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Sample records for emergency referrals safer

  1. Support and Assessment for Fall Emergency Referrals (SAFER 1): Cluster Randomised Trial of Computerised Clinical Decision Support for Paramedics

    PubMed Central

    Snooks, Helen Anne; Carter, Ben; Dale, Jeremy; Foster, Theresa; Humphreys, Ioan; Logan, Philippa Anne; Lyons, Ronan Anthony; Mason, Suzanne Margaret; Phillips, Ceri James; Sanchez, Antonio; Wani, Mushtaq; Watkins, Alan; Wells, Bridget Elizabeth; Whitfield, Richard; Russell, Ian Trevor

    2014-01-01

    Objective To evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS) for paramedics attending older people who fall. Design Cluster trial randomised by paramedic; modelling. Setting 13 ambulance stations in two UK emergency ambulance services. Participants 42 of 409 eligible paramedics, who attended 779 older patients for a reported fall. Interventions Intervention paramedics received CCDS on Tablet computers to guide patient care. Control paramedics provided care as usual. One service had already installed electronic data capture. Main Outcome Measures Effectiveness: patients referred to falls service, patient reported quality of life and satisfaction, processes of care. Safety Further emergency contacts or death within one month. Cost-Effectiveness Costs and quality of life. We used findings from published Community Falls Prevention Trial to model cost-effectiveness. Results 17 intervention paramedics used CCDS for 54 (12.4%) of 436 participants. They referred 42 (9.6%) to falls services, compared with 17 (5.0%) of 343 participants seen by 19 control paramedics [Odds ratio (OR) 2.04, 95% CI 1.12 to 3.72]. No adverse events were related to the intervention. Non-significant differences between groups included: subsequent emergency contacts (34.6% versus 29.1%; OR 1.27, 95% CI 0.93 to 1.72); quality of life (mean SF12 differences: MCS −0.74, 95% CI −2.83 to +1.28; PCS −0.13, 95% CI −1.65 to +1.39) and non-conveyance (42.0% versus 36.7%; OR 1.13, 95% CI 0.84 to 1.52). However ambulance job cycle time was 8.9 minutes longer for intervention patients (95% CI 2.3 to 15.3). Average net cost of implementing CCDS was £208 per patient with existing electronic data capture, and £308 without. Modelling estimated cost per quality-adjusted life-year at £15,000 with existing electronic data capture; and £22,200 without. Conclusions Intervention paramedics referred twice as many participants to falls services with no

  2. Different causes of referral to ophthalmology emergency room

    PubMed Central

    Jafari, Alireza Keshtkar; Bozorgui, Shima; Shahverdi, Nooshin; Ameri, Ahmad; Akbari, Mohammad Reza; Salmasian, Hojat

    2012-01-01

    Background: Eye-related complaints compose approximately 1–6% of complaints of patients referring to general emergency ward around the world. Eye injuries are the most common cause of referral to eye emergency ward. To understand the impact of eye injuries in Iran and to plan preventive strategies, it is important to understand the complete magnitude of the problem with regard to true population-based data and standard reproducible definitions. Aim: The main goal of this study was to identify the major causes of referrals to eye emergency ward in patients with eye-related complaints in an eye referral Hospital in Iran. Settings and Design: In a cross-sectional study, 3150 patients who referred to Farabi Hospital emergency ward, Tehran, Iran, from January to December 2007 were included in the study and their detailed information were recorded. Materials and Methods: The patients’ demographic data, medical history and final diagnosis were recorded in a questionnaire. Results: The mean age of patients was 33.2±16.8 years and 2380 patients (75.6%) were males. While 299 patients (9.5%) were referred for non-urgent reasons, work-related injuries were the most common cause of referral (955 patients; 30.3%). In patients referred due to trauma (1950 patients), work-related injuries occurred in 955 patients (49%) and occurred accidentally (by chance) in 819 patients (42%). The majority of patients referred with traumatic injuries were males (1708 patients; 87.6% versus 242 patients; 12.4%). The most common etiologies of eye trauma (1950 patients) were metal filings (814 patients; 41.8%), blunt trauma (338 patients; 17.3%), fireworks (236 patients; 12.1%) and sharp objects (222 patients; 11.4%). Globe injury was diagnosed in 1865 patients (95.7%) of trauma cases. In patients referred due to non-traumatic reason (1200 patients), eye infection occurred in 482 patients (40.2%) and 299 patients (24.9%) were referred for non-urgent reasons. There was little difference between

  3. Referrals between Public Sector Health Institutions for Women with Obstetric High Risk, Complications, or Emergencies in India - A Systematic Review.

    PubMed

    Singh, Samiksha; Doyle, Pat; Campbell, Oona M; Mathew, Manu; Murthy, G V S

    2016-01-01

    Emergency obstetric care (EmOC) within primary health care systems requires a linked referral system to be effective in reducing maternal death. This systematic review aimed to summarize evidence on the proportion of referrals between institutions during pregnancy and delivery, and the factors affecting referrals, in India. We searched 6 electronic databases, reviewed four regional databases and repositories, and relevant program reports from India published between 1994 and 2013. All types of study or reports (except editorials, comments and letters) which reported on institution-referrals (out-referral or in-referral) for obstetric care were included. Results were synthesized on the proportion and the reasons for referral, and factors affecting referrals. Of the 11,346 articles identified by the search, we included 232 articles in the full text review and extracted data from 16 studies that met our inclusion criteria Of the 16, one was RCT, seven intervention cohort (without controls), six cross-sectional, and three qualitative studies. Bias and quality of studies were reported. Between 25% and 52% of all pregnancies were referred from Sub-centres for antenatal high-risk, 14% to 36% from nurse run delivery or basic EmOC centres for complications or emergencies, and 2 to 7% were referred from doctor run basic EmOC centres for specialist care at comprehensive EmOC centres. Problems identified with referrals from peripheral health centres included low skills and confidence of staff, reluctance to induce labour, confusion over the clinical criteria for referral, non-uniform standards of care at referral institutions, a tendency to by-pass middle level institutions, a lack of referral communication and supervision, and poor compliance. The high proportion of referrals from peripheral health centers reflects the lack of appropriate clinical guidelines, processes, and skills for obstetric care and referral in India. This, combined with inadequate referral communication

  4. A multifaceted approach to improving the quality of ENT Emergency Clinic referrals

    PubMed Central

    Swords, Chloe; Leach, Laura; Kasbekar, Anand; Jani, Piyush

    2017-01-01

    It is imperative that primary care referrals are directed to the appropriate secondary care service. Patients presenting to a primary care physician with ENT conditions may require review in an Emergency Clinic. The latter clinics provide patients with rapid access to secondary care, for urgent, yet non-life-threatening conditions. In our department, we noticed that patients with conditions inappropriate to the capabilities of the Clinic were being booked in or reviewed too late; thus causing wasted journeys for the patient. We conducted a Quality Improvement Project to improve the efficiency of the referral process. A prospective evaluation of referrals was collected continuously over a two-month period. Overall, 5 domains were deemed crucial to enable timely and accurate booking of patients to clinic: booking date, urgency, legibility, patient identification and appropriateness. Our proposed standard set for this project was 100% compliance over the 5 domains. Three separate interventions were instigated following the first cycle. The main components of the intervention were the phased development of an electronic referral system and an educational initiative for junior doctors. 20 referral forms were analysed during the initial 3-week period. No referrals met the recommended overall compliance standard of 100% (mean number of domains achieved: 3.38; standard deviation (SD): 0.637). Legibility and patient information were included in 21% and 30% of referrals, respectively. There was a trend of improvement following initiation of interventions. The mean number of domains achieved was 4.27 (SD 0.647; n=13) in the second data collection period, 4.53 (SD 0.514; n=16) in the third, and 4.75 (SD 0.452; n=24) in the fourth. Using linear regression, this change demonstrates a statistically significant improvement (p<0.001). An e-Proforma referral system represents a safe and efficient communication technology. When implementing policy change, it is crucial to acquire

  5. It Takes Two to Tango: Improving Patient Referrals from the Emergency Department to Inpatient Clinicians

    PubMed Central

    Lawrence, Sean; Spencer, Lyndall M.; Sinnott, Michael; Eley, Robert

    2015-01-01

    Background The transfer of responsibility for patient care across clinical specialties is a complex process. Published and anecdotal data suggest that referrals often fail to meet the needs of one or both parties and that patient focus can be lost during the process. Little is known about the Australian situation. Methods To obtain a more complete understanding of the referral process, including the nature of communication in an Australian context, we conducted semistructured interviews in a convenience sample of 25 volunteers. Two established strategies for analyzing qualitative data were used. Results All respondents considered the following information essential components of a referral: an account of the patient's current condition, a working diagnosis or problem statement and history of the presenting concern, key test results or tests awaiting results, a potential management plan, and any special characteristics of the patient. Respondents acknowledged implied, if not literal, power to accept or reject an emergency department (ED) referral and said the imbalance of power was reinforced when the ED physician was junior to the inpatient clinician. Respondents also noted that in addition to the predominant organizational culture, an independent culture is associated with specific shifts. Foremost among the nonclinical aspects of a referral considered to be important was the timeliness of the contact made to achieve the transition. Respondents also said the success of a referral depended on the speaking and listening abilities of all parties. The individual's motivation to accept or reject a referral can also have an impact on communication. Conclusion Respondents attributed the difficulty of negotiating the transfer of a patient's care across the ED and inpatient interface to three distinct factors: variations in the clinical information required, the culture of the organization and of the clinical team in which the transaction takes place, and the

  6. Self-referring patients at the emergency department: appropriateness of ED use and motives for self-referral

    PubMed Central

    2014-01-01

    Background Nearly all Dutch citizens have a general practitioner (GP), acting as a gatekeeper to secondary care. Some patients bypass the GP and present to the emergency department (ED). To make best use of existing emergency care, Dutch health policy makers and insurance companies have proposed the integration of EDs and GP cooperatives (GPCs) into one facility. In this study, we examined ED use and assessed the characteristics of self-referrals and non-self-referrals, their need for hospital emergency care and self-referrals' motives for presenting at the ED. Methods A descriptive cohort study was conducted in a Dutch level 1 trauma centre. Differences in patient characteristics, time of presentation and need for hospital emergency care were analysed using χ2 tests and t tests. A patient was considered to need hospital emergency care when he/she was admitted to the hospital, had an extremity fracture and/or when diagnostic tests were performed. Main determinants of self-referral were identified via logistic regression. Results Of the 5,003 consecutive ED patients registering within the 5-week study period, 3,028 (60.5%) were self-referrals. Thirty-nine percent of the self-referrals had urgent acuity levels, as opposed to 65% of the non-self-referrals. Self-referrals more often suffered from injuries (49 vs. 20%). One third of the self-referrals presented during office hours. Of all self-referrals, 51% needed hospital emergency care. Younger age; non-urgent acuity level; chest pain, ear, nose or throat problems; and injuries were independent predictors for self-referral. Most cited motives for self-referring were ‘accessibility and convenience’ and perceived ‘medical necessity’. Conclusions A substantial part of the self-referrals needed hospital emergency care. The 49% self-referrals who were eligible for GP care presented during out-of-hours as well as during office hours. This calls for an integrative approach to this health care problem. PMID:25097670

  7. Gender Differences in Emergency Department Visits and Detox Referrals for Illicit and Nonmedical Use of Opioids

    PubMed Central

    Ryoo, Hyeon-Ju; Choo, Esther K.

    2016-01-01

    Introduction Visits to the emergency department (ED) for use of illicit drugs and opioids have increased in the past decade. In the ED, little is known about how gender may play a role in drug-related visits and referrals to treatment. This study performs gender-based comparison analyses of drug-related ED visits nationwide. Methods We performed a cross-sectional analysis with data collected from 2004 to 2011 by the Drug Abuse Warning Network (DAWN). All data were coded to capture major drug categories and opioids. We used logistic regression models to find associations between gender and odds of referral to treatment programs. A second set of models were controlled for patient “seeking detox,” or patient explicitly requesting for detox referral. Results Of the 27.9 million ED visits related to drug use in the DAWN database, visits by men were 2.69 times more likely to involve illicit drugs than visits by women (95% CI [2.56, 2.80]). Men were more likely than women to be referred to detox programs for any illicit drugs (OR 1.12, 95% CI [1.02–1.22]), for each of the major illicit drugs (e.g., cocaine: OR 1.27, 95% CI [1.15–1.40]), and for prescription opioids (OR 1.30, 95% CI [1.17–1.43]). This significant association prevailed after controlling for “seeking detox.” Conclusion Women are less likely to receive referrals to detox programs than men when presenting to the ED regardless of whether they are “seeking detox.” Future research may help determine the cause for this gender-based difference and its significance for healthcare costs and health outcomes. PMID:27330662

  8. Audit of Childbirth Emergency Referrals by Trained Traditional Birth Attendants in Enugu, Southeast, Nigeria

    PubMed Central

    Okafor, II; Arinze-Onyia, SU; Ohayi, SAR; Onyekpa, JI; Ugwu, EO

    2015-01-01

    Background: The essence of training traditional birth attendants (TBAs) is to attend to women in uncomplicated labor and to refer them immediately to hospitals when complications develop. Aim: The aim was to audit childbirth emergency referrals by trained TBAs to a specialist hospital in Enugu, Nigeria. Subjects and Methods: A retrospective study of 205 childbirth emergencies referred to Semino Hospital and Maternity (SHM), Enugu by trained TBAs from August 1, 2011 to January 31, 2014. Data analysis was descriptive and inferential at 95% confidence level. Results: Most of the patients (185/205, 90.2%) were married and (100/205, 48.8%) had earlier booked for antenatal care in formal health facilities. There were obstetric danger signs or previous bad obstetric histories (pregnancies with unfavorable outcome) in 110 (110/205, 53.7%) women on admission at SHM. One hundred and fifteen (115/205, 56.1%) women walked into the hospital by themselves while 50 (50/205, 24.39%) could not walk. The fetal heart sounds were normal in 94 (94/205, 45.6%), abnormal in 65 (65/205, 31.8%) and absent in 42 (42/205, 20.4%) of the women on admission. Five healthy babies were delivered by the TBAs before referring their mothers. Delays of more than 12 h had occurred in 155 (155/205, 76.6%) of the women before referrals. Prolonged labor (100/205, 48.8%), obstructed labor (40/205, 19.5%), attempted vaginal birth after previous cesarean delivery (40/205, 19.5%) and malpresentation (30/205, 14.6%) were the common indications for referrals. The maternal mortality and perinatal mortality ratios were 610/100,000 live births and 228/1000 total births respectively. Conclusion: Delays at TBA centers are common before referral and most patients are referred in poor clinical state. Further training and re-training of the TBAs with more emphasis on recognition of obstetric danger signs and bad obstetric histories may help in screening high-risk patients for prompt referral to hospitals before

  9. Emergency peripartum hysterectomy: experience of a major referral hospital in Ankara, Turkey.

    PubMed

    Danisman, N; Baser, E; Togrul, C; Kaymak, O; Tandogan, M; Gungor, T

    2015-01-01

    The objective of this study was to report and discuss the incidence, clinical characteristics and outcomes of emergency peripartum hysterectomies (EPH) performed at a tertiary referral hospital in Ankara, Turkey. The labour and delivery unit database was retrospectively analysed for emergency peripartum hysterectomies (EPH) performed between January 2008 and January 2013, at the Zekai Tahir Burak Women's Health Training and Research Hospital. A total of 92,887 deliveries were accomplished within the study period. EPH was performed in 48 cases, and the incidence was 0.51 in 1,000. Abnormal placentation was the most common indication for EPH. Most common complications were blood product transfusion and postoperative fever. None of the cases resulted in maternal mortality. Serious maternal complication rates were relatively low in our study. In cases that are unresponsive to initial conservative measures, EPH should be performed without delay and a multidisciplinary team approach should be conducted whenever possible.

  10. Role of the emergency medical services system in regionwide health monitoring and referral.

    PubMed

    Hsiao, A K; Hedges, J R

    1993-11-01

    The emergency medical services (EMS) system of the future has the opportunity to serve as a regional community health monitoring and referral system. Such a system would shift attention from care of the individual to cost-effective community health efforts using community resource integration, while emphasizing individual responsibility for health. This health care system model requires the establishment of a centralized monitoring agency, the "regional center." The regional center would coordinate the monitoring of regional EMS use and linkage of patients with essential health promotion and behavior change organizations. Many of these supporting organizations are in place but are functioning without the benefit of communitywide health monitoring or effective referral and follow-up links with other resources. Coordination through the EMS system and a regional center would permit these resources to be used in an efficient and accountable fashion. We propose a model in which the EMS system could contribute to coordinated regional health monitoring and maintenance, timely and appropriate health care legislation and regulation, and high-impact health care education and intervention in the setting of self-destructive individual behavior.

  11. Barriers to knowledge sharing in Chinese healthcare referral services: an emergent theoretical model

    PubMed Central

    Nunes, Miguel Baptista

    2016-01-01

    Background This paper reports on a research study that aims to identify and explain barriers to knowledge sharing (KS) in the provision of healthcare referral services in Chinese healthcare organisations. Design An inductive case study approach was employed, in which 24 healthcare professionals and workers from four healthcare organisations in the province of Hubei, Central China, were interviewed using semi-structured scripts. Results Through data analysis, 14 KS barriers emerged in four main themes: interpersonal trust barriers, communication barriers, management and leadership barriers, and inter-institutional barriers. A cause–consequence analysis of the identified barriers revealed that three of them are at the core of the majority of problems, namely, the absence of national and local policies for inter-hospital KS, lack of a specific hospital KS requirement, and lack of mutual acquaintance. Conclusions To resolve KS problems, it is of great importance that healthcare governance agencies, both at the national and regional levels, take leadership in the process of KS implementation by establishing specific and strong policies for inter-institutional KS in the referral process. This paper raises important issues that exceed academic interests and are important to healthcare professionals, hospital managers, and Information communication technology (ICT) managers in hospitals, as well as healthcare politicians and policy makers. PMID:26895146

  12. Referrals to hospital emergency departments from residential aged care facilities: stuck in a time warp.

    PubMed

    O'Connell, Beverly; Hawkins, Mary; Considine, Julie; Au, Catherine

    2013-10-01

    This research aimed to describe the number and type of residents admitted to emergency departments (EDs) over 2 years; and to explore nurses' perceptions of the reasons why residential aged care facility (RACF) residents are referred to EDs. The research objective was addressed in a retrospective exploratory study using data on admissions to EDs from RACFs (N = 3,094) at the participating organisation over a 2-year period, and interview data on seven RACF and four ED nurses' perceptions of the issues involved. Most residents presenting at EDs required urgent medical attention. Major themes identified by RACF and ED nurses included issues related to staff competency, availability of general practitioners, lack of equipment in RACFs, residents and family members requesting referrals, communication difficulties, and poor attitudes towards RACF staff. There is a need to use strategies to detect residents whose conditions are deteriorating and treat them promptly in RACFs.

  13. Feasibility of emergency department bilingual computerized alcohol screening, brief intervention, and referral to treatment.

    PubMed

    Vaca, Federico; Winn, Diane; Anderson, Craig; Kim, Doug; Arcila, Mauricio

    2010-10-01

    The purpose of this study was to assess the feasibility of utilizing a computerized alcohol screening and intervention (CASI) kiosk in an emergency department (ED). An interactive English and Spanish audiographical computer program, developed for used on a mobile computer cart, was administered to 5103 patients. Patients who screened at risk (19%) also received a fully computer-guided brief negotiated interview (BNI) and a printed personal alcohol reduction plan. A higher percentage of younger patients, and males (31% versus 16% females), screened at risk or dependent. Patient surveys indicated CASI was easy to use and over 75% did not prefer a medical professional over the computer. The ED-based bilingual computerized alcohol screening, brief intervention, and referral to treatment required little time to administer, was acceptable to patients, identified at-risk and dependent drinkers, and was able to provide personalized feedback and brief intervention.

  14. Referrals between Public Sector Health Institutions for Women with Obstetric High Risk, Complications, or Emergencies in India – A Systematic Review

    PubMed Central

    Singh, Samiksha; Doyle, Pat; Campbell, Oona M.; Mathew, Manu; Murthy, G. V. S.

    2016-01-01

    Emergency obstetric care (EmOC) within primary health care systems requires a linked referral system to be effective in reducing maternal death. This systematic review aimed to summarize evidence on the proportion of referrals between institutions during pregnancy and delivery, and the factors affecting referrals, in India. We searched 6 electronic databases, reviewed four regional databases and repositories, and relevant program reports from India published between 1994 and 2013. All types of study or reports (except editorials, comments and letters) which reported on institution-referrals (out-referral or in-referral) for obstetric care were included. Results were synthesized on the proportion and the reasons for referral, and factors affecting referrals. Of the 11,346 articles identified by the search, we included 232 articles in the full text review and extracted data from 16 studies that met our inclusion criteria Of the 16, one was RCT, seven intervention cohort (without controls), six cross-sectional, and three qualitative studies. Bias and quality of studies were reported. Between 25% and 52% of all pregnancies were referred from Sub-centres for antenatal high-risk, 14% to 36% from nurse run delivery or basic EmOC centres for complications or emergencies, and 2 to 7% were referred from doctor run basic EmOC centres for specialist care at comprehensive EmOC centres. Problems identified with referrals from peripheral health centres included low skills and confidence of staff, reluctance to induce labour, confusion over the clinical criteria for referral, non-uniform standards of care at referral institutions, a tendency to by-pass middle level institutions, a lack of referral communication and supervision, and poor compliance. The high proportion of referrals from peripheral health centers reflects the lack of appropriate clinical guidelines, processes, and skills for obstetric care and referral in India. This, combined with inadequate referral communication

  15. Emergent mechanical support in the community: improvement with early transplant center referral.

    PubMed

    Morris, Rohinton J; Pochettino, Alberto; O'Hara, Marylou; Gardner, Timothy J; Acker, Michael A

    2005-06-01

    Emergent mechanical support for the failing ventricle, with eventual transfer for definitive care, is often required at non-transplant centers. Transfer for definitive care, in terms of bridge to transplant, may require ventricular assist device (VAD) placement at the primary institution or at the transplant center. Review of consecutive single transplant center referrals was conducted to decipher optimal management. From January 1997 to December 2000, 104 patients were transferred to the University of Pennsylvania Heart Failure/Transplant Service. Most were transferred from active cardiac surgical programs, with 56 patients having post-cardiotomy failure at the primary site. A VAD was placed in procedures done at the outside hospital (OSH) in 28 patients, most commonly (60%) an Abiomed device. Of the 76 patients that received a VAD at the transplant center (TxpC), 86% received a TCI or Thoratec device. Biventricular support was required in 34 patients. Overall survival was 57%, with 54 patients bridged to transplantation and 5 patients undergoing recovery. Patients having a VAD placed at the OSH had a 32% (9 of 28) survival, whereas at the TxpC survival was 65% (45 of 76) (p < 0.05). Mid-term follow-up showed that all 5 patients weaned are presently alive, and 52 patients are alive at >1-year post-transplant. The most common cause of death was multi-system organ failure (19 of 45), followed by major neurologic event (15 of 45). Infection was the cause of death in only 6 patients. Left ventricular failure can be treated by emergent VAD placement. Overall survival is substantial if these patients are referred to a transplant center with multiple options. In contrast to previous reports, survival rates may be improved by earlier referral, before VAD placement at non-transplant centers and use of a VAD with longer-term capability.

  16. Safer Choice

    EPA Pesticide Factsheets

    Safer Choice is a voluntary program that works to advance the mission of EPA to protect human health and the environment by helping product manufacturers choose the safest chemical ingredients possible.

  17. Conducting an audit to improve the facilitation of emergency maternal and newborn referral in northern Ghana.

    PubMed

    Awoonor-Williams, John Koku; Bailey, Patricia E; Yeji, Francis; Adongo, Ayire Emmanuel; Baffoe, Peter; Williams, Afua; Mercer, Sarah

    2015-10-01

    Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; district management addressed the costliness and lack of transport and increased midwives' ability to communicate with pregnant women and drivers; and that facility staff increasingly adhered to guidelines and facilitating mechanisms. By conducting an audit of maternal and newborn referrals, the Ghana Health Service identified areas for improvement that service providers and management at multiple levels addressed, demonstrating a platform for problem solving that could be a model elsewhere.

  18. Safer Environment

    EPA Pesticide Factsheets

    The U.S. Environmental Protection Agency (EPA) has proposed Mercury and Air Toxics Standards (MATS) for power plants to limit mercury, acid gases and other toxic pollution from power plants. This page describes how new rules mean a safer environment.

  19. Benefits and Limitations of a Community-Engaged Emergency Referral System in a Remote, Impoverished Setting of Northern Ghana.

    PubMed

    Patel, Sneha; Koku Awoonor-Williams, John; Asuru, Rofina; Boyer, Christopher B; Awopole Yepakeh Tiah, Janet; Sheff, Mallory C; Schmitt, Margaret L; Alirigia, Robert; Jackson, Elizabeth F; Phillips, James F

    2016-12-23

    Although Ghana has a well-organized primary health care system, it lacks policies and guidelines for developing or providing emergency referral services. In 2012, an emergency referral pilot-the Sustainable Emergency Referral Care (SERC) initiative-was launched by the Ghana Health Service in collaboration with community stakeholders and health workers in one subdistrict of the Upper East Region where approximately 20,000 people reside. The pilot program was scaled up in 2013 to a 3-district (12-subdistrict) plausibility trial that served a population of approximately 184,000 over 2 years from 2013 to 2015. The SERC initiative was fielded as a component of a 6-year health systems strengthening and capacity-building project known as the Ghana Essential Health Intervention Program. Implementation research using mixed methods, including quantitative analysis of key process and health indicators over time in the 12 intervention subdistricts compared with comparison districts, a survey of health workers, and qualitative systems appraisal with community members, provided data on effectiveness of the system as well as operational challenges and potential solutions. Monitoring data show that community exposure to SERC was associated with an increased volume of emergency referrals, diminished reliance on primary care facilities not staffed or equipped to provide surgical care, and increased caseloads at facilities capable of providing appropriate acute care (i.e., district hospitals). Community members strongly endorsed the program and expressed appreciation for the service. Low rates of adherence to some care protocols were noted: referring facilities often failed to alert receiving facilities of incoming patients, not all patients transported were accompanied by a health worker, and receiving facilities commonly failed to provide patient outcome feedback to the referring facility. Yet in areas where SERC worked to bypass substandard points of care, overall facility

  20. Benefits and Limitations of a Community-Engaged Emergency Referral System in a Remote, Impoverished Setting of Northern Ghana

    PubMed Central

    Patel, Sneha; Koku Awoonor-Williams, John; Asuru, Rofina; Boyer, Christopher B; Awopole Yepakeh Tiah, Janet; Sheff, Mallory C; Schmitt, Margaret L; Alirigia, Robert; Jackson, Elizabeth F; Phillips, James F

    2016-01-01

    ABSTRACT Although Ghana has a well-organized primary health care system, it lacks policies and guidelines for developing or providing emergency referral services. In 2012, an emergency referral pilot—the Sustainable Emergency Referral Care (SERC) initiative—was launched by the Ghana Health Service in collaboration with community stakeholders and health workers in one subdistrict of the Upper East Region where approximately 20,000 people reside. The pilot program was scaled up in 2013 to a 3-district (12-subdistrict) plausibility trial that served a population of approximately 184,000 over 2 years from 2013 to 2015. The SERC initiative was fielded as a component of a 6-year health systems strengthening and capacity-building project known as the Ghana Essential Health Intervention Program. Implementation research using mixed methods, including quantitative analysis of key process and health indicators over time in the 12 intervention subdistricts compared with comparison districts, a survey of health workers, and qualitative systems appraisal with community members, provided data on effectiveness of the system as well as operational challenges and potential solutions. Monitoring data show that community exposure to SERC was associated with an increased volume of emergency referrals, diminished reliance on primary care facilities not staffed or equipped to provide surgical care, and increased caseloads at facilities capable of providing appropriate acute care (i.e., district hospitals). Community members strongly endorsed the program and expressed appreciation for the service. Low rates of adherence to some care protocols were noted: referring facilities often failed to alert receiving facilities of incoming patients, not all patients transported were accompanied by a health worker, and receiving facilities commonly failed to provide patient outcome feedback to the referring facility. Yet in areas where SERC worked to bypass substandard points of care, overall

  1. Safer Bridges

    NASA Technical Reports Server (NTRS)

    1977-01-01

    Safer bridges are among a number of spinoff benefits from NASA procedures for testing 'cfracture toughness" of a structural part, meaning its ability to -siscracktsh at might cause failure. The New River Bridge in West Virginia, shown under construction, is the world's largest single span bridge. U.S. Steel fracture toughness requirements for such bridges include NASA-developed test procedures. Bridge materials and other metal structures may develop flaws during their service lifetimes. Such flaws can affect the structural integrity of the part. Thus, it is important to know the "fracture toughness" of a structural part, or its ability to resist cracks. NASA has long experience in developing fracture toughness tests for aerospace hardware. Since 1960, NASA-Lewis has worked closely with the American Society for Testing & Materials. Lewis and NASA-funded industrial contractors have made many important contributions to test procedures, now recommended by ASTM, for measuring fracture toughness.

  2. Determinants of out-of-hours service users' potentially inappropriate referral or non-referral to an emergency department: a retrospective cohort study in a local health authority, Veneto Region, Italy

    PubMed Central

    Toffanin, Roberto; Rigon, S; Sandonà, P; Carrara, T; Damiani, G; Baldo, V

    2016-01-01

    Background A growing presence of inappropriate patients has been recognised as one of the main factors influencing emergency department (ED) overcrowding, which is a very widespread problem all over the world. On the other hand, out-of-hours (OOH) physicians must avoid delaying the diagnostic and therapeutic course of patients with urgent medical conditions. The aim of this study was to analyse the appropriateness of patient management by OOH services, in terms of their potentially inappropriate referral or non-referral of non-emergency cases to the ED. Methods This was an observational retrospective cohort study based on data collected in 2011 by the local health authority No. 4 in the Veneto Region (Italy). After distinguishing between patients contacting the OOH service who were or were not referred to the ED, and checking for patients actually presenting to the ED within 24 hours thereafter, these patients’ medical management was judged as potentially appropriate or inappropriate. Results The analysis considered 22 662 OOH service contacts recorded in 2011. The cases of potentially inappropriate non-referral to the ED were 392 (1.7% of all contacts), as opposed to 1207 potentially inappropriate referrals (5.3% of all contacts). Age, nationality, type of disease and type of intervention by the OOH service were the main variables associated with the appropriateness of patient management. Conclusions These findings may be useful for pinpointing the factors associated with a potentially inappropriate patient management by OOH services and thus contribute to improving the deployment of healthcare and the quality of care delivered by OOH services. PMID:27503862

  3. The burden of bone, native joint and soft tissue infections on orthopaedic emergency referrals in a city hospital.

    PubMed

    Howell, A; Parker, S; Tsitskaris, K; Oddy, M J

    2016-01-01

    Introduction Bone, native joint and soft tissue infections are frequently referred to orthopaedic units although their volume as a proportion of the total emergency workload has not been reported previously. Geographic and socioeconomic variation may influence their presentation. The aim of this study was to quantify the burden of such infections on the orthopaedic department in an inner city hospital, determine patient demographics and associated risk factors, and review our current utilisation of specialist services. Methods All cases involving bone, native joint and soft tissue infections admitted under or referred to the orthopaedic team throughout 2012 were reviewed retrospectively. Prosthetic joint infections were excluded. Results Almost 15% of emergency admissions and referrals were associated with bone, native joint or soft tissue infection or suspected infection. The cohort consisted of 169 patients with a mean age of 43 years (range: 1-91 years). The most common diagnosis was cellulitis/other soft tissue infection and the mean length of stay was 13 days. Two-thirds of patients (n=112, 66%) underwent an operation. Fifteen per cent of patients were carrying at least one blood borne virus, eleven per cent were alcohol dependent, fifteen per cent were using or had been using intravenous drugs and nine per cent were homeless or vulnerably housed. Conclusions This study has shown that a significant number of patients are admitted for orthopaedic care as a result of infection. These patients are relatively young, with multiple complex medical and social co-morbidities, and a long length of stay.

  4. The epidemiology and type of injuries seen at the accident and emergency unit of a Nigerian referral center

    PubMed Central

    Adoga, Adeyi A.; Ozoilo, Kenneth N.

    2014-01-01

    Background: A plethora of injuries present at any accident and emergency unit, but the pattern of the injuries varies from region to region especially in ours with the increased ethno-religious clashes and terrorist attacks. This study aims to determine the epidemiology and type of injuries presenting to our center with the possibility of developing injury surveillance initiatives in our center and Nigeria as a whole. Materials and Methods: Injured patients consecutively presenting to the accident and emergency department of the Jos University Teaching Hospital within the period February 2011 to January 2012 were prospectively recorded. Results: A total of 720 injured patients admitted with an age range of 8 months to 75 years (mean = 37.9; SD = ±52.4), which consists of 544 males and 176 females giving a male to female ratio of 3.1:1. Patients aged 20-29 years were in the majority (n = 220, 30.6%) with peak incidences in the period of communal clashes. Injuries sustained from motorcycles were the highest (n = 248, 34.4%). Others were 160 (22.2%) in other vehicular and pedestrian injuries, machete (n = 128), gunshots (n = 92), burns (n = 36), bomb blast injuries (n = 16), fall from heights (n = 32) and miscellaneous (n = 8). Injuries sustained in communal clashes and terrorist attacks accounted for 236 (32.8%) presentations. The most common site of injury was the head (n = 30 4, 42.2%). Relatives, passersby and law enforcement agencies brought patients to the hospital with times between injury and presentation ranging from 1 h to 3 weeks. 40 (5.6%) patients were brought in dead. Conclusion: A collective effort - on the part of the government and the citizenry is required to ensure better outcomes and a safer society for all. PMID:24812451

  5. Incidence and Etiology of Surgical Site Infections among Emergency Postoperative Patients in Mbarara Regional Referral Hospital, South Western Uganda

    PubMed Central

    Joel, Bazira; Justina Lucy, Najjuka

    2017-01-01

    Background. This prospective hospital based study was conducted to determine the incidence, risk factors, and causative agents of surgical site infection their susceptibility to among 114 emergency postoperative patients at the Mbarara Regional Referral Hospital between September 2014 and January 2015. Methods. Consented patients were consecutively enrolled and their preoperative, intraoperative, and postoperative data were collected. Follow-ups were done in the surgical outpatient clinics. Wound specimens were collected and processed as per Sops; susceptibility testing was done using the Kirby-Bauer disc diffusion technique. Data was analyzed using STATA 11.0. Results. Overall SSI incidence was 16.4%: 5.9% superficial and 47.1% deep and organ space SSIs each. Klebsiella pneumoniae was the most predominant organism (50%) followed by Staphylococcus aureus (27.8%). E. coli and P. aeruginosa both accounted for 11.1%. Wound class (p = 0.009), anaemia (p = 0.024), low serum albumin (p = 0.046), and property of suture material used (p = 0.006) were significantly associated with SSIs. All organisms had 100% resistance to ampicillin, tetracycline, septrin, and erythromycin. Ciprofloxacin and ceftriaxone are highly sensitive to all organisms. Conclusion. The incidence of SSI in this hospital is very high. Klebsiella pneumoniae is the predominant cause. Ciprofloxacin are very potent antibiotics against organisms that cause SSI. PMID:28168215

  6. Incidence and Etiology of Surgical Site Infections among Emergency Postoperative Patients in Mbarara Regional Referral Hospital, South Western Uganda.

    PubMed

    Lubega, Abubaker; Joel, Bazira; Justina Lucy, Najjuka

    2017-01-01

    Background. This prospective hospital based study was conducted to determine the incidence, risk factors, and causative agents of surgical site infection their susceptibility to among 114 emergency postoperative patients at the Mbarara Regional Referral Hospital between September 2014 and January 2015. Methods. Consented patients were consecutively enrolled and their preoperative, intraoperative, and postoperative data were collected. Follow-ups were done in the surgical outpatient clinics. Wound specimens were collected and processed as per Sops; susceptibility testing was done using the Kirby-Bauer disc diffusion technique. Data was analyzed using STATA 11.0. Results. Overall SSI incidence was 16.4%: 5.9% superficial and 47.1% deep and organ space SSIs each. Klebsiella pneumoniae was the most predominant organism (50%) followed by Staphylococcus aureus (27.8%). E. coli and P. aeruginosa both accounted for 11.1%. Wound class (p = 0.009), anaemia (p = 0.024), low serum albumin (p = 0.046), and property of suture material used (p = 0.006) were significantly associated with SSIs. All organisms had 100% resistance to ampicillin, tetracycline, septrin, and erythromycin. Ciprofloxacin and ceftriaxone are highly sensitive to all organisms. Conclusion. The incidence of SSI in this hospital is very high. Klebsiella pneumoniae is the predominant cause. Ciprofloxacin are very potent antibiotics against organisms that cause SSI.

  7. Referral for psychological therapy of people with long term conditions improves adherence to antidepressants and reduces emergency department attendance: Controlled before and after study

    PubMed Central

    de Lusignan, Simon; Chan, Tom; Tejerina Arreal, Maria C.; Parry, Glenys; Dent-Brown, Kim; Kendrick, Tony

    2013-01-01

    Background Referral to psychological therapies is recommended for people with common mental health problems (CMHP) however its impact on healthcare utilisation in people with long term conditions (LTCs) is not known. Method Routinely collected primary care, psychological therapy clinic and hospital data were extracted for the registered population of 20 practices (N = 121199). These data were linked using the SAPREL (Secure and Private Record Linkage) method. We linked the 1118 people referred to psychological therapies with 6711 controls, matched for age, gender and practice. We compared utilisation of healthcare resources by people with LTCs, 6 months before and after referral, and conducted a controlled before and after study to compare health utilisation with controls. We made the assumption that collection of a greater number of repeat prescriptions for antidepressants was associated with greater adherence. Results Overall 21.8% of people with an LTC had CMHP vs. 18.8% without (p < 0.001). People with LTCs before referral were more likely to use health care resources (2-tailed t-test p < 0.001). Cases with LTCs showed referral to the psychological therapies clinic was associated with increased antidepressant medication prescribing (mean differences 0.62, p < 0.001) and less use of emergency department than controls (mean difference −0.21, p = 0.003). Conclusions Referral to improved access to psychological therapies (IAPT) services appears of value to people with LTC. It is associated with the issue of a greater number of prescriptions for anti-depressant medicines and less use of emergency services. Further studies are needed to explore bed occupancy and outpatient attendance. PMID:23639304

  8. Emergency department waiting room: many requests, many insured and many primary care physician referrals

    PubMed Central

    2013-01-01

    Background Increase in waiting time often results in patients leaving the emergency department (ED) without being seen, ultimately decreasing patient satisfaction. We surveyed low-acuity patients in the ED waiting room to understand their preferences and expectations. Methods An IRB approved, 42-item survey was administered to 400 adult patients waiting in the ED waiting room for >15 min from April to August 2010. Demographics, visit reasons, triage and waiting room facility preferences were collected. Results The mean age of patients was 38.9 years (SD = 14.8), and 52.5% were females. About 53.8% of patients were employed, 79.4% had access to a primary care physician (PCP), and 17% did not have any medical insurance. The most common complaint was pain. A total of 44.4% respondents reported that they believed their problems were urgent and required immediate attention, prompting them to come to the ED, while 14.6% reported that they could not get a timely PCP appointment, and 42.9% were actually referred by their PCP to come to the ED. About 57.7% of patients considered leaving the ED if the waiting times were too long. The mean acceptable waiting time before leaving ED was 221 min (SD = 194; median 180 min, IQR 120–270). A total of 39.1% survey respondents reported being most comfortable being triaged by a physician. Respondents were least comfortable being triaged by residents. On analyzing waiting room expectations for the survey respondents, we found that 70% of the subjects wanted a better estimate of waiting time and 43.5% wanted better information on reasons for the long wait. Conclusion Contrary to popular belief, at our ED a large proportion of low-acuity patients has a PCP and is medically insured. Providing patients with appropriate reasons for the wait, an accurate estimate of waiting time and creating separate areas to examine minor illness/injuries would increase patient satisfaction within our population subset. PMID:24083339

  9. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy

    PubMed Central

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  10. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy.

    PubMed

    Aradeon, Susan B; Doctor, Henry V

    2016-01-01

    The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support

  11. The Impact of Screening, Brief Intervention and Referral for Treatment in Emergency Department Patients’ Alcohol Use: A 3-, 6- and 12-month Follow-up

    PubMed Central

    2010-01-01

    Aims: This study aims to determine the impact of Screening, Brief Intervention and Referral for Treatment (SBIRT) in reducing alcohol consumption in emergency department (ED) patients at 3, 6, and 12 months following exposure to the intervention. Methods: Patients drinking above the low-risk limits (at-risk to dependence), as defined by National Institute of Alcohol Abuse and Alcoholism (NIAAA), were recruited from 14 sites nationwide from April to August 2004. A quasi-experimental comparison group design included sequential recruitment of intervention and control patients at each site. Control patients received a written handout. The Intervention group received the handout and participated in a brief negotiated interview with direct referral for treatment if indicated. Follow-up surveys were conducted at 3, 6, and 12 months by telephone using an Interactive Voice Response (IVR) system. Results: Of the 1132 eligible patients consented and enrolled (581 control, 551 intervention), 699 (63%), 575 (52%) and 433 (38%) completed follow-up surveys via IVR at 3, 6, and 12 months, respectively. Regression analysis adjusting for the clustered sampling design and using multiple imputation procedures to account for subject attrition revealed that those receiving SBIRT reported roughly three drinks less per week than controls (B = −3.00, SE = 1.06, P < 0.05) and the level of maximum drinks per occasion was approximately three-fourths of a drink less than controls (B = -0.76, SE = 0.29, P < 0.05) at 3 months. At 6 and 12 months post-intervention, these effects had weakened considerably and were no longer statistically or substantively significant. Conclusion: SBIRT delivered by ED providers appears to have short-term effectiveness in reducing at-risk drinking, but multi-contact interventions or booster programs may be necessary to maintain long-term reductions in risky drinking. PMID:20876217

  12. Does a pre-hospital emergency pathway improve early diagnosis and referral in suspected stroke patients? – Study protocol of a cluster randomised trial [ISRCTN41456865

    PubMed Central

    Ferri, Marica; De Luca, Assunta; Rossi, Paolo Giorgi; Lori, Giuliano; Guasticchi, Gabriella

    2005-01-01

    Background Early interventions proved to be able to improve prognosis in acute stroke patients. Prompt identification of symptoms, organised timely and efficient transportation towards appropriate facilities, become essential part of effective treatment. The implementation of an evidence based pre-hospital stroke care pathway may be a method for achieving the organizational standards required to grant appropriate care. We performed a systematic search for studies evaluating the effect of pre-hospital and emergency interventions for suspected stroke patients and we found that there seems to be only a few studies on the emergency field and none about implementation of clinical pathways. We will test the hypothesis that the adoption of emergency clinical pathway improves early diagnosis and referral in suspected stroke patients. We designed a cluster randomised controlled trial (C-RCT), the most powerful study design to assess the impact of complex interventions. The study was registered in the Current Controlled Trials Register: ISRCTN41456865 – Implementation of pre-hospital emergency pathway for stroke – a cluster randomised trial. Methods/design Two-arm cluster-randomised trial (C-RCT). 16 emergency services and 14 emergency rooms were randomised either to arm 1 (comprising a training module and administration of the guideline), or to arm 2 (no intervention, current practice). Arm 1 participants (152 physicians, 280 nurses, 50 drivers) attended an interactive two sessions course with continuous medical education CME credits on the contents of the clinical pathway. We estimated that around 750 patients will be met by the services in the 6 months of observation. This duration allows recruiting a sample of patients sufficient to observe a 30% improvement in the proportion of appropriate diagnoses. Data collection will be performed using current information systems. Process outcomes will be measured at the cluster level six months after the intervention. We will

  13. Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication

    PubMed Central

    Vardy, J; Keliher, T; Fisher, J; Ritchie, F; Bell, C; Chekroud, M; Clarey, F; Blackwood, L; Barry, L; Paton, E; Clark, A; Connelly, R

    2016-01-01

    Objectives Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption. Setting ED of a UK tertiary referral hospital. Participants All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%). Primary outcome measures Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician. Secondary outcome measures Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria. Results 1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with ‘Severe’ or ‘Very Severe’ acute alcohol intoxication (p<0.001). Admissions due to alcohol differed to admissions not due to alcohol being on average younger (45 vs 56 years, p<0.001) more often male (73.4% vs 45.1% males, p<0.001) and more likely to have a diagnosis synonymous with alcohol or related to recreational drug use, pancreatitis, deliberate self-harm, head injury, gastritis, suicidal ideation, upper gastrointestinal bleeds or seizures (p<0.001). An increase in admissions due to alcohol on Saturdays reflects a surge in admissions with acute alcohol intoxication above the weekly average (p=0.003). Conclusions Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD. PMID:27324707

  14. Safer Chemicals Research Fact Sheets

    EPA Pesticide Factsheets

    Chemical safety is a major priority of the U.S. EPA. Moving toward a healthier, more sustainable environment requires making safer, “greener” chemicals and producing new and existing chemicals in ways that are safer for humans and wildlife.

  15. Screening, Brief Intervention, and Referral to Treatment (SBIRT) in a Polish Emergency Department: Three-Month Outcomes of a Randomized, Controlled Clinical Trial*

    PubMed Central

    Cherpitel, Cheryl J.; Moskalewicz, Jacek; Swiatkiewicz, Grazyna; Ye, Yu; Bond, Jason

    2009-01-01

    Objective: A randomized, controlled trial of screening, brief intervention, and referral to treatment (SBIRT) for drinking and related problems among at-risk and dependent drinkers was conducted in an emergency department (ED) in Sosnowiec, Poland, among patients ages 18 years and older. Method: Data were collected over a 23-week period, from 4:00 pm to midnight, and resulted in 446 patients being recruited into the study (90% of those who screened positive) and randomized to three conditions following a two-stage process: screened only (n = 147), assessed (n = 152), and received intervention (n = 147). Patients in the assessment (85%) and intervention (83%) conditions were blindly reassessed at 3 months via a telephone interview. Results: At 3-month follow-up, both groups showed significant decreases in the proportion who were positive for at-risk drinking, the primary outcome variable. Both groups also showed significant decreases in drinking days per week, drinks per drinking day, maximum drinks per occasion, and negative consequences of drinking. Using analysis of covariance to control for baseline measures and demographic characteristics, no difference in outcome measures was found between intervention and assessment conditions. Subgroup analysis found some significant interactions between intervention and secondary outcomes. Conclusions: Although the main findings were similar to those from other brief-intervention studies in Western cultures, findings here also suggest that intervention may have differential benefits for specific subgroups of patients in the ED, an area of research that may warrant additional study of brief intervention in the ED setting. PMID:19895777

  16. B-SAFER: A Web-Based Intervention for Drug Use and Intimate Partner Violence Demonstrates Feasibility and Acceptability Among Women in the Emergency Department

    PubMed Central

    Choo, Esther K.; Zlotnick, Caron; Strong, David R.; Squires, Daniel D.; Tapé, Chantal; Mello, Michael J.

    2016-01-01

    Background Addressing violence along with drug use change goals is critical for women with coexisting intimate partner violence (IPV) and substance use disorders (SUD). Methods This was an acceptability and feasibility study of BSAFER, a brief Web-based program and booster phone call addressing violence and drug use. A screening survey identified women with recent drug use and IPV in the emergency department (ED). Participants were randomized to BSAFER or a Web-based control program and booster call providing education about home fire safety. Program completion, usability, satisfaction and MI adherence were primary outcomes. Drug use and IPV outcomes were measured at baseline, one and three months. Results Forty women were enrolled (21 BSAFER, 19 control); 50% were non-white and mean age was 30 years. Most commonly used drugs were marijuana (88%) and cocaine (30%); 45% reported physical abuse and 33% severe combined physical and sexual abuse. Thirty-nine (98%) completed the Web program, 30 (75%) completed the booster, and 29 (73%) completed 3-month follow up. Mean System Usability Scale (SUS) for the BSAFER Web program was 84 (95% CI 78–89) of 100; mean Client Satisfaction Questionnaire (CSQ-8) was 28 (95% CI 26–29) of 32. MI adherence scores were high and similar for both the Web program and the booster. Both intervention and control groups had small mean decreases in weekly drug use days (0.7 days vs. 1.5 days); participants using drugs other than marijuana demonstrated greater average reductions in drug use than those using marijuana only. Conclusions An ED Web-based intervention for SUD and IPV in women demonstrated feasibility and acceptability. Future studies will examine efficacy of the BSAFER program and investigate whether specific subgroups of drug using women may be most responsive to ED-based Web interventions. PMID:26714233

  17. Qualitative study on maternal referrals in rural Tanzania: decision making and acceptance of referral advice.

    PubMed

    Pembe, Andrea B; Urassa, David P; Darj, Elisabeth; Carlsted, Anders; Olsson, Pia

    2008-08-01

    The aim of this study was to describe perceptions of maternal referrals in a rural district in Tanzania. Focus group discussions (FGDs) with health workers and community members, stratified by age and gender, were conducted. The FGDs revealed that husbands and relatives are the decision makers in maternal referrals, whereas the women had limited influence, especially on emergency referrals. The process in deciding to seek referral care is envisaged within community perception of seriousness of the condition, difficulty to access and cost involved in transport, living expenses at the hospital, and perceived quality of care at facility level. The hospitals were seen as providing acceptable quality of care, whereas, the health centres had lower quality than expected. To improve maternal referral compliance and reduce perinatal and maternal morbidity and mortality, community views of existing referral guidelines, poverty reduction, women's empowerment and male involvement in maternal care are necessary.

  18. Is your plant inherently safer?

    SciTech Connect

    Snyder, P.G.

    1996-07-01

    Managing process risk begins at the conceptual design stage. Using these guidelines, engineers can explore how to make existing and future plants inherently safer. Despite progress made in process design tools and development of industry standards for design, procurement and construction, the hydrocarbon processing industry (HPI) struggles to improve the safety and operation of existing facilities. The paper discusses design standards and practices, plant design success stories, and achieving inherently safer plant designs.

  19. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Justice. 11.17 Section 11.17 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Referral to Department of Justice. When Department of Justice approval or consultation is required under § 11.16, the referral or request shall be transmitted to the Department of Justice by the Chief...

  20. Safer, More Effective Pain Management

    MedlinePlus

    ... Data Fentanyl Encounters Data CDC Guideline for Prescribing Opioids for Chronic Pain For Patients For Providers Guideline Resources Clinical Tools ... used carefully. The new CDC Guideline for Prescribing Opioids for Chronic Pain helps inform providers’ ability to offer safer, more ...

  1. How to sell safer sex.

    PubMed

    Overs, C

    1991-09-01

    Social and economic factors determine the extent of the sex industry in societies. Despite AIDS, the sex industry will continue to thrive. Accordingly, health promotion strategies aimed at sex workers and their clients should not stem from the belief that the industry should cease to exist. This paper offers advice in developing and implementing programs to promote safer sex among sex workers. The social context is 1 element to consider in planning successful campaigns. Interventions must be combined with well-planned prevention campaigns aimed at entire populations. The opinions and participation of those involved in the industry should also be sought, while worker discussion and action upon other community issues should not be discouraged. Care should be given to target the numerous and diverse sex worker audiences in addition to other persons related to and involved in the industry. Programs should address the main obstacles to practicing safer sex, and attention should be given to ensure the provision of an adequate and regular supply of cheap or free condoms through varied distribution channels. In the area of service provision, sex workers need easy access to social support and health care services from which they are often excluded. Activities conducted around the world include the marketing of safer sex, distributing printed information on HIV and AIDS to clients, training sex workers to pass designated constructive ideas to others involved in the sex industry, referring sex workers to sex businesses supportive of safer sex practices, and developing street theater and cabaret shows in bars.

  2. Safer Aviation Materials Tested

    NASA Technical Reports Server (NTRS)

    Palaszewski, Bryan A.

    2001-01-01

    A series of thermally stable polymer samples were tested. These materials are called low heat release materials and are designed for aircraft interior decorative materials. The materials are designed to give off a minimum amount of noxious gases when heated, which increases the possibility that people can escape from a burning aircraft. New cabin materials have suitably low heat release so that fire does not spread, toxic chemicals are not given off, and the fire-emergency escape time for crew and passengers is lengthened. These low heat-release materials have a variety of advantages and applications: interiors for ground-based facilities, interiors of space vehicles, and many commercial fire-protection environments. A microscale combustion calorimeter at the Federal Aviation Administration's (FAA) Technical Center tested NASA Langley Research Center materials samples. The calorimeter is shown. A sharp, quantitative, and reproducible heat-release-rate peak is obtained in the microscale heat-release-rate test. The newly tested NASA materials significantly reduced the heat release capacity and total heat release. The thermal stability and flammability behavior of the samples was very good. The new materials demonstrated a factor of 4 reduction in total heat release over ULTEM (a currently used material). This information is provided in the following barchart. In other tests, the materials showed greater than a factor 9 reduction in heat-release capacity over ULTEM. The newly tested materials were developed for low dielectric constant, low color, and good solubility. A scale up of the material samples is needed to determine the repeatability of the performance in larger samples. Larger panels composed of the best candidate materials will be tested in a larger scale FAA Technical Center fire facility. The NASA Glenn Research Center, Langley (Jeff Hinkley), and the FAA Technical Center (Richard Lyon) cooperatively tested these materials for the Accident Mitigation

  3. Chemical Safety Alert: Safer Technology and Alternatives

    EPA Pesticide Factsheets

    This alert is intended to introduce safer technology concepts and general approaches, explains the concepts and principles, and gives brief examples of the integration of safer technologies into facility risk management activities.

  4. The business case for transitioning to safer chemicals.

    PubMed

    McFadden, Roger D

    2011-01-01

    Emerging domestic and international chemical regulations and a heightened consumer awareness of chemicals of concern in products is challenging American businesses to reevaluate and reconsider their approaches to supply chain management and product design. Some of these companies recognize business opportunities and are responding proactively with innovative strategies and tactics. This article describes steps that Staples Inc., the world's largest office products provider, is taking to meet demand for products that are safer and more sustainable. In trying to meet the demand for safer products, Staples faces significant barriers, including the complexity of supply chains, data gaps, and confidential business information. New collaborations between companies, government, and advocates, and improved tools and criteria for defining safer products enhance the ability of businesses, like Staples, to meet new consumer demands.

  5. Communicating the Benefits of SAFER

    DTIC Science & Technology

    2010-07-01

    collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE JUL 2010 2. REPORT TYPE N/A 3 . DATES COVERED...by the DDESB. DoD 6055.09-STD Chapter 17 provides guidance on preparing and submitting a risk-based site plan (Ref. 3 ). 3.2 RISK MANAGEMENT SAFER...Australian explosives safety seminars (PARARI), International Society of Explosives Engineers ( ISEE ) conferences, the International System Safety

  6. Profile of microorganisms and antimicrobial resistance at a tertiary care referral burn centre in Iran: emergence of Citrobacter freundii as a common microorganism.

    PubMed

    Khorasani, G; Salehifar, E; Eslami, G

    2008-11-01

    Infection and antimicrobial resistance are important issues in severe burn. The aims of this prospective study were to investigate the profile of microorganisms and resistance to antimicrobial agents in a tertiary referral burn centre; 113 people aged >10 years, with partial- or full-thickness burns, were included in the study. A total of 733 samples including 275 swabs, 164 tissue biopsies, 258 urine samples, 26 blood samples and 10 sputum samples were collected, from which 124 microorganisms were isolated. Pseudomonas aeruginosa and Citrobacter spp were the most prevalent isolates (57.3% and 35.5%, respectively); 95.5% of Citrobacter. isolates were Citrobacter freundii. Antibiogram results obtained from 15 antimicrobial agents demonstrated that imipenem was the most effective agent against P. aeruginosa, followed by ciprofloxacin and piperacillin/tazobactam (67.9%, 43% and 37.5% sensitive, respectively). At least 60% of all Citrobacter isolates were sensitive to various antimicrobial agents, the highest sensitivity being obtained by ceftazidime and cefepime (81.6% and 78.4%, respectively). Sensitivity of P. aeruginosa isolates to the agents of each antimicrobial class was significantly different (p<0.001). The incidence of C. freundii and the resistance of P. aeruginosa to anti-pseudomonas agents were exceptionally high.

  7. 70 Years Making the World Safer

    SciTech Connect

    2017-01-01

    This video shows our roles in making the world safer — working to end World War II, providing stable isotopes for research, providing unique precision manufacturing capabilities, and meeting nonproliferation and global security missions.

  8. 70 Years Making the World Safer: Extended

    SciTech Connect

    2017-01-01

    Extended version with narration. This video shows our roles in making the world safer — working to end World War II, providing stable isotopes for research, providing unique precision manufacturing capabilities, and meeting nonproliferation and global security missions.

  9. Brazilian Specialists’ Perspectives on the Patient Referral Process

    PubMed Central

    Juliani, Carmen; MacPhee, Maura; Spiri, Wilza

    2017-01-01

    Since 1988, healthcare has been considered a citizen’s right in Brazil. The Sistema Único de Saúde (SUS), has undergone development and expansion to ensure universal health coverage for the Brazilian public, the world’s fifth largest population. The coordination of effective communications between primary care physicians, specialists and patients is a significant challenge, particularly the referral process. Our study objective was to understand the facilitators and barriers associated with referral process communications between primary care physicians and regional university hospital specialists in the State of Sao Paulo. This paper reports specialists’ perspectives of the referral process. This was a phenomenological study that employed a qualitative research method with three components (description, reduction and comprehension). We conducted focus groups with 54 hospital residents from different specialties (surgery, medicine, obstetrics/gynecology, pediatrics) from July to October 2014. The main results showed lack of an adequate referral-return referral process resulting in treatment delays and inappropriate use of emergency services. Communications were impeded by lack of integrated, computerized booking and standardized referral-return referral processes; underlying lack of trust in primary care physicians; and patients’ inappropriate use of healthcare services. Although computerized systems will facilitate communications between primary and specialty care, other strategies are needed to promote collaboration between services, and ensure appropriate utilization of them. PMID:28146046

  10. Greener is Cleaner, and Safer

    ERIC Educational Resources Information Center

    Science Scope, 2005

    2005-01-01

    One easy way to reduce the number of accidents in the lab is to go "green." Green chemistry, or sustainable chemistry, emerged about a decade ago, but the concept has been practiced for centuries by indigenous people of many continents. The basic principles of green chemistry are that you should use only what you need and recycle what you can.…

  11. The current state of electronic consultation and electronic referral systems in Canada: an environmental scan.

    PubMed

    Liddy, Clare; Hogel, Matthew; Blazkho, Valerie; Keely, Erin

    2015-01-01

    Access to specialist care is a point of concern for patients, primary care providers, and specialists in Canada. Innovative e-health platforms such as electronic consultation (eConsultation) and referral (eReferral) can improve access to specialist care. These systems allow physicians to communicate asynchronously and could reduce the number of unnecessary referrals that clog wait lists, provide a record of the patient's journey through the referral system, and lead to more efficient visits. Little is known about the current state of eConsultation and eReferral in Canada. The purpose of this work was to identify current systems and gain insight into the design and implementation process of existing systems. An environmental scan approach was used, consisting of a systematic and grey literature review, and targeted semi-structured key informant interviews. Only three eConsultation/eReferral systems are currently in operation in Canada. Four themes emerged from the interviews: eReferral is an end goal for those provinces without an active eReferral system, re-organization of the referral process is a necessity prior to automation, engaging the end-user is essential, and technological incompatibilities are major impediments to progress. Despite the acknowledged need to improve the referral system and increase government spending on health information technology, eConsultation and eReferral systems remain scarce as Canada lags behind the rest of the developed world.

  12. Informational influences on physician referrals.

    PubMed

    Beltramini, R F; Sirsi, A K

    1992-01-01

    Today's health care marketers are devoting significant resources to increase physician referrals, an area vital to their continued survival. The goal of this investigation was to integrate the findings of previous research on physician referrals, and to provide an up-to-date assessment of those influences underlying physician referral behavior. A questionnaire was mailed to 1,800 physicians differing in specialty and years in practice. Three informational influences were found to affect physician referrals: Program Information, Patient Input, and Location. The results suggest a need for specialists and other organizations interested in managing physician referrals to (a) establish and maintain a network of relationships among those physicians referring patients and specialists being referred to through personal communication, (b) maintain a pool of knowledgeable professionals willing to supply relevant and current information to physicians, and (c) provide complete and prompt feedback information to the referring physician. Managerial implications and directions for future research are also discussed.

  13. Improved and safer nuclear power.

    PubMed

    Taylor, J J

    1989-04-21

    Recent progress in advanced nuclear power development in the United States is revealing high potential for nuclear reactor systems that are smaller and easier to operate than the present generation. Passive, or intrinsic, characteristics are applied not only to provide inherent stability of the chain reaction but also to ensure continued cooling of the fuel and its containment systems even if a major breakdown of the normal cooling and control functions were to occur. The chance of a severe accident is thereby substantially reduced. The plant designs that are emerging are simpler and more rugged, have a longer life span, and place less burden on equipment and operating personnel. Modular design concepts and design standardization are also used to reduce construction time and engineering costs, giving promise that the cost of generating power from these systems will be competitive with alternative methods.

  14. Retinoblastoma Referral Pattern in Kenya

    PubMed Central

    Nyamori, Joseph M.; Kimani, Kahaki; Njuguna, Margaret W.; Dimaras, Helen

    2014-01-01

    Purpose: Kenya is a large country with a widely dispersed population. As retinoblastoma requires specialized treatment, we determined the referral pattern for patients with retinoblastoma in Kenya to facilitate the formulation of a national policy. Materials and Methods: A retrospective study was performed for retinoblastoma patients who presented from January 1, 2006 to December 31, 2007. Data were collected on the referral process from presenting health facility to the hospital where patient was treated. Data were also collected on the time interval when the first symptoms were noticed to the time of presentation at a health facility (lag time). For cases that could be traced to a referral hospital, the time delay due to referral (referral lag time) was recorded. Results: There were 206 patients diagnosed with retinoblastoma in 51 Kenyan and 2 foreign healthcare facilities, and they received final treatment at a Kenyan hospital. Mean lag time was 6.8 months (±6.45). Of all patients, 18% (38/206) were treated at the hospital where they first presented and 82% (168/206) were referred elsewhere. Of those referred, 35% (58/168) were lost to follow-up. The mean referral lag time was 1.7 months (±2.5). Conclusions: A significant proportion of cases presented late, and either delayed seeking further treatment or were lost after initial referral. We recommend the implementation of a national strategy that emphasizes early detection, documentation and follow up of retinoblastoma patients. PMID:25371638

  15. Using Technology to Create Safer Schools.

    ERIC Educational Resources Information Center

    Townley, Arthur J.; Martinez, Kenneth

    1995-01-01

    Although classes to create student self-esteem and antigang programs are gaining in popularity, most school districts have not used available technology to help create safer campuses. Increased availability of telephones and two-way radios would enhance school security, along with incorporation of newer technologies such as computers, digitized…

  16. Safer Choice Partner of the Year Awards Application Form

    EPA Pesticide Factsheets

    EPA's Design for the Environment program developed the Safer Product Labeling Program Partner of the Year Award program to recognize DfE stakeholders that have furthered the safer chemistry goals of the program

  17. 40 CFR 304.21 - Referral of claims.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Referral of claims. 304.21 Section 304.21 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST...

  18. 40 CFR 304.21 - Referral of claims.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Referral of claims. 304.21 Section 304.21 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST...

  19. 40 CFR 304.21 - Referral of claims.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Referral of claims. 304.21 Section 304.21 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST...

  20. Lost Opportunities to Reduce Periconception HIV Transmission: Safer Conception Counseling By South African Providers Addresses Perinatal but not Sexual HIV Transmission

    PubMed Central

    Milford, Cecilia; Kaida, Angela; Ehrlich, Matthew J.; Ng, Courtney; Greener, Ross; Mosery, F. N.; Harrison, Abigail; Psaros, Christina; Safren, Steven A.; Bajunirwe, Francis; Wilson, Ira B.; Bangsberg, David R.; Smit, Jennifer A.

    2014-01-01

    Introduction: Safer conception strategies create opportunities for HIV-serodiscordant couples to realize fertility goals and minimize periconception HIV transmission. Patient–provider communication about fertility goals is the first step in safer conception counseling. Methods: We explored provider practices of assessing fertility intentions among HIV-infected men and women, attitudes toward people living with HIV (PLWH) having children, and knowledge and provision of safer conception advice. We conducted in-depth interviews (9 counselors, 15 nurses, 5 doctors) and focus group discussions (6 counselors, 7 professional nurses) in eThekwini District, South Africa. Data were translated, transcribed, and analyzed using content analysis with NVivo10 software. Results: Among 42 participants, median age was 41 (range, 28–60) years, 93% (39) were women, and median years worked in the clinic was 7 (range, 1–27). Some providers assessed women's, not men's, plans for having children at antiretroviral therapy initiation, to avoid fetal exposure to efavirenz. When conducted, reproductive counseling included CD4 cell count and HIV viral load assessment, advising mutual HIV status disclosure, and referral to another provider. Barriers to safer conception counseling included provider assumptions of HIV seroconcordance, low knowledge of safer conception strategies, personal feelings toward PLWH having children, and challenges to tailoring safer sex messages. Conclusions: Providers need information about HIV serodiscordance and safer conception strategies to move beyond discussing only perinatal transmission and maternal health for PLWH who choose to conceive. Safer conception counseling may be more feasible if the message is distilled to delaying conception attempts until the infected partner is on antiretroviral therapy. Designated and motivated nurse providers may be required to provide comprehensive safer conception counseling. PMID:25436820

  1. Under construction: building a safer industry.

    PubMed Central

    Tibbetts, John

    2002-01-01

    A revolution in the building industry over the past decade has spawned a new generation of safer materials and practices, decreasing some health risks for construction workers. Concerned consumers, builders, materials manufacturers, and government regulatory agencies have all contributed to a turn toward "green" building materials and practices, meaning that homeowners and office workers now are better able to live and work in healthier environments, and many construction workers are handling and installing less-toxic materials. PMID:11882489

  2. STS-64 SAFER Assembly development team members

    NASA Technical Reports Server (NTRS)

    1993-01-01

    The Simplified Aid for EVA Rescue (SAFER) system, to be tested on the STS-64 flight, is surrounded by the team members who have spent a number of recent man hours in preparation for the system's first test-flight. In front are (left to right) Russell L. Flack and Bob Lowe. In the back row are (left to right) Jack D. Humphreys, Chuck Deason, Bill Wood and James Brown.

  3. Safer Systems: A NextGen Aviation Safety Strategic Goal

    NASA Technical Reports Server (NTRS)

    Darr, Stephen T.; Ricks, Wendell R.; Lemos, Katherine A.

    2008-01-01

    The Joint Planning and Development Office (JPDO), is charged by Congress with developing the concepts and plans for the Next Generation Air Transportation System (NextGen). The National Aviation Safety Strategic Plan (NASSP), developed by the Safety Working Group of the JPDO, focuses on establishing the goals, objectives, and strategies needed to realize the safety objectives of the NextGen Integrated Plan. The three goal areas of the NASSP are Safer Practices, Safer Systems, and Safer Worldwide. Safer Practices emphasizes an integrated, systematic approach to safety risk management through implementation of formalized Safety Management Systems (SMS) that incorporate safety data analysis processes, and the enhancement of methods for ensuring safety is an inherent characteristic of NextGen. Safer Systems emphasizes implementation of safety-enhancing technologies, which will improve safety for human-centered interfaces and enhance the safety of airborne and ground-based systems. Safer Worldwide encourages coordinating the adoption of the safer practices and safer systems technologies, policies and procedures worldwide, such that the maximum level of safety is achieved across air transportation system boundaries. This paper introduces the NASSP and its development, and focuses on the Safer Systems elements of the NASSP, which incorporates three objectives for NextGen systems: 1) provide risk reducing system interfaces, 2) provide safety enhancements for airborne systems, and 3) provide safety enhancements for ground-based systems. The goal of this paper is to expose avionics and air traffic management system developers to NASSP objectives and Safer Systems strategies.

  4. Referral Practices of School Counselors.

    ERIC Educational Resources Information Center

    Ritchie, Martin H.; Partin, Ronald L.

    1994-01-01

    Surveyed school counselors (n=149) concerning their referral practices. Found that average number of students that counselors reported referring to other professionals during typical year was 30 (average of 6.5% of students they served). Emotional concerns, family concerns, alcoholism or drug abuse, and suspected child abuse were concerns most…

  5. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM STANDARDS OF CONDUCT AND REFERRAL OF KNOWN OR SUSPECTED CRIMINAL VIOLATIONS Referral of Known or Suspected Criminal Violations § 612.2301 Referrals. (a..., appropriate investigation, and reporting of criminal activity. Within 30 calendar days of determining...

  6. Space Station Live: FLEX in Space for Safer Combustion

    NASA Video Gallery

    Flame Extinguishment Experiment (FLEX) Principal Investigator Mark Hickman, from Glenn Research Center, discusses why scientists study flames in space. One reason is to create a safer environment t...

  7. Molecular approaches for safer and stronger vaccines.

    PubMed

    Del Giudice, G; Rappuoli, R

    1999-11-20

    Progress in molecular biology and biotechnology is making possible the development of new vaccines or the improvement of already existing ones. Recombinant DNA technology, genetic attenuation of bacterial and viral pathogens and their use as vectors for heterologous proteins, expression of microbial antigens in transgenic edible plants, and naked nucleic acid technology represent the most popular approaches hitherto adopted. A successful biotechnological approach to the development of new and improved vaccines has been based on genetic detoxification of bacterial toxins, such as the toxin of Bordetella pertussis, the heat-labile enterotoxin of Escherichia coli, and the toxin of Vibrio cholerae. Genetically detoxified Bordetella pertussis is now included in a commercially available acellular vaccine against pertussis. Genetically detoxified Escherichia coli and Vibrio cholerae have been shown to behave as very strong and safe mucosal adjuvants and are now entering the clinical stage. These results demonstrate that a rational molecular approach to the development of safer and stronger vaccines is feasible.

  8. Parental influence, gay youths, and safer sex.

    PubMed

    LaSala, Michael C

    2007-02-01

    To begin to understand the role that family relationships and interactions play in young gay men's decisions to avoid unsafe sexual practices, parents and sons (ages 16 to 25) in 30 families were qualitatively interviewed about issues and concerns related to HIV risk. Most of the youths reported feeling obliged to their parents to stay healthy, and these feelings of obligation were important factors in their decisions to avoid unsafe sex. Youths who reported no parental influence came from families in which parents had historically been preoccupied with personal or marital problems or in which there was a history of parental rejection. On the basis of these exploratory findings, AIDS prevention specialists are advised to recruit parents, assess family relationships, and facilitate parent-child communication in their efforts to encourage gay youths to consistently engage in safer sex practices.

  9. Development of safer molecules through chirality.

    PubMed

    Patil, P A; Kothekar, M A

    2006-10-01

    Many of the drugs currently used in medical practice are mixtures of enantiomers (racemates). Many a times, the two enantiomers differ in their pharmacokinetic and pharmacodynamic properties. Replacing existing racemates with single isomers has resulted in improved safety and/or efficacy profile of various racemates. In this review, pharmacokinetic and pharmacodynamic implications of chirality are discussed in brief, followed by an overview of some important chiral switches that have yielded safer alternatives. These include levosalbutamol, S-ketamine, levobupivacaine, S-zopiclone, levocetirizine, S-amlodipine, S-atenolol, S-metoprolol, S-omeprazole, S-pantoprazole and R-ondansetron. Few potential chiral switches under evaluation and some chiral switches that have not been successful are also discussed.

  10. Automatic referral to cardiac rehabilitation.

    PubMed

    Fischer, Jane P

    2008-01-01

    The pervasive negative impact of cardiovascular disease in the United States is well documented. Although advances have been made, the campaign to reduce the occurrence, progression, and mortality continues. Determining evidence-based data is only half the battle. Implementing new and updated clinical guidelines into daily practice is a challenging task. Cardiac rehabilitation is an example of a proven intervention whose benefit is hindered through erratic implementation. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American College of Cardiology (ACC), and the American Heart Association (AHA) have responded to this problem by publishing the AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services. This new national guideline recommends automatic referral to cardiac rehabilitation for every eligible patient (performance measure A-1). This article offers guidance for the initiation of an automatic referral system, including individualizing your protocol with regard to electronic or paper-based order entry structures.

  11. A study of referral failures for potentially suicidal patients: a method of medical care evaluation.

    PubMed

    Knesper, D J

    1982-01-01

    To learn more about the methodological problems inherent in medical care evaluation studies, a quality assurance committee conducted a study of rates of referral failure for potentially suicidal patients seen in the psychiatry division of a university hospital's emergency room. A simple 5-point scale was used to identify for study a similarly ill patient group: 296 patients with moderately to extremely severe suicide potential. The rates of referral failure for the emergency room's psychiatry division were 24 per cent for referrals within the university hospital system and 33 per cent outside the system, which compared favorably with other facilities. Outlier analysis-a statistical procedure that holds promise for medical care evaluation studies-was used to identify clinicians whose rates of referral failure differed significantly from their peer's rates of. As a result, an instance of substandard performance was identified and corrected through the transfer of information about exceptionally good performance.

  12. Determinants of Safer Sex Behaviors among College Students

    ERIC Educational Resources Information Center

    Kanekar, Amar; Sharma, Manoj

    2010-01-01

    Safer sex behaviors (monogamy, sexual abstinence, correct and consistent condom usage) are important for prevention of sexually transmitted diseases and HIV/AIDS among college students. The purpose of this article was to review studies addressing determinants of safer sex behaviors among college students. In order to collect materials for this…

  13. Swimming Emergencies

    PubMed Central

    Beerman, Stephen B.

    1988-01-01

    Persons who have undergone swimming emergencies are seen in emergency departments everywhere. They are frequently young healthy citizens. In some instances they will receive better care in large specialized referral hospitals. Other problems can be managed well at local facilities. This article attempts to equip all family physicians with some knowledge and management guidelines for dealing with swimming emergencies, submersion injuries including near-drowning, accidental hypothermia, and triathalon hypothermia. The unique problems of hot tub near-drowning, infant water intoxication, and spinal injuries caused by diving are presented. PMID:21253260

  14. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda J.

    1991-01-01

    In a critique of the existing literature, the author found that most studies simply calculate referral rates and count letters between referring physicians and specialists. Longitudinal studies that consider all participants' views and place referral in a broader context could reveal more about this complex process. This article is the first of a six-part series reporting on a longitudinal study of 50 referrals in Ontario and Manitoba. PMID:21229088

  15. GPs' payment contracts and their referral practice.

    PubMed

    Mariñoso, Begoña Garcia; Jelovac, Izabela

    2003-07-01

    This paper compares the role of general practitioners in determining access to specialists in two types of health care systems: gate-keeping systems, where a general practitioner (GP) referral is compulsory to visit a specialist, and non-gate-keeping systems, where this referral is optional. We model the dependence between the GP's diagnosis effort and her referral behaviour, and identify the optimal contracts that induce the best behaviour from a public insurer's point of view, where there is asymmetry of information between the insurer and the GP regarding diagnosis effort and referral decisions. We show that gate keeping is superior wherever GP's incentives matter.

  16. Development of a quarterly referral productivity report.

    PubMed

    Wu, Cai; Sandoval, Alex; Hicks, Katrina N; Edwards, Tim J; Green, Lyle D

    2007-10-11

    The Office of Physician Relations at The University of Texas M. D. Anderson Cancer Center (MDACC) has developed a dynamic referral productivity reporting tool for its Multidisciplinary Care Centers (MCC). The tool leverages information within the institution's Enterprise Information Warehouse (EIW) using business intelligent software Hyperion Intelligent Explorer Suite 8.3. the referral productivity reports are intended to provide each MCC with detailed referral and registration data outlining how, and from where, patients arrive here for treatment. The reports supports operational and strategic initiatives aimed at improving referral processes and market related program development.

  17. Safer Electrolytes for Lithium-Ion Cells

    NASA Technical Reports Server (NTRS)

    Kejha, Joe; Smith, Novis; McCloseky, Joel

    2004-01-01

    A number of nonvolatile, low-flammability liquid oligomers and polymers based on aliphatic organic carbonate molecular structures have been found to be suitable to be blended with ethylene carbonate to make electrolytes for lithium-ion electrochemical cells. Heretofore, such electrolytes have often been made by blending ethylene carbonate with volatile, flammable organic carbonates. The present nonvolatile electrolytes have been found to have adequate conductivity (about 2 mS/cm) for lithium ions and to remain liquid at temperatures down to -5 C. At normal charge and discharge rates, lithiumion cells containing these nonvolatile electrolytes but otherwise of standard design have been found to operate at current and energy densities comparable to those of cells now in common use. They do not perform well at high charge and discharge rates -- an effect probably attributable to electrolyte viscosity. Cells containing the nonvolatile electrolytes have also been found to be, variously, nonflammable or at least self-extinguishing. Hence, there appears to be a basis for the development of safer high-performance lithium-ion cells.

  18. Injury/illness physician referral profile from a youth university-sponsored summer sport camp program.

    PubMed

    Oller, Daria M; Vairo, Giampietro L; Sebastianelli, Wayne J; Buckley, William E

    2013-08-01

    Participation at university-sponsored summer sport camps is popular among youth athletes; however, there is a dearth of information to describe the injuries/illnesses experienced by camp participants. Data from a university-sponsored sport camp program from 2008 to 2011 were accessed retrospectively. The sport camp program had approximately 80 camps for 28 sports over 12 weeks annually. Male and female participants were 10 to 17 years old. Athletic trainers maintained medical documentation and provided medical referrals. Referrals were made for 9.9% (n=478) of all injuries/illnesses. Emergency department referrals were made for 2.9% of injuries/illnesses. University health services received 42.5% of referrals. There were 1.1 referrals per 100 participants. Boys comprised 60.7% of referrals. Rugby had the highest referral rate--5.0 per 100 participants. These data help increase physician preparedness and guide the delivery of sports medicine services for related sport camp programs as a means to improve quality of care delivered to participants.

  19. Motherhood can be safer -- even where conditions are hard.

    PubMed

    1996-01-01

    The Prevention of Maternal Mortality (PMM) Network in West Africa has demonstrated that, even under sub-optimal conditions, motherhood can be safer and needless deaths can be avoided. The PMM Network's 10 teams from Ghana, Nigeria, and Sierra Leone designed projects to enable women with complications during pregnancy or delivery to overcome delays in deciding to seek medical help, travelling to a health facility, and receiving help after arriving at the facility. Operating rooms and blood banks were opened in some hospitals and health centers were upgraded at a cost under US $15,000. In one case, an abandoned warehouse was turned into a health center. Other PMM activities included staff training, making drugs more readily available, setting up a fund to lower drug prices, and increasing stocks of safe blood. The teams arranged for local truck drivers' unions to provide emergency transport and organized groups of men in remote villages to carry women in hammocks to motorized transport. The teams worked with traditional leaders and held educational sessions at community gatherings. Even in the poorest areas, the number of women seeking care for obstetric complications increased and their risk of dying dropped. The PMM Network is supported by Columbia University's School of Public Health, with funding from the Carnegie Corporation.

  20. Dental Emergencies

    PubMed Central

    Symington, J.M.

    1988-01-01

    Patients with dental emergencies sometimes present to their physician. This article outlines the role of the physician in the management of dental patients who have suffered traumatic injuries, postoperative hemorrhage, pain, and infection. It deals with those difficulties for which the physician may easily prescribe treatment and outlines the treatment that would be undertaken by a dentist who receives such a patient on referral. PMID:21253249

  1. Referral to pediatric surgical specialists.

    PubMed

    Klein, Michael D

    2014-02-01

    The American Academy of Pediatrics, with the collaboration of the Surgical Sections of the American Academy of Pediatrics, has created referral recommendations intended to serve as voluntary practice parameters to assist general pediatricians in determining when and to whom to refer their patients for pediatric surgical specialty care. It is recognized that these recommendations may be difficult to implement, because communities vary in terms of access to major pediatric medical centers. Limited access does not negate the value of the recommendations, however, because the child who needs specialized surgical and anesthetic care is best served by the skills of the appropriate pediatric surgical team. Major congenital anomalies, malignancies, major trauma, and chronic illnesses (including those associated with preterm birth) in infants and children should be managed by pediatric medical subspecialists and pediatric surgical specialists at pediatric referral centers that can provide expertise in many areas, including the pediatric medical subspecialties and surgical specialties of pediatric radiology, pediatric anesthesiology, pediatric pathology, and pediatric intensive care. The optimal management of the child with complex problems, chronic illness, or disabilities requires coordination, communication, and cooperation of the pediatric surgical specialist with the child's primary care pediatrician or physician.

  2. GMES Sentinel-3: A Safer Satellite for a Safer Space World

    NASA Astrophysics Data System (ADS)

    Heinrich, S.; Derenne, P.; Palmade, J. L.; Paoli, F.; Baillion, Y.; Berruti, B.

    2013-09-01

    The Sentinel-3 Mission is part of the Global Monitoring for Environment and Security (GMES) initiative whose overall objective is to support Europe's goals regarding sustainable development and global governance of the environment by providing timely and quality data, information, services and knowledge. In that way, Sentinel-3 will help humanity by contributing to the improvement of the life quality.The Sentinel-3 mission will be more particularly devoted to the provision of Ocean observation data in routine, long term (20 years of operations) and continuous fashion with a consistent quality and a very high level of availability. In addition, the mission will be designed to generate Land optical observation products, ice topography and land hydrology products.THALES ALENIA Space has successfully performed during past years the definition phase of this mission and the system together with ESA to come to an optimized system answering to the users' needs. The results of this development phase and the way forward for a successful implementation of the mission safety compliant to applicable standards will be presented in this paper. In particular, the technical baseline and evolutions will be presented in order to demonstrate the safety improvements versus the previous generation of similar spacecrafts in term of design and operations. A specific focus will be given on quality and safety topics raised and managed during satellite development.The intention of this paper is to present: * The benefits of GMES initiative and specifically of the Sentinel-3 mission for the global humanity to contribute "for a Safer World". * The improvements of Sentinel-3 satellite design & operations in term of Space Safety with regard to previous similar satellites in demonstrating complianceto IADCGuidelines"foraSaferSpace" * The specific Safety and Quality management process implemented daily and the safety concerns raised during Satellite development "for a Safer Satellite" * The

  3. Wear your hat: representational resistance in safer sex discourse.

    PubMed

    Nelson, S D

    1994-01-01

    Through an analysis of four posters used by the AIDS Action Committee of Massachusetts, this article asks how representation can effectively promote safer sex practices. The images under investigation have different targeted groups--one is aimed at African-American men, one at Latinas, and two at gay men. Using a frame-work that connects definitions of sex in the respective communities with differences surrounding gender, race, and class, the imagery is unpacked in order to expose the effects of safer sex representation. This essay then argues that the degree to which ingrained definitions of sex are challenged constitutes a determining factor in the success or failure of safer sex representations.

  4. 2 CFR 175.20 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Referral. 175.20 Section 175.20 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved AWARD TERM FOR TRAFFICKING IN PERSONS § 175.20 Referral. An agency official should inform the...

  5. 2 CFR 175.20 - Referral.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 2 Grants and Agreements 1 2011-01-01 2011-01-01 false Referral. 175.20 Section 175.20 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS AWARD TERM FOR TRAFFICKING IN PERSONS § 175.20 Referral....

  6. 13 CFR 120.926 - Referral fee.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Loan Program (504) Third Party Loans § 120.926 Referral fee. The CDC can receive a reasonable referral fee from the Third Party Lender if the CDC secured the Third Party Lender for the Borrower under a written contract between the CDC and the Third Party Lender. Both the CDC and the Third Party Lender...

  7. 13 CFR 120.926 - Referral fee.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Loan Program (504) Third Party Loans § 120.926 Referral fee. The CDC can receive a reasonable referral fee from the Third Party Lender if the CDC secured the Third Party Lender for the Borrower under a written contract between the CDC and the Third Party Lender. Both the CDC and the Third Party Lender...

  8. 13 CFR 120.926 - Referral fee.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Loan Program (504) Third Party Loans § 120.926 Referral fee. The CDC can receive a reasonable referral fee from the Third Party Lender if the CDC secured the Third Party Lender for the Borrower under a written contract between the CDC and the Third Party Lender. Both the CDC and the Third Party Lender...

  9. 13 CFR 120.926 - Referral fee.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Loan Program (504) Third Party Loans § 120.926 Referral fee. The CDC can receive a reasonable referral fee from the Third Party Lender if the CDC secured the Third Party Lender for the Borrower under a written contract between the CDC and the Third Party Lender. Both the CDC and the Third Party Lender...

  10. 13 CFR 120.926 - Referral fee.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Loan Program (504) Third Party Loans § 120.926 Referral fee. The CDC can receive a reasonable referral fee from the Third Party Lender if the CDC secured the Third Party Lender for the Borrower under a written contract between the CDC and the Third Party Lender. Both the CDC and the Third Party Lender...

  11. 28 CFR 35.174 - Referral.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Referral. 35.174 Section 35.174 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION ON THE BASIS OF DISABILITY IN STATE AND LOCAL GOVERNMENT SERVICES Compliance Procedures § 35.174 Referral. If the public entity declines to enter into...

  12. 28 CFR 35.174 - Referral.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Referral. 35.174 Section 35.174 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION ON THE BASIS OF DISABILITY IN STATE AND LOCAL GOVERNMENT SERVICES Compliance Procedures § 35.174 Referral. If the public entity declines to enter into...

  13. 28 CFR 35.174 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Referral. 35.174 Section 35.174 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION ON THE BASIS OF DISABILITY IN STATE AND LOCAL GOVERNMENT SERVICES Compliance Procedures § 35.174 Referral. If the public entity declines to enter into...

  14. Correctional Service Canada to undertake Safer Tattooing Practices Initiative.

    PubMed

    2004-08-01

    In 1994, the Expert Committee on AIDS and Prisons recommended that tattooing equipment and supplies be authorized for use in federal correctional institutions, and that prisoners who would offer tattooing services to other prisoners be instructed on how to use tattooing equipment safely. Ten years later, Correctional Service Canada (CSC) has finally announced that, as part of a Safer Tattooing Practices Initiative, it will set up safer tattooing pilot projects in six federal prisons in 2004, and evaluate the initiative.

  15. Safer Vehicles for People and the Planet

    SciTech Connect

    Wenzel, Thomas P; Wenzel, Thomas P; Ross, Marc

    2008-03-01

    those riding in them is flawed. For starters, all else is never equal; other aspects of vehicle design appear to control what really happens in a crash, as reflected in the safety record of different kinds of vehicles. What's more, the use of high-strength steel, light-weight metals such as aluminum and magnesium, and fiber-reinforced plastics now offers automotive engineers the means to fashion vehicles that are simultaneously safer and less massive than their predecessors, and such designs would, of course, enjoy the better fuel economy that shedding pounds brings.

  16. Safer Aircraft Possible With Nitrogen Generation

    NASA Technical Reports Server (NTRS)

    Palaszewski, Bryan A.

    2001-01-01

    A system named On-Board Inert Gas Generation System/On-Board Oxygen Generation System (OBIGGS/OBOGS) was studied with Boeing. The study established the requirements for nitrogen purge (for fuel tank inerting and cargo compartment fire suppression) and oxygen (for passengers and crew). The nitrogen would be used for suppressing fires and fuel tank explosions on the aircraft, and the oxygen would be used for breathing gas during high-altitude or emergency operations.

  17. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... classified information from inadvertent disclosure. (b) Automatic declassification. The referral process for records subject to automatic declassification entails identification of records containing classified... be completed prior to the date of automatic declassification established by section 3.3(a) of...

  18. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... classified information from inadvertent disclosure. (b) Automatic declassification. The referral process for records subject to automatic declassification entails identification of records containing classified... be completed prior to the date of automatic declassification established by section 3.3(a) of...

  19. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or mental health staff for evaluation and, when appropriate,...

  20. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or mental health staff for evaluation and, when appropriate,...

  1. Referral pathways for patients with TIA avoiding hospital admission: a scoping review

    PubMed Central

    Evans, Bridie Angela; Ali, Khalid; Bulger, Jenna; Ford, Gary A; Jones, Matthew; Moore, Chris; Porter, Alison; Pryce, Alan David; Quinn, Tom; Seagrove, Anne C; Whitman, Shirley; Rees, Nigel

    2017-01-01

    Objective To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital. Design Scoping review. Data sources PubMed, CINAHL Web of Science, Scopus. Study selection Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services. Data extraction We screened studies for eligibility and extracted data from relevant studies. Data were analysed to describe setting, assessment and referral processes, treatment, implementation and outcomes. Results 8 international studies were identified, mostly cohort designs. 4 pathways were used by family doctors and 3 pathways by emergency department physicians. No pathways used by paramedics were found. Referrals were made to specialist clinic either directly or via a 24-hour helpline. Practitioners identified TIA symptoms and risk of further events using a checklist including the ABCD2 tool or clinical assessment. Antiplatelet medication was often given, usually aspirin unless contraindicated. Some patients underwent tests before referral and discharge. 5 studies reported reduced incident of stroke at 90 days, from 6–10% predicted rate to 1.3–2.1% actual rate. Between 44% and 83% of suspected TIA cases in these studies were referred through the pathways. Conclusions Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalisation of patients with TIA. No pathways for paramedical use were reported. We will use results of this scoping review to inform development of a paramedical referral pathway to be tested in a feasibility trial. Trial registration number ISRCTN85516498. Stage: pre-results. PMID:28196949

  2. The Nature of All "Inappropriate Referrals" Made to a Countywide Physical Activity Referral Scheme: Implications for Practice

    ERIC Educational Resources Information Center

    Johnston, Lynne Halley; Warwick, Jane; De Ste Croix, Mark; Crone, Diane; Sldford, Adrienne

    2005-01-01

    Objective: The aim of this study was to evaluate the impact of a centralised referral mechanism (CRM) upon the number and type of "inappropriate referrals" made to a countywide physical activity referral scheme. Design: Case study. Method: Phase 1: Hierarchical Content Analysis of 458 "inappropriate referrals" made to a countywide scheme over a…

  3. Safety Assessment for Explosive Risk (SAFER) peer review report.

    SciTech Connect

    Heimdahl, Olaf E. R.; LaHoud, Paul; Chapman, Leon Darrel

    2004-08-01

    At the direction of the Department of Defense Explosives Safety Board (DDESB), a Peer Review Team was established to review the status of development of the risk-based explosives safety siting process and criteria as currently implemented in the software 'Safety Assessment for Explosive Risk (SAFER)' Version 2.1. The objective of the Peer Review Team was to provide an independent evaluation of the components of the SAFER model, the ongoing development of the model and the risk assessment process and criteria. This peer review report addressed procedures; protocols; physical and statistical science algorithms; related documents; and software quality assurance, validation and verification. Overall, the risk-based method in SAFER represents a major improvement in the Department of Defense (DoD) approach to explosives safety management. The DDESB and Risk Based Explosives Safety Criteria Team (RBESCT) have made major strides in developing a methodology, which over time may become a worldwide model. The current status of all key areas of the SAFER code has been logically developed and is defensible. Continued improvement and refinement can be expected as implementation proceeds. A consistent approach to addressing and refining uncertainty in each of the primary areas (probability of event, consequences of event and exposure) will be a very beneficial future activity.

  4. Referral Finder: Saving Time and Improving The Quality of In-hospital Referrals.

    PubMed

    Cathcart, Jennifer; Cowan, Neil; Tully, Vicki

    2016-01-01

    Making referrals to other hospital specialties is one of the key duties of the foundation doctor, which can be difficult and time consuming. In Ninewells hospital, Scotland, in our experience the effectiveness of referrals is limited by contact details not being readily accessible and foundation doctors not knowing what information is relevant to each specialty. We surveyed foundation doctors on their experience of the existing referral process to identify where we needed to focus to improve the process. The doctors reported significant delays in obtaining contact details from the operator, and found they did not know the specific information needed in each referral. To increase the information available to foundation doctors, we set up a page on the staff intranet called 'Referral Finder'. This page includes contact details, guidelines for referral, and links to relevant protocols for each specialty. By making this information readily accessible our objective was to increase the speed and quality of referrals. When surveyed two months after the web page was established, foundation doctors reported a reduction in calls to operator from baseline and reported achieving more effective referrals. When asked to comment, many doctors asked if the page could include details for other hospitals in our health board and provide more specialty specific information. This feedback prompted us to extend the scope of the page to include the district general hospital in our region, and update many of the existing details. Doctors were then surveyed after the updates, 100% agreed that the website saved time and there was a 49.3% reduction in doctors who reported not knowing the specific information needed for a referral. Having adequate information improved referrals and resulted in time saved. This would allow more time for patient care. The quality improvement project was praised among doctors as a useful, innovative and replicable project.

  5. A survey of referral patterns to a paediatric dentistry unit over a 2-year period.

    PubMed

    Shaw, A J; Nunn, J H; Welbury, R R

    1994-12-01

    Following the changes in October 1990 in the payment system for children's dental treatment within the General Dental Service in the UK there has been widespread concern that repercussions would be felt in other branches of dentistry. The aim of this survey was to investigate the referral of children for specialist care to the Department of Child Dental Health in Newcastle upon Tyne after the changes in 1990, so that consultant clinics and the provision of advice and treatment could be targeted more effectively. Information was obtained from the patients' referral letters and from their hospital records between March 1991 and March 1993. There were 513 referrals (excluding those for orthodontic treatment, extractions under general anaesthesia and acute emergencies), the number more than doubling during the 2-year survey period. 83% of these patients lived within 15 miles of the hospital. 84% of these referrals were from general dental practitioners, and the greater proportion were from those who graduated within the previous 4 years. The most common reason for referral involved behaviour problems. Changes in the payment system that occurred in 1990 may have been a contributory factor in explaining these findings.

  6. Vascular Surgical Emergencies: How will Future Surgeons be Trained?

    PubMed Central

    Richards, T; Pittathankal, AA; Kahn, PY; Magee, TR; Lewis, MH; Galland, RB

    2006-01-01

    INTRODUCTION We wished to assess whether pattern and impact of emergency vascular surgical referrals has altered since a previous study in 1990. Following introduction of shift working patterns, we wished to assess how these changes may affect vascular training and vascular on-call cover. PATIENTS AND METHODS Prospective survey of emergency vascular referrals at two district general hospitals (DGH-R and DGH-L) in 2003. DGH-R received only regional referrals whereas DGH-L also received ‘next day’ referrals from a smaller hospital. Results were compared between centres and with a previous study undertaken at DGH-R in 1990. RESULTS From 1990 to 2003 emergency vascular referrals at DGH-R increased by 51% (53 to 80). The number seen at DGH-R and DGH-L were similar in 2003. There were significantly more out-of-hours referrals in DGH-R than DGH-L (59% versus 35%; P = 0.0123). Referrals were more likely to be seen initially by the vascular team at DGH-L than DGH-R (80% versus 47%, P < 0.0001). CONCLUSIONS Vascular emergency referrals have increased. A trainee was likely to see more emergency referrals at DGH-L than DGH-R. This may impact on future training. PMID:17132313

  7. USAR Nurse Referral and Retention Program.

    PubMed

    Foley, J E; Foley, B J

    1992-09-01

    In 1987, the 804th Hospital Center made alleviating the shortfall of registered nurses in the Command a priority. The Command had only 79% of its registered nurse positions filled at the time. Using the recruitment strategies of an employee referral program and a mailing list, the Command reached 100% fill in 2 years and maintained those gains for an additional year. Retention strategies were also implemented which lowered the attrition rate. This paper describes the Army Nurse Referral and Retention Program developed and implemented at the 804th Hospital Center that relieved the shortfall of registered nurses in the United States Army Reserve in New England.

  8. 49 CFR 655.62 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Referral, evaluation, and treatment. 655.62... OPERATIONS Consequences § 655.62 Referral, evaluation, and treatment. If a covered employee has a verified... and treatment programs....

  9. 2 CFR 175.20 - Referral.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false Referral. 175.20 Section 175.20 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved AWARD TERM FOR TRAFFICKING IN PERSONS §...

  10. 2 CFR 175.20 - Referral.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 2 Grants and Agreements 1 2012-01-01 2012-01-01 false Referral. 175.20 Section 175.20 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS NATIONAL POLICY REQUIREMENTS AWARD TERM FOR TRAFFICKING...

  11. 2 CFR 175.20 - Referral.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false Referral. 175.20 Section 175.20 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS NATIONAL POLICY REQUIREMENTS AWARD TERM FOR TRAFFICKING...

  12. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda

    1991-01-01

    Fifty referrals from family physicians in Ontario were examined by interviewing the patients, referring physicians, consultants, and others involved at various points in the process. This, the second in a series of six articles, introduces the participants and describes how grounded theory methodology was used to analyze the approximately 3000 pages of field notes. PMID:21229052

  13. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... an NDC database system. (3) Notification of referral of records accessioned into NARA or in the... unmarked Restricted Data or Formerly Restricted Data shall be referred to the Department of Energy through the NDC. If the Department of Energy confirms that the document contains Restricted Data or...

  14. Information and Referral Service, District Office Training.

    ERIC Educational Resources Information Center

    Health and Welfare Council of Central Maryland, Inc., Baltimore.

    Within a standard format the details of instruction and training in various areas (units) of information and referral (I and R) services are given for Social Security Administration workers. Each unit is specified by the following categories: objective, special consideration, background, presentation, participation, review, and examples. There are…

  15. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure....

  16. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure....

  17. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure....

  18. Behavior Analytic Consultation for Academic Referral Concerns

    ERIC Educational Resources Information Center

    Dufrene, Brad A.; Zoder-Martell, Kimberly A.; Dieringe, Shannon Titus; Labrot, Zachary

    2016-01-01

    Applied behavior analysis provides a technology of human behavior that demonstrates great potential for improving socially important outcomes for individuals. School-based consultation may provide a vehicle for delivering applied behavior analysis services in schools to address academic referral concerns. In this article, we propose that…

  19. Alternative Education's Impact on Office Disciplinary Referrals

    ERIC Educational Resources Information Center

    Gut, Eva; McLaughlin, John M.

    2012-01-01

    Disruptive behaviors negatively impact learning by taking time away from classroom instruction (Gottlieb and Polirstok 2005) and may also produce unsafe school environments. This study examined changes in the number of office disciplinary referrals (ODRs) received in public schools prior to and following the schools partnering with one particular…

  20. Integrating zebrafish toxicology and nanoscience for safer product development.

    PubMed

    Kim, Ki-Tae; Tanguay, Robert L

    2013-04-01

    The design, manufacture and application of safer products and manufacturing processes have been important goals over the last decade and will advance in the future under the umbrella of "Green Chemistry". In this review, we focus on the burgeoning diversity of new engineered nanomaterials (ENMs) and the prescient need for a nanotoxicology paradigm that quickly identifies potentially hazardous nanochemistries. Advances in predictive toxicological modeling in the developing zebrafish offer the most immediate translation to human hazard that is practically achievable with high throughput approaches. Translation in a vertebrate model that is also a low cost alternative to rodents for hazard prediction has been a desirable but elusive testing paradigm. The utility of zebrafish, if applied early in the ENM discovery pipeline, could greatly enhance efforts toward greener and more efficient nanoscience. Early pipeline detection of human and environmental health impacts will quickly inform decisions in the design and production of safer commercial ENMs.

  1. Sources of referral information: a marketing analysis of physician behavior.

    PubMed

    Powers, T L; Swan, J E; Taylor, J A; Bendall, D

    1998-01-01

    The referral process is an important means of obtaining patients and it is necessary to determine ways of influencing the referral process to increase the patient base. This article reports research based on a survey of the referral habits of 806 primary care physicians. The results are examined in the context of physician receptivity to marketer-controlled versus health services sources of referral information.

  2. Psychosocial predictors of "safer sex" behaviors in young adults.

    PubMed

    Basen-Engquist, K

    1992-01-01

    This study tested a model of safer sex behavior using variables from social learning theory, the health belief model, the theory of reasoned action, and theories of cognitive coping style. Two types of safer sex behavior were measured: frequency of condom use and the discussion of AIDS and past partners with a sexual partner. The participants--275 undergraduate students--completed an anonymous written questionnaire. The variables (behavioral intention, perceived susceptibility, barriers, self-efficacy, monitoring, blunting, and social support) predicted 35% of the variance in condom use and 13% of the variance in discussion (adjusted R2s). Intention was the strongest predictor of both types of safer sex behavior. Perceived susceptibility and perceived barriers were associated with intention to use a condom; perceived barriers was inversely related to condom use. Self-efficacy was associated with the intention to discuss and reported discussion of AIDS and past partners with a sexual partner; social support was related to the intention to discuss. An information-avoiding coping style was negatively associated with condom use. Implications for future research and intervention efforts in the area of AIDS prevention are discussed.

  3. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Referral to Department of Justice. 1014.7 Section 1014.7... § 1014.7 Referral to Department of Justice. (a) When Department of Justice approval or consultation is required under § 1014.6, the referral or request shall be transmitted to the Department of Justice by...

  4. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to Department of Justice... Procedures § 17.9 Referral to Department of Justice. When Department of Justice approval or consultation is required under § 17.8, the referral or request shall be transmitted to the Department of Justice by...

  5. 34 CFR 303.206 - Referral policies for specific children.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Referral policies for specific children. 303.206... Referral policies for specific children. Each application must include the State's policies and procedures that require the referral for early intervention services under this part of specific children...

  6. SAFER Inspection of Space Shuttle Thermal Protection System

    NASA Technical Reports Server (NTRS)

    Scoville, Zebulon C.; Rajula, Sudhakar

    2005-01-01

    In the aftermath of the space shuttle Columbia accident, it quickly became clear that new methods would need to be developed that would provide the capability to inspect and repair the shuttle's thermal protection system (TPS). A boom extension to the Remote Manipulator System (RMS) with a laser topography sensor package was identified as the primary means for measuring the damage depth in acreage tile as well as scanning Reinforced Carbon- Carbon (RCC) surfaces. However, concern over the system's fault tolerance made it prudent to investigate alternate means of acquiring close range photographs and contour depth measurements in the event of a failure. One method that was identified early was to use the Simplified Aid For EVA Rescue (SAFER) propulsion system to allow EVA access to damaged areas of concern. Several issues were identified as potential hazards to SAFER use for this operation. First, the ability of an astronaut to maintain controlled flight depends upon efficient technique and hardware reliability. If either of these is insufficient during flight operations, a safety tether must be used to rescue the crewmember. This operation can jeopardize the integrity of the Extra-vehicular Mobility Unit (EMU) or delicate TPS materials. Controls were developed to prevent the likelihood of requiring a tether rescue, and procedures were written to maximize the chances for success if it cannot be avoided. Crewmember ability to manage tether cable tension during nominal flight also had to be evaluated to ensure it would not negatively affect propellant consumption. Second, although propellant consumption, flight control, orbital dynamics, and flight complexity can all be accurately evaluated in Virtual Reality (VR) Laboratory at Johnson Space Center, there are some shortcomings. As a crewmember's hand is extended to simulate measurement of tile damage, it will pass through the vehicle without resistance. In reality, this force will push the crewmember away from the

  7. Follow‐up care in cancer: adjusting for referral targets and extending choice

    PubMed Central

    Wilson, Kate; Lydon, Anne; Amir, Ziv

    2011-01-01

    Abstract Background  Over recent years, several initiatives have impacted on the referral of patients to secondary care, most notably targets for urgent referral in suspected cancer and the patient choice agenda. At the same time, improved long‐term survival in cancer has increased numbers attending follow‐up, doubts about the effectiveness of specialist follow‐up have emerged, and alternative models of follow‐up have been tested. Aim  The aim of the study was to explore patient and carer perspectives on the flexibility and responsiveness of cancer services. This article focuses on findings relating to referral, subsequent outpatient appointments and cessation of outpatient follow‐up. Methods  Issues were explored in a qualitative study using face‐to‐face interviews with a purposive sample of 54 people affected by cancer. Data were analysed concurrently with data collection, using qualitative analysis software. Findings  The study gave rise to a number of salient themes. Links were identified between three of these: choice and responsiveness during referral; the flexibility and responsiveness of outpatient appointment systems; and negotiating cessation of follow‐up. It appeared that policy on urgent referrals might be adversely affecting practice relating to appointment systems and the continuance of follow‐up. Discussion and conclusions  Hospital‐based cancer follow‐up is being given decreasing priority because of doubts about effectiveness and a target‐driven focus on referral. This is impacting on patients, who may value outpatient follow‐up as a ‘safety net’ but have difficulties in obtaining appointments, and may be discharged without negotiation or adequate support. For these reasons, new forms of flexible/responsive aftercare are urgently needed. PMID:21615642

  8. From passive tool holders to microsurgeons: safer, smaller, smarter surgical robots.

    PubMed

    Bergeles, Christos; Yang, Guang-Zhong

    2014-05-01

    Within only a few decades from its initial introduction, the field of surgical robotics has evolved into a dynamic and rapidly growing research area with increasing clinical uptake worldwide. Initially introduced for stereotaxic neurosurgery, surgical robots are now involved in an increasing number of procedures, demonstrating their practical clinical potential while propelling further advances in surgical innovations. Emerging platforms are also able to perform complex interventions through only a single-entry incision, and navigate through natural anatomical pathways in a tethered or wireless fashion. New devices facilitate superhuman dexterity and enable the performance of surgical steps that are otherwise impossible. They also allow seamless integration of microimaging techniques at the cellular level, significantly expanding the capabilities of surgeons. This paper provides an overview of the significant achievements in surgical robotics and identifies the current trends and future research directions of the field in making surgical robots safer, smaller, and smarter.

  9. Pre-referral rectal artesunate for severe malaria

    PubMed Central

    Okebe, Joseph; Eisenhut, Michael

    2014-01-01

    Background Severe or complicated malaria is a medical emergency and people die as a result of delays in starting treatment. Most patients need parenteral treatment, and in primary healthcare facilities, where intravenous therapy is not available but intramuscular injections can be given, intramuscular quinine, artesunate, and artemether have been used before transporting patients to hospital. However, in rural settings with limited access to health care, intramuscular injections may also be unavailable. In these situations, rectal artesunate given prior to transfer to hospital by volunteers with little medical training, may be a feasible option. Objectives To evaluate the effects of pre-referral treatment with rectal artesunate on mortality and morbidity in people with severe malaria. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) published in The Cochrane Library; MEDLINE; EMBASE and LILACS up to 21 May 2014. We also searched the WHO clinical trial registry platform and the metaRegister of Controlled Trials (mRCT) for ongoing trials. Selection criteria Individual or cluster-randomized controlled trials comparing pre-referral rectal artesunate with placebo or injectable antimalarials in children and children with severe malaria. Data collection and analysis Two authors independently screened titles and abstracts for potentially eligible trials, and extracted data from the included trials. Dichotomous outcomes were summarized using risk ratios (RR) and presented with 95% confidence intervals (95% CI). Where data allowed, we conducted subgroup analyses by age, trial region and whether participants were included in the trial analysis. We assessed the quality of evidence for the most important outcomes using the GRADE approach. Main results One trial met the inclusion criteria; a placebo-controlled trial of 17,826 children and adults living in rural villages in Ghana and Tanzania (Africa) and Bangladesh (Asia). Villagers with no

  10. Characteristics of Successful and Unsuccessful Mental Health Referrals of Refugees.

    PubMed

    Shannon, Patricia J; Vinson, Gregory A; Cook, Tonya L; Lennon, Evelyn

    2016-07-01

    In this community based participatory research study, we explored key characteristics of mental health referrals of refugees using stories of providers collected through an on-line survey. Ten coders sorted 60 stories of successful referrals and 34 stories of unsuccessful referrals into domains using the critical incident technique. Principal components analysis yielded categories of successful referrals that included: active care coordination, establishing trust, proactive resolution of barriers, and culturally responsive care. Unsuccessful referrals were characterized by cultural barriers, lack of care coordination, refusal to see refugees, and system and language barriers. Recommendations for training and policy are discussed.

  11. [Appropriateness of referrals for magnetic resonance imaging in Latium, Italy].

    PubMed

    Prota, Federica; Rosano, Aldo; San Martini, Elena; Cau, Norberto; Guasticchi, Gabriella

    2012-01-01

    Long wait times for access to Nuclear Magnetic resonance imaging (MRI) examinations are a concern and for this reason the project "Appropriateness of referrals for MRI examinations" has been launched in Latium (Italy). The aim of this preliminary study was to describe the main characteristics of MRI referrals in the region. Findings highlight a large variation in referral rates across the region, with 80% of MRI referrals being ordered by general practitioners and family pediatricians. The latter points to the possibility of inappropriate referrals for MRI imaging in Latium.

  12. Depression in older adults: screening and referral.

    PubMed

    Vieira, Edgar Ramos; Brown, Ellen; Raue, Patrick

    2014-01-01

    Depression is related to disability and affects rehabilitation participation, outcomes, and compliance with treatment. Improving older adult depression detection and referral requires knowledge, skills, supportive organizational policies, and access to mental health experts. This review provides a selected overview of evidence-based approaches for screening of suspected cases of depression in older adults by physical therapists and other non-mental health professionals and discusses procedures to refer suspected cases to primary care providers and/or mental health specialists for evaluation, including resources and a tool to assist in communicating depression-related information to the primary care provider or mental health specialist. We hope that this review will promote the incorporation of evidence-based screening and referral of suspected cases of depression in older adults into routine practice.

  13. Idiopathic pulmonary fibrosis: Early detection and referral

    PubMed Central

    Oldham, Justin M.; Noth, Imre

    2016-01-01

    Summary Idiopathic pulmonary fibrosis (IPF), a devastating progressive interstitial lung disease (ILD) with no known cause or cure, is the most common and deadly of the idiopathic interstitial pneumonias. With a median survival of 3–5 years following diagnosis, IPF is characterized by a progressive decline in lung function and quality of life in most patients. Vigilance among clinicians in recognizing IPF early in the disease course remains critical to properly caring for these patients, as this provides the widest range of management options. When IPF is suspected, a multidisciplinary evaluation (MDE) by a clinician, radiologist and pathologist with ILD expertise should occur, as this improves diagnostic agreement in both community and academic settings. When community MDE is not possible, or diagnostic doubt exists, referral to an ILD center should be considered. ILD center referral may also provide access specialized care, including clinical trials and lung transplantation, and should be considered for any patient with an established diagnosis of IPF. PMID:24746629

  14. Airport baggage scanning technology makes flying safer for Americans

    SciTech Connect

    Martz, Harry

    2013-08-28

    Each time you step on a commercial flight, you can feel safer because of a researcher you've probably never heard of. His name is Harry Martz. He's a veteran scientist at the Lawrence Livermore National Laboratory (LLNL) who wakes up every day thinking how his research can advance X-ray imaging technology to thwart the next terrorist attack. "My job is to improve national security," Martz said. "That's why my research team exists. We have to outsmart the terrorists. It's a constant battle."

  15. Electronic cigarettes: a safer alternative or potential poison?

    PubMed

    Smith, Janet E

    2014-10-01

    Electronic cigarettes have been marketed as a safer alternative to cigarettes, and their use is expanding exponentially. However, there is a severe lack of scientific data about the ingredients in the liquid used in the device and the health consequences of using electronic cigarettes. As technology has outpaced regulations, the production and sale of electronic cigarettes are, as yet, unregulated and do not fall under the purview of the Food and Drug Administration. This article will review the mechanism of action and what is currently known about the safety of electronic cigarettes. The risk of poisoning for children will also be identified, as well as the implications for home healthcare clinicians.

  16. Artificial Intelligence For A Safer And More Efficient Car Driving

    NASA Astrophysics Data System (ADS)

    Adorni, Giovanni

    1989-03-01

    In this paper a project, PROMETHEUS, is described in which fourteen of Europe's leading car manufacturers are to join with approximately forty research institutes and governmental agencies to make the traffic of Europe safer, more efficient and more economical. PROMETHEUS project is divided into seven areas. In this paper one of the seven areas, PRO-ART, is described. PRO-ART is aimed at clarifying the need for and the principles of the artificial intelligence to be used in the next generation automobile. After a brief description of the overhall project, the description of the seven years PRO-ART Italian research programme will be given.

  17. Seismographs, sensors, and satellites: Better technology for safer communities

    USGS Publications Warehouse

    Groat, C.G.

    2004-01-01

    In the past 25 years, our ability to measure, monitor, and model the processes that lead to natural disasters has increased dramatically. Equally important has been the improvement in our technological capability to communicate information about hazards to those whose lives may be affected. These innovations in tracking and communicating the changes-floods, earthquakes, wildfires, volcanic eruptions-in our dynamic planet, supported by a deeper understanding of earth processes, enable us to expand our predictive capabilities and point the way to a safer future. ?? 2004 Elsevier Ltd. All rights reserved.

  18. A mechanism of institutional isomorphism in referral networks among hospitals in Seoul, South Korea.

    PubMed

    Jung, Minsoo; Choi, Mankyu

    2010-01-01

    Hospitals engage in medical referral system relations voluntarily, by virtue of their own service capacities. These capacities include medical technology, equipment supply, and patient management, which are assessed individually by medical institutions in efforts to control costs and maintain efficiency in tertiary hospitals. This study assessed referral networks according to the institutional isomorphism theory of new economic sociology. As a result, the referral networks were shown to exhibit emergent structural hierarchy via cumulative clustering by established year and were not affected by attributive variables such as region, bed number, and year of establishment. In particular, the networks evidenced institutional isomorphism with certain central hospitals. As a consequence, personal indices were shown to decrease in accordance with its period, and only the structural index increased. Normative pressures cause organizations to become hierarchically homogenized, in accordance with the principle of organizational learning in specialized fields. Therefore, normative isomorphism on the basis of public domains should be considered an inherent factor in the development of referral networks.

  19. Integrating MBSE into Ongoing Projects: Requirements Validation and Test Planning for the ISS SAFER

    NASA Technical Reports Server (NTRS)

    Anderson, Herbert A.; Williams, Antony; Pierce, Gregory

    2016-01-01

    The International Space Station (ISS) Simplified Aid for Extra Vehicular Activity (EVA) Rescue (SAFER) is the spacewalking astronaut's final safety measure against separating from the ISS and being unable to return safely. Since the late 1990s, the SAFER has been a standard element of the spacewalking astronaut's equipment. The ISS SAFER project was chartered to develop a new block of SAFER units using a highly similar design to the legacy SAFER (known as the USA SAFER). An on-orbit test module was also included in the project to enable periodic maintenance/propulsion system checkout on the ISS SAFER. On the ISS SAFER project, model-based systems engineering (MBSE) was not the initial systems engineering (SE) approach, given the volume of heritage systems engineering and integration (SE&I) products. The initial emphasis was ensuring traceability to ISS program standards as well as to legacy USA SAFER requirements. The requirements management capabilities of the Cradle systems engineering tool were to be utilized to that end. During development, however, MBSE approaches were applied selectively to address specific challenges in requirements validation and test and verification (T&V) planning, which provided measurable efficiencies to the project. From an MBSE perspective, ISS SAFER development presented a challenge and an opportunity. Addressing the challenge first, the project was tasked to use the original USA SAFER operational and design requirements baseline, with a number of additional ISS program requirements to address evolving certification expectations for systems operating on the ISS. Additionally, a need to redesign the ISS SAFER avionics architecture resulted in a set of changes to the design requirements baseline. Finally, the project added an entirely new functionality for on-orbit maintenance. After initial requirements integration, the system requirements count was approaching 1000, which represented a growth of 4x over the original USA SAFER system

  20. Vulnerable Decision Points for Disproportionate Office Discipline Referrals: Comparisons of Discipline for African American and White Elementary School Students

    ERIC Educational Resources Information Center

    Smolkowski, Keith; Girvan, Erik J.; McIntosh, Kent; Nese, Rhonda N. T.; Horner, Robert H.

    2016-01-01

    Racial disparities in rates of exclusionary school discipline are well documented and seemingly intractable. However, emerging theories on implicit bias show promise in identifying effective interventions. In this study, we used school discipline data from 1,666 elementary schools and 483,686 office discipline referrals to identify specific…

  1. Streamlined approach for environmental restoration (SAFER): Development, implementation, and lessons learned

    SciTech Connect

    Smyth, J.D.; Amaya, J.P.

    1994-05-01

    This report reviews the US Department of Energy`s (DOE`s) Streamlined Approach for Environmental Restoration (SAFER) effort during FY 1992, FY 1993, and the first quarter of FY 1994. The report comprises three sections: Introduction, Activities Summary, and Lessons Learned and Related Activities. This section provides context for the report by briefly reviewing the development of SAFER and its operational assumptions. Section 2 describes SAFER workshops and site-specific SAFER implementation support. Additionally, Section 2 provides an update on the status of sites that initially received support from either Observational Approach or SAFER teams and subsequently implemented either of these two related approaches to site restoration streamlining. Section 3 describes lessons learned and upcoming SAFER activities.

  2. Neurotology symptoms at referral to vestibular evaluation

    PubMed Central

    2013-01-01

    Background Dizziness-vertigo is common in adults, but clinical providers may rarely diagnose vestibular impairment and referral could be delayed. To assess neurotology symptoms (including triggers) reported by patients with peripheral vestibular disease, during the year just before their referral to vestibular evaluation. Methods 282 patients with peripheral vestibular disease and 282 control subjects accepted to participate. They had no middle ear, retinal, neurological, psychiatric, autoimmune or autonomic disorders. They reported their symptoms by a standardized questionnaire along with their anxiety/depression symptoms. Results Patients were referred after months or years from the onset of their symptoms, 24% of them reported frequent falls with a long clinical evolution; 10% of them reported no vertigo but instability related to specific triggers; 86% patients and 12% control subjects reported instability when moving the head rapidly and 79% patients and 6% control subjects reported instability when changing posture. Seven out of the 9 symptoms explored by the questionnaire allowed the correct classification of circa 95% of the participants (Discriminant function analysis, p < 0.001). High blood pressure, dyslipidemia and anxiety/depression symptoms showed a mild correlation with the total score of symptoms (multiple R2 =0.18, p < 0.001). Conclusions Late referral to vestibular evaluation may underlie a history of frequent falls; some patients may not report vertigo, but instability related to specific triggers, which could be useful to prompt vestibular evaluation. High blood pressure, dyslipidemia and anxiety/depression symptoms may have a mild influence on the report of symptoms of vestibular disease in both, patients and control subjects. PMID:24279682

  3. Variation in periodontal referral by general dental practitioners.

    PubMed

    Linden, G J

    1998-08-01

    This study investigated the extent of and reasons for variation in the periodontal referral patterns of general dental practitioners in Northern Ireland. A questionnaire was circulated to all general dental practitioners in Northern Ireland. This questionnaire investigated the management of periodontal disease in the general dental service and referral for specialist periodontal advice and treatment. A usable return was made by 355 (68%) of those surveyed. The mean number of periodontal referrals by each respondent in the past year was 6.5 (SD 7.7), range 0 to 80. Backward stepwise logistic regression analysis indicated that independent predictors of high referral rate were practice location close to the referral centre (p<0.0001); dissatisfaction with ability to treat periodontal disease under the National Health Service (p=0.001); that previous refusals of referral had not dissuaded a dentist from continuing to offer referral (p=0.002); not offering root planing as a treatment (p=0.005); and perceived inadequate postgraduate education in periodontology (p=0.03). It is concluded that considerable variation exists between general dental practitioners working in Northern Ireland in relation to the referral of patients for specialist periodontal advice and treatment. It is further concluded that in many cases non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in relation to periodontal referral.

  4. A Safer Formulation Concept for Flame-Generated Engineered Nanomaterials

    PubMed Central

    Gass, Samuel; Cohen, Joel M.; Pyrgiotakis, Georgios; Sotiriou, Georgios A.; Pratsinis, Sotiris E.; Demokritou, Philip

    2013-01-01

    The likely success or failure of the nanotechnology industry depends on the environmental health and safety of engineered nanomaterials (ENMs). While efforts toward engineering safer ENMs are sparse, such efforts are considered crucial to the sustainability of the nanotech industry. A promising approach in this regard is to coat potentially toxic nanomaterials with a biologically inert layer of amorphous SiO2. Core-shell particles exhibit the surface properties of their amorphous SiO2 shell while maintaining specific functional properties of their core material. A major challenge in the development of functional core-shell particles is the design of scalable high-yield processes that can meet large-scale industrial demand. Here, we present a safer formulation concept for flame-generated ENMs based on a one-step, in flight SiO2 encapsulation process, which was recently introduced by the authors as a means for a scalable manufacturing of SiO2 coated ENMs. Firstly, the versatility of the SiO2-coating process is demonstrated by applying it to four ENMs (CeO2, ZnO, Fe2O3, Ag) marked by their prevalence in consumer products as well as their range in toxicity. The ENM-dependent coating fundamentals are assessed and process parameters are optimized for each ENM investigated. The effects of the SiO2-coating on core material structure, composition and morphology, as well as the coating efficiency on each nanostructured material, are evaluated using state-of-the-art analytical methods (XRD, N2 adsorption, TEM, XPS, isopropanol chemisorption). Finally, the biological interactions of SiO2-coated vs. uncoated ENMs are evaluated using cellular bioassays, providing valuable evidence for reduced toxicity for the SiO2-coated ENMs. Results indicate that the proposed ‘safer by design’ concept bears great promise for scaled-up application in industry in order to reduce the toxicological profile of ENMs for certain applications. PMID:23961338

  5. Developmental Screening Referrals: Child and Family Factors that Predict Referral Completion

    ERIC Educational Resources Information Center

    Jennings, Danielle J.; Hanline, Mary Frances

    2013-01-01

    This study researched the predictive impact of developmental screening results and the effects of child and family characteristics on completion of referrals given for evaluation. Logistical and hierarchical logistic regression analyses were used to determine the significance of 10 independent variables on the predictor variable. The number of…

  6. Do GP referral guidelines really work? Audit of an electronic urgent referral system for suspected head and neck cancer.

    PubMed

    Kennedy, Ann-Maree; Aziz, Abdul; Khalid, Sameena; Hurman, David

    2012-05-01

    We adapted the 2002 Scottish Referral Guidelines for suspected squamous cell carcinoma of the head and neck (SCCHN) as a set of "alarm symptoms." These were then incorporated into a new Suspected Cancer Urgent Referral Electronically (SeCURE) system enabling immediate electronic referral from primary care to the appropriate hospital-based multi-disciplinary cancer team. All referrals made via the SeCURE system during the first year of its implementation were reviewed retrospectively. One hundred and ninety patients were urgently referred, of whom 15 (8%) were ultimately diagnosed with SCCHN. This audit demonstrated overall poor compliance with the referral guidelines. Although the electronic referral system helped for speedy clinic appointments, there was a low pick up rate of positive head and neck cancer cases. Continuing education for GPs is important and following discussion with colleagues in primary care, steps have been taken to reinforce awareness and more appropriate use of the SeCURE system.

  7. Safer lithium ion batteries based on nonflammable electrolyte

    NASA Astrophysics Data System (ADS)

    Zeng, Ziqi; Wu, Bingbin; Xiao, Lifen; Jiang, Xiaoyu; Chen, Yao; Ai, Xinping; Yang, Hanxi; Cao, Yuliang

    2015-04-01

    The safety of lithium ion batteries has long been a critical obstacle for their high-power and large-scale applications because of the flammable nature of their carbon anode and organic carbonate electrolytes. To eliminate the potential safety hazards, lithium ion batteries should be built up with thermal-stable electrodes and nonflammable electrolytes. Here we report safer lithium ion batteries using nonflammable phosphonate electrolyte, thermal-stable LiFePO4 cathode and alloy anodes. Benefiting from the electrochemical compatibility and strong fire-retardancy of the phosphonate electrolyte, the cathode and anode materials in the nonflammable phosphonate electrolyte demonstrate similar charge-discharge performances with those in the conventional carbonate electrolyte, showing a great prospect for large-scale applications in electric vehicles and grid-scale electric energy storage.

  8. Teamwork: building healthier workplaces and providing safer patient care.

    PubMed

    Clark, Paul R

    2009-01-01

    A changing healthcare landscape requires nurses to care for more patients with higher acuity during their shift than ever before. These more austere working conditions are leading to increased burnout. In addition, patient safety is not of the quality or level that is required. To build healthier workplaces where safe care is provided, formal teamwork training is recommended. Formal teamwork training programs, such as that provided by the MedTeams group, TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), or participatory action research programs such as the Healthy Workplace Intervention, have decreased errors in the workplace, increased nurse satisfaction and retention rates, and decreased staff turnover. This article includes necessary determinants of teamwork, brief overviews of team-building programs, and examples of research programs that demonstrate how teamwork brings about healthier workplaces that are safer for patients. Teamwork programs can bring about these positive results when implemented and supported by the hospital system.

  9. Eight principles for safer opioid prescribing and cautions with benzodiazepines.

    PubMed

    Webster, Lynn R; Reisfield, Gary M; Dasgupta, Nabarun

    2015-01-01

    The provision of long-term opioid analgesic therapy for chronic pain requires a careful risk/benefit analysis followed by clinical safety measures to identify and reduce misuse, abuse, and addiction and their associated morbidity and mortality. Multiple data sources show that benzodiazepines, prescribed for comorbid insomnia, anxiety, and mood disorders, heighten the risk of respiratory depression and other adverse outcomes when combined with opioid therapy. Evidence is presented for hazards associated with coadministration of opioids and benzodiazepines and the need for caution when initiating opioid therapy for chronic pain. Clinical recommendations follow, as drawn from 2 previously published literature reviews, one of which proffers 8 principles for safer opioid prescribing; the other review presents risks associated with benzodiazepines, suggests alternatives for co-prescribing benzodiazepines and opioids, and outlines recommendations regarding co-prescribing if alternative therapies are ineffective.

  10. Building Safer Communities: The Integrated Community Safety Approach

    SciTech Connect

    Fawcett, Ricky Lee; Kerr, Thomas A; Jordan, Steven Albert

    2001-03-01

    This paper discusses an integrated community safety approach to creating safer communities. It defines community broadly to include two categories of community members: “industry” and “neighbors.” Potential community members within the “industry” category include facilities, government/regulators, customers, stockholders, and suppliers. Within the “neighbors” category are towns, cities, counties, states; people/commodity flow systems; news media and special interest groups; environment; and families of employees. Each of these potential community members and its characteristics are discussed. The integrated community safety approach consists of three major activities: (1) define the boundaries of the community; (2) facilitate the sense of community; and (3) address the needs of the community. Defining the boundaries of the community includes determining the geographical and social boundaries; this is accomplished through conducting a hazard analysis and community involvement to identify all of the community members. Facilitating the sense of community includes conducting a capability/needs assessment and continuing community involvement to identify the issues and concerns of community members. Addressing the needs of the community involves master planning to consider safety issues in all community development actions and continuing community education and involvement. The integrated community safety approach is a workable approach for existing industries and their neighbors as well as new projects that industries and their neighbors might be considering. By using this socio-technical approach to integrating industry and all of its neighbors into a safer community, the integrated community safety approach will better assure the viability and safety of industry and its neighbors while maintaining or improving the overall quality of life.

  11. Verification in referral-based crowdsourcing.

    PubMed

    Naroditskiy, Victor; Rahwan, Iyad; Cebrian, Manuel; Jennings, Nicholas R

    2012-01-01

    Online social networks offer unprecedented potential for rallying a large number of people to accomplish a given task. Here we focus on information gathering tasks where rare information is sought through "referral-based crowdsourcing": the information request is propagated recursively through invitations among members of a social network. Whereas previous work analyzed incentives for the referral process in a setting with only correct reports, misreporting is known to be both pervasive in crowdsourcing applications, and difficult/costly to filter out. A motivating example for our work is the DARPA Red Balloon Challenge where the level of misreporting was very high. In order to undertake a formal study of verification, we introduce a model where agents can exert costly effort to perform verification and false reports can be penalized. This is the first model of verification and it provides many directions for future research, which we point out. Our main theoretical result is the compensation scheme that minimizes the cost of retrieving the correct answer. Notably, this optimal compensation scheme coincides with the winning strategy of the Red Balloon Challenge.

  12. Verification in Referral-Based Crowdsourcing

    PubMed Central

    Naroditskiy, Victor; Rahwan, Iyad; Cebrian, Manuel; Jennings, Nicholas R.

    2012-01-01

    Online social networks offer unprecedented potential for rallying a large number of people to accomplish a given task. Here we focus on information gathering tasks where rare information is sought through “referral-based crowdsourcing”: the information request is propagated recursively through invitations among members of a social network. Whereas previous work analyzed incentives for the referral process in a setting with only correct reports, misreporting is known to be both pervasive in crowdsourcing applications, and difficult/costly to filter out. A motivating example for our work is the DARPA Red Balloon Challenge where the level of misreporting was very high. In order to undertake a formal study of verification, we introduce a model where agents can exert costly effort to perform verification and false reports can be penalized. This is the first model of verification and it provides many directions for future research, which we point out. Our main theoretical result is the compensation scheme that minimizes the cost of retrieving the correct answer. Notably, this optimal compensation scheme coincides with the winning strategy of the Red Balloon Challenge. PMID:23071530

  13. EPA introduces new Safer Choice labels and recognizes five Chicago area partners

    EPA Pesticide Factsheets

    Chicago (July 21, 2015) - U.S. Environmental Protection Agency Region 5 Administrator Susan Hedman today highlighted the benefits of the Agency's new Safer Choice label and congratulated five Chicago area Safer Choice award-winners at an event at the Loyol

  14. The SAFER Latinos Project: Addressing a Community Ecology Underlying Latino Youth Violence

    ERIC Educational Resources Information Center

    Edberg, Mark; Cleary, Sean D.; Collins, Elizabeth; Klevens, Joanne; Leiva, Rodrigo; Bazurto, Martha; Rivera, Ivonne; del Cid, Alex Taylor; Montero, Luisa; Calderon, Melba

    2010-01-01

    This paper describes the intervention model, early implementation experience, and challenges for the "Seguridad, Apoyo, Familia, Educacion, y Recursos" (SAFER) Latinos project. The SAFER Latinos project is an attempt to build the evidence for a multilevel participatory youth violence prevention model tailored to the specific circumstances of…

  15. Determinants of Safer Sex Patterns among Gay/Bisexual Male Adolescents.

    ERIC Educational Resources Information Center

    Rotherram-Borus, Mary Jane; And Others

    1995-01-01

    Examined cognitive-behavioral (health-belief, social cognitive, peer support), risk-taking, and stress/coping models as predictors of safer sex practices among 136 gay/bisexual males, ages 14-19. Components of the health-belief, self-efficacy theories, and emotional distress models corresponded with safer sex practices; peer support was not…

  16. 32 CFR 727.9 - Referrals to civilian lawyers.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Referrals to civilian lawyers. 727.9 Section 727... ASSISTANCE § 727.9 Referrals to civilian lawyers. (a) General. If it is determined that the legal assistance... the assistance requested, the client should be referred to a civilian lawyer. When the client does...

  17. 32 CFR 727.9 - Referrals to civilian lawyers.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 5 2011-07-01 2011-07-01 false Referrals to civilian lawyers. 727.9 Section 727... ASSISTANCE § 727.9 Referrals to civilian lawyers. (a) General. If it is determined that the legal assistance... the assistance requested, the client should be referred to a civilian lawyer. When the client does...

  18. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Referral to Department of Justice. 1620.8 Section 1620.8 Protection of Environment CHEMICAL SAFETY AND HAZARD INVESTIGATION BOARD ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice....

  19. User Satisfaction with Referrals at a Collaborative Virtual Reference Service

    ERIC Educational Resources Information Center

    Kwon, Nahyun

    2006-01-01

    Introduction: This study investigated unmonitored referrals in a nationwide, collaborative chat reference service. Specifically, it examined the extent to which questions are referred, the types of questions that are more likely to be referred than others, and the level of user satisfaction with the referrals in the collaborative chat reference…

  20. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Referral to Dispute Resolution Committee. 902.3 Section 902.3 Judicial Administration NATIONAL CRIME PREVENTION AND PRIVACY COMPACT COUNCIL DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five...

  1. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Referral to Dispute Resolution Committee. 902.3 Section 902.3 Judicial Administration NATIONAL CRIME PREVENTION AND PRIVACY COMPACT COUNCIL DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five...

  2. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Referral to Dispute Resolution Committee. 902.3 Section 902.3 Judicial Administration NATIONAL CRIME PREVENTION AND PRIVACY COMPACT COUNCIL DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five...

  3. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Referral to Dispute Resolution Committee. 902.3 Section 902.3 Judicial Administration NATIONAL CRIME PREVENTION AND PRIVACY COMPACT COUNCIL DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five...

  4. 28 CFR 902.3 - Referral to Dispute Resolution Committee.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Referral to Dispute Resolution Committee. 902.3 Section 902.3 Judicial Administration NATIONAL CRIME PREVENTION AND PRIVACY COMPACT COUNCIL DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five...

  5. 5 CFR 831.1309 - Referral for litigation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Referral for litigation. 831.1309 Section 831.1309 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Collection of Debts § 831.1309 Referral for litigation. From time to time and in...

  6. 7 CFR 3.21 - Referrals of Debts to Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Referrals of Debts to Justice. 3.21 Section 3.21... and Compromise of Claims § 3.21 Referrals of Debts to Justice. An agency shall promptly refer to Justice for litigation debts on which aggressive collection activity has been taken in accordance...

  7. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Referral to Department of Justice. 177... ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.108 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  8. 29 CFR 502.37 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 502.37 Section 502.37... § 502.37 Referral to Administrative Law Judge. (a) Upon receipt of a timely request for a hearing filed... Judge, for a determination in an administrative proceeding as provided herein. The notice...

  9. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 801.63 Section 801.63... § 801.63 Referral to Administrative Law Judge. (a) Upon receipt of a timely request for a hearing filed... Judge, for a determination in an administrative proceeding as provided herein. The notice...

  10. 29 CFR 500.224 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 500.224 Section 500... Hearing § 500.224 Referral to Administrative Law Judge. (a) Upon receipt of a timely request for a hearing... Administrative Law Judge, for a determination in an administrative proceeding as provided herein. The notice...

  11. 29 CFR 580.10 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 580.10 Section 580.10... Referral to Administrative Law Judge. (a) Upon receipt of a timely exception to a determination of... Administrative Law Judge, for a determination in an administrative proceeding as provided herein. A copy of...

  12. 10 CFR 733.7 - Referral to the contracting officer.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Referral to the contracting officer. 733.7 Section 733.7 Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.7 Referral to the contracting... misconduct, the DOE Element should forward the allegation to the contracting officer responsible...

  13. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 3 2011-01-01 2011-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  14. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  15. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 3 2013-01-01 2013-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  16. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 3 2012-01-01 2012-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  17. 10 CFR 430.54 - Referral to the Attorney General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 3 2014-01-01 2014-01-01 false Referral to the Attorney General. 430.54 Section 430.54 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Small Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for...

  18. 45 CFR 1619.3 - Referral to the Corporation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Referral to the Corporation. 1619.3 Section 1619.3 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION DISCLOSURE OF INFORMATION § 1619.3 Referral to the Corporation. If a person requests information, not...

  19. NETWORK. A History of the Scottish Telephone Referral Service.

    ERIC Educational Resources Information Center

    Smith, Vernon

    Since its beginnings in 1974 as an outgrowth of the BBC Adult Literacy project, NETWORK SCOTLAND LTD (formerly the Scottish Telephone Referral Service) has grown to play a key role in the provision of broadcast support and educational information services in the United Kingdom. The referral service was originally established to provide a mechanism…

  20. Seriously mentally ill women's safer sex behaviors and the theory of reasoned action.

    PubMed

    Randolph, Mary E; Pinkerton, Steven D; Somlai, Anton M; Kelly, Jeffrey A; McAuliffe, Timothy L; Gibson, Richard H; Hackl, Kristin

    2009-10-01

    Seriously mentally ill women at risk for HIV infection (n = 96) participated in structured interviews assessing sexual and substance-use behavior over a 3-month period. The majority of the women (63.5%) did not use condoms. Consistent with the theory of reasoned action, attitudes toward condom use and perceived social norms about safer sex were associated with safer sex intentions. Supplementing variables from the theory of reasoned action with safer sex self-efficacy explained additional variance in safer sex intentions. Greater safer sex intentions were related to both greater condom use and less frequent unprotected intercourse. In addition, less frequent sex after drug use and a less fatalistic outlook were associated with less frequent unprotected intercourse. Life circumstances specific to this population are particularly important to examine to improve the effectiveness of risk reduction interventions for seriously mentally ill women.

  1. Emergency management of alveolar osteitis.

    PubMed

    Summers, Anthony

    2011-12-01

    Patients with urgent dental problems who present to emergency departments (EDs) during weekday office hours are usually referred to their dentists, often after being provided with analgesia. Outside these hours, however, ED professionals may have to provide treatment before referral. One dental emergency with which patients may present but of which ED staff are unlikely to have experience is alveolar osteitis, a painful condition that occurs usually after tooth extraction. This article defines alveolar osteitis and describes management in an ED.

  2. EPA Recognizes Partners for Creating and Using Safer Choice Products/June 22 is the first annual awards ceremony for 2015 Safer Choice Partner of the Year Award Winners

    EPA Pesticide Factsheets

    WASHINGTON - The U.S. Environmental Protection Agency (EPA) is announcing 21 Safer Choice Partner of the Year winners across 15 states for outstanding achievement in the design, manufacture, promotion, and use of Safer Choice products for the nation.

  3. Referral and Timing of Referral to Hospice Care in Nursing Homes: The Significant Role of Staff Members

    ERIC Educational Resources Information Center

    Welch, Lisa C.; Miller, Susan C.; Martin, Edward W.; Nanda, Aman

    2008-01-01

    Purpose: Given concerns about end-of-life care for many nursing home (NH) residents, this study sought to understand factors influencing hospice referral or nonreferral as well as timing of referral. Design and Methods: We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors…

  4. Introducing Technology in Child Welfare Referrals: A Case Study

    PubMed Central

    Lovato-Hermann, Kristina; Wolf, Jennifer Price; Curry, Susanna R.; Freisthler, Bridget

    2016-01-01

    Access to social services is important for the safety of children and ultimately for reunification of families involved in the child welfare system. The process of linking families to services however, varies by caseworker and can be cumbersome and time-consuming. The DCFS Needs Portal is an internet-based intervention to improve the timing and quality of social service referrals in Los Angeles County We used a case study approach including in-depth interviews, direct observations and user feedback obtained from the Needs Portal to 1) determine perceived benefits and barriers to adopting the Needs Portal and 2) report how the flow of information between users and developers was used to adapt to user needs. Our analyses revealed four major barriers: 1) caseworker apprehension regarding new technology, 2) variation in communication styles by user type, 3) lack of technological infrastructure and 4) competing workplace demands. Information sharing between developers and users has the potential to better meet the needs of users and ultimately maximize utilization of new technology. Although internet-based interventions are designed to inexpensively and effectively coordinate services, emerging interventions may require in-person assistance and modifications in order to succeed. PMID:27799852

  5. Medicare program: changes to the hospital inpatient prospective payment systems and fiscal year 2009 rates; payments for graduate medical education in certain emergency situations; changes to disclosure of physician ownership in hospitals and physician self-referral rules; updates to the long-term care prospective payment system; updates to certain IPPS-excluded hospitals; and collection of information regarding financial relationships between hospitals. Final rules.

    PubMed

    2008-08-19

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs to implement changes arising from our continuing experience with these systems, and to implement certain provisions made by the Deficit Reduction Act of 2005, the Medicare Improvements and Extension Act, Division B, Title I of the Tax Relief and Health Care Act of 2006, the TMA, Abstinence Education, and QI Programs Extension Act of 2007, and the Medicare Improvements for Patients and Providers Act of 2008. In addition, in the Addendum to this final rule, we describe the changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes are generally applicable to discharges occurring on or after October 1, 2008. We also are setting forth the update to the rate-of-increase limits for certain hospitals and hospital units excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2008. In addition to the changes for hospitals paid under the IPPS, this document contains revisions to the patient classifications and relative weights used under the long-term care hospital prospective payment system (LTCH PPS). This document also contains policy changes relating to the requirements for furnishing hospital emergency services under the Emergency Medical Treatment and Labor Act of 1986 (EMTALA). In this document, we are responding to public comments and finalizing the policies contained in two interim final rules relating to payments for Medicare graduate medical education to affiliated teaching hospitals in certain emergency situations. We are revising the regulatory requirements relating to disclosure to patients of physician ownership or investment interests in hospitals and responding to public comments on a

  6. Examining the variation in GPs’ referral practice: a cross-sectional study of GPs’ reasons for referral

    PubMed Central

    Ringberg, Unni; Fleten, Nils; Førde, Olav Helge

    2014-01-01

    Background There is a large variation in referral rates to secondary care among GPs, which is partly unexplained. Aim To explore associations between reasons for referral to secondary care and patient, GP, and healthcare characteristics. Design and setting A cross-sectional study in Northern Norway. Method Data were derived from 44 (42%) of 104 randomly selected GPs between 2008 and 2010. GPs scored the relevance of nine predefined reasons for 595 referrals from 4350 consecutive consultations on a four-level categorical scale. Associations were examined by multivariable ordered and multivariable multilevel logistic regression analyses. Results Medical necessity was assessed as a relevant reason in 93% of the referrals, 43.7% by patient preference, 27.5% to avoid overlooking anything, and 14.6% to reassure the patient. The higher the referral rates, the more frequently the GPs referred to avoid overlooking anything. Female GPs referred to reassure the patient and due to perceived deficient medical knowledge significantly more often than male GPs. However, perceived easy accessibility of specialists was significantly less frequently given as a reason for referral by female GPs compared with male GPs. When the GPs scored the referrals to be of lesser medical necessity, male GPs referred significantly more frequently than female GPs to reassure the patient due to patient preference and perceived deficient medical knowledge. Conclusion There are striking differences in reasons for referral between Norwegian male and female GPs and between GPs with high and low referral rates, which reflects difficulties in handling professional uncertainty. Referring to reassure the patients, especially when referrals are less medically necessary, may reflect consideration and acquiescence towards the patients. PMID:24982495

  7. How Can We Make PV Modules Safer?: Preprint

    SciTech Connect

    Wohlgemuth, J. H.; Kurtz, S. R.

    2012-06-01

    Safety is a prime concern for the photovoltaics (PV) industry. As a technology deployed on residential and commercial buildings, it is critical that PV not cause damage to the buildings nor harm the occupants. Many of the PV systems on buildings are of sufficiently high voltage (300 to 600 Volts dc) that they may present potential hazards. These PV systems must be safe in terms of mechanical damage (nothing falls on someone), shock hazard (no risk of electrical shock when touching an exposed circuit element), and fire (the modules neither cause nor promote a fire). The present safety standards (IEC 61730 and UL 1703) do a good job of providing for design rules and test requirements for mechanical, shock, and spread of flame dangers. However, neither standard addresses the issue of electrical arcing within a module that can cause a fire. To make PV modules, they must be designed, built, and installed with an emphasis on minimizing the potential for open circuits and ground faults. This paper provides recommendations on redundant connection designs, robust mounting methods, and changes to the safety standards to yield safer PV modules.

  8. Maternal smoking and infant feeding: breastfeeding is better and safer.

    PubMed

    Dorea, Jose G

    2007-05-01

    The rise in smoking rates among young women has implications for children's health aggravated in lower social strata where infant morbidity and mortality rates are higher. The protection afforded by breastfeeding is beneficial to infants in rich and poor countries alike. Women (especially when young, uneducated, and unsupported) who are smokers constitute a risk group for abandoning breastfeeding; moreover, their bottle-fed newborns run a greater risk of morbidity and mortality. Bottle-feeding is attendant on maternal cigarette smoking. The advantages of breastfeeding over bottle-feeding are discussed with regard to systemic effects and the specific effects of cyanide (which can affect the iodine metabolism of infants) and nicotine derived from food and maternal smoking. Despite great strides in bans on smoking, public health policies should be designed to keep in perspective that breastfeeding is an effective tool to counterbalance the health disadvantages that under-privileged infants of smoking mothers face. This paper argues that infants born to smoking parents are better protected by breastfeeding than by formula feeding. Therefore, if public health policies cannot stop addicted mothers from smoking during pregnancy it is fundamental not to miss the chance of encouraging and supporting breastfeeding. The food and health inequalities of socially disadvantaged groups demand well crafted public-health policies to reduce the incidence of diseases and compress morbidity: these policies need to make it clear that breastfeeding is better and safer.

  9. Can we select health professionals who provide safer care.

    PubMed

    Firth-Cozens, J; Cording, H; Ginsburg, R

    2003-12-01

    In order to improve patient safety, health services are looking to other industries' experiences and as a result are adopting a systems approach to learning from error, rather than simply focusing the blame on the individual. However, in health care the individual will remain an important contributor to safety and this paper looks at other literatures besides health to consider a number of individual characteristics and the role they might play in terms of work practices that affect patient safety. It considers the effects of a variety of personality profiles including sensation seeking, Type A, and those with high self esteem; looks at our ability to select for psychological wellbeing; and discusses the ways that psychometrics have been used in medicine to predict performance. It concludes that although rarely used, psychometrics has been shown to be useful in predicting some aspects of performance in medicine and suggests that this is an area well worth further study for the benefit of patient care. Nevertheless, we are a long way away from being able to select safer staff and should instead be developing this knowledge to enable us to recognise and address potential difficulties.

  10. The WIPP transportation system -- ``Safer than any other``

    SciTech Connect

    Ward, T.R.; Spooner, R.

    1991-12-31

    The Department of Energy (DOE) has developed an integrated transportation system to transport transuranic (TRU) waste from ten widely dispersed generator sites to the Waste Isolation Pilot Plant (WIPP). The system consists of a Type B container, a specially designed trailer, a lightweight tractor, the DOE TRANSCOM satellite-based vehicle tracking system, and uniquely qualified and highly trained drivers. The DOE has demonstrated that this system is ready to transport the TRU waste to the WIPP site efficiently and safely. Since the system was put in place in November 1988, it has been repeatedly upgraded and enhanced to incorporate additional safety measures. In June of 1989, the National Academy of Sciences (NAS) reviewed the transportation system and concluded that ``the system proposed for transportation of TRU waste to WIPP is safer than that employed for any other hazardous material in the United States today and will reduce risk to very low levels`` (emphasis added). The NAS conclusion was made before the DOE implemented the Enhanced Driver Training Course for carrier drivers. The challenge facing the DOE was to examine the transportation system objectively and determine what additional improvements could be made to further enhance safety.

  11. Chemical Safety Alert: Use Multiple Data Sources for Safer Emergency Response

    EPA Pesticide Factsheets

    Increases awareness of Material Safety Data Sheet (MSDS) limitations so that first responders to accidental releases can take proper precautions and identify additional sources of chemical information, such as reactivity and incompatibility.

  12. District nurses' triggers for referral of patients to the Macmillan nurse.

    PubMed

    Aitken, Alexandra

    2006-03-01

    This study aimed to identify the triggers which motivate district nurses to refer patients to the Macmillan nursing service and resulted from observation within the researcher's clinical practice, when it was noted that referral patterns from district nurses to the Macmillan nursing service were very inconsistent. A qualitative exploratory descriptive design was utilised and the analysis of the findings identified three 'key' themes, which motivate district nurses to refer: knowledge and skills, interprofessional issues and perception of Macmillan. Within each theme emerged an amalgam of triggers which were complex in nature, pertaining not only to patient need, but also to the needs of the district nursing service. However, it became apparent during the analysis that there was also a lack of knowledge regarding the role of the Macmillan nurse. This lack of knowledge relating to the Macmillan nurse role had been affirmed previously by several authors (Graves and Nash 1993, Clark et al 2002, Ahmed et al 2004) but the literature also reported that the Macmillan nurse role was open to confusion (Clark et al 2002, Corner 2003). This confusion may potentially affect referrals and prevent patients from receiving the services of the Macmillan nurse. This study has established a need for the development of referral criteria into the Macmillan nursing service and that there is also an identified need for further research, providing scope for the Macmillan nurse and district nurse to work collaboratively to improve palliative services in the community.

  13. Keeping mammography referral appointments: motivation, health beliefs, and access barriers experienced by older minority women.

    PubMed

    Bernstein, J; Mutschler, P; Bernstein, E

    2000-01-01

    Older women of color tend to have much lower rates of regular mammography screening for breast cancer than younger Caucasian women; yet, they have higher rates of mortality. This study was designed to increase mammography rates among inner-city women aged 50 years or older. Another goal was to investigate differences in mammography utilization related to race/ethnicity and language after barriers associated with cost and the difficulty of making an appointment are removed. A peer delivered intervention, which consisted of interview, mammography referral, and the scheduling of a next-day appointment, was conducted among a convenience sample of 151 culturally and racially diverse older women through a primary care referral project operating within an urban emergency department (ED). A brief motivational interview and mammography referral at the time of an ED visit, including scheduling of a next-day no cost appointment, was followed by a cross-sectional telephone survey of utilization and motivating and hindering factors. Follow-up was achieved with 96 women (66%). Fifty-eight women (60%) had a post-intervention mammogram; of those, 69% were first time users. More than 90% planned a repeat mammogram the following year. Of the 27 who did not receive a mammogram, 21 (77%) requested a "second try" appointment. These findings demonstrate that an interactive intervention among older women of color has the potential to dramatically increase mammography rates.

  14. Nurture personal referrals--your best source of new patients.

    PubMed

    Jameson, C

    1996-01-01

    In your morning meetings, identify those patients who would be a great person to ask for a referral--patients who have expressed pleasure in receiving treatment from you. Then, determine who is going to ask for that referral. You wouldn't want to have EVERY-ONE ask them for a referral, so give someone that responsibility. Be sure that you have done some role playing and have practiced the verbal skills of "asking" for a referral. Get comfortable asking. Know that you will never know what you will get unless you ASK!!! All good businesses ask for referrals from their best customers. Learn from the masters. Pattern your own behavior after those who have acquired admirable results. When you identify patients who have accepted and have been pleased with your treatment, have come to their appointments on time, have gladly paid their bills, and have been a joy to treat, ASK these folks for a referral. More than likely they will refer others to you who are of like character. You can build a practice "on good patients just like you" and expect that to happen!!! Together, as a team, develop ways of acknowledging and nurturing your referral sources. If these wonderful people provide 70+ percent of your new patients, it benefits you to invest time and money in maximizing this source of practice growth.

  15. Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning.

    PubMed

    Pintye, Jillian; Ngure, Kenneth; Curran, Kathryn; Vusha, Sophie; Mugo, Nelly; Celum, Connie; Baeten, Jared M; Heffron, Renee

    2015-09-01

    HIV-serodiscordant couples often choose to attempt pregnancy despite their HIV transmission risk. Optimizing delivery of HIV risk reduction strategies during peri-conception periods (i.e., safer conception) requires understanding how HIV-serodiscordant couples approach fertility decisions. We conducted 36 in-depth individual interviews with male and female partners of Kenyan heterosexual HIV-serodiscordant couples who recently conceived. Transcripts were analyzed by gender and HIV serostatus using open coding. Matrices were used to identify patterns and emerging themes. Most participants expressed acceptance of being in an HIV-serodiscordant couple and affirmed their resilience to live with serodiscordance and achieve their fertility goals. Overall, while the goal for childbearing was unchanged, conception became an urgent desire so that both partners could experience childrearing together while the HIV-infected partner was still healthy. Children also add value to the relationship, and multiple children were a commonly expressed desire. Couples' desires dominated those of individual partners in fertility decision-making, but male preferences were more influential when the individual desires differed. Values and preferences of the couple as a unit may mediate fertility decision-making in HIV-discordant couples. Thus, it is important that safer conception programs include both partners when appropriate and consider the relationship context during risk reduction counseling and when recommending risk reduction interventions.

  16. Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning

    PubMed Central

    Pintye, Jillian; Ngure, Kenneth; Curran, Kathryn; Vusha, Sophie; Mugo, Nelly; Celum, Connie; Baeten, Jared M.

    2015-01-01

    Abstract HIV-serodiscordant couples often choose to attempt pregnancy despite their HIV transmission risk. Optimizing delivery of HIV risk reduction strategies during peri-conception periods (i.e., safer conception) requires understanding how HIV-serodiscordant couples approach fertility decisions. We conducted 36 in-depth individual interviews with male and female partners of Kenyan heterosexual HIV-serodiscordant couples who recently conceived. Transcripts were analyzed by gender and HIV serostatus using open coding. Matrices were used to identify patterns and emerging themes. Most participants expressed acceptance of being in an HIV-serodiscordant couple and affirmed their resilience to live with serodiscordance and achieve their fertility goals. Overall, while the goal for childbearing was unchanged, conception became an urgent desire so that both partners could experience childrearing together while the HIV-infected partner was still healthy. Children also add value to the relationship, and multiple children were a commonly expressed desire. Couples' desires dominated those of individual partners in fertility decision-making, but male preferences were more influential when the individual desires differed. Values and preferences of the couple as a unit may mediate fertility decision-making in HIV-discordant couples. Thus, it is important that safer conception programs include both partners when appropriate and consider the relationship context during risk reduction counseling and when recommending risk reduction interventions. PMID:26301703

  17. Determining factors for implant referral rates.

    PubMed

    Levin, Roger P

    2002-01-01

    The research findings indicate that the field of implant dentistry will only grow at a moderately low level unless certain changes are made. Findings indicated that the effort by the implant companies has been nothing short of dramatic, and yet almost 60% of restorative doctors do not participate annually in any implant case. There was no clear indication that younger restorative doctors will significantly increase the number of implant referrals, as their overall implant education has not dramatically differed from those dentists who graduated in earlier years. Once the research was completed, it became obvious to Levin Group that the driving force behind implant referral growth will be implant surgeons, because of their one-to-one relationship with restorative doctors. The Levin Group Implant Management and Marketing Consulting Program is based on approaching restorative doctors in several different levels, starting with awareness all the way through to case facilitation and long-term tracking and communication. Finally, a continuing marketing/education effort needs to be consistently in place with effective materials, not only to create a high level of awareness, but also to motivate restorative doctors to refer cases and then work through the case with the implant surgeon to a satisfactory completion for the restorative doctor, implant surgeon, and patient. While the surgical insertion of implants may seem to carry a high-profit margin relative to the restoration of implants, the truth is that the restoration of implants usually provides a 40% higher profit margin for the restorative doctor than traditional dental services. One of the key issues is that referring doctors have not necessarily learned how to set fees and present cases with regard to implant dentistry. The key factor here is to ensure that the patient understands that implant services involve higher fees than traditional services, because of the necessarily higher levels of experience, education

  18. Making safer preoperative arrangements for patients using vitamin K antagonists

    PubMed Central

    van Fessem, Joris; Willems, Jessica; Kruip, Marieke; Hoeks, Sanne; Jan Stolker, Robert

    2017-01-01

    Use of vitamin K antagonists creates a risk for patient health and safety. The Dutch framework “Nationwide Standard Integrated Care of Anticoagulation” propagates a shared plan and responsibility by surgeon and anesthesiologist together in the preoperative setting. In our institution, this framework had not been implemented. Therefore, a quality-improvement project was started at the Anesthesia Department to improve perioperative safety. After exploration of barriers, multiple interventions were carried out to encourage co-workers at the preoperative screening department to take shared responsibility: distribution of prints, adjustments in electronic patient records, introduction of a protocol and education sessions. Efficacy was measured retrospectively performing a before-after study collecting perioperative data of patients using vitamin K antagonists. The primary outcome measure was the percentage of predefined safe preoperative plans. Secondary outcome measures were (1) incidence of postoperative bleeding and thrombo-embolic events within the first 24 hours after intervention and (2) necessity to preoperative correction of anticoagulation. Before intervention 72 (29%) safe, 93 (38%) partially unsafe and 83 (33%) unsafe arrangements were made. After the intervention these numbers were 105 (80%), 23 (17%) en 4 (3%), respectively: a significant 51% increase in safe preoperative plans (P<0.001). We observed no significant difference (P=0.369) regarding bleeding and thrombo-embolic events: pre-intervention 12 (5%) cases of postoperative bleeding were documented, vs. 6 (5%) post intervention and the number of thrombo-embolic events was 5 (2%) vs. 0. Also, no significant differences concerning preoperative correction of anticoagulation were observed: 11 (4%) vs. 8 (6%) (P=0.489). This quality improvement project demonstrates a major improvement in safer preoperative arrangements in our institution regarding vitamin K antagonists, using the described interventions

  19. [Urine incontinence referral criteria for primary care].

    PubMed

    Brenes Bermúdez, F J; Cozar Olmo, J M; Esteban Fuertes, M; Fernández-Pro Ledesma, A; Molero García, J M

    2013-01-01

    Despite the high incidence of urinary incontinence (UI), health professional awareness of this disease is low, which in itself is not serious but significantly limits the lives of the patients. The Primary Care associations, Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Médicos Generales y de Familia [SEMG], Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) along with the Asociación Española de Urología (EAU) have developed this consensus with the proposal of making GPs aware, and to help them in the diagnosis, treatment and referral to Urologists. The first goal in primary care must be the detection of UI, thus an opportunistic screening at least once in the lifetime of asymptomatic women > 40 years old and asymptomatic men > 55 years old. The diagnosis, based on medical history and physical examination, must determine the type and severity of the UI in order to refer severe cases to the Urologist. Except for overactive bladder (OAB), non-pharmacological conservative treatment is the first approach to uncomplicated UI in females and males. Antimuscarinics are the only drugs that have demonstrated efficacy and safety in urge urinary incontinence (UUI) and OAB. In men with mixed symptoms, excluding severe obstruction cases, a combination therapy of alpha-blockers and antimuscarinics should be chosen.

  20. [Urine incontinence referral criteria for primary care].

    PubMed

    Brenes Bermúdez, F J; Cozar Olmo, J M; Esteban Fuertes, M; Fernández-Pro Ledesma, A; Molero García, J M

    2013-05-01

    Despite the high incidence of urinary incontinence (UI), health professional awareness of this disease is low, which in itself is not serious but significantly limits the lives of the patients. The Primary Care associations, Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Médicos Generales y de Familia [SEMG], Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) along with the Asociación Española de Urología (EAU) have developed this consensus with the proposal of making GPs aware, and to help them in the diagnosis, treatment and referral to Urologists. The first goal in primary care must be the detection of UI, thus an opportunistic screening at least once in the lifetime of asymptomatic women > 40 years old and asymptomatic men > 55 years old. The diagnosis, based on medical history and physical examination, must determine the type and severity of the UI in order to refer severe cases to the Urologist. Except for overactive bladder (OAB), non-pharmacological conservative treatment is the first approach to uncomplicated UI in females and males. Antimuscarinics are the only drugs that have demonstrated efficacy and safety in urge urinary incontinence (UUI) and OAB. In men with mixed symptoms, excluding severe obstruction cases, a combination therapy of alpha-blockers and antimuscarinics should be chosen.

  1. 12 CFR 313.123 - Certification and referral of debt.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PROCEDURES FOR CORPORATE DEBT COLLECTION Tax Refund Offset § 313.123 Certification and referral of debt. When... judgment debt or as otherwise allowed by law, the debt is referred for offset within ten years after...

  2. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Referrals to the Department of Justice... COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral. The... Justice, Washington, DC 20530. (2) Unless otherwise provided by DOJ regulations or procedures, EPA...

  3. EPA Honors PRIDE Industries with Safer Choice Partner of the Year Award

    EPA Pesticide Factsheets

    SAN FRANCISCO - The U.S. Environmental Protection Agency awarded its first ever Safer Choice Partner of the Year awards for outstanding achievement in the design, manufacture, promotion and use of environmentally friendly products in the nation's homes, sc

  4. EPA announces two Safer Choice Partners of the Year winners in Southern California

    EPA Pesticide Factsheets

    SAN FRANCISCO - The U.S. Environmental Protection Agency awarded its first ever Safer Choice Partner of the Year awards for outstanding achievement in the design, manufacture, promotion and use of environmentally friendly products in the nation's ho

  5. CDC Vital Signs: Making Health Care Safer -- Protect Patients from Antibiotic Resistance

    MedlinePlus

    ... Press Kit Read the MMWR Science Clips Making Health Care Safer Protect patients from antibiotic resistance Language: English ... hours later. Know when to stop antibiotic treatment. Health care facility CEOs/ administrators can Prevent infections and their ...

  6. CDC Vital Signs: Making Health Care Safer -- Antibiotic Rx in Hospitals

    MedlinePlus

    ... Press Kit Read the MMWR Science Clips Making Health Care Safer Antibiotic Rx in Hospitals: Proceed with Caution ... resistance and improving prescribing practices. Work with other health care facilities to prevent infections, transmission, and resistance. Problem ...

  7. CDC Vital Signs: Making Health Care Safer -- Stop Infections from Lethal CRE Germs Now

    MedlinePlus

    ... 62 MB] Read the MMWR Science Clips Making Health Care Safer Stop Infections from Lethal CRE Germs Now ... to otherwise healthy people outside of medical facilities. Health Care Providers can Know if patients in your facility ...

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

    MedlinePlus

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

  9. EPAs Safer Choice program encourages better decisions when choosing spring cleaning products

    EPA Pesticide Factsheets

    PHILADELPHIA (March 24, 2015) - The snow is gone and temperatures are rising. That means it is time for spring cleaning, and the U.S. Environmental Protection Agency through its Safer Choice program this spring is encouraging consumers to loo

  10. Online referrals one way capitated groups gain efficiencies, reduce errors.

    PubMed

    2002-08-01

    An online referral system is just the latest money and time-saving tool in the e-commerce arsenal at Hill Physicians Medical Group. Using a modified version of Healinx Corp.'s secure e-mail messaging platform, Hill is testing a custom-made online referral system at two primary care practices that appear to be helping the practice boost its bottom line under capitation.

  11. Environmental Protection: Improved Inspections and Enforcement Would Ensure Safer Underground Storage Tanks

    DTIC Science & Technology

    2001-11-01

    Enforcement Would Ensure Safer Underground Storage Tanks Statement of John Stephenson, Director, Natural Resources and Environment GAO-01-176T Report...Inspections and Enforcement Would Ensure Safer Underground Storage Tanks Contract Number Grant Number Program Element Number Author(s) Project Number...resources they need to improve tank compliance and safety. Therefore, to better ensure that underground storage tanks meet federal requirements to prevent

  12. Environmental Protection: Improved Inspections and Enforcement Would Ensure Safer Underground Storage Tanks

    DTIC Science & Technology

    2002-05-08

    and Enforcement Would Ensure Safer Underground Storage Tanks Statement of John Stephenson, Director, Natural Resources and Environment GAO-02-712T...Inspections and Enforcement Would Ensure Safer Underground Storage Tanks Contract Number Grant Number Program Element Number Author(s) Project Number...02-712T Underground Storage Tanks Madam Chairwoman and Members of the Subcommittee: I am pleased to have this opportunity to come before you today to

  13. A real-life example of choosing an inherently safer process option.

    PubMed

    Study, Karen

    2007-04-11

    While choosing an inherently safer alternative may seem straightforward, sometimes what seems to be the most obvious alternative may not provide the best risk reduction. The process designer must maintain a broad perspective to be able to recognize all potential hazards when evaluating design options. All aspects of operation such as start-up, shut-down, utility failure, as well as normal operation should be considered. Choosing the inherently safer option is best accomplished early in the option selection phase of a project; however, recycle back to the option selection phase may be needed if an option is not thoroughly evaluated early in the process. In this paper, a project to supply ammonia to a catalytic reactor will be reviewed. During the course of the project, an "inherently safer" alternative was selected and later discarded due to issues uncovered during the detail design phase. The final option chosen will be compared to (1) the original design and (2) the initial "inherently safer" alternative. The final option was inherently safer than both the original design and the initial "inherently safer" alternative even though the design team initially believed that it would not be.

  14. “I Always Worry about What Might Happen Ahead”: Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda

    PubMed Central

    Bajunirwe, Francis; Kastner, Jasmine; Sanyu, Naomi; Akatukwasa, Cecilia; Ng, Courtney; Rifkin, Rachel; Milford, Cecilia; Moore, Lizzie; Wilson, Ira B.; Bangsberg, David R.; Smit, Jennifer A.; Kaida, Angela

    2016-01-01

    Background. We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients. Methods. We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis. Results. Of 38 providers, 76% were women with median age 34 years (range 24–57). First, we discuss providers' reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on “family planning” and maternal and child health; (3) empathize with the importance of having children for HIV-affected clients; and (4) describe opportunities to counsel HIV-serodiscordant couples. Second, we discuss provider-level challenges that impede safer conception counseling. Emergent themes included the following: (1) providers struggle to translate reproductive rights language into individualized risk reduction given concerns about maternal health and HIV transmission and (2) providers lack safer conception training and support needed to provide counseling. Discussion. Tailored guidelines and training are required for providers to implement safer conception counseling. Such support must respond to provider experiences with adverse HIV-related maternal and child outcomes and a national emphasis on pregnancy prevention. PMID:27051664

  15. ER Doctor Offers Tips for Safer Snow Shoveling

    MedlinePlus

    ... of MedlinePlus, the National Library of Medicine, the National Institutes of Health, or the U.S. Department of Health and Human Services. More Health News on: Heart Attack Winter Weather Emergencies Recent Health News Related MedlinePlus Health Topics ...

  16. Safer-drinking strategies used by chronically homeless individuals with alcohol dependence.

    PubMed

    Grazioli, Véronique S; Hicks, Jennifer; Kaese, Greta; Lenert, James; Collins, Susan E

    2015-07-01

    Chronically homeless individuals with alcohol dependence experience severe alcohol-related consequences. It is therefore important to identify factors that might be associated with reduced alcohol-related harm, such as the use of safer-drinking strategies. Whereas effectiveness of safer-drinking strategies has been well-documented among young adults, no studies have explored this topic among more severely affected populations, such as chronically homeless individuals with alcohol dependence. The aims of this study were thus to qualitatively and quantitatively document safer-drinking strategies used in this population. Participants (N=31) were currently or formerly chronically homeless individuals with alcohol dependence participating in a pilot study of extended-release naltrexone and harm-reduction counseling. At weeks 0 and 8, research staff provided a list of safer-drinking strategies for participants to endorse. Implementation of endorsed safer-drinking strategies was recorded at the next appointment. At both time points, strategies to buffer the effects of alcohol on the body (e.g., eating prior to and during drinking) were most highly endorsed, followed by changing the manner in which one drinks (e.g., spacing drinks), and reducing alcohol consumption. Quantitative analyses indicated that all participants endorsed safer-drinking strategies, and nearly all strategies were implemented (80-90% at weeks 0 and 8, respectively). These preliminary findings indicate that chronically homeless people with alcohol dependence use strategies to reduce harm associated with their drinking. Larger randomized controlled trials are needed to test whether interventions that teach safer-drinking strategies may reduce overall alcohol-related harm in this population.

  17. Piroxicam-β-Cyclodextrin: A GI Safer Piroxicam

    PubMed Central

    Scarpignato, C

    2013-01-01

    to a more rapid onset of action after oral administration and improved GI tolerability because of minimization of the drug gastric effects. One such drug, piroxicam-β-cyclodextrin (PBC), has been used in Europe for 25 years. Preclinical and clinical pharmacology of PBC do show that the β-cyclodextrin inclusion complex of piroxicam is better tolerated from the upper GI tract than free piroxicam, while retaining all the analgesic and anti-inflammatory properties of the parent compound. In addition, the drug is endowed with a quick absorption rate, which translates into a faster onset of analgesic activity, an effect confirmed in several clinical studies. An analysis of the available trials show that PBC has a GI safety profile, which is better than that displayed by uncomplexed piroxicam. Being an inclusion complex of piroxicam, whose CV safety has been pointed out by several observational studies, PBC should be viewed as a CV safe anti-inflmmatory compound and a GI safer alternative to piroxicam. As a consequence, it should be considered as a useful addition to our therapeutic armamentarium. PMID:23394552

  18. Summary of hunting injuries in central Wisconsin: a 4-year experience at a rural referral center.

    PubMed

    Stueland, D; Carpenter, W S; Cleveland, D

    1995-05-01

    Surveillance of hunting-associated injuries was performed over a 4-year period at a rural Emergency Department in central Wisconsin. Over that period of time, 125 individuals sought treatment for hunting-related injuries. The majority of injuries were related to autumn deer hunting and included both gun and bow and arrow hunting. Over half of the persons injured while hunting with a bow and arrow fell from a height. The admission rate for persons in the immediate area was 35.1%, but for those from outside the area, it was 64.8%. The effects of the referral bias result in severe injuries being seen in rural Emergency Departments during hunting seasons, necessitating such departments to be prepared for a wide range of injuries.

  19. Urgent cancer referral guidelines: a retrospective cohort study of referrals for upper gastrointestinal adenocarcinoma.

    PubMed

    Panter, Simon J; Bramble, Mike G; O'Flanagan, Hilda; Hungin, A Pali S

    2004-08-01

    Dyspepsia in primary care is common and guidelines indicate that patients with alarm symptoms, as defined by the urgent cancer referral guidelines, should be investigated by gastroscopy. The specificity and sensitivity of alarm symptoms is poor and only a small percentage of patients will turn out to have malignant disease. This primary care study shows that employing current guidelines will identify only 72% of patients at their initial visit to a general practitioner, but this figure could be increased to 86% if the guidelines included patients with weight loss or anaemia in the absence of dyspepsia. Past performance indicates that the majority of patients with the commonest symptom complex were not referred quickly and less than half were seen within 4 weeks.

  20. Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management

    PubMed Central

    Cox, Jonathan MS; Steel, Nicholas; Clark, Allan B; Kumaravel, Bharathy; Bachmann, Max O

    2013-01-01

    Background Ninety-one per cent of primary care trusts were using some form of referral management in 2009, although evidence for its effectiveness is limited. Aim To assess the impact of three referral-management centres (RMCs) and two internal peer-review approaches to referral management on hospital outpatient attendance rates. Design and setting A retrospective time-series analysis of 376 000 outpatient attendances over 3 years from 85 practices divided into five groups, with 714 000 registered patients in one English primary care trust. Method The age-standardised GP-referred first outpatient monthly attendance rate was calculated for each group from April 2009 to March 2012. This was divided by the equivalent monthly England rate, to derive a rate ratio. Linear regression tested for association between the introduction of referral management and change in the outpatient attendance rate and rate ratio. Annual group budgets for referral management were obtained. Results Referral management was not associated with a reduction in the outpatient attendance rate in any group. There was a statistically significant increase in attendance rate in one group (a RMC), which had an increase of 1.05 attendances per 1000 persons per month (95% confidence interval = 0.46 to 1.64; attendance rate ratio increase of 0.07) after adjustment for autocorrelation. Mean annual budgets ranged from £0.55 to £6.23 per registered patient in 2011/2012. RMCs were more expensive (mean annual budget £5.18 per registered patient) than internal peer-review approaches (mean annual budget £0.97 per registered patient). Conclusion Referral-management schemes did not reduce outpatient attendance rates. RMCs were more expensive than internal peer review. PMID:23735409

  1. Old boys' network in general practitioners' referral behavior?

    PubMed

    Hackl, Franz; Hummer, Michael; Pruckner, Gerald J

    2015-09-01

    We analyzed the impact of social networks on general practitioners' (GPs) referral behavior based on administrative panel data from 2,684,273 referrals to specialists made between 1998 and 2007. For the definition of social networks, we used information on the doctors' place and time of study and their hospital work history. We found that GPs referred more patients to specialists within their personal networks and that patients referred within a social network had fewer follow-up consultations and less inpatient days thereafter. The effects on patient outcomes (e.g. waiting periods, days in hospital) of referrals within personal networks and affinity-based networks differed. Specifically, whereas empirical evidence showed a concentration on high-quality specialists for referrals within the personal network, suggesting that referrals within personal networks overcome information asymmetry with respect to specialists' abilities, the empirical evidence for affinity-based networks was different and less clear. Same-gender networks tended to refer patients to low-quality specialists.

  2. Practices and attitudes of doctors and patients to downward referral in Shanghai, China

    PubMed Central

    Yu, Wenya; Li, Meina; Nong, Xin; Ding, Tao; Ye, Feng; Liu, Jiazhen; Dai, Zhixing; Zhang, Lulu

    2017-01-01

    Objectives In China, the rate of downward referral is relatively low, as most people are unwilling to be referred from hospitals to community health systems (CHSs). The aim of this study was to explore the effect of doctors' and patients' practices and attitudes on their willingness for downward referral and the relationship between downward referral and sociodemographic characteristics. Methods Doctors and patients of 13 tertiary hospitals in Shanghai were stratified through random sampling. The questionnaire surveyed their sociodemographic characteristics, attitudes towards CHSs and hospitals, understanding of downward referral, recognition of the community first treatment system, and downward referral practices and willingness. Descriptive statistics, χ2 test and stepwise logistic regression analysis were employed for statistical analysis. Results Only 20.8% (161/773) of doctors were willing to accept downward referrals, although this proportion was higher among patients (37.6%, 326/866). Doctors' willingness was influenced by education, understanding of downward referral, and perception of health resources in hospitals. Patients' willingness was influenced by marital status, economic factors and recognition of the community first treatment system. Well-educated doctors who do not consider downward referral would increase their workloads and those with a more comprehensive understanding of hospitals and downward referral process were more likely to make a downward referral decision. Single-injury patients fully recognising the community first treatment system were more willing to accept downward referral. Patients' willingness was significantly increased if downward referral was cost-saving. A better medical insurance system was another key factor for patients to accept downward referral decisions, especially for the floating population. Conclusions To increase the rate of downward referral, the Chinese government should optimise the current referral system and

  3. Community Influences on Married Women's Safer Sex Negotiation Attitudes in Bangladesh: A Multilevel Analysis.

    PubMed

    Jesmin, Syeda S; Cready, Cynthia M

    2016-02-01

    The influence of disadvantaged or deprived community on individuals' health risk-behaviors is increasingly being documented in a growing body of literature. However, little is known about the effects of community characteristics on women's sexual attitudes and behaviors. To examine community effects on married women's safer sex negotiation attitudes, we analyzed cross-sectional data from the 2011 Bangladesh Demographic and Health Surveys on a sample of 15,134 married women in 600 communities. We estimated two multilevel logistic regression models. Model 1, which included only individual-level variables, showed that women's autonomy/empowerment, age, and HIV knowledge had significant associations with their safer sex negotiation attitudes. We did not find any socioeconomic status gradient in safer sex negotiation attitudes at the individual level. Adding community-level variables in Model 2 significantly improved the fit of the model. Strikingly, we found that higher community-level poverty was associated with greater positive safer sex negotiation attitudes. Prevailing gender norms and overall women's empowerment in the community also had significant effects. While research on community influences calls for focusing on disadvantaged communities, our research highlights the importance of not underestimating the challenges that married women in economically privileged communities may face in negotiating safer sex. To have sufficient and equitable impact on married women's sexual and reproductive health, sexual and reproductive health promotion policies and programs need to be directed to women in wealthier communities as well.

  4. Understanding barriers to safer sex practice in Zimbabwean marriages: implications for future HIV prevention interventions.

    PubMed

    Mugweni, Esther; Omar, Mayeh; Pearson, Stephen

    2015-06-01

    Against the backdrop of high human immunodeficiency virus (HIV) prevalence in stable relationships in Southern Africa, our study presents sociocultural barriers to safer sex practice in Zimbabwean marriages. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008. Our aim was to identify barriers faced by married women when negotiating for safer sex. Participants identified individual, relational and community-level barriers. Individual level barriers made women voiceless to negotiate for safer sex. Being voiceless emanated from lack sexual decision-making power, economic dependence, low self-efficacy or fear of actual or perceived consequences of negotiating for safer sex. Relational barriers included trust and self-disclosure. At the community level, extended family members and religious leaders were said to explicitly or implicitly discourage women's safer sex negotiation. Given the complexity and multi-levelled nature of barriers affecting sexual behaviour in marriage, our findings suggest that HIV prevention interventions targeted at married women would benefit from empowering individual women, couples and also addressing the wider community.

  5. Development of an algorithm to identify urgent referrals for suspected cancer from the Danish Primary Care Referral Database

    PubMed Central

    Toftegaard, Berit Skjødeberg; Guldbrandt, Louise Mahncke; Flarup, Kaare Rud; Beyer, Hanne; Bro, Flemming; Vedsted, Peter

    2016-01-01

    Background Accurate identification of specific patient populations is a crucial tool in health care. A prerequisite for exploring the actions taken by general practitioners (GPs) on symptoms of cancer is being able to identify patients urgently referred for suspected cancer. Such system is not available in Denmark; however, all referrals are electronically stored. This study aimed to develop and test an algorithm based on referral text to identify urgent cancer referrals from general practice. Methods Two urgently referred reference populations were extracted from a research database and linked with the Primary Care Referral (PCR) database through the unique Danish civil registration number to identify the corresponding electronic referrals. The PCR database included GP referrals directed to private specialists and hospital departments, and these referrals were scrutinized. The most frequently used words were integrated in the first version of the algorithm, which was further refined by an iterative process involving two population samples from the PCR database. The performance was finally evaluated for two other PCR population samples against manual assessment as the gold standard for urgent cancer referral. Results The final algorithm had a sensitivity of 0.939 (95% confidence intervals [CI]: 0.905–0.963) and a specificity of 0.937 (95% CI: 0.925–0.963) compared to the gold standard. The positive and negative predictive values were 69.8% (95% CI: 65.0–74.3) and 99.0% (95% CI: 98.4–99.4), respectively. When applying the algorithm on referrals for a population without earlier cancer diagnoses, the positive predictive value increased to 83.6% (95% CI: 78.7–87.7) and the specificity to 97.3% (95% CI: 96.4–98.0). Conclusion The final algorithm identified 94% of the patients urgently referred for suspected cancer; less than 3% of the patients were incorrectly identified. It is now possible to identify patients urgently referred on cancer suspicion from

  6. Prediction of Mental Health Services Use One Year After Regular Referral to Specialized Care Versus Referral to Stepped Collaborative Care.

    PubMed

    van Orden, Mirjam; Leone, Stephanie; Haffmans, Judith; Spinhoven, Philip; Hoencamp, Erik

    2017-04-01

    Referral to collaborative mental health care within the primary care setting is a service concept that has shown to be as effective as direct referral to specialized mental health care for patients with common mental disorders. Additionally it is more efficient in terms of lower mental health services use. This post-hoc analysis examines if treatment intensity during 1-year of follow-up can be predicted prospectively by baseline characteristics. With multilevel multivariate regression analyses baseline characteristics were examined as potential predictors of visit counts. Results showed that only the enabling factors service concept and referral delay for treatment had a significant association with mental health visit counts, when outcome was dichotomized in five or more visits. Inclusion of the outcome variable as a count variable confirmed the predictive value of service concept and referral delay, but added marital status as a significant predictor. Overall, enabling factors (service concept and referral delay) seem to be important and dominant predictors of mental health services use.

  7. Impact of catheter and surgical ablation on arrhythmia treatment in a tertiary referral centre.

    PubMed Central

    Cunningham, D; Rowland, E

    1992-01-01

    Invasive cardiac electrophysiology studies began as diagnostic studies. The past decade has seen the introduction of several new treatments which have broadened the scope of invasive electrophysiology studies. In particular, the development of catheter ablation techniques increasingly allows curative treatment to be delivered in the catheter laboratory. The workload of electrophysiological procedures has steadily increased in our tertiary referral centre. Over 1000 patients have been treated in the past 20 years and it is projected that 219 new patients will be treated in 1991 and 342 procedures will be carried out. Over 25% of patients now receive either catheter or surgical ablation and almost 80% of these are cured permanently without the need for further drug treatment. The development of safer techniques for catheter ablation has led to its increased use and a decline in surgical ablations. Because catheter ablation is a much simpler and less traumatic procedure than surgical ablation there are great advantages both for the patient and in terms of cost-effectiveness. Antitachycardia pacing, relatively common in 1985, has now largely been supplanted by ablation and implantation of defibrillators. As the tendency to non-pharmacological treatment increases and evidence mounts that cost-effectiveness is greater for electrophysiological treatments, the implications for the funding of electrophysiology services grow. The initially high cost of curative treatment needs to be balanced against the longer term and potentially higher costs of palliative drug treatment. The potential to cure patients with catheter procedures may lead to a greater demand for this expertise and a need for an increase in training and facilities. PMID:1739536

  8. Referral pattern for epilepsy surgery after evidence-based recommendations

    PubMed Central

    Haneef, Zulfi; Stern, John; Dewar, Sandra; Engel, Jerome

    2010-01-01

    Background: Class I evidence for surgical effectiveness in refractory temporal lobe epilepsy (TLE) in 2001 led to an American Academy of Neurology practice parameter in 2003 recommending “referral to a surgical epilepsy center on failing appropriate trials of first-line antiepileptic drugs.” We examined whether this led to a change in referral patterns to our epilepsy center. Methods: We compared referral data for patients with TLE at our center for 1995 to 1998 (group 1, n = 83) and 2005 to 2008 (group 2, n = 102) to determine whether these recommendations resulted in a change in referral patterns for surgical evaluation. Patients with brain tumors, previous epilepsy surgery evaluations, or brain surgery (including epilepsy surgery) were excluded. Results: We did not find a difference between the groups in the duration from the diagnosis of habitual seizures to referral (17.1 ± 10.0 vs 18.6 ± 12.6 years, p = 0.39) or the age at the time of evaluation (34.1 ± 10.3 vs 37.0 ± 11.8 years, p = 0.08). However, there was a difference in the distributions of age at evaluation (p = 0.03) and the duration of pharmacotherapy (p = 0.03) between the groups, with a greater proportion of patients in group 2 with drug-resistant epilepsy both earlier and later in their treatment course. Nonepileptic seizures were referred significantly earlier than TLE in either group or when combined. Conclusions: Our analysis does not identify a significantly earlier referral for epilepsy surgery evaluation as recommended in the practice parameter, but suggests a hopeful trend in this direction. GLOSSARY AAN = American Academy of Neurology; AED = antiepileptic drug; ERSET = Early Randomized Surgical Epilepsy Trial; NES = nonepileptic seizures; RCT = randomized controlled trial; TLE = temporal lobe epilepsy; VNS = vagus nerve stimulator. PMID:20733145

  9. Expediting Groundwater Sampling at Hanford and Making It Safer - 13158

    SciTech Connect

    Connell, Carl W. Jr.; Conley, S.F.; Carr, Jennifer S.; Schatz, Aaron L.; Brown, W.L.; Hildebrand, R. Douglas

    2013-07-01

    documents, the system saves three-to-four man days each month for the field personnel taking the measurements and the scientists and administrators managing the data and the documentation. After the information has received technical review, FLEDG automatically updates the database for water-level measurements and loads the document management system with the completed sampling report. Due to safety considerations, access to wells is conditional. A spreadsheet with appropriate data not only lists the wells that are cleared for work, but also the safety personnel who must be present before work can start. This spreadsheet is used in planning daily activities. Daily plans are structured to ensure that the wells to be sampled are cleared for work and the appropriate safety personnel have been assigned and are present before the work starts. Historically, the spreadsheets have been prepared manually, and as a result, are potentially subject to human error. However, a companion database application has been developed to work with FLEDG - making the entire sampling process more efficient and safer for personnel. The Well Access List - Electronic, WAL-E, is a database that contains much the same information that was previously manually loaded into the spread sheet. In addition, WAL-E contains a managed work-flow application that shows the access requirements and allows for appropriate reviews of the compiled well. Various CHPRC organizations, including Industrial Hygiene, RADCON, and Well Maintenance and Sample Administration are able to enter and review the wells added or deleted from the WAL-E database. The FLEDG system then accesses this database information to identify appropriate support personnel and provide safety requirements to field personnel. In addition, WAL-E offers the assurance that wells have appropriate locks and are correctly labeled and electrically grounded as required, before well activities begin. This feature is an extremely important aspect of the FLEDG

  10. The drive for a safer chemicals policy in the United States.

    PubMed

    Belliveau, Michael E

    2011-01-01

    This article analyzes the history, policies and politics of the modern era of safer chemical policy reform in the United States. In the last decade, state laws have modeled a chemical policy framework to phase out unnecessary dangerous chemicals in favor of safer alternatives. These state drivers, along with market campaigns to reduce downstream business use of hazardous chemicals, have weakened the chemical industry's resistance to fixing the broken federal chemical safety system. The obsolete Toxic Substances Control Act of 1976 (TSCA) has failed to protect public health and the environment and has stifled innovation toward greener chemistry. Health advocates with a progressive policy vision tempered by legislative pragmatism have launched a TSCA reform campaign to challenge chemical industry power in a weak Congress. The opportunity and limits to winning meaningful TSCA reform are characterized and marked as a critical milestone on the path to a truly comprehensive safer chemical policy for the United States.

  11. Graphene Based Ultra-Capacitors for Safer, More Efficient Energy Storage

    NASA Technical Reports Server (NTRS)

    Roberson, Luke B.; Mackey, Paul J.; Zide, Carson J.

    2016-01-01

    Current power storage methods must be continuously improved in order to keep up with the increasingly competitive electronics industry. This technological advancement is also essential for the continuation of deep space exploration. Today's energy storage industry relies heavily on the use of dangerous and corrosive chemicals such as lithium and phosphoric acid. These chemicals can prove hazardous to the user if the device is ruptured. Similarly they can damage the environment if they are disposed of improperly. A safer, more efficient alternative is needed across a wide range of NASA missions. One solution would a solid-state carbon based energy storage device. Carbon is a safer, less environmentally hazardous alternative to current energy storage materials. Using the amorphous carbon nanostructure, graphene, this idea of a safer portable energy is possible. Graphene was electrochemically produced in the lab and several coin cell devices were built this summer to create a working prototype of a solid-state graphene battery.

  12. SAFE(R): A Matlab/Octave Toolbox (and R Package) for Global Sensitivity Analysis

    NASA Astrophysics Data System (ADS)

    Pianosi, Francesca; Sarrazin, Fanny; Gollini, Isabella; Wagener, Thorsten

    2015-04-01

    Global Sensitivity Analysis (GSA) is increasingly used in the development and assessment of hydrological models, as well as for dominant control analysis and for scenario discovery to support water resource management under deep uncertainty. Here we present a toolbox for the application of GSA, called SAFE (Sensitivity Analysis For Everybody) that implements several established GSA methods, including method of Morris, Regional Sensitivity Analysis, variance-based sensitivity Analysis (Sobol') and FAST. It also includes new approaches and visualization tools to complement these established methods. The Toolbox is released in two versions, one running under Matlab/Octave (called SAFE) and one running in R (called SAFER). Thanks to its modular structure, SAFE(R) can be easily integrated with other toolbox and packages, and with models running in a different computing environment. Another interesting feature of SAFE(R) is that all the implemented methods include specific functions for assessing the robustness and convergence of the sensitivity estimates. Furthermore, SAFE(R) includes numerous visualisation tools for the effective investigation and communication of GSA results. The toolbox is designed to make GSA accessible to non-specialist users, and to provide a fully commented code for more experienced users to complement their own tools. The documentation includes a set of workflow scripts with practical guidelines on how to apply GSA and how to use the toolbox. SAFE(R) is open source and freely available from the following website: http://bristol.ac.uk/cabot/resources/safe-toolbox/ Ultimately, SAFE(R) aims at improving the diffusion and quality of GSA practice in the hydrological modelling community.

  13. First flight test results of the Simplified Aid For EVA Rescue (SAFER) propulsion unit

    NASA Technical Reports Server (NTRS)

    Meade, Carl J.

    1995-01-01

    The Simplified Aid for EVA Rescue (SAFER) is a small, self-contained, propulsive-backpack system that provides free-flying mobility for an astronaut engaged in a space walk, also known as extravehicular activity (EVA.) SAFER contains no redundant systems and is intended for contingency use only. In essence, it is a small, simplified version of the Manned Maneuvering Unit (MMU) last flown aboard the Space Shuttle in 1985. The operational SAFER unit will only be used to return an adrift EVA astronaut to the spacecraft. Currently, if an EVA crew member inadvertently becomes separated from the Space Shuttle, the Orbiter will maneuver to within the crew member's reach envelope, allowing the astronaut to regain contact with the Orbiter. However, with the advent of operations aboard the Russian MIR Space Station and the International Space Station, the Space Shuttle will not be available to effect a timely rescue. Under these conditions, a SAFER unit would be worn by each EVA crew member. Flight test of the pre-production model of SAFER occurred in September 1994. The crew of Space Shuttle Mission STS-64 flew a 6.9 hour test flight which included performance, flying qualities, systems, and operational utility evaluations. We found that the unit offers adequate propellant and control authority to stabilize and enable the return of a tumbling/separating crew member. With certain modifications, production model of SAFER can provide self-rescue capability to a separated crew member. This paper will present the program background, explain the flight test results and provide some insight into the complex operations of flight test in space.

  14. Urban women's negotiation strategies for safer sex with their male partners.

    PubMed

    Williams, S P; Gardos, P S; Ortiz-Torres, B; Tross, S; Ehrhardt, A A

    2001-01-01

    Heterosexual transmission of HIV is growing at an increasing rate. One primary prevention strategy is to consistently use condoms. With the exception of female condoms, women do not "wear" condoms and therefore must negotiate condom use with their male partners. This present study examines the strategies women believe they would use in a safer sex negotiation with a male partner including (1) initiating negotiations, (2) resolving conflict, and (3) maintaining the intention to practice safer sex. The findings highlight the importance of understanding women's patterns of negotiation as well as their repertoire of negotiation skills prior to their exposure to behavioral interventions and prevention programs.

  15. Managing risk in cancer presentation, detection and referral: a qualitative study of primary care staff views

    PubMed Central

    Cook, Neil; Thomson, Gillian; Dey, Paola

    2014-01-01

    Objectives In the UK, there have been a number of national initiatives to promote earlier detection and prompt referral of patients presenting to primary care with signs and symptoms of cancer. The aim of the study was to explore the experiences of a range of primary care staff in promoting earlier presentation, detection and referral of patients with symptoms suggestive of cancer. Setting Six primary care practices in northwest England. Participants: 39 primary care staff from a variety of disciplines took part in five group and four individual interviews. Results The global theme to emerge from the interviews was ‘managing risk’, which had three underpinning organising themes: ‘complexity’, relating to uncertainty of cancer diagnoses, service fragmentation and plethora of guidelines; ‘continuity’, relating to relationships between practice staff and their patients and between primary and secondary care; ‘conflict’ relating to policy drivers and staff role boundaries. A key concern of staff was that policymakers and those implementing cancer initiatives did not fully understand how risk was managed within primary care. Conclusions Primary care staff expressed a range of views and opinions on the benefits of cancer initiatives. National initiatives did not appear to wholly resolve issues in managing risk for all practitioners. Staff were concerned about the number of guidelines and priorities they were expected to implement. These issues need to be considered by policymakers when developing and implementing new initiatives. PMID:24928585

  16. Safer Design - Composable EHRs and Mechanisms for Safety.

    PubMed

    Senathirajah, Yalini

    2015-01-01

    As the deployment of health information technology progresses, issues of usability and safety, including the possibility of technology-induced errors have come to the fore. Increased complexity of care delivery models and emergent conditions such as the Ebola scare in the US point to the difficulty of design that allows for human cognitive limits while meeting complex needs. We previously described a modular composable approach to health information systems, which gives the end-user some control of design and allows for creation of systems meeting myriad and varied needs. Here we discuss how the different drag/drop interaction paradigm has implications for health IT safety via several mechanisms. These include display fragmentation and the need to changeably prioritize information elements, interruptions, fit to tasks and contexts, and rapid changeability allowing low-cost readjustments when lack of fit is found.

  17. The Teacher Assistance Team: A Pre-Referral Support System.

    ERIC Educational Resources Information Center

    Hayek, Robert A.

    1987-01-01

    Use of building-level teacher assistance teams (TATs) to provide suggested alternative instructional strategies and support services to regular teachers with problem learners prior to referral to special education is discussed in terms of relationship to special education, purposes, organization and operation, staff training, attitudinal issues,…

  18. Safety Tips: The ACS Chemical Health and Safety Referral Service.

    ERIC Educational Resources Information Center

    Gallagher, Barbara

    1984-01-01

    Describes an American Chemical Society (ACS) service which helps individuals not familiar with the resources of safety information. The service, which provides referrals to literature, films, educational courses, or organizations that can provide answers, exists to help in complying with legislation and dealing with all aspects of chemical health…

  19. Underdiagnosis and Referral Bias of Autism in Ethnic Minorities

    ERIC Educational Resources Information Center

    Begeer, Sander; El Bouk, Saloua; Boussaid, Wafaa; Terwogt, Mark Meerum; Koot, Hans M.

    2009-01-01

    This study examined (1) the distribution of ethnic minorities among children referred to autism institutions and (2) referral bias in pediatric assessment of autism in ethnic minorities. It showed that compared to the known community prevalence, ethnic minorities were under-represented among 712 children referred to autism institutions. In…

  20. Sound-Field Amplification: Preliminary Information Regarding Special Education Referrals

    ERIC Educational Resources Information Center

    Flexer, C.; Long, S.

    2004-01-01

    In this clinical exchange, the authors discuss acoustic accessibility and sound-field amplification in general education classrooms. They bridge theory to practice by presenting preliminary information from two different school systems demonstrating how an improved signal-to-noise ratio can have a positive impact on special education referrals.

  1. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a) Each... associated with the misuse of alcohol, including the names, addresses, and telephone numbers of substance... alcohol misuse. (c)(1) Before a covered employee returns to duty requiring the performance of a...

  2. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a) Each... associated with the misuse of alcohol, including the names, addresses, and telephone numbers of substance... alcohol misuse. (c)(1) Before a covered employee returns to duty requiring the performance of a...

  3. Outpatient nephrology referral rates after acute kidney injury.

    PubMed

    Siew, Edward D; Peterson, Josh F; Eden, Svetlana K; Hung, Adriana M; Speroff, Theodore; Ikizler, T Alp; Matheny, Michael E

    2012-02-01

    AKI associates with an increased risk for the development and progression of CKD and mortality. Processes of care after an episode of AKI are not well described. Here, we examined the likelihood of nephrology referral among survivors of AKI at risk for subsequent decline in kidney function in a US Department of Veterans Affairs database. We identified 3929 survivors of AKI hospitalized between January 2003 and December 2008 who had an estimated GFR (eGFR) <60 ml/min per 1.73 m(2) 30 days after peak injury. We analyzed time to referral considering improvement in kidney function (eGFR ≥60 ml/min per 1.73 m(2)), dialysis initiation, and death as competing risks over a 12-month surveillance period. Median age was 73 years (interquartile range, 62-79 years) and the prevalence of preadmission kidney dysfunction (baseline eGFR <60 ml/min per 1.73 m(2)) was 60%. Overall mortality during the surveillance period was 22%. The cumulative incidence of nephrology referral before dying, initiating dialysis, or experiencing an improvement in kidney function was 8.5% (95% confidence interval, 7.6-9.4). Severity of AKI did not affect referral rates. These data demonstrate that a minority of at-risk survivors are referred for nephrology care after an episode of AKI. Determining how to best identify survivors of AKI who are at highest risk for complications and progression of CKD could facilitate early nephrology-based interventions.

  4. Early Childhood Developmental Screenings: Predictors of Screening Referral Completion

    ERIC Educational Resources Information Center

    Jennings, Danielle J.

    2012-01-01

    Developmental screening programs identify young children with delayed skill growth or challenging behaviors and refer them to community agencies for evaluation or other services. This research studied the predictive impact of developmental screening results and child and family characteristics on the completion of these referrals for evaluation. A…

  5. Tennis Anyone? A Case Study of Inaccurate Patron Referrals

    ERIC Educational Resources Information Center

    Turner, Deborah

    2004-01-01

    This case study examines how analyzing inaccurate referrals can provide key insights into managing change. The author analyzes what went wrong in an attempt to identify opportunities for an Access Services department to consider how it might adapt to constant change. She wishes to show how the nature of change today demands that one pay…

  6. A Descriptive Study of School Discipline Referrals in First Grade

    ERIC Educational Resources Information Center

    Rusby, Julie C.; Taylor, Ted K.; Foster, E. Michael

    2007-01-01

    School discipline referrals (SDRs) may be useful in the early detection and monitoring of disruptive behavior problems to inform prevention efforts in the school setting, yet little is known about the nature and validity of SDRs in the early grades. For this descriptive study, SDR data were collected on a sample of first grade students who were at…

  7. GP Exercise Referral Schemes: Improving the Patient's Experience

    ERIC Educational Resources Information Center

    Wormald, Helen; Ingle, Lee

    2004-01-01

    Objective: The main objective of this study was to explore patients' perceptions of general practitioner (GP) exercise referral (ER) schemes with a view to providing a better service for future patients. Design: A qualitative focus group methodology. Setting: Meeting rooms or communal areas in leisure centres across North Yorkshire. Method: Thirty…

  8. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 5 2011-04-01 2011-04-01 false Consumer complaint and information... HOUSING AND URBAN DEVELOPMENT MANUFACTURED HOME PROCEDURAL AND ENFORCEMENT REGULATIONS Consumer Complaint Handling and Remedial Actions § 3282.403 Consumer complaint and information referral. When a...

  9. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Special treatment: Referral centers. 412.96 Section... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective Payment System for Inpatient Operating Costs § 412.96 Special...

  10. 17 CFR 143.6 - Referral for litigation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Referral for litigation. 143.6 Section 143.6 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION COLLECTION OF CLAIMS OWED THE UNITED STATES ARISING FROM ACTIVITIES UNDER THE COMMISSION'S JURISDICTION General...

  11. 29 CFR 15.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Referral to Department of Justice. 15.8 Section 15.8 Labor Office of the Secretary of Labor ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT AND RELATED... Justice. An award, compromise or settlement of a claim under § 2672 title 28, United States Code, and...

  12. Evaluation and Referral for Child Maltreatment in Pediatric Poisoning Victims

    ERIC Educational Resources Information Center

    Wood, Joanne N.; Pecker, Lydia H.; Russo, Michael E.; Henretig, Fred; Christian, Cindy W.

    2012-01-01

    Objective: Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine…

  13. 29 CFR 501.37 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 501.37 Section 501.37... to Administrative Law Judge. (a) Upon receipt of a timely request for a hearing filed pursuant to and... shall be filed of record in the Office of the Chief Administrative Law Judge and shall, respectively,...

  14. 29 CFR 530.404 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 530.404 Section 530... Administrative Law Judge. Upon receipt of a timely request for a hearing, the request and a copy of the notice of... Law Judge, for a determination in an administrative proceeding as provided herein. The notice...

  15. Referrals to the Marie Curie nursing service in North Yorkshire.

    PubMed

    Hanratty, B; Feather, J; Ward, C

    2000-01-01

    District and Marie Curie nurses participated in a small-scale study to describe referrals to a Marie Curie service in one English health district over a 3-month period. The number of new patients referred was small; they were geographically clustered and had widely differing life expectancies. Anecdotal reports of difficulties with the 'Nurselink' referral system were not confirmed, and in situations where the system was in operation, Marie Curie nurses were more likely to speak directly to the referring nurse. The most frequently cited reason for referral was general nursing needs; however, Marie Curie nurses felt that they were most often involved to provide family support. These findings suggest that there may not be a shared understanding of the Marie Curie nurse's role, and that equity in community palliative nursing care merits examination. Defining and publicizing the role of the Marie Curie nurse, providing guidance for referrals and prioritizing communication between professionals are proposed not only to enhance the service locally but to ensure that the service is available to all. This article illustrates the value of research to identify ways to improve service delivery.

  16. Discipline Referral Outcomes: Meeting the Needs of Students

    ERIC Educational Resources Information Center

    Bergh, Bethney; Cowell, Joan

    2013-01-01

    In this study, school disciplinary procedures/programs used in response to disciplinary referrals and programs that schools have in place to prevent, intervene, and respond to behaviors that result in suspensions or expulsions from the classroom or school were investigated. The focus of this study was school leaders' concerns regarding the…

  17. 25 CFR 217.3 - Referral of questions by superintendent.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false Referral of questions by superintendent. 217.3 Section 217.3 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF... his analysis of alternative solutions to each question or problem, to the business committee and...

  18. Public Library Information and Referral Project, Phase II. Final Report.

    ERIC Educational Resources Information Center

    Childers, Thomas; Krauser, Cheri

    This study is the second of a two-phase survey of public library information and referral (I&R) service. In this phase, seven public libraries offering I&R services were studied in depth to provide descriptions of their operations, organizational factors, and the reactions of their users. Organizational factors and operations were studied through…

  19. 49 CFR 825.10 - Referral of record.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Referral of record. 825.10 Section 825.10 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL TRANSPORTATION SAFETY BOARD RULES OF PROCEDURE FOR MERCHANT MARINE APPEALS FROM DECISIONS OF THE COMMANDANT, U.S. COAST GUARD §...

  20. Identification and Referral for Mental Health Services in Juvenile Detention.

    ERIC Educational Resources Information Center

    Rogers, Kenneth M.; Pumariega, Andres J.; Cuffe, Steven P.

    This report discusses the outcomes of a study that examined the mental health referral patterns of youth referred to a public sector mental health system as the result of a judicial consent decree. The study included two samples of youth ages 13-17 from the entire state of South Carolina. The first group included incarcerated youth recruited from…

  1. 24 CFR 3282.403 - Consumer complaint and information referral.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Consumer complaint and information... HOUSING AND URBAN DEVELOPMENT MANUFACTURED HOME PROCEDURAL AND ENFORCEMENT REGULATIONS Consumer Complaint Handling and Remedial Actions § 3282.403 Consumer complaint and information referral. When a...

  2. Musculoskeletal clinic in general practice: study of one year's referrals.

    PubMed Central

    Peters, D; Davies, P; Pietroni, P

    1994-01-01

    BACKGROUND. A musculoskeletal clinic, staffed by a general practitioner trained in osteopathy, medical acupuncture and intralesional injections, was set up in an inner London general practice in 1987. AIM. A retrospective study was undertaken of one year's referrals to the clinic in 1989-90 to determine how general practitioners were using the clinic in terms of problems referred; consultation patterns of patients attending the clinic and 12 months after initially being seen; and how access to the clinic influenced referrals to relevant hospital departments. METHOD. Day sheets were studied which recorded information on demographic characteristics of patients referred to the clinic and their problems, diagnoses made, duration of symptoms, number and range of treatments given, and recurrence of problems. Use of secondary referral sources was also examined. RESULTS. During the study year 154 of 3264 practice patients were referred to the musculoskeletal clinic, and attended a mean of 3.5 times each. Of all the attenders 64% were women and 52% were 30-54 years old. Eighty one patients (53%) presented with neck, back or sciatic pain. A specific traumatic, inflammatory or other pathological process could be ascribed to only 19% of patients. Regarding treatment, 88% of patients received osteopathic manual treatment or acupuncture, or a combination of these treatments and 4% received intralesional injections. Nine patients from the clinic (6%) were referred to an orthopaedic specialist during the year, two with acute back pain. Referrals to orthopaedic specialists by the practice as a whole were not significantly lower than the national average, although the practice made fewer referrals to physiotherapy and rheumatology departments than national figures would have predicted. Seventeen patients (11%) returned to the clinic with a recurrence of their main complaint within a year of their initial appointment; second courses of treatment were usually brief. CONCLUSION. The

  3. 20 CFR 702.504 - Vocational rehabilitation; referrals to State Employment Agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Vocational rehabilitation; referrals to State... AND PROCEDURE Vocational Rehabilitation § 702.504 Vocational rehabilitation; referrals to State Employment Agencies. Vocational rehabilitation advisers will arrange referral procedures with...

  4. 10 CFR 15.67 - Referral to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Referral to the Department of Justice. 15.67 Section 15.67 Energy NUCLEAR REGULATORY COMMISSION DEBT COLLECTION PROCEDURES Referral of a Claim § 15.67 Referral to... be given as part of a demand letter or as a separate document. (d) The NRC shall preserve all...

  5. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... referrals to the Department of Justice. 1.953 Section 1.953 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs § 1.953 Minimum amount of referrals to the Department of Justice. (a) Except as otherwise provided in...

  6. 10 CFR 1015.505 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Minimum amount of referrals to the Department of Justice... THE UNITED STATES Referrals to the Department of Justice § 1015.505 Minimum amount of referrals to the Department of Justice. (a) DOE shall not refer for litigation claims of less than $2,500, exclusive...

  7. 6 CFR 11.13 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Referrals to the Department of Justice. 11.13 Section 11.13 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CLAIMS § 11.13 Referrals to the Department of Justice. Referrals of debts to the Department of Justice for collection...

  8. The Relationship between Reading Fluency Intervention and the Need for Special Education Referrals

    ERIC Educational Resources Information Center

    Polcyn, Dawn M.

    2012-01-01

    Students are often referred for special education evaluations following teacher generated referrals. These referrals indicate observable poor academic progress, although often there is no indication of the cause of the poor performance as well as no indication of remediation attempts prior to a special education referral. Students who demonstrate…

  9. Parameters for safer gambling behavior: examining the empirical research.

    PubMed

    Peller, Allyson J; LaPlante, Debi A; Shaffer, Howard J

    2008-12-01

    There have been claims that new gambling technology is hazardous to player health, and that technological interventions can alleviate gambling-related harm. In this paper, we systematically review the empirical research about the nexus between gambling and technology to evaluate the veracity of these claims. We use a public health perspective (i.e., the Epidemiologic Triangle) to organize and present study results (i.e., agent, host, and environment). This review intends to offer insight about emerging technology and identify areas that indicate a need for additional research. Forty-seven studies met our inclusion and exclusion criteria; a review of this body of work shows that attempts to develop and implement safety features for new gambling technology are promising, but methodologically are rudimentary and limited in scope. Increased attention to the dynamic interaction among host, agent, and environment factors hold potential to advance the field. In addition, improved study methods (e.g., longitudinal analyses of actual betting behavior), and collaboration among policymakers, manufacturers, and researchers can increase understanding of how new gambling technology affects the public health and stimulate new strategies for implementing effective public health interventions.

  10. Using Social Cognitive Theory to Predict Safer Sex Behaviors in African American College Students

    ERIC Educational Resources Information Center

    Kanekar, Amar; Sharma, Manoj

    2009-01-01

    Safer sex is important for protection against STDs and HIV/AIDS. Most of the HIV-related research is targeted towards high-risk groups such as prostitutes, gays and substance abusers there is evidence that HIV/AIDS is increasing in college students particularly among African-American college students. The purpose of this study was to study…

  11. Seriously Mentally Ill Women's Safer Sex Behaviors and the Theory of Reasoned Action

    ERIC Educational Resources Information Center

    Randolph, Mary E.; Pinkerton, Steven D.; Somlai, Anton M.; Kelly, Jeffrey A.; McAuliffe, Timothy L.; Gibson, Richard H.; Hackl, Kristin

    2009-01-01

    Seriously mentally ill women at risk for HIV infection (n = 96) participated in structured interviews assessing sexual and substance-use behavior over a 3-month period. The majority of the women (63.5%) did not use condoms. Consistent with the theory of reasoned action, attitudes toward condom use and perceived social norms about safer sex were…

  12. Incorporating Risk Assessment and Inherently Safer Design Practices into Chemical Engineering Education

    ERIC Educational Resources Information Center

    Seay, Jeffrey R.; Eden, Mario R.

    2008-01-01

    This paper introduces, via case study example, the benefit of including risk assessment methodology and inherently safer design practices into the curriculum for chemical engineering students. This work illustrates how these tools can be applied during the earliest stages of conceptual process design. The impacts of decisions made during…

  13. Achieving Safety: Safer Sex, Communication, and Desire among Young Gay Men

    ERIC Educational Resources Information Center

    Eisenberg, Anna; Bauermeister, Jose A.; Pingel, Emily; Johns, Michelle Marie; Santana, Matthew Leslie

    2011-01-01

    Conceptualizations of safer sex practices among young gay men (YGM) are frequently structured around communication between partners and the subsequent utilization or absence of condoms in a sexual encounter. Drawing on a sample of 34 in-depth interviews with YGM, ages 18 to 24, the authors explore the ways in which conceptualizations and…

  14. Are some "safer alternatives" hazardous as PBTs? The case study of new flame retardants.

    PubMed

    Gramatica, Paola; Cassani, Stefano; Sangion, Alessandro

    2016-04-05

    Some brominated flame retardants (BFRs), as PBDEs, are persistent, bioaccumulative, toxic (PBT) and are restricted/prohibited under various legislations. They are replaced by "safer" flame retardants (FRs), such as new BFRs or organophosphorous compounds. However, informations on the PBT behaviour of these substitutes are often lacking. The PBT assessment is required by the REACH regulation and the PBT chemicals should be subjected to authorization. Several new FRs, proposed and already used as safer alternatives to PBDEs, are here screened by the cumulative PBT Index model, implemented in QSARINS (QSAR-Insubria), new software for the development/validation of QSAR models. The results, obtained directly from the chemical structure for the three studied characteristics altogether, were compared with those from the US-EPA PBT Profiler: the two different approaches are in good agreement, supporting the utility of a consensus approach in these screenings. A priority list of the most harmful FRs, predicted in agreement by the two modelling tools, has been proposed, highlighting that some supposed "safer alternatives" are detected as intrinsically hazardous for their PBT properties. This study also shows that the PBT Index could be a valid tool to evaluate appropriate and safer substitutes, a priori from the chemical design, in a benign by design approach, avoiding unnecessary synthesis and tests.

  15. Predictors of safer sex on the college campus: a social cognitive theory analysis.

    PubMed

    O'Leary, A; Goodhart, F; Jemmott, L S; Boccher-Lattimore, D

    1992-05-01

    In April and May 1989, the authors surveyed a sample of students enrolled on four college campuses in New Jersey (N = 923) concerning their HIV transmission-related behavior, knowledge, and a variety of conceptual variables taken primarily from social cognitive theory that were thought to be potentially predictive of safer sexual behavior. Analyses of sexually active, unmarried students' responses indicated that men expected more negative outcomes of condom use and were more likely to have sexual intercourse while under the influence of alcohol or other drugs, whereas women reported higher perceived self-efficacy to practice safer sex. Regression analyses indicated that, among the factors assessed, stronger perceptions of self-efficacy to engage in safer behavior, expecting fewer negative outcomes of condom use, and less frequency of sex in conjunction with alcohol or other drug use significantly predicted safer sexual behavior. Enhanced self-efficacy to discuss personal history with a new partner was associated with a greater number of risky encounters. Implications of these findings for intervention efforts with students are discussed.

  16. Federal Policy Mandating Safer Cigarettes: A Hypothetical Simulation of the Anticipated Population Health Gains or Losses

    ERIC Educational Resources Information Center

    Tengs, Tammy O.; Ahmad, Sajjad; Moore, Rebecca; Gage, Eric

    2004-01-01

    If manufacturing a safer cigarette is technically possible--an open question--then mandating that tobacco manufacturers improve the safety of cigarettes would likely have both positive and negative implications for the nation's health. On the one hand, removing toxins may reduce the incidence of smoking-related diseases and premature mortality in…

  17. Understanding Barriers to Safer Sex Practice in Zimbabwean Marriages: Implications for Future HIV Prevention Interventions

    ERIC Educational Resources Information Center

    Mugweni, Esther; Omar, Mayeh; Pearson, Stephen

    2015-01-01

    Against the backdrop of high human immunodeficiency virus (HIV) prevalence in stable relationships in Southern Africa, our study presents sociocultural barriers to safer sex practice in Zimbabwean marriages. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008. Our aim was to identify…

  18. A Safer and Convenient Synthesis of Sulfathiazole for Undergraduate Organic and Medicinal Chemistry Classes

    ERIC Educational Resources Information Center

    Boyle, Jeff; Otty, Sandra; Sarojini, Vijayalekshmi

    2012-01-01

    A safer method for the synthesis of the sulfonamide drug sulfathiazole, for undergraduate classes, is described. This method improves upon procedures currently followed in several undergraduate teaching laboratories for the synthesis of sulfathiazole. Key features of this procedure include the total exclusion of pyridine, which has potential…

  19. HIV-Positive Mothers' Communication about Safer Sex and Std Prevention with Their Children

    ERIC Educational Resources Information Center

    Murphy, Debra A.; Roberts, Kathleen Johnston; Herbeck, Diane M.

    2012-01-01

    Mothers play an important role in promoting the sexual health of their adolescent children. Fifty-seven HIV-positive mothers with adolescent children participated in an in-depth, qualitative interview regarding whether they have talked to their children about safer sex and sexually transmitted disease (STD) prevention, including at what age they…

  20. Guidance Notes on Safer School Construction: Global Facility for Disaster Reduction and Recovery

    ERIC Educational Resources Information Center

    World Bank Publications, 2009

    2009-01-01

    This document provides a framework of guiding principles and general steps addressing the construction of safer and more disaster resilient education facilities. It is aimed to be adapted to the local context and used to develop a context-specific plan to address a critical gap to reaching the Education for All (EFA) and Millennium Development…

  1. Are Schools Making the Grade? School Districts Nationwide Adopt Safer Pest Management Policies.

    ERIC Educational Resources Information Center

    Piper, Cortney; Owens, Kagan

    2002-01-01

    This report documents school districts that have adopted safer pest management policies, such as integrated pest management (IPM), in response to state requirements or as a voluntary measure that exceeds state law. It also documents the state of local school pest management policies and illustrates the opportunities that exist for better…

  2. Stigma to Sage: Learning and Teaching Safer Sex Practices Among Canadian Sex Trade Workers. NALL Working Paper.

    ERIC Educational Resources Information Center

    Meaghan, Diane

    A study interviewed 37 Canadian sex workers in 4 cities to determine how they acquire a working knowledge of safer sex practices and what that knowledge constituted. Findings indicated the vast majority exhibited high levels of knowledge and efficacy regarding safer sex practices; sex workers took the initiative to obtain information and engage in…

  3. Lung Emergencies

    MedlinePlus

    ... Emergencies Cardiac Emergencies Eye Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at ... should be considered an emergency. Symptoms of sudden lung collapse (pneumothorax) Symptoms of a sudden lung collapse ...

  4. A NOVEL SAFER CONCEPTION COUNSELING TOOLKIT FOR THE PREVENTION OF HIV: A MIXED-METHODS EVALUATION IN KISUMU, KENYA

    PubMed Central

    Brown, Joelle; Njoroge, Betty; Akama, Eliud; Breitnauer, Brooke; Leddy, Anna; Darbes, Lynae; Omondi, Richard; Mmeje, Okeoma

    2017-01-01

    Safer conception strategies can prevent HIV transmission between HIV-discordant partners while allowing them to conceive. However, HIV care providers in sub-Saharan Africa report they are not trained in safer conception, and patients are not routinely offered safer conception services. This mixed-methods pilot study evaluated the impact, acceptability, and feasibility of a novel Safer Conception Counseling Toolkit among providers and patients in Kenya. We enrolled 20 HIV-positive women, 10 HIV-discordant couples, and 10 providers from HIV care and treatment clinics. Providers completed questionnaires before/after training, and then counseled HIV-affected patients. Change in patient knowledge was assessed before/after counseling. Qualitative interviews were conducted among providers and patients. The Toolkit was associated with large, significant increases in patient knowledge, and provider confidence, knowledge, and favorable attitudes toward safer conception counseling; 20% felt confident before versus 100% after training (p < 0.01). PMID:27925487

  5. Negotiation for safer sex among married women in Cambodia: the role of women's autonomy.

    PubMed

    Ung, Mengieng; Boateng, Godfred O; Armah, Frederick A; Amoyaw, Jonathan A; Luginaah, Isaac; Kuuire, Vincent

    2014-01-01

    Negotiating safer sex among married women has been identified as an important determinant of vulnerability or resilience to new HIV infections. Using the Cambodia Demographic and Health Survey data of 2010, this paper examined negotiation for safer sex among 11,218 married women in the context of Cambodia's highly touted reduction in HIV/AIDS prevalence. The results from a complementary log-log regression model indicate that wealthier and highly educated married women were more likely to report that they can refuse sexual intercourse and ask their husbands to use a condom. Interestingly, while women who were fully involved in decision-making on their own health care were 19% more likely to refuse sex, they were 14% less likely to be able to ask their husbands to use a condom, compared with their counterparts who were not involved in this decision-making. Women who were partially involved in decision-making on family visits were 17% less likely to be able to ask their husbands to use a condom compared with those who were not involved. In this context, involvement in decision-making may have translated into trust and risk compensation. Those who believed in HIV transmission myths were less likely to negotiate safer sex relative to their counterparts who did not hold such myths to be true. Women's ability to negotiate for safer sex is, therefore, a function of their autonomy in terms of their full participation in decision-making in health care, household expenditure and mobility. Policy implications of the capacity of women to negotiate for safer sex are delineated.

  6. Attitudes Associated With Alcohol and Marijuana Referral Actions by Resident Assistants

    PubMed Central

    Osborn, Cynthia J.; Rossheim, Matthew E.; Suzuki, Sumihiro

    2014-01-01

    This exploratory study examined associations between resident assistant (RA) attitudes and referral actions to identify training strategies for strengthening the ability of these paraprofessionals to recognize and refer college students in their living units who misuse alcohol and marijuana. The study’s hypotheses were that (1) referral self-efficacy and perceived referral norms would be positively associated with RA referral actions and (2) perceived referral barriers and referral anticipatory anxiety would be negatively associated with RAs’ referral actions. A total of 317 RAs at eight residential campuses in different regions of the U.S. took part in the study. All participating RAs had at least one semester of work experience. Just prior to the Fall semester of 2012, RA’s responded to an online survey that assessed their alcohol and marijuana referral attitudes and referral actions. Overall, RAs reported considerable anxiety about approaching and referring students who may have an alcohol and/or marijuana problem. Perceived referral norms among RAs indicated substantial variability in perceptions about others’ expectations of them for referring students who may have alcohol and marijuana problems. Results from two multivariable logistic regression analyses showed that referral self-efficacy distinguished RAs who took alcohol referral actions and marijuana referral actions from those who did not do so. Neither length of RA service nor time spent on campus was associated with referral actions. RA training programs could give attention to strengthening referral self-efficacy through a series of increasingly difficult skill-building activities during pre- and in-service training. In addition, senior residence life and housing professional staff may consider assessing the extent to which RAs under their supervision follow established protocols for assisting students with possible alcohol and marijuana problems. The development of evidence-based RA training

  7. Emergency presentations by vulnerable road users: implications for injury prevention

    PubMed Central

    Meuleners, L B; Lee, A H; Haworth, C

    2006-01-01

    Most emergency presentations by vulnerable road users were the result of collisions that did not involve a motor vehicle. Many injuries occurred off‐road without police attendance. Hence, reliance on official police records would underestimate the magnitude and scope of these injuries. Suggestions to provide a safer road environment are given. PMID:16461413

  8. Service referral for juvenile justice youths: associations with psychiatric disorder and recidivism.

    PubMed

    Hoeve, Machteld; McReynolds, Larkin S; Wasserman, Gail A

    2014-05-01

    Secondary multiple regression analyses related disorder profile, probation officers' mental health/substance use service referrals, and recidivism in 361 juvenile justice youths. Those with externalizing (disruptive behavior or substance use) disorder or substance offenses were most likely to receive service referrals. Substance disordered youths with service referrals had lower recidivism risk compared to counterparts without referrals; referral lowered the recidivism odds to approximately that for youths without a substance use disorder. Providing juvenile justice youths with systematic mental health assessment and linking those with substance use disorder to mental health and substance use services likely reduces recidivism risk.

  9. Oncology social workers' attitudes toward hospice care and referral behavior.

    PubMed

    Becker, Janet E

    2004-02-01

    Members of the Association of Oncology Social Workers completed a survey, which included the Hospice Philosophy Scale (HPS) assessing the likelihood of the worker referring a terminally ill patient to hospice, background and experience, and demographics. The respondents held overwhelmingly favorable attitudes toward hospice philosophy and care, yet the average proportion of terminally ill patients whom they referred to hospice was only 49.5 percent. The worker's HPS score was related significantly, although weakly, to the likelihood of referral. A follow-up study was undertaken to determine the reasons for the discrepancy between the workers' self-reported favorable attitudes toward hospice and their relatively low rate of patient referral. The factor identified most frequently was resistance from families because of the requirement that hospice patients discontinue active treatment.

  10. Referral rates and waiting lists: some empirical evidence.

    PubMed

    Goddard, J A; Tavakoli, M

    1998-09-01

    This paper provides some empirical evidence on topics discussed at greater length in a recent paper in Health Economics (Goddard, J.A., Malek, M. and Tavakoli, M. Health Economics 1995; 4: 41-55), which modelled the relationship between referral rates and waiting lists for hospital treatment for non-urgent conditions within a queuing theory framework. Here, we estimate a version of the demand function used in this model, with panel data for Scottish Health Board Areas during the period 1990-1992. Separate models are estimated for each of six broadly defined 'waiting list' specialisms, for which we have data on referral rates and waiting times. The six specialisms are General Surgery, Ear Nose and Throat Surgery, Gynaecology, Ophthalmology, Orthopaedics and Urology.

  11. [Correct and timely referral of patients to centers of reference].

    PubMed

    Costa, Joana; Valença-Filipe, Rita; Rodrigues, Jorge

    2013-01-01

    The correct and timely referral of patients, from peripheral hospitals, without specialized surgical care, namely in hand surgery, like Plastic Surgery or Orthopedics is of crucial importance. The authors report the case of a patient that presents in the Plastic Surgery Department with a chronic infection of the hypothenar eminence of the right hand. The clinical history suggests the persistence of a foreign body, despite two previous surgical procedures for removal, performed in the residence hospital. Surgical exploration was performed and the foreign body was removed without complications. The intent of this presentation is to alert for the importance of the timely referral of patients that can benefit of specialized care, namely of plastic surgery, when this is no possible in the residence hospital, in view of better health care and better patient treatment.

  12. Follow-up Actions on Electronic Referral Communicationin a Multispecialty Outpatient Setting

    PubMed Central

    Esquivel, Adol; Sittig, Dean F.; Murphy, Daniel; Kadiyala, Himabindu; Schiesser, Rachel; Espadas, Donna; Petersen, Laura A.

    2010-01-01

    ABSTRACT OBJECTIVES Electronic health records (EHR) enable transmission and tracking of referrals between primary-care practitioners (PCPs) and subspecialists. We used an EHR to examine follow-up actions on electronic referral communication in a large multispecialty VA facility. METHODS We retrieved outpatient referrals to five subspecialties between October 2006 and December 2007, and queried the EHR to determine their status: completed, discontinued (returned to PCP), or unresolved (no action taken by subspecialist). All unresolved referrals, and random samples of discontinued and completed referrals were reviewed to determine whether subspecialists took follow-up actions (i.e., schedule appointments anytime in the future) within 30 days of referral-receipt. For referrals without timely follow-up, we determined whether inaction was supported by any predetermined justifiable reasons or associated with certain referral characteristics. We also reviewed if PCPs took the required action on returned information. RESULTS Of 61,931 referrals, 22,535 were discontinued (36.4%), and 474 were unresolved (0.8%). We selected 412 discontinued referrals randomly for review. Of these, 52% lacked follow-up actions within 30 days. Appropriate justifications for inaction were documented in 69.8% (150/215) of those without action and included lack of prerequisite testing by the PCP and subspecialist opinion that no intervention was required despite referral. We estimated that at 30 days, 6.3% of all referrals were associated with an unexplained lack of follow-up actions by subspecialists. Conversely, 7.4% of discontinued referrals returned to PCPs were associated with an unexplained lack of follow-up. CONCLUSIONS Although the EHR facilitates transmission of valuable information at the PCP-subspecialist interface, unexplained communication breakdowns in the referral process persist in a subset of cases. PMID:20848235

  13. Parent-Adolescent Sexual Communication and Adolescent Safer Sex Behavior: A Meta-Analysis

    PubMed Central

    Widman, Laura; Choukas-Bradley, Sophia; Noar, Seth M.; Nesi, Jacqueline; Garrett, Kyla

    2016-01-01

    Importance Parent-adolescent sexual communication has received considerable attention as one factor that can positively impact safer sex among youth; however, the evidence linking communication to youth contraceptive and condom use has not been empirically synthesized. Objective This meta-analysis examined the effect of parent-adolescent sexual communication on youth safer sex behavior and explored potential moderators of this association. Data Sources A systematic search was conducted of studies published through June 2014 using Medline, PsycINFO, and Communication & Mass Media Complete databases and relevant review articles. Study Selection Studies were included if they: 1) sampled adolescents (mean sample age≤18); 2) included an adolescent report of sexual communication with parent(s); 3) measured safer sex behavior; and 4) were published in English. Data Extraction and Synthesis Correlation coefficients (r) and 95% confidence intervals (CIs) were computed from studies and meta-analyzed using random-effects models. Main Outcomes and Measures The primary outcome was safer sex behavior, including use of contraceptives/birth control or condoms. Results Seventy-one independent effects representing over three decades of research on 25,314 adolescents (mean age = 15.1) were synthesized. Across studies, there was a small, significant weighted mean effect (r = .10, [95% CI:0.08–0.13]) linking parent-adolescent sexual communication to safer sex behavior, which was statistically heterogeneous (Q = 203.50, p < .001, I2 = 65.60). Moderation analyses revealed larger effects for communication with girls (r = .12) than boys (r = .04), and among youth who discussed sex with mothers (r = .14) compared to fathers (r = .03). Effects did not differ for contraceptive versus condom use, or among longitudinal versus cross-sectional studies, indicating parent sexual communication had a similar impact across study designs and outcomes. Several methodological issues were identified

  14. Outpatient Nephrology Referral Rates after Acute Kidney Injury

    PubMed Central

    Siew, Edward D.; Peterson, Josh F.; Eden, Svetlana K.; Hung, Adriana M.; Speroff, Theodore; Ikizler, T. Alp

    2012-01-01

    AKI associates with an increased risk for the development and progression of CKD and mortality. Processes of care after an episode of AKI are not well described. Here, we examined the likelihood of nephrology referral among survivors of AKI at risk for subsequent decline in kidney function in a US Department of Veterans Affairs database. We identified 3929 survivors of AKI hospitalized between January 2003 and December 2008 who had an estimated GFR (eGFR) <60 ml/min per 1.73 m2 30 days after peak injury. We analyzed time to referral considering improvement in kidney function (eGFR ≥60 ml/min per 1.73 m2), dialysis initiation, and death as competing risks over a 12-month surveillance period. Median age was 73 years (interquartile range, 62–79 years) and the prevalence of preadmission kidney dysfunction (baseline eGFR <60 ml/min per 1.73 m2) was 60%. Overall mortality during the surveillance period was 22%. The cumulative incidence of nephrology referral before dying, initiating dialysis, or experiencing an improvement in kidney function was 8.5% (95% confidence interval, 7.6–9.4). Severity of AKI did not affect referral rates. These data demonstrate that a minority of at-risk survivors are referred for nephrology care after an episode of AKI. Determining how to best identify survivors of AKI who are at highest risk for complications and progression of CKD could facilitate early nephrology-based interventions. PMID:22158435

  15. Assessment and Policy for Commercial Driver License Referrals

    PubMed Central

    Miller, Christopher M.; Khanna, Amit; Strohl, Kingman P.

    2007-01-01

    This report describes experiences, subsequent action, and policy recommendations regarding sleep disorders assessment of veterans in relation to a commercial driver medical examiner referral. A series of 6 veterans were seen in our sleep clinic, presenting with an order from a commercial driver medical examiner (CDME) for polysomnography and/or Multiple Sleep Latency Testing (PSG/MSLT). We searched the literature for an evidence-based justification for handling this referral, and we concluded that there is neither federal policy nor current evidence to suggest that any current diagnostic test, including PSG/MSLT and/or MWT, is capable of predicting which individual drivers are at risk for fall-asleep crashes. The best indicator of risk is self-reported sleepiness, regardless of cause. Thus, we concluded that an administrative request for a “PSG/MSLT” is not a rational use of VA resources. Procedures and a policy for the Cleveland VA system were developed to respond to the request for evaluation, recognizing that sleep problems and disorders other than sleep apnea may be present in this population. An educational component was an important feature of this response. We suspect that this approach may be appropriate for managed care systems in general. Citation: Miller CM; Khanna A; Strohl KP. Assessment and policy for commercial driver license referrals. J Clin Sleep Med 2007;3(4):417-423. PMID:17694732

  16. Bell's palsy: a summary of current evidence and referral algorithm.

    PubMed

    Glass, Graeme E; Tzafetta, Kallirroi

    2014-12-01

    Spontaneous idiopathic facial nerve (Bell's) palsy leaves residual hemifacial weakness in 29% which is severe and disfiguring in over half of these cases. Acute medical management remains the best way to improve outcomes. Reconstructive surgery can improve long term disfigurement. However, acute and surgical options are time-dependent. As family practitioners see, on average, one case every 2 years, a summary of this condition based on common clinical questions may improve acute management and guide referral for those who need specialist input. We formulated a series of clinical questions likely to be of use to family practitioners on encountering this condition and sought evidence from the literature to answer them. The lifetime risk is 1 in 60, and is more common in pregnancy and diabetes mellitus. Patients often present with facial pain or paraesthesia, altered taste and intolerance to loud noise in addition to facial droop. It is probably caused by ischaemic compression of the facial nerve within the meatal segment of the facial canal probably as a result of viral inflammation. When given early, high dose corticosteroids can improve outcomes. Neither antiviral therapy nor other adjuvant therapies are supported by evidence. As the facial muscles remain viable re-innervation targets for up to 2 years, late referrals require more complex reconstructions. Early recognition, steroid therapy and early referral for facial reanimation (when the diagnosis is secure) are important features of good management when encountering these complex cases.

  17. Investigating referral pathways from primary care to consumer health organisations.

    PubMed

    Young, Charlotte E; Mutch, Allyson J; Boyle, Frances M; Dean, Julie H

    2010-01-01

    While chronic disease places an increasing burden on Australia's primary care system it is unrealistic to expect GPs to meet the range of support needs experienced by patients managing chronic conditions. Consumer health organisations (CHO) have the potential to augment clinical care by providing a variety of supportive services; however, they are underutilised by patients and GPs. This qualitative study investigates GPs' knowledge and perceptions of CHO and their contributions to chronic disease care. The study involved semi-structured interviews with 10 GPs. Overall, participants demonstrated clear understanding of the role of CHO in chronic disease management, but a critical finding was the way GPs' view of their own chronic care role appears to influence referral practices. GPs operating in a traditional role were less likely to refer to CHO than those who had adopted a chronic care approach. A second key finding related to GPs' views of Diabetes Australia. All GPs identified this organisation as an important referral point, providing some reassurance that CHO can be integrated into the primary care sector. Further research is needed to determine how the 'definite advantages' associated with Diabetes Australia can be used to extend GP referral and enhance the health system's integration of other CHO.

  18. Innovative Opioid Peptides and Biased Agonism: Novel Avenues for More Effective and Safer Analgesics to Treat Chronic Pain.

    PubMed

    Bedini, Andrea; Spampinato, Santi Mario

    2017-02-15

    Chronic pain is a clinically relevant and yet unsolved conditions that is poorly treated with the currently available drugs, thus highlighting the urgent need of innovative analgesics. Although opiates are not very effective in the treatment of inflammatory and neuropathic pain, developing novel opioid receptor peptide agonists, as well as modulating the opioid receptor-mediated responses in a ligand-specific fashion, may represent an innovative and promising strategy to identify more efficacious and safer antalgic drugs. In this review, novel analogues of endomorphin 1 (a mu opioid receptor selective agonist able to induce analgesia in different animal models of pain - including neuropathic pain) and dermorphin (one of the most potent opioid peptide existing in nature) will be discussed as they are emerging as a promising starting point to develop novel opioid agonists: endomorphin 1 analogues, in fact, may determine antinociception in different models of neuropathic pain with reduced side effects as compared to classic opiates as morphine; dermorphin analogues may elicit analgesia in animal models of both inflammatory and neuropathic pain and with less severe adverse effects. Furthermore, such opioid peptides may allow to explore unprecedented modalities of ligand-receptor interactions, helping to characterize biased agonism at opioid receptors: exploiting functional selectivity at opioid receptor may lead to identify innovative analgesic with improved pharmacological responses and optimized side effects. Thus, innovative opioid peptides, as those outlined in this review, are promising candidates to develop more effective opioid analgesics to be employed as medications for chronic pain states, as inflammatory or neuropathic pain.

  19. PFP Emergency Lighting Study

    SciTech Connect

    BUSCH, M.S.

    2000-02-02

    NFPA 101, section 5-9 mandates that, where required by building classification, all designated emergency egress routes be provided with adequate emergency lighting in the event of a normal lighting outage. Emergency lighting is to be arranged so that egress routes are illuminated to an average of 1.0 footcandle with a minimum at any point of 0.1 footcandle, as measured at floor level. These levels are permitted to drop to 60% of their original value over the required 90 minute emergency lighting duration after a power outage. The Plutonium Finishing Plant (PFP) has two designations for battery powered egress lights ''Emergency Lights'' are those battery powered lights required by NFPA 101 to provide lighting along officially designated egress routes in those buildings meeting the correct occupancy requirements. Emergency Lights are maintained on a monthly basis by procedure ZSR-12N-001. ''Backup Lights'' are battery powered lights not required by NFPA, but installed in areas where additional light may be needed. The Backup Light locations were identified by PFP Safety and Engineering based on several factors. (1) General occupancy and type of work in the area. Areas occupied briefly during a shiftly surveillance do not require backup lighting while a room occupied fairly frequently or for significant lengths of time will need one or two Backup lights to provide general illumination of the egress points. (2) Complexity of the egress routes. Office spaces with a standard hallway/room configuration will not require Backup Lights while a large room with several subdivisions or irregularly placed rooms, doors, and equipment will require Backup Lights to make egress safer. (3) Reasonable balance between the safety benefits of additional lighting and the man-hours/exposure required for periodic light maintenance. In some plant areas such as building 236-Z, the additional maintenance time and risk of contamination do not warrant having Backup Lights installed in all rooms

  20. The SAFER Latinos project: Addressing a community ecology underlying Latino youth violence.

    PubMed

    Edberg, Mark; Cleary, Sean D; Collins, Elizabeth; Klevens, Joanne; Leiva, Rodrigo; Bazurto, Martha; Rivera, Ivonne; del Cid, Alex Taylor; Montero, Luisa; Calderon, Melba

    2010-08-01

    This paper describes the intervention model, early implementation experience, and challenges for the Seguridad, Apoyo, Familia, Educacion, y Recursos (SAFER) Latinos project. The SAFER Latinos project is an attempt to build the evidence for a multilevel participatory youth violence prevention model tailored to the specific circumstances of Central American immigrants. Specific circumstances targeted in this intervention are decreased family cohesion as a result of sequential immigration (i.e., parents arriving first and bringing their children years later or youth arriving without parents); multiple school barriers; community disorganization and low community efficacy; limited access to services; and a social context (including gang presence) that is linked to youth norms supporting violence. In its implementation, the initial intervention model was adapted to address barriers and challenges. These are described, along with lessons learned and the ongoing evaluation.

  1. Towards Safer Rocket Fuels: Hypergolic Imidazolylidene-Borane Compounds as Replacements for Hydrazine Derivatives.

    PubMed

    Huang, Shi; Qi, Xiujuan; Liu, Tianlin; Wang, Kangcai; Zhang, Wenquan; Li, Jianlin; Zhang, Qinghua

    2016-07-11

    Currently, toxic and volatile hydrazine derivatives are still the main fuel choices for liquid bipropellants, especially in some traditional rocket propulsion systems. Therefore, the search for safer hypergolic fuels as replacements for hydrazine derivatives has been one of the most challenging tasks. In this study, six imidazolylidene-borane compounds with zwitterionic structure have been synthesized and characterized, and their hypergolic reactivity has been studied. As expected, these compounds exhibited fast spontaneous combustion upon contact with white fuming nitric acid (WFNA). Among them, compound 5 showed excellent integrated properties including wide liquid operating range (-70-160 °C), superior loading density (0.99 g cm(-3) ), ultrafast ignition delay times with WFNA (15 ms), and high specific impulse (303.5 s), suggesting promising application potential as safer hypergolic fuels in liquid bipropellant formulations.

  2. Out of the ashes: the life, death, and rebirth of the "safer" cigarette in the United States.

    PubMed

    Fairchild, Amy; Colgrove, James

    2004-02-01

    From 1964 through the early 1980s, both federal and voluntary agencies endorsed the concept of "safer" cigarettes. Beginning in the mid-1980s, several factors, including revelations of tobacco industry malfeasance, the development of nicotine replacement therapy, and the reconceptualization of smoking as a chronic disease, led to "safer" cigarettes being discredited. In the past few years, some public health professionals have begun to reconsider the viability of developing such products. The issue before us is stark: will a commitment to limiting the toll exacted by smoking preclude the tolerance of a product that while not safe may possibly be safer?

  3. Can Computer-Mediated Interventions Change Theoretical Mediators of Safer Sex? A Meta-Analysis

    ERIC Educational Resources Information Center

    Noar, Seth M.; Pierce, Larson B.; Black, Hulda G.

    2010-01-01

    The purpose of this study was to conduct a meta-analysis of computer-mediated interventions (CMIs) aimed at changing theoretical mediators of safer sex. Meta-analytic aggregation of effect sizes from k = 20 studies indicated that CMIs significantly improved HIV/AIDS knowledge, d = 0.276, p less than 0.001, k = 15, N = 6,625; sexual/condom…

  4. The SAFER-Project and Seismic Early Warning in Europe (Invited)

    NASA Astrophysics Data System (ADS)

    Zschau, J.; Gasparini, P.

    2009-12-01

    SAFER (Seismic EArly Warning For EuRope) is the first large scale scientific project in Europe on earthquake early warning. It is funded by the European Commission in the context of Framework Program 6 under the theme Sustainable Development, Global Change and Ecosystems. Its general objective is to develop knowledge and tools for increasing the capability of effective earthquake early warning in Europe and to implement and test these tools in selected European cities. The SAFER project was carried out between 2006 and 2009 by a consortium formed by 20 institutes from 11 European and Mediterranean countries (Germany, Italy, Greece, Romania, Switzerland, Norway, France, the Netherlands, Iceland, Turkey and Egypt) and one each from Japan, Taiwan and USA. Five major earthquake prone cities were chosen as test areas: Athens, Bucharest, Cairo, Istanbul and Naples. The combined population of these cities is about 40 million inhabitants and all have experienced severe earthquakes in recent years. SAFER is strongly multi-disciplinary, calling upon expertise in seismology, structural and geotechnical engineering, informatics and statistics. Some of the specific problems addressed are related to - the rapid determination of earthquake size, complex earthquake features, and damage potential; - the implementation of a fully probabilistic framework for applications of earthquake early warning based on cost-benefit analysis; - the development of a new generation of early warning systems being decentralised and people-centred, and - the implementation of the real-time “shake map”-technology in large European cities. The presentation will review the major scientific findings, comment on the improvements of the earthquake early warning capabilities achieved by SAFER in the five test cities, and present some ideas for the future development of earthquake early warning in Europe.

  5. Immobilizer-assisted management of metal-contaminated agricultural soils for safer food production.

    PubMed

    Kim, Kwon-Rae; Kim, Jeong-Gyu; Park, Jeong-Sik; Kim, Min-Suk; Owens, Gary; Youn, Gyu-Hoon; Lee, Jin-Su

    2012-07-15

    Production of food crops on metal contaminated agricultural soils is of concern because consumers are potentially exposed to hazardous metals via dietary intake of such crops or crop derived products. Therefore, the current study was conducted to develop management protocols for crop cultivation to allow safer food production. Metal uptake, as influenced by pH change-induced immobilizing agents (dolomite, steel slag, and agricultural lime) and sorption agents (zeolite and compost), was monitored in three common plants representative of leafy (Chinese cabbage), root (spring onion) and fruit (red pepper) vegetables, in a field experiment. The efficiency of the immobilizing agents was assessed by their ability to decrease the phytoavailability of metals (Cd, Pb, and Zn). The fruit vegetable (red pepper) showed the least accumulation of Cd (0.16-0.29 mgkg(-1) DW) and Pb (0.2-0.9 mgkg(-1) DW) in edible parts regardless of treatment, indicating selection of low metal accumulating crops was a reasonable strategy for safer food production. However, safer food production was more likely to be achievable by combining crop selection with immobilizing agent amendment of soils. Among the immobilizing agents, pH change-induced immobilizers were more effective than sorption agents, showing decreases in Cd and Pb concentrations in each plant well below standard limits. The efficiency of pH change-induced immobilizers was also comparable to reductions obtained by 'clean soil cover' where the total metal concentrations of the plow layer was reduced via capping the surface with uncontaminated soil, implying that pH change-induced immobilizers can be practically applied to metal contaminated agricultural soils for safer food production.

  6. E-referral Solutions: Successful Experiences, Key Features and Challenges- a Systematic Review

    PubMed Central

    Naseriasl, Mansour; Adham, Davoud; Janati, Ali

    2015-01-01

    Background: around the world health systems constantly face increasing pressures which arise from many factors, such as an ageing population, patients and providers demands for equipment’s and services. In order to respond these challenges and reduction of health system’s transactional costs, referral solutions are considered as a key factor. This study was carried out to identify referral solutions that have had successes. Methods: relevant studies identified using keywords of referrals, consultation, referral system, referral model, referral project, electronic referral, electronic booking, health system, healthcare, health service and medical care. These searches were conducted using PubMed, ProQuest, Google Scholar, Scopus, Emerald, Web of Knowledge, Springer, Science direct, Mosby’s index, SID, Medlib and Iran Doc data bases. 4306 initial articles were obtained and refined step by step. Finally, 27 articles met the inclusion criteria. Results: we identified seventeen e-referral systems developed in UK, Norway, Finland, Netherlands, Denmark, Scotland, New Zealand, Canada, Australia, and U.S. Implemented solutions had variant degrees of successes such as improved access to specialist care, reduced wait times, timeliness and quality of referral communication, accurate health information transfer and integration of health centers and services. Conclusion: each one of referral solutions has both positive and changeable aspects that should be addressed according to sociotechnical conditions. These solutions are mainly formed in a small and localized manner. PMID:26236167

  7. WISDOM GPR investigations in a Mars-analog environment during the SAFER rover operation simulation

    NASA Astrophysics Data System (ADS)

    Dorizon, S.; Ciarletti, V.; Plettemeier, D.; Vieau, A.-J.; Benedix, W.-S.; Mütze, M.; Hassen-Kodja, R.; Humeau, O.

    2014-04-01

    The WISDOM (Water Ice Subsurface Deposits Observations on Mars) Ground Penetrating Radar has been selected to be onboard the ExoMars 2018 rover mission [1]. This instrument will investigate the Martian shallow subsurface and provide the geological context of the mission, by characterizing the subsurface in terms of structure, stratigraphy and potential buried objects. It will also quantify the geoelectrical properties of the medium, which are directly related to its nature, its water or salts content and its hardness [2]. WISDOM data will provide important clues to guide the drilling operations to location of potential exobiological interest. A prototype available in LATMOS, France, is currently tested in a wide range of natural environments. In this context, the WISDOM team participated in the SAFER (Sample Acquisition Field Experiment with a Rover) field trial that occurred from 7th to 13th October 2013 in the Atacama Desert, Chile. Designed to gather together scientists and engineers in a context of a real Martian mission with a rover, the SAFER trial was the opportunity to use three onboard ExoMars instruments, namely CLUPI (Close- UP Imager), PANCAM (Panoramic Camera) and WISDOM, to investigate the chosen area. We present the results derived from WISDOM data acquired over the SAFER trial site to characterize the shallow subsurface of the area.

  8. Identifying Psychosocial Variables That Predict Safer Sex Intentions in Adolescents and Young Adults

    PubMed Central

    Brüll, Phil; Ruiter, Robert A. C.; Wiers, Reinout W.; Kok, Gerjo

    2016-01-01

    Young people are especially vulnerable to sexually transmitted infections (STIs). The triad of deliberate and effective safer sex behavior encompasses condom use, combined with additional information about a partner’s sexual health, and the kind of sex acts usually performed. To identify psychosocial predictors of young people’s intentions to have safer sex, as related to this triad, we conducted an online study with 211 sexually active participants aged between 18 and 24 years. Predictors [i.e., perceived behavioral control (PBC), subjective norms, and intention] taken from Fishbein and Ajzen’s Reasoned Action Approach (RAA), were combined with more distal variables (e.g., behavioral inhibition, sensation seeking, parental monitoring, and knowledge about STIs). Beyond the highly predictive power of RAA variables, additional variance was explained by the number of instances of unprotected sexual intercourse (SI) during the last 12 months and reasons for using barrier protection during first SI. In particular, past condom non-use behavior moderated PBC related to intended condom use. Further, various distal variables showed significant univariate associations with intentions related to the three behaviors of interest. It may, therefore, be helpful to include measures of past behavior as well as certain additional distal variables in future safer sex programs designed to promote health-sustaining sexual behavior. PMID:27148520

  9. Chemlink Laboratories in Kennesaw, Ga. Among 21 Partners to be Recognized for Creating and Using Safer Choice Products / June 22 is the first annual awards ceremony for 2015 Safer Choice Partner of the Year Award Winners

    EPA Pesticide Factsheets

    ATLANTA - The U.S. Environmental Protection Agency (EPA) is announcing that Chemlink Laboratories in Kennesaw, Ga. is among 21 Safer Choice Partner of the Year winners across 15 states. The awards are for outstanding achievement in the design, manufa

  10. Safer Science

    ERIC Educational Resources Information Center

    Roy, Ken

    2011-01-01

    This column provides best safety practices for the science classroom and laboratory. In this month's issue, pregnancy policy in the laboratory is discussed. One can't ignore the fact that student and faculty pregnancies--and the resulting potential hazards in the science laboratory--exist at the high school level. Science teachers need to be…

  11. Community resources for psychiatric and psychosocial problems. Family physicians' referral patterns in urban Ontario.

    PubMed Central

    Craven, M. A.; Allen, C. J.; Kates, N.

    1995-01-01

    OBJECTIVE: To document the number and pattern of psychiatric and psychosocial referrals to community resources by family physicians (FPs) and to determine whether referral practices correlate with physician variables. DESIGN: Cross-sectional survey of referrals by FPs to 34 key psychiatric and psychosocial community resources identified by a panel of FPs, psychiatric social workers, psychiatric nurses, public health nurses, and the local community information service. SETTING: Regional municipality of 434,000 persons in Ontario. PARTICIPANTS: Twenty-seven of 34 (79%) community agencies identified 261 FPs who made 4487 referrals to participating agencies (range 0 to 65, median 15, mean 17.19 +/- 13.42). MAIN OUTCOME MEASURES: Number of referrals to all agencies; variables, such as physician sex, school of graduation, year of graduation, and certificate status in the College of Family Physicians of Canada, related to referral patterns. RESULTS: Referrals to outpatient psychiatric clinics, support services, and general counseling services accounted for 96% of all referrals. Physicians' average annual referral profile was as follows: 8.6 patients to a support service, 6.3 to an outpatient psychiatric service, 1.6 to a counseling service, and 0.46 to a substance abuse service. Referral profiles of individual physicians varied greatly. Female FPs made fewer referrals than male FPs to support services, but both made similar numbers of referrals to psychiatric, counseling, and substance abuse services. The more recent the year of graduation, the greater the number of referrals to psychiatric (r = 0.158, P = 0.0107) and counseling services (r = 0.137, P = 0.0272) and the higher the fraction of referrals to psychiatric services (r = 0.286, P = 0.0001). CONCLUSIONS: Family physicians in Hamilton-Wentworth made few referrals to psychiatric and psychosocial services. Only physician sex and year of graduation correlated significantly with numbers of referrals made. Recent

  12. [Rapid headache guidelines. Neurology consensus between Neurology (SAN) and Primary Care (SEMERGEN Andalucía). Referral criteria].

    PubMed

    Gil Campoy, J A; González Oria, C; Fernández Recio, M; Gómez Aranda, F; Jurado Cobo, C M; Heras Pérez, J A

    2012-01-01

    Headache is one of the most frequent reasons for consultation in our health centers, something which should not be surprising if we consider that is one of the most common symptoms experienced by the population. The main concern of the family physician and emergency physician is to reach a correct diagnosis by clinical history and a basic neurological examination and adapted to the time and means at its disposal. In case of diagnostic doubts or suspected secondary headache, the primary care physician or emergency medical have to refer the patient to be studied and/or treated for Neurology services, such referral shall be made with varying degrees of urgency depending on the presence, or not, of symptoms or signs of alarm. A working group consisting of Neurologists of Sociedad Andaluza de Neurología (SAN) to provide services in different hospitals in Andalucía and Family Physicians representatives of the Sociedad Andaluza de Medicina Familiar y Comunitaria (SAMFyC) and the Sociedad Española de Médicos de Atención Primaria (SEMERGEN Andalucía), has developed a Quick Guide headache, which addresses the more practical aspects for the diagnosis, treatment and monitoring of patients with headache. We show you in this paper, the chapter that deals the alarm criteria and referral.

  13. Businesses and advocacy groups create a road map for safer chemicals: the BizNGO Principles for Chemicals Policy.

    PubMed

    Rossi, Mark S; Thorpe, Beverley; Peele, Cheri

    2011-01-01

    This paper details how businesses and environmental organizations are collaborating to define and implement a visionary agenda for integrating safer chemicals into products, describing the challenges they confront and how they are overcoming those challenges. The framework for this assessment is the Principles for Chemicals Policy developed by the Business-NGO Working Group for Safer Chemicals and Sustainable Materials (BizNGO). The four principles--1) knowing and disclosing chemicals in products, 2) assessing and avoiding hazards, 3) committing to continuous improvement, and 4) supporting public policies and industry standards--while appearing to be straightforward, are, in fact, very complex to implement in practice. Together businesses and environmental organizations are charting a path to safer chemicals by sharing best practices, addressing technical aspects of safer chemicals substitution, and analyzing and supporting public policies that advance the rapid development and diffusion of greener chemicals in the economy.

  14. Characteristics of Referrals for Gender Dysphoria Over a 13-Year Period

    PubMed Central

    Chen, Melinda; Fuqua, John; Eugster, Erica A.

    2017-01-01

    Purpose Our Pediatric Endocrinology Clinic has seen a sharp increase in referrals for gender dysphoria (GD) during recent years. However, the frequency and characteristics of referrals have not been objectively examined. Methods A retrospective chart review of referrals for GD during the past 13 years was performed. Variables analyzed included numbers of referrals per year, patient characteristics, comorbid conditions, and hormonal therapy. Timing of referral and eligibility for treatment were measured against established recommendations. Results Of 38 patients, 74% were referred during the last 3 years. Most patients presented late in puberty before a GD-specific psychological evaluation and few were eligible for hormonal treatment at baseline. Over half had psychiatric and/or developmental comorbidities. Conclusions A dramatic increase in referrals for GD since 2002 was confirmed. Enhanced provider education and outreach regarding care of patients with GD are needed. PMID:26903434

  15. Sexual communication, safer sex self-efficacy, and condom use among young Chinese migrants in Beijing, China.

    PubMed

    Xiao, Zhiwen; Li, Xiaoming; Lin, Danhua; Jiang, Shulin; Liu, Yingjie; Li, Shuming

    2013-12-01

    Mediation effect of sexual communication on the relationship between safer sex self-efficacy and condom use was tested among 307 homosexually active migrant men, 376 heterosexually active migrant men, and 265 heterosexually active migrant women. The study found certain aspects of sexual communication mediated the effect of self-efficacy on condom use among the three samples. The findings underscored the importance of including components that promote safer sex self-efficacy and sexual communication in HIV prevention interventions for Chinese migrants.

  16. Clinical Characteristics of Diabetic Patients Transferred to Korean Referral Hospitals

    PubMed Central

    Oh, Min Young; Kim, Sang Soo; Lee, In Kyu; Baek, Hong Sun; Lee, Hyoung Woo; Chung, Min Young

    2014-01-01

    Background We evaluated the disease profile and clinical management, including the status of both glycemic control and complications, in patients with diabetes who were transferred to referral hospitals in Korea. Methods Patients referred to 20 referral hospitals in Gyeongsangnam/Gyeongsangbuk-do and Jeollanam/Jeollabuk-do with at least a 1-year history of diabetes between January and June 2011 were retrospectively reviewed using medical records, laboratory tests, and questionnaires. Results A total of 654 patients were enrolled in the study. In total, 437 patients (67%) were transferred from clinics and 197 (30%) patients were transferred from hospitals. A total of 279 patients (43%) visited higher medical institutions without a written medical request. The main reason for the referral was glycemic control in 433 patients (66%). Seventy-three patients (11%) had received more than one session of diabetic education. Only 177 patients (27%) had been routinely self-monitoring blood glucose, and 146 patients (22%) were monitoring hemoglobin A1c. In addition, proper evaluations for diabetic complications were performed for 74 patients (11%). The most common complication was neuropathy (32%) followed by nephropathy (31%). In total, 538 patients (82%) had been taking oral hypoglycemic agents. A relatively large number of patients (44%) had been taking antihypertensive medications. Conclusion We investigated the clinical characteristics of diabetic patients and identified specific problems in diabetic management prior to the transfer. We also found several problems in the medical system, which were divided into three medical institutions having different roles in Korea. Our findings suggested that the relationships among medical institutions have to be improved, particularly for diabetes. PMID:25349826

  17. Referral system for hard exudates in eye fundus.

    PubMed

    Naqvi, Syed Ali Gohar; Zafar, Muhammad Faisal; Haq, Ihsan ul

    2015-09-01

    Hard exudates are one of the most common anomalies/artifacts found in the eye fundus of patients suffering from diabetic retinopathy. These exudates are the major cause of loss of sight or blindness in people having diabetic retinopathy. Diagnosis of hard exudates requires considerable time and effort of an ophthalmologist. The ophthalmologists have become overloaded, so that there is a need for an automated diagnostic/referral system. In this paper a referral system for the hard exudates in the eye-fundus images has been presented. The proposed referral system works by combining different techniques like Scale Invariant Feature Transform (SIFT), K-means Clustering, Visual Dictionaries and Support Vector Machine (SVM). The system was also tested with Back Propagation Neural Network as a classifier. To test the performance of the system four fundus image databases were used. One publicly available image database was used to compare the performance of the system to the existing systems. To test the general performance of the system when the images are taken under different conditions and come from different sources, three other fundus image databases were mixed. The evaluation of the system was also performed on different sizes of the visual dictionaries. When using only one fundus image database the area under the curve (AUC) of maximum 0.9702 (97.02%) was achieved with accuracy of 95.02%. In case of mixed image databases an AUC of 0.9349 (93.49%) was recorded having accuracy of 87.23%. The results were compared to the existing systems and were found better/comparable.

  18. Eye Emergencies

    MedlinePlus

    ... Fight for victory. Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Eye Emergencies Lung Emergencies Surgeries Eye Emergencies Marfan syndrome significantly increases your risk of retinal detachment, a ...

  19. Childhood Emergencies

    MedlinePlus

    ... SUBSCRIBE Emergency 101 Share this! Home » Emergency 101 Childhood Emergencies Keeping children healthy and safe is every ... and tools to prevent, recognize and address a childhood emergency is the first step in keeping your ...

  20. Increasing Referrals to a YMCA-Based Diabetes Prevention Program: Effects of Electronic Referral System Modification and Provider Education in Federally Qualified Health Centers

    PubMed Central

    Wylie-Rosett, Judith; Blank, Arthur E.; Ouziel, Judy; Hollingsworth, Nicole; Riley, Rachael W.; Selwyn, Peter A.

    2015-01-01

    Introduction The Diabetes Prevention Program has been translated to community settings with varying success. Although primary care referrals are used for identifying and enrolling eligible patients in the Diabetes Prevention Program, little is known about the effects of strategies to facilitate and sustain eligible patient referrals using electronic health record systems. Methods To facilitate and sustain patient referrals, a modification to the electronic health record system was made and combined with provider education in 6 federally qualified health centers in the Bronx, New York. Referral data from April 2012 through November 2014 were analyzed using segmented regression analysis. Results Patient referrals increased significantly after the modification of the electronic health record system and implementation of the provider education intervention. Before the electronic system modification, 0 to 2 patients were referred per month. During the following year (September 2013 through August 2014), which included the provider education intervention, referrals increased to 1 to 9 per month and continued to increase to 5 to 11 per month from September through November 2014. Conclusions Modification of an electronic health record system coupled with a provider education intervention shows promise as a strategy to identify and refer eligible patients to community-based Diabetes Prevention Programs. Further refinement of the electronic system for facilitating referrals and follow-up of eligible patients should be explored. PMID:26542141

  1. Interdepartmental Dermatology: Characteristics and Impact of Dermatology Inpatient Referrals at a Teaching Hospital in Eastern India

    PubMed Central

    Chowdhury, Satyendra Nath; Podder, Indrasish; Saha, Abanti; Bandyopadhyay, Debabrata

    2017-01-01

    Background: Dermatology is primarily considered to be an outpatient-centered specialty. However, several inpatient admissions to other specialties require dermatologic consultation for optimum management. Aims: To analyze the causes of inpatient dermatology referrals, departments sending referrals, and impact of dermatology consultation on patient management. Materials and Methods: We conducted a cross-sectional study by analyzing the records of 486 patient referrals over a 4-year period. The demographic details, specialties requesting consultation, cause of referral, and dermatological advice have been recorded and analyzed. Results: Dermatology consultation changed the dermatologic diagnosis and treatment of almost two-thirds of patients. General medicine requested the maximum number of referrals, “skin rash” being the most common cause for referral. Accurate diagnosis on referrals was provided by only 30.2% of nondermatologists. Common dermatological disorders were often misdiagnosed by these physicians, and dermatology referrals had significant impact on the diagnosis and subsequent management of these patients. Conclusion: While dermatologic referral leads to improved patient care, there is a need for better training of nondermatologists enabling them to recognize and treat common dermatoses. PMID:28216722

  2. Diagnostic accuracy and appropriateness of general practitioner referrals to a dermatology out-patient clinic.

    PubMed

    Basarab, T; Munn, S E; Jones, R R

    1996-07-01

    A study was undertaken of new referrals by GPs to a dermatology clinic in a district general hospital over a 6-month period. Six hundred and eighty-six consecutive referrals to one consultant were analysed for diagnostic accuracy and requirement for referral. Only 47% of referral letters contained the correct diagnosis. Viral warts and psoriasis were best diagnosed (82 and 78%, respectively), but seborrhoeic warts and dermatofibromas caused difficulty (22 and 19%, respectively). Cutaneous malignancy was correctly diagnosed in 45% of referrals, and eczema, the commonest condition referred, in 54% of cases. Sixty-eight percent of referrals required hospital-based facilities for diagnosis (31%) or treatment/management (37%). Twenty-one per cent of patients referred attended for once-only visits, requiring no specialized diagnostic or therapeutic procedures. Such referrals should decrease with improved GP education. Eleven percent of referrals were for minor surgical procedures such as curettage, shave biopsy, or cryotherapy and would become unnecessary if such facilities were available in the community. Our data demonstrate the potential for management of up to one-third of current dermatological referrals within the community by improving education of GPs and providing appropriate facilities within the community. However, over two-thirds of patients required hospital facilities, a finding of considerable relevance to the future location of dermatological services.

  3. Pediatric Hematology Providers on Referral for Transplant Evaluation for Sickle Cell Disease: A Regional Perspective

    PubMed Central

    Mikles, Bethany; Bhatia, Monica; Oyeku, Suzette O.; Jin, Zhezhen; Green, Nancy S.

    2014-01-01

    Summary Hematology referral for evaluation is a key step for hematopoietic stem cell transplantation for sickle cell disease (SCD). Pediatric SCD providers in the US Northeast (New York-Mid-Atlantic and New England regions) were surveyed anony-mously for perspectives and practices regarding transplant referral and compared by whether they practiced at SCD transplant centers. Data were analyzed using the Fisher exact test, χ2 test, and logistic regression. Half of the respondents practiced primarily at transplant sites. Most (79%) were enthusiastic about transplant for SCD and 78% had recently referred ≥1 child for evaluation. Overall, 77% limited referral to certain sickle hemoglobinopathies and 44% preferred referral for β-thalassemia to SCD. Indications selected for referral resembled current transplant criteria, plus family request or poor response to therapy. Referral for children on chronic transfusions predicted enthusiasm and prior referral. Many (66%) referred children with multiple SCD complications, even without matched sibling donors, 37% with sibling donors despite limited disease. Practitioners at transplant centers more commonly accepted event-free survival rates of ≤90% (P = 0.002). North-eastern providers expressed varying enthusiasm for referral for evaluation based on eligibility, donor availability, and acceptable risk, with modestly more interest from practitioners at transplant centers. Differing provider perspectives may affect patient referral for transplant consideration. PMID:24633300

  4. Patterns in Office Referral Data by Grade, Race/Ethnicity and Gender

    PubMed Central

    Kaufman, Joy S.; Jaser, Sarah S.; Vaughan, Ellen L.; Reynolds, Jesse S.; Di Donato, John; Bernard, Stanley N.; Hernandez-Brereton, Maria

    2014-01-01

    Research supports that office referral data is useful in informing programmatic decisions and in planning interventions such as Positive Behavior Interventions and Supports (PBIS). Knowledge of the different patterns of office referrals may facilitate the development of interventions that are targeted to specific groups of students. This study examines patterns in office referrals within an urban district by gender, race/ethnicity and grade. Findings reveal that there are clear differences by grade that appear to be related to developmental level, with greater numbers of referrals for aggression in younger students (grades K-8), greater numbers of referrals for disrespectful behavior in middle school students (grades 7–8), and greater numbers of referrals for attendance problems in high school students. There were also gender differences in the rate and type of referrals, with significantly more referrals for boys’ delinquent and aggressive behavior than girls, which may relate to how schools define unacceptable behavior and the method used to collect this data. Finally, there were differences by race/ethnicity, in that there were significantly more referrals for African American/black students than Hispanic students, which suggest that schools need to consider students’ racial/ethnic background in the development of behavioral expectations. PMID:25580076

  5. Nurse's Desk: food bank-based outreach and screening to decrease unmet referral needs.

    PubMed

    Larsson, Laura S; Kuster, Emilie

    2013-01-01

    The Nurse's Desk health screening project used the Intervention Wheel model to conduct outreach, screening, education, and referral for food bank clients (n = 506). Blood glucose, blood pressure, health care utilization, and unmet referral needs were assessed. Screening results identified 318 clients (62.8%) with 1 or more unmet referral needs, including 6 clients (3.16%) with capillary blood glucose more than 199 mg/dL and 132 (31.9%) with hypertension. Clients had higher-than-average systolic and diastolic blood pressures and undiagnosed diabetes than in the general population. A client-approved method for tracking completed referrals is needed for this potentially high-risk population.

  6. Diabetes Mellitus in Outpatients in Debre Berhan Referral Hospital, Ethiopia

    PubMed Central

    Habtewold, Tesfa Dejenie; Tsega, Wendwesen Dibekulu; Wale, Bayu Yihun

    2016-01-01

    Introduction. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Most people with diabetes live in low- and middle-income countries and these will experience the greatest increase in cases of diabetes over the next 22 years. Objective. To assess the prevalence and associated factors of diabetes mellitus among outpatients of Debre Berhan Referral Hospital. Methods and Materials. A cross-sectional study was conducted from April to June 2015 among 385 patients. Random quota sampling technique was used to get individual patients and risk factors assessment. Patients diabetes status was ascertained by World Health Organization Diabetes Mellitus Diagnostic Criteria. The collected data were entered, cleaned, and analyzed and Chi-square test was applied to test any association between dependent and independent variable. Result. Out of the total 385 study patients, 368 have participated in the study yielding a response rate of 95.3%. Concerning clinical presentation of diabetes mellitus, 13.3% of patients reported thirst, 14.4% of patients declared polyurea, and 14.9% of patients ascertained unexplained weight loss. The statistically significant associated factors of diabetes mellitus were hypertensive history, obesity, the number of parities, and smoking history. Conclusion. The prevalence of diabetes mellitus among outpatients in Debre Berhan Referral Hospital was 0.34% and several clinical and behavioral factors contribute to the occurrence of diabetes mellitus which impose initiation of preventive, promotive, and curative strategies. PMID:26881245

  7. Neuropathic Pain Referrals to a Multidisciplinary Pediatric Cancer Pain Service

    PubMed Central

    Anghelescu, Doralina L.; Faughnan, Lane G.; Popenhagen, Mark P.; Oakes, Linda L.; Pei, Deqing; Burgoyne, Laura L.

    2012-01-01

    Objectives Neuropathic pain (NP) in children with cancer is not well characterized. We describe the prevalence of NP and the characteristics, duration of follow-up, and interventions provided for NP among patients referred to a pediatric oncology center’s pain management service. Methods Retrospective review of patient data from a 3.5-year period. Results Fifteen percent (66/439) of all referrals to our pain service were for NP (56/323 patients, 17%; 34 male, 22 female). The NP patient group had 1401 clinical visits (778 inpatient visits [55.5%] and 623 outpatient visits [44.5%]). Patients with NP had a significantly greater mean number of pain visits per consult (p=0.008) and significantly more days (median) of pain service follow-up (p <0.001) than did other patients. The most common cause of NP was cancer treatment rather than the underlying malignancy. Pharmacological management of NP was complex, often comprising 3 medications. Nonpharmacological approaches were used for 57.6% of NP referrals. Discussion NP is less frequently encountered than non-NP in children with cancer; nevertheless, it is more difficult to treat, requiring longer follow up, more clinical visits, complex pharmacological management, and the frequent addition of non-pharmacological interventions. PMID:24602431

  8. Passionate scholarship 2001-2010: a vision for making academe safer for joyous risk-takers.

    PubMed

    Heinrich, Kathleen T

    2010-01-01

    What is passionate scholarship? According to students and graduates from a nursing doctoral program interviewed 10 years ago, passionate scholars must risk committing to a personally meaningful and socially relevant topic close to the heart. This insight spawned a string of exploratory inquiries and educational interventions in search of the "ideal conditions" that foster passionate scholarship. Updating the findings of that original study published in Advances in Nursing Science in 2001, this article describes a 3-year, faculty development initiative. Beyond increasing scholarly productivity, the findings suggest that turning faculty groups into communities of scholarly caring can make academic environments safer for passionate risk-takers.

  9. [Are z-hypnotics better and safer sleeping pills than benzodiazepines?].

    PubMed

    Mellingsaeter, Trude C; Bramness, Jørgen G; Slørdal, Lars

    2006-11-16

    Benzodiazepines and the benzodiazepine-like z-hypnotics (zopiclone, zolpidem, and zaleplon) have the same mode of action and many of the same effects. The use of z-hypnotics has had a steady and large increase since their introduction in Norway, and sales data suggest extensive use among the elderly. The relatively short half-lives of these drugs may cause less hangover effects, but z-hypnotics are hardly more effective or safer than benzodiazepines. The two classes of drugs should be prescribed with similar caution.

  10. Self-rescue strategies for EVA crewmembers equipped with the SAFER backpack

    NASA Technical Reports Server (NTRS)

    Williams, Trevor; Baughman, David

    1994-01-01

    An extravehicular astronaut who becomes separated from a space station has three options available: grappling the station immediately by means of a 'shepherd's crook' device; rescue by either a second crewmember flying an MMU or a robotic-controlled MMU; or self-rescue by means of a propulsive system. The first option requires very fast response by a tumbling astronaut; the second requires constant availability of an MMU, as well as a rendezvous procedure thousands of feet from the station. This paper will consider the third option, propulsive self-rescue. In particular, the capability of the new Simplified Aid for EVA Rescue (SAFER) propulsive backpack, which is to be tested on STS-64 in Sep. 1994, will be studied. This system possesses an attitude hold function that can automatically detumble an astronaut after separation. On-orbit tests of candidate self-rescue systems have demonstrated the need for such a feature. SAFER has a total delta(v) capability of about 10 fps, to cover both rotations and translations, compared with a possible separation rate of 2.5 fps. But the delta(v) required for self-rescue is critically dependent on the delay before return can be initiated, as a consequence of orbital effects. A very important practical question is then whether the total delta(v) of SAFER is adequate to perform self-rescue for worst case values of separation speed, time to detumble, and time for the astronaut to visually acquire the station. This paper shows that SAFER does indeed have sufficient propellant to carry out self-rescue in all realistic separation cases, as well as in cases which are considerably more severe than anything likely to be encountered in practice. The return trajectories and total delta(v)'s discussed are obtained by means of an 'inertial line-of-sight targeting' scheme, derived in the paper, which allows orbital effects to be corrected by making use of the visual information available to the pilot, namely the line-of-sight direction to the

  11. Adding additional grab bars as a possible strategy for safer hospital stays.

    PubMed

    Tzeng, Huey-Ming; Yin, Chang-Yi

    2010-02-01

    Patient room design should fulfill the safety needs of most patients. This article addresses the safety concerns related to grab bars and handrails (a United States-based review) and describes our proposed innovative approaches to promote safer hospital stays. The fixed augmentation of high-low grab bars and handrails can economically prevent inpatient falls in the areas commonly used by patients (e.g., patient rooms, patients' bathrooms, and hallways). The optimum grab bar and handrail configurations require further research. Revisions to guidelines for health care facilities related to grab bars and handrails should allow a range that respond to age- and disability-specific needs.

  12. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  13. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  14. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  15. 10 CFR 52.23 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.23 Section 52.23 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Early Site Permits § 52.23 Referral to the Advisory...

  16. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  17. 10 CFR 52.165 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.165 Section 52.165 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Manufacturing Licenses § 52.165 Referral to the...

  18. 10 CFR 52.87 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.87 Section 52.87 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Combined Licenses § 52.87 Referral to the Advisory Committee...

  19. 10 CFR 52.23 - Referral to the Advisory Committee on Reactor Safeguards (ACRS).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Referral to the Advisory Committee on Reactor Safeguards (ACRS). 52.23 Section 52.23 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) LICENSES, CERTIFICATIONS, AND APPROVALS FOR NUCLEAR POWER PLANTS Early Site Permits § 52.23 Referral to the Advisory...

  20. 22 CFR 224.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Referral of complaint and answer to the ALJ. 224.11 Section 224.11 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT § 224.11 Referral of complaint and answer to the ALJ. Upon receipt of...

  1. 75 FR 50880 - TRICARE: Non-Physician Referrals for Physical Therapy, Occupational Therapy, and Speech Therapy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-18

    ... for authorizing certified physician assistants and certified nurse practitioners (non-physicians) to... certified nurse practitioners will be allowed to issue referrals to patients for physical therapy... if based on a referral from a certified physician assistant or certified nurse practitioner....

  2. Early Referral and Other Factors Affecting Vocational Rehabilitation Outcome for the Workers' Compensation Client.

    ERIC Educational Resources Information Center

    Gardner, John A.

    1991-01-01

    Estimated benefits from systematic early referral of injured workers for vocational rehabilitation services. Used data from Florida workers' compensation cases closed in 1985 to estimate gains from referral for evaluation not later than six months from injury date. Concludes that social benefits could be nearly $10 million annually and that…

  3. Community Information in the 80s: Towards the Automation of Information and Referral Files.

    ERIC Educational Resources Information Center

    Shroder, Emelie J.; And Others

    1981-01-01

    Four papers describe systems adopted by public libraries in the United States for computerizing community information services and information and referral programs. Word processing at the Fresno County Information and Referral Network and the automation of library processes in the Pikes Peak Library District are among the topics discussed. (JL)

  4. 43 CFR 10010.47 - Pre-decision referrals to CEQ.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... POLICY ACT Relationship to Decision-Making § 10010.47 Pre-decision referrals to CEQ. (a) Upon receipt of... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Pre-decision referrals to CEQ. 10010.47 Section 10010.47 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH...

  5. 43 CFR 10010.47 - Pre-decision referrals to CEQ.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... POLICY ACT Relationship to Decision-Making § 10010.47 Pre-decision referrals to CEQ. (a) Upon receipt of... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Pre-decision referrals to CEQ. 10010.47 Section 10010.47 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH...

  6. 43 CFR 10010.47 - Pre-decision referrals to CEQ.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... POLICY ACT Relationship to Decision-Making § 10010.47 Pre-decision referrals to CEQ. (a) Upon receipt of... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Pre-decision referrals to CEQ. 10010.47 Section 10010.47 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH...

  7. 43 CFR 10010.47 - Pre-decision referrals to CEQ.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... POLICY ACT Relationship to Decision-Making § 10010.47 Pre-decision referrals to CEQ. (a) Upon receipt of... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Pre-decision referrals to CEQ. 10010.47 Section 10010.47 Public Lands: Interior Regulations Relating to Public Lands (Continued) UTAH...

  8. Referral Pattern and Special Interests in Children and Adolescents with Asperger Syndrome: A Turkish Referred Sample

    ERIC Educational Resources Information Center

    Tanidir, Canan; Mukaddes, Nahit M.

    2014-01-01

    Objectives: To investigate the most frequent reasons for referral, the most common special interests, age at first referral to a mental health service, and the age of diagnosis in children and adolescents with Asperger syndrome living in Turkey. Methods: This study includes 61 children and adolescents diagnosed with Asperger syndrome using…

  9. A Qualitative Investigation of the Referral Process from School Counselors to Mental Health Providers

    ERIC Educational Resources Information Center

    Lemberger, Matthew E.; Wachter Morris, Carrie A.; Clemens, Elysia V.; Smith, Allison L.

    2010-01-01

    This qualitative study explores the referral process to mental health providers by school counselors, as perceived by school counselors. Using an open-ended survey instrument, school counselors were asked to describe the referral process, including prevalence, decisional factors, follow-up, and evaluation. Results suggest that school counselors…

  10. Neighborhood Communications Centers: Planning Information and Referral Services in The Urban Library.

    ERIC Educational Resources Information Center

    Yin, Robert K.; And Others

    The potential development of information and referral (I&R) services in branch libraries was explored by examining five cases where such services have been initiated. The extent to which the public library system is appropriate for information and referral services was carefully examined in the light of its ability to carry on seven functions: (1)…

  11. 37 CFR 354.3 - Register of Copyrights' authority to redesignate referrals.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2011-07-01 2011-07-01 false Register of Copyrights... REGISTER OF COPYRIGHTS § 354.3 Register of Copyrights' authority to redesignate referrals. If, during the 14-day period of a discretionary referral of a material question of law under § 354.1, the...

  12. 37 CFR 354.3 - Register of Copyrights' authority to redesignate referrals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2012-07-01 2012-07-01 false Register of Copyrights... REGISTER OF COPYRIGHTS § 354.3 Register of Copyrights' authority to redesignate referrals. If, during the 14-day period of a discretionary referral of a material question of law under § 354.1, the...

  13. 37 CFR 354.3 - Register of Copyrights' authority to redesignate referrals.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2014-07-01 2014-07-01 false Register of Copyrights... REGISTER OF COPYRIGHTS § 354.3 Register of Copyrights' authority to redesignate referrals. If, during the 14-day period of a discretionary referral of a material question of law under § 354.1, the...

  14. 37 CFR 354.3 - Register of Copyrights' authority to redesignate referrals.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2013-07-01 2013-07-01 false Register of Copyrights... REGISTER OF COPYRIGHTS § 354.3 Register of Copyrights' authority to redesignate referrals. If, during the 14-day period of a discretionary referral of a material question of law under § 354.1, the...

  15. Effects of Schools Attuned on Special Education Referrals for African American Boys

    ERIC Educational Resources Information Center

    Rodriguez, Andrea B.

    2010-01-01

    This study compared the number of special education referrals for African American boys before and after the implementation of the training program, "Schools Attuned". The purpose of the research was to ascertain if the number of special education referrals for African American boys generated in schools with teachers trained in "Schools Attuned"…

  16. Exploring Primary Referral Source Impact on Student Initial Perceptions of Counseling

    ERIC Educational Resources Information Center

    Blau, Gary; DiMino, John; Sheridan, Natalie; Stein, Alexander; Casper, Steven; Chessler, Marcy; Beverly, Clyde

    2015-01-01

    There has been no published research to date comparing the impact of different primary referral sources for a student seeking counseling services on student initial counseling perceptions. Using 82 undergraduates in counseling, this study partitioned these students into two referral groups, where 1 = self-referred (myself), N = 45 versus 2 =…

  17. 21 CFR 20.51 - Referral to primary source of records.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Referral to primary source of records. 20.51... PUBLIC INFORMATION Procedures and Fees § 20.51 Referral to primary source of records. Upon receipt of a... primary source of the record or document....

  18. Referral of African American Children for Evaluation of Emotional or Behavioral Concerns

    ERIC Educational Resources Information Center

    Riccio, Cynthia A.; Ochoa, Salvador Hector; Garza, Sylvia G.; Nero, Collette L.

    2003-01-01

    Research indicates that high numbers of African American children receive special education services. To address the overrepresentation of African Americans in special education, this study examined the source of referral and the behaviors that precipitate the referral of African Americans for evaluation due to behavioral or emotional concerns.…

  19. 29 CFR 1614.306 - Referral of case to Special Panel.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Referral of case to Special Panel. 1614.306 Section 1614... SECTOR EQUAL EMPLOYMENT OPPORTUNITY Related Processes § 1614.306 Referral of case to Special Panel. If... shall be immediately certified to the Special Panel established pursuant to 5 U.S.C. 7702(d)....

  20. 5 CFR 1201.171 - Referral of case to Special Panel.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Referral of case to Special Panel. 1201... Panel § 1201.171 Referral of case to Special Panel. If the Board reaffirms its decision under § 1201.162... Panel established under 5 U.S.C. 7702(d). Upon certification, the Board, within 5 days...

  1. 45 CFR 96.33 - Referral of cases to the Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Referral of cases to the Inspector General. 96.33 Section 96.33 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION BLOCK GRANTS Financial Management § 96.33 Referral of cases to the Inspector General. State or tribal officials who...

  2. 20 CFR 702.505 - Vocational rehabilitation; referrals to other public and private agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Vocational rehabilitation; referrals to other... ADMINISTRATION AND PROCEDURE Vocational Rehabilitation § 702.505 Vocational rehabilitation; referrals to other... made by the vocational rehabilitation adviser, where appropriate, on an individual basis when...

  3. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... SPECIALIZED SERVICES FURNISHED BY SUPPLIERS Conditions for Coverage: Portable X-Ray Services § 486.106 Condition for coverage: Referral for service and preservation of records. All portable X-ray services... are properly preserved. (a) Standard—referral by a physician. Portable X-ray examinations...

  4. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SPECIALIZED SERVICES FURNISHED BY SUPPLIERS Conditions for Coverage: Portable X-Ray Services § 486.106 Condition for coverage: Referral for service and preservation of records. All portable X-ray services... are properly preserved. (a) Standard—referral by a physician. Portable X-ray examinations...

  5. 42 CFR 486.106 - Condition for coverage: Referral for service and preservation of records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SPECIALIZED SERVICES FURNISHED BY SUPPLIERS Conditions for Coverage: Portable X-Ray Services § 486.106 Condition for coverage: Referral for service and preservation of records. All portable X-ray services... are properly preserved. (a) Standard—referral by a physician. Portable X-ray examinations...

  6. 10 CFR 13.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Referral of complaint and answer to the ALJ. 13.11 Section 13.11 Energy NUCLEAR REGULATORY COMMISSION PROGRAM FRAUD CIVIL REMEDIES § 13.11 Referral of complaint and answer to the ALJ. Upon receipt of an answer, the reviewing official shall file the complaint...

  7. The Effects of Implementing a Positive Behavior Intervention Support Program on Office Discipline Referrals

    ERIC Educational Resources Information Center

    Thomas, Cheryl Denise

    2015-01-01

    The purpose of this study was to determine if the implementation of PBIS (Positive Behavioral Intervention Support) program had a positive significant effect in decreasing office discipline referrals in a local elementary school. A sample independent t-Test was used to examine data on the school's average office discipline referrals for two years…

  8. The Disproportionality Dilemma: Patterns of Teacher Referrals to School Counselors for Disruptive Behavior

    ERIC Educational Resources Information Center

    Bryan, Julia; Day-Vines, Norma L.; Griffin, Dana; Moore-Thomas, Cheryl

    2012-01-01

    Disproportionality plagues schools nationwide in special education placement, dropout, discipline referral, suspension, and expulsion rates. This study examined predictors of teacher referrals to school counselors for disruptive behavior in a sample of students selected from the Educational Longitudinal Study 2002 (National Center for Education…

  9. 42 CFR 422.105 - Special rules for self-referral and point of service option.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for self-referral and point of... OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Benefits and Beneficiary Protections § 422.105 Special rules for self-referral and point of service option. (a)...

  10. 28 CFR 115.178 - Referrals for prosecution for detainee-on-detainee sexual abuse.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Referrals for prosecution for detainee-on-detainee sexual abuse. 115.178 Section 115.178 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Lockups Discipline § 115.178 Referrals...

  11. 28 CFR 115.178 - Referrals for prosecution for detainee-on-detainee sexual abuse.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Referrals for prosecution for detainee-on-detainee sexual abuse. 115.178 Section 115.178 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Lockups Discipline § 115.178 Referrals...

  12. 28 CFR 115.178 - Referrals for prosecution for detainee-on-detainee sexual abuse.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Referrals for prosecution for detainee-on-detainee sexual abuse. 115.178 Section 115.178 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Lockups Discipline § 115.178 Referrals...

  13. Strategies for Students with Behavioral Issues Prior to Referral for Special Education Assessment

    ERIC Educational Resources Information Center

    Vallejos, Antoinette Martinez

    2010-01-01

    By law, public schools need to exhaust all general education services prior to referral for special education services (IDEA, 1990). Unfortunately, many teachers are unaware of the pre-referral interventions they can employ to teach children displaying behavior problems. The review of literature focused on the following: (a) legislative history,…

  14. A Collaborative Process Model for Promoting Successful Referrals in College Counseling

    ERIC Educational Resources Information Center

    Iarussi, Melanie M.; Shaw, Brian M.

    2016-01-01

    The need to refer students to off-campus mental health providers is common in college counseling. Such referrals can be challenging for college counselors who strive to meet students' counseling needs while adhering to ethical and center policy guidelines. In this article, the authors explore the nature and challenges of referral in college…

  15. 42 CFR 411.353 - Prohibition on certain referrals by physicians and limitations on billing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... limitations on billing. 411.353 Section 411.353 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... § 411.353 Prohibition on certain referrals by physicians and limitations on billing. (a) Prohibition on...) Limitations on billing. An entity that furnishes DHS pursuant to a referral that is prohibited by paragraph...

  16. 42 CFR 411.353 - Prohibition on certain referrals by physicians and limitations on billing.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... limitations on billing. 411.353 Section 411.353 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... § 411.353 Prohibition on certain referrals by physicians and limitations on billing. (a) Prohibition on...) Limitations on billing. An entity that furnishes DHS pursuant to a referral that is prohibited by paragraph...

  17. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Referral to the Department of Justice. 304.9 Section 304.9 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or...

  18. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Referral to the Department of Justice. 304.9 Section 304.9 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or...

  19. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Referral to the Department of Justice. 304.9 Section 304.9 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or...

  20. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Referral to the Department of Justice. 304.9 Section 304.9 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or...

  1. 22 CFR 304.9 - Referral to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Referral to the Department of Justice. 304.9 Section 304.9 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or...

  2. 22 CFR 224.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Referral of complaint and answer to the ALJ. 224.11 Section 224.11 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT § 224.11 Referral of complaint and answer to the ALJ. Upon receipt of...

  3. 22 CFR 35.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Referral of complaint and answer to the ALJ. 35.11 Section 35.11 Foreign Relations DEPARTMENT OF STATE CLAIMS AND STOLEN PROPERTY PROGRAM FRAUD CIVIL REMEDIES § 35.11 Referral of complaint and answer to the ALJ. Upon receipt of an answer, the...

  4. 22 CFR 213.37 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Referrals to the Department of Justice. 213.37... Department of Justice § 213.37 Referrals to the Department of Justice. (a) The CFO, through the FMS cross... of Justice's Nationwide Central Intake Facility as required by the Claims Collection...

  5. 24 CFR 17.75 - Referral to GAO or Justice Department.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to GAO or Justice... General Provisions § 17.75 Referral to GAO or Justice Department. (a) Claims referred. Claims which cannot... to the General Accounting Office in accordance with 31 U.S.C. 71 or to the Department of Justice...

  6. 31 CFR 904.4 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Department of Justice. 904.4 Section 904.4 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FEDERAL CLAIMS COLLECTION STANDARDS (DEPARTMENT OF THE TREASURY-DEPARTMENT OF JUSTICE) REFERRALS TO THE DEPARTMENT OF JUSTICE § 904.4 Minimum amount of referrals to the Department of Justice....

  7. 7 CFR 1403.17 - Referral of debts to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 1403.17... PROCEDURES § 1403.17 Referral of debts to Department of Justice. Debts which cannot be collected in accordance with these regulations may be referred to the Department of Justice for collection action....

  8. 7 CFR 792.18 - Referral of debts to Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 792.18... § 792.18 Referral of debts to Department of Justice. (a) Debts that exceed $100,000.00 exclusive of... referred to the Department of Justice before they can be discharged. (b) Debts which cannot be...

  9. 49 CFR 1018.72 - Referral to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Referral to the Department of Justice. 1018.72... Claim § 1018.72 Referral to the Department of Justice. (a) Claims for which the gross original amount is... Justice, Washington, DC 20530. Claims for which the gross original amount is $500,000 or less must...

  10. 45 CFR 5.23 - Referral of requests outside the Department.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Referral of requests outside the Department. 5.23 Section 5.23 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION FREEDOM OF INFORMATION REGULATIONS Obtaining a Record § 5.23 Referral of requests outside the Department. If you request records that were created by,...

  11. 31 CFR 501.746 - Referral to United States Department of Justice; administrative collection measures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Referral to United States Department....746 Referral to United States Department of Justice; administrative collection measures. In the event... administrative collection measures or to the United States Department of Justice for appropriate action...

  12. 31 CFR 501.746 - Referral to United States Department of Justice; administrative collection measures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Referral to United States Department....746 Referral to United States Department of Justice; administrative collection measures. In the event... administrative collection measures or to the United States Department of Justice for appropriate action...

  13. 31 CFR 501.746 - Referral to United States Department of Justice; administrative collection measures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Referral to United States Department....746 Referral to United States Department of Justice; administrative collection measures. In the event... administrative collection measures or to the United States Department of Justice for appropriate action...

  14. 31 CFR 501.746 - Referral to United States Department of Justice; administrative collection measures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Referral to United States Department....746 Referral to United States Department of Justice; administrative collection measures. In the event... administrative collection measures or to the United States Department of Justice for appropriate action...

  15. 31 CFR 585.705 - Referral to United States Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Referral to United States Department... HERZEGOVINA SANCTIONS REGULATIONS Penalties § 585.705 Referral to United States Department of Justice. In the... States Department of Justice for appropriate action to recover the penalty in a civil suit in a...

  16. 31 CFR 501.746 - Referral to United States Department of Justice; administrative collection measures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Referral to United States Department....746 Referral to United States Department of Justice; administrative collection measures. In the event... administrative collection measures or to the United States Department of Justice for appropriate action...

  17. 31 CFR 16.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Referral of complaint and answer to the ALJ. 16.11 Section 16.11 Money and Finance: Treasury Office of the Secretary of the Treasury REGULATIONS IMPLEMENTING THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 16.11 Referral of complaint and...

  18. 29 CFR 22.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 1 2014-07-01 2013-07-01 true Referral of complaint and answer to the ALJ. 22.11 Section 22.11 Labor Office of the Secretary of Labor PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 22.11 Referral of complaint and answer to the ALJ. Upon receipt of an answer, the reviewing official shall...

  19. 14 CFR § 1264.110 - Referral of complaint and answer to the presiding officer.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Referral of complaint and answer to the presiding officer. § 1264.110 Section § 1264.110 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL PENALTIES ACT OF 1986 § 1264.110 Referral of...

  20. 14 CFR 1264.110 - Referral of complaint and answer to the presiding officer.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Referral of complaint and answer to the presiding officer. 1264.110 Section 1264.110 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL PENALTIES ACT OF 1986 § 1264.110 Referral of...

  1. 7 CFR 1.311 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 1 2013-01-01 2013-01-01 false Referral of complaint and answer to the ALJ. 1.311 Section 1.311 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS Procedures Related to Administrative Hearings Under the Program Fraud Civil Remedies Act of 1986 § 1.311 Referral...

  2. Service Coordinators' Perceptions of Autism-Specific Screening and Referral Practices in Early Intervention

    ERIC Educational Resources Information Center

    Pizur-Barnekow, Kris; Muusz, Marta; McKenna, Catherine; O'Connor, Emily; Cutler, Ann

    2013-01-01

    Service coordinators in a statewide early intervention program were surveyed to develop an understanding of screening and referral practices to identify children on the autism spectrum. Quantitative and qualitative data summarizing autism-specific screening and referral practices are reported. More than 50% of the respondents reported that they…

  3. Intellectual Disabilities, Challenging Behaviour and Referral Texts: A Critical Discourse Analysis

    ERIC Educational Resources Information Center

    Nunkoosing, Karl; Haydon-Laurelut, Mark

    2011-01-01

    The texts of referrals written by workers in residential services for people with learning difficulties constitute sites where contemporary discourses of intellectual disabilities are being constructed. This paper uses Critical Discourse Analysis to examine referrals made to a Community Learning Disability Team (CLDT). The study finds referral…

  4. 7 CFR 1.311 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Referral of complaint and answer to the ALJ. 1.311 Section 1.311 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS Procedures Related to Administrative Hearings Under the Program Fraud Civil Remedies Act of 1986 § 1.311 Referral...

  5. 45 CFR 73.735-1304 - Referral of matters arising under the standards of this part.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... to the Department of Justice, suspected violations of the criminal laws regarding employee standards... 45 Public Welfare 1 2010-10-01 2010-10-01 false Referral of matters arising under the standards of... GENERAL ADMINISTRATION STANDARDS OF CONDUCT Reporting Violations § 73.735-1304 Referral of matters...

  6. 20 CFR 658.414 - Referral of non-JS-related complaints.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Referral of non-JS-related complaints. 658... Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the... take from MSFWs in writing non-JS related complaints which allege violations of employment related...

  7. 20 CFR 658.414 - Referral of non-JS-related complaints.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Referral of non-JS-related complaints. 658... Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the... take from MSFWs in writing non-JS related complaints which allege violations of employment related...

  8. 20 CFR 658.414 - Referral of non-JS-related complaints.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Referral of non-JS-related complaints. 658... Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the... take from MSFWs in writing non-JS related complaints which allege violations of employment related...

  9. 20 CFR 658.414 - Referral of non-JS-related complaints.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Referral of non-JS-related complaints. 658... ADMINISTRATIVE PROVISIONS GOVERNING THE JOB SERVICE SYSTEM Job Service Complaint System State Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the operation of...

  10. 20 CFR 658.414 - Referral of non-JS-related complaints.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Referral of non-JS-related complaints. 658... ADMINISTRATIVE PROVISIONS GOVERNING THE JOB SERVICE SYSTEM Job Service Complaint System State Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the operation of...

  11. 19 CFR 176.21 - Referral of statement of agreed facts for certification.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 2 2011-04-01 2011-04-01 false Referral of statement of agreed facts for... of Agreed Facts § 176.21 Referral of statement of agreed facts for certification. Statements of agreed facts (also referred to as stipulations) to be used by the Department of Justice in...

  12. 19 CFR 176.21 - Referral of statement of agreed facts for certification.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Referral of statement of agreed facts for... of Agreed Facts § 176.21 Referral of statement of agreed facts for certification. Statements of agreed facts (also referred to as stipulations) to be used by the Department of Justice in...

  13. 10 CFR 13.11 - Referral of complaint and answer to the ALJ.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Referral of complaint and answer to the ALJ. 13.11 Section 13.11 Energy NUCLEAR REGULATORY COMMISSION PROGRAM FRAUD CIVIL REMEDIES § 13.11 Referral of complaint and answer to the ALJ. Upon receipt of an answer, the reviewing official shall file the complaint...

  14. 28 CFR 115.222 - Policies to ensure referrals of allegations for investigations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Policies to ensure referrals of allegations for investigations. 115.222 Section 115.222 Judicial Administration DEPARTMENT OF JUSTICE... Responsive Planning § 115.222 Policies to ensure referrals of allegations for investigations. (a) The...

  15. Patterns of Risk in Adult Protection Referrals for Sexual Abuse and People with Intellectual Disability

    ERIC Educational Resources Information Center

    Cambridge, Paul; Beadle-Brown, Julie; Milne, Alisoun; Mansell, Jim; Whelton, Beckie

    2011-01-01

    Background: Adult protection monitoring data held by local authorities in England provide opportunities to examine referrals for alleged sexual abuse for people with intellectual disability to identify patterns of risk. Methods: Adult protection monitoring data collected by two local authorities was analysed, with referrals for alleged sexual…

  16. A Safer Sodium‐Ion Battery Based on Nonflammable Organic Phosphate Electrolyte

    PubMed Central

    Zeng, Ziqi; Jiang, Xiaoyu; Li, Ran; Yuan, Dingding; Ai, Xinping; Yang, Hanxi

    2016-01-01

    Sodium‐ion batteries are now considered as a low‐cost alternative to lithium‐ion technologies for large‐scale energy storage applications; however, their safety is still a matter of great concern for practical applications. In this paper, a safer sodium‐ion battery is proposed by introducing a nonflammable phosphate electrolyte (trimethyl phosphate, TMP) coupled with NaNi0.35Mn0.35Fe0.3O2 cathode and Sb‐based alloy anode. The physical and electrochemical compatibilities of the TMP electrolyte are investigated by igniting, ionic conductivity, cyclic voltammetry, and charge–discharge measurements. The results exhibit that the TMP electrolyte with FEC additive is completely nonflammable and has wide electrochemical window (0–4.5 V vs. Na/Na+), in which both the Sb‐based anode and NaNi0.35Mn0.35Fe0.3O2 cathode show high reversible capacity and cycling stability, similarly as in carbonate electrolyte. Based on these results, a nonflammable sodium‐ion battery is constructed by use of Sb anode, NaNi0.35Mn0.35Fe0.3O2 cathode, and TMP + 10 vol% FEC electrolyte, which works very well with considerable capacity and cyclability, demonstrating a promising prospect to build safer sodium‐ion batteries for large‐scale energy storage applications. PMID:27711263

  17. A Safer Sodium-Ion Battery Based on Nonflammable Organic Phosphate Electrolyte.

    PubMed

    Zeng, Ziqi; Jiang, Xiaoyu; Li, Ran; Yuan, Dingding; Ai, Xinping; Yang, Hanxi; Cao, Yuliang

    2016-09-01

    Sodium-ion batteries are now considered as a low-cost alternative to lithium-ion technologies for large-scale energy storage applications; however, their safety is still a matter of great concern for practical applications. In this paper, a safer sodium-ion battery is proposed by introducing a nonflammable phosphate electrolyte (trimethyl phosphate, TMP) coupled with NaNi0.35Mn0.35Fe0.3O2 cathode and Sb-based alloy anode. The physical and electrochemical compatibilities of the TMP electrolyte are investigated by igniting, ionic conductivity, cyclic voltammetry, and charge-discharge measurements. The results exhibit that the TMP electrolyte with FEC additive is completely nonflammable and has wide electrochemical window (0-4.5 V vs. Na/Na(+)), in which both the Sb-based anode and NaNi0.35Mn0.35Fe0.3O2 cathode show high reversible capacity and cycling stability, similarly as in carbonate electrolyte. Based on these results, a nonflammable sodium-ion battery is constructed by use of Sb anode, NaNi0.35Mn0.35Fe0.3O2 cathode, and TMP + 10 vol% FEC electrolyte, which works very well with considerable capacity and cyclability, demonstrating a promising prospect to build safer sodium-ion batteries for large-scale energy storage applications.

  18. Designing safer chemicals: Predicting the rates of metabolism of halogenated alkanes

    SciTech Connect

    Yin, H.; Anders, M.W.; Higgins, L.

    1995-11-21

    A computational model is presented that can be used as a tool in the design of safer chemicals. This model predicts that rate of hydrogen-atom abstraction by cytochrome P450 enzymes. Excellent correlations between biotransformation rates and the calculated activation energies ({Delta}H{sub act}) of the cytochrome P450-mediated hydrogen-atom abstractions were obtained for the in vitro biotransformation of six halogenated alkanes (1-fluoro-1,1,1,2,2-tetrachloroethane, 1,1,1,2-tetrafluoro-2-chloroethane, 1,1,1,2,2-pentafluoroethane, and 2-bromo-2-chloro-1,1,1-trifluoroethane) with both rat and human enzyme preparations: (rate, human CYP2E1) = 44.99 - 1.79 ({Delta}H{sub act}), r{sup 2} = 0.86; In (rate, human Cyp2E1)= 46399 -1.77 ({Delta}H{sub act}), r{sup 2} = 0.97 (rates are in nmol of product per min per nmol of cytochrome P450 and energies are in kcal/mol). Correlations were also obtained for five inhalation anesthetics (enflurane, sevoflurane, desflurane, methoxyflurane, and isoflurane) for both in vivo and in vitro data have been shown to agree in any species. The model presented herein provides an archetype for the methodology that may be used in the future design of safer chemicals, particularly hydrochlorofluorocarbons and inhalation anesthetics. 41 refs., 1 fig., 2 tabs.

  19. Require safer substitutes and solutions: making the substitution principle the cornerstone of sustainable chemical policies.

    PubMed

    Thorpe, Beverley; Rossi, Mark

    2007-01-01

    Currently, chemical regulations in the United States do not prioritize the production and use of inherently safe chemicals. At present, when regulations get passed to target a chemical for control, safer substitutes are not the goal nor are there specific guidelines or tools used to achieve Green Chemistry, Clean Production, or sustainable product design. In most cases, the replacement is often just as hazardous or simply a reduction of the quantity or concentration of the toxic substance that has been targeted. In contrast, by placing the Substitution Principle at the heart of new chemical policies and regulations, hazardous chemicals would be replaced with less hazardous alternatives or preferably alternatives for which no hazards can be identified. This would hasten the uptake of Green Chemistry, or environmentally benign chemical synthesis. Substituting hazardous chemicals goes beyond finding a drop-in chemical alternative and can include systems, materials or process changes. Regulatory drivers include a clear timeline for phase out of priority chemicals based on their inherent hazard, mandatory substitution planning for hazardous chemicals, financial and technical support for companies to find safer materials, and increased funding for green chemistry development and uptake by companies.

  20. Diagnostic and referral intervals for Manitoba women with epithelial ovarian cancer - the Manitoba Ovarian Cancer Outcomes (MOCO) study group: a retrospective cross-sectional study

    PubMed Central

    Love, Allison J.; Lambert, Pascal; Turner, Donna; Lotocki, Robert; Dean, Erin; Popowich, Shaundra; Altman, Alon D.; Nachtigal, Mark W.

    2017-01-01

    Background: Epithelial ovarian cancer has the highest mortality of all gynecologic cancers. The poor survival rates are often attributed to the advanced stage at which most of these cancers are detected. We sought to examine the effects of patient demographics, comorbidities and presenting symptoms on diagnostic and referral intervals by location of first presentation (emergency department v. elsewhere) and to identify factors that affect these intervals. Methods: We performed a retrospective analysis of chart and medical record data for ovarian cancers, with the exceptions of sex cord and germ cell tumours, diagnosed between 2004 and 2010 in Manitoba, Canada. Data were collected on baseline characteristics, time to diagnosis and referral, number and type of physician visits and emergency department visits. Results: The final cohort consisted of 601 patients. Sixty-three percent of patients received their diagnosis within 60 days of initial presentation, and 75.2% had their cancer diagnosed within 2 physician encounters. The median diagnostic interval for all stages of patients presenting to the emergency department was 7 days, compared with 55 days for patients presenting elsewhere. Early stage patients not presenting to the emergency department had their diagnosis a median of 34.0 days later than patients with advanced disease (95% confidence interval [CI] 22.22 to 45.69, p < 0.0001). The presence of some symptoms was associated with shortened diagnostic intervals. Patients with serous, clear-cell or endometrioid histotypes were less likely to have first presentation beginning in the emergency department (odds ratio [OR] 0.40, 95% CI 0.24 to 0.64, p = 0.0001; OR 0.28, 95% CI 0.14 to 0.59, p = 0.007) than those with unclassified epithelial histotype. Interpretation: For this group of patients, the main factor associated with diagnostic and referral intervals is presentation to the emergency department. These patients likely required more urgent attention for their

  1. The start of the transplant journey: Referral for pediatric solid organ transplantation

    PubMed Central

    Shellmer, Diana; Brosig, Cheryl; Wray, Jo

    2014-01-01

    The focus of the majority of the psychosocial transplant literature is on post-transplant outcomes but the transplant journey starts much earlier than this, at the point when transplantation is first considered and a referral for transplant evaluation is made. In this review we cover information regarding the meaning of the referral process for solid organ transplantation. We discuss various factors of the referral for transplantation including the impact of referral on the pediatric patient and the family, potential expectations and misconceptions held by pediatric patients and parents, the role of health literacy, decision making factors, and the informational needs of pediatric patients and parents. We elucidate steps that providers can take to enhance transplant referral and provide suggestions for much needed research within this area. PMID:24438194

  2. Improving the effectiveness of electronic health record-based referral processes.

    PubMed

    Esquivel, Adol; Sittig, Dean F; Murphy, Daniel R; Singh, Hardeep

    2012-09-13

    Electronic health records are increasingly being used to facilitate referral communication in the outpatient setting. However, despite support by technology, referral communication between primary care providers and specialists is often unsatisfactory and is unable to eliminate care delays. This may be in part due to lack of attention to how information and communication technology fits within the social environment of health care. Making electronic referral communication effective requires a multifaceted "socio-technical" approach. Using an 8-dimensional socio-technical model for health information technology as a framework, we describe ten recommendations that represent good clinical practices to design, develop, implement, improve, and monitor electronic referral communication in the outpatient setting. These recommendations were developed on the basis of our previous work, current literature, sound clinical practice, and a systems-based approach to understanding and implementing health information technology solutions. Recommendations are relevant to system designers, practicing clinicians, and other stakeholders considering use of electronic health records to support referral communication.

  3. The start of the transplant journey: referral for pediatric solid organ transplantation.

    PubMed

    Shellmer, Diana; Brosig, Cheryl; Wray, Jo

    2014-03-01

    The focus of the majority of the psychosocial transplant literature is on post-transplant outcomes, but the transplant journey starts much earlier than this, at the point when transplantation is first considered and a referral for transplant evaluation is made. In this review, we cover information regarding the meaning of the referral process for solid organ transplantation. We discuss various factors of the referral for transplantation including the impact of referral on the pediatric patient and the family, potential expectations and misconceptions held by pediatric patients and parents, the role of health literacy, decision-making factors, and the informational needs of pediatric patients and parents. We elucidate steps that providers can take to enhance transplant referral and provide suggestions for much needed research within this area.

  4. Predictors of responses to psychotherapy referral of WTC utility disaster workers.

    PubMed

    Jayasinghe, Nimali; Giosan, Cezar; Difede, Joann; Spielman, Lisa; Robin, Lisa

    2006-04-01

    This study examined male utility disaster workers' responses to referral for trauma-specific psychotherapy. Among 328 workers offered referral for symptoms related to the World Trade Center (WTC) attacks during psychological screening, approximately 48% chose to accept, 28% chose to consider only, and 24% chose to decline. Analyses examined predisposing factors, i.e., age, race/ethnicity, marital status, education, previous mental health treatment, and previous disorder; as well as illness level; i.e., posttraumatic stress disorder (PTSD), depression, and general psychiatric distress; current treatment; and time of referral as predictors of referral response. PTSD (specifically reexperiencing and hyperarousal symptoms), depressive symptoms, and previous mental health treatment were positively associated with workers' accepting referral. Implications and limitations of these findings are discussed.

  5. Emergency contraception

    MedlinePlus

    Morning-after pill; Postcoital contraception; Birth control - emergency; Plan B; Family planning - emergency contraception ... Emergency contraception most likely prevents pregnancy in the same way as regular birth control pills: By preventing or delaying ...

  6. Emergency Contraception

    MedlinePlus

    ... contraception are available: emergency contraceptive pills and the copper-containing intrauterine device (IUD).Emergency contraceptive pills include ... for emergency use, talk to your doctor.The copper-containing IUD (brand name: Paragard) is a small, ...

  7. Statistical analysis of referrals by general practitioner at Health Insurance Organization clinics in Alexandria.

    PubMed

    Abdel Wahab, Moataza M; Nofal, Laila M; Guirguis, Wafaa W; Mahdy, Nehad H

    2004-01-01

    Referral of patients generates significant economic costs for both physician fees and diagnostic tests. Variation in referral rates between general practices and between individual GPs has long been the focus of attention for policy makers. The present study aimed to analyze the referrals by General Practitioners (GP) at Health Insurance Organization (HIO) clinics in Alexandria. The study was conducted at 18 Health Insurance Organization (HIO) comprehensive clinics in Alexandria, distributed in the 6 districts of Alexandria HIO. Retrospective analysis of records and cross sectional interview to 180 GPs were carried out. Male GPs comprised 82.2% of the sample. On the average, GPs received 6.6 +/- 4.5 patients per working hour. Over the year 2002, 8.4% of consultations were referred to specialists, 5.4% referred to laboratory and only 0.09% were referred to hospital. The highest percent of referrals from GP to specialist were directed to internal medicine followed by orthopedics, general surgery, E.N.T, dermatology, neuropsychiatry, chest then urology clinics. Referral rate from GPs to specialists was found to have a 6.6-fold variation among clinics, and a 54.8-fold variation among individual GPs. Moreover, there was no homogeneity in variations in referral rates of clinics within 3 of the 6 districts. Using multiple regression analysis, the only significant factor was the indirect relation with workload. Comparison of referral rates of GPs with the limits set by HIO (8-17%) revealed that, 48.9% of GPs were within limits, 37.2% were lower and 13.9% were higher than limits. GPs who had diploma or master were average referrers in 51.5%, low referrers in 30.3% and high referrers in 18.2%, compared to 45.6%, 50.6% and only 3.8%, respectively for those with bachelor degree; the difference was statistically significant.

  8. Treatment and referral patterns for psoriasis in United Kingdom primary care: a retrospective cohort study

    PubMed Central

    2013-01-01

    Background In the UK, referrals to specialists are initiated by general practitioners (GPs). Study objectives were to estimate the incidence of diagnosed psoriasis in the UK and identify factors associated with GP referrals to dermatologists. Methods Newly diagnosed patients with psoriasis were identified in The Health Improvement Network (THIN) database between 01 July 2007-31 Oct 2009. Incidence of diagnosed psoriasis was calculated using the number of new psoriasis patients in 2008 and the mid-year total patient count for THIN in 2008. A nested case–control design and conditional logistic regression were used to identify factors associated with referral. Results Incidence rate of diagnosed adult psoriasis in 2008 was 28/10,000 person-years. Referral rate to dermatologists was 18.1 (17.3-18.9) per 100 person-years. In the referred cohort (N=1,950), 61% were referred within 30 days of diagnosis and their median time to referral was 0 days from diagnosis. For those referred after 30 days (39%, median time to referral: 5.6 months), an increase in the number of GP visits prior to referral increased the likelihood of referral (OR=1.87 95% CI:1.73-2.01). A prescription of topical agents such as vitamin D3 analogues 30 days before referral increased the likelihood of being referred (OR=4.67 95% CI: 2.78-7.84), as did corticosteroids (OR=2.45 95% CI: 1.45-4.07) and tar products (OR=1.95 95% CI: 1.02-3.75). Conclusions Estimates of the incidence of diagnosed adult psoriasis, referral rates to dermatologists, and characteristics of referred patients may assist in understanding the burden on the UK healthcare system and managing this population in primary and secondary care. PMID:23957883

  9. SCREENING, ASSESSMENT, AND REFERRAL PRACTICES IN ADULT CORRECTIONAL SETTINGS

    PubMed Central

    TAXMAN, FAYE S.; CROPSEY, KAREN L.; YOUNG, DOUGLAS W.; WEXLER, HARRY

    2008-01-01

    The use of screening and assessment tools to gauge substance abuse disorders and the risk for recidivism are two widely recommended practices. A national survey of adult prisons, jails, and community correctional agencies was conducted to examine the practices used to place offenders in appropriate treatment services. Study findings indicate that 58.2% of the surveyed respondents report the use of a standardized substance abuse-screening tool, and that 34.2% use an actuarial risk tool. The provision of higher intensity treatment programs, the use of standardized risk tools, and the provision of more community referral services were all independently associated with the use of a standardized substance abuse-screening tool. Because practices vary considerably, agencies desiring to improve correctional programming should consider different dissemination, implementation, and technology transfer strategies. PMID:18458758

  10. Ammons quick test validity among randomly selected referrals.

    PubMed

    Zagar, Robert John; Kovach, Joseph W; Busch, Kenneth G; Zablocki, Michael D; Osnowitz, William; Neuhengen, Jonas; Liu, Yutong; Zagar, Agata Karolina

    2013-12-01

    After selection using a random number table, from volunteer referrals, 89 Youth (61 boys, 28 girls; 48 African Americans, 2 Asian Americans, 27 Euro-Americans, 12 Hispanic Americans), and 147 Adults (107 men, 40 women; 11 African Americans, 6 Asian Americans, 124 Euro-Americans, 6 Hispanic Americans) were administered the Ammons Quick Test (QT). Means, confidence intervals, standard deviations, and Pearson product-moment correlations among tests were computed. The Ammons QT was moderately to strongly and significantly correlated statistically with: the Peabody Picture Vocabulary Test-3b (PPVT-3b); the Vineland Adaptive Behavior Scales-2 Parent/Teacher Form; the Wechsler Intelligence Scale for Children (WISC-4) or the Wechsler Adult Intelligence Scale (WAIS-4); and the Wide Range Achievement Test-Fourth Edition (WRAT-4) Blue and Green Forms. After 51 years, the original norms for the Ammons QT remain valid measures of receptive vocabulary, verbal intelligence, and auditory information processing useful to clinicians.

  11. ECRS (extra-contractual referrals). Mind the gaps.

    PubMed

    Johnstone, P; Grice, D

    1995-08-10

    METHOD. Buckinghamshire HA's ECR account budget sheet was reviewed for a five-month period from April 1993, to identify adult mental health patients who were residents. Children under 16 and patients with physical disabilities were excluded from the study. All local consultant psychiatrists who either referred the patients or were responsible for their care were interviewed by a public health doctor, using a structured questionnaire. Basic demographic details, diagnoses, details of the ECR request, reasons for referral, current care needs and future patient plans were analysed for patients known by their consultants. RESULTS. Thirty-two patients were identified from the ECR account sheet. Twenty-eight patients were known by a local consultant and included in the analysis. Of the outstanding four patients (14 per cent), one had returned to their local provider unit but was still being invoiced as an ECR patient, and three were long-term chronically ill patients referred before ECRs were introduced.

  12. Pediatric Chiropractic Care: The Subluxation Question And Referral Risk.

    PubMed

    Homola, Samuel

    2016-02-01

    Chiropractors commonly treat children for a variety of ailments by manipulating the spine to correct a 'vertebral subluxation' or a 'vertebral subluxation complex' alleged to be a cause of disease. Such treatment might begin soon after a child is born. Both major American chiropractic associations - the International Chiropractic Association and the American Chiropractic Association - support chiropractic care for children, which includes subluxation correction as a treatment or preventive measure. I do not know of any credible evidence to support chiropractic subluxation theory. Any attempt to manipulate the immature, cartilaginous spine of a neonate or a small child to correct a putative chiropractic subluxation should be regarded as dangerous and unnecessary. Referral of a child to a chiropractor for such treatment should not be considered lest a bad outcome harms the child or leads to a charge of negligence or malpractice.

  13. Psychiatric referrals during peace and wartimes: a Nigerian experience.

    PubMed

    Okulate, Gbenga T

    2005-07-01

    Using a questionnaire administered by us, we sought to investigate the differences between patients referred to the psychiatric department of a Nigerian military general hospital during peacetime and those referred during the civil war in Liberia in which Nigerian soldiers were involved as peacekeepers. Referrals to psychiatry in peacetime were quite few but increased considerably during the period of combat in direct relation to the increase in the number of surgical wounded in action cases. Organic mental disorders and anxiety disorders were more frequently referred in peacetime than in war, whereas substance abuse disorders were more frequent during the combat period. Non-psychotic psychiatric conditions were less referred in the wartime group, partly because of nonrecognition at the mission areas and also because of recovery in front-line areas or consideration of their evacuation as a nonpriority. Mental health workers engaged at the mission areas require more training in the identification of such cases.

  14. Expert Consensus for Discharge Referral Decisions Using Online Delphi

    PubMed Central

    Bowles, Kathy H.; Holmes, John H.; Naylor, Mary D.; Liberatore, Matthew; Nydick, Robert

    2003-01-01

    This paper describes the results of using a modified Delphi approach designed to achieve consensus from eight discharge planning experts regarding the decision to refer hospitalized older adults for post-discharge follow-up. Experts reviewed 150 cases using an online website designed to facilitate their interaction and efforts to reach agreement on the need for a referral for post-discharge care and the appropriate site for such care. In contrast to an average of eight weeks to complete just 50 cases using the traditional mail method, the first online Delphi round for 150 cases were completed in six weeks. Data provided by experts suggest that online Delphi is a time efficient and acceptable methodology for reaching group consensus. Other benefits include instant access to Delphi decision results, live knowledge of the time requirements and progress of each expert, and cost savings in postage, paper, copying, and storage of paper documents. This online Delphi methodology is highly recommended. PMID:14728143

  15. Relating therapy for people who hear voices: perspectives from clients, family members, referrers and therapists.

    PubMed

    Hayward, Mark; Fuller, Ella

    2010-01-01

    Current psychological models of voice hearing emphasise the personal meaning that individuals attribute to the voice hearing experience. Recent developments in theory and research have highlighted the importance of the relationship between the hearer and the voice. This study aims to contribute to this area of research, by exploring the experience and usefulness of a new form of 'Relating Therapy' that aims to modify distressing relationships with voices. Semi-structured interviews were conducted with ten participants and explored the experience and usefulness of a pilot of Relating Therapy: three therapists, three voice hearers, two relatives and two referrers. Interviews were transcribed and analysed using Interpretative Phenomenological Analysis. Three themes that emerged from the analysis are presented for discussion: engaging with the therapeutic model; developing a new relating style; and how change is described and defined by participants. This study is consistent with the growing body of theory and research that highlights the interpersonal nature of the voice hearing experience. It also offers tentative support for a therapeutic framework that aims to modify distressing relationships with voices as a means of bringing about positive change. Clinical implications and areas for future research are outlined. 

  16. Relationship between the Social and Demographic Characteristics of Post-Sentence Offenders and the Outcomes of Forensic Psychiatric Referrals.

    ERIC Educational Resources Information Center

    Prandoni, Jogues R.

    1984-01-01

    Examined differences between offenders (N=240) by referral source, completion of referral, and recommendation for further services. The most substantial relationship was between source and outcome of referral, with probationers referred by probation officers more likely to be recommended for mental health services. (JAC)

  17. Parents with Learning Disabilities and Speech and Language Therapy. A Service Evaluation of Referrals and Episodes of Care

    ERIC Educational Resources Information Center

    Stansfield, Jois

    2012-01-01

    The speech and language therapy (SLT) service in an area of northern England receives referrals of parents who have learning disabilities. The aim of this study was to identify current referral patterns and quantify the level of demand upon the SLT service from this relatively new referral population to enable to service to meet the needs of these…

  18. Partner referral as a component of integrated sexually transmitted disease services in two Rwandan towns.

    PubMed Central

    Steen, R; Soliman, C; Bucyana, S; Dallabetta, G

    1996-01-01

    OBJECTIVE: To document partner referral rates at health centres with improved STD services, and to determine factors contributing to successful referral. METHODS: Partner referral was initiated as part of the upgrading of STD services in primary care health facilities in two semi-urban Rwanda towns. After syndromic management of the presenting complaint, index patients received prevention education and condom demonstration, and were urged to refer sexual partners to the health centre for a free examination. Partner referral coupons linked by code number to the symptomatic index patient were given to facilitate referral; no identifying information was collected on partners from the index patients. RESULTS: Three quarters of the symptomatic patients seen at the two primary health care facilities were women. Overall, the ratio of referred partners to index patients was 26%. Only 58% of index patients accepted partner referral coupons. The referral rate for those who did accept coupons was 45%. Partner referral worked best for regular partners. Most index patients and partners were married and only four index patients referred more than one partner. Women index patients, especially when pregnant, were more successful in referring partners than men. Index patients who referred partners tended to be older than those who did not. Awareness of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of partner referral. CONCLUSIONS: Efforts to improve rates of partner referral should begin at the clinic level with improved counselling to convince more index patients of the importance of partner referral. Partner symptom recognition may be useful for increasing rates of partner referral. Supplementary strategies are needed to reach non-regular partners. When syndromic management is used, counselling should take into account the lower predictive

  19. Mother and newborn survival according to point of entry and type of human resources in a maternal referral system in Kayes (Mali)

    PubMed Central

    2011-01-01

    Background Since 2001, a referral system has been operating in Kayes (Mali) to reduce maternal and perinatal deaths. Normal deliveries are managed in community health centers (CHC). Complicated cases are referred to a district health center (DHC) or the regional hospital (RH). Women with obstetric emergencies can directly access the DHC and the RH. Objective To assess, in women presenting with an obstetric complication: 1) the effects of the point of entry into the referral system on joint mother-newborn survival; and 2) the effects of the configuration of healthcare team at the CHCs on joint mother-newborn survival. Method Cross-sectional study of 7,214 women users of the referral system in the region of Kayes in 2006-2009. Bivariate probit equations were fitted to estimate joint mother-newborn survival. The marginal effects of the point of entry into the referral system and of the configuration of the healthcare team at the CHCs were evaluated with a probit bivariate regression. Results Entering the referral system at the RH was associated with the best joint mother-newborn survival; the most qualified the CHCs team was, the best was mother-newborn survival. Distance traveled interacts with the point of entry and the configuration of the CHCs team. For women coming from far (over 50 km), going directly to the RH increased the probability of joint mother-newborn survival by 11.90% (p < 0.001) as compared with entry at the CHC. Entry at the CHC while coming from a distance of less than 5 km increased the likelihood of joint survival by 8.50% (p < 0.001). Among women who go first to a CHC, physician presence increased joint mother-newborn survival, compared with having no physician and fewer than three professionals. The size of the healthcare team at the CHC is significantly associated with mother-newborn survival only when distance traveled is 5 km or less. Conclusion Mother-newborn survival in the Kayes maternal referral system is influenced by combined effects

  20. Suicidality and hospitalization as cause and outcome of pediatric psychiatric emergency room visits.

    PubMed

    Grudnikoff, Eugene; Soto, Erin Callahan; Frederickson, Anne; Birnbaum, Michael L; Saito, Ema; Dicker, Robert; Kane, John M; Correll, Christoph U

    2015-07-01

    The aim of this study was to identify predictors of suicidality in youth presenting to a pediatric psychiatric emergency room service (PPERS). To this end, we conducted a retrospective cohort study of youth aged <18 years consecutively assessed by a PPERS 01.01.2002-12.31.2002, using a 12-page semi-structured institutional evaluation form and the Columbia Classification Algorithm for Suicide Assessment. Multivariate regression analyses were conducted to identify correlates of suicidal thoughts and attempts/preparation and their relationship to outpatient/inpatient disposition. Of 1,062 youth, 265 (25.0%) presented with suicidal ideation (16.2%) or attempt/preparation (8.8%). Suicidal ideation was associated with female sex, depression, adjustment disorder, absent referral by family/friend/self, school referral, precipitant of peer conflict, and no antipsychotic treatment (p < 0.0001). Suicidal attempt/preparation was associated with female sex, depression, lower GAF score, past suicide attempt, precipitant of peer conflict, and no stimulant treatment (p < 0.0001). Compared to suicidal attempt/preparation, suicidal ideation was associated with school referral, and higher GAF score (p < 0.0001). Of the 265 patients with suicidality, 58.5% were discharged home (ideation = 72.1% vs. attempt/preparation = 33.7%, p < 0.0001). In patients with suicidal ideation, outpatient disposition was associated with higher GAF score, school referral, and adjustment disorder (p < 0.0001). In patients with suicidal attempt/preparation, outpatient disposition was associated with higher GAF score, lower acuity rating, and school referral (p < 0.0001). Suicidality is common among PPERS evaluations. Higher GAF score and school referral distinguished suicidal ideation from suicidal attempt/preparation and was associated with outpatient disposition in both presentations. Increased education of referral sources and establishment of different non-PPERS evaluation systems may improve

  1. WISDOM GPR subsurface investigations in the Atacama desert during the SAFER rover operation simulation

    NASA Astrophysics Data System (ADS)

    Dorizon, Sophie; Ciarletti, Valérie; Vieau, André-Jean; Plettemeier, Dirk; Benedix, Wolf-Stefan; Mütze, Marco; Hassen-Kodja, Rafik; Humeau, Olivier

    2014-05-01

    SAFER (Sample Acquisition Field Experiment with a Rover) is a field trial that occured from 7th to 13th October 2013 in the Atacama desert, Chile. This trial was designed to gather together scientists and engineers in a context of a real spatial mission with a rover. This is ESA's opportunity to validate operations procedures for the ExoMars 2018 mission, since a rover, provided by Astrium, was equipped with three ExoMars payload instruments, namely the WISDOM (Water Ice Subsurface Deposits Observations on Mars) Ground Penetrating Radar, PANCAM (Panoramic Camera) and CLUPI (Close-UP Imager), and was used to experiment the real context of a Martian rover mission. The test site was located close to the Paranal ESO's Observatory (European Southern Observatorys) while the operations were conducted in the Satellite Applications Catapult remote Center in Harwell, UK. The location was chosen for its well-known resemblance with Mars' surface and its arid dryness. To provide the best from this trial, geologists, engineers and instrumentation scientists teams collaborated by processing and analyzing the data, planning in real time the next trajectories for the Bridget rover, as well as the sites of interest for WISDOM subsurface investigations. This WISDOM GPR has been designed to define the geological context of the ExoMars 2018 landing site by characterizing the shallow subsurface in terms of electromagnetic properties and structures. It will allow to lead the drill to locations of potential exobiologocal interest. WISDOM is a polarimetric step frequency radar operating from 0.5GHz to 3GHz, which allows a vertical resolution of a few centimeters over a few meters depth. Provided with a DEM (Digital Elevation Model) and a low-resolution map to assist the team with the rover's operations, several soudings with WISDOM were done over the area. The WISDOM data allowed, in collaboration with the SCISCYS team, to map the electromagnetic contrasts into the subsurface underneath

  2. Nursing and midwife staffing needs in maternity wards in Burkina Faso referral hospitals

    PubMed Central

    2014-01-01

    Background In 2006, Burkina Faso set up a policy to subsidize the cost of obstetric and neonatal emergency care. This policy has undoubtedly increased attendance at all levels of the health pyramid. The aim of this study was to measure the capacity of referral hospitals’ maternity services to cope with the demand for health services after the implementation of this policy. Methods This study was conducted in three referral health centres (CMAs, CHRs, and CHUs). The CHU Yalgado Ouédraogo (tertiary level) and the CMA in Sector 30 (primary level) were selected as health facilities in the capital, along with the Kaya CHR (secondary level). At each health facility, the study included official maternity ward staff only. We combined the two occupational categories (nurses and midwives) because they perform the same activities in these health facilities. We used the WISN method recommended by WHO to assess the availability of nurses and midwives. Results Nurses and midwives represented 38% of staff at the University Hospital, 65% in the CHR and 80% in the CMA. The number of nurses and midwives needed for carrying out the activities in the maternity ward in the University Hospital and the CMA is greater than the current workforce, with WISN ratio of 0.68 and 0.79 respectively. In the CHR, the current workforce is greater than the number required (WISN ratio = 2). This medical centre is known for performing a high number curative and preventive activities compared to the Kaya CHR. Like the CHU, the delivery room is a very busy unit. This activity requires more time and more staff compared to other activities. Conclusion This study showed a shortage of nurses and midwives in two health facilities in Ouagadougou, which confirms that there is considerable demand. At the Kaya CHR, there is currently enough staff to handle the workload in the maternity ward, which may indicate a need to expand the analysis to other health facilities to determine whether a redistribution of

  3. Racial and ethnic differences in reported criminal justice referral at treatment admission.

    PubMed

    Arfken, Cynthia L; Said, Manal; Owens, Darlene

    2012-01-01

    In the U.S. and elsewhere, the criminal justice system is a frequent referral source for substance abuse treatment admission. To expand and improve pathways to treatment, outreach efforts need additional information about different demographic groups. Locally, clinicians observed racial and ethnic differences between minority groups in self-identifying criminal justice as the referral sources for admission. To test this clinical observation, reported criminal justice referral was examined by race/ethnicity and gender in multiple years of both national and local treatment admissions. Confirming the clinical observations, racial/ethnic referral source by gender systematically differed across years nationally (p < .001) and in an examination of verbatim recorded presenting problems locally (p < .001). African Americans and Puerto Ricans were less likely to have criminal justice referral sources than the White reference group, whereas American Indians, Arab Americans, Asian Americans, and other Hispanic ethnicities were more likely to have criminal justice referral sources. Racial/ethnic groups systematically differed in reported criminal justice involvement, suggesting hypotheses potentially impacting clinical treatment and outreach. Published primary referral sources may underestimate criminal justice involvement in treatment admissions.

  4. Referral decisions of teachers and school psychologists for twice-exceptional students

    NASA Astrophysics Data System (ADS)

    Hoffman, Jennifer Marie

    The accurate and timely referral and identification of twice-exceptional students remains a challenge. In a statewide study, the referral decisions for both special education and gifted programming evaluations made by four participant groups (i.e., general education teachers, special education teachers, gifted education teachers, and school psychologists) were compared. Participants were randomly assigned to read one of three identically described students in a vignette that differed only in the presence of a diagnostic label--- autism spectrum disorder (ASD), specific learning disability (SLD), or no diagnostic label. In all, special education teachers made the most special education referrals, while gifted education teachers made the most gifted programming referrals, both regardless of the diagnostic label present. The students with diagnostic labels were recommended for special education referrals significantly more than for gifted programming, while this difference was not evident in the no diagnostic label condition. Moreover, the student with the ASD label was the most likely to be referred for evaluations for both special education and gifted programming out of all three vignette conditions. Overall findings indicated the importance of considering the referral source as well as how the presence of a diagnostic label might influence educational referral decisions, particularly in how this might influence overall multidisciplinary team decisions for these unique learners.

  5. First quality score for referral letters in gastroenterology—a validation study

    PubMed Central

    Eskeland, Sigrun Losada; Brunborg, Cathrine; Seip, Birgitte; Wiencke, Kristine; Hovde, Øistein; Owen, Tanja; Skogestad, Erik; Huppertz-Hauss, Gert; Halvorsen, Fred-Arne; Garborg, Kjetil; Aabakken, Lars; de Lange, Thomas

    2016-01-01

    Objective To create and validate an objective and reliable score to assess referral quality in gastroenterology. Design An observational multicentre study. Setting and participants 25 gastroenterologists participated in selecting variables for a Thirty Point Score (TPS) for quality assessment of referrals to gastroenterology specialist healthcare for 9 common indications. From May to September 2014, 7 hospitals from the South-Eastern Norway Regional Health Authority participated in collecting and scoring 327 referrals to a gastroenterologist. Main outcome measure Correlation between the TPS and a visual analogue scale (VAS) for referral quality. Results The 327 referrals had an average TPS of 13.2 (range 1–25) and an average VAS of 4.7 (range 0.2–9.5). The reliability of the score was excellent, with an intra-rater intraclass correlation coefficient (ICC) of 0.87 and inter-rater ICC of 0.91. The overall correlation between the TPS and the VAS was moderate (r=0.42), and ranged from fair to substantial for the various indications. Mean agreement was good (ICC=0.47, 95% CI (0.34 to 0.57)), ranging from poor to good. Conclusions The TPS is reliable, objective and shows good agreement with the subjective VAS. The score may be a useful tool for assessing referral quality in gastroenterology, particularly important when evaluating the effect of interventions to improve referral quality. PMID:27855107

  6. Improving referrals for tilt table testing in patients with transient loss of consciousness

    PubMed Central

    Thornton, Luke; Rahunathan, Nithusa; Verma, Narain; Wong, Kenneth

    2016-01-01

    Tilt table testing has been used for over twenty years in the investigation of patients with transient loss of consciousness. The European Society of Cardiology (ESC) recently recommended new guidance regarding indications for tilt table testing. We conducted an educational intervention and produced a new referral proforma that referring clinicians are expected to fill in for all patients referred for tilt table testing. At baseline, 76% (n=84) of referrals for tilt table testing were made in accordance to ESC guidance. Following a simple educational intervention, 100% (n=6) were in line with ESC guidance. After the introduction of the referral proforma, 92% (n=12) of referrals followed ESC guidance. At final data collection, 100% (n=11) of referrals followed ESC guidance. In conclusion, a simple educational intervention and the use of a referral proforma in this quality improvement project have made a sustained difference in improving the appropriateness of referrals for tilt table testing. This has the potential to optimise the efficient use of resources and improve patient care through avoiding unnecessary investigation. PMID:27096093

  7. Phosphoryl-rich flame-retardant ions (FRIONs): towards safer lithium-ion batteries.

    PubMed

    Rectenwald, Michael F; Gaffen, Joshua R; Rheingold, Arnold L; Morgan, Alexander B; Protasiewicz, John D

    2014-04-14

    The functionalized catecholate, tetraethyl (2,3-dihydroxy-1,4-phenylene)bis(phosphonate) (H2 -DPC), has been used to prepare a series of lithium salts Li[B(DPC)(oxalato)], Li[B(DPC)2], Li[B(DPC)F2], and Li[P(DPC)3]. The phosphoryl-rich character of these anions was designed to impart flame-retardant properties for their use as potential flame-retardant ions (FRIONs), additives, or replacements for other lithium salts for safer lithium-ion batteries. The new materials were fully characterized, and the single-crystal structures of Li[B(DPC)(oxalato)] and Li[P(DPC)3] have been determined. Thermogravimetric analysis of the four lithium salts show that they are thermally stable up to around 200 °C. Pyrolysis combustion flow calorimetry reveals that these salts produce high char yields upon combustion.

  8. SWOT analysis for safer carriage of bulk liquid chemicals in tankers.

    PubMed

    Arslan, Ozcan; Er, Ismail Deha

    2008-06-15

    The application of strengths, weaknesses, opportunities and threats (SWOT) analysis to formulation of strategy concerned with the safe carriage of bulk liquid chemicals in maritime tankers was examined in this study. A qualitative investigation using SWOT analysis has been implemented successfully for ships that are designed to carry liquid chemicals in bulk. The originality of this study lies in the use of SWOT analysis as a management tool to formulate strategic action plans for ship management companies, ship masters and officers for the carriage of dangerous goods in bulk. With this transportation-based SWOT analysis, efforts were made to explore the ways and means of converting possible threats into opportunities, and changing weaknesses into strengths; and strategic plans of action were developed for safer tanker operation.

  9. Goneis.gr: Training Greek Parents on ICT and Safer Internet

    NASA Astrophysics Data System (ADS)

    Manouselis, Nikos; Riviou, Katerina; Palavitsinis, Nikos; Giannikopoulou, Vasiliki; Tsanakas, Panayotis

    Children's use of the Internet has significantly risen in the last decade. Nevertheless, children spend a lot of time online which makes them susceptible to various threats (such as inappropriate material, offensive language, etc). Parents are the last frontier to this menace but they also need to be educated and trained in order to protect their children. Goneis.gr is an initiative launched by the Greek government that aims to educate parents on safer Internet and the use of parental control software. Parents are also entitled to distance learning courses covering basic computer skills. This paper presents the results of two separate surveys that took place in the last few months (December 2008-January 2009). The first survey targeted the parents that have completed the programme and the second one the educational providers that participate in the programme and offer the training to the beneficiaries.

  10. A Highly Thermostable Ceramic-Grafted Microporous Polyethylene Separator for Safer Lithium-Ion Batteries.

    PubMed

    Zhu, Xiaoming; Jiang, Xiaoyu; Ai, Xinping; Yang, Hanxi; Cao, Yuliang

    2015-11-04

    The safety concern is a critical obstacle to large-scale energy storage applications of lithium-ion batteries. A thermostable separator is one of the most effective means to construct the safe lithium-ion batteries. Herein, we demonstrate a novel ceramic (SiO2)-grafted PE separator prepared by electron beam irradiation. The separator shows similar thickness and pore structure to the bare separator, while displaying strong dimensional thermostability, as the shrinkage ratio is only 20% even at an elevated temperature of 180 °C. Besides, the separator is highly electrochemically inert, showing no adverse effect on the energy and power output of the batteries. Considering the excellent electrochemical and thermal stability, the SiO2-grafted PE separator developed in this work is greatly beneficial for constructing safer lithium-ion batteries.

  11. Safer sex knowledge, behavior, and attitudes of inner-city women.

    PubMed

    Hobfoll, S E; Jackson, A P; Lavin, J; Britton, P J; Shepherd, J B

    1993-11-01

    Sexual behavior, knowledge of HIV transmission and prevention, perceived risk of AIDS, and safer sex behavior were studied in a sample of 289 single, pregnant, inner-city women. African-American and European-American women were equally represented. Women had poor AIDS knowledge. Sexual behavior placed women at risk for HIV infection due to the lack of condom or spermicide use. Women did not perceive themselves at risk for the AIDS virus, although they did recognize that heterosexuals were at risk. Their lack of risk perception was partly based on their having a single sexual partner. They did not regard their partner's current or past behavior as placing them at risk. Recommendations for intervention and cultural differences were discussed.

  12. Special Aviation Fire and Explosion Reduction (SAFER) Advisory Committee. Volume IIB.

    DTIC Science & Technology

    1980-06-26

    teA -i ot L, 4 ;i’I ttEldan(-ci ar Lhe meetcing. 4)f -hese, fU ric A M. Aer.~ ir’ ’ ~ r: ner~~!-.the SAFER \\Ndvisorv C oun Ie e.. n1ii t, ag ree d...2 r’i! O I Ifl td 1. N d i;-*issi oi !! C~ie tea -. ’ i tv of short -term, rule rn ’- 1. .tl ra!r of 10ong’-ternl 1Lbjt-(t1Ve.-, 1o be SLni!i:,e. e...determined by the time-to-incapacitation of the albino rat inside a motor-driven, rotating cage. The combustion tube furnace should be charged with a

  13. Developing a Safer Conception Intervention for Men Living with HIV in South Africa.

    PubMed

    Khidir, Hazar; Psaros, Christina; Greener, Letitia; O'Neil, Kasey; Mathenjwa, Mxolisi; Mosery, F N; Moore, Lizzie; Harrison, Abigail; Bangsberg, David R; Smit, Jennifer A; Safren, Steven A; Matthews, Lynn T

    2017-02-13

    Within sexual partnerships, men make many decisions about sexual behavior, reproductive goals, and HIV prevention. There are increasing calls to involve men in reproductive health and HIV prevention. This paper describes the process of creating and evaluating the acceptability of a safer conception intervention for men living with HIV who want to have children with partners at risk for acquiring HIV in KwaZulu-Natal, South Africa. Based on formative work conducted with men and women living with HIV, their partners, and providers, we developed an intervention based on principles of cognitive-behavioral therapy to support men in the adoption of HIV risk-reduction behaviors such as HIV-serostatus disclosure and uptake of and adherence to antiretroviral therapy. Structured group discussions were used to explore intervention acceptability and feasibility. Our work demonstrates that men are eager for reproductive health services, but face unique barriers to accessing them.

  14. Adherence patterns to National Comprehensive Cancer Network (NCCN) guidelines for referral to cancer genetic professionals

    PubMed Central

    Febbraro, Terri; Robison, Katina; Wilbur, Jennifer Scalia; Laprise, Jessica; Bregar, Amy; Lopes, Vrishali; Legare, Robert; Stuckey, Ashley

    2016-01-01

    Objective Genetic predisposition is responsible for 5–10% of breast cancer, 10% of ovarian cancer and 2–5% of uterine cancer. The study objective was to compare genetic counseling and testing referral rates among women with breast cancer that met NCCN referral guidelines to the referral rates among women with gynecologic cancers and determine predictors of referral. Methods Utilizing an institutional tumor registry database, patients from an academic women's oncology program were identified who met a subset of NCCN guidelines for genetic referral between 2004 and 2010. Patients diagnosed with ovarian cancer, breast cancer ≤50 years of age, or uterine cancer <50 years of age were included. A retrospective electronic chart review was conducted to evaluate for a genetic referral and uptake of genetic testing. Results 820 women were included (216 uterine, 314 breast, and 290 ovarian cancer). The overall genetic referral rate was 21.7%. 34% of eligible breast cancer patients were referred compared to 13.4% of uterine cancer and 14.5% ofovarian cancer patients (p < 0.0001). Younger age, breast cancer diagnosis, family history and earlier stage were all significant referral predictors. The odds of being referred increased with the number of affected family members. 70.8% of referred patients, consulted with genetics. Among those who consulted with genetics, 95.2% underwent testing. Conclusions Although increasing, genetic counseling remains underutilized across cancer diagnosis. Women with breast cancer are more likely to be referred than women with gynecologic cancers. Younger age, earlier stage and positive family history appear to be predictive of referral for genetic evaluation. PMID:25933682

  15. Summary of the proceedings of the international forum 2016: "Imaging referral guidelines and clinical decision support - how can radiologists implement imaging referral guidelines in clinical routine?"

    PubMed

    2017-02-01

    The International Forum is held once a year by the ESR and its international radiological partner societies with the aim to address and discuss selected subjects of global relevance in radiology. In 2016, the issue of implementing imaging referral guidelines in clinical routine was analysed. The legal environment in the USA requires that after January 1, 2017, physicians must consult government-approved, evidence-based appropriate-use criteria through a clinical decision support system when ordering advanced diagnostic imaging exams. The ESR and the National Decision Support Company are developing "ESR iGuide", a clinical decision support system for European imaging referral guidelines using ESR imaging referral guidelines based on ACR Appropriateness Criteria. In many regions of the world, the situation is different and quite diverse, depending on the specific features of health care systems in different countries, but there are, unlike in the USA and EU, no legal obligations to implement imaging referral guidelines into the clinical practice. Imaging referral guidelines and clinical decision support implementation is a complex issue everywhere and the legal environment surrounding it even more so; how they will be implemented into the clinical practice in different areas of the world needs yet to be decided.

  16. Infectious disease emergencies in primary care.

    PubMed

    Kwitkowski, V E; Demko, S G

    1999-01-01

    Infectious disease emergencies can be described as infectious processes that, if not recognized and treated immediately, can lead to significant morbidity or mortality. These emergencies can present as common or benign infections, fooling the primary care provider into using more conservative treatment strategies than are required. This review discusses the pathophysiology, history and physical findings, diagnostic criteria, and treatment strategies for the following infectious disease emergencies: acute bacterial meningitis, ehrlichiosis, Rocky Mountain spotted fever, meningococcemia, necrotizing soft tissue infections, toxic shock syndrome, food-borne illnesses, and infective endocarditis. Because most of the discussed infectious disease emergencies require hospital care, the primary care clinician must be able to judge when a referral to a specialist or a higher-level care facility is indicated.

  17. Think Stoma Nurse: a tool to trigger referral to specialist care.

    PubMed

    Hanley, Judy; Adams, Jane

    This article describes the initial development and subsequent evolution of a simple referral assessment tool for stoma care. The first author's personal experience identified that there was widespread inconsistency in perceptions of local multidisciplinary teams as to when it was appropriate to refer to specific specialist nursing teams. This resulted in both inappropriate and delayed referrals. A 'Think Specialist Nurse' initiative was developed across the author's trust, building on the traffic light template from the 'ThinkGlucose' tool, to facilitate referrals to clinical nurse specialists. The stoma-care specific tool, 'Think Stoma Nurse', has subsequently evolved beyond its initial audience, and has been adapted into materials aimed at patients and carers.

  18. Cost-effectiveness analysis of timely dialysis referral after renal transplant failure in Spain

    PubMed Central

    2012-01-01

    Background A cost-effectiveness analysis of timely dialysis referral after renal transplant failure was undertaken from the perspective of the Public Administration. The current Spanish situation, where all the patients undergoing graft function loss are referred back to dialysis in a late manner, was compared to an ideal scenario where all the patients are timely referred. Methods A Markov model was developed in which six health states were defined: hemodialysis, peritoneal dialysis, kidney transplantation, late referral hemodialysis, late referral peritoneal dialysis and death. The model carried out a simulation of the progression of renal disease for a hypothetical cohort of 1,000 patients aged 40, who were observed in a lifetime temporal horizon of 45 years. In depth sensitivity analyses were performed in order to ensure the robustness of the results obtained. Results Considering a discount rate of 3 %, timely referral showed an incremental cost of 211 €, compared to late referral. This cost increase was however a consequence of the incremental survival observed. The incremental effectiveness was 0.0087 quality-adjusted life years (QALY). When comparing both scenarios, an incremental cost-effectiveness ratio of 24,390 €/QALY was obtained, meaning that timely dialysis referral might be an efficient alternative if a willingness-to-pay threshold of 45,000 €/QALY is considered. This result proved to be independent of the proportion of late referral patients observed. The acceptance probability of timely referral was 61.90 %, while late referral was acceptable in 38.10 % of the simulations. If we however restrict the analysis to those situations not involving any loss of effectiveness, the acceptance probability of timely referral was 70.10 %, increasing twofold that of late referral (29.90 %). Conclusions Timely dialysis referral after graft function loss might be an efficient alternative in Spain, improving both patients’ survival rates and

  19. Osprey Biotechnics, Inc. in Sarasota, Fla. Among 21 Partners to be Recognized for Creating and Using Safer Choice Products / June 22 is the first annual awards ceremony for 2015 Safer Choice Partner of the Year Award Winners

    EPA Pesticide Factsheets

    ATLANTA - The U.S. Environmental Protection Agency (EPA) is announcing that Osprey Biotechnics, Inc. in Sarasota, Fla. is among 21 Safer Choice Partner of the Year winners across 15 states. The awards are for outstanding achievement in the design, ma

  20. Pre-referral rectal artesunate in severe malaria: flawed trial

    PubMed Central

    2011-01-01

    Background Immediate injectable treatment is essential for severe malaria. Otherwise, the afflicted risk lifelong impairment or death. In rural areas of Africa and Asia, appropriate care is often miles away. In 2009, Melba Gomes and her colleagues published the findings of a randomized, placebo-controlled trial of rectal artesunate for suspected severe malaria in such remote areas. Enrolling nearly 18,000 cases, the aim was to evaluate whether, as patients were in transit to a health facility, a pre-referral artesunate suppository blocked disease progression sufficiently to reduce these risks. The affirmative findings of this, the only trial on the issue thus far, have led the WHO to endorse rectal artesunate as a pre-referral treatment for severe malaria. In the light of its public health importance and because its scientific quality has not been assessed for a systematic review, our paper provides a detailed evaluation of the design, conduct, analysis, reporting, and practical features of this trial. Results We performed a checklist-based and an in-depth evaluation of the trial. The evaluation criteria were based on the CONSORT statement for reporting clinical trials, the clinical trial methodology literature, and practice in malaria research. Our main findings are: The inclusion and exclusion criteria and the sample size justification are not stated. Many clearly ineligible subjects were enrolled. The training of the recruiters does not appear to have been satisfactory. There was excessive between center heterogeneity in design and conduct. Outcome evaluation schedule was not defined, and in practice, became too wide. Large gaps in the collection of key data were evident. Primary endpoints were inconsistently utilized and reported; an overall analysis of the outcomes was not done; analyses of time to event data had major flaws; the stated intent-to-treat analysis excluded a third of the randomized subjects; the design-indicated stratified or multi

  1. A Randomised Controlled Trial Using Mobile Advertising to Promote Safer Sex and Sun Safety to Young People

    ERIC Educational Resources Information Center

    Gold, J.; Aitken, C. K.; Dixon, H. G.; Lim, M. S. C.; Gouillou, M.; Spelman, T.; Wakefield, M.; Hellard, M. E.

    2011-01-01

    Mobile phone text messages (SMS) are a promising method of health promotion, but a simple and low cost way to obtain phone numbers is required to reach a wide population. We conducted a randomised controlled trial with simultaneous brief interventions to (i) evaluate effectiveness of messages related to safer sex and sun safety and (ii) pilot the…

  2. Does Motivational Interviewing Counseling Time Influence HIV-Positive Persons’ Self-Efficacy to Practice Safer Sex?

    PubMed Central

    Chariyeva, Zulfiya; Golin, Carol E.; Earp, Jo Anne; Suchindran, Chirayath

    2013-01-01

    Objective This study examined the impact of motivational interviewing (MI) counseling time on self-efficacy to practice safer sex for people living with HIV/AIDS (PLWHA). Methods In 4 month intervals we followed a cohort of 490 PLWHA for 12 months. We conducted hierarchical linear regression models to examine changes in safer sex self-efficacy when participants received zero, low to moderate (5–131 minutes) and high (132–320 minutes) doses of MI time. We conducted a similar analysis using number of counseling sessions as the predictor variable. Results Participants with low to moderate doses of MI counseling had 0.26 higher self-efficacy scores than participants with zero MI time (p=0.01). Also, they had 0.26 lower self-efficacy scores than participants with high amounts of MI time (p=0.04). Participants with high doses of MI had a 0.5 higher self-efficacy score than participants with zero amount of MI time (p<0.0001). Participants who received 3–4 counseling sessions had 0.41 greater self-efficacy scores than participants who did not receive any sessions (p<0.0001) but did not differ from participants receiving 1–2 sessions. Conclusion MI time is a key to enhancing safer sex self-efficacy among PLWHA. Practice Implications Safer sex self-efficacy improves the more MI counseling time and sessions PLWHA receive. PMID:21890300

  3. Preliminary Findings from a Brief, Peer-Led Safer Sex Intervention for College Students Living in Residence Halls

    ERIC Educational Resources Information Center

    O'Grady, Megan A.; Wilson, Kristina; Harman, Jennifer J.

    2009-01-01

    The purpose of this study was to evaluate a single-session peer-led safer sex intervention, based on the Information-Motivation-Behavioral Skills theoretical model, for college students residing in campus residence halls. Participants (N = 108) were assigned to either an hour long control or 5-module intervention session. Compared to the control…

  4. Women's autonomy in negotiating safer sex to prevent HIV: findings from the 2011 Nepal Demographic and Health Survey.

    PubMed

    Atteraya, Madhu Sudhan; Kimm, Heejin; Song, In Han

    2014-02-01

    Women with greater autonomy have higher HIV-related knowledge and condom use. Inability to negotiate safer sex in high-risk situations might increase HIV infection. This study examined the relationship between women's autonomy and ability to negotiate safer sex practices among married women. The 2011 Nepal Demographic and Health Survey data were used. The data were collected by two-stage stratified cluster sampling and face-to-face interviews. Autonomy was measured in Decision-Making Participation and Assets Ownership, while ability to negotiate safer sex consists of Refusal of Sex and Ask for Condom Use. Among 12,674 women of 15-49 years, married women were analyzed (n = 8,896). Women with greater autonomy in decision-making participation were more likely to negotiate safer sex. After controlling for socio-demographic factors, odds ratios (OR) for refusal of sex was 2.70 (95% CI [2.14, 3.40]) in women with the highest decision-making participation. These women showed higher OR for 'ask for condom use' in high risk situations (2.10, 95% CI [1.81, 2.44]). Assets ownership also demonstrated a positive statistical relationship with asking for a condom use (OR 1.31, 95% CI [1.10, 1.56]). The results point to the importance of women's autonomy on sexual health. It emphasizes women's empowerment-based approach to curbing HIV/AIDS in developing countries.

  5. Effects of a Televised Two-City Safer Sex Mass Media Campaign Targeting High-Sensation-Seeking and Impulsive-Decision-Making Young Adults

    ERIC Educational Resources Information Center

    Zimmerman, Rick S.; Palmgreen, Philip M.; Noar, Seth M.; Lustria, Mia Liza A.; Lu, Hung-Yi; Horosewski, Mary Lee

    2007-01-01

    This study evaluates the ability of a safer sex televised public service announcement (PSA) campaign to increase safer sexual behavior among at-risk young adults. Independent, monthly random samples of 100 individuals were surveyed in each city for 21 months as part of an interrupted-time-series design with a control community. The 3-month…

  6. Primary thrombophilia in Mexico: a single tertiary referral hospital experience.

    PubMed

    Lacayo-Leñero, Dennis; Hernández-Hernández, Darinel; Valencia-Martínez, Andrés; Barrales-Benítez, Olga; Vargas-Ruiz, Angel G

    2016-12-01

    Thrombophilia is a complex hypercoagulable state that increases the risk of thrombosis. Most reports in medical literature of the Mexican population with this disease lack statistical validity. Therefore, the aim of this study is to describe the prevalence of primary thrombophilia in a tertiary referral hospital in Mexico. This is a study of patients referred to our hospital because of a hypercoagulable state and who later on were diagnosed with primary thrombophilia. The thrombophilia workup included methylenetetrahydrofolate reductase (MTHFR) C677T, antiphospholipid antibodies, protein C, protein S, antithrombin, factor VIII, factor V Leiden, prothrombin mutation G20210A, activated protein C resistance, JAK2 V617F and homocysteine. Ninety-five individuals were tested. The MTHFR C677T polymorphism was the most frequent anomaly in 84.1% of the tested individuals. There was a relatively low prevalence of factor V Leiden (5.2%) and anticoagulant protein deficiency (8.3%). The MTHFR C677T polymorphism has a very high prevalence compared with the low prevalence of anticoagulant protein deficiency and factor V Leiden mutation in Mexicans.

  7. Psychotic symptoms in young people warrant urgent referral.

    PubMed

    Deakin, Julia; Lennox, Belinda

    2013-03-01

    There is a worse prognosis for psychosis and schizophrenia when onset is in childhood or adolescence. However, outcomes are improved with early detection and treatment. Psychotic symptoms can be associated with a variety of disorders including schizophrenia, schizoaffective disorder, drug-induced psychosis, personality disorder, epilepsy and autistic spectrum disorder. Positive symptoms include hallucinations and delusions. Negative symptoms include apathy, lack of drive, poverty of speech, social withdrawal and self-neglect. The DSM IV criteria for schizophrenia include two or more of the following: hallucinations, delusions, disorganised speech, grossly disorganised or catatonic behaviour and negative symptoms. Adults may raise concerns about social withdrawal, bizarre ideas, a change in behaviour or a decline in achievement. Most children and young people with psychotic symptoms will not go on to develop psychosis or schizophrenia. Direct enquiry may be needed to elicit suspected unusual beliefs or hallucinations. To distinguish unusual ideas from delusions the ideas should be tested for fixity. For example by asking: 'Are you sure? Could there be another explanation?' Mood and anxiety symptoms should be explored. The assessment should include a developmental history with particular attention to premorbid functioning. Failure to make expected progress whether personal, social or academic is significant. Better outcomes in terms of symptoms and social function are associated with a shorter duration of untreated psychosis. The detection of psychotic symptoms in primary care therefore warrants an urgent referral to secondary care mental health services for assessment and treatment.

  8. Thermal referral: evidence for a thermoceptive uniformity illusion without touch

    PubMed Central

    Cataldo, Antonio; Ferrè, Elisa Raffaella; di Pellegrino, Giuseppe; Haggard, Patrick

    2016-01-01

    When warm thermal stimulators are placed on the ring and index fingers of one hand, and a neutral-temperature stimulator on the middle finger, all three fingers feel warm. This illusion is known as thermal referral (TR). On one interpretation, the heterogenous thermal signals are overridden by homogenous tactile signals. This cross-modal thermo-tactile interaction could reflect a process of object recognition, based on the prior that many objects are thermally homogenous. Interestingly, the illusion was reported to disappear when the middle digit was lifted off the thermal stimulator, suggesting that tactile stimulation is necessary. However, no study has investigated whether purely thermal stimulation might induce TR, without any tactile object to which temperature can be attributed. We used radiant thermal stimulation to deliver purely thermal stimuli, which either were or were not accompanied by simultaneous touch. We found identical TR effects in both the original thermo-tactile condition, and in a purely thermoceptive condition where no tactile object was present. Control experiments ruled out explanations based on poor spatial discrimination of warm signals. Our purely thermoceptive results suggest that TR could reflect low-level organization of the thermoceptive pathway, rather than a cognitive intermodal modulation based on tactile object perception. PMID:27775034

  9. Overview: referrals for genetic evaluation from child psychiatrists.

    PubMed

    Press, Katharine R; Wieczorek, Laura; Hoover-Fong, Julie; Bodurtha, Joann; Taylor, Lynn

    2016-01-01

    A growing multitude of known genetic diagnoses can result in presentation to child psychiatry. For numerous reasons, it is important to identify a genetic etiology in child psychiatry patients when it is present. Genetic diagnoses can guide treatment and enable access to specialized clinics and appropriate screening measures. They can also allow for genetic counseling for the patient and family. A better understanding of etiology with a named diagnosis can itself be of great value to many patients and families; prognostic information can be empowering. Since patients with genetic conditions may present to psychiatric care in diverse ways, child psychiatrists must decide who to refer for genetic evaluation. Here we create a table to provide a framework of concerning/notable history and exam features that a practicing child psychiatrist may encounter that should prompt one to consider whether a larger, unifying genetic diagnosis is at hand. We hope this framework will facilitate referral of child psychiatry patients to genetics so that more patients can benefit from an appropriate diagnosis.

  10. Triaging referrals as part of hematology/oncology fellowship training.

    PubMed

    Kyei, Mark; Lavelle, Ellen; Kyasa, Jameel; Safar, Mazin; Makhoul, Issam; Mehta, Paulette

    2010-09-01

    We developed an integrative component of the consult rotation for fellows training in hematology/oncology. This component consisted of triaging all consults to the hematology/oncology service of the CAVHS during a 1-year period of time. The goals of the rotation were to improve timeliness of response to consultation requests, to gain experience in differential diagnosis of patients with potential hematologic/oncologic disorders through of such patients, review of decisions with attending physicians, and communication of such with the referring physician. The major benefits were that fellows integrated didactic learning into real-life clinical cases, selected patients for their continuity clinic to assure sufficient variety and complexity of cases, honed their communication skills, learned about referring and attending physicians' styles, and gained practice in clinical vignettes representative of cases they would be expected to see in clinical practice. Disadvantages were time involvement (approximately 2 h/day) and risks of over- or under-referrals. Administratively, there was a significant decline in the wait time for patients to be seen in the hematology/oncology service. In all, this elective is a valuable integrative experience of senior fellows, but may have less value for first year fellows.

  11. Genetic counselling in a national referral centre for pulmonary hypertension.

    PubMed

    Girerd, Barbara; Montani, David; Jaïs, Xavier; Eyries, Mélanie; Yaici, Azzedine; Sztrymf, Benjamin; Savale, Laurent; Parent, Florence; Coulet, Florence; Godinas, Laurent; Lau, Edmund M; Tamura, Yuichi; Sitbon, Olivier; Soubrier, Florent; Simonneau, Gérald; Humbert, Marc

    2016-02-01

    Genetic causes of pulmonary arterial hypertension (PAH) and pulmonary veno-occlusive disease (PVOD) have been identified, leading to a growing need for genetic counselling.Between 2003 and 2014, genetic counselling was offered to 529 PAH and 100 PVOD patients at the French Referral Centre for Pulmonary Hypertension.Mutations in PAH-predisposing genes were identified in 72 patients presenting as sporadic PAH (17% of cases; 62 mutations in BMPR2, nine in ACVRL1 (ALK1) and one in ENG) and in 94 patients with a PAH family history (89% of cases; 89 mutations in BMPR2, three in ACVRL1 (ALK1) and two in KCNK3). Bi-allelic mutations in EIF2AK4 were identified in all patients with a family history of PVOD (n=19) and in seven patients (8.6%) presenting as sporadic PVOD. Pre-symptomatic genetic diagnosis was offered to 272 relatives of heritable PAH patients, identifying mutations in 36.4% of them. A screening programme is now offered to asymptomatic mutation carriers to detect PAH in an early phase and to identify predictors of outcomes in asymptomatic BMPR2 mutation carriers. BMPR2 screening allowed us to offer pre-implantation diagnosis to two couples with a BMPR2 mutation.Genetic counselling can be implemented in pulmonary hypertension centres.

  12. Epidemic keratoconjunctivitis outbreak at a tertiary referral eye care clinic.

    PubMed

    Montessori, V; Scharf, S; Holland, S; Werker, D H; Roberts, F J; Bryce, E

    1998-08-01

    An outbreak of epidemic keratoconjunctivitis (EKC) occurred at a tertiary referral eye care clinic between late September and mid-November 1995. Before the outbreak, instruments were cleaned with 70% isopropyl alcohol and handwashing between patients was not routine. Infection control measures were implemented when the outbreak was recognized in mid-October. Control measures included triaging suspected cases to a separate waiting area, cohorting cases to a specific examining room, endorsing the use of gloves and handwashing during examinations of patients, and cleaning instruments with a buffered bleach solution. Thirty-six cases were diagnosed before the infection control measures were taken, and 3 cases were seen after the control measures were taken. Also, numerous secondary cases occurred in the community. No additional cases were diagnosed from DEcember to February 25, 1996. Acquisition of the infection was linked to visits to 4 of 20 physicians in the eye clinic with 61% of cases associated with visits to 1 of those 4 physicians. The use of diagnostic lenses applied directly to the eye was associated with infection (odds ratio = 2.83, 95% confidence interval = 0.79 to 10.4), although this did not reach statistical significance. The use of tonometers, ophthalmic solutions, or laser therapy was not associated with infection, and all environmental cultures were negative. This outbreak emphasizes the need for implementation of routine infection control guidelines to prevent nosocomial transmission of epidemic keratoconjunctivitis and stresses the need for appropriate disinfection of instruments.

  13. Community perceptions of childbearing and use of safer conception strategies among HIV-discordant couples in Kisumu, Kenya

    PubMed Central

    Breitnauer, Brooke T; Mmeje, Okeoma; Njoroge, Betty; Darbes, Lynae A; Leddy, Anna; Brown, Joelle

    2015-01-01

    Introduction Safer conception strategies (SCS) have the potential to decrease HIV transmission among HIV-discordant couples who desire children. Community perceptions of SCS may influence the scale-up and uptake of these services, but little is known about how communities will react to these strategies. Without community support for SCS, their success as an HIV prevention tool may be limited. The objective of this study is to characterize community perceptions of SCS for HIV-discordant couples in Kisumu, Kenya, to inform ongoing and future safer conception intervention studies in low-resource settings. Methods We conducted six focus group discussions and 11 in-depth-interviews in Kisumu, Kenya, among a diverse group (N=59) of community members, including men, women, youth (age 19–25), community health workers and local leaders. An iterative qualitative analysis using a grounded theory approach was employed. Results and discussion All participants emphasized the importance of childbearing in their society and the right to have children, regardless of an individual's HIV status. While most participants believed that HIV-discordant couples should be allowed to have children, they discussed several barriers to the uptake of SCS such as HIV-related stigma, fear of HIV transmission to the uninfected partner and child, fear of unfamiliar medical procedures and lack of information among community members and health care providers about HIV prevention interventions that allow safer conception. Access to information, community experiences with successful safer conception interventions, healthcare provider training, male engagement and community mobilization may help overcome these barriers. Though assisted reproduction strategies generated the most negative reactions from participants, our results suggest that with education and explanation of these services, participants express interest in these strategies and want them to be offered in their community. Conclusions Many

  14. The Theory and Application of Information and Referral Systems in the University of Maryland Residence Halls

    ERIC Educational Resources Information Center

    Thoman, Cherie; Moore, Jerry E.

    1977-01-01

    This resource system consists of eight information and referral centers each housing a resource instrument (binders and flip chart), an operator, outreach staff, one mobile instrument, a systematic updating system and an evaluation system. (Author/DOW)

  15. 20 CFR 416.941 - Establishment and use of referral and monitoring agencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Alcoholism § 416.941 Establishment and use of referral and monitoring agencies. We will contract with one or... whose disabilities are based on a determination that drug addiction or alcoholism is a...

  16. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... period from October 16, 2003 through March 16, 2009: (1) Retail pharmacy drug referral certification and... standards identified in paragraph (a) of this section; and (2)(i) Retail pharmacy drugs....

  17. 45 CFR 162.1302 - Standards for referral certification and authorization transaction.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... period from October 16, 2003 through March 16, 2009: (1) Retail pharmacy drug referral certification and... standards identified in paragraph (a) of this section; and (2)(i) Retail pharmacy drugs....

  18. Referrals and Treatment Completion for Prescription Opioid Admissions: Five Years of National Data

    PubMed Central

    St Marie, Barbara; Sahker, Ethan; Arndt, Stephan

    2016-01-01

    This study examines sources of referral for prescription opioid admission to substance use disorder treatment facilities and their relative completion success rates using secondary analysis of an existing data set (Treatment Episode Datasets – Discharge). Five years of data from public and private treatment facilities were extracted for client discharges with no prior treatment (N = 2,909,884). Healthcare professionals account for very few referrals to treatment (<10%). Prescription opioid clients referred into treatment had lower treatment success compared to other substance clients and when referred by healthcare providers had lower success rates (OR = 0.72, 95% CI 0.70 – 0.75) than clients from other referral sources. Fewer treatment referrals for prescription opioid misuse by healthcare providers and lower success rates are significant and timely findings due to the prevalence of prescription opioid misuse. Healthcare providers are well positioned to refer early for prescription opioid misuse and continue support of their patients during treatment. PMID:26362002

  19. Blending Administrative and Clinical Needs: The Development of a Referring Physician Database and Automatic Referral Letter

    PubMed Central

    Roberts, Mark S.; Dreese, Elizabeth M.; Hurley, Noreen; Zullo, Nan; Peterson, Mark

    1991-01-01

    The development of a system to collect and verify the name of a patient's referring physician and link that to the automatic production of a referral letter and discharge summary is described. PMID:1807664

  20. The practice of imaging self-referral doesn't produce much one-stop service.

    PubMed

    Sunshine, Jonathan; Bhargavan, Mythreyi

    2010-12-01

    Imaging as a result of self-referral-when a physician refers patients for imaging tests at a facility owned or leased by the same physician-is widespread. The practice has come under much scrutiny because it is associated with higher volumes of imaging services. Proponents of such self-referral argue that the practice offers patients convenient same-day, one-stop service and allows treatment to start sooner. Our analysis of 2006 and 2007 Medicare data showed that self-referral provided same-day imaging for 74 percent of straightforward x-rays, but for only 15 percent of more-advanced procedures such as computed tomography and magnetic resonance imaging. Policy makers attempting to make the use of imaging more responsible should consider narrowing Medicare's special provision allowing referrals to a physician's own practice so that the provision covers x-rays only.

  1. Determinants of referral practices of clients by traditional birth attendants in Ilorin, Nigeria.

    PubMed

    Abodunrin, O L; Akande, T M; Musa, I O; Aderibigbe, S A

    2010-06-01

    A sizeable number of deliveries still take place with the assistance of Traditional Birth Attendants in Nigeria. This study aims to determine the factors that determine the referral practices of the TBAs in Ilorin of high risk and complicated pregnancies. This descriptive study was conducted among all the 162 registered TBAs in Ilorin that were traceable using pre-tested semi-structured interviewer-administered questionnaire. About 90%, whose source of skill acquisition was by inheritance did not refer their clients appropriately compared with 48% of those whose source of skill acquisition was through formal training (p<0.05). The more the numbers of trainings, the more appropriate the referral (p<0.05). Having supervisory visit by qualified personnel is associated with appropriate referral practices (p<0.05). Regular training and re-training of TBAs with routine monitoring and supportive supervision will promote prompt referral of high risk and complicated pregnancies and deliveries.

  2. Emergency Contraception

    MedlinePlus

    ... against STDs even when using another method of birth control. If a condom breaks (or a couple has ... Emergency contraception is not recommended as a regular birth control method . Instead, it is used for emergencies only. ...

  3. Emergency Contraception

    MedlinePlus

    f AQ FREQUENTLY ASKED QUESTIONS FAQ114 CONTRACEPTION Emergency Contraception • What is emergency contraception (EC)? • How does EC work? • What are the different types of EC? • What is the most ...

  4. Past Emergencies

    EPA Pesticide Factsheets

    These activities, some of national significance requiring coordination with other agencies, demonstrate the emergency response program and provide valuable experience so that EPA can better prevent, prepare for, and respond to emergencies in the future.

  5. Timing of Hospice Referral: Assessing Satisfaction While the Patient Receives Hospice Services.

    PubMed

    Adams, Carolyn E; Bader, Julia; Horn, Kathryn V

    2009-02-01

    Generally, satisfaction with timing of hospice referral was measured in mortality follow back surveys of patients who died in hospice. In contrast in this study, investigators assessed timing of the hospice referral in patients/families enrolled in hospice for a minimum of two weeks. About 1/3 of patients/families identified it would have been easier if they started hospice earlier. Barriers to early hospice access were associated primarily with access to the healthcare system.

  6. Primary-to-secondary care referral experience of suspected colorectal malignancy in young adults

    PubMed Central

    Patel, K; Doulias, T; Hoad, T; Lee, C; Alberts, JC

    2016-01-01

    Introduction Colorectal cancer in patients younger than 50 years of age is increasing steadily in the UK with limited guidelines available indicating need for secondary care referral. The aims of this study were to report the cancer incidence in those aged under 50 years referred to secondary care with suspected colorectal malignancy and also to analyse the quality of those referrals. Methods A total of 197 primary care referrals made between 2008 and 2014 to a UK district general hospital for suspected colorectal malignancy were analysed. All confirmed cancers were further evaluated regarding presenting symptoms, tumour characteristics and clinical outcomes. Each referral was given a referral performance score (out of 9) dependant on relevant information documented. Results The overall malignancy rate was 9.1% (11 male and 7 female patients). The median age in this cohort was 41.5 years (interquartile range [IQR]: 37–49 years). Abdominal pain was the only presenting symptom to differ significantly when comparing malignant with non-malignant patients (44.4% vs 21.8% respectively, p=0.042). The median time period between referral date and colorectal specialist consultation was 11 days (IQR: 7–13 days) and the median referral performance score was 5 (range: 3–9). Conclusions Malignancy is prevalent in patients under 50 years of age who are referred to secondary care for suspected colorectal cancer. Those referred with abdominal pain in the presence of other high risk lower gastrointestinal symptoms are at significant risk of having a malignancy. Major deficiencies are apparent in urgent primary care referrals, highlighting the need for further national guidance to aid early diagnosis of colorectal cancer in the young. PMID:27023637

  7. Emergent Expertise?

    ERIC Educational Resources Information Center

    McGivern, Patrick

    2014-01-01

    The concept of emergence appears in various places within the literature on expertise and expert practice. Here, I examine some of these applications of emergence in the light of two prominent accounts of emergence from the philosophy of science and philosophy of mind. I evaluate these accounts with respect to several specific contexts in which…

  8. Characteristics of patients with diabetes who accept referrals for care management services

    PubMed Central

    Holtz, Bree; Annis, Ann M; Morrish, Wendy; Davis Burns, Jennifer; Krein, Sarah L

    2016-01-01

    Introduction: Patients with chronic conditions can improve their health through participation in self-care programs. However, awareness of and enrollment in these programs are generally low. Objective: We sought to identify factors influencing patients’ receptiveness to a referral for programs and services supporting chronic disease management. Methods: We analyzed data from 541 high-risk diabetic patients who completed an assessment between 2010 and 2013 from a computer-based, nurse-led Navigator referral program within a large primary care clinic. We compared patients who accepted a referral to those who declined. Results: A total of 318 patients (75%) accepted 583 referrals, of which 52% were for self-care programs. Patients who accepted a referral had more primary care visits in the previous year, were more likely to be enrolled in another program, expressed more interest in using the phone and family or friends for support, and were more likely to report recent pain than those who declined a referral. Discussion: Understanding what factors influence patients’ decisions to consider and participate in self-care programs has important implications for program design and development of strategies to connect patients to programs. This work informs outreach efforts to identify and engage patients who are likely to benefit from self-care activities. PMID:26835018

  9. A technician-delivered 'virtual clinic' for triaging low-risk glaucoma referrals.

    PubMed

    Kotecha, A; Brookes, J; Foster, P J

    2017-02-17

    PurposeThe purpose of this study is to describe the outcomes of a technician-delivered glaucoma referral triaging service with 'virtual review' of resultant data by a consultant ophthalmologist.Patients and methodsThe Glaucoma Screening Clinic reviewed new optometrist or GP-initiated glaucoma suspect referrals into a specialist ophthalmic hospital. Patients underwent testing by three ophthalmic technicians in a dedicated clinical facility. Data were reviewed at a different time and date by a consultant glaucoma ophthalmologist. Approximately 10% of discharged patients were reviewed in a face-to-face consultant-led clinic to examine the false-negative rate of the service.ResultsBetween 1 March 2014 and 31 March 2016, 1380 patients were seen in the clinic. The number of patients discharged following consultant virtual review was 855 (62%). The positive predictive value of onward referrals was 84%. Three of the 82 patients brought back for face-to-face review were deemed to require treatment, equating to negative predictive value of 96%.ConclusionsOur technician-delivered glaucoma referral triaging clinic incorporates consultant 'virtual review' to provide a service model that significantly reduces the number of onward referrals into the glaucoma outpatient department. This model may be an alternative to departments where there are difficulties in implementing optometrist-led community-based referral refinement schemes.Eye advance online publication, 17 February 2017; doi:10.1038/eye.2017.9.

  10. Surgical referral criteria for degenerative rotator cuff tears: a Delphi questionnaire study.

    PubMed

    Griffiths, Stephanie; Yohannes, A M

    2014-06-01

    Selecting the most appropriate patients to refer for surgery is crucial for high-quality and efficient clinical care. However, there are no specific referral criteria to guide the referral of appropriate patients for rotator cuff repair surgery. The aim of the present study was to design robust surgical referral criteria for patients with degenerative rotator cuff tears using consensus methodology. A two-round Delphi questionnaire was undertaken with a nationally representative sample of 41 specialist shoulder surgeons experienced in rotator cuff repair. Surgical referral criteria for degenerative rotator cuff tear were developed where consensus of at least 70% agreement was achieved. The initial questionnaire consisted of 24 items. Consensus was reached on 14 items, including: severity of pain, functional limitation, the identification of fat atrophy, agreement that a course of physiotherapy should be attempted before surgical referral, and exclusion for those with an active frozen shoulder. However, there was no consensus with regard to the dimensions of the tear. The surgical referral criteria developed were novel and promising for patients with degenerative rotator cuff tears, and further research is required to examine their efficacy.

  11. Quality of caesarean delivery services and documentation in first-line referral facilities in Afghanistan: a chart review

    PubMed Central

    2012-01-01

    Background Increasing appropriate use and documentation of caesarean section (CS) has the potential to decrease maternal and perinatal mortality in settings with low CS rates. We analyzed data collected as part of a comprehensive needs assessment of emergency obstetric and newborn care (EmONC) facilities in Afghanistan to gain a greater understanding of the clinical indications, timeliness, and outcomes of CS deliveries. Methods Records were reviewed at 78 government health facilities expected to function as EmONC providers that were located in secure areas of the country. Information was collected on the three most recent CS deliveries in the preceding 12 months at facilities with at least one CS delivery in the preceding three months. After excluding 16 facilities with no recent CS deliveries, the sample includes 173 CS deliveries at 62 facilities. Results No CS deliveries were performed in the previous three months at 21% of facilities surveyed; all of these were lower-level facilities. Most CS deliveries (88%) were classified as emergencies, and only 12% were referrals from another facility. General anesthesia was used in 62% of cases, and spinal or epidural anesthesia in 34%. Only 28% of cases were managed with a partograph. Surgery began less than one hour after the decision for a CS delivery in just 30% of emergency cases. Among the 173 cases, 27 maternal deaths, 28 stillbirths, and 3 early neonatal deaths were documented. In cases of maternal and fetal death, the most common indications for CS delivery were placenta praevia or abruption and malpresentation. In 62% of maternal deaths, the fetus was stillborn or died shortly after birth. In 48% of stillbirths, the fetus had a normal heart rate at the last check. Information on partograph use was missing in 38% of cases, information on parity missing in 23% of cases and indications for cesareans missing in 9%. Conclusions Timely referral within and to EmONC facilities would decrease the proportion of CS

  12. Design and Implementation of a Physician Coaching Pilot to Promote Value-Based Referrals to Specialty Care

    PubMed Central

    Tuzzio, Leah; Ludman, Evette J; Chang, Eva; Palazzo, Lorella; Abbott, Travis; Wagner, Edward H; Reid, Robert J

    2017-01-01

    Introduction Referral rates to specialty care from primary care physicians vary widely. To address this variability, we developed and pilot tested a peer-to-peer coaching program for primary care physicians. Objectives To assess the feasibility and acceptability of the coaching program, which gave physicians access to their individual-level referral data, strategies, and a forum to discuss referral decisions. Methods The team designed the program using physician input and a synthesis of the literature on the determinants of referral. We conducted a single-arm observational pilot with eight physicians which made up four dyads, and conducted a qualitative evaluation. Results Primary reasons for making referrals were clinical uncertainty and patient request. Physicians perceived doctor-to-doctor dialogue enabled mutual learning and a pathway to return joy to the practice of primary care medicine. The program helped physicians become aware of their own referral data, reasons for making referrals, and new strategies to use in their practice. Time constraints caused by large workloads were cited as a barrier both to participating in the pilot and to practicing in ways that optimize referrals. Physicians reported that the program could be sustained and spread if time for mentoring conversations was provided and/or nonfinancial incentives or compensation was offered. Conclusion This physician mentoring program aimed at reducing specialty referral rates is feasible and acceptable in primary care settings. Increasing the appropriateness of referrals has the potential to provide patient-centered care, reduce costs for the system, and improve physician satisfaction. PMID:28368789

  13. Outcomes of Cataract Surgery at a Referral Center

    PubMed Central

    Mohammadi, Seyed-Farzad; Hashemi, Hassan; Mazouri, Arash; Rahman-A, Nazanin; Ashrafi, Elham; Mehrjardi, Hadi Z.; Roohipour, Ramak; Fotouhi, Akbar

    2015-01-01

    Purpose: To report the outcomes of cataract surgery at a large referral eye hospital and to identify factors associated with less than excellent visual outcomes. Methods: Hospital records of patients, who had undergone age-related cataract extraction (1,285 procedures) within a two-year period were sampled randomly for 353 patients (405 eyes) and baseline characteristics were recorded. Up to three causes of visual loss (contributory reasons) were considered and the principal cause of “less than excellent outcome,” i.e., best spectacle corrected visual acuity (BSCVA) <20/25 was defined as the primary reason. Results: Mean age of the participants was 68.6 years, and 50.7% of enrolled subjects were female. Phacoemulsification had been performed in 92.1% of cases. Out of 405 eyes, 54%, 78%, and 97% achieved BSCVA of ≥20/25, ≥20/40, and ≥20/200, respectively. Poor visual outcomes were significantly associated with older age (OR: 4.55 for age >70 years), female gender (OR: 4.64), ocular comorbidities (OR: 7.68), surgically challenging eyes (OR: 7.33), long and short eyes (versus eyes with normal axial length, OR: 3.24), and being operated on by a novice surgeon (OR: 2.41). The leading contributory reasons for unfavorable outcome, in descending order were maculopathy (17%), posterior capsule opacification (PCO, 11.8%), corneal opacity (5.7%), and degenerative myopia (5.4%). Conclusion: Maculopathy, PCO, corneal opacity, degenerative myopia and ARMD may contribute to unfavorable outcomes in cataract surgery. PMID:26730309

  14. Corneal Transplantation at an Ophthalmological Referral Center in Colombia: Indications and Techniques (2004-2011)

    PubMed Central

    Galvis, Virgilio; Tello, Alejandro; Gomez, Augusto José; Rangel, Carlos Mario; Prada, Angélica María; Camacho, Paul Anthony

    2013-01-01

    Purpose: To analize changing trends in indications and surgical techniques of corneal transplantation at an ophthalmological tertiary referral center in Colombia over a 7 year period. Methods: A retrospective analysis was performed of medical records from patients who underwent corneal transplantation surgeries at Fundación Oftalmológica de Santander (FOSCAL) in Bucaramanga, Colombia, between August 2004 and August 2011. Results: During this period from a total of 450 corneal transplants performed, we had access to 402 medical records (89.4%). The patients’ mean age was 55. Leading indications were: pseudophakic/aphakic bullous kerathopathy (PBK/ABK) (34.6%), corneal scar (15.7%), active infectious keratitis (14.4%) and keratoconus (12.7%). During the first period (2004-2007) PBK/ABK was the leading indication, followed by stromal opacities and keratoconus. During the second period (2008-2011) PBK/ABK remained the leading indication. Infectious keratitis, however, became the second most common indication. Stromal opacities and keratoconus, moved to third and fourth, respectively. All transplants performed in the first period (2004-2007) were penetrating keratoplasties. In the second period (2008-2011) 18.7% of the procedures were performed using the Descemet’s stripping automated endothelial keratoplasty technique (DSAEK). Conclusions: Similar to other international results, PBK/ABK was the leading indication for corneal transplantation at our institution. Keratoconus is becoming a less common indication for keratoplasty in our institution. Infectious keratitis remains a frequent indication for corneal transplantation in this geographical area. In our institution we started performing DSAEK in 2009, and it is emerging as the procedure of choice in corneal diseases that involve only the endothelial layers. PMID:23898357

  15. United States Directory of Sources, United States International Environmental Referral Center. National Focal Point of the United Nations Environment Program/International Referral System.

    ERIC Educational Resources Information Center

    Environmental Protection Agency, Washington, DC.

    The United Nations Environment Program (UNEP) was created in 1972. UNEP is an independent agency of the United Nations and has its headquarters in Nairobi, Kenya. In order to carry out its goals, several programs were created, one of which is the International Referral System (UNEP/IRS). The UNEP/IRS is composed of over 60 national and…

  16. Health Professionals' Perspectives on Exercise Referral and Physical Activity Promotion in Primary Care: Findings from a Process Evaluation of the National Exercise Referral Scheme in Wales

    ERIC Educational Resources Information Center

    Din, Nafees U.; Moore, Graham F.; Murphy, Simon; Wilkinson, Clare; Williams, Nefyn H.

    2015-01-01

    Background and objectives: Referring clinicians' experiences of exercise referral schemes (ERS) can provide valuable insights into their uptake. However, most qualitative studies focus on patient views only. This paper explores health professionals' perceptions of their role in promoting physical activity and experiences of a National Exercise…

  17. Development of a theory-guided pan-European computer-assisted safer sex intervention.

    PubMed

    Nöstlinger, Christiana; Borms, Ruth; Dec-Pietrowska, Joanna; Dias, Sonia; Rojas, Daniela; Platteau, Tom; Vanden Berghe, Wim; Kok, Gerjo

    2016-12-01

    HIV is a growing public health problem in Europe, with men-having-sex-with-men and migrants from endemic regions as the most affected key populations. More evidence on effective behavioral interventions to reduce sexual risk is needed. This article describes the systematic development of a theory-guided computer-assisted safer sex intervention, aiming at supporting people living with HIV in sexual risk reduction. We applied the Intervention Mapping (IM) protocol to develop this counseling intervention in the framework of a European multicenter study. We conducted a needs assessment guided by the information-motivation-behavioral (IMB) skills model, formulated change objectives and selected theory-based methods and practical strategies, i.e. interactive computer-assisted modules as supporting tools for provider-delivered counseling. Theoretical foundations were the IMB skills model, social cognitive theory and the transtheoretical model, complemented by dual process models of affective decision making to account for the specifics of sexual behavior. The counseling approach for delivering three individual sessions was tailored to participants' needs and contexts, adopting elements of motivational interviewing and cognitive-behavioral therapy. We implemented and evaluated the intervention using a randomized controlled trial combined with a process evaluation. IM provided a useful framework for developing a coherent intervention for heterogeneous target groups, which was feasible and effective across the culturally diverse settings. This article responds to the need for transparent descriptions of the development and content of evidence-based behavior change interventions as potential pillars of effective combination prevention strategies.

  18. Making licensed venues safer for patrons: what environmental factors should be the focus of interventions?

    PubMed

    Homel, Ross; Carvolth, Russell; Hauritz, Marge; McIlwain, Gillian; Teague, Rosie

    2004-03-01

    The Queensland Safety Action Projects operationalized a problem-focused responsive regulatory model in order to make nightclubs and other venues safer. A problem-focused approach requires a careful analysis of the total environment of licensed venues, including drinking and its controls but also the social and physical environments, patron mix and management practices. We present new analyses of observational data collected in 1994 and 1996 in the north Queensland cities of Cairns, Townsville and Mackay. Major reductions in aggression and violence were observed, as well as improvements in many aspects of the venue environment and management practices. We do not argue in this paper that the interventions caused the environmental and management changes, although we believe this to be true. Rather, our assumption is that whatever caused them, some of the environmental and management changes were critical to the reductions in aggression. Regression techniques were used to identify those factors that best explained the declines in aggression. For reduced physical violence four key predictors were identified: improved comfort, availability of public transport, less overt sexual activity and fewer highly drunk men. For reduced non-physical aggression, four key predictors were: fewer Pacific Islander patrons, less male swearing, fewer intoxicated patrons requiring that management be called and more chairs with armrests. The analyses are consistent with the argument that the control of drinking is necessary but not sufficient to reduce aggression and violence.

  19. Between '0' and '1': safer sex and condom use among young gay men in Hong Kong.

    PubMed

    Yeo, Tien Ee Dominic; Fung, Tsz Hin

    2016-01-01

    Young men who have sex with men are becoming the most at-risk subgroup for HIV incidence in Hong Kong. To understand how young gay men in Hong Kong interpret and implement safer sex and condom use, focus-group discussions and individual in-depth interviews were held. The 74 participants were nearly all ethnic Chinese gay men aged between 18 and 25 years. Findings indicate that the challenge for health intervention lies in young gay men's inconsistent condom use despite their high level of HIV-related knowledge. Participants described using condoms, testing for HIV and abstaining from anal sex as measures undertaken to prevent HIV infection. However, sociocultural norms and expectations pertaining to '0' (docile, bottom) and '1' (assertive, top) roles and trust between partners complicate the consistent implementation of risk-reduction measures. Influenced by heteronormative and romantic beliefs, sexual behaviours such as condomless anal sex and internal ejaculation hold symbolic meanings - exclusivity, commitment, intimacy, possession - for young gay men in Hong Kong, which override health concerns. These findings support more empowerment-driven HIV programming for young gay men.

  20. Heavy Sexual Content Versus Safer Sex Content: A Content Analysis of the Entertainment Education Drama Shuga.

    PubMed

    Booker, Nancy Achieng'; Miller, Ann Neville; Ngure, Peter

    2016-12-01

    Extremely popular with Kenyan youth, the entertainment-education drama Shuga was designed with specific goals of promoting condom use, single versus multiple sexual partners, and destigmatization of HIV. Almost as soon as it aired, however, it generated controversy due to its extensive sexual themes and relatively explicit portrayal of sexual issues. To determine how safer sex, antistigma messages, and overall sexual content were integrated into Shuga, we conducted a content analysis. Results indicated that condom use and HIV destigmatization messages were frequently and clearly communicated. Negative consequences for risky sexual behavior were communicated over the course of the entire series. Messages about multiple concurrent partnerships were not evident. In addition, in terms of scenes per hour of programming, Shuga had 10.3 times the amount of sexual content overall, 8.2 times the amount of sexual talk, 17.8 times the amount of sexual behavior, and 9.4 times the amount of sexual intercourse as found in previous analysis of U.S. entertainment programming. Research is needed to determine how these factors may interact to influence adolescent viewers of entertainment education dramas.