on nonattendance in public hospital outpatient clinics: study protocol for a randomized controlled trial.

PubMed

Blæhr, Emely Ek; Kristensen, Thomas; Væggemose, Ulla; Søgaard, Rikke

2016-06-13

Nonattendance at scheduled appointments in public hospitals presents a challenge for efficient resource use and may ultimately affect health outcomes due to longer waiting times. Seven percent of all scheduled outpatient appointments in the United Kingdom are estimated to be nonattended. Various reminder systems have been shown to moderately reduce nonattendance, although the effect of issuing fines for nonattendance has not yet been tested in a randomized context. However, such use of financial incentives could impact access to care differently across the different socioeconomic groups. The aim of this study is to assess the effect of fines on hospital outpatient nonattendance. A 1:1 randomized controlled trial of scheduled outpatient appointments was used, with follow-ups until the date of appointment. The setting is an orthopedic clinic at a regional hospital in Denmark. Appointments for users who are scheduled for diagnostics, treatment, surgery, or follow-ups were included from May 2015 to November 2015. Appointments assigned to the intervention arm include an attachment of the appointment letter explaining that a fine will be issued in the case of nonattendance without prior notice. Appointments assigned to the control arm follow usual practice (same system but no letter attachment). The primary outcome is the proportion of nonattendance. Secondary outcomes are proportions of cancellations, sociodemographics, and health-problem characteristics. Furthermore, the intervention costs and production value of nonattended appointments will be measured. An analysis of effect and cost-effectiveness will be conducted based on a 5 % significance level. The study is initiated and funded by the Danish Regions, which have the responsibility for the Danish public healthcare sector. The results are expected to inform future decisions about the introduction of fines for nonattendance at public hospitals. Current Controlled Trials, ISRCTN61925912 . Registered on 6 July 2015.

[A study of the properties of tablets from mixtures of two size degrees of alpha-lactose monohydrate and microcrystalline cellulose].

PubMed

Muzíková, J

2006-03-01

The paper examines the strength and disintegration time of compacts from the mixtures of two types of Tablettosas. Tablettosa 70 and Tablettosa 100 with microcrystalline cellulose represented by Vivapur 102. The mixtures of dry binders were prepared in the ratios of 3:1, 1:1, and 1:3. The effect of two concentrations of the lubricant magnesium stearate on the strength and disintegration time of compacts was also examined. Tablet strength increased with higher representation of microcrystalline cellulose in the mixture, and decreased with higher stearate concentration. The compacts from the mixtures with Tablettosa 100 showed higher strength. Disintegration time was highest in the compacts with the largest perccintage of microcrystalline cellulose, and longer in the case of the mixtures with Tablettosa 100. Stearate did not exert a negative effect on disintegration time. In the mixtures of Tablettosas with Vivapur 102 in a ratio of 1:1, the effect of the model active ingredient acetylsalicylic acid on the above-mentioned properties of tablets was tested. acetylsalicylic acid produced a further decrease in the strength of compacts and shortened the disintegration time in more instances in the cased of the mixtures with Tahlettosa 100.

Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data.

PubMed

Cowling, Thomas E; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem

2016-06-01

The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. To determine whether primary care access is associated with the route of emergency admission-via a GP versus via an A and E department. Retrospective analysis of national administrative data from English hospitals for 2011-2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access-the percentage of patients able to get a general practice appointment on their last attempt-was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effect of calcium hydroxide and triple antibiotic paste as intracanal medicaments on the incidence of inter-appointment flare-up in diabetic patients: An in vivo study.

PubMed

Pai, Swathi; Vivekananda Pai, A R; Thomas, Manuel S; Bhat, Vishal

2014-05-01

To evaluate and compare the effect of antibacterial intracanal medicaments on inter-appointment flare-up in diabetic patients. Fifty diabetic patients requiring root canal treatment were assigned into groups I, II, and III. In group I, no intracanal medicament was placed. In groups II and III, calcium hydroxide and triple antibiotic pastes were placed as intracanal medicaments, respectively. Patients were instructed to record their pain on days 1, 2, 3, 7, and 14. Inter-appointment flare-up was evaluated using verbal rating scale (VRS). Overall incidence of inter-appointment flare-up among diabetic patients was found to be 16%. In group I, 50% of the patients and in group II, 15% of the patients developed inter-appointment flare-up. However, no patients in group III developed inter-appointment flare-up. The comparison of these results was found to be statistically significant (P = 0.002; χ(2) = 12.426). However, with respect to intergroup comparison, only the difference between groups I and III was found to be statistically significant (P = 0.002; χ(2) = 12.00). Calcium hydroxide and triple antibiotic paste are effective for managing inter-appointment flare-ups in diabetic patients. Triple antibiotic paste is more effective than calcium hydroxide in preventing the occurrence of flare-up in diabetic patients.

Effect of calcium hydroxide and triple antibiotic paste as intracanal medicaments on the incidence of inter-appointment flare-up in diabetic patients: An in vivo study

PubMed Central

Pai, Swathi; Vivekananda Pai, A. R.; Thomas, Manuel S.; Bhat, Vishal

2014-01-01

Aim: To evaluate and compare the effect of antibacterial intracanal medicaments on inter-appointment flare-up in diabetic patients. Materials and Methods: Fifty diabetic patients requiring root canal treatment were assigned into groups I, II, and III. In group I, no intracanal medicament was placed. In groups II and III, calcium hydroxide and triple antibiotic pastes were placed as intracanal medicaments, respectively. Patients were instructed to record their pain on days 1, 2, 3, 7, and 14. Inter-appointment flare-up was evaluated using verbal rating scale (VRS). Results: Overall incidence of inter-appointment flare-up among diabetic patients was found to be 16%. In group I, 50% of the patients and in group II, 15% of the patients developed inter-appointment flare-up. However, no patients in group III developed inter-appointment flare-up. The comparison of these results was found to be statistically significant (P = 0.002; χ2 = 12.426). However, with respect to intergroup comparison, only the difference between groups I and III was found to be statistically significant (P = 0.002; χ2 = 12.00). Conclusions: Calcium hydroxide and triple antibiotic paste are effective for managing inter-appointment flare-ups in diabetic patients. Triple antibiotic paste is more effective than calcium hydroxide in preventing the occurrence of flare-up in diabetic patients. PMID:24944440

Operations research methods improve chemotherapy patient appointment scheduling.

PubMed

Santibáñez, Pablo; Aristizabal, Ruben; Puterman, Martin L; Chow, Vincent S; Huang, Wenhai; Kollmannsberger, Christian; Nordin, Travis; Runzer, Nancy; Tyldesley, Scott

2012-12-01

Clinical complexity, scheduling restrictions, and outdated manual booking processes resulted in frequent clerical rework, long waitlists for treatment, and late appointment notification for patients at a chemotherapy clinic in a large cancer center in British Columbia, Canada. A 17-month study was conducted to address booking, scheduling and workload issues and to develop, implement, and evaluate solutions. A review of scheduling practices included process observation and mapping, analysis of historical appointment data, creation of a new performance metric (final appointment notification lead time), and a baseline patient satisfaction survey. Process improvement involved discrete event simulation to evaluate alternative booking practice scenarios, development of an optimization-based scheduling tool to improve scheduling efficiency, and change management for implementation of process changes. Results were evaluated through analysis of appointment data, a follow-up patient survey, and staff surveys. Process review revealed a two-stage scheduling process. Long waitlists and late notification resulted from an inflexible first-stage process. The second-stage process was time consuming and tedious. After a revised, more flexible first-stage process and an automated second-stage process were implemented, the median percentage of appointments exceeding the final appointment notification lead time target of one week was reduced by 57% and median waitlist size decreased by 83%. Patient surveys confirmed increased satisfaction while staff feedback reported reduced stress levels. Significant operational improvements can be achieved through process redesign combined with operations research methods.

Patient compliance and supportive periodontal therapy: Study among young adults of Namakkal district

PubMed Central

Gokulanathan, Subramanium; Balan, Natarajan; Aravind, Ramaraj Jayabalan; Thangavelu, Kavin

2014-01-01

Aims: The aim of this study is to assess the patient compliance to supportive and maintenance periodontal therapy and to determine the reason for noncompliance among young adult patients of Namakkal district, India. Materials and Methods: This was a cross-sectional study conducted on 400 patients who underwent periodontal therapy and subsequently recalled for supportive and maintenance periodontal treatment in the Department of Periodontics, Vivekanandha Dental College for Women, Namakkal. Patients age group 25-35 years and of both gender were equally selected and grouped by occupation and socioeconomic status. According to their compliance with appointments, they are categorized as complete compliance, partially compliance and insufficient or noncompliance. Noncompliance and partially compliance patients were contacted and asked to rate their experience and reason for noncompliance. Results: In this study, 80% of patients showed complete compliance and were regular for supportive periodontal therapy appointments. Women were more regular in maintaining recall appointments than men. Salaried employers showed 84.3% complete compliance, while self-employed personals showed 77% complete compliance and 75% of nonworking personals were regular to the appointment schedule. Noncompliance person has quoted lack of time and forgetting the appointment date as a major reason for missed appointments. Conclusions: This study recommends the need for improvement in communication skills of practitioners and weekend appointment for patient undergoing periodontal maintenance therapy. PMID:25210365

A compact codimension-two braneworld with precisely one brane

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

Akerblom, Nikolas; Cornelissen, Gunther; Department of Mathematics, Utrecht University

Building on earlier work on football-shaped extra dimensions, we construct a compact codimension-two braneworld with precisely one brane. The two extra dimensions topologically represent a 2-torus which is stabilized by a bulk cosmological constant and magnetic flux. The torus has positive constant curvature almost everywhere, except for a single conical singularity at the location of the brane. In contradistinction to the football-shaped case, there is no fine-tuning required for the brane tension. We also present some plausibility arguments why the model should not suffer from serious stability issues.

Part-Time Faculty Employment. Project on the Status and Education of Women.

ERIC Educational Resources Information Center

Association of American Colleges, Washington, DC.

Different types of policies adopted by colleges and universities to deal with part-time faculty employment and kinds of issues that may arise are considered. Three types of part-time teaching appointments are distinguished, and the shared appointments or split contracts arrangement is described. The shared appointment is one full-time position…

"El Escalafon y el Doble Turno": An International Perspective on School Director Preparation

ERIC Educational Resources Information Center

Slater, Charles L.; Boone, Mike; Nelson, Sarah; De La Colina, Maria; Garcia, Elizabeth; Grimaldo, Leticia; Rico, Grace; Rodriguez, Sonia; Sirios, Cheryl; Womack, Damaris; Garduno, Jose Maria Garcia; Arriaga, Ruth

2006-01-01

"El Escalafon" is the process for appointing school directors and "el Doble Turno" is the double shift of morning and afternoon session in Mexican schools. These two concepts open the door to examine more general issues in the appointment of school directors and the structure of the school day. Director appointment and school…

77 FR 21109 - Senior Executive Service; Appointment of Members to the Performance Review Board

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-09

... DEPARTMENT OF LABOR Office of the Secretary Senior Executive Service; Appointment of Members to the Performance Review Board Title 5 U.S.C. 4314(c)(4) provides that Notice of the Appointment of an individual to serve as a member of the Performance Review Board of the Senior Executive Service shall be...

31 CFR 224.3 - When may a surety corporation provide a bond without appointing a process agent?

Code of Federal Regulations, 2011 CFR

2011-07-01

... MANAGEMENT SERVICE FEDERAL PROCESS AGENTS OF SURETY CORPORATIONS § 224.3 When may a surety corporation provide a bond without appointing a process agent? A surety corporation may provide a bond without... a bond without appointing a process agent? 224.3 Section 224.3 Money and Finance: Treasury...

26 CFR 25.2514-3 - Powers of appointment created after October 21, 1942.

Code of Federal Regulations, 2010 CFR

2010-04-01

... of appointment created after October 21, 1942. (a) In general. The exercise, release, or lapse... exercise of a power of appointment that is not a general power is considered to be a transfer if it is... adverse to the exercise of the power in favor of the possessor, his estate, his creditors, or the...

32 CFR 1648.4 - Appointment for personal appearances.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Appointment for personal appearances. 1648.4... CLASSIFICATION BY LOCAL BOARD § 1648.4 Appointment for personal appearances. (a) Not less than 10 days (unless... classification in Class 1-A-O or Class 1-O fail to appear at his scheduled personal appearance, the board will...

32 CFR 1648.4 - Appointment for personal appearances.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Appointment for personal appearances. 1648.4... CLASSIFICATION BY LOCAL BOARD § 1648.4 Appointment for personal appearances. (a) Not less than 10 days (unless... classification in Class 1-A-O or Class 1-O fail to appear at his scheduled personal appearance, the board will...

5 CFR 315.710 - Professional and administrative career employees serving under Schedule B appointments.

Code of Federal Regulations, 2011 CFR

2011-01-01

...-conditional appointments at the GS-9 level in any position in a PAC occupation when such employees— (1) Complete at least 1 year of Schedule B service at the GS-7 level that meets the quality of experience... career-conditional appointment except those requirements concerning competitive selection from a register...

77 FR 71419 - Notice of Appointment of New FASAB Member and Release of the Exposure Draft Regarding Deferral of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-30

... FEDERAL ACCOUNTING STANDARDS ADVISORY BOARD Notice of Appointment of New FASAB Member and Release... Information AGENCY: Federal Accounting Standards Advisory Board. ACTION: Notice. Board Action: Pursuant to 31... appointed to a five-year term as a member of the Federal Accounting Standards Advisory Board (FASAB...

Reminder systems to improve patient adherence to tuberculosis clinic appointments for diagnosis and treatment

PubMed Central

Liu, Qin; Abba, Katharine; Alejandria, Marissa M; Sinclair, David; Balanag, Vincent M; Lansang, Mary Ann D

2014-01-01

Background People with active tuberculosis (TB) require six months of treatment. Some people find it difficult to complete treatment, and there are several approaches to help ensure completion. One such system relies on reminders, where the health system prompts patients to attend for appointments on time, or re-engages people who have missed or defaulted on a scheduled appointment. Objectives To assess the effects of reminder systems on improving attendance at TB diagnosis, prophylaxis, and treatment clinic appointments, and their effects on TB treatment outcomes. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, Cochrane Effective Practice andOrganization of Care Group Specialized Register, CENTRAL,MEDLINE, EMBASE, LILACS, CINAHL, SCI-EXPANDED, SSCI, m RCT, and the Indian Journal of Tuberculosis without language restriction up to 29 August 2014. We also checked reference lists and contacted researchers working in the field. Selection criteria Randomized controlled trials (RCTs), including cluster RCTs and quasi-RCTs, and controlled before-and-after studies comparing reminder systems with no reminders or an alternative reminder system for people with scheduled appointments for TB diagnosis, prophylaxis, or treatment. Data collection and analysis Two review authors independently extracted data and assessed the risk of bias in the included trials. We compared the effects of interventions by using risk ratios (RR) and presented RRs with 95% confidence intervals (CIs). Also we assessed the quality of evidence using the GRADE approach. Main results Nine trials, including 4654 participants, met our inclusion criteria. Five trials evaluated appointment reminders for people on treatment for active TB, two for people on prophylaxis for latent TB, and four for people undergoing TB screening using skin tests.We classified the interventions into 'pre-appointment' reminders (telephone calls or letters prior to a scheduled appointment) or'default' reminders (telephone calls, letters, or home visits to people who had missed an appointment). For people being treated for active TB, clinic attendance and TB treatment completion were higher in people receiving pre-appointment reminder phone-calls (clinic attendance: 66% versus 50%; RR 1.32, 95% CI 1.10 to 1.59, one trial (USA), 615 participants, low quality evidence; TB treatment completion: 100% versus 88%; RR 1.14, 95% CI 1.02 to 1.27, one trial (Thailand), 92 participants, low quality evidence). Clinic attendance and TB treatment completion were also higher with default reminders (letters or home visits) (clinic attendance: 52% versus 10%; RR 5.04, 95% CI 1.61 to 15.78, one trial (India), 52 participants, low quality evidence; treatment completion: RR 1.17, 95% CI 1.11 to 1.24, two trials (Iraq and India), 680 participants, moderate quality evidence). For people on TB prophylaxis, clinic attendance was higher with a policy of pre-appointment phone-calls (63% versus 48%; RR 1.30, 95% CI 1.07 to 1.59, one trial (USA), 536 participants); and attendance at the final clinic was higher with regular three-monthly phone-calls or nurse visits (93% versus 65%, one trial (Spain), 318 participants). For people undergoing screening for TB, three trials of pre-appointment phone-calls found little or no effect on the proportion of people returning to clinic for the result of their skin test (three trials, 1189 participants, low quality evidence), and two trials found little or no effect with take home reminder cards (two trials, 711 participants). All four trials were conducted among healthy volunteers in the USA. Authors' conclusions Policies of sending reminders to people pre-appointment, and contacting people who miss appointments, seem sensible additions to any TB programme, and the limited evidence available suggests they have small but potentially important benefits. Future studies of modern technologies such as short message service (SMS) reminders would be useful, particularly in low-resource settings. Plain Language Summary Reminder systems to improve patient attendance at tuberculosis clinics This Cochrane Review summarizes trials evaluating the effects of reminder systems on attendance at tuberculosis (TB) clinics and completion of TB treatment. After searching for relevant trials up to 29 August 2014, we included nine trials, including 4654 people. What are reminder systems and how might they help? Effective treatment for TB requires people to take multiple drugs daily for at least six months. Consequently, once they start to feel well again, some patients stop attending clinics and stop taking theirmedication which can lead to the illness returning and the development of drug resistance. One strategy theWorldHealthOrganization recommends is that an appointed person (a health worker or volunteer) watches the person take their medication everyday (called direct observation). Other strategies include reminder systems to prompt patients to attend for appointments on time, or to re-engage people who have missed or defaulted on a scheduled appointment. These prompts may be in the form of telephone calls or letters before the next scheduled appointment (“pre-appointment reminders”), or phone calls, letters, or home visits after a missed appointment (“default reminders”). What the research says: For people being treated for active TB: - More people attended the clinic and completed TB treatment with pre-appointment reminder phone-calls (low quality evidence). - More people attended the clinic and completed TB treatment with a policy of default reminders (low and moderate quality evidence respectively). For people on TB prophylaxis: - More people attended the clinic with pre-appointment phone-calls, and the number attending the final clinic was higher with threemonthly phone-calls or nurse home visits. For people being treated for active TB: - Similar numbers of people attended clinic for skin test reading with and without pre-appointment phone-calls (low quality evidence). - Similar numbers of people attended clinic for skin test reading with and without take home reminder cards. PMID:25403701

Albanian women in physics

NASA Astrophysics Data System (ADS)

Deda, Antoneta; Alushllari, Mirela; Mico, Silvana

2015-12-01

In this report, presented at the 5th IUPAP International Conference on Women in Physics, we describe the status of women physicists in Albania and offer some statistical data illustrating the present situation. Undergraduate physics enrollment by girls is high and stable, more women are receiving financial support for doctoral studies, women are well represented in recent academic promotions, and recently women scientists have been appointed to several leadership positions. However, both women and men are challenged by the overall low levels of funding for research and by issues of availability and affordability of child care.

Working Papers: Astronomy and Astrophysics Panel Reports

NASA Technical Reports Server (NTRS)

Bahcall, John N.; Beichman, Charles A.; Canizares, Claude; Cronin, James; Heeschen, David; Houck, James; Hunten, Donald; Mckee, Christopher F.; Noyes, Robert; Ostriker, Jeremiah P.

1991-01-01

The papers of the panels appointed by the Astronomy and Astrophysics survey Committee are compiled. These papers were advisory to the survey committee and represent the opinions of the members of each panel in the context of their individual charges. The following subject areas are covered: radio astronomy, infrared astronomy, optical/IR from ground, UV-optical from space, interferometry, high energy from space, particle astrophysics, theory and laboratory astrophysics, solar astronomy, planetary astronomy, computing and data processing, policy opportunities, benefits to the nation from astronomy and astrophysics, status of the profession, and science opportunities.

The Cost of Journals

NASA Astrophysics Data System (ADS)

Moore, John W.

1997-08-01

On page 896 we announce appointment of a new Publications Coordinator for the Journal, Richard Schwenz of the University of Northern Colorado. After five years of yeoman service, Ken Emerson of Montana State University, is retiring. Ken has seen the Journal through a lot of change: a new editor, a new advertising representative, a new subscription fulfillment agent, and a consolidation of the Journal's print, software, and online operations. All this has taken a lot of work and intelligence, and the entire editorial staff thanks Ken for all of his efforts on our behalf.

Non-English speakers attend gastroenterology clinic appointments at higher rates than English speakers in a vulnerable patient population

PubMed Central

Sewell, Justin L.; Kushel, Margot B.; Inadomi, John M.; Yee, Hal F.

2009-01-01

Goals We sought to identify factors associated with gastroenterology clinic attendance in an urban safety net healthcare system. Background Missed clinic appointments reduce the efficiency and availability of healthcare, but subspecialty clinic attendance among patients with established healthcare access has not been studied. Study We performed an observational study using secondary data from administrative sources to study patients referred to, and scheduled for an appointment in, the adult gastroenterology clinic serving the safety net healthcare system of San Francisco, California. Our dependent variable was whether subjects attended or missed a scheduled appointment. Analysis included multivariable logistic regression and classification tree analysis. 1,833 patients were referred and scheduled for an appointment between 05/2005 and 08/2006. Prisoners were excluded. All patients had a primary care provider. Results 683 patients (37.3%) missed their appointment; 1,150 (62.7%) attended. Language was highly associated with attendance in the logistic regression; non-English speakers were less likely than English speakers to miss an appointment (adjusted odds ratio 0.42 [0.28,0.63] for Spanish, 0.56 [0.38,0.82] for Asian language, p < 0.001). Other factors were also associated with attendance, but classification tree analysis identified language to be the most highly associated variable. Conclusions In an urban safety net healthcare population, among patients with established healthcare access and a scheduled gastroenterology clinic appointment, not speaking English was most strongly associated with higher attendance rates. Patient related factors associated with not speaking English likely influence subspecialty clinic attendance rates, and these factors may differ from those affecting general healthcare access. PMID:19169147

Translating research into action: An evaluation of the World Trade Center Health Registry's Treatment Referral Program.

PubMed

Welch, Alice E; Debchoudhury, Indira; Jordan, Hannah T; Petrsoric, Lysa J; Farfel, Mark R; Cone, James E

2014-01-01

This manuscript describes the design, implementation and evaluation of the World Trade Center (WTC) Health Registry's Treatment Referral Program (TRP), created to respond to enrollees' self-reported 9/11-related physical and mental health needs and promote the use of WTC-specific health care. In 2009-2011, the TRP conducted personalized outreach, including an individualized educational mailing and telephone follow-up to 7,518 selected enrollees who resided in New York City, did not participate in rescue/recovery work, and reported symptoms of 9/11-related physical conditions or posttraumatic stress disorder (PTSD) on their most recently completed Registry survey. TRP staff spoke with enrollees to address barriers to care and schedule appointments at the WTC Environmental Health Center for those eligible. We assessed three nested outcomes: TRP participation (e.g., contact with TRP staff), scheduling appointments, and keeping scheduled appointments. A total of 1,232 (16.4%) eligible enrollees participated in the TRP; 32% of them scheduled a first-time appointment. We reached 84% of participants who scheduled appointments; 79.4% reported having kept the appointment. Scheduling an appointment, but not keeping it, was associated with self-reported unmet health care need, PTSD, and poor functioning (≥14 days of poor physical or mental health in the past 30 days) ( P < 0.05). Neither scheduling nor keeping an appointment was associated with demographic characteristics. Successful outreach to disaster-exposed populations may require a sustained effort that employs a variety of methods in order to encourage and facilitate use of post-disaster services. Findings from this evaluation can inform outreach to the population exposed to 9/11 being conducted by other organizations.

Factors affecting patients' adherence to orthodontic appointments.

PubMed

Bukhari, Omair M; Sohrabi, Keyvan; Tavares, Mary

2016-03-01

Studies show that attendance at orthodontic appointments affects treatment outcomes, treatment duration, and the probability of side effects. The aim of this study was to predict factors that influence patients' attendance at orthodontic appointments. We conducted a face-to-face guided interview survey of 153 participants from orthodontic clinics in the Greater Boston area. Attendance at scheduled orthodontic appointments was self-reported as always, sometimes, or rarely. Participants' characteristics, including demographics, dental insurance, and oral hygiene practices, were self-reported. Moreover, from dental records, we collected the time that the participants spent undergoing active orthodontic treatment. Multivariable ordered logistic regression was used to report proportional odds ratios and attendance probabilities. A likelihood ratio test was performed to ensure that the proportional odds assumption held. For overall appointment attendance, 76% of the participants reported always attending, 16% reported sometimes attending, and 8% reported rarely attending. Based on multivariable logistic regression (adjusted for age, race, and sex), the participants with optimal oral hygiene practices were almost 6 times (5.9) more likely to attend appointments than those who did not (P = 0.002). The odds of attending appointments decreased significantly (by 23%) for every 6-month increase in treatment duration (P = 0.008). Participants covered by non-Medicaid insurance were 4 times (P = 0.018) more likely to attend appointments than were those with Medicaid insurance. Our findings indicate that adherence to orthodontic treatment follow-up visits was strongly correlated to insurance type, treatment duration, and oral hygiene practices. Unlike previous studies, sex was not a significant predictor of adherence. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Weekday affects attendance rate for medical appointments: large-scale data analysis and implications.

PubMed

Ellis, David A; Jenkins, Rob

2012-01-01

The financial cost of missed appointments is so great that even a small percentage reduction in Did Not Attend (DNA) rate could save significant sums of money. Previous studies have identified many factors that predict DNA rate, including patient age, gender, and transport options. However, it is not obvious how healthcare providers can use this information to improve attendance, as such factors are not under their control. One factor that is under administrative control is appointment scheduling. Here we asked whether DNA rate could be reduced by altering scheduling policy. In Study 1, we examined attendance records for 4,538,294 outpatient hospital appointments across Scotland between January 1st 2008 and December 31st 2010. DNA rate was highest for Mondays (11%), lowest for Fridays (9.7%), and decreased monotonically over the week (Monday-Friday comparison [χ(2)(1, N  = 1,585,545)  = 722.33, p<0.0001]; Relative Risk Reduction 11.8%). This weekly decline was present for male and female patient groups of all ages, but was steeper for younger age groups. In Study 2, we examined attendance records for 10,895 appointments at a single GP clinic in Glasgow. Here again, DNA rate was highest for Mondays (6.2%), lowest for Fridays (4.2%), and decreased monotonically over the week (Monday-Friday comparison [χ(2)(1, N  = 4767)  = 9.20, p<0.01]; Relative Risk Reduction 32.3%). In two very different settings, appointments at the beginning of the week were more likely to be missed than appointments at the end of the week. We suggest that DNA rate could be significantly reduced by preferentially loading appointments onto high-attendance days.

Validation of the Hospital Episode Statistics Outpatient Dataset in England.

PubMed

Thorn, Joanna C; Turner, Emma; Hounsome, Luke; Walsh, Eleanor; Donovan, Jenny L; Verne, Julia; Neal, David E; Hamdy, Freddie C; Martin, Richard M; Noble, Sian M

2016-02-01

The Hospital Episode Statistics (HES) dataset is a source of administrative 'big data' with potential for costing purposes in economic evaluations alongside clinical trials. This study assesses the validity of coverage in the HES outpatient dataset. Men who died of, or with, prostate cancer were selected from a prostate-cancer screening trial (CAP, Cluster randomised triAl of PSA testing for Prostate cancer). Details of visits that took place after 1/4/2003 to hospital outpatient departments for conditions related to prostate cancer were extracted from medical records (MR); these appointments were sought in the HES outpatient dataset based on date. The matching procedure was repeated for periods before and after 1/4/2008, when the HES outpatient dataset was accredited as a national statistic. 4922 outpatient appointments were extracted from MR for 370 men. 4088 appointments recorded in MR were identified in the HES outpatient dataset (83.1%; 95% confidence interval [CI] 82.0-84.1). For appointments occurring prior to 1/4/2008, 2195/2755 (79.7%; 95% CI 78.2-81.2) matches were observed, while 1893/2167 (87.4%; 95% CI 86.0-88.9) appointments occurring after 1/4/2008 were identified (p for difference <0.001). 215/370 men (58.1%) had at least one appointment in the MR review that was unmatched in HES, 155 men (41.9%) had all their appointments identified, and 20 men (5.4%) had no appointments identified in HES. The HES outpatient dataset appears reasonably valid for research, particularly following accreditation. The dataset may be a suitable alternative to collecting MR data from hospital notes within a trial, although caution should be exercised with data collected prior to accreditation.

Appointment keeping for medical review among patients with selected chronic diseases in an urban area of Uganda

PubMed Central

Kalyango, Joan Nakayaga; Hall, Maurice; Karamagi, Charles

2014-01-01

Introduction Proper management of chronic diseases is important for prevention of disease complications and yet some patients miss appointments for medical review thereby missing the opportunity for proper monitoring of their disease conditions. There is limited information on missed appointments among chronic disease patients in resource limited settings. This study aimed to determine the prevalence of missed appointments for medical review and associated factors among chronic disease patients in an urban area of Uganda. Methods Patients or caregivers of children with chronic diseases were identified as they bought medicines from a community pharmacy. They were visited at home to access their medical documents and those whose chronic disease status was ascertained were enrolled. The data was collected using: questionnaires, review of medical documents, and in-depth interviews with chronic disease patients. Results The prevalence of missed appointments was 42% (95%CI = 35-49%). The factors associated with missed appointments were: monthly income ≤30US Dollars (OR = 2.56, CI = 1.25–5.26), affording less than half of prescribed drugs (OR = 3.92, CI = 1.64–9.40), not experiencing adverse events (OR = 2.66, CI = 1.26–5.61), not sure if treatment helps (OR = 2.84, CI = 1.047.77), not having a medicines administration schedule (OR = 6.77, CI = 2.11–21.68), and increasing number of drugs (OR = 0.72, CI = 0.53–0.98). Conclusion Patients missed appointments mainly due to: financial and health system barriers, conflicting commitments with appointments, and perceptions of the disease condition. Patients should be supported with accessible and affordable health services. PMID:25838857

Risk Prediction Tool for Medical Appointment Attendance Among HIV-Infected Persons with Unsuppressed Viremia

PubMed Central

Person, Anna; Rebeiro, Peter; Kheshti, Asghar; Raffanti, Stephen; Pettit, April

2015-01-01

Abstract Successful treatment of HIV infection requires regular clinical follow-up. A previously published risk-prediction tool (RPT) utilizing data from the electronic health record (EHR) including medication adherence, previous appointment attendance, substance abuse, recent CD4+ count, prior antiretroviral therapy (ART) exposure, prior treatment failure, and recent HIV-1 viral load (VL) has been shown to predict virologic failure at 1 year. If this same tool could be used to predict the more immediate event of appointment attendance, high-risk patients could be identified and interventions could be targeted to improve this outcome. We conducted an observational cohort study at the Vanderbilt Comprehensive Care Clinic from August 2013 through March 2014. Patients with routine medical appointments and most recent HIV-1 VL >200 copies/mL were included. Risk scores for a modified RPT were calculated based on data from the EHR. Odds ratios (OR) for missing the next appointment were estimated using multivariable logistic regression. Among 510 persons included, median age was 39 years, 74% were male, 55% were black, median CD4+ count was 327 cells/mm3 [Interquartile Range (IQR): 142–560], and median HIV-1 VL was 21,818 copies/mL (IQR: 2,030–69,597). Medium [OR 3.95, 95% confidence interval (CI) 2.08–7.50, p-value<0.01] and high (OR 9.55, 95% CI 4.31–21.16, p-value<0.01) vs. low RPT risk scores were independently associated with missing the next appointment. RPT scores, constructed using readily available data, allow for risk-stratification of HIV medical appointment non-attendance and could support targeting limited resources to improve appointment adherence in groups most at-risk of poor HIV outcomes. PMID:25746288

Resource Planning in Glaucoma: A Tool to Evaluate Glaucoma Service Capacity.

PubMed

Batra, Ruchika; Sharma, Hannah E; Elaraoud, Ibrahim; Mohamed, Shabbir

2017-12-28

The National Patient Safety Agency (2009) publication advising timely follow-up of patients with established glaucoma followed several reported instances of visual loss due to postponed appointments and patients lost to follow-up. The Royal College of Ophthalmologists Quality Standards Development Group stated that all hospital appointments should occur within 15% of the intended follow-up period. To determine whether: 1. Glaucoma follow-up appointments at a teaching hospital occur within the requested time 2. Appointments are requested at appropriate intervals based on the NICE Guidelines 3. The capacity of the glaucoma service is adequate Methods: A two-part audit was undertaken of 98 and 99 consecutive patients respectively attending specialist glaucoma clinics. In the first part, the reasons for delayed appointments were recorded. In the second part the requested follow-up was compared with NICE guidelines where applicable. Based on the findings, changes were implemented and a re-audit of 100 patients was carried out. The initial audit found that although clinical decisions regarding follow-up intervals were 100% compliant with NICE guidelines where applicable, 24% of appointments were delayed beyond 15% of the requested period, due to administrative errors and inadequate capacity, leading to significant clinical deterioration in two patients. Following the introduction of an electronic appointment tracker and increased clinical capacity created by extra clinics and clinicians, the re-audit found a marked decrease in the percentage of appointments being delayed (9%). This audit is a useful tool to evaluate glaucoma service provision, assist in resource planning for the service and bring about change in a non-confrontational way. It can be widely applied and adapted for use in other medical specialities.

Primary care access improvement: an empowerment-interaction model.

PubMed

Ledlow, G R; Bradshaw, D M; Shockley, C

2000-05-01

Improving community primary care access is a difficult and dynamic undertaking. Realizing a need to improve appointment availability, a systematic approach based on measurement, empowerment, and interaction was developed. The model fostered exchange of information and problem solving between interdependent staff sections within a managed care system. Measuring appointments demanded but not available proved to be a credible customer-focused approach to benchmark against set goals. Changing the organizational culture to become more sensitive to changing beneficiary needs was a paramount consideration. Dependent-group t tests were performed to compare the pretreatment and posttreatment effect. The empowerment-interaction model significantly improved the availability of routine and wellness-type appointments. The availability of urgent appointments improved but not significantly; a better prospective model needs to be developed. In aggregate, appointments demanded but not available (empowerment-interaction model) were more than 10% before the treatment and less than 3% with the treatment.

Effects of an appointment reminder call on patient show rates.

PubMed

Gariti, P; Alterman, A I; Holub-Beyer, E; Volpicelli, J R; Prentice, N; O'Brien, C P

1995-01-01

A pilot study (N = 80) was conducted to determine if (1) prospective substance-dependent patients randomly selected to be reminded (TC) of their scheduled intake evaluation the day before their first appointment would have a higher show rate than those not contacted (NC); and (2) if TC subjects administered a satisfaction questionnaire 1-3 days after intake would exhibit higher treatment retention rates at one week and one month posttreatment entry than NC subjects not exposed to the questionnaire. The findings suggest that reminding prospective patients of their initial scheduled appointments and following up with phone calls to those who fail to show can improve the rate at which patients will initiate treatment, provided initial appointments are scheduled in a timely manner (7 days or less). Similarly, the combination of the reminder call and the satisfaction questionnaire were associated with higher treatment retention rates for those whose initial appointments were scheduled in a timely manner.

An algorithm for computing the gene tree probability under the multispecies coalescent and its application in the inference of population tree

PubMed Central

2016-01-01

Motivation: Gene tree represents the evolutionary history of gene lineages that originate from multiple related populations. Under the multispecies coalescent model, lineages may coalesce outside the species (population) boundary. Given a species tree (with branch lengths), the gene tree probability is the probability of observing a specific gene tree topology under the multispecies coalescent model. There are two existing algorithms for computing the exact gene tree probability. The first algorithm is due to Degnan and Salter, where they enumerate all the so-called coalescent histories for the given species tree and the gene tree topology. Their algorithm runs in exponential time in the number of gene lineages in general. The second algorithm is the STELLS algorithm (2012), which is usually faster but also runs in exponential time in almost all the cases. Results: In this article, we present a new algorithm, called CompactCH, for computing the exact gene tree probability. This new algorithm is based on the notion of compact coalescent histories: multiple coalescent histories are represented by a single compact coalescent history. The key advantage of our new algorithm is that it runs in polynomial time in the number of gene lineages if the number of populations is fixed to be a constant. The new algorithm is more efficient than the STELLS algorithm both in theory and in practice when the number of populations is small and there are multiple gene lineages from each population. As an application, we show that CompactCH can be applied in the inference of population tree (i.e. the population divergence history) from population haplotypes. Simulation results show that the CompactCH algorithm enables efficient and accurate inference of population trees with much more haplotypes than a previous approach. Availability: The CompactCH algorithm is implemented in the STELLS software package, which is available for download at http://www.engr.uconn.edu/ywu/STELLS.html. Contact: ywu@engr.uconn.edu Supplementary information: Supplementary data are available at Bioinformatics online. PMID:27307621

A quality by design approach to investigate the effect of mannitol and dicalcium phosphate qualities on roll compaction.

PubMed

Souihi, Nabil; Dumarey, Melanie; Wikström, Håkan; Tajarobi, Pirjo; Fransson, Magnus; Svensson, Olof; Josefson, Mats; Trygg, Johan

2013-04-15

Roll compaction is a continuous process for solid dosage form manufacturing increasingly popular within pharmaceutical industry. Although roll compaction has become an established technique for dry granulation, the influence of material properties is still not fully understood. In this study, a quality by design (QbD) approach was utilized, not only to understand the influence of different qualities of mannitol and dicalcium phosphate (DCP), but also to predict critical quality attributes of the drug product based solely on the material properties of that filler. By describing each filler quality in terms of several representative physical properties, orthogonal projections to latent structures (OPLS) was used to understand and predict how those properties affected drug product intermediates as well as critical quality attributes of the final drug product. These models were then validated by predicting product attributes for filler qualities not used in the model construction. The results of this study confirmed that the tensile strength reduction, known to affect plastic materials when roll compacted, is not prominent when using brittle materials. Some qualities of these fillers actually demonstrated improved compactability following roll compaction. While direct compression qualities are frequently used for roll compacted drug products because of their excellent flowability and good compaction properties, this study revealed that granules from these qualities were more poor flowing than the corresponding powder blends, which was not seen for granules from traditional qualities. The QbD approach used in this study could be extended beyond fillers. Thus any new compound/ingredient would first be characterized and then suitable formulation characteristics could be determined in silico, without running any additional experiments. Copyright © 2013 Elsevier B.V. All rights reserved.

77 FR 4591 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-30

... Effectiveness of Proposed Rule Change Related to the Appointments in Hybrid 3.0 Classes January 23, 2012...'') appointments in Hybrid 3.0 classes.\\5\\ The text of the proposed rule change is available on the Exchange's Web... electronic quotes in their appointed classes. ``Hybrid 3.0 Platform'' is an electronic trading platform on...

5 CFR 315.601 - Appointment of former employees of the Canal Zone Merit System or Panama Canal Employment System.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Appointment of former employees of the Canal Zone Merit System or Panama Canal Employment System. 315.601 Section 315.601 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS CAREER AND CAREER-CONDITIONAL EMPLOYMENT Career or Career-Conditional Appointment Unde...

Temps at the Top: Factors Related to the Appointment of Interim Community College Presidents

ERIC Educational Resources Information Center

Goff, Susan L.

2012-01-01

The appointment of interim community college presidents, the topic of this study, is a little understood phenomenon. A growing shortage of community college presidents coupled with a lack of replacements suggests the appointment of interims will continue well into the future. This study, with a purpose of looking at the factors related to the…

42 CFR 21.52 - Waiver of entrance qualifications for original appointment in time of war or national emergency.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Waiver of entrance qualifications for original appointment in time of war or national emergency. 21.52 Section 21.52 Public Health PUBLIC HEALTH SERVICE... entrance qualifications for original appointment in time of war or national emergency. If, in time of war...

75 FR 33389 - TierOne Bank Lincoln, Nebraska; Notice of Appointment of Receiver

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-11

... DEPARTMENT OF THE TREASURY Office of Thrift Supervision TierOne Bank Lincoln, Nebraska; Notice of Appointment of Receiver Notice is hereby given that, pursuant to the authority contained in section 5(d)(2) of the Home Owners' Loan Act, the Office of Thrift Supervision has duly appointed the Federal Deposit Insurance Corporation as sole Receiver...

26 CFR 20.2041-2 - Powers of appointment created on or before October 21, 1942.

Code of Federal Regulations, 2010 CFR

2010-04-01

... estate for the reason that the power will not be treated as having been exercised. Example (4). A... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Powers of appointment created on or before... Gross Estate § 20.2041-2 Powers of appointment created on or before October 21, 1942. (a) In general...

3 CFR - Delegation of Authority To Appoint Commissioned Officers of the Ready Reserve Corps of the Public...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 3 The President 1 2014-01-01 2014-01-01 false Delegation of Authority To Appoint Commissioned Officers of the Ready Reserve Corps of the Public Health Service Presidential Documents Other Presidential Documents Memorandum of March 29, 2013 Delegation of Authority To Appoint Commissioned Officers of the Ready Reserve Corps of the Public Health...

3 CFR - Delegation of Authority To Appoint Commissioned Officers of the Ready Reserve Corps of the Public...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 3 The President 1 2012-01-01 2012-01-01 false Delegation of Authority To Appoint Commissioned Officers of the Ready Reserve Corps of the Public Health Service Presidential Documents Other Presidential Documents Memorandum of May 31, 2011 Delegation of Authority To Appoint Commissioned Officers of the Ready Reserve Corps of the Public Health...

31 CFR 370.5 - How can I appoint a financial institution to receive payments on my behalf?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Entries § 370.5 How can I appoint a financial institution to receive payments on my behalf? You must name a financial institution to receive payments through credit entries using the ACH method. You also... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false How can I appoint a financial...

42 CFR 21.34 - Certification by candidate; requirement of new physical examination.

Code of Federal Regulations, 2011 CFR

2011-10-01

... from the date on which it is contemplated that he will be appointed or called to active duty, he shall, prior to being appointed or called to active duty, certify that to the best of his knowledge and belief... one year from the date on which it is contemplated that he will be appointed or called to active duty...

Training and Appointing Processes of School Leaders in Developed and Developing Countries: How Is the Situation in Turkey?

ERIC Educational Resources Information Center

Saglam, Aycan Çiçek; Geçer, Ali; Bag, Derya

2017-01-01

Goal of the study is to compare training and appointing processes of education administrators in developed and developing countries to see similarities and differences and also the situation in Turkey so as to give some suggestion thought to have some positive impacts on training and appointing-related problems of Turkish Education. Within the…

31 CFR 224.5 - Who may a surety corporation appoint to be a process agent?

Code of Federal Regulations, 2010 CFR

2010-07-01

... to be a process agent? 224.5 Section 224.5 Money and Finance: Treasury Regulations Relating to Money... FEDERAL PROCESS AGENTS OF SURETY CORPORATIONS § 224.5 Who may a surety corporation appoint to be a process agent? A surety corporation may appoint either of the following as process agent—(a) An official of the...

Barriers to Obtaining Diagnostic Testing for Coronary Artery Disease Among Veterans

PubMed Central

Hausmann, Leslie R. M.; Ibrahim, Said

2008-01-01

Objectives. We sought to identify factors associated with appointment nonattendance for diagnostic testing of coronary artery disease among veterans. For patients with possible heart disease, appointment nonattendance may seriously compromise short- and long-term outcomes. Understanding factors associated with nonattendance may help improve care while reducing inefficiency in service delivery. Methods. We surveyed patients who attended (n = 240) or did not attend (n = 139) a scheduled cardiac appointment at a midwestern Veterans Administration medical center. Multivariable regression models were used to assess factors associated with nonattendance. Results. Younger age, lower income, unemployment, and longer wait times for appointments were predictive of nonattendance. Nonattenders reported fewer cardiac symptoms and were more likely to attribute their symptoms to something other than heart disease. Nonattendance was also associated with a coping style characterized by avoidance of aversive information. Logistical issues, fear of diagnostic procedures, disbelief that one had heart disease, and medical mistrust were some of the reasons given for missed appointments. Conclusions. Appointment nonattendance among veterans scheduled for cardiology evaluation was associated with several important cognitive factors. These factors should be considered when one is designing clinical systems to reduce patient nonattendance. PMID:18381987

Factors affecting adherence to appointment system in the clinic for non-communicable diseases in UNRWA's Khan Younis Health Centre and the role of mobile phone text messages to improve adherence: a descriptive cross-sectional study.

PubMed

Al Najjar, Sanaa; Al Shaer, Tamer

2018-02-21

To meet the emerging needs of the increasing numbers of patients with non-communicable diseases and to provide optimum care with optimum contact time and minimum waiting time, as stated in UNRWA guidelines, the mobile phone text messaging system was implemented in UNRWA centres to remind patients of upcoming appointments and to thereby improve the quality of care for vulnerable patients and regulate the work load in the clinics for non-communicable diseases. The aim of this study was to assess the causes for lack of adherence to the appointment system at UNRWA centres. This descriptive cross-sectional study was done in the UNRWA's Khan Younis Health Centre (KYHC), which serves the same refugee population as other UNRWA health centres and follows the same guidelines with minimal variation. Data were collected through interviewer-administered questionnaires, with ten medical staff members involved in the appointment process and 50 patients with non-communicable diseases selected randomly from patients attending the KYHC. The text-message reminder intervention targeted 1000 patients with non-communicable diseases and consisted of an electronic message technique that was developed to remind patients about the day and time of upcoming appointments. Administrative approval was obtained from the chief of UNRWA health programme. Verbal consent was obtained from participants. We followed the Modified International Code of Ethics Principles (1975), known as the Declaration of Helsinki. The main barrier to adherence to appointments in the clinic for non-communicable diseases was forgetting the appointment. Other factors were lack of awareness, clinic overcrowding, appointments that do not match the patient's preference, availability of other service providers, and financial issues. In March, 2016, after the completion of the intervention, the proportion of patients that adhered to their appointment by date and time was 76%, compared with about 45% in January and February, 2016 (p=0·013). The text messaging reminder is a successful way of improving patient's adherence to appointments in UNRWA clinics for non-communicable diseases. The intervention should be continued and integrated in daily work. More financial resources are needed to support the text messaging reminder system. None. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Effectiveness of SMS Reminders on Appointment Attendance: a Meta-Analysis.

PubMed

Boksmati, Nasim; Butler-Henderson, Kerryn; Anderson, Kevin; Sahama, Tony

2016-04-01

To identify the efficacy of short message service (SMS) reminders in health care appointment attendance. A systematic review was undertaken to identify studies published between 2005 and 2015 that compared the attendance rates of patients receiving SMS reminders compared to patients not receiving a reminder. Each article was examined for information regarding the study design, sample size, population demographics and intervention methods. A meta-analysis was used to calculate a pooled estimate odds ratio. Twenty-eight (28) studies were included in the review, including 13 (46 %) randomized controlled trials. The pooled odds ratio of the randomized control trials was 1.62 (1.35-1.94). Half of the studies reviewed sent the reminder within 48 h prior to the appointment time, yet no significant subgroups differences with respect to participant age, SMS timing, rate or type, setting or specialty was detectable. All studies, except one with a small sample size, demonstrated a positive OR, indicating SMS reminders were an effective means of improving appointment attendance. There was no significant difference in OR when controlling for when the SMS was sent, the frequency of the reminders or the content of the reminder. SMS appointment reminders are an effective and operative method in improving appointment attendance in a health care setting and this effectiveness has improved over the past 5 years. Further research is required to identify the optimal SMS reminder timing and frequency, specifically in relation to the length of time since the appointment.

COMPACTLY SUPPORTED CORRELATION FUNCTIONS. (R825173)

EPA Science Inventory

The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

Bag of Lines (BoL) for Improved Aerial Scene Representation

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

Sridharan, Harini; Cheriyadat, Anil M.

2014-09-22

Feature representation is a key step in automated visual content interpretation. In this letter, we present a robust feature representation technique, referred to as bag of lines (BoL), for high-resolution aerial scenes. The proposed technique involves extracting and compactly representing low-level line primitives from the scene. The compact scene representation is generated by counting the different types of lines representing various linear structures in the scene. Through extensive experiments, we show that the proposed scene representation is invariant to scale changes and scene conditions and can discriminate urban scene categories accurately. We compare the BoL representation with the popular scalemore » invariant feature transform (SIFT) and Gabor wavelets for their classification and clustering performance on an aerial scene database consisting of images acquired by sensors with different spatial resolutions. The proposed BoL representation outperforms the SIFT- and Gabor-based representations.« less

Brain delivery research in public-private partnerships: The IMI-JU COMPACT consortium as an example.

PubMed

Meyer, Axel H; Untucht, Christopher; Terstappen, Georg C

2017-07-01

The Blood-Brain Barrier (BBB) represents a major hurdle in the development of treatments for CNS disorders due to the fact that it very effectively keeps drugs, especially biological macromolecules, out of the brain. Concomitantly with the increasing importance of biologics research on the BBB and, more specifically, on brain delivery technologies has intensified in recent years. Public-Private Partnerships (PPPs) represent an innovative opportunity to address such complex challenges as they bring together the best expertise from both industry and academia. Here we present the IMI-JU COMPACT (Collaboration on the Optimisation of Macromolecular Pharmaceutical Access to Cellular Targets) consortium working on nanocarriers for targeted delivery of macromolecules as an example. The scope of the consortium, its goals and the expertise within the consortium are outlined. This article is part of the Special Issue entitled "Beyond small molecules for neurological disorders". Copyright © 2016 Elsevier Ltd. All rights reserved.

75 FR 35864 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-23

... Effectiveness of Proposed Rule Change To Establish the Appointment Cost for Options on the iPath S&P 500 VIX... Proposed Rule Change CBOE proposes to amend Rule 8.3 to establish the appointment cost for options on the i... the appointment cost for options on the iPath S&P 500 VIX Short-Term Futures Index ETN (``VXX...

17 CFR 249.1330 - Form MA-NR, for appointment of agent for service of process by non-resident municipal advisor...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 17 Commodity and Securities Exchanges 4 2014-04-01 2014-04-01 false Form MA-NR, for appointment of... Information Regarding Certain Natural Persons § 249.1330 Form MA-NR, for appointment of agent for service of... Register citations affecting Form MA-NR, see the List of CFR Sections Affected, which appears in the...

25 CFR 291.10 - What is the role of the mediator appointed by the Secretary?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false What is the role of the mediator appointed by the... ENTERPRISES CLASS III GAMING PROCEDURES § 291.10 What is the role of the mediator appointed by the Secretary? (a) The mediator must ask the Indian tribe and the State to submit their last best proposal for Class...

WSTB appoints New Members

NASA Astrophysics Data System (ADS)

Anderson, Mary P.

Paul Busch (Malcolm Pirnie), Leo Eisel (Wright Water Engineers), and Mary P. Anderson (University of Wisconsin—Madison) have been appointed to 3-year terms as members of the Water Science and Technology Board (WSTB) of the National Research Council (NRC), and David W. Miller (Geraghty & Miller, Inc.) has been appointed to a second term. The WSTB was established in 1982 to oversee the National Research Council's activities related to water resources.

Around Marshall

NASA Image and Video Library

1998-09-01

Mr. Arthur G. Stephenson has been serving as the ninth Director of NASA's Marshall Space Flight Center since his appointment on September 11, 1998. Prior to his appointment, Mr. Stephenson worked for TRW, Redondo Beach, California, for 28 years and was president of Oceaneering Advanced Technologies in Houston, Texas, at the time of his appointment. Mr. Stephenson has over 30 years of experience as a manager in spacecraft and high-technology systems.

A compact physical model for the simulation of pNML-based architectures

NASA Astrophysics Data System (ADS)

Turvani, G.; Riente, F.; Plozner, E.; Schmitt-Landsiedel, D.; Breitkreutz-v. Gamm, S.

2017-05-01

Among emerging technologies, perpendicular Nanomagnetic Logic (pNML) seems to be very promising because of its capability of combining logic and memory onto the same device, scalability, 3D-integration and low power consumption. Recently, Full Adder (FA) structures clocked by a global magnetic field have been experimentally demonstrated and detailed characterizations of the switching process governing the domain wall (DW) nucleation probability Pnuc and time tnuc have been performed. However, the design of pNML architectures represent a crucial point in the study of this technology; this can have a remarkable impact on the reliability of pNML structures. Here, we present a compact model developed in VHDL which enables to simulate complex pNML architectures while keeping into account critical physical parameters. Therefore, such parameters have been extracted from the experiments, fitted by the corresponding physical equations and encapsulated into the proposed model. Within this, magnetic structures are decomposed into a few basic elements (nucleation centers, nanowires, inverters etc.) represented by the according physical description. To validate the model, we redesigned a FA and compared our simulation results to the experiment. With this compact model of pNML devices we have envisioned a new methodology which makes it possible to simulate and test the physical behavior of complex architectures with very low computational costs.

An aging population and growing disease burden will require a large and specialized health care workforce by 2025.

PubMed

Dall, Timothy M; Gallo, Paul D; Chakrabarti, Ritasree; West, Terry; Semilla, April P; Storm, Michael V

2013-11-01

As the US population ages, the increasing prevalence of chronic disease and complex medical conditions will have profound implications for the future health care system. We projected future prevalence of selected diseases and health risk factors to model future demand for health care services for each person in a representative sample of the current and projected future population. Based on changing demographic characteristics and expanded medical coverage under the Affordable Care Act, we project that the demand for adult primary care services will grow by approximately 14 percent between 2013 and 2025. Vascular surgery has the highest projected demand growth (31 percent), followed by cardiology (20 percent) and neurological surgery, radiology, and general surgery (each 18 percent). Market indicators such as long wait times to obtain appointments suggest that the current supply of many specialists throughout the United States is inadequate to meet the current demand. Failure to train sufficient numbers and the correct mix of specialists could exacerbate already long wait times for appointments, reduce access to care for some of the nation's most vulnerable patients, and reduce patients' quality of life.

Impact of Appointment-Based Medication Synchronization on Proportion of Days Covered for Chronic Medications.

PubMed

Dao, Nancy; Lee, Sun; Hata, Micah; Sarino, Lord

2018-05-22

Appointment-based medication synchronization (ABMS) programs have been associated with increased adherence and persistence to chronic medications. Adherence to statin therapy, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and non-insulin antidiabetic medications (NIDM) are used to determine a health plan's Centers for Medicare and Medicaid Services (CMS) Star Rating under a pay-for-performance model. The objective of this study was to evaluate the impact of implementing an ABMS program on overall pharmacy adherence measures for statins, ACEI/ARBs, and NIDM, as presented through the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP©) platform. This retrospective, pre-post ABMS program study evaluated EQuIPP© generated adherence performance measures, represented as proportion of days covered (PDC), 6-months before and 6- and 12-months after the ABMS service for statin therapy, ACEIs/ARBs, and NIDM. All adherence measures showed statistically significant improvement in PDC percentage post ABMS implementation, except for NIDM percentage in 6-months post-ABMS service. This study shows that a comprehensive medication synchronization program can enhance adherence measures that are important to health plans to increase CMS Star Rating under a pay-for-performance model.

Understanding the mediating effects of relationship quality on technology acceptance: an empirical study of e-appointment system.

PubMed

Chen, Shih-Chih; Liu, Shih-Chi; Li, Shing-Han; Yen, David C

2013-12-01

This study extends the Technology Acceptance Model (TAM) by incorporating relationship quality as a mediator to construct a comprehensive framework for understanding the influence on continuance intention in the hospital e-appointment system. A survey of 334 Taiwanese citizens who were contacted via phone or the Internet and Structural Equation Modeling (SEM) is used for path analysis and hypothesis tests. The study shows that perceived ease of use (PEOU) and perceived usefulness (PU) have significant influence on continuance intention through the mediation of relationship quality, consisting of satisfaction and trust. The direct impact of relationship quality on continuance intention is also significant. The analytical results reveal that the relationship between the hospital, patients and e-appointment users can be improved via enhancing the continued usage of e-appointment. This paper also proposes a general model to synthesize the essence of PEOU, PU, and relationship quality for explaining users' continuous intention of e-appointment.

Differential impact of current diagnosis and clinical stage on attendance at a youth mental health service.

PubMed

Cross, Shane P M; Hermens, Daniel F; Scott, Jan; Salvador-Carulla, Luis; Hickie, Ian B

2017-06-01

To examine whether clinical stage of illness and current diagnosis influence appointment behaviour in a specialized primary-level youth mental health service. Factors associated with attendance at 8697 appointments made by 828 young people (females = 497) aged 12-25 years over a 1-year period were analysed. The number of appointments made did not correlate with the rates of attendance. However, those with more severe psychiatric morbidity made significantly more appointments and missed significantly more appointments than those with less severe presentations. Impaired social functioning was the best predictor of female attendance rates, whereas age and clinical stage of illness best predicted male attendance rates. Current diagnosis rather than functional impairment appeared to influence the level of input offered by clinicians. Age, gender, severity of illness, functioning and psychological distress had differential associations with both planned treatment intensity and attendance rates. These differences are likely to have implications for service provision in this youth population. © 2016 John Wiley & Sons Australia, Ltd.

Approximate dynamic programming approaches for appointment scheduling with patient preferences.

PubMed

Li, Xin; Wang, Jin; Fung, Richard Y K

2018-04-01

During the appointment booking process in out-patient departments, the level of patient satisfaction can be affected by whether or not their preferences can be met, including the choice of physicians and preferred time slot. In addition, because the appointments are sequential, considering future possible requests is also necessary for a successful appointment system. This paper proposes a Markov decision process model for optimizing the scheduling of sequential appointments with patient preferences. In contrast to existing models, the evaluation of a booking decision in this model focuses on the extent to which preferences are satisfied. Characteristics of the model are analysed to develop a system for formulating booking policies. Based on these characteristics, two types of approximate dynamic programming algorithms are developed to avoid the curse of dimensionality. Experimental results suggest directions for further fine-tuning of the model, as well as improving the efficiency of the two proposed algorithms. Copyright © 2018 Elsevier B.V. All rights reserved.

Patient-Centered Appointment Scheduling Using Agent-Based Simulation

PubMed Central

Turkcan, Ayten; Toscos, Tammy; Doebbeling, Brad N.

2014-01-01

Enhanced access and continuity are key components of patient-centered care. Existing studies show that several interventions such as providing same day appointments, walk-in services, after-hours care, and group appointments, have been used to redesign the healthcare systems for improved access to primary care. However, an intervention focusing on a single component of care delivery (i.e. improving access to acute care) might have a negative impact other components of the system (i.e. reduced continuity of care for chronic patients). Therefore, primary care clinics should consider implementing multiple interventions tailored for their patient population needs. We collected rapid ethnography and observations to better understand clinic workflow and key constraints. We then developed an agent-based simulation model that includes all access modalities (appointments, walk-ins, and after-hours access), incorporate resources and key constraints and determine the best appointment scheduling method that improves access and continuity of care. This paper demonstrates the value of simulation models to test a variety of alternative strategies to improve access to care through scheduling. PMID:25954423

Effect of clamping pressure on ohmic resistance and compression of gas diffusion layers for polymer electrolyte fuel cells

NASA Astrophysics Data System (ADS)

Mason, Thomas J.; Millichamp, Jason; Neville, Tobias P.; El-kharouf, Ahmad; Pollet, Bruno G.; Brett, Daniel J. L.

2012-12-01

This paper describes the use of an in situ analytical technique based on simultaneous displacement and resistance measurement of gas diffusion layers (GDLs) used in polymer electrolyte fuel cells (PEFCs), when exposed to varying compaction pressure. In terms of the losses within fuel cells, the ohmic loss makes up a significant portion. Of this loss, the contact resistance between the GDL and the bipolar plate (BPP) is an important constituent. By analysing the change in thickness and ohmic resistance of GDLs under compression, important mechanical and electrical properties are obtained. Derived parameters such as the 'displacement factor' are used to characterise a representative range of commercial GDLs. Increasing compaction pressure leads to a non-linear decrease in resistance for all GDLs. For Toray paper, compaction becomes more irreversible with pressure with no elastic region observed. Different GDLs have different intrinsic resistance; however, all GDLs of the same class share a common compaction profile (change in resistance with pressure). Cyclic compression of Toray GDL leads to progressive improvement in resistance and reduction in thickness that stabilises after ∼10 cycles.

Stress wave propagation and mitigation in two polymeric foams

NASA Astrophysics Data System (ADS)

Pradel, Pierre; Malaise, Frederic; Cadilhon, Baptiste; Quessada, Jean-Hugues; de Resseguier, Thibaut; Delhomme, Catherine; Le Blanc, Gael

2017-06-01

Polymeric foams are widely used in industry for thermal insulation or shock mitigation. This paper investigates the ability of a syntactic epoxy foam and an expanded polyurethane foam to mitigate intense (several GPa) and short duration (<10-6 s) stress pulses. Plate impact and electron beam irradiation experiments have been conducted to study the dynamic mechanical responses of both foams. Interferometer Doppler Laser method is used to record the target rear surface velocity. A two-wave structure associated with the propagation of an elastic precursor followed by the compaction of the pores has been observed. The compaction stress level deduced from the velocity measurement is a good indicator of mitigation capability of the foams. Quasi-static tests and dynamic soft recovery experiments have also been performed to determine the compaction mechanisms. In the polyurethane foam, the pores are closed by elastic buckling of the matrix and damage of the structure. In the epoxy foam, the compaction is due to the crushing of glass microspheres. Two porous material models successfully represent the macroscopic response of these polymeric foams.

A partial structural and functional rescue of a retinitis pigmentosa model with compacted DNA nanoparticles.

PubMed

Cai, Xue; Nash, Zack; Conley, Shannon M; Fliesler, Steven J; Cooper, Mark J; Naash, Muna I

2009-01-01

Previously we have shown that compacted DNA nanoparticles can drive high levels of transgene expression after subretinal injection in the mouse eye. Here we delivered compacted DNA nanoparticles containing a therapeutic gene to the retinas of a mouse model of retinitis pigmentosa. Nanoparticles containing the wild-type retinal degeneration slow (Rds) gene were injected into the subretinal space of rds(+/-) mice on postnatal day 5. Gene expression was sustained for up to four months at levels up to four times higher than in controls injected with saline or naked DNA. The nanoparticles were taken up into virtually all photoreceptors and mediated significant structural and biochemical rescue of the disease without histological or functional evidence of toxicity. Electroretinogram recordings showed that nanoparticle-mediated gene transfer restored cone function to a near-normal level in contrast to transfer of naked plasmid DNA. Rod function was also improved. These findings demonstrate that compacted DNA nanoparticles represent a viable option for development of gene-based interventions for ocular diseases and obviate major barriers commonly encountered with non-viral based therapies.

A conformally flat realistic anisotropic model for a compact star

NASA Astrophysics Data System (ADS)

Ivanov, B. V.

2018-04-01

A physically realistic stellar model with a simple expression for the energy density and conformally flat interior is found. The relations between the different conditions are used without graphic proofs. It may represent a real pulsar.

NUCLEIC ACID PURIFICATION USING COMPACTION AGENTS (R825354)

EPA Science Inventory

The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

Variance in binary stellar population synthesis

NASA Astrophysics Data System (ADS)

Breivik, Katelyn; Larson, Shane L.

2016-03-01

In the years preceding LISA, Milky Way compact binary population simulations can be used to inform the science capabilities of the mission. Galactic population simulation efforts generally focus on high fidelity models that require extensive computational power to produce a single simulated population for each model. Each simulated population represents an incomplete sample of the functions governing compact binary evolution, thus introducing variance from one simulation to another. We present a rapid Monte Carlo population simulation technique that can simulate thousands of populations in less than a week, thus allowing a full exploration of the variance associated with a binary stellar evolution model.

17 CFR 269.5 - Form F-X, for appointment of agent for service of process by issuers registering securities on...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 17 Commodity and Securities Exchanges 3 2011-04-01 2011-04-01 false Form F-X, for appointment of... INDENTURE ACT OF 1939 § 269.5 Form F-X, for appointment of agent for service of process by issuers..., F-10 or F-80. Form F-X shall be filed with the Commission: (a) By any issuer registering securities...

17 CFR 269.5 - Form F-X, for appointment of agent for service of process by issuers registering securities on...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Form F-X, for appointment of... INDENTURE ACT OF 1939 § 269.5 Form F-X, for appointment of agent for service of process by issuers..., F-10 or F-80. Form F-X shall be filed with the Commission: (a) By any issuer registering securities...

Scheduling rules to achieve lead-time targets in outpatient appointment systems.

PubMed

Nguyen, Thu-Ba T; Sivakumar, Appa Iyer; Graves, Stephen C

2017-12-01

This paper considers how to schedule appointments for outpatients, for a clinic that is subject to appointment lead-time targets for both new and returning patients. We develop heuristic rules, which are the exact and relaxed appointment scheduling rules, to schedule each new patient appointment (only) in light of uncertainty about future arrivals. The scheduling rules entail two decisions. First, the rules need to determine whether or not a patient's request can be accepted; then, if the request is not rejected, the rules prescribe how to assign the patient to an available slot. The intent of the scheduling rules is to maximize the utilization of the planned resource (i.e., the physician staff), or equivalently to maximize the number of patients that are admitted, while maintaining the service targets on the median, the 95th percentile, and the maximum appointment lead-times. We test the proposed scheduling rules with numerical experiments using real data from the chosen clinic of Tan Tock Seng hospital in Singapore. The results show the efficiency and the efficacy of the scheduling rules, in terms of the service-target satisfaction and the resource utilization. From the sensitivity analysis, we find that the performance of the proposed scheduling rules is fairly robust to the specification of the established lead-time targets.

Factors related to noncompliance with screening mammogram appointments among low-income African-American women.

PubMed Central

Crump, S. R.; Mayberry, R. M.; Taylor, B. D.; Barefield, K. P.; Thomas, P. E.

2000-01-01

Despite current mammography recommendations, screening rates among African-American women are suboptimal. The purpose of this case-control study was to identify the psychological, demographic, and health care system barriers to screening mammography use among low-income African-American women. A total of 574 women with screening mammogram appointments at an urban hospital were interviewed to determine the predictors of mammogram appointment noncompliance. Predictor variables included: demographics; breast cancer knowledge, attitudes, beliefs, and screening practices; and type of health care provider making the referral. Age was inversely related to mammogram appointment noncompliance. Relative to women 40 to 49 years old, women 70 years of age and older were the least likely to miss their appointments (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2, 0.5). Women referred for mammography by a physician's assistant or nurse practitioner were less likely to miss their appointments than women referred by a physician (OR, 0.3; 95% CI, 0.1, 0.8). Embarrassment, lack of breast symptoms, and forgetfulness also contributed to noncompliance. Key demographic, attitudinal, and health care system factors hinder low-income African-American women from obtaining screening mammograms. These findings have significant health education and policy implications for health care delivery to women in this population. PMID:10881473

[The Appointment of Paediatric Professorships in the Soviet Occupation Zone and the early GDR. The Impact of the Political System Change after 1945].

PubMed

Hinz-Wessels, Annette

2016-01-01

This paper examines the impact of the political system change after 1945 on the appointment of paediatric professorships in the Soviet Occupation Zone and the GDR up until the time the Wall was built in 1961. It can be demonstrated that the political purge in the post-war period had only minor impact on the appointment of professorships and the National Socialist past no longer mattered after the conclusion of denazification. In 1957, the proportion of former NSDAP members among East German university professors of paediatrics was 100 per cent. When it came to new appointments, both members of the "bourgeois" academic non-professorial teaching staff from the GDR as well as paediatricians from West Germany, who had largely gained their scientifically qualifications under National Socialism, were in the running. A politically-controlled elite exchange did not take place until the construction of the Wall. State and party organs generally followed the personnel proposals of the universities since an insufficient number of qualified candidates was available for the systematic appointment of ,,progressive" paediatricians. Given the lack of staff, the SED personnel policy was aimed at the integration of previous elites, as long as they behaved loyally towards the new state. Since the East German faculties continued to make the questioning of the professionally competent professors in West Germany and East Germany the basis for their appointment lists, West German university paediatricians were able to exert considerable influence on the appointment of East German paediatric professorship until 1960s.

Effectiveness and Cost of a Personalized Reminder Intervention to Improve Adherence to Glaucoma Care.

PubMed

Pizzi, Laura T; Tran, Judie; Shafa, Anousheh; Waisbourd, Michael; Hark, Lisa; Murchison, Ann P; Dai, Yang; Mayro, Eileen L; Haller, Julia A

2016-04-01

Glaucoma is the leadi ng cause of irreversible blindness in the USA. Glaucomatous vision loss is preventable with proper eye care, including appointment adherence. Therefore, interventions that improve appointment adherence can reduce the number of patients with more severe glaucoma. The primary study aim was to determine the efficacy and cost-effectiveness of a multifaceted personal reminder intervention, which included a customized letter and personal telephone outreach, in improving appointment adherence of patients with glaucoma. A secondary study aim was to identify patient characteristics that were associated with non-adherence. This prospective, randomized, controlled study included a cost-effectiveness analysis completed using a decision analytic model. The subjects included 256 patients with glaucoma. Study measures included appointment adherence and incremental cost effectiveness ratios. Patients in the intervention group were more likely to adhere to appointments (82.31 vs. 69.05 %; RR 1.23; 95 % CI 1.04-1.37, p < 0.012) than patients in the usual care group. Patients in the intervention group were 23 % more likely to adhere to appointments (RR 1.23; 95 % CI 1.08-1.41, p < 0.0021) than patients in the usual care group, when adjusting for age, secondary insurance, primary open angle glaucoma diagnosis, number of previous visits at Wills Eye Hospital, and follow-up recommendation using Poisson regression. Per-patient cost of the program was US$11.32, and cost per follow-up attended within the adherence window was US$73.56. A low cost reminder intervention consisting of a personalized letter and telephone outreach significantly improved appointment adherence of patients with glaucoma.

Preclinic group education sessions reduce waiting times and costs at public pain medicine units.

PubMed

Davies, Stephanie; Quintner, John; Parsons, Richard; Parkitny, Luke; Knight, Paul; Forrester, Elizabeth; Roberts, Mary; Graham, Carl; Visser, Eric; Antill, Tracy; Packer, Tanya; Schug, Stephan A

2011-01-01

To assess the effects of preclinic group education sessions and system redesign on tertiary pain medicine units and patient outcomes. Prospective cohort study. Two public hospital multidisciplinary pain medicine units. People with persistent pain. A system redesign from a "traditional" model (initial individual medical appointments) to a model that delivers group education sessions prior to individual appointments. Based on Patient Triage Questionnaires patients were scheduled to attend Self-Training Educative Pain Sessions (STEPS), a two day eight hour group education program, followed by optional patient-initiated clinic appointments. Number of patients completing STEPS who subsequently requested individual outpatient clinic appointment(s); wait-times; unit cost per new patient referred; recurrent health care utilization; patient satisfaction; Global Perceived Impression of Change (GPIC); and utilized pain management strategies. Following STEPS 48% of attendees requested individual outpatient appointments. Wait times reduced from 105.6 to 16.1 weeks at one pain unit and 37.3 to 15.2 weeks at the second. Unit cost per new patient appointed reduced from $1,805 Australian Dollars (AUD) to AUD$541 (for STEPS). At 3 months, patients scored their satisfaction with "the treatment received for their pain" more positively than at baseline (change score=0.88; P=0.0003), GPIC improved (change score=0.46; P<0.0001) and mean number of active strategies utilized increased by 4.12 per patient (P=0.0004). The introduction of STEPS was associated with reduced wait-times and costs at public pain medicine units and increased both the use of active pain management strategies and patient satisfaction. Wiley Periodicals, Inc.

Addressing parental concerns about pain during childhood vaccination: is there enough time to include pain management in the ambulatory setting?

PubMed

Taddio, Anna; Hogan, Mary-Ellen; Gerges, Sandra; Girgis, Angela; Moyer, Paul; Wang, Linda; Murphy, Claire; Ho, Tommy; Greenberg, Saul; Ipp, Moshe

2012-01-01

Pain from vaccine injections remains undertreated, despite the availability of numerous pain-relieving strategies. Healthcare providers report lack of time within current office workflows as a major barrier to routine pain management. The objective was to document the total time involved in outpatient vaccine appointments to test the hypothesis that offering pain-relieving strategies can be practically implemented when considering the element of time to vaccine injection. Prospective naturalistic study in 8 urban outpatient primary care clinics (4 pediatric and 4 family practice) in Toronto. For 48 to 59 consecutive childhood vaccination appointments at each site, child waiting time from clinic arrival until first vaccine injection was tracked. Altogether, 405 vaccine appointments were included. The median age of the child undergoing vaccination was 12 months. The mean (SD) time from clinic arrival until first vaccine injection was 41.6 minutes (20.9), with a range of 7 to 132 minutes. Linear regression identified a significant (P<0.05) difference according to clinic [ranging from 19.4 min (6.5) to 57.5 min (20.2)] and number of family members in the appointment [ranging from 40.6 min (21.0) for an appointment in the index child only to 50 min (14.3) for an appointment in the index child and 2 other family members]. Contrary to healthcare provider perceptions, the timing of outpatient childhood vaccine appointments allows for the inclusion of pain management interventions. Efforts should now focus on educating healthcare providers and parents about the value of pain management and how to implement evidence-based strategies.

Improvements in dental care using a new mobile app with cloud services.

PubMed

Lin, Chia-Yung; Peng, Kang-Lin; Chen, Ji; Tsai, Jui-Yuan; Tseng, Yu-Chee; Yang, Jhih-Ren; Chen, Min-Huey

2014-10-01

Traditional dental care, which includes long-term oral hygiene maintenance and scheduled dental appointments, requires effective communication between dentists and patients. In this study, a new system was designed to provide a platform for direct communication between dentists and patients. A new mobile app, Dental Calendar, combined with cloud services specific for dental care was created by a team constituted by dentists, computer scientists, and service scientists. This new system would remind patients about every scheduled appointment, and help them take pictures of their own oral cavity parts that require dental treatment and send them to dentists along with a symptom description. Dentists, by contrast, could confirm or change appointments easily and provide professional advice to their patients immediately. In this study, 26 dentists and 32 patients were evaluated by a questionnaire containing eight dental-service items before and after using this system. Paired sample t test was used for statistical analysis. After using the Dental Calendar combined with cloud services, dentists were able to improve appointment arrangements significantly, taking care of the patients with sudden worse prosthesis (p < 0.05). Patients also achieved significant improvement in appointment reminder systems, rearrangement of appointments in case of sudden worse prosthesis, and establishment of a direct relationship with dentists (p < 0.05). Our new mobile app, Dental Calendar, in combination with cloud services, provides efficient service to both dentists and patients, and helps establish a better relationship between them. It also helps dentists to arrange appointments for patients with sudden worsening of prosthesis function. Copyright © 2014. Published by Elsevier B.V.

Self-management model in the scheduling of successive appointments in rheumatology.

PubMed

Castro Corredor, David; Cuadra Díaz, José Luis; Mateos Rodríguez, Javier José; Anino Fernández, Joaquín; Mínguez Sánchez, María Dolores; de Lara Simón, Isabel María; Tébar, María Ángeles; Añó, Encarnación; Sanz, María Dolores; Ballester, María Nieves

2018-01-08

The rheumatology service of Ciudad Real Hospital, located in an autonomous community of that same name that is nearly in the center of Spain, implemented a self-management model of successive appointments more than 10 years ago. Since then, the physicians of the department schedule follow-up visits for their patients depending on the disease, its course and ancillary tests. The purpose of this study is to evaluate and compare the self-management model for successive appointments in the rheumatology service of Ciudad Real Hospital versus the model of external appointment management implemented in 8 of the hospital's 15 medical services. A comparative and multivariate analysis was performed to identify variables with statistically significant differences, in terms of activity and/or performance indicators and quality perceived by users. The comparison involved the self-management model for successive appointments employed in the rheumatology service of Ciudad Real Hospital and the model for external appointment management used in 8 hospital medical services between January 1 and May 31, 2016. In a database with more than 100,000 records of appointments involving the set of services included in the study, the mean waiting time and the numbers of non-appearances and rescheduling of follow-up visits in the rheumatology department were significantly lower than in the other services. The number of individuals treated in outpatient rheumatology services was 7,768, and a total of 280 patients were surveyed (response rate 63.21%). They showed great overall satisfaction, and the incidence rate of claims was low. Our results show that the self-management model of scheduling appointments has better results in terms of activity indicators and in quality perceived by users, despite the intense activity. Thus, this study could be fundamental for decision making in the management of health care organizations. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs

PubMed Central

Richards, David A; Meakins, Joan; Tawfik, Jane; Godfrey, Lesley; Dutton, Evelyn; Richardson, Gerald; Russell, Daphne

2002-01-01

Objective To compare the workloads of general practitioners and nurses and costs of patient care for nurse telephone triage and standard management of requests for same day appointments in routine primary care. Design Multiple interrupted time series using sequential introduction of experimental triage system in different sites with repeated measures taken one week in every month for 12 months. Setting Three primary care sites in York. Participants 4685 patients: 1233 in standard management, 3452 in the triage system. All patients requesting same day appointments during study weeks were included in the trial. Main outcome measures Type of consultation (telephone, appointment, or visit), time taken for consultation, presenting complaints, use of services during the month after same day contact, and costs of drugs and same day, follow up, and emergency care. Results The triage system reduced appointments with general practitioner by 29-44%. Compared with standard management, the triage system had a relative risk (95% confidence interval) of 0.85 (0.72 to 1.00) for home visits, 2.41 (2.08 to 2.80) for telephone care, and 3.79 (3.21 to 4.48) for nurse care. Mean overall time in the triage system was 1.70 minutes longer, but mean general practitioner time was reduced by 2.45 minutes. Routine appointments and nursing time increased, as did out of hours and accident and emergency attendance. Costs did not differ significantly between standard management and triage: mean difference £1.48 more per patient for triage (95% confidence interval –0.19 to 3.15). Conclusions Triage reduced the number of same day appointments with general practitioners but resulted in busier routine surgeries, increased nursing time, and a small but significant increase in out of hours and accident and emergency attendance. Consequently, triage does not reduce overall costs per patient for managing same day appointments. What is already known on this topicNurse telephone triage is used to manage the increasing demand for same day appointments in general practiceEvidence that nurse telephone triage is effective is limitedWhat this study addsTriage resulted in 29-44% fewer same day appointments with general practitioners than standard managementNursing and overall time increased in the triage group as 40% of patients were managed by nursesTriage was not less costly than standard management because of increased costs for nursing, follow up, out of hours, and accident and emergency care PMID:12446539

7 CFR 1220.204 - Appointment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN PROMOTION, RESEARCH, AND CONSUMER INFORMATION Soybean Promotion and Research Order United Soybean Board § 1220.204 Appointment. From...

7 CFR 1220.204 - Appointment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN PROMOTION, RESEARCH, AND CONSUMER INFORMATION Soybean Promotion and Research Order United Soybean Board § 1220.204 Appointment. From...

[Advance directives. Representatives' opinions].

PubMed

Busquets I Font, J M; Hernando Robles, P; Font I Canals, R; Diestre Ortin, G; Quintana, S

The use and usefulness of Advance Directives has led to a lot of controversy about their validity and effectiveness. Those areas are unexplored in our country from the perspective of representatives. To determine the opinion of the representatives appointed in a registered Statement of Advance Directives (SAD) on the use of this document. Telephone survey of representatives of 146 already dead people and who, since February 2012, had registered a SAD document. More the two-thirds (98) of respondents recalled that the SAD was consulted, with 86 (58.9%) saying that their opinion as representative was consulted, and 120 (82.1%) believe that the patient's will was respected. Of those interviewed, 102 (69.9%) believe that patients who had previously planned their care using a SAD had a good death, with 33 (22.4%) saying it could have been better, and 10 (6.9%) believe they suffered greatly. The SAD were mostly respected and consulted, and possibly this is related to the fact that most of the representatives declare that the death of those they represented was perceived as comfortable. It would be desirable to conduct further studies addressed at health personnel in order to know their perceptions regarding the use of Advance Directives in the process of dying. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Observations on gender equality in a UK Earth Sciences department

NASA Astrophysics Data System (ADS)

Imber, Jonathan; Allen, Mark; Chamberlain, Katy; Foulger, Gillian; Gregory, Emma; Hoult, Jill; Macpherson, Colin; Winship, Sarah

2016-04-01

The progress of women to senior positions within UK higher education institutes has been slow. Women are worst represented in science, engineering and technology disciplines, where, in 2011, only 15% of professors were female. The national position is reflected in the Department of Earth Sciences at Durham University. The Department's gender profile shows steadily increasing proportions of females from undergraduate (ca. 38%) to postgraduate (ca. 42%) to postdoctoral (ca. 45%) levels, before dropping sharply with increasing seniority to 33% (n=1), 14% (n=1), 14% (n=1) and 13% (n=2), respectively, of lecturers, senior lecturers, readers and professors. The data suggest there is no shortage of talented female postgraduates and postdoctoral researchers; however, females are not applying, not being shortlisted, or not being appointed to academic roles in the expected proportions. Analysis of applications to academic positions in the Department during the period 2010-2015 suggests that "head hunting" senior academics, in some cases driven by external factors such as the UK Research Excellence Framework, resulted in a small proportion (between 0% and 11%) of female applicants. These results can be explained by the small number of senior female Earth Scientists nationally and, probably, internationally. Junior lectureship positions attracted between 24% and 33% female applicants, with the greatest proportion of females applying where the specialism within Earth Sciences was deliberately left open. In addition to these externally advertised posts, the Department has had some success converting independent research Fellowships, held by female colleagues, into permanent academic positions (n=2 between 2010 and 2015). Data for academic promotions show there is a significant negative correlation between year of appointment to first academic position within the Department (r=0.81, n=19, p<0.01), and the time taken to achieve first promotion at Durham. Data for our promoted female staff fall at the extreme ends of this distribution. Recently appointed female staff achieved promotion within 3 years of first appointment, compared with up to 13 years for long-standing female colleagues. The reasons for this discrepancy are complex, but probably include changing attitudes towards gender equality issues, and greater awareness of conscious and unconscious biases against women. The Department's long term goal is fairness of opportunity for all, with a gender balance amongst academic staff that reflects the balance at postgraduate and postdoctoral levels. Our strategy is to attract greater numbers of high quality female applicants to academic positions, by making the application process more transparent, and by promoting positive cultural changes at all levels within the Department. As an example, we have recently introduced a mentoring scheme for postdoctoral staff, and plan to extend the scheme to academic staff. Nevertheless, we are conscious that achieving a representative gender balance amongst academic colleagues will take many years, based on historic staff turnover rates, and that lasting cultural change can be difficult to achieve.

STRUCTURED RNA ISOLATION AND FRACTIONATION WITH COMPACTION AGENTS. (R825354)

EPA Science Inventory

The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

Nonlinear load-deflection behavior of abutment backwalls with varying height and soil density.

DOT National Transportation Integrated Search

2011-12-01

We address the scaling of abutment wall lateral response with wall height and compaction condition through testing and analytical work. The : analytical work was undertaken to develop hyperbolic curves representing the load-deflection response of bac...

A COMPACT FIELD PORTABLE CAPILLARY ION CHROMATOGRAPH. (R825344)

EPA Science Inventory

The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

Compact Spreader Schemes

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

Placidi, M.; Jung, J. -Y.; Ratti, A.

2014-07-25

This paper describes beam distribution schemes adopting a novel implementation based on low amplitude vertical deflections combined with horizontal ones generated by Lambertson-type septum magnets. This scheme offers substantial compactness in the longitudinal layouts of the beam lines and increased flexibility for beam delivery of multiple beam lines on a shot-to-shot basis. Fast kickers (FK) or transverse electric field RF Deflectors (RFD) provide the low amplitude deflections. Initially proposed at the Stanford Linear Accelerator Center (SLAC) as tools for beam diagnostics and more recently adopted for multiline beam pattern schemes, RFDs offer repetition capabilities and a likely better amplitude reproducibilitymore » when compared to FKs, which, in turn, offer more modest financial involvements both in construction and operation. Both solutions represent an ideal approach for the design of compact beam distribution systems resulting in space and cost savings while preserving flexibility and beam quality.« less

Expressing the sense of the House of Representatives that the Speaker should immediately request a conference and appoint conferees to complete work on a fiscal year 2014 budget resolution with the Senate.

THOMAS, 113th Congress

Rep. Van Hollen, Chris [D-MD-8

2013-04-23

House - 06/20/2013 Motion to Discharge Committee filed by Mr. Van Hollen. Petition No: 113-3. (All Actions) Notes: On 6/20/2013, a motion was filed to discharge the Committee on the Budget from the consideration of H.Res.174. A discharge petition requires 218 signatures for further action. (Discharge Petition No. 113-3: text with signatures.) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Evaluation of the deformation behavior of binary systems of methacrylic acid copolymers and hydroxypropyl methylcellulose using a compaction simulator.

PubMed

Tatavarti, Aditya S; Muller, Francis X; Hoag, Stephen W

2008-02-04

Methacrylic acid copolymers have been shown to enhance release of weakly basic drugs from rate controlling polymer matrices through the mechanism of microenvironmental pH modulation. Since these matrices are typically formed through a compaction process, an understanding of the deformation behavior of these polymers in there neat form and in combination with rate controlling polymers such as HPMC is critical to their successful formulation. Binary mixes of two methacrylic acid copolymers, Eudragit L100 and L100-55 in combination with HPMC K4M were subjected to compaction studies on a compaction simulator. The deformation behavior of the powder mixes was analyzed based on pressure-porosity relationships, strain rate sensitivity (SRS), residual die wall force data and work of compaction. Methacrylic acid copolymers, L100-55 and L-100 and the hydrophilic polymer, HPMC K4M exhibited Heckel plots representative of plastic deformation although L-100 exhibited significantly greater resistance to densification as evident from the high yield pressure values ( approximately 120MPa). The yield pressures for the binary mixes were linearly related to the weight fractions of the components. All powder mixes exhibited significant speed sensitivity with SRS values ranging from 21.7% to 42.4%. The residual die-wall pressures indicated that at slow speeds (1mm/s) and at lower pressures (<150MPa), HPMC possesses significant elastic behavior. However, the good compacts formed at this punch speed indicate significant plastic deformation and bond formation which is able to predominate over the elastic recovery component. The apparent mean yield pressure values, the residual die-wall forces and the net work of compaction exhibited a linear relationship with mixture composition, thereby indicating predictability of these parameters based on the behavior of the neat materials.

Searching for Compact Radio Sources Associated with UCH ii Regions

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

Masqué, Josep M.; Trinidad, Miguel A.; Rodríguez-Rico, Carlos A.

Ultra-compact (UC)H ii regions represent a very early stage of massive star formation. The structure and evolution of these regions are not yet fully understood. Interferometric observations showed in recent years that compact sources of uncertain nature are associated with some UCH ii regions. To examine this, we carried out VLA 1.3 cm observations in the A configuration of selected UCH ii regions in order to report additional cases of compact sources embedded in UCH ii regions. With these observations, we find 13 compact sources that are associated with 9 UCH ii regions. Although we cannot establish an unambiguous naturemore » for the newly detected sources, we assess some of their observational properties. According to the results, we can distinguish between two types of compact sources. One type corresponds to sources that are probably deeply embedded in the dense ionized gas of the UCH ii region. These sources are photoevaporated by the exciting star of the region and will last for 10{sup 4}–10{sup 5} years. They may play a crucial role in the evolution of the UCH ii region as the photoevaporated material could replenish the expanding plasma and might provide a solution to the so-called lifetime problem of these regions. The second type of compact sources is not associated with the densest ionized gas of the region. A few of these sources appear resolved and may be photoevaporating objects such as those of the first type, but with significantly lower mass depletion rates. The remaining sources of this second type appear unresolved, and their properties are varied. We speculate on the similarity between the sources of the second type and those of the Orion population of radio sources.« less

The INTEGRAL long monitoring of persistent ultra compact X-ray bursters

NASA Astrophysics Data System (ADS)

Fiocchi, M.; Bazzano, A.; Ubertini, P.; Bird, A. J.; Natalucci, L.; Sguera, V.

2008-12-01

Context: The combination of compact objects, short period variability and peculiar chemical composition of the ultra compact X-ray binaries make up a very interesting laboratory to study accretion processes and thermonuclear burning on the neutron star surface. Improved large optical telescopes and more sensitive X-ray satellites have increased the number of known ultra compact X-ray binaries allowing their study with unprecedented detail. Aims: We analyze the average properties common to all ultra compact bursters observed by INTEGRAL from 0.2 keV to 150 keV. Methods: We have performed a systematic analysis of the INTEGRAL public data and Key-Program proprietary observations of a sample of the ultra compact X-ray binaries. In order to study their average properties in a very broad energy band, we combined INTEGRAL with BeppoSAX and SWIFT data whenever possible. For sources not showing any significant flux variations along the INTEGRAL monitoring, we build the average spectrum by combining all available data; in the case of variable fluxes, we use simultaneous INTEGRAL and SWIFT observations when available. Otherwise we compared IBIS and PDS data to check the variability and combine BeppoSAX with INTEGRAL /IBIS data. Results: All spectra are well represented by a two component model consisting of a disk-blackbody and Comptonised emission. The majority of these compact sources spend most of the time in a canonical low/hard state, with a dominating Comptonised component and accretion rate dot {M} lower than 10-9 {M⊙}/yr, not depending on the model used to fit the data. INTEGRAL is an ESA project with instruments and Science Data Center funded by ESA member states (especially the PI countries: Denmark, France, Germany, Italy, Switzerland, Spain), Czech Republic and Poland, and with the participation of Russia and the USA.

[Implementation of a safety and health planning system in a teaching hospital].

PubMed

Mariani, F; Bravi, C; Dolcetti, L; Moretto, A; Palermo, A; Ronchin, M; Tonelli, F; Carrer, P

2007-01-01

University Hospital "L. Sacco" had started in 2006 a two-year project in order to set up a "Health and Safety Management System (HSMS)" referring to the technical guideline OHSAS 18001:1999 and the UNI and INAIL "Guidelines for a health and safety management system at workplace". So far, the following operations had been implemented: Setting up of a specific Commission within the Risk Management Committee; Identification and appointment of Departmental Representatives of HSMS; Carrying out of a training course addressed to Workers Representatives for Safety and Departmental Representatives of HSMS; Development of an Integrated Informative System for Prevention and Safety; Auditors qualification; Inspection of the Occupational Health Unit and the Prevention and Safety Service: reporting of critical situations and monitoring solutions adopted. Short term objectives are: Self-evaluation through check-lists of each department; Sharing of the Improvement Plan among the departments of the hospital; Planning of Health and Safety training activities in the framework of the Hospital Training Plan; Safety audit.

Thermodynamic analysis of the disorder-to-α-helical transition of 18.5-kDa myelin basic protein reveals an equilibrium intermediate representing the most compact conformation.

PubMed

Vassall, Kenrick A; Jenkins, Andrew D; Bamm, Vladimir V; Harauz, George

2015-05-22

The intrinsically disordered, 18.5-kDa isoform of myelin basic protein (MBP) is a peripheral membrane protein that is essential to proper myelin formation in the central nervous system. MBP acts in oligodendrocytes both to adjoin membrane leaflets to each other in forming myelin and as a hub in numerous protein-protein and protein-membrane interaction networks. Like many intrinsically disordered proteins (IDPs), MBP multifunctionality arises from its high conformational plasticity and its ability to undergo reversible disorder-to-order transitions. One such transition is the disorder-to-α-helical conformational change that is induced upon MBP-membrane binding. Here, we have investigated the disorder-to-α-helical transition of MBP-derived α-peptides and the full-length 18.5-kDa protein. This transition was induced through titration of the membrane-mimetic solvent trifluoroethanol into both protein and peptide solutions, and conformational change was monitored using circular dichroism spectroscopy, 1-anilinonaphthalene-8-sulfonic acid binding, tryptophan fluorescence quenching, and Förster (fluorescence) resonance energy transfer measurements. The data suggest that the disorder-to-α-helical transition of MBP follows a 3-state model: disordered↔intermediate↔α-helical, with each of the identified equilibrium states likely representing a conformational ensemble. The disordered state is characterized by slight compaction with little regular secondary structure, whereas the intermediate is also disordered but globally more compact. Surprisingly, the α-helical conformation is less compact than the intermediate. This study suggests that multifunctionality in MBP could arise from differences in the population of energetically distinct ensembles under different conditions and also provides an example of an IDP that undergoes cooperative global conformation change. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial.

PubMed

Allgood, Prue C; Maroni, Roberta; Hudson, Sue; Offman, Judith; Turnbull, Anne E; Peacock, Lesley; Steel, Jim; Kirby, Geraldine; Ingram, Christine E; Somers, Julie; Fuller, Clare; Threlfall, Anthony G; Gabe, Rhian; Maxwell, Anthony J; Patnick, Julietta; Duffy, Stephen W

2017-07-01

In England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP). In this open, randomised controlled trial, women in six centres in the NHSBSP in England who were invited for routine breast cancer screening were randomly assigned (1:1) to receive an invitation to a second appointment with fixed date and time (intervention) or an invitation letter with a telephone number to call to book their new screening appointment (control) in the event of non-attendance at the first offered appointment. Randomisation was by SX number, a sequential unique identifier of each woman within the NHSBSP, and at the beginning of the study a coin toss decided whether women with odd or even SX numbers would be allocated to the intervention group. Women aged 50-70 years who did not attend their first offered appointment were eligible for the analysis. The primary endpoint was participation (ie, attendance at breast cancer screening) within 90 days of the date of the first offered appointment; we used Poisson regression to compare the proportion of women who participated in screening in the study groups. All analyses were by intention to treat. This trial is registered with Barts Health, number 009304QM. We obtained 33 146 records of women invited for breast cancer screening at the six centres between June 2, 2014, and Sept 30, 2015, who did not attend their first offered appointment. 26 054 women were eligible for this analysis (12 807 in the intervention group and 13 247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22%] of 12 807) than in the control group (1632 [12%] of 13 247); relative risk of participation 1·81 (95% CI 1·70-1·93; p<0·0001). These findings show that a policy of second appointments with fixed date and time for non-attenders of breast screening is effective in improving participation. This strategy can be easily implemented by the screening sites and, if combined with simple interventions, could further increase participation and ensure an upward shift in the participation trend nationally. Whether the policy should vary by time since last attended screen will have to be considered. National Health Service Cancer Screening Programmes and Department of Health Policy Research Programme. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Primary care access for new patients on the eve of health care reform.

PubMed

Rhodes, Karin V; Kenney, Genevieve M; Friedman, Ari B; Saloner, Brendan; Lawson, Charlotte C; Chearo, David; Wissoker, Douglas; Polsky, Daniel

2014-06-01

Current measures of access to care have intrinsic limitations and may not accurately reflect the capacity of the primary care system to absorb new patients. To assess primary care appointment availability by state and insurance status. We conducted a simulated patient study. Trained field staff, randomly assigned to private insurance, Medicaid, or uninsured, called primary care offices requesting the first available appointment for either routine care or an urgent health concern. The study included a stratified random sample of primary care practices treating nonelderly adults within each of 10 states (Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas), selected for diversity along numerous dimensions. Collectively, these states comprise almost one-third of the US nonelderly, Medicaid, and currently uninsured populations. Sampling was based on enrollment by insurance type by county. Analyses were weighted to obtain population-based estimates for each state. The ability to schedule an appointment and number of days to the appointment. We also examined cost and payment required at the visit for the uninsured. Between November 13, 2012, and April 4, 2013, we made 12,907 calls to 7788 primary care practices requesting new patient appointments. Across the 10 states, 84.7% (95% CI, 82.6%-86.8%) of privately insured and 57.9% (95% CI, 54.8%-61.0%) of Medicaid callers received an appointment. Appointment rates were 78.8% (95% CI, 75.6%-82.0%) for uninsured patients with full cash payment but only 15.4% (95% CI, 13.2%-17.6%) if payment required at the time of the visit was restricted to $75 or less. Conditional on getting an appointment, median wait times were typically less than 1 week (2 weeks in Massachusetts), with no differences by insurance status or urgency of health concern. Although most primary care physicians are accepting new patients, access varies widely across states and insurance status. Navigator programs are needed, not only to help patients enroll but also to identify practices accepting new patients within each plan's network. Tracking new patient appointment availability over time can inform policies designed to strengthen primary care capacity and enhance the effectiveness of the coverage expansions with the Patient Protection and Affordable Care Act.

Improving Appointment Adherence among Young Adults with HIV in Peru with an mHealth Intervention: a Feasibility Study

PubMed Central

Prochazka, Mateo; Batey, D Scott; Zinski, Anne; Dionne-Odom, Jodie; Otero, Larissa; Rodriguez, J Martin; González, Elsa

2017-01-01

Abstract Background Mobile Health (mHealth) interventions, including short message services (SMS) reminders and motivational messages, are associated with improved HIV appointment adherence, though feasibility is context-dependent. We assessed the feasibility of an mHealth intervention to improve appointment adherence among young adults with HIV in Lima, Peru. Methods Between November 2016 and April 2017, we implemented a one-way mHealth pilot intervention in an outpatient hospital without electronic medical records. We enrolled young adults (age 18–29) entering HIV care in a 3-component intervention: (i) reminder SMS prior to scheduled appointments (provider, laboratory, pharmacy); (ii) motivational SMS after each visit; and (iii) phone call following a missed visit. Feasibility evaluation included enrollment acceptance, visit tracking (information captured in the study database within 3 days of attendance), and proportion of intervention delivery (threshold >90%). We performed a qualitative assessment to identify implementation challenges reviewing staff field notes and meeting minutes. Results We enrolled 80/94 (85.1%) eligible participants. The median age was 25 years and 83% were male. The median time of follow-up after enrollment was 115 [interquartile range (IQR): 84–141] days, and participants had a median of 10 (IQR: 8–14) visits during the study period. Among 850 total participant visits, study personnel tracked 751 (88.4%); most (80.8%) untracked visits were pharmacy pickups. Of all tracked visits, most (78.7%) were scheduled appointments and 160 (21.3%) were unscheduled walk-ins. Intervention delivery reached 556/591 (94.1%) for reminder SMS; 733/751 (97.6%) for motivational messages, and 169/170 (99.4%) phone calls for missed visits, 127 (75.1%) of which were answered. Qualitative assessment revealed 2 major themes: real-time appointment tracking in a paper-based system consumed most staff time and resources, and meticulous in-person coordination between the implementation and hospital staff was essential for tracking. Conclusion An mHealth intervention to improve appointment adherence among young adults with HIV in Peru appears feasible with dedicated staff and a reliable appointment tracking system. Digitalized appointment systems may be needed to address challenges for scale-up. Disclosures All authors: No reported disclosures.