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Sample records for emergency referrals safer

  1. SAFER - Services and Applications For the Emergency Response: en route for a safer world with the GMES operational services

    NASA Astrophysics Data System (ADS)

    Denis, G.; Hello, D.

    2009-04-01

    In the frame of GMES, SAFER prepares the implementation of operational versions of the Emergency Response Core Service. SAFER is a large integrated project which has been selected by the European Commission (FP7 call GMES). SAFER will reinforce European capacity to respond to emergency situations: fires, floods, earthquakes, volcanic eruptions, landslides, humanitarian crisis. The main goal of SAFER is the upgrade of the service and the validation of its performance with 2 priorities: - First priority is the improvement of response when crisis occurs, with the rapid mapping capacity after disastrous events, including the relevant preparatory services. For validation purposes, the project will deliver services at full scale for real events or during exercises. The main performance criterion is the response time. - The second priority is the extension to core service components before and after the crisis. It targets the longer term service evolution, through the provision of thematic products, to be added in the portfolio of services. The main performance criterion is the added-value of products with risk-specific information. Coordinated by Infoterra, the consortium is built around a core team of European service providers. A wide network of scientific partners and service providers will extend the European dimension. The presentation will highlight: - The heritage and foundations. - The expected contribution to the implementation of the operational Emergency Response Core Service. - The key challenges to move from the research and development and project-driven logic to the sustainable operations. - The possible synergies with other services.

  2. Emerging Partnerships: Safer Communities, Transformed Offenders, Shared Educational Resources.

    ERIC Educational Resources Information Center

    Brockett, E. Anne; Gibbons, Virginia M.

    Applying the philosophy that strategic partnerships are the most effective way to share knowledge, skills, and resources, emerging community corrections adult education programs and existing community adult education service providers have begun to forge critical linkages. In Texas, the law now requires assessment of the educational level of all…

  3. Male involvement in birth preparedness and complication readiness for emergency obstetric referrals in rural Uganda

    PubMed Central

    2011-01-01

    Background Every pregnant woman faces risk of life-threatening obstetric complications. A birth-preparedness package promotes active preparation and assists in decision-making for healthcare seeking in case of such complications. The aim was to assess factors associated with birth preparedness and complication-readiness as well as the level of male participation in the birth plan among emergency obstetric referrals in rural Uganda. Methods This was a cross-sectional study conducted at Kabale regional hospital maternity ward among 140 women admitted as emergency obstetric referrals in antenatal, labor or the postpartum period. Data was collected on socio-demographics and birth preparedness and what roles spouses were involved in during developing the birth plan. Any woman who attended antenatal care at least 4 times, received health education on pregnancy and childbirth danger signs, saved money for emergencies, made a plan of where to deliver from and made preparations for a birth companion, was deemed as having made a birth plan. Multivariate logistic regression analysis was conducted to analyze factors that were independently associated with having a birth plan. Results The mean age was 26.8 ± 6.6 years, while mean age of the spouse was 32.8 ± 8.3 years. Over 100 (73.8%) women and 75 (55.2%) of their spouses had no formal education or only primary level of education respectively. On multivariable analysis, Primigravidae compared to multigravidae, OR 1.8 95%CI (1.0-3.0), education level of spouse of secondary or higher versus primary level or none, OR 3.8 95%CI (1.2-11.0), formal occupation versus informal occupation of spouse, OR 1.6 95%CI (1.1-2.5), presence of pregnancy complications OR 1.4 95%CI (1.1-2.0) and the anticipated mode of delivery of caesarean section versus vaginal delivery, OR 1.6 95%CI (1.0-2.4) were associated with having a birth plan. Conclusion Individual women, families and communities need to be empowered to contribute positively to making

  4. Understanding the Impact of Residents' Interpersonal Relationships During Emergency Department Referrals and Consultations

    PubMed Central

    Chan, Teresa; Sabir, Kameron; Sanhan, Sarila; Sherbino, Jonathan

    2013-01-01

    Background Communicating with colleagues is a key physician competency. Yet few studies have sought to uncover the complex nature of relationships between referring and consulting physicians, which may be affected by the inherent relationships between the participants. Objective Our study examines themes identified from discussions about communications and the role of relationships during the referral-consultation process. Methods From March to September 2010, 30 residents (10 emergency medicine, 10 general surgery, 10 internal medicine) were interviewed using a semistructured focus group protocol. Two investigators independently reviewed the transcripts using inductive methods and grounded theory to generate themes (using codes for ease of analysis) until saturation was reached. Disagreements were resolved by consensus, yielding an inventory of themes and subthemes. Measures for ensuring trustworthiness of the analysis included generating an audit trail and external auditing of the material by investigators not involved with the initial analysis. Results Two main relationship-related themes affected the referral-consultation process: familiarity and trust. Various subthemes were further delineated and studied in the context of pertinent literature. Conclusions Relationships between physicians have a powerful influence on the emergency department referral-consultation dynamic. The emergency department referral-consultation may be significantly altered by the familiarity and perceived trustworthiness of the referring and consulting physicians. Our proposed framework may further inform and improve instructional methods for teaching interpersonal communication. Most importantly, it may help junior learners understand inherent difficulties they may encounter during the referral process between emergency and consulting physicians. PMID:24455004

  5. 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

  6. 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

  7. Audit of referral of obstetric emergencies in Angola: a tool for assessing quality of care.

    PubMed

    Strand, R T; de Campos, P A; Paulsson, G; de Oliveira, J; Bergström, S

    2009-06-01

    By auditing various aspects of referrals of obstetric emergencies, we wanted to study the effectiveness over time of a recently established network of peripheral birth units and two central hospitals in Luanda. 157 women referred for obstetric emergencies were studied regarding clinical outcome and process indicators like waiting time, partogramme quality and Caesarean section rate (CSR). After a change in routines at hospital admission and further partogramme education 92 referred women were compared with the former. Maternal mortality decreased from 17.8% to nil in the second. Total mean waiting time was reduced from 13.7 hours to 1.2 hours. Partogramme quality was significantly improved. CSR increased from 13 to 30%. Prolonged labour was the most common diagnosis.This study demonstrates the importance of clinic-based audit to enhance quality of care regarding referrals of patients with obstetric emergencies. PMID:20690251

  8. 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

  9. 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

  10. MEDICATION HISTORY DOCUMENTATION IN REFERRAL LETTERS OF CHILDREN PRESENTING AT THE EMERGENCY UNIT OF A TEACHING HOSPITAL IN LAGOS, NIGERIA

    PubMed Central

    Oshikoya, K.A.; Orji, M.U.; Oreagba, I.A.

    2016-01-01

    Background: Medical literature has demonstrated that referral hospitals often receive inadequate information about the care and medications their patients received from referring hospitals. Objective: This study aimed to assess the completeness of referral letters, especially the medication history, for patient presenting at the children emergency room of a teaching hospital in Lagos, Nigeria. Method: A pro forma form was developed to obtain from the referral letters the demographic information of children referred to the emergency room of the Lagos University Teaching Hospital (LUTH), Idiaraba, over a period of three months. The nature of the referring centre, tentative diagnoses made at the referring centre, duration of illness prior to referral, vital signs and physical examination findings, investigation results, and treatment given were also extracted from the letters. In addition, we extracted from the letters the name, dosage, frequency and duration of use of medicines administered at the referring centres. Parents were also interviewed about the details of medicines used prior to presentation of their child at the referring centres. Results: Among those referred with a letter, 100 patients met the inclusion criteria and constituted those evaluated in this study. Most of the patients were referred from general hospitals (31%), another tertiary hospital (29%), and private hospitals/clinics (24%). Gender (30%) and tentative diagnoses (12%) were omitted in the referral letters. However, information about the weight (82%), vital signs (57%), physical examination findings (44%), treatment given (92%), and medication history (71%) were much more omitted in the referral letters. Conclusion: Medication history as well as many other data points is infrequently reported in referral letters to a tertiary care hospital in Lagos, Nigeria. Standard referral guidelines may be useful to improve documentation of medication history. PMID:27721681

  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. The Basics of Alcohol Screening, Brief Intervention and Referral to Treatment in the Emergency Department

    PubMed Central

    Vaca, Federico E.; Winn, Diane

    2007-01-01

    Nearly eight million emergency department (ED) visits are attributed to alcohol every year in the United States. A substantial proportion is due to trauma. In 2005, 16,885 people were killed as a result of alcohol-related motor vehicle crashes. Patients with alcohol-use problems (AUPs) are not only more likely to drive after drinking but are also at greater risk for serious alcohol-related illness and injury. Emergency departments have an important and unique opportunity to identify these patients and intervene during the “teachable moment” of an ED visit. The American College of Emergency Physicians, Emergency Nurses Association, American College of Surgeons-Committee on Trauma, American Public Health Association, and the National Highway Traffic Safety Administration, have identified Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) as a pivotal injury- and illness-prevention strategy to improve the health and well-being of ED patients. We provide a general overview of the basis and need for integrating SBIRT into EDs. Models of SBIRT, as well as benefits and challenges to its implementation, are also discussed. PMID:19561690

  13. 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

  14. 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.

  15. Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

    PubMed Central

    Raj, Sunil Saksena; Manthri, Suneedh; Sahoo, Pratap Kumar

    2015-01-01

    Background: An effective emergency referral transport system is the link between the home of the pregnant woman and a health facility providing basic or comprehensive emergency obstetric care. This study attempts to explore the role of emergency transport associated with maternal deaths in Unnao district, Uttar Pradesh (UP). Methods: A descriptive study was carried out to assess the causes of and factors leading to maternal deaths in Unnao district, UP, through community based Maternal Death Review (MDR) using verbal autopsy, in a sample of 57 maternal deaths conducted between June 1, 2009, and May 31, 2010. A facility review was also conducted in 15 of the 16 block level and district health facilities to collect information on preparedness of the facilities for treating obstetric complications including referral transportation. A descriptive analysis was carried out using ratios and percentages to analyze the availability of basic facilities which may lead to maternal deaths. Results: It was found that there were only 10 ambulances available at 15 facilities against 19 required as per Indian Public Health Standards (IPHS). About 47% of the deaths took place in a facility, 30% enroute to a health facility and 23% at home. Twenty five percent of women were taken to one facility, 32% were taken to two facilities, and 25% were taken to three facilities while 19% were not taken to any facility before their death. Sixteen percent of the pregnant women could not arrange transportation to reach any facility. The mean time to make arrangements for travel from home to facility-1 and facility-2 to facility-3 was 3.1 hours; whereas from facility-1 to facility-2 was 9.9 hours. The mean travel time from home to facility-1 was 1 hour, from facility-1 to facility-2 was 1.4 hours and facility-2 to facility-3 was 1.6 hours. Conclusion: The public health facility review and MDR, clearly indicates that the inter-facility transfers appropriateness and timeliness of referral are major

  16. 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.

  17. Emergency obstetric referral in rural Sierra Leone: what can motorbike ambulances contribute? A mixed-methods study.

    PubMed

    Bhopal, Sunil S; Halpin, Stephen J; Gerein, Nancy

    2013-08-01

    Giving birth remains a dangerous endeavour for many of the world's women. Progress to improve this has been slow in sub-Saharan Africa. The second delay, where transport infrastructure is key in allowing a woman to reach care, has been a relatively neglected field of study. Six eRanger motorbike ambulances, specifically engineered for use on poor roads in resource-poor situations were provided in 2006 as part of an emergency referral system in rural Sierra Leone. The aim of this study was to evaluate the implementation of this referral system in terms of its use, acceptability and accessibility. Data were collected from usage records, and a series of semi-structured interviews and focus groups conducted to provide deeper understanding of the service. A total of 130 records of patients being transported to a health facility were found, 1/3 of which were for obstetric cases. The ambulance is being used regularly to transport patients to a health care facility. It is well known to the communities, is acceptable and accessible, and is valued by those it serves. District-wide traditional birth attendant training and the sensitisation activities provided a foundation for the introduction of the ambulance service, creating a high level of awareness of the service and its importance, particularly for women in labour. Motorbike ambulances are suited to remote areas and can function on poor roads inaccessible to other vehicles.

  18. Oral surgery in Norwegian general dental practice--a survey. Extent, scope, referrals, emergencies, and medically compromised patients.

    PubMed

    Berge, T I

    1992-02-01

    A questionnaire containing 37 questions concerning oral surgery and oral medicine was mailed to a systematic random sample of 500 Norwegian general dental practitioners in October 1989. A 60% return rate was obtained. From the 20 questions included in this paper the following conclusions were drawn: Norwegian general practitioners perform a substantial number and diversity of procedures in the field of oral surgery and oral medicine. The predictor variables sex, age, geographic location, and type of practice (private/public) showed by multiple classification analysis only limited correlation with the amount and diversity of procedures. On average, 12.3 patients were referred per practitioner per year to specialists in oral surgery. The indicated need for orthognathic consultations was 0.75 patient per year per practitioner. Serious emergencies demanding referral seldom occurred. Each month 6.6 medically compromised patients were seen in general practice, among which cardiovascular disorders dominated. PMID:1533083

  19. Evaluation of Publicly Financed and Privately Delivered Model of Emergency Referral Services for Maternal and Child Health Care in India

    PubMed Central

    Prinja, Shankar; Bahuguna, Pankaj; Lakshmi, P. V. M.; Mokashi, Tushar; Aggarwal, Arun Kumar; Kaur, Manmeet; Reddy, K. Rahul; Kumar, Rajesh

    2014-01-01

    Background Emergency referral services (ERS) are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost. Methods Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS) standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective. Results On an average, an ambulance transported 3–4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7) per patient transported or INR 21 (USD 0.35) per km travelled. Conclusion Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR) should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system. PMID:25360798

  20. 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

  1. 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

  2. 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

  3. Refusing to Be Excluded: Finding Ways of Integrating Psychotherapeutic Modalities to the Emerging Needs of a Pupil Referral Unit

    ERIC Educational Resources Information Center

    Malberg, Norka T.

    2008-01-01

    This paper describes the application of child psychotherapy, its theory and practice, in a Pupil Referral Unit (PRU). It examines the importance of a flexible approach to outreach work and the implementation of interventions that take into consideration both the internal and the external world of the adolescent. Furthermore, the process of…

  4. Incongruous referrals.

    PubMed

    Hannay, D R; Maddox, E J

    1975-12-13

    A survey of 1344 patients registered at a new health centre in Glasgow assessed the prevalence of symptoms and referrals together with subjective, gradings of medical symptoms in terms of pain, disability, and perceived seriousness, and of social symptoms in terms of worry or inconvenience. These grading scales were used to define referral behaviour which appeared to be incongruous in the light of the respondents' own perceptions of their symptoms. In this way incongruous referrals indicated the size of the medical and social symptom "iceberg" and "trivia". For both medical and social symptoms the "icebergs" were larger than the "trivia"; the medical-symptom "iceberg" was two to three times greater than the medical-symptom "trivia".

  5. 44 CFR 6.10 - Assistance and referrals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Assistance and referrals. 6.10 Section 6.10 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... referrals. Requests for assistance and referral to the responsible system manager or other FEMA...

  6. 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

  7. 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

  8. 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

  9. Dealing with extracontractual referrals.

    PubMed Central

    Williamson, J D

    1991-01-01

    OBJECTIVE--To describe the mechanism established by Richmond, Twickenham, and Roehampton Health Authority to manage extracontractual referral requests made on behalf of its resident population and to examine its working in the first three months of the new arrangements. DESIGN--Description of the procedures for managing extracontractual referrals and the decisions made on requests submitted to the district health authority between 1 April and 30 June 1991. RESULTS--235 requests were submitted, 79 for emergency care. 156 requests were clearly for elective treatments and, of these, 61 were ultimately refused, 20 because the district health authority was not liable to pay. Of the remaining 41, 17 were appealed successfully and three unsuccessfullly. More than half of the elective extracontractual referrals correctly submitted were to either orthopaedics, general surgery, oral surgery, gynaecology, or plastic surgery. Overall, the district health authority approved three quarters of the requests for which it would be financially liable; this was the predicted workload for the period. CONCLUSIONS--The management of extracontractual referral requests is complex and time consuming for clinicians and managers alike. Patient choice is clearly being limited to some extent, but this is necessary if the number of requests is not to exceed the levels on which funding is based. PMID:1912860

  10. Emergency room referral to internal medicine wards or to coronary care units of patients with first acute myocardial infarction. Israel Study Group on First Acute Myocardial Infarction.

    PubMed

    Drory, Y; Shapira, I; Goldbourt, U; Fisman, E Z; Villa, Y; Tenenbaum, A; Pines, A

    2000-01-01

    The objective of the study was to assess factors associated with ward assignment in the emergency room for patients < or = 65 years old with first acute myocardial infarction. We analysed uni- and multivariate predictors for ward assignment (coronary care unit versus internal ward). Eight major centrally located Israeli hospitals provided data during one year. The study population included 1252 patients, of whom 83% were men, 37% were hypertensives, 22% were diabetics, and 14% had previous anginal syndrome. Most patients (83%) were admitted to the coronary care unit. Internal medicine ward assignment was significantly associated with advanced age, history of hypertension or diabetes, a longer time from appearance of symptoms to arrival at the hospital, and myocardial infarction type (non-Q-wave or non-anterior). The likelihood of medical ward referral increased stepwise with the increasing number of a patient's predictive factors: those with > or = 4 factors had a > 30% chance of being assigned to a medical ward compared to a < 10% chance when there were 0-3 risk factors. Exclusion of patients with thrombolysis had no effect on the results. The shortage of cardiac care unit beds apparently leads to emergency room selection acting in detriment of patients with poorest prognoses. Clear guidelines for decision making in the emergency room are needed to resolve this paradoxical situation. PMID:10998758

  11. Safer Head Start Playgrounds.

    ERIC Educational Resources Information Center

    Cunningham, Gayle; Hendricks, Charlotte

    1996-01-01

    Argues that there are three areas to evaluate when creating safer playgrounds for children: environment, supervision, and education. Discusses the importance of safe and properly installed equipment, resilient surfacing, removal of hazards, proper maintenance, appropriate adult-to-child ratio, and enforcement of proper playground safety and injury…

  12. 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

  13. An Evidence-Based Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) Curriculum for Emergency Department (ED) Providers Improves Skills and Utilization

    PubMed Central

    Bernstein, Edward; Bernstein, Judith; Feldman, James; Fernandez, William; Hagan, Melissa; Mitchell, Patricia; Safi, Clara; Woolard, Robert; Mello, Mike; Baird, Janette; Lee, Cristina; Bazargan-Hejazi, Shahrzad; Broderick, Kerry; LaPerrier, Kathryn A.; Kellermann, Arthur; Wald, Marlena M.; Taylor, Robert E.; Walton, Kim; Grant-Ervin, Michelle; Rollinson, Denise; Edwards, David; Chan, Theodore; Davis, Dan; Marshall, Jean Buchanan; Aseltine, Robert; James, Amy; Abu-Hasaballah, Khamis; Schilling, Elizabeth; Baumann, Brigitte M.; Boudreaux, Edwin D.; Maio, Ronald; Cunningham, Rebecca; Murrell, Teresa; Doezema, David; Bauer, Michael J.; Anglin, Deirdre; Eliassen, Adriana; Martin, Marcus; Pines, Jesse; Buchanan, Leslie; Turner, James; D'Onofrio, Gail; Degutis, Linda C.; Owens, Patricia

    2014-01-01

    SUMMARY Objective Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices. Methods ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.ed.bmc.org/sbirt). A pre-post repeated measures design assessed changes in provider beliefs and practices at three and 12 months post-exposure. Results Among 402 ED providers, 74% reported < 10 hours of prior professional alcohol-related education and 78% had < 2 hours exposure in the previous year. At 3-month follow-up, scores for self-reported confidence in ability, responsibility to intervene, and actual utilization of SBIRT skills all improved significantly over baseline. Gains decreased somewhat at 12 months, but remained above baseline. Length of time in practice was positively associated with SBIRT utilization, controlling for gender, race and type of profession. Persistent barriers included time limitations and lack of referral resources. Conclusions ED providers respond favorably to SBIRT. Changes in utilization were substantial at three months post-exposure to a standardized curriculum, but less apparent after 12 months. Booster sessions, trained assistants and infrastructure supports may be needed to sustain changes over the longer term. PMID:18077305

  14. 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

  15. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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...

  16. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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...

  17. 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...

  18. 44 CFR 11.17 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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...

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 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. Inclusion and Discipline Referrals.

    ERIC Educational Resources Information Center

    Krank, H. Mark; Moon, Charles E.; Render, Gary F.

    2002-01-01

    Discipline referrals for special needs students and other students in a rural K-8 school were examined before and after the school shifted to inclusive-school policies and practices. In the year after the shift, discipline referrals declined sharply for special needs students and slightly for other students, reflecting positive social outcomes of…

  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 sex in tourist resorts.

    PubMed

    Ford, N; Inman, M

    1992-01-01

    A survey in Torbay, England, indicated substantial sexual interaction of an unsafe kind between young residents and tourists. A pilot programme is described which sought to promote safer sexual behaviour: the attention of both tourists and local people who frequented nightclubs was engaged by peer groups who conveyed educational messages. PMID:1637480

  3. 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

  4. Five Steps to Safer Health Care

    MedlinePlus

    ... to Safer Health Care Five Steps to Safer Health Care: Patient Fact Sheet This information is for reference ... safety is one of the Nation's most pressing health care challenges. A 1999 report by the Institute of ...

  5. 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.

  6. 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. PMID:22001038

  7. Safety referral procedures clarified.

    PubMed

    2014-12-01

    Two types of referrals are available for the purpose of harmonising pharmacovigilance decisions across the EU: the urgent procedure and the "normal" procedure. In both cases, the Pharmacovigilance Risk Assessment Committee (PRAC) issues a recommendation that the marketing authorisation committees concerned must take into account when formulating their opinions. If Member States disagree in their decisions, a final referral is available, although it lacks transparency. The European Commission's final decision is binding on all Member States. PMID:25629154

  8. An Evidence-Based Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) Curriculum for Emergency Department (ED) Providers Improves Skills and Utilization

    ERIC Educational Resources Information Center

    Substance Abuse, 2007

    2007-01-01

    Objective: Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience…

  9. Referral expectations of radiology.

    PubMed

    Smith, W; Altmaier, E; Berberoglu, L; Morris, K; O'Halloran, C

    1992-08-01

    In summary, the data suggest that the traditional role of the radiologist as an expert consultant who provides an accurate written report is still the dominant perception. This study emphasizes the importance of development of communication skills and communication standards, with particular emphasis on written data as the single most important factor in keeping a strong clinician referral base. PMID:10121759

  10. Predictors of Safer Sex Intentions and Protected Sex Among Heterosexual HIV-Negative Methamphetamine Users

    PubMed Central

    Mausbach, Brent T.; Semple, Shirley J.; Strathdee, Steffanie A; Patterson, Thomas L.

    2009-01-01

    The purpose of this study was to test a version of the Theory of Planned Behavior (TPB) for predicting safe sex behavior in a sample of 228 HIV-negative heterosexual methamphetamine users. We hypothesized that, in addition to TPB constructs, participants’ amount of methamphetamine use and desire to stop unsafe sex behaviors would predict intentions to engage in safer sex behaviors. In turn, we predicted that safer sex intentions would be positively correlated with participants’ percentage of protected sex. Hierarchical linear regression indicated that 48% of the total variance in safer sex intentions was predicted by our model, with less negative attitudes toward safer sex, greater normative beliefs, greater control beliefs, less methamphetamine use, less intent to have sex, and greater desire to stop unsafe sex emerging as significant predictors of greater safer sex intentions. Safer sex intentions were positively associated with future percent protected sex (p<.05). These findings suggest that, among heterosexual methamphetamine users, the TPB is an excellent model for predicting safer sex practices in this population, as are some additional factors (e.g., methamphetamine use). Effective interventions for increasing safer sex practices in methamphetamine user will likely include constructs from this model with augmentations to help reduce methamphetamine use. PMID:19085216

  11. Safer sex and the polyamorous lesbian.

    PubMed

    Munson, M

    1999-01-01

    SUMMARY In recent years, concern about transmission of AIDS and other STDs has prompted people of all sexual orientations to use various safer sex techniques. This article explains why monogamy is not necessarily any safer than polyamory. Research on the low risk of woman-to-woman transmission of HIV and other STDs is described.

  12. Determinants and Outcomes of Emergency Caesarean Section following Failed Instrumental Delivery: 5-Year Observational Review at a Tertiary Referral Centre in London

    PubMed Central

    McDonnell, Sian; Chandraharan, Edwin

    2015-01-01

    Objectives. To review the determinants for a failed operative vaginal delivery and to examine associated fetal and maternal morbidity. Design. Retrospective observational study. Setting. Large London Teaching Hospital. Method. A retrospective review of case notes during a 5-year period was carried out. Results. Overall 119 women (0.44%) out of 26,856 births had a caesarean section following a failed instrumental delivery, which comprised 5.1% of all operative vaginal births. 73% had a spontaneous onset of labour and 63% required syntocinon at some time prior to delivery. 71.5% of deliveries were complicated by malposition. Only 20% of deliveries were attended by a consultant obstetrician. Almost 50% of women and 8.4% of neonates sustained trauma at the time of either their failed instrumental delivery or the caesarean section. Conclusions. Emergency caesarean section during the second stage of labour is associated with maternal and fetal complications. A ‘failed instrumental delivery score' (FIDS) may aid practitioners in predicting an increased likelihood of a failed operative vaginal birth and therefore to consider a trial of operative vaginal delivery in the theatre. Senior input should also be sought because a failed operative vaginal birth is associated with increased maternal and fetal morbidity. PMID:26078882

  13. Safer work clothing for fishermen.

    PubMed

    Geving, Ingunn Holmen; Reitan, Jarl; Sandsund, Mariann; Faerevik, Hilde; Reinertsen, Randi Eidsmo; Aasjord, Halvard

    2006-01-01

    The fisherman's work environment consists of many potential risks. A study of occupational accidents in the Norwegian fishing industry in the nine-year period from 1998 to 2006 shows that more than 3/4 of the deaths were caused by loss of fishing vessel or man-overboard accidents. Furthermore, the greatest risk of drowning is found in the smallest fleet. The aim of our project was to develop safer work clothing and through this contribute to a reduction in work accidents and injuries in the fishing fleet. We considered that it is possible to produce protective work clothing that satisfies a specification of requirements covering the fishermen's needs for protection and comfort during work. An end user-centred process including twenty-three personal interviews and a questionnaire was used to clarify the fishermen's needs and wishes before detailed design and product development. We identified an overview of all the fishermen's needs for protection during work, and produced a prioritised list of functional requirements for the clothing. The results show that the clothing previously preferred by fishermen does not satisfy all the users' demands for safety, functionality and comfort. These demands have been taken into consideration when designing improved work clothing for the fishing fleet. A selected number of prototypes were developed on the basis of the established specification of requirements. The prototypes were evaluated according to the users' requirements through tests in SINTEF's Work Physiology Laboratory and on board fishing vessels. The results demonstrate that the new protective clothing satisfies the fishermen's requirements. PMID:17312698

  14. Safer work clothing for fishermen.

    PubMed

    Geving, Ingunn Holmen; Reitan, Jarl; Sandsund, Mariann; Faerevik, Hilde; Reinertsen, Randi Eidsmo; Aasjord, Halvard

    2006-01-01

    The fisherman's work environment consists of many potential risks. A study of occupational accidents in the Norwegian fishing industry in the nine-year period from 1998 to 2006 shows that more than 3/4 of the deaths were caused by loss of fishing vessel or man-overboard accidents. Furthermore, the greatest risk of drowning is found in the smallest fleet. The aim of our project was to develop safer work clothing and through this contribute to a reduction in work accidents and injuries in the fishing fleet. We considered that it is possible to produce protective work clothing that satisfies a specification of requirements covering the fishermen's needs for protection and comfort during work. An end user-centred process including twenty-three personal interviews and a questionnaire was used to clarify the fishermen's needs and wishes before detailed design and product development. We identified an overview of all the fishermen's needs for protection during work, and produced a prioritised list of functional requirements for the clothing. The results show that the clothing previously preferred by fishermen does not satisfy all the users' demands for safety, functionality and comfort. These demands have been taken into consideration when designing improved work clothing for the fishing fleet. A selected number of prototypes were developed on the basis of the established specification of requirements. The prototypes were evaluated according to the users' requirements through tests in SINTEF's Work Physiology Laboratory and on board fishing vessels. The results demonstrate that the new protective clothing satisfies the fishermen's requirements.

  15. 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.…

  16. Team training for safer birth.

    PubMed

    Cornthwaite, Katie; Alvarez, Mary; Siassakos, Dimitrios

    2015-11-01

    Effective and coordinated teamworking is key to achieving safe birth for mothers and babies. Confidential enquiries have repeatedly identified deficiencies in teamwork as factors contributing to poor maternal and neonatal outcomes. The ingredients of a successful multi-professional team are varied, but research has identified some fundamental teamwork behaviours, with good communication, proficient leadership and situational awareness at the heart. Simple, evidence-based methods in teamwork training can be seamlessly integrated into a core, mandatory obstetric emergency training. Training should be an enjoyable, inclusive and beneficial experience for members of staff. Training in teamwork can lead to improved clinical outcomes and better birth experience for women.

  17. Will the next generation of "safer" cigarettes be safer?

    PubMed

    Warner, Kenneth E

    2005-10-01

    There are three basic means of avoiding smoking-related diseases: never starting to smoke, quitting, and avoiding smoke-filled environments. Recently, a fourth possibility has emerged: use of new, ostensibly less toxic products by smokers who cannot or will not quit, including "reduced toxin" cigarettes and novel smokeless tobacco products. To their purveyors, these new "tobacco harm reduction" (THR) products represent an opportunity for inveterate smokers to reduce their risk of lung cancer and other diseases. To health professionals, the new products pose a myriad of risks. This new generation of THR products is not the first to promise reduced risk, however. Both filtered cigarettes and low tar and nicotine cigarettes were marketed with explicit health themes, ultimately with disastrous results for public health. THR products enter the market subject to no product regulation whatsoever; thus, the opportunity for objective, independent scientific evaluation of their risks and benefits, and for regulation of advertising or sale as a result, is absent. This paper describes the new generation of THR products, discusses potential benefits and risks, examines lessons from the experience with filtered and low tar and nicotine cigarettes, and describes the principal challenges that confront the medical profession, government, and the public in determining what to do with this perplexing array of novel products. PMID:16217258

  18. 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. PMID:17738303

  19. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false Referrals. 612.2301 Section 612.2301 Banks and 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) Each institution and its board of...

  20. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false Referrals. 612.2301 Section 612.2301 Banks and 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) Each institution and its board of...

  1. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Referrals. 612.2301 Section 612.2301 Banks and 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) Each institution and its board of...

  2. 12 CFR 612.2301 - Referrals.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Referrals. 612.2301 Section 612.2301 Banks and 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) Each institution and its board of...

  3. 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…

  4. Technologies that make administration of vaccines safer.

    PubMed

    Clements, C John; Larsen, Gordon; Jodar, Luis

    2004-05-01

    There is an ever-expanding technology that is aimed at making the administration of vaccines safer. Conventional ways of administering vaccines are being upgraded, modified or replaced by a wide variety of innovations. The paradigm of liquid vaccines, needles and syringes is slow to change, but already developments are occurring that will change for ever the way vaccines are administered and will improve the safety record of immunization. The oral route of vaccine administration has generally been thought of as safe, but until now only the polio vaccine has been widely used in this way. The conventional method of vaccine administration is by injection. Many ingenious devices have become available that now make injecting safer. Inventors are now looking imaginatively to alternative routes and technologies for delivering vaccines. Vaccines are generally manufactured to extremely high standards and rarely are shown to be the cause of safety issues. People remain the weakest safety link is vaccine administration. Technologies that bypasses the ability of man to make bad decisions or to behave incorrectly are of tremendous value. The vaccine world is in the middle of a radical re-think about how vaccines might best be administered. The presentation of the vaccine can be altered to fit new technologies such as powder jet guns, or skin patches. Even the conventional needle and syringe have evolved to much safer versions, and are set to continue this evolution. All this means even safer vaccines and their delivery.

  5. 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

  6. HMO physicians' use of referrals.

    PubMed

    Bachman, K H; Freeborn, D K

    1999-02-01

    Clinical uncertainty is a source of variation in medical decision-making as well as a source of work-related stress. Increasing enrollment in organized health care systems has intensified interest in understanding referral utilization as well as issues such as physician dissatisfaction and burnout. We examined whether primary care physicians' affective reactions to uncertainty and their job characteristics were associated with use of referrals and burnout. Data came from mail surveys of primary care physicians practicing in two large group model health maintenance organizations (HMOs) in the USA. Consistent with past research, we found that younger physicians had higher referral rates than older physicians, and that general internists had higher rates than either family practitioners or pediatricians. Greater stress from uncertainty increased referrals and referrals were negatively correlated with heavier work demands (patient visits per hour). Greater stress from uncertainty, perceived workload (too high) and a sense of loss of control over the practice environment were associated with higher levels of burnout.

  7. Maternity referral systems in developing countries: current knowledge and future research needs.

    PubMed

    Murray, Susan F; Pearson, Stephen C

    2006-05-01

    A functioning referral system is generally considered to be a necessary element of successful Safe Motherhood programmes. This paper draws on a scoping review of available literature to identify key requisites for successful maternity referral systems in developing countries, to highlight knowledge gaps, and to suggest items for a future research agenda. Key online social science, medical and health system bibliographic databases, and websites were searched in July 2004 for evidence relating to referral systems for maternity care. Documentary evidence on implementation is scarce, but it suggests that many healthcare systems in developing countries are failing to optimise women's rapid access to emergency obstetric care, and that the poor and marginalised are affected disproportionately. Likely requisites for successful maternity referral systems include: a referral strategy informed by the assessment of population needs and health system capabilities; an adequately resourced referral centre; active collaboration between referral levels and across sectors; formalised communication and transport arrangements; agreed setting-specific protocols for referrer and receiver; supervision and accountability for providers' performance; affordable service costs; the capacity to monitor effectiveness; and underpinning all of these, policy support. Theoretically informed social and organisational research is required on the referral care needs of the poor and marginalised, on the maternity workforce and organisation, and on the implications of the mixed economy of healthcare for referral networks. Clinical research is required to determine how maternity referral fits within newborn health priorities and where the needs are different. Finally, research is required to determine how and whether a more integrated approach to emergency care systems may benefit women and their communities.

  8. 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

  9. Emerging technologies and challenges for better and safer drugs.

    PubMed

    Theodosiou, Maria; Amir-Aslani, Arsia; Mégarbane, Bruno

    2014-04-01

    Regardless of stringent safety regulations and increased compound selectivity by pharmaceutical companies, prediction of toxicity in humans is still far from perfect and adverse drug reactions are still detected after drug marketing. High costs of failures due to toxicity has led pharmaceutical companies to search for screening methods that would allow detection of toxicity issues at an early stage and improve their preclinical and clinical toxicology. Thanks to the last decade's biotechnology revolution, new technologies like toxicogenomics have demonstrated the capacity to improve toxicity assessment. However, our understanding of toxicological mechanisms is still incomplete and a wide range of approaches must be used to gain insight into toxicity issues. Consequently, an array of in silico, in vitro and in vivo methods is utilized to predict toxicity and its causative mechanisms, improving drug development processes and minimizing costs of failure. PMID:24243233

  10. "The Friendly Clergy": Characteristics and Referral.

    ERIC Educational Resources Information Center

    Faiver, Christopher M.; O'Brien, Eugene M.; McNally, Christopher J.

    1998-01-01

    Among the recommendations possible in assessment of clients' religious beliefs is that of referral to the "friendly clergy." Delineates guidelines for referral as well as ideal characteristics of that spiritual profession. (Author)

  11. The language of "Circule": discursive construction of false referral in Iranian teaching hospitals.

    PubMed

    Mirhosseini, Seyyed-Abdolhamid; Fattahi, Hossein

    2010-09-01

    This article explores the practice of false patient out-referral by medical students in Iranian teaching hospital emergency departments. Drawing on participant-observations and interviews during eight months in six hospitals in Tehran, we investigate how discourse is appropriated to construct and legitimate out-referrals through four general strategies of sympathy, mystification, intimidation, and procrastination. Based on a critical approach to false out-referral discourse, we revisit the medical and educational functioning of teaching hospitals in Iran: Focusing on medical students involved in false out-referrals, their discursive reproduction of deception is examined along with their legitimate challenges to institutional structures. Moreover, focusing on the institution of hospital, institutional corruption is discussed along with the problematic of covert cultural defiance faced by a modernist organizational construct in a nonmainstream cultural context. Finally, we argue that the discourse of false out-referral calls for more profound public awareness in dealing with health institutions.

  12. Safer staining method for acid fast bacilli.

    PubMed Central

    Ellis, R C; Zabrowarny, L A

    1993-01-01

    To develop a method for staining acid fast bacilli which excluded highly toxic phenol from the staining solution. A lipophilic agent, a liquid organic detergent, LOC High Studs, distributed by Amway, was substituted. The acid fast bacilli stained red; nuclei, cytoplasm, and cytoplasmic elements stained blue on a clear background. These results compare very favourably with acid fast bacilli stained by the traditional method. Detergents are efficient lipophilic agents and safer to handle than phenol. The method described here stains acid fast bacilli as efficiently as traditional carbol fuchsin methods. LOC High Suds is considerably cheaper than phenol. Images PMID:7687254

  13. Safer staining method for acid fast bacilli.

    PubMed

    Ellis, R C; Zabrowarny, L A

    1993-06-01

    To develop a method for staining acid fast bacilli which excluded highly toxic phenol from the staining solution. A lipophilic agent, a liquid organic detergent, LOC High Studs, distributed by Amway, was substituted. The acid fast bacilli stained red; nuclei, cytoplasm, and cytoplasmic elements stained blue on a clear background. These results compare very favourably with acid fast bacilli stained by the traditional method. Detergents are efficient lipophilic agents and safer to handle than phenol. The method described here stains acid fast bacilli as efficiently as traditional carbol fuchsin methods. LOC High Suds is considerably cheaper than phenol.

  14. 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.

  15. 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...

  16. Priority-setting tools for rheumatology disease referrals: a review of the literature.

    PubMed

    De Coster, Carolyn; Fitzgerald, Avril; Cepoiu, Monica

    2008-11-01

    As part of a larger body of work to develop a rheumatology priority referral score, a literature review was conducted. The objective of the literature review was to identify preexisting priority-setting, triage, and referral tools/scales developed to guide referrals from primary care to specialist care/consultation usually provided by a rheumatologist. Using a combination of database, citation, Internet, and hand-searching, 20 papers were identified that related to referral prioritization in three areas: rheumatoid arthritis (RA; 5), musculoskeletal (MSK) diseases other than RA (3), and MSK diseases in general (12). No single set of priority-setting criteria was identified for rheumatologic disorders across the spectrum of patients who may be referred from primary care providers (PCPs) to rheumatologists. There appears to be more congruence on conditions at either end of the urgency spectrum with conditions such as suspected cranial arteritis or systemic vasculitis deemed to be emergency referrals and fibromyalgia and other soft-tissue syndromes deemed to be more routine referrals. Between these two extremes, there is a divergence of opinion about urgency and few papers on the issue. The exception to this is referral for early RA for which several criteria have been established. Despite the inherent complexities in developing a tool to prioritize patients referred by PCPs to rheumatologists, there are compelling reasons to proceed. With the aging of the population, the number of patients being referred to rheumatologists is expected to increase. With pharmaceutical advances, there are demonstrable benefits in early referral for some conditions. These trends have led to increased pressure on scarce rheumatological human resources. A tool to prioritize referrals is a critical component of improving access and the referral process.

  17. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda J.

    1992-01-01

    In this, the concluding article of a six-part series on a longitudinal study of 50 referrals from family physicians in Ontario and Manitoba, the end of the referral process and responsibility for it are examined. Referral seemed to function as a process that, sometimes inappropriately, restored faith or held out hope that medical solutions could be found for difficult, chronic problems. Outcomes were linked to patient agendas and expectations.

  18. 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…

  19. Marketing a physician referral service.

    PubMed

    Wiggins, C

    1988-01-01

    A recent survey of 670 CEOs revealed that 51 percent had already established physician referral services and 65.2 percent were involved in various activities geared towards strengthening physician relations, one of which was increasing staff personnel to perform these functions (Hospitals March 20, 1987). It is apparent that PRPs have gained wide acceptance and have proved helpful in bettering relations between hospitals and physicians and, at the same time, helped both of them to offer better health care to the public. These programs can be very beneficial to patients and help make the referral system more organized and formal, based on relevant data and knowledge of patients' needs and physicians' needs, qualifications and specialties. Current literature on PRPs is appearing more frequently. Enough hospitals have begun such programs that a new PRP director should be able to research the subject quite thoroughly and become familiar with the possible strengths and weaknesses. Software for PRPs has been developed by various companies which should make the program more useful in terms of data collection, follow-up and provision of feedback. In my opinion PRPs are needed, and if they are marketed correctly, to the physicians initially and then to patients, such programs will prove extremely advantageous to all involved: hospitals, physicians and patients.

  20. 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.

  1. Advancing safer alternatives through functional substitution.

    PubMed

    Tickner, Joel A; Schifano, Jessica N; Blake, Ann; Rudisill, Catherine; Mulvihill, Martin J

    2015-01-20

    To achieve the ultimate goal of sustainable chemicals management policy–the transition to safer chemicals, materials, products, and processes–current chemicals management approaches could benefit from a broader perspective. Starting with considerations of function, rather than characterizing and managing risks associated with a particular chemical, may provide a different, solutions-oriented lens to reduce risk associated with the uses of chemicals. It may also offer an efficient means, complementing existing tools, to reorient chemicals management approaches from time-intensive risk assessment and risk management based on single chemicals to comparative evaluation of the best options to fulfill a specific function. This article describes a functional approach to chemicals management we call “functional substitution” that encourages decision-makers to look beyond chemical by chemical substitution to find a range of alternatives to meet product performance. We define functional substitution, outline a rationale for greater use of this concept when considering risks posed by uses of chemicals, and provide examples of how functional approaches have been applied toward the identification of alternatives. We also discuss next steps for implementing functional substitution in chemical assessment and policy development.

  2. Enhanced trabeculectomy: the Moorfields Safer Surgery System.

    PubMed

    Khaw, Peng Tee; Chiang, Mark; Shah, Peter; Sii, Freda; Lockwood, Alastair; Khalili, Ashkan

    2012-01-01

    Trabeculectomy with anti-fibrotic treatment is still the most popular incisional procedure for glaucoma filtration surgery (GFS) worldwide. The advent of anti-fibrotic agents reduced failure due to scarring but resulted in increased complications. Advances in trabeculectomy surgery have been driven by the need to minimise the risk of: (1) complications and (2) surgical failure. This chapter covers preoperative, intraoperative and postoperative strategies, which improve the outcome of GFS. Strategies to reduce the risk of complications centre on the prevention of postoperative hypotony by minimising the risk of overdrainage, postoperative wound leaks and poor bleb morphology. Surgical techniques to reduce the risk of postoperative fibrosis by the use of anti-fibrotic agents (including mitomycin C) are discussed in detail. These techniques are based on a combination of considerable clinical experience, observation and laboratory research. The need to address pre-, intra- and postoperative issues in each individual patient is emphasised. These changes are embodied in the system we call the 'Moorfields Safer Surgery System'. The use of these strategies has considerably reduced the incidence of major complications including hypotony, cystic blebs and endophthalmitis in practices around the world. Most of these techniques are simple, require minimal equipment and can be easily mastered. They are associated with an improvement in overall outcome and it is hoped that this chapter will help the reader benefit from these advances.

  3. 75 FR 71123 - Agency Information Collection Activities; Proposed Collection; Comment Request; Safer Detergent...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-22

    ... AGENCY Agency Information Collection Activities; Proposed Collection; Comment Request; Safer Detergent... ICR, entitled: ``Safer Detergent Stewardship Initiative (SDSI) Program'' and identified by EPA ICR No... surfactants. Title: Safer Detergent Stewardship Initiative (SDSI) Program. ICR numbers: EPA ICR No....

  4. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Initial referral. 549.62 Section 549.62 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES 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...

  5. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Initial referral. 549.62 Section 549.62 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 31 CFR 904.1 - Prompt referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... COLLECTION STANDARDS (DEPARTMENT OF THE TREASURY-DEPARTMENT OF JUSTICE) REFERRALS TO THE DEPARTMENT OF JUSTICE § 904.1 Prompt referral. (a) Agencies shall promptly refer to the Department of Justice for... interest and penalties, shall be referred to the Civil Division or other division responsible...

  12. 38 CFR 1.950 - Prompt referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Referrals to Gao, Department of Justice, Or Irs § 1.950 Prompt referral. (a) VA shall promptly refer debts to Department of Justice (DOJ) for litigation where aggressive collection activity has been taken in... may direct, exclusive of interest and other late payment charges, shall be referred to the...

  13. 48 CFR 919.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Referral. 919.602-1 Section 919.602-1 Federal Acquisition Regulations System DEPARTMENT OF ENERGY SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Eligibility 919.602-1 Referral....

  14. 48 CFR 619.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Referral. 619.602-1 Section 619.602-1 Federal Acquisition Regulations System DEPARTMENT OF STATE SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Eligibility 619.602-1 Referral....

  15. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral Procedures § 303.303 Referral procedures. (a) General. (1) The lead agency's child find system described...

  16. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral Procedures § 303.303 Referral procedures. (a) General. (1) The lead agency's child find system described...

  17. 34 CFR 303.303 - Referral procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... the subject of a substantiated case of child abuse or neglect; or (2) Is identified as directly... DISABILITIES Child Find, Evaluations and Assessments, and Individualized Family Service Plans Referral Procedures § 303.303 Referral procedures. (a) General. (1) The lead agency's child find system described...

  18. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.41 Institutional referral....

  19. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.41 Institutional referral....

  20. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.41 Institutional referral....

  1. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.41 Institutional referral....

  2. 28 CFR 541.41 - Institutional referral.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.41 Institutional referral....

  3. 48 CFR 1319.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SMALL BUSINESS PROGRAMS Certificates of Competency and Determination of Responsibility 1319.602-1 Referral. When the contracting officer determines that the successful small business offeror lacks certain... cognizant Small Business Administration Government Contracting Area Office. A copy of the referral shall...

  4. An event-level analysis of condom use as a function of mood, alcohol use, and safer sex negotiations.

    PubMed

    Schroder, Kerstin E E; Johnson, Christopher J; Wiebe, John S

    2009-04-01

    Daily self-reports of condom-protected intercourse were analyzed as a function of emotional states, alcohol consumption, and safer sex negotiations in a sample of single, low-income Hispanic students. The sample included 15 women and 17 men who reported a minimum of four sexual episodes as well as inconsistent condom use over a 3-month self-reporting period. The analyses focused on 829 days out of 2,586 daily self-reports on which sexual intercourse was reported. Hierarchical linear modeling was used to predict condom-protected intercourse as a function of mood states, substance use, and safer sex negotiations. Safer sex negotiation was the strongest positive predictor of condom use. Contrary to expectation, unprotected intercourse was less likely to occur in episodes characterized by greater negative affect and more likely in episodes in which greater positive mood was reported. No main effect of alcohol consumption on safer sex was observed; however, an interaction between alcohol consumption and positive mood emerged, indicating that unprotected intercourse was most likely to occur when positive mood was combined with alcohol consumption. The results contradict the assumption that emotional distress predicts engagement in more risky sexual behavior and indicate that safer sex negotiations are likely to outweigh any effects of mood or alcohol consumption on subsequent condom use.

  5. Market conditions and general practitioners' referrals.

    PubMed

    Iversen, Tor; Ma, Ching-to Albert

    2011-12-01

    We study how market conditions influence referrals of patients by general practitioners (GPs). We set up a model of GP referral for the Norwegian health care system, where a GP receives capitation payment based on the number of patients in his practice, as well as fee-for-service reimbursements. A GP may accept new patients or close the practice to new patients. We model GPs as partially altruistic, and compete for patients. We show that a GP operating in a more competitive market has a higher referral rate. To compete for patients and to retain them, a GP satisfies patients' requests for referrals. Furthermore, a GP who faces a patient shortage will refer more often than a GP who does not. Tests with Norwegian GP radiology referral data support our theory. PMID:22009482

  6. Newer Epilepsy Drugs May Be Safer During Pregnancy

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_160751.html Newer Epilepsy Drugs May Be Safer During Pregnancy Small British ... 2016 (HealthDay News) -- Women who take the new epilepsy drugs levetiracetam and topiramate during pregnancy don't ...

  7. Salmonella Is a Sneaky Germ: Seven Tips for Safer Eating

    MedlinePlus

    ... our food safer to eat focuses on reducing contamination from Salmonella. Don't let Salmonella sneak up ... used to be a common cause of Salmonella contamination. To counter that, stringent procedures for cleaning and ...

  8. The impact of snow on orthopaedic trauma referrals.

    PubMed

    Weston-Simons, John; Jack, Christopher M; Doctor, Cyrus; Brogan, Kit; Reed, Daniel; Ricketts, David

    2012-07-01

    Adverse weather has been shown to increase orthopaedic referrals and place strain on services. This retrospective study undertaken at a teaching hospital concerned referrals between April 2009 and April 2010 comparing days when snow fell to days when it did not. Referrals increased significantly on snow days (to 74.9 per day) in comparison to normal weather days (33.5 per day). During snow days there were significant increases in the number of distal radius and ankle fractures referred but not of fractured necks of femur. Complications during the snow fall period were related to procedures performed outside of the trauma unit with further difficulties related to a lack of operating equipment and implant availability. As a result of our study, we recommend that during periods of heavy snow fall orthopaedic and trauma units should place senior orthopaedic trainees in Accident and Emergency to review patients as a triage service, organise trauma lists related to surgeon specific expertise and avoid sending trauma patients outside the unit for operation.

  9. 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.

  10. 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,...

  11. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 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,...

  12. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 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,...

  13. Exploring the interface between first and second level of care: referrals in rural Africa.

    PubMed

    Nordberg, E; Holmberg, S; Kiugu, S

    1996-02-01

    The studies aimed to determine the referral rate, the characteristics of patients referred, the reasons for referral and, in a sub-sample, its outcome. Study I recorded data on 602 patients referred to hospital from 13 rural clinics; follow-up interviews were conducted with a sub-sample of 57 referred patients. Study II interviewed 97 consecutive outpatients seeking care at Meru District Hospital. Both studies were carried out in a rural area of Meru district in central Kenya. The 602 referred cases represent between 0.3 and 1.8% of all new patients at the respective clinic with a mean of 0.5%, or 8.7 referrals annually per 1000 catchment area population. More than half of the referrals were for treatment only while 13% were for investigation, 63% were considered urgent, and 85% were referred in writing. Of the 57 subsequently interviewed, all except one had complied, and 52 patients, mostly with infections, injuries or obstetric disorders, reported improvement at the time of interview. The second study found that only 19 (20%) of the 97 outpatients had been referred (II in writing and 8 verbally). Rates of formal clinic-to-hospital referral were very low. Reasons included poor access to transport; patient inability to pay user fees, transport outlays, and other expenses; time constraints in emergency situations; and lack of feedback information from hospital to clinic. Verbal referral was common. Further research should focus on the selection of patients for referral, on follow-up of cases referred, on the communication between institutions involved, and on options for the financing of emergency transport to hospital.

  14. 29 CFR 20.105 - Minimum referral amount.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 1 2011-07-01 2011-07-01 false Minimum referral amount. 20.105 Section 20.105 Labor Office... referral amount. The IRS annually establishes the minimum amount for debts otherwise eligible for referral. Minimum referral amounts are established separately for individual debts and business debts, as set...

  15. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., Training, and Referral § 382.605 Referral, evaluation, and treatment. The requirements for referral, evaluation, and treatment must be performed in accordance with 49 CFR part 40, Subpart O. ... 49 Transportation 5 2013-10-01 2013-10-01 false Referral, evaluation, and treatment....

  16. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., Training, and Referral § 382.605 Referral, evaluation, and treatment. The requirements for referral, evaluation, and treatment must be performed in accordance with 49 CFR part 40, Subpart O. ... 49 Transportation 5 2014-10-01 2014-10-01 false Referral, evaluation, and treatment....

  17. Safer Playgrounds for Young Children. ERIC Digest.

    ERIC Educational Resources Information Center

    Hendricks, Charlotte M.

    Each year, almost 200,000 children are treated at hospital emergency rooms for injuries occurring on playgrounds. At this time, the U.S. Consumer Product Safety Commission has established voluntary guidelines for equipment and surfacing, but there are no required standards regarding the manufacture or installation of equipment and resilient…

  18. Severe systolic hypertension and the search for safer motherhood.

    PubMed

    Martin, James N

    2016-03-01

    Timely and appropriate response to severe hypertension during gestation is an important component of quality, safe care for pregnant or puerperal mothers regardless of causation. The reduction of severe maternal morbidity and maternal mortality in the hypertensive mother is clearly enhanced by the addition of standard protocols for provider response to severe hypertension, particularly severe systolic hypertension. The program developed in New York State via the Safe Motherhood Initiative promotes the implementation of unit-specific safety bundles, especially one that is focused upon a standardized approach to handling the obstetric emergency of severe hypertension usually associated with preeclampsia/eclampsia. The comprehensive preeclampsia/eclampsia safety bundle as summarized by Drs. Moroz and colleagues is reviewed especially from the perspective of its focus on the timely and specific responses for health care providers to make when severe hypertension is detected in the pregnant patient. Evidence-based guidance to practice considerations and clinical care of patients with preeclampsia/eclampsia is embedded within the program outlined for New York State by Moroz and her District II ACOG colleagues. There is a central focus on timely and appropriate antepartum/postpartum management of severe hypertension, a core concept to lessen maternal risk for cerebral hemorrhage. Ten considerations for further integration into the New York program are suggested. Beyond blood pressure control, there is a need for systematic review of interventions and outcomes over time, attention to possible future variations of the protocol for racial/ethnic patient groups at highest risk for maternal morbidity and mortality, and the identification of biomarker(s) that further specify and quantify risk to the maternal brain and other organ systems when severe hypertension develops. Safer motherhood will happen when evidence for best practice is integrated into systems of care for all

  19. 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…

  20. Referral guidelines: carpal tunnel syndrome.

    PubMed

    Laws, E R

    1997-07-15

    The contribution on the postoperative management and rehabilitation of patients with carpal tunnel syndrome should be carefully considered by every surgeon. The operation is simply not over when the last stitch goes in; careful postoperative management is quite important if one is to obtain optimal surgical results. The principles outlined here are valuable and help to explain the occasional poor outcome. We have become convinced that the use of a dorsal splint in the 1st week to 10 days following surgery is a helpful measure. It is designed to prevent the median nerve from prolapsing forward and becoming adherent to or trapped by the edges of the severed transverse carpal ligament. With regard to surgical management of carpal tunnel syndrome. It is exceedingly important to continue producing outcome studies showing that our interventions really do eliminate the problem and allow people to return to productive work. Templates for outcome assessment are under development by the Outcomes Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons and also by the American College of surgeons. Hopefully, they can be applied to the treatment of carpal tunnel syndrome. The following segment represents some suggested referral guidelines for patients with carpal tunnel syndrome. The present differential diagnosis, methods of confirming the diagnosis, and appropriate indications for considering surgery. These guidelines have been reviewed by the various authors who have contributed to this issue of Neurosurgical Focus and other colleagues in neurosurgery, orthopedics, plastic surgery, neurology, and occupational therapy. It is hoped that they will be a reasonable start in our efforts to inform referring physicians as to the nature of median thenar neuropathy and its overall management.

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

    PubMed

    Raphael, Debbie O; Geiger, Chris A

    2011-01-01

    Local governments like the City and County of San Francisco have shouldered the burden of toxic chemicals released into the environment through the substantial costs of health care, environmental cleanup, and infrastructure to purify drinking water, manage wastewater, and manage solid waste. Cities can no longer afford to wait for federal regulation to prevent toxic chemicals from appearing in products used locally. San Francisco's Precautionary Principle Policy calls on the City to act on early warning signs of harm and to use the best available science to identify safer alternatives. Under its umbrella, a wide array of policy tools have been utilized including financial incentives through procurement contracts, certification and promotion of safer business practices, requirements for information disclosure, and bans and restrictions on the sale of products when safer alternatives are readily available. These policies can often become the models for regional, state, and national change. PMID:22001035

  2. 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. PMID:7798606

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

    PubMed

    Raphael, Debbie O; Geiger, Chris A

    2011-01-01

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

  4. Challenges and approaches for the development of safer immunomodulatory biologics.

    PubMed

    Sathish, Jean G; Sethu, Swaminathan; Bielsky, Marie-Christine; de Haan, Lolke; French, Neil S; Govindappa, Karthik; Green, James; Griffiths, Christopher E M; Holgate, Stephen; Jones, David; Kimber, Ian; Moggs, Jonathan; Naisbitt, Dean J; Pirmohamed, Munir; Reichmann, Gabriele; Sims, Jennifer; Subramanyam, Meena; Todd, Marque D; Van Der Laan, Jan Willem; Weaver, Richard J; Park, B Kevin

    2013-04-01

    Immunomodulatory biologics, which render their therapeutic effects by modulating or harnessing immune responses, have proven their therapeutic utility in several complex conditions including cancer and autoimmune diseases. However, unwanted adverse reactions--including serious infections, malignancy, cytokine release syndrome, anaphylaxis and hypersensitivity as well as immunogenicity--pose a challenge to the development of new (and safer) immunomodulatory biologics. In this article, we assess the safety issues associated with immunomodulatory biologics and discuss the current approaches for predicting and mitigating adverse reactions associated with their use. We also outline how these approaches can inform the development of safer immunomodulatory biologics. PMID:23535934

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

    PubMed Central

    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. PMID:27158494

  6. Paediatric orbital fractures: the importance of regular thorough eye assessment and appropriate referral.

    PubMed

    Kassam, Karim; Rahim, Ishrat; Mills, Caroline

    2013-01-01

    The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated "red flags", and appropriate referral are discussed in this short paper. PMID:24349804

  7. 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

  8. Safer choices: reducing teen pregnancy, HIV, and STDs.

    PubMed Central

    Coyle, K.; Basen-Engquist, K.; Kirby, D.; Parcel, G.; Banspach, S.; Collins, J.; Baumler, E.; Carvajal, S.; Harrist, R.

    2001-01-01

    OBJECTIVES: This study evaluated the long-term effectiveness of Safer Choices, a theory-based, multi-component educational program designed to reduce sexual risk behaviors and increase protective behaviors in preventing HIV, other STDs, and pregnancy among high school students. METHODS: The study used a randomized controlled trial involving 20 high schools in California and Texas. A cohort of 3869 ninth-grade students was tracked for 31 months from fall semester 1993 (baseline) to spring semester 1996 (31-month follow-up). Data were collected using self-report surveys administered by trained data collectors. Response rate at 31-month follow-up was 79%. RESULTS: Safer Choices had its greatest effect on measures involving condom use. The program reduced the frequency of intercourse without a condom during the three months prior to the survey, reduced the number of sexual partners with whom students had intercourse without a condom, and increased use of condoms and other protection against pregnancy at last intercourse. Safer Choices also improved 7 of 13 psychosocial variables, many related to condom use, but did not have a significant effect upon rates of sexual initiation. CONCLUSIONS: The Safer Choices program was effective in reducing important risk behaviors for HIV, other STDs, and pregnancy and in enhancing most psychosocial determinants of such behavior. PMID:11889277

  9. Exercise in the 70s--Implications for Safer Practices.

    ERIC Educational Resources Information Center

    Morehouse, Chauncey A.

    1981-01-01

    Precautionary measures that should be taken by individuals to provide for safer participation in a vigorous exercise program are outlined, including the need for physical examinations, physical conditioning and warm-up, proper clothing and equipment, and awareness of environmental hazards. (JMF)

  10. Identifying Subtypes of Spousal Assaulters Using the B-SAFER

    ERIC Educational Resources Information Center

    Thijssen, Jill; de Ruiter, Corine

    2011-01-01

    In the present study, a structured risk assessment instrument for intimate partner violence, the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER), was coded for 146 files of spousal assault cases from the Dutch probation service, dating from 2004 and 2005. The aim of the study was twofold: (a) to validate Holtzworth-Munroe and…

  11. 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.

  12. Making Children, Families, and Communities Safer from Violence.

    ERIC Educational Resources Information Center

    National Crime Prevention Council, Washington, DC.

    There is something everyone can do to combat violence. The highest priority is making oneself and one's family safer from violence. Parents should consider carefully about having weapons, especially firearms, in the home, since statistics show that a firearm in the home is more than forty times as likely to injure or kill a family member as to…

  13. 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....

  14. 49 CFR 655.62 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 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....

  15. Elevated levels of serum creatinine: recommendations for management and referral

    PubMed Central

    Mendelssohn, D C; Barrett, B J; Brownscombe, L M; Ethier, J; Greenberg, D E; Kanani, S D; Levin, A; Toffelmire, E B

    1999-01-01

    BACKGROUND: The potential benefits of earlier referral to a nephrologist of patients with elevated levels of serum creatinine include identifying and treating reversible causes of renal failure, slowing the rate of decline associated with progressive renal insufficiency, managing the coexisting conditions associated with chronic renal failure and facilitating efficient entry into dialysis programs for all patients who might benefit. METHODS: A subcommittee of the Canadian Society of Nephrology, which included representatives from family practice and internal medicine, conducted a MEDLINE search for the period 1966 to 1998 using the key words referral and consultation, dialysis, hemodialysis, peritoneal dialysis, renal replacement therapy and kidney diseases. Where published evidence was lacking, conclusions were reached by consensus. GUIDELINES: Earlier referral to nephrologists of patients with elevated creatinine levels is expected to lead to better health care outcomes and lower costs for both the patients and the health care system. All patients with newly discovered renal insufficiency (as evidenced by serum creatinine elevated to a level above the upper limit of the normal range of that laboratory, adjusted for age and height in children) must undergo investigations to determine the potential reversibility of disease, to evaluate the prognosis and to optimize planning of care. All patients with an established, progressive increase in serum creatinine level should be followed with a nephrologist. Adequate preparation for dialysis or transplantation (or both) requires at least 12 months of relatively frequent contact with a renal care team. Nephrologists should provide consultation in a timely manner for any patient with an elevated serum creatinine level. In addition, they should provide advice about what aspects of the condition require particularly urgent or emergency assessment. SPONSORS: This clinical practice guideline has been endorsed by the Canadian

  16. Physiatrist referral preferences for postacute stroke rehabilitation.

    PubMed

    Cormier, David J; Frantz, Megan A; Rand, Ethan; Stein, Joel

    2016-08-01

    This study was intended to determine if there is variation among physiatrists in referral preferences for postacute rehabilitation for stroke patients based on physician demographic characteristics or geography.A cross-sectional survey study was developed with 5 fictional case vignettes that included information about medical, social, and functional domains. Eighty-six physiatrist residents, fellows, and attendings were asked to select the most appropriate postacute rehabilitation setting and also to rank, by importance, 15 factors influencing the referral decision. Chi-square bivariate analysis was used to analyze the data.Eighty-six surveys were collected over a 3-day period. Bivariate analysis (using chi-square) showed no statistically significant relationship between any of the demographic variables and poststroke rehabilitation preference for any of the cases. The prognosis for functional outcome and quality of postacute facility had the highest mean influence ratings (8.63 and 8.31, respectively), whereas location of postacute facility and insurance had the lowest mean influence ratings (5.74 and 5.76, respectively).Physiatrists' referral preferences did not vary with any identified practitioner variables or geographic region; referral preferences only varied significantly by case. PMID:27537563

  17. 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... compliance negotiations or if negotiations are unsuccessful, the designated agency shall refer the matter...

  18. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Referrals to the... Justice, Washington DC. (2) Debts for which the principal amount is $1,000,000 or less, or such other... part and 31 CFR parts 900 through 904, debts shall be referred to Justice as early as possible, and,...

  19. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Referrals to the... Justice, Washington DC. (2) Debts for which the principal amount is $1,000,000 or less, or such other... part and 31 CFR parts 900 through 904, debts shall be referred to Justice as early as possible, and,...

  20. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Referrals to the... Justice, Washington DC. (2) Debts for which the principal amount is $1,000,000 or less, or such other... part and 31 CFR parts 900 through 904, debts shall be referred to Justice as early as possible, and,...

  1. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Welfare Department of Health and Human Services GENERAL ADMINISTRATION CLAIMS COLLECTION Referrals to the... Justice, Washington DC. (2) Debts for which the principal amount is $1,000,000 or less, or such other... part and 31 CFR parts 900 through 904, debts shall be referred to Justice as early as possible, and,...

  2. Understanding the Process of Medical Referral

    PubMed Central

    Muzzin, Linda J.

    1991-01-01

    In a study of 50 referrals, family physicians were shown to choose consultants whom they trusted. They had previously worked with them or had indirect evidence, including patient reports, of their technical and communication skills and effectiveness with patients. By trial and error, “good” ones were retained and “bad” ones - including those not trusted by patients - were avoided. PMID:20469520

  3. 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…

  4. Gifted Girls: Gender Bias in Gifted Referrals

    ERIC Educational Resources Information Center

    Bianco, Margarita; Harris, Bryn; Garrison-Wade, Dorothy; Leech, Nancy

    2011-01-01

    The goal of this mixed-methods study was to explore the effect of gender on teachers' willingness to refer students to a gifted and talented program. Teachers (N = 28) were provided with one of two profiles (i.e., female or male) describing a gifted student. Results indicated that teachers' decisions for referral to gifted programs were…

  5. 45 CFR 30.33 - Prompt referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... part and 31 CFR parts 900 through 904, debts shall be referred to Justice as early as possible, and, in... Department of Justice of any payments credited by the Department to the debtor's account. Pursuant to 31 CFR... Department of Justice § 30.33 Prompt referral. (a)(1) The Secretary promptly shall refer to Justice...

  6. Descriptive Analysis of Selected Data Referral Networks.

    ERIC Educational Resources Information Center

    MAXIMA Corp., Silver Spring, MD.

    The National Environmental Data Referral Service (NEDRES) is being developed in response to a national need to improve the awareness of and access to a broad range of environmental data files. Two studies were conducted in support of this effort: a survey of prospective users confirming the need for and willingness to pay fees for the service and…

  7. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Referrals. 2001.34 Section 2001.34 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification §...

  8. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 6 2012-07-01 2012-07-01 false Referrals. 2001.34 Section 2001.34 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification §...

  9. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Referrals. 2001.34 Section 2001.34 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification §...

  10. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Referrals. 2001.34 Section 2001.34 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification §...

  11. 32 CFR 2001.34 - Referrals.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 6 2014-07-01 2014-07-01 false Referrals. 2001.34 Section 2001.34 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Declassification §...

  12. 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…

  13. 48 CFR 1419.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Referral. 1419.602-1 Section 1419.602-1 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Responsibility...

  14. 48 CFR 419.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Referral. 419.602-1 Section 419.602-1 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Responsibility...

  15. 48 CFR 2819.602-1 - Referral.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Referral. 2819.602-1 Section 2819.602-1 Federal Acquisition Regulations System DEPARTMENT OF JUSTICE Socioeconomic Programs SMALL BUSINESS PROGRAMS Certificates of Competency and Determinations of Eligibility 2819.602-1...

  16. 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

  17. Information and Referral Services: The Resource File.

    ERIC Educational Resources Information Center

    Long, Nicholas; And Others

    This manual was prepared to assist managers of information and referral (I&R) services to develop and maintain an adequate file of resources for the I&R center. Topics covered include preliminary planning, time estimates for set-up and file up-dating; the concept of recruiting volunteers to help operate the center and training that would be…

  18. 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...

  19. 8 CFR 235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form...

  20. 8 CFR 235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form...

  1. 8 CFR 235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form...

  2. 8 CFR 235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form...

  3. 8 CFR 235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form...

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

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 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. 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...

  6. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 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...

  7. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 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...

  8. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 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...

  9. 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...

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

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 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...

  11. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 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...

  12. 10 CFR 1014.7 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 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...

  13. 24 CFR 17.9 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 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...

  14. 29 CFR 500.224 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... REGULATIONS MIGRANT AND SEASONAL AGRICULTURAL WORKER PROTECTION Administrative Proceedings Referral for Hearing § 500.224 Referral to Administrative Law Judge. (a) Upon receipt of a timely request for a hearing... 29 Labor 3 2010-07-01 2010-07-01 false Referral to Administrative Law Judge. 500.224 Section...

  15. Handedness, Birth Order, Reading Problems: Referrals to a School Psychologist.

    ERIC Educational Resources Information Center

    Altus, Grace T.; Altus, William D.

    To investigate the influence of handedness in the referral of elementary school students to a school psychologist, 120 left-handed referrals were matched with 120 right-handed referrals by sex, full-scale intelligence quotient, and chronological age. Comparison of the groups revealed that twins were more numerous among the left-handed students.…

  16. Chicago's Safer Foundation: A Road Back for Ex-Offenders. Program Focus.

    ERIC Educational Resources Information Center

    Finn, Peter

    The Safer Foundation in Chicago, Illinois, is the largest community-based provider of employment services for ex-offenders in the United States. Established in 1972, Safer has a professional staff of nearly 200 in 6 locations. Safer runs a private school, called the PACE (Programmed Activities for Correctional Education) Institute, at the Cook…

  17. Integrating zebrafish toxicology and nanoscience for safer product development

    PubMed Central

    Kim, Ki-Tae; Tanguay, Robert L.

    2013-01-01

    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. PMID:23772181

  18. Breast clinic triage tool: telephone assessment of new referrals.

    PubMed

    Cusack, Leila; Brennan, Meagan; Weissenberg, Leisha; Moore, Katrina

    2012-04-01

    Efficient systems to triage increasing numbers of new referrals to breast clinics are needed, to optimise the management of patients with cancer and benign disease. A tool was developed to triage the urgency of referrals and allocate the most appropriate clinician consultation (surgeon or breast physician (BP)). 259 consecutive new referrals were triaged using the tool. 100% new cancers and 256 (98.8%) referrals overall were triaged to both appropriate category of urgency and the appropriate clinician. This triage tool provides a simple method for assessing new referrals to a breast clinic and can be easily delivered by trained administrative staff by telephone.

  19. Perception of HIV and safer sexual behaviors among lesbians.

    PubMed

    Fishman, Seja Joyce; Anderson, Elizabeth H

    2003-01-01

    There is little data on female-to-female transmission of HIV. Some women who have sex with women (WSW) have other high-risk behaviors that could lead to HIV infection. The belief that WSW are at no risk may lead to unsafe sexual practices. In this study, a convenience sample of 78 women was surveyed in order to explore the perception of HIV risk among lesbians, their sexual behaviors, and their sources of information about safer sex. Fifty-three percent reported they were at low risk for contracting HIV. Women reported knowledge of barrier methods (89% to 99%) and no sex during menstruation (92%). However, 35% to 40% reported no knowledge of less common safer sex practices. Women reported their source of knowledge as media (36%), workshops (22%), and friends (12%). Eighty-five percent stated that their health care provider knew they were lesbian, but only 15% reported receiving safer sex education. Nurses and nurse practitioners are aptly poised to provide critical HIV education and health care for this population.

  20. Comparison of specialty referral patterns of primary care providers.

    PubMed

    Fisher, Linda W

    2002-01-01

    Difficulty, perceived by 17 treatment facilities, of obtaining specialty referral appointments at Dwight David Eisenhower Army Medical Center (DDEAMC), a major referral center, prompted this study that utilizes provider profiling as a tool to answer three questions that examine the problem: (1) Is the difficulty in obtaining referral appointments real or perceived? (2) Are the referral patterns of the providers contributing factors in the perceived inability to meet the demand for specialty appointments? (3) If the providers' referral patterns are a contributing factor, which provider behaviors need to be modified? Major findings of the study included: 1. the referral rate of the primary care providers was 8 percent, compared to the national average of 7.5 percent; 2. interns and residents were provider outliers with referral rates of 11.7 percent and 13.5 percent, respectively; and 3. of the 32,182 referral appointments requested during Fiscal Year 1999, slightly less than 2.4 percent were disengaged. Data analysis indicates opportunities for improvement of referral rates in DDEAMC's department of primary care by addressing the referral practices of residents and interns, which will therefore decrease the number of disengaged patients. By decreasing the number of referrals, the organization will more effectively control internal costs in an era of shrinking budgets. PMID:12055901

  1. 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

  2. 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.

  3. Assisting gay men to maintain safer sex: an evaluation of an AIDS service organization's safer sex maintenance program.

    PubMed

    Miller, R L

    1995-01-01

    As the second decade of the AIDS crisis unfolds, increasing concern has been raised that the widespread adoption of condom use that occurred among gay men in the 1980s is not being maintained. Most interventions to promote condom use among gay men are delivered by community-based organizations via programs that are virtually undocumented; little is known about their effectiveness, or the processes by which they may work. This study describes safer sex practices among self-identified gay men following their participation in an intervention developed and implemented by a community-based organization. The intervention was designed to enhance men's attitudes, beliefs, and self-efficacy expectations to maintain safer sex. Among 150 men with complete data at both assessments, self-reported condom use was low. Men reported using condoms more consistently for anal sexual behavior than oral sexual behavior, but there were men who reported consistent unprotected anal sexual intercourse. The intervention had little impact on patterns of behavior over time, although desired changes in attitudes, beliefs, and self-efficacy expectations were evidenced following the intervention. The results suggest the importance of assisting community-based organizations to document program models. Findings also suggest that community-based organizations can develop interventions to successfully enhance factors that theoretically support maintenance of safer sexual behaviors.

  4. Improving referral compliance after public cholesterol screening.

    PubMed Central

    Maiman, L A; Hildreth, N G; Cox, C; Greenland, P

    1992-01-01

    BACKGROUND. Noncompliance with referral to a physician for retesting and diagnosis is a concern in public cholesterol screening. METHODS. Participants (n = 2109) were referred by a health professional or lay communicator and randomly assigned to a coupon offer, referral reminder letter, or control group. A questionnaire was completed at screening, and a telephone interview was conducted 5 months later. RESULTS. Physician visit rates showed no professional or lay differences. For "no history" subjects, the behavioral interventions were effective compared with controls (coupon = 60.7% and reminder = 57.7% vs control = 46.1%). With professional counseling, only the coupon was effective; for lay counseling, both coupon and reminder yielded higher visit rates. Adjusted for sociodemographics, heart disease risk factors, and health perceptions, the intervention effects remained (professional-coupon offer: odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.21, 3.09; professional-reminder letter: OR = 1.04, 95% CI = 0.67, 1.63; lay-coupon offer: OR = 2.52, 95% CI = 1.52, 4.18; and lay-reminder letter: OR = 3.10, 95% CI = 1.83, 5.22). CONCLUSIONS. For unaware participants, lay counselors and referral follow-up efforts tailored to specific cholesterol risk groups are indicated. PMID:1316721

  5. 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. PMID:20436330

  6. 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…

  7. 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.

  8. 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.

  9. 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."

  10. 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.

  11. 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

  12. 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

  13. Screening, Brief Intervention, and Referral to Treatment.

    PubMed

    Borus, Joshua; Parhami, Iman; Levy, Sharon

    2016-10-01

    Screening, Brief Intervention, and Referral to Treatment is a quick, effective technique with which to manage substance use in adolescents and young adults. Use of a validated measure for detecting substance use and abuse is significantly more effective than unvalidated tools or provider intuition. There are a variety of validated tools available to use in the adolescent/young adult population, and there are opportunities to increase the efficiency and scalability of screening by using computerized questionnaires. This area continues to evolve rapidly. PMID:27613340

  14. Physician Factors Associated with Outpatient Palliative Care Referral

    PubMed Central

    Ahluwalia, Sangeeta C.; Fried, Terri R.

    2010-01-01

    Background Outpatient palliative care can provide significant benefits to seriously ill patients, but several barriers to appropriate referrals remain. No study has examined the physician factors associated with referral to outpatient palliative care. Objective To determine physician factors, with a focus on physician beliefs, associated with referral to palliative care. Design Cross-sectional study of 170 primary care physicians at Kaiser Permanente (KP), a large nonprofit health maintenance organization (HMO), using a self-administered questionnaire. Results Of the 145 respondents, 100 (70%) reported referring any patients to the palliative care program in the prior year, with a median of 3 referrals (interquartile range 2, 6). Factors associated with referral included working at KP between 10 and 20 years as compared to <10 years [Odds ratio [OR] 6.29 (95% confidence interval [CI] 1.38, 28.6)] and having personal experience with palliative care [OR 2.13 (95% CI 0.95, 4.976)]. None of the beliefs scales was associated with referral. Conclusions Physician characteristics other than their beliefs about palliative care played a significant role in determining referral. Palliative care programs should aim to increase their visibility in the outpatient setting to increase referrals by primary care physicians. Tools that help physicians identify seriously ill patients who could benefit from palliative care may also serve to increase appropriate referrals. PMID:19460830

  15. 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…

  16. Information and Referral Services: Information-Giving and Referral (Working Draft, 2nd Revision).

    ERIC Educational Resources Information Center

    Tessari, Diane C.; And Others

    The basic linkage service of an information and Referral (I and R) center is discussed in this manual. By itself, information-giving can be very important. It helps make people in a community more aware of the services available to them, and it can go a long way toward making their lives healthier and happier. In addition, if records are properly…

  17. 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.

  18. 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

  19. Dropping the Baton: Specialty Referrals in the United States

    PubMed Central

    Mehrotra, Ateev; Forrest, Christopher B; Lin, Caroline Y

    2011-01-01

    Context: In the United States, more than a third of patients are referred to a specialist each year, and specialist visits constitute more than half of outpatient visits. Despite the frequency of referrals and the importance of the specialty-referral process, the process itself has been a long-standing source of frustration among both primary care physicians (PCPs) and specialists. These frustrations, along with a desire to lower costs, have led to numerous strategies to improve the specialty-referral process, such as using gatekeepers and referral guidelines. Methods: This article reviews the literature on the specialty-referral process in order to better understand what is known about current problems with the referral process and what solutions have been proposed. The article first provides a conceptual framework and then reviews prior literature on the referral decision, care coordination including information transfer, and access to specialty care. Findings: PCPs vary in their threshold for referring a patient, which results in both the underuse and the overuse of specialists. Many referrals do not include a transfer of information, either to or from the specialist; and when they do, it often contains insufficient data for medical decision making. Care across the primary-specialty interface is poorly integrated; PCPs often do not know whether a patient actually went to the specialist, or what the specialist recommended. PCPs and specialists also frequently disagree on the specialist's role during the referral episode (e.g., single consultation or continuing co-management). Conclusions: There are breakdowns and inefficiencies in all components of the specialty-referral process. Despite many promising mechanisms to improve the referral process, rigorous evaluations of these improvements are needed. PMID:21418312

  20. 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

  1. 24 CFR 576.102 - Emergency shelter component.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... progress; (F) Providing information and referrals to other providers; (G) Providing ongoing risk assessment... outpatient treatment of medical conditions and are provided by licensed medical professionals. Emergency... their health needs; providing directly or assisting program participants to obtain appropriate...

  2. 24 CFR 576.102 - Emergency shelter component.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... progress; (F) Providing information and referrals to other providers; (G) Providing ongoing risk assessment... outpatient treatment of medical conditions and are provided by licensed medical professionals. Emergency... their health needs; providing directly or assisting program participants to obtain appropriate...

  3. 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.

  4. A Safer Cigarette? A Comparative Study. A Consensus Report.

    PubMed

    2000-01-01

    This special issue describes the scientific progress and scientific review process to develop a safer cigarette. A peer-review panel, the ECLIPSE Expert Panel, was convened to critically review the potential health hazards of this new cigarette to a reference, conventional cigarette that bums tobacco. This new cigarette is lit and smoked much like other cigarettes, but it burns very little tobacco and paper. Also, unlike other cigarettes, it does not burn down to a butt, nor does it produce loose ash. Such a product would be expected to have less "tar" and other combustion products than cigarettes that burn tobacco and should greatly reduce any sidestream smoke. This panel assessed the chemistry and physical characteristics, as well as the biological activity, of this new cigarette.

  5. 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.

  6. 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.

  7. The Relationship of Season of Birth and Special Education Referral.

    ERIC Educational Resources Information Center

    Wallingford, Elizabeth L.; Prout, H. Thompson

    2000-01-01

    Study evaluated referrals of students (N=1,222) for special education from grades K-5 to determine if youngest children were experiencing a higher rate of referral. Data confirmed the hypothesis that children referred for evaluations within the 5- to 7-year-old-group had summer birthdates. Article discusses ways of providing educational services…

  8. 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…

  9. 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... DISPUTE ADJUDICATION PROCEDURES § 902.3 Referral to Dispute Resolution Committee. (a) The five person Dispute Resolution Committee membership shall be determined according to Compact Article VI (g). Should...

  10. 29 CFR 1601.29 - Referral to the Attorney General.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Referral to the Attorney General. 1601.29 Section 1601.29... of Civil Actions § 1601.29 Referral to the Attorney General. If the Commission is unable to obtain... shall inform the Attorney General of the appropriate facts in the case with recommendations for...

  11. 45 CFR 30.36 - Minimum amount of referrals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Minimum amount of referrals. 30.36 Section 30.36... to the Department of Justice § 30.36 Minimum amount of referrals. (a) Except as in paragraph (b) of... such other amount as the Attorney General may prescribe, shall not be referred for litigation. (b)...

  12. 29 CFR 102.172 - Minimum referral amount.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Minimum referral amount. 102.172 Section 102.172 Labor... Procedures By Federal Income Tax Refund Offset § 102.172 Minimum referral amount. The minimum amount of a... business debtors. The amount referred may include the principal portion of the debt, as well as any...

  13. 32 CFR 727.9 - Referrals to civilian lawyers.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 5 2012-07-01 2012-07-01 false Referrals to civilian lawyers. 727.9 Section 727.9 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL LEGAL ASSISTANCE § 727.9 Referrals to civilian lawyers. (a) General. If it is determined that the legal...

  14. 45 CFR 31.4 - Certification and referral of debt.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Certification and referral of debt. 31.4 Section... § 31.4 Certification and referral of debt. (a) Certification. The Secretary shall certify to FMS that: (1) The debt is past-due and legally enforceable in the amount submitted and that the Department...

  15. 25 CFR 700.139 - Referral for action.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 2 2011-04-01 2011-04-01 false Referral for action. 700.139 Section 700.139 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Relocation Requirements § 700.139 Referral for action. Upon the expiration of all notice periods and upon...

  16. 25 CFR 700.139 - Referral for action.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 2 2013-04-01 2013-04-01 false Referral for action. 700.139 Section 700.139 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Relocation Requirements § 700.139 Referral for action. Upon the expiration of all notice periods and upon...

  17. 25 CFR 700.139 - Referral for action.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 2 2012-04-01 2012-04-01 false Referral for action. 700.139 Section 700.139 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Relocation Requirements § 700.139 Referral for action. Upon the expiration of all notice periods and upon...

  18. 25 CFR 700.139 - Referral for action.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Referral for action. 700.139 Section 700.139 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Relocation Requirements § 700.139 Referral for action. Upon the expiration of all notice periods and upon...

  19. 8 CFR 1235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration...

  20. 8 CFR 1235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration...

  1. 8 CFR 1235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration...

  2. 8 CFR 1235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration...

  3. 8 CFR 1235.6 - Referral to immigration judge.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration...

  4. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... applies when a Federal, State, or local court holds in abeyance, or refers to the Commissioner, any matter... promptly agree or decline to accept a court referral. Whenever feasible in light of agency priorities and resources, the Commissioner shall agree to accept a referral and shall proceed to determine the...

  5. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... applies when a Federal, State, or local court holds in abeyance, or refers to the Commissioner, any matter... promptly agree or decline to accept a court referral. Whenever feasible in light of agency priorities and resources, the Commissioner shall agree to accept a referral and shall proceed to determine the...

  6. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... applies when a Federal, State, or local court holds in abeyance, or refers to the Commissioner, any matter... promptly agree or decline to accept a court referral. Whenever feasible in light of agency priorities and resources, the Commissioner shall agree to accept a referral and shall proceed to determine the...

  7. 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...

  8. 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...

  9. 21 CFR 10.60 - Referral by court.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Referral by court. 10.60 Section 10.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE PRACTICES AND PROCEDURES General Administrative Procedures § 10.60 Referral by court. (a) This...

  10. Best practices in developmental screening and referral for young children.

    PubMed

    Myers, Lynnea

    2014-12-13

    Developmental screening is recommended by the American Academy of Pediatrics as best practice to identify children with developmental delays. Nurse practitioners play a critical role in developmental screening and referral. This article describes best practices in developmental screening and referral resources available to NPs performing developmental screening. PMID:25397740

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 33 2014-07-01 2014-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  16. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 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...

  17. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 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...

  18. 7 CFR 3.21 - Referrals of Debts to Justice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... 7 Agriculture 1 2012-01-01 2012-01-01 false Referrals of Debts to Justice. 3.21 Section...

  19. 7 CFR 3.21 - Referrals of Debts to Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... 7 Agriculture 1 2013-01-01 2013-01-01 false Referrals of Debts to Justice. 3.21 Section...

  20. 7 CFR 3.21 - Referrals of Debts to Justice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... 7 Agriculture 1 2014-01-01 2014-01-01 false Referrals of Debts to Justice. 3.21 Section...

  1. 29 CFR 15.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 1 2012-07-01 2012-07-01 false 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... Referral to Department of Justice. An award, compromise or settlement of a claim under section 2672...

  2. 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... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  3. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 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...

  4. 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...

  5. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 34 2013-07-01 2013-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

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

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... 7 Agriculture 1 2010-01-01 2010-01-01 false Referrals of Debts to Justice. 3.21 Section...

  7. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 34 2012-07-01 2012-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  8. 40 CFR 1620.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 33 2011-07-01 2011-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  9. 5 CFR 177.108 - Referral to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 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...

  10. 7 CFR 3.21 - Referrals of Debts to Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... 7 Agriculture 1 2011-01-01 2011-01-01 false Referrals of Debts to Justice. 3.21 Section...

  11. 40 CFR 1504.3 - Procedure for referrals and response.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... importance and request the referring and lead agencies to pursue their decision process. (5) Determine that... Procedure for referrals and response. (a) A Federal agency making the referral to the Council shall: (1...) Contain a finding by the agency whether the issue raised is of national importance because of the...

  12. 40 CFR 304.21 - Referral of claims.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... CLAIMS Jurisdiction of Arbitrator, Referral of Claims, and Appointment of Arbitrator § 304.21 Referral of... submitted pursuant to the procedures established by this part by an Arbitrator appointed pursuant to § 304... effective, any such modification must be signed by the Arbitrator and all other parties. The joint...

  13. Developing At-Risk Referral Procedures for Rural Areas.

    ERIC Educational Resources Information Center

    Olson, Jennifer; Bostick, Mary

    1986-01-01

    A screening and referral procedure for rural, at-risk infants was developed by a three-step process that: (1) identified key professionals; (2) educated rural medical personnel regarding benefits and strategies of early intervention; and (3) implemented a screening and referral system with low temporal and monetary costs for hospital personnel.…

  14. 32 CFR 516.36 - Referral to Litigation Division.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Referral to Litigation Division. 516.36 Section... Property Claims Assertion of Other Claims § 516.36 Referral to Litigation Division. (a) General. The... channels to Litigation Division with a litigation report. (See § 516.23 of this part). (b)...

  15. 49 CFR 199.243 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... for drugs, as directed by the substance abuse professional, to be performed in accordance with 49 CFR... 49 Transportation 3 2011-10-01 2011-10-01 false Referral, evaluation, and treatment. 199.243... ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.243 Referral, evaluation, and treatment. (a)...

  16. 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... contract to provide treatment for alcohol problems on behalf of the operator; (3) The sole source of... 49 Transportation 3 2010-10-01 2010-10-01 false Referral, evaluation, and treatment....

  17. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  18. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  19. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  20. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  1. 5 CFR 880.202 - Referral to Associate Director.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Referral to Associate Director. 880.202... § 880.202 Referral to Associate Director. Any OPM office that receives information concerning the possibility that an annuitant might have disappeared will notify the Associate Director....

  2. 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.

  3. Recommendations for safer radiotherapy: what’s the message?

    PubMed Central

    Dunscombe, Peter

    2012-01-01

    Radiotherapy, with close to a million courses delivered per year in North America, is a very safe and effective intervention for a devastating disease. However, although rare, several deeply regrettable incidents have occurred in radiotherapy and have rightly been the subject of considerable public interest. Partly in response to reports of these incidents a variety of authoritative organizations across the globe has harnessed the expertise amongst their members in attempts to identify the measures that will make radiotherapy safer. While the intentions of all these organizations are clearly good it is challenging for the health care providers in the clinic to know where to start with so much advice coming from so many directions. Through a mapping exercise we have identified commonalities between recommendations made in seven authoritative documents and identified those issues most frequently cited. The documents reviewed contain a total of 117 recommendations. Using the 37 recommendations in “Towards Safer Radiotherapy” as the initial base layer, recommendations in the other documents were mapped, adding to the base layer to accommodate all the recommendations from the additional six documents as necessary. This mapping exercise resulted in the distillation of the original 117 recommendations down to 61 unique recommendations. Twelve topics were identified in three or more of the documents as being pertinent to the improvement of patient safety in radiotherapy. They are, in order of most to least cited: training, staffing, documentation, incident learning, communication, check lists, quality control and preventive maintenance, dosimetric audit, accreditation, minimizing interruptions, prospective risk assessment, and safety culture. This analysis provides guidance for the selection of those activities most likely to enhance safety and quality in radiotherapy based on the frequency of citation in selected recent authoritative literature. PMID:23061045

  4. Online referral and OPD booking from the GP desktop.

    PubMed

    Nicholson, Caroline; Jackson, Claire L; Wright, Bernadette; Mainwaring, Paul; Holliday, Dimity; Lankowski, Andrew; Kardash, Christine

    2006-08-01

    The Brisbane Inner South E-referral Project (BISEP) developed an application which allowed general practitioners, from their desktop, to successfully search for and book an available hospital outpatient appointment for patients with suspected cancer, send the referral electronically, and inform the patient of both the appointment and referral during the consultation. The hospital changed their outpatient department processes to allow such functionality for local GPs with patients with suspected cancer, working from a mutually agreed set of best practice referral criteria. A group of 19 GPs participated in an 11-week pilot implementation of the application, and were enthusiastic about continuing and expanding the approach. Patient satisfaction measures post intervention indicated that they perceived no major disadvantage in this form of outpatient department referral. PMID:16879099

  5. 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…

  6. Neurosarcoidosis in a Tertiary Referral Center

    PubMed Central

    Leonhard, Sonja E.; Fritz, Daan; Eftimov, Filip; van der Kooi, Anneke J.; van de Beek, Diederik; Brouwer, Matthijs C.

    2016-01-01

    Abstract The aim of this study was to evaluate clinical characteristics, diagnostic strategy, and treatment in patients with neurosarcoidosis in a tertiary referral centre. In a cross-sectional study, we included all patients with neurosarcoidosis treated at our tertiary referral center between September 2014 and April 2015. We identified 52 patients, among them 1 patient was categorized as having definite neurosarcoidosis, 37 probable neurosarcoidosis, and 14 possible neurosarcoidosis. Neurologic symptoms were the first manifestation of sarcoidosis in 37 patients (71%). Chronic aseptic meningitis was the most common presentation (19/52 patients [37%]), followed by cranial neuropathy (16/52 patients [31%]). Serum angiotensin-converting enzyme and lysozyme levels were elevated in 18 of 41 (44%) and 12 of 26 cases (46%). Pulmonary or lymph node sarcoidosis was identified by chest X-ray in 21 of 39 cases (54%) and by computed tomography of the chest in 25 of 31 cases (81%); 18Fluorodeoxyglucose-Positron emission tomography showed signs of sarcoidosis in 15 of 19 cases (79%). Thirty-one of the 46 cases receiving treatment (67%) improved, 13 cases (28%) stabilized, and 2 cases (4%) deteriorated. First-line treatment with corticosteroids resulted in satisfactory reduction of symptoms in 21 of 43 patients (49%). Seventeen patients (33%) needed second-line cytostatic treatment, and 10 patients (19%) were treated with tumor necrosis factor-α inhibitors. The majority of patients with neurosarcoidosis present with chronic meningitis without a history of systemic sarcoidosis. The diagnosis can be difficult to make because of the poor sensitivity of most diagnostic tests. Half of patients had a satisfactory reduction of symptoms on first-line therapy. PMID:27057889

  7. 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…

  8. 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.

  9. 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

  10. Impact of referral transport system on institutional deliveries in Haryana, India

    PubMed Central

    Prinja, Shankar; Jeet, Gursimer; Kaur, Manmeet; Aggarwal, Arun Kumar; Manchanda, Neha; Kumar, Rajesh

    2014-01-01

    Background & objectives: Creation of a strong referral transport network across the country is necessary for improving physical access to public sector health facilities. In this study we evaluated the referral transport services in Haryana, i.e. Haryana Swasthya Vaahan Sewa (HSVS), now known as National Ambulance Service (NAS), to assess the extent and pattern of utilization, and to ascertain its effect on public sector institutional deliveries. Methods: Secondary data on 116,562 patients transported during April to July 2011 in Haryana state were analysed to assess extent and pattern of NAS utilization. Exit interviews were conducted with 270 consecutively selected users and non- users of referral services respectively in Ambala (High NAS utilization), Hisar (medium utilization) and Narnaul (low utilization) districts. Month-wise data on institutional deliveries in public facilities during 2005-2012 were collected in these three districts, and analysed using interrupted time series analysis to assess the impact of NAS on institutional deliveries. Results: Female gender (OR = 77.7), rural place of residence (OR = 5.96) and poor socio-economic status (poorest wealth quintile OR = 2.64) were significantly associated with NAS ambulance service usage. Institutional deliveries in Haryana rose significantly after the introduction of NAS service in Ambala (OR=137.4, 95% CI=22.4-252.4) and Hisar (OR=215, 95% CI=88.5-341.3) districts. No significant increase was observed in Narnaul (OR=4.5, 95% CI= -137.4 to 146.4) district. Interpretation & conclusions: The findings of the present study showed a positive effect of referral transport service on increasing institutional deliveries. However, this needs to be backed up with adequate supply of basic and emergency obstetric care at hospitals and health centres. PMID:25109723

  11. 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.

  12. New "safer sex initiative" stresses "it takes two".

    PubMed

    1994-11-01

    Until very recently, no major manufacturer of oral contraceptives was willing to provide concrete education about STDs. Wyeth-Ayerst Laboratories recently launched its Nordette Safer Sex Initiative: a pouch containing a pack of Nordette pills, illustrated educational materials about oral contraceptives including health benefits and use instructions, instructions for protection against sexually transmitted diseases (STD), a sample Ramses condom from Schmid Laboratories, and a discount coupon toward future condom purchases. Ortho subsequently released a patient education program/package including a Lifestyles condom. This latter kit includes self-assessment questionnaires designed to help women rate their risk for STDs, and videotapes for both the patient and the provider. The kit is a box containing the sample condom, a pack of pills, a reference card to explain start dates, a question and answer booklet, and an audiocassette describing how the pill works. These collaborative programs between oral contraceptive manufacturers and condom manufacturers is welcomed as a real breakthrough by numerous reproductive health organizations and providers. The Wyeth program is actually a pilot program offered to 16,000 office-based obstetrician/gynecologists, but it is being considered for distribution to federally-funded clinics. For its part, the entire Ortho kit is available only to physicians, but the company is offering some of the material free to federally-funded clinics. PMID:12289956

  13. The Nuclear Posture Review (NPR) : are we safer?

    SciTech Connect

    Brune, Nancy E.

    2010-07-01

    Nuclear Posture Review (NPR) is designed to make world safer by reducing the role of U.S. nuclear weapons and reducing the salience of nuclear weapons. U.S. also seeks to maintain a credible nuclear deterrent and reinforce regional security architectures with missile defenses and other conventional military capabilities. But recent studies suggest that nuclear proliferation is a direct response to the perceived threat of U.S. conventional capabilities not U.S. nuclear stockpile. If this is true, then the intent of the NPR to reduce the role and numbers of nuclear weapons and strengthen conventional military capabilities may actually make the world less safe. First stated objective of NPR is to reduce the role and numbers of U.S. nuclear weapons, reduce the salience of nuclear weapons and move step by step toward eliminating them. Second stated objective is a reaffirmation of U.S. commitment to maintaining a strong deterrent which forms the basis of U.S. assurances to allies and partners. The pathway - made explicit throughout the NPR - for reducing the role and numbers of nuclear weapons while maintaining a credible nuclear deterrent and reinforcing regional security architectures is to give conventional forces and capabilities and missile defenses (e.g. non-nuclear elements) a greater share of the deterrence burden.

  14. Can we select health professionals who provide safer care

    PubMed Central

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

    2003-01-01

    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. PMID:14645743

  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. PMID:26301703

  16. 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.

  17. 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

  18. [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.

  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

    2013-05-01

    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.

  20. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  1. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  2. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  3. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  4. 29 CFR 801.63 - Referral to Administrative Law Judge.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... for the Secretary upon the person requesting the hearing, in the manner provided in 29 CFR 18.3. ... APPLICATION OF THE EMPLOYEE POLYGRAPH PROTECTION ACT OF 1988 Administrative Proceedings Referral for...

  5. Making effective referrals: a knowledge-management approach.

    PubMed Central

    Einbinder, J. S.; Klein, D. A.; Safran, C. S.

    1997-01-01

    Patients and physicians often choose specially consultants with only limited knowledge of the available options. Access to information about specialists that was directly relevant to patient and clinician preferences could improve the effectiveness of the referral process. We have developed a prescriptive representation of the process of selecting consultants. This "referral map," based on decision theory, uses patient and provider preferences elicited through a literature review and interviews with physicians and provides a formal framework for representing referral knowledge and for evaluating referral options. Our method suggests that the goals and processes of selecting consultants can be managed more systematically using explicit repositories. Such systematic management promises to have a beneficial impact on the delivery of health care, as well as on patient satisfaction. PMID:9357642

  6. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 1 2014-07-01 2014-07-01 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...

  7. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 1 2011-07-01 2011-07-01 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...

  8. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 1 2013-07-01 2013-07-01 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...

  9. 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...

  10. 40 CFR 13.33 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 1 2012-07-01 2012-07-01 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...

  11. 10 CFR 820.72 - Referral to the Attorney General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Referral to the Attorney General. 820.72 Section 820.72 Energy DEPARTMENT OF ENERGY PROCEDURAL RULES FOR DOE NUCLEAR ACTIVITIES Criminal Penalties § 820.72 Referral to the Attorney General. If there is reason to believe a criminal violation of the Act or the DOE Nuclear Safety Requirements has occurred,...

  12. Safe blood and safer sex. Education and counselling.

    PubMed

    1996-01-01

    Education and counseling services aimed at blood donors have the potential not only to increase the safety of the blood supply, but also to promote safer sexual behavior. Public education campaigns should emphasize the social responsibility aspect of blood donation, including stories about lives saved with blood transfusions, and stress the need for donors to act responsibly by not putting others at risk of human immunodeficiency virus (HIV). When people first come to the blood collection center or mobile van, it is helpful to give a talk or show a video about the blood collection process. Also recommended are one-to-one sessions with a trained health worker in which potential donors can assess, on the basis of questions about their personal risk factors, whether they should exclude themselves. After the Honduras Red Cross National Blood Program introduced a brochure containing information about HIV risk and the importance of not donating blood if one has engaged in high-risk activities, the HIV prevalence among donors declined from 0.38 in 1990 to 0.19 a year later, despite increases in HIV seroprevalence in the general population. In Zimbabwe, the National Blood Transfusion Service has developed special outreach programs for students 16 years and older, the source of 65% of the country's blood supply. Talks are given at schools, and students are trained to be peer promoters. School leaders are invited to register for regular blood collection services at community centers; many formally pledge to donate blood 25 times in their life-time and to seek to remain HIV-negative.

  13. Positive reinforcement to promote safer sex among clients.

    PubMed

    Raman, S

    1992-01-01

    The AIDS Research Foundation of India (ARFI) began an intervention program with sex workers in Madras where the women reported that they were willing to use condoms, whereas the customers were not. Accordingly, ARFI is focusing on clients using a positive reinforcement approach: repetition of the desirability of condom use by communication. First, truck drivers and dock workers have been targeted. Drivers interviewed by ARFI were familiar with the condom as a contraceptive method rather than a disease-preventing method, and used it with their wives. The ARFI program has convinced tobacco shopkeepers to stock condoms for drivers. Truckers receive key chains with a holder for a condom. At transit site tea shops songs are aired about road and roadside safety sponsored by a tire manufacturer with a message about rubber (tires and condoms). Women selling sex at transit sites are also educated about the human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs) while attempting to increase their level of hygiene. The typical Friday night sex-seeking behavior among dock workers consists of drinking in a wine shop and soliciting sex workers. Port management and unions have also been recruited for promoting AIDS-related education after participating in health education sessions with flip charts and flash cards. Rest rooms display posters on condom use, some men have been recruited as condom holders for distribution on Friday nights, and barber shops also feature posters with messages about safer sex. AIDS/STD prevention programs have to deal with prevailing practices, values, and beliefs. Results indicate increased condom use among clients as shown by increased sales at transit site tobacco shops and shops around the port. In the future the program will pay more attention to improving the negotiation skills of sex workers.

  14. 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 ...

  15. 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 ...

  16. 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 ...

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

    PubMed Central

    Eisenberg, Anna; Bauermeister, José; Johns, Michelle Marie; Pingel, Emily; 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, we explore the ways in which conceptualizations and definitions of safer sex are discussed and enacted. Placing attention on their safer sex practices, we analyze the conversations that do and do not occur among YGM and their partners, including the strategies (e.g., negotiated safety, condom communication and negotiation) that are commonly perceived as most useful by YGM. We provide recommendations regarding how to craft safer sex messages for YGM by considering their competing demands. PMID:21894239

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

    PubMed

    Eisenberg, Anna; Bauermeister, José; Johns, Michelle Marie; Pingel, Emily; Santana, Matthew Leslie

    2011-09-01

    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, we explore the ways in which conceptualizations and definitions of safer sex are discussed and enacted. Placing attention on their safer sex practices, we analyze the conversations that do and do not occur among YGM and their partners, including the strategies (e.g., negotiated safety, condom communication and negotiation) that are commonly perceived as most useful by YGM. We provide recommendations regarding how to craft safer sex messages for YGM by considering their competing demands. PMID:21894239

  19. 3 in 4 Teens Think E-Cigarettes Safer Than Tobacco: Survey

    MedlinePlus

    ... in 4 Teens Think E-Cigarettes Safer Than Tobacco: Survey But devices deliver as much, if not ... notions about the safety of cigars and smokeless tobacco. And the perception of the safety of these ...

  20. Psychological and physiological characteristics of a proposed object-referral/self-referral continuum of self-awareness.

    PubMed

    Travis, Frederick; Arenander, Alarik; DuBois, David

    2004-06-01

    This research extends and confirms recent brainwave findings that distinguished an individual's sense-of-self along an Object-referral/Self-referral Continuum of self-awareness. Subjects were interviewed and were given tests measuring inner/outer orientation, moral reasoning, anxiety, and personality. Scores on the psychological tests were factor analyzed. The first unrotated PCA component of the test scores yielded a "Consciousness Factor," analogous to the intelligence "g" factor, which accounted for over half of the variance among groups. Analysis of unstructured interviews of these subjects revealed fundamentally different descriptions of self-awareness. Individuals who described themselves in terms of concrete cognitive and behavioral processes (predominantly Object-referral mode) exhibited lower Consciousness Factor scores, lower frontal EEG coherence, lower alpha and higher gamma power during tasks, and less efficient cortical preparatory responses (contingent negative variation). In contrast, individuals who described themselves in terms of an abstract, independent sense-of-self underlying thought, feeling and action (predominantly Self-referral mode) exhibited higher Consciousness Factor scores, higher frontal coherence, higher alpha and lower gamma power during tasks, and more efficient cortical responses. These data suggest that definable states of brain activity and subjective experiences exist, in addition to waking, sleeping and dreaming, that may be operationally defined by psychological and physiological measures along a continuum of Object-referral/Self-referral Continuum of self-awareness.

  1. Safer sexual decision making in adolescent women: perspectives from the conflict theory of decision-making.

    PubMed

    Chambers, Kathryn B; Rew, Lynn

    2003-01-01

    Adolescent women are at risk for unintended pregnancies and sexually transmitted diseases, including human immune deficiency virus (HIV)/acquired immunodeficiency deficiency syndrome (AIDS), if they do not engage in safer sexual practices. Adolescent women are biologically, behaviorally, and socially more at risk for sexually transmitted diseases (STDs) and HIV than adolescent men. Although abstinence is the safest sexual health practice for adolescent women, once sexual activity begins, safer sexual practices involve condom and contraceptive use, and communicating with sexual partners to negotiate condom use. A number of implicit and explicit decisions are involved in these activities. A number of researchers have examined safer sexual decisions of adolescent women, some of whom have used theory models such as the Transtheoretical Model of Change. Although these findings have contributed to the knowledge base about safer sexual decision making, many questions remain unanswered about how adolescent women make safer sexual decisions. The Conflict Model of Decision Making is presented and discussed as a framework for enhanced understanding of safer sexual decision making by adolescent women.

  2. “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

  3. Emergency workload in otolaryngology.

    PubMed Central

    Bleach, N. R.; Williamson, P. A.; Mady, S. M.

    1994-01-01

    A 6-month prospective audit of the otolaryngology emergency workload in a district general hospital was undertaken. A total of 742 cases was referred of whom 193 (26%) were children (< 16 years). The male to female ratio was equal, and 69% of cases were referred from the accident and emergency department. Although most conditions were minor enough to be managed in the ward treatment room and either discharged (40%) or followed up as outpatients (27%), more than one-quarter of patients (28%) needed management by a post-fellowship ENT surgeon. Of the patients, 31% (230/742) were admitted, of whom 107 (46%) required an operation under general anaesthesia. The consequent ENT emergency workload represented 24% of all new patient referrals, 20% of ENT ward admissions and 10% of ENT surgical procedures. PMID:7979078

  4. Safer Wards: reducing violence on older people's mental health wards.

    PubMed

    Brown, Juliette; Fawzi, Waleed; McCarthy, Cathy; Stevenson, Carmel; Kwesi, Solomon; Joyce, Maggie; Dusoye, Jenny; Mohamudbucus, Yasin; Shah, Amar

    2015-01-01

    Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people's mental health wards. This was done using quality improvement methods and supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust. We established a multi-disciplinary group who led on the project on each ward and used a Pareto diagram to establish the focus of our work. We established a dashboard of measures based on our incident reporting system Datix, including number of incidents of violence, days between incidents, days of staff sickness, days between staff injury, use of restraint, and use of rapid tranquilisation (the last two being balancing measures in the reduction of violence). Each team identified factors driving physical violence on the wards, under headings of unmet patient needs, staff needs and staff awareness, which included lack of activity and a safe and therapeutic environment. Using driver diagrams, we identified change ideas that included hourly rounding (proactive checks on patient well-being), the addition of sensory rooms, flexible leave for patients, and a structured activity programme. We also introduced exercise to music, therapeutic groups led by patients, and focused on discharge planning and pet therapy, each of which starting sequentially over the course of a one year period from late 2013 and subject to a cycle of iterative learning using PDSA methods. The specific aim was a 20% decrease in violent incidents on three wards in City and Hackney, and Newham. Following our interventions, days between violent incidents increased from an average of three to an average of six. Days between staff injury due to physical violence rose from an average of

  5. Safer Wards: reducing violence on older people's mental health wards

    PubMed Central

    Brown, Juliette; Fawzi, Waleed; McCarthy, Cathy; Stevenson, Carmel; Kwesi, Solomon; Joyce, Maggie; Dusoye, Jenny; Mohamudbucus, Yasin; Shah, Amar

    2015-01-01

    Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people's mental health wards. This was done using quality improvement methods and supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust. We established a multi-disciplinary group who led on the project on each ward and used a Pareto diagram to establish the focus of our work. We established a dashboard of measures based on our incident reporting system Datix, including number of incidents of violence, days between incidents, days of staff sickness, days between staff injury, use of restraint, and use of rapid tranquilisation (the last two being balancing measures in the reduction of violence). Each team identified factors driving physical violence on the wards, under headings of unmet patient needs, staff needs and staff awareness, which included lack of activity and a safe and therapeutic environment. Using driver diagrams, we identified change ideas that included hourly rounding (proactive checks on patient well-being), the addition of sensory rooms, flexible leave for patients, and a structured activity programme. We also introduced exercise to music, therapeutic groups led by patients, and focused on discharge planning and pet therapy, each of which starting sequentially over the course of a one year period from late 2013 and subject to a cycle of iterative learning using PDSA methods. The specific aim was a 20% decrease in violent incidents on three wards in City and Hackney, and Newham. Following our interventions, days between violent incidents increased from an average of three to an average of six. Days between staff injury due to physical violence rose from an average of

  6. 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. PMID:15296562

  7. Oncologist Factors That Influence Referrals to Subspecialty Palliative Care Clinics

    PubMed Central

    Schenker, Yael; Crowley-Matoka, Megan; Dohan, Daniel; Rabow, Michael W.; Smith, Cardinale B.; White, Douglas B.; Chu, Edward; Tiver, Greer A.; Einhorn, Sara; Arnold, Robert M.

    2014-01-01

    Purpose: Recent research and professional guidelines support expanded use of outpatient subspecialty palliative care in oncology, but provider referral practices vary widely. We sought to explore oncologist factors that influence referrals to outpatient palliative care. Methods: Multisite, qualitative interview study at three academic cancer centers in the United States with well-established palliative care clinics. Seventy-four medical oncologists participated in semistructured interviews between February and October 2012. The interview guide asked about experiences and decision making regarding outpatient palliative care use. A multidisciplinary team analyzed interview transcripts using constant comparative methods to inductively develop and refine themes related to palliative care referral decisions. Results: We identified three main oncologist barriers to subspecialty palliative care referrals at sites with comprehensive palliative care clinics: persistent conceptions of palliative care as an alternative philosophy of care incompatible with cancer therapy, a predominant belief that providing palliative care is an integral part of the oncologist's role, and a lack of knowledge about locally available services. Participants described their views of subspecialty palliative care as evolving in response to increasing availability of services and positive referral experiences, but emphasized that views of palliative care as valuable in addition to standard oncology care were not universally shared by oncologists. Conclusions: Improving provision of palliative care in oncology will likely require efforts beyond increasing service availability. Raising awareness of ways in which subspecialty palliative care complements standard oncology care and developing ways for oncologists and palliative care physicians to collaborate and integrate their respective skills may help. PMID:24301842

  8. Cancer genetics evaluation: barriers to and improvements for referral.

    PubMed

    Brandt, Rachael; Ali, Zonera; Sabel, Allison; McHugh, Terri; Gilman, Paul

    2008-03-01

    Despite the availability of cancer susceptibility testing, little information exists regarding physicians' selection and referral of eligible patients. This study provides insight into whom, why, and when physicians refer for cancer genetics evaluation, as well as their comfort level within this role. Eighty-two physicians (51 primary care, 15 gynecology, 11 surgery and 5 oncology) completed a survey (response rate: 34%) regarding cancer genetics referral practices. Of these, 59% reported an awareness of the hospital's cancer genetics program. Program awareness was greater among oncologists, surgeons, and gynecologists than among primary care physicians (p < 0.0001). Patients were referred for enhanced risk assessment (88%), improved medical management (85%), and concern for family members (83%). Patient eligibility was based on family cancer history (96%), patient cancer history (83%), and patient request (73%). Patients were not referred mainly due to patient disinterest (54%) or physician concern about either insurance coverage (44%) or insurance discrimination (31%). Primary care physicians were less comfortable with identifying patients for referral (p < 0.001) and with discussing genetics (p < 0.002) than specialists. The largest barriers to referral were lack of program awareness and limited knowledge regarding patient eligibility, improved insurance coverage, and antidiscrimination legislation. Physician-targeted marketing and education may improve the referral process. PMID:18373400

  9. Criminal justice referral and incentives in outpatient substance abuse treatment

    PubMed Central

    DeFulio, Anthony; Stitzer, Maxine; Roll, John; Petry, Nancy; Nuzzo, Paul; Schwartz, Robert P.; Stabile, Patricia

    2013-01-01

    A substantial number of substance abusers entering outpatient psychosocial counseling treatment are referred from the criminal justice (CJ) system. This secondary analysis of previously published findings from a large (N=415) multi-site trial of a prize-based abstinence incentive intervention (Petry et al., 2005) examined the influence of CJ referral on usual care outcomes and response to the incentive procedure. CJ referrals (n=138) were more likely than those not CJ referred (n=277) to provide stimulant negative urine samples whether missing samples were counted as positive (50 versus 41%, p=.016) or as missing (96 versus 91%, p<.001). A significant interaction term was found only for percentage of treatment completers (p=.027). However, on that retention variable, and three additional drug use measures, significant incentive effects were confined to participants who entered treatment without referral from the criminal justice system. The study suggests that abstinence incentives should be offered as a first priority to stimulant users entering treatment without criminal justice referral. However, incentives can be considered for use with CJ-referred stimulant users based on the observation that best outcomes were obtained in CJ referrals who also received the abstinence incentive program. PMID:23433822

  10. Application of an ecological framework to examine barriers to the adoption of safer conception strategies by HIV-affected couples.

    PubMed

    Saleem, Haneefa T; Surkan, Pamela J; Kerrigan, Deanna; Kennedy, Caitlin E

    2016-01-01

    Safer conception interventions can significantly reduce the risk of horizontal HIV transmission between HIV-serodiscordant partners. However, prior to implementing safer conception interventions, it is essential to understand potential barriers to their adoption so that strategies can be developed to overcome these barriers. This paper examines potential barriers to the adoption of safer conception strategies by HIV-affected couples in Iringa, Tanzania using an ecological framework. We interviewed 30 HIV-positive women, 30 HIV-positive men and 30 health providers engaged in delivering HIV-related services. We also conducted direct observations at five health facilities. Findings suggest that there are multiple barriers to safer conception that operate at the individual, relational, environmental, structural, and super-structural levels. The barriers to safer conception identified are complex and interact across these levels. Barriers at the individual level included antiretroviral adherence, knowledge of HIV status, knowledge and acceptability of safer conception strategies, and poor nutrition. At the relational level, unplanned pregnancies, non-disclosure of status, gendered power dynamics within relationships, and patient-provider interactions posed a threat to safer conception. HIV stigma and distance to health facilities were environmental barriers to safer conception. At the structural level there were multiple barriers to safer conception, including limited safer conception policy guidelines for people living with HIV (PLHIV), lack of health provider training in safer conception strategies and preconception counseling for PLHIV, limited resources, and lack of integration of HIV and sexual and reproductive health services. Poverty and gender norms were super-structural factors that influenced and reinforced barriers to safer conception, which influenced and operated across different levels of the framework. Multi-level interventions are needed to ensure

  11. Referrals from general practitioners to a social services department.

    PubMed

    Sheppard, M G

    1983-01-01

    One year's referrals from general practitioners to a social services department were studied. There was a low referral rate and a bias towards women, the elderly and the less affluent. The referrals were predominantly made for practical help with problems of ill health. A high proportion of clients were allocated to non-social work staff, and the social service intervention, generally of short duration, showed a sympathetic response to the practical requests of general practitioners. The limited use of social workers by doctors is considered to be the result of ignorance or scepticism about psychodynamic social work skills. Closer liaison between general practitioners and social workers, and a clearer presentation by social workers of their professional skills, are suggested solutions to this problem.

  12. 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

  13. A window of opportunity: referral of adolescents to the hospital Child Protection Team.

    PubMed

    Glasser, Saralee; Chen, Wendy; Stoffman, Nava; Lerner-Geva, Liat

    2008-01-01

    The arrival of an adolescent at the hospital provides a window of opportunity to help those exposed to abuse or neglect, by looking beyond the presenting symptom. The Child Protection Team (CPT) assesses cases of suspected abuse or neglect (SCAN) referred by hospital staff. As adolescents pose a particular array of presentations, this study assessed their socio-demographic features and characteristics of hospitalization in order to improve procedures for identifying SCAN. The study group included all 674 referrals of 10-17-year-olds to the CPT from 1991-2007. Their files were abstracted and demographics compared to similarly-aged Emergency Department (ED) admissions. Different patterns were found by gender and age group. The youngest group (10-13 years) included a higher rate of boys than girls (47.9% vs. 27.6%), and among the oldest (16-17 years) the rate of girls was higher (31.9% vs 15.8%). Comparison with all ED admissions indicated a lower rate of younger girls and a higher rate of 14-15-year-old girls in the study group. The study group also had a higher rate of immigrants (12.8% vs. 4.7%). The most frequent reason for arrival at the hospital was suicidal behavior (30.9%). Older age was related to fewer arrivals for trauma/burn and more suicidal behavior. In 83.1% of the referrals, reports were made to welfare authorities and/or police. The suspicion in 64.2% of the referrals was emotional abuse or physical/emotional neglect; in 18.8%, physical and/or sexual abuse was suspected. The older groups had lower rates of physical and/or sexual abuse and higher rates of emotional abuse or physical/emotional neglect. This study highlights the importance of age-by-gender analysis and understanding of the differential susceptibility of early, middle and late adolescence to SCAN.

  14. 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

  15. Appropriateness of referrals for removal of wisdom teeth.

    PubMed

    Westcott, K; Irvine, G H

    2002-08-01

    A 6-month prospective study of 166 patients was undertaken to assess whether general dental practitioners who referred patients for removal of wisdom teeth were following current national guidelines. It was found that 92% of referrals followed the guidelines of the Faculty of Dental Surgery of the Royal College of Surgeons of England and the National Institute for Clinical Excellence. There were 13 inappropriate referrals - 3 patients were asymptomatic, 9 patients had a single episode of pericoronitis and 1 had crowding of the lower anterior incisors. General dental practitioners in this study seem to be following current guidelines consistently. No teeth were removed prophylactically.

  16. 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.

  17. Introduction of Electronic Referral from Community Associated with More Timely Review by Secondary Services

    PubMed Central

    Warren, J.; White, S.; Day, K.J.; Gu, Y.; Pollock, M.

    2011-01-01

    Background Electronic referral (eReferral) from community into public secondary healthcare services was introduced to 30 referring general medical practices and 28 hospital based services in late 2007. Objectives To measure the extent of uptake of eReferral and its association with changes in referral processing. Methods Analysis of transactional data from the eReferral message service and the patient information management system of the affected hospital; interview of clinical, operational and management stakeholders. Results eReferral use rose steadily to 1000 transactions per month in 2008, thereafter showing moderate growth to 1200 per month in 2010. Rate of eReferral from the community in 2010 is estimated at 56% of total referrals to the hospital from general practice, and as 71% of referrals from those having done at least one referral electronically. Referral latency from letter date to hospital triage improves significantly from 2007 to 2009 (p<0.001), from a paper referral median of 8 days (inter-quartile range, IQR: 4–14) in 2007 to an eReferral median of 5 days (IQR: 2–9) and paper referral median of 6 days (IQR: 2–12) in 2009. Specialists upgrade the referrer-assigned eReferral priority in 19.2% of cases and downgrade it 18.6% of the time. Clinical users appreciate improvement of referral visibility (status and content access); however, both general practitioners and specialists point out system usability issues. Discussion With eReferrals, a referral’s status can be checked, and its content read, by any authorized user at any time. The period of eReferral uptake was associated with significant speed-up in referral processing without changes in staffing levels. The eReferral system provides a foundation for further innovation in the community-secondary interface, such as electronic decision support and shared care planning systems. Conclusions We observed substantial rapid voluntary uptake of eReferrals associated with faster, more reliable and

  18. 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

  19. GPs' reasons for referral of patients with chest pain: a qualitative study

    PubMed Central

    Bruyninckx, Rudi; Bruel, Ann Van den; Hannes, Karin; Buntinx, Frank; Aertgeerts, Bert

    2009-01-01

    Background Prompt diagnosis of an acute coronary syndrome is very important and urgent referral to a hospital is imperative because fast treatment can be life-saving and increase the patient's life expectancy and quality of life. The aim of our study was to identify GPs' reasons for referring or not referring patients presenting with chest pain. Methods In a semi-structured interview, 21 GPs were asked to describe why they do or do not refer a patient presenting with chest pain. Interviews were taped, transcribed and qualitatively analysed. Results Histories of 21 patients were studied. Six were not referred, seven were referred to a cardiologist and eight to the emergency department. GPs' reasons for referral were background knowledge about the patient, patient's age and cost-benefit estimation, the perception of a negative attitude from the medical rescue team, recent patient contact with a cardiologist without detection of a coronary disease and the actual presentation of signs and symptoms, gut feeling, clinical examination and ECG results. Conclusion This study suggests that GPs believe they do not exclusively use the 'classical' signs and symptoms in their decision-making process for patients presenting with chest pain. Background knowledge about the patient, GPs' personal ideas and gut feeling are also important. PMID:19646225

  20. 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

  1. 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.

  2. Examining the Principles of Influence on Safer Sex Communication During Casual and Committed Sexual Encounters.

    PubMed

    Reynolds-Tylus, Tobias; Rinaldi-Miles, Anna; Quick, Brian L

    2015-01-01

    Teens and young people are at risk for contracting sexually transmitted infections. Understanding how relationship context may moderate the effectiveness of safer sex communication strategies among this demographic is important information for practitioners striving to promote safer sex behaviors. In this study, focus groups (N = 9) with college students were conducted and analyzed to examine the relation between 6 principles of influence (authority, consistency, liking, reciprocity, scarcity, and social proof) and safer sex communication during committed and casual sexual encounters. Results revealed that with the exceptions of social proof and consistency, the principles of influence were endorsed more frequently for casual than committed sexual encounters. For casual sexual encounters, the principles of authority, reciprocity, and scarcity arose as influential principles. For committed sexual encounters, the principles of consistency, liking, and reciprocity arose as influential principles. These results are discussed with an emphasis on the theoretical and practical implications.

  3. Interviewer's Handbook for Selection and Referral to Training and Placement.

    ERIC Educational Resources Information Center

    Manpower Administration (DOL), Washington, DC. U.S. Training and Employment Service.

    This handbook is designed to assist local employment service personnel in effective selection and referral of applicants to training and job opportunities. Guidelines for placement are combined with detailed information on training programs. General guidelines for the identification of disadvantaged applicants are supplemented with a discussion of…

  4. 32 CFR 727.9 - Referrals to civilian lawyers.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... the assistance requested, the client should be referred to a civilian lawyer. When the client does not... organization, lawyer referral service, legal aid society, or other local organization for assistance in... organization. (b) Fees charged by civilian lawyers. Legal assistance clients being referred to a...

  5. 29 CFR 1603.201 - Referral and scheduling for hearing.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Referral and scheduling for hearing. 1603.201 Section 1603... scheduling for hearing. (a) Upon request by the complainant under paragraph (b) of this section or if the... of Federal Operations shall transmit the complaint file to an administrative law judge,...

  6. 29 CFR 1603.201 - Referral and scheduling for hearing.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 4 2011-07-01 2011-07-01 false Referral and scheduling for hearing. 1603.201 Section 1603... scheduling for hearing. (a) Upon request by the complainant under paragraph (b) of this section or if the... of Federal Operations shall transmit the complaint file to an administrative law judge,...

  7. Academic Performance Difficulties: Age and Grade at First Referral

    ERIC Educational Resources Information Center

    Harman, Marsha J.; Kordinak, S. Thomas; Bruce, A. Jerry

    2008-01-01

    Archival records of 43 children referred for diagnosis and treatment for academic difficulties were examined. Results revealed a significant difference for age at first referral and diagnoses. Those with disorders such as learning disability and severe emotional disturbance tended to be older, while the ADHD and dysthymic disorders tended to be…

  8. 29 CFR 1603.103 - Referral of complaints.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... EXEMPT STATE AND LOCAL GOVERNMENT EMPLOYEE COMPLAINTS OF EMPLOYMENT DISCRIMINATION UNDER SECTION 304 OF THE GOVERNMENT EMPLOYEE RIGHTS ACT OF 1991 Administrative Process § 1603.103 Referral of complaints. (a) The Commission will notify an FEP agency, as defined in 29 CFR 1601.3(a), when a complaint...

  9. 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…

  10. 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.

  11. 45 CFR 30.36 - Minimum amount of referrals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... to the Department of Justice § 30.36 Minimum amount of referrals. (a) Except as in paragraph (b) of this section, claims of less than $2,500 exclusive of interest, penalties, and administrative costs, or... the Financial Litigation Staff of the Executive Office for United States Attorneys in Justice prior...

  12. 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…

  13. 49 CFR 825.10 - Referral of record.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 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 §...

  14. 38 CFR 1.920 - Referral of VA debts.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... purpose of salary offset shall be done in accordance with 38 CFR 1.980 through 1.995 and regulations prescribed by the Director of the Office of Personnel Management (OPM) in 5 CFR part 550, subpart K... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Referral of VA debts....

  15. 38 CFR 1.920 - Referral of VA debts.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... purpose of salary offset shall be done in accordance with 38 CFR 1.980 through 1.995 and regulations prescribed by the Director of the Office of Personnel Management (OPM) in 5 CFR part 550, subpart K... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Referral of VA debts....

  16. 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…

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 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 TRIBAL ASSETS OF UTE INDIAN TRIBE, UINTAH AND OURAY RESERVATION, UTAH, BY THE TRIBE AND THE...

  18. 25 CFR 217.3 - Referral of questions by superintendent.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 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 TRIBAL ASSETS OF UTE INDIAN TRIBE, UINTAH AND OURAY RESERVATION, UTAH, BY THE TRIBE AND THE...

  19. Disagreement Rules, Referral Rules and the Spanish Feminine Article "el."

    ERIC Educational Resources Information Center

    Harris, J. W.

    1987-01-01

    The Spanish feminine article /el/, ordinarily the singular masculine definite article, has been used as evidence of the need for obligatory disagreement rules. Others explain the anamoly by means of referral rules. A third solution is suggested: an allomorphy rule which can be interpreted syntactically or phonologically. (LMO)

  20. 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...

  1. 29 CFR 15.8 - Referral to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 1 2011-07-01 2011-07-01 false 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 section 2672 title 28, United States...

  2. 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…

  3. 29 CFR 1603.103 - Referral of complaints.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... EXEMPT STATE AND LOCAL GOVERNMENT EMPLOYEE COMPLAINTS OF EMPLOYMENT DISCRIMINATION UNDER SECTION 304 OF THE GOVERNMENT EMPLOYEE RIGHTS ACT OF 1991 Administrative Process § 1603.103 Referral of complaints... filed by a state or local government employee or applicant under this part concerning an...

  4. 42 CFR 412.96 - Special treatment: Referral centers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... citations affecting § 412.96, see the List of CFR Sections Affected, which appears in the Finding Aids... 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...

  5. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., evaluation, and treatment must be performed in accordance with 49 CFR part 40, Subpart O. ... 49 Transportation 5 2010-10-01 2010-10-01 false Referral, evaluation, and treatment. 382.605... CONTROLLED SUBSTANCES AND ALCOHOL USE AND TESTING Alcohol Misuse and Controlled Substances Use...

  6. 49 CFR 382.605 - Referral, evaluation, and treatment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., evaluation, and treatment must be performed in accordance with 49 CFR part 40, Subpart O. ... 49 Transportation 5 2011-10-01 2011-10-01 false Referral, evaluation, and treatment. 382.605... CONTROLLED SUBSTANCES AND ALCOHOL USE AND TESTING Alcohol Misuse and Controlled Substances Use...

  7. 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.

  8. Developing Material and Organizational Resources: The Resource and Referral Service.

    ERIC Educational Resources Information Center

    Hull, William L.

    The Resource and Referral Service (RRS), is a central services contractor to the Research and Development Exchange (RDx), which facilitates the flow of outputs from Research and Development (R&D) based organizations, specializing in fast responses to questions from states transmitted by the Regional Exchanges on R&D in education, testing, and…

  9. Diagnostic Classification Decisions As a Function of Referral Information.

    ERIC Educational Resources Information Center

    Ysseldyke, James E.; Algozzine, Bob

    Educational decision makers (N=224) participated in a computer simulated decision making experience to ascertain the extent to which referral information on a child with a suspected handicapping condition biased classification decisions. Ss were randomly assigned to 16 conditions varying on the basis of the child's sex, socioeconomic status,…

  10. 29 CFR 1425.5 - Referral to FSIP.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE MEDIATION ASSISTANCE IN THE FEDERAL SERVICE § 1425.5 Referral to FSIP. If the mediation process has been completed and the parties are... Federal Services Impasses Panel. The Service shall not refer a case to FSIP until the mediation...

  11. 20 CFR 628.510 - Intake, referrals and targeting.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... UNDER TITLE II OF THE JOB TRAINING PARTNERSHIP ACT Program Design Requirements for Programs Under Title II of the Job Training Partnership Act § 628.510 Intake, referrals and targeting. (a) Collection of..., including the Job Corps program. In these cases, information on the full array of services available in...

  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. 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

  15. Referrals for obstetrical complications from Ejisu district, Ghana.

    PubMed

    Martey, J O; Djan, J O; Twum, S; Browne, E N; Opoku, S A

    1998-01-01

    A study of referrals due to obstetrical complications from the Ejisu district, Ashanti region, Ghana was done to determine the institutions that receive them, their outcome and the effectiveness of the referral system. This formed part of a multidisciplinary research on the prevention of maternal mortality in the district. It covered 15 health facilities in the district. The receiving institutions identified in the study were Komfo Anokye teaching Hospital (KATH) in Kumasi, Agogo Presbyterian Hospital in the neighbouring Ashanti Akim district and the St. Michael's Hospital at Pramso in the same district. In the period under review, there were 192 referrals from the district, 139 to KATH with 87 (63%) reporting, 19 to Pramso with 14 (74%) reporting and 34 to Agogo with 17 (50%) reporting. The 3 most important complications referred were maternal haemorrhage (29%), high-risk pregnancy (24%) and delayed second stage (21%). The referring institutions had a defaulting rate varying from 8-56% with a median of 42%. This study did not specifically investigate the factors influencing the high defaulting rates in some institutions. However, focus-group discussions (FGDs) held in selected communities revealed the following factors as inhibiting the utilization of health services: * prohibitive hospital fees; * illegal fees and bribes; * irregular transport and uncooperative drivers; * poor and unmotorable roads; * lack of drugs and essential supplies and; * negative staff attitudes. Those health facilities with low defaulting rates had their own transport or were close to major trunk roads. From the study, the referral system was very weak. It is also possible that some of the referrals reported at the receiving institutions but were not classified as such. Interventions to improve the situation are currently being implemented.

  16. Is Self-Referral Associated with Higher Quality Care?

    PubMed Central

    Pollack, Craig Evan; Rastegar, Afshin; Keating, Nancy L; Adams, John L; Pisu, Maria; Kahn, Katherine L

    2015-01-01

    Objective To assess the extent to which patients self-refer to cancer specialists and whether self-referral is associated with better experiences and quality of care. Data Sources Data from surveys and medical record abstraction collected through the Cancer Care Outcomes Research and Surveillance Consortium. Study Design Observational study of patients with lung and colorectal cancer diagnosed from 2003 through 2005 in five geographically defined regions and five integrated health care delivery systems. Methods Multivariable logistic regression models used to assess factors associated with self-referral and propensity score-weighted doubly robust models to test the association between self-referral and experiences/quality of care. Principal Findings Among 5,882 patients, 9.7 percent of lung cancer patients and 14.9 percent of colorectal cancer patients self-referred to at least one cancer specialist. Black patients were less likely to self-refer than white patients (odds ratio: 0.48, 95 percent confidence interval: 0.35, 0.64); patients with high incomes (vs. low) and with a college degree (vs. non-high school graduates) were significantly more likely to self-refer. Self-referral was associated with lower ratings of overall physician communication for patients with lung cancer but, conversely, higher odds of curative surgery among patients with stage I/II lung cancer. Conclusions A small but significant proportion of patients self-referred to their cancer specialists; rates varied by patient race and socioeconomic status. To the extent that self-referral is associated with quality, it may reinforce disparities in care. PMID:25759002

  17. 42 CFR 411.357 - Exceptions to the referral prohibition related to compensation arrangements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...Referral/10_CPI-U_Updates.asp. (3) Where an entity has inadvertently provided nonmonetary compensation to a... physician self-referral web site: http://www.cms.hhs.gov/PhysicianSelfReferral/10_CPI-U_Updates.asp. (6) The... remuneration (consisting of items and services in the form of hardware, software, or information technology...

  18. 42 CFR 411.357 - Exceptions to the referral prohibition related to compensation arrangements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...Referral/10_CPI-U_Updates.asp. (3) Where an entity has inadvertently provided nonmonetary compensation to a... physician self-referral web site: http://www.cms.hhs.gov/PhysicianSelfReferral/10_CPI-U_Updates.asp. (6) The... remuneration (consisting of items and services in the form of hardware, software, or information technology...

  19. 42 CFR 411.357 - Exceptions to the referral prohibition related to compensation arrangements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... nonmonetary compensation limit on the physician self-referral Web site: http://www.cms.hhs.gov/PhysicianSelf... physician self-referral web site: http://www.cms.hhs.gov/PhysicianSelfReferral/10_CPI-U_Updates.asp. (6) The... than the physician) that is providing malpractice insurance (including a self-funded...

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 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...

  1. 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...

  2. 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... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  3. 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...

  4. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 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...

  5. 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... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

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

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 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. 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... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  8. 10 CFR 1015.505 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 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...

  9. 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...

  10. 6 CFR 11.13 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 6 Domestic Security 1 2011-01-01 2011-01-01 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...

  11. 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... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  12. 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...

  13. 6 CFR 11.13 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 6 Domestic Security 1 2014-01-01 2014-01-01 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...

  14. 6 CFR 11.13 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 6 Domestic Security 1 2013-01-01 2013-01-01 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...

  15. 6 CFR 11.13 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 6 Domestic Security 1 2012-01-01 2012-01-01 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...

  16. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 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...

  17. 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... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  18. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 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...

  19. 34 CFR 303.310 - Post-referral timeline (45 days).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Post-referral timeline (45 days). 303.310 Section 303.310 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL... Post-Referral Procedures-Screenings, Evaluations, and Assessments § 303.310 Post-referral timeline...

  20. 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…

  1. Impact of a referral management “gateway” on the quality of referral letters; a retrospective time series cross sectional review

    PubMed Central

    2013-01-01

    Background Referral management centres (RMC) for elective referrals are designed to facilitate the primary to secondary care referral path, by improving quality of referrals and easing pressures on finite secondary care services, without inadvertently compromising patient care. This study aimed to evaluate whether the introduction of a RMC which includes triage and feedback improved the quality of elective outpatient referral letters. Methods Retrospective, time-series, cross-sectional review involving 47 general practices in one primary care trust (PCT) in South-East England. Comparison of a random sample of referral letters at baseline (n = 301) and after seven months of referral management (n = 280). Letters were assessed for inclusion of four core pieces of information which are used locally to monitor referral quality (blood pressure, body mass index, past medical history, medication history) and against research-based quality criteria for referral letters (provision of clinical information and clarity of reason for referral). Results Following introduction of the RMC, the proportion of letters containing each of the core items increased compared to baseline. Statistically significant increases in the recording of ‘past medical history’ (from 71% to 84%, p < 0.001) and ‘medication history’ (78% to 87%, p = 0.006) were observed. Forty four percent of letters met the research-based quality criteria at baseline but there was no significant change in quality of referral letters judged on these criteria across the two time periods. Conclusion Introduction of RMC has improved the inclusion of past medical history and medication history in referral letters, but not other measures of quality. In approximately half of letters there remains room for further improvement. PMID:23945378

  2. 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 ...

  3. 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. PMID:1602092

  4. 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…

  5. 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…

  6. 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…

  7. Safer conception interventions for HIV-affected couples: implications for resource-constrained settings.

    PubMed

    Chadwick, Rachelle J; Mantell, Joanne E; Moodley, Jennifer; Harries, Jane; Zweigenthal, Virginia; Cooper, Diane

    2011-11-01

    Developing and testing safer conception methods that reduce HIV transmission to HIV-seronegative partners in serodiscordant couples and reduce superinfection in HIV-seroconcordant couples is a crucial but often unaddressed component of HIV prevention programs. Most research has focused on developed-world settings, where "high-technology" assisted reproduction techniques are used for HIV-serodiscordant couples in which the male is HIV-infected. There is a dearth of research on safer conception methods for HIV-seropositive women and "low-technology" harm-reduction strategies for HIV-affected couples, including vaginal insemination for HIV-seropositive women and natural conception methods for HIV-seroconcordant and -serodiscordant couples. This review summarizes international studies of safer conception interventions for HIV-affected couples, with a focus on feasibility in public-sector health settings where assisted reproductive technology is not readily available. Given that such low-technology options are feasible in most settings, well-designed, prospective interventions offering low-technology safer conception methods need to be developed and tested.

  8. 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…

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

    PubMed

    Gramatica, Paola; Cassani, Stefano; Sangion, Alessandro

    2016-04-01

    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.

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

    PubMed

    Gramatica, Paola; Cassani, Stefano; Sangion, Alessandro

    2016-04-01

    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. PMID:26742016

  13. 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…

  14. 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…

  15. 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…

  16. Social Support and Maintenance of Safer Sex Practices among People Living with HIV/AIDS

    ERIC Educational Resources Information Center

    Reilly, Thom; Woo, Grace

    2004-01-01

    The study discussed in this article addressed the relationship of social support to the maintenance of long-term safer sex practices of 360 HIV-positive adults recruited from outpatient medical facilities. Medical professionals, friends, and siblings were reported the most frequent sources for assistance, whereas regular sexual partners, medical…

  17. 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…

  18. 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.

  19. Year of Safe Motherhood: making pregnancy and childbirth safer.

    PubMed

    1998-06-01

    On World Health Day 1998, an Inter-Agency group, including the UN Population Fund, the UN Children's Fund, the World Health Organization, the International Planned Parenthood Federation, the Population Council, and Family Care International, launched a year-long campaign to promote awareness of what must be done to reduce maternal mortality and to gain commitments for implementing the affordable measures needed to prevent most of the 600,000 annual maternal deaths. To launch the campaign, health officials highlighted what must be done to improve maternal health worldwide, and the US First Lady pointed out the shocking facts that every minute a woman dies, 110 women experience a pregnancy-related injury, and 190 women face an unplanned or unwanted pregnancy because the political will does not exist to remedy this situation. Preparation for the "Year of Safe Motherhood" began with an October 1997 conference that reviewed the results of 10 years of research on safe motherhood. This research revealed that maternal deaths could be reduced drastically by provision of 1) routine perinatal care; 2) emergency care for life-threatening obstetric complications; 3) services to prevent and manage the complications of unsafe abortion; 4) family planning to prevent unwanted pregnancies; 5) health education and services for adolescents; and 6) community education for women, their families, and decision-makers. Maternal and newborn health services would cost as little as US$3/person/year in developing countries. PMID:12348557

  20. 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…

  1. 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

  2. Methadone toxicity in a poisoning referral center

    PubMed Central

    Taheri, Fatemeh; Yaraghi, Ahmad; Sabzghabaee, Ali Mohammad; Moudi, Maryam; Eizadi-Mood, Nastaran; Gheshlaghi, Farzad; Farajzadegan, Ziba

    2013-01-01

    Objective: Methadone poisoning can occur accidentally or intentionally for suicide or homicide purposes. The aim of this study was to evaluate the epidemiological and clinical manifestations of Methadone poisoning. Methods: A descriptive analytical study was performed from 2010 to 2012 in the poisoning emergency and clinical toxicology departments of Noor hospital affiliated with Isfahan University of Medical Sciences (Isfahan, Iran). All patients with Methadone poisoning within this period of time were investigated. Different variables were recorded in a checklist. Findings: A total of 385 patients were studied. About 85.7% had ingested only Methadone and 14.3% had ingested other medications with Methadone. Mean ± standard deviation of the age was 32.1 ± 15 years (range: 1-90). Most of the patients were male (76.4%). Nearly 40% of the patients were narcotic addicts, 25.5% were addicts under surveillance of Methadone maintenance therapy centers and 34.5% were non-addicts. Intentional poisoning was observed in most of the patients (57.7%). Most of the patients had a low level of consciousness on admission (58.2%). Respiratory depression and hypotension was observed in 35.6% and 12.7% of the cases as the most common symptoms. Regarding vital signs, there was a significant difference in respiratory rate on admission among different evaluated groups (P = 0.02). Length of hospital stay was 18.79 ± 0.72 h (range: 4-240 h, median: 15 h). About 57 patients (25.8%) from the intentionally poisoned patients and 19 patients (12.3%) from the unintentionally poisoned patients had a history of psychiatric disorder (P = 0.001). Most of the patients survived without complications. Conclusion: Addiction, age, gender, attempt to suicide and a history of psychiatric disorder were of the most important factors effective in Methadone poisoning, which should be considered in the public training and prevention of poisoning. PMID:24991620

  3. Can guidelines improve referral to elective surgical specialties for adults? A systematic review

    PubMed Central

    Blundell, N; Forde, I; Musila, N; Spitzer, D; Naqvi, S; Browne, J

    2010-01-01

    Aim To assess effectiveness of guidelines for referral for elective surgical assessment. Method Systematic review with descriptive synthesis. Data sources Medline, EMBASE, CINAHL and Cochrane database up to 2008. Hand searches of journals and websites. Selection of studies Studies evaluated guidelines for referral from primary to secondary care, for elective surgical assessment for adults. Outcome measures Appropriateness of referral (usually measured as guideline compliance) including clinical appropriateness, appropriateness of destination and of pre-referral management (eg, diagnostic investigations), general practitioner knowledge of referral appropriateness, referral rates, health outcomes and costs. Results 24 eligible studies (5 randomised control trials, 6 cohort, 13 case series) included guidelines from UK, Europe, Canada and the USA for referral for musculoskeletal, urological, ENT, gynaecology, general surgical and ophthalmological conditions. Interventions varied from complex (“one-stop shops”) to simple guidelines. Four randomized control trials reported increases in appropriateness of pre-referral care (diagnostic investigations and treatment). No evidence was found for effects on practitioner knowledge. Mixed evidence was reported on rates of referral and costs (rates and costs increased, decreased or stayed the same). Two studies reported on health outcomes finding no change. Conclusions Guidelines for elective surgical referral can improve appropriateness of care by improving pre-referral investigation and treatment, but there is no strong evidence in favour of other beneficial effects. PMID:20211956

  4. Patient referral patterns by family doctors and to selected specialists in Tajikistan.

    PubMed

    Steinmann, Peter; Baimatova, Malika; Wyss, Kaspar

    2012-12-01

    Referral rates are a key measure for the functioning of a healthcare system. The objective of this study was to assess referral patterns from family doctors (FD) and selected specialists to other specialists and hospitals in two rayons (districts) of Tajikistan. Quantitative data on referral decisions and self-referral was collected among FDs and selected specialists over a 10-workday period in 2008. For comparison, the collected information was contrasted to routinely recorded data and figures from the national health information system (HIS). The mean referral rate of FDs was 20.0% while the referral rate according to the HIS was 4.5%. In one rayon, the majority of the referred patients were sent to hospitals (65.6%) while in the other rayon, 65.9% were advised to see a specialist. Technical diagnostic tests not available at the primary healthcare level triggered the majority of all referrals. A need for diagnosis and treatment by specialists accounted for 19.2% of the referrals. Self-referral was common among patients seen by ophthalmologists and otorhinolaryngologists (76.0%). We conclude that referral rates among Tajik FD patients are high and self-referral of patients to a specialist is the norm. The routine HIS fails to provide accurate data. PMID:24029672

  5. Substance Use Screening, Brief Intervention, and Referral to Treatment.

    PubMed

    2016-07-01

    The enormous public health impact of adolescent substance use and its preventable morbidity and mortality show the need for the health care sector, including pediatricians and the medical home, to increase its capacity related to substance use prevention, detection, assessment, and intervention. The American Academy of Pediatrics published its policy statement "Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians" in 2011 to introduce the concepts and terminology of screening, brief intervention, and referral to treatment (SBIRT) and to offer clinical guidance about available substance use screening tools and intervention procedures. This policy statement is a revision of the 2011 SBIRT statement. An accompanying clinical report updates clinical guidance for adolescent SBIRT. PMID:27325638

  6. 10 rare tumors that warrant a genetics referral.

    PubMed

    Banks, Kimberly C; Moline, Jessica J; Marvin, Monica L; Newlin, Anna C; Vogel, Kristen J

    2013-03-01

    The number of described cancer susceptibility syndromes continues to grow, as does our knowledge on how to manage these syndromes with the aim of early detection and cancer prevention. Oncologists now have greater responsibility to recognize patterns of cancer that warrant referral for a genetics consultation. While some patterns of common cancers are easy to recognize as related to hereditary cancer syndromes, there are a number of rare tumors that are highly associated with cancer syndromes yet are often overlooked given their infrequency. We present a review of ten rare tumors that are strongly associated with hereditary cancer predisposition syndromes: adrenocortical carcinoma, carcinoid tumors, diffuse gastric cancer, fallopian tube/primary peritoneal cancer, leiomyosarcoma, medullary thyroid cancer, paraganglioma/pheochromocytoma, renal cell carcinoma of chromophobe, hybrid oncocytoic, or oncocytoma histology, sebaceous carcinoma, and sex cord tumors with annular tubules. This review will serve as a guide for oncologists to assist in the recognition of rare tumors that warrant referral for a genetic consultation.

  7. 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. PMID:9809711

  8. [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.

  9. "Stark" reality: self-referral rule holds risk and opportunity.

    PubMed

    Lebowitz, P H

    2001-01-01

    On January 4, 2001, the Health Care Financing Administration (now the Center for Medicare and Medicaid Services or CMS) issued Phase I of the final Stark II regulations (Final Rule). The Final Rule implements the Ethics in Patient Referral Act of 1989 (Stark I), as amended by the Omnibus Budget and Reconciliation Act of 1993 (Stark II), collectively the Stark Law. It is intended to provide more flexibility to providers by interpreting the prohibitions narrowly and the exceptions broadly. Generally, the Stark Law prohibits physicians from referring Medicare or Medicaid patients to an entity for the provision of "designated health services (DHS)" if the physician (or a member of the physician's immediate family) has a direct or indirect financial relationship with the entity. The Final Rule establishes two principal exceptions to the referral prohibition that apply to both ownership/investment interests and compensation arrangements. The physician service exception permits referrals for DHS that are furnished by a member or physician in the same group practice as the referring physician, or under their supervision. The in-office ancillary services exception permits referral for provision of DHS in the same building in which the referring physician or his group routinely provides the full range of the group's or physician's medical services. The final regulations redefine the prior description of radiology and radiation therapy services subject to Stark II. The principal change is to segregate radiation therapy and supplies from radiology and other imaging services. It is uncertain whether Stark Law enforcement will be a priority under the Bush Administration. Nonetheless, because the Final Rule offers more flexibility than the proposed rule, providers and suppliers should revisit proposed and abandoned arrangements that they believed to be prohibited.

  10. Identifying sick children requiring referral to hospital in Bangladesh.

    PubMed Central

    Kalter, H. D.; Schillinger, J. A.; Hossain, M.; Burnham, G.; Saha, S.; de Wit, V.; Khan, N. Z.; Schwartz, B.; Black, R. E.

    1997-01-01

    The object of this study was to evaluate and improve the guidelines for the Integrated Management of Childhood Illness (IMCI) with respect to identifying young infants and children requiring referral to hospital in an area of low malaria prevalence. A total of 234 young infants (aged 1 week to 2 months) and 668 children (aged 2 months to 5 years) were prospectively sampled from patients presenting at a children's hospital in Dhaka, Bangladesh. The study paediatricians obtained a standardized history and carried out a physical examination, including items in the IMCI guidelines developed by WHO and UNICEF. The paediatricians made a provisional diagnosis and judged whether each patient needed hospital admission. Using the paediatrician's assessment of a need for admission as the standard, the sensitivity and specificity of the current and modified IMCI guidelines for correctly referring patients to hospital were examined. The IMCI's sensitivity for a paediatrician's assessment in favour of hospital admission was 84% (95% confidence interval (CI): 75-90) for young infants and 86% (95% CI: 81-90) for children, and the specificity was, respectively, 54% (95% CI: 45-63) and 64% (95% CI: 59-69). One fourth or more in each group had a provisional diagnosis of pneumonia, and the IMCI's specificity was increased without lowering sensitivity by modifying the respiratory signs calling for referral. These results show that the IMCI has good sensitivity for correctly referring young infants and children requiring hospital admission in a developing country setting with a low prevalence of malaria. The guidelines' moderate specificity will result in considerable over-referral of patients not needing admission, thereby decreasing opportunities for successful treatment of patients at first-level health facilities. The impact of the IMCI guidelines on children's health and the health care system must be judged in the light of current treatment practices, health outcomes and referral

  11. Public Library Information and Referral Project: Phase I, Survey.

    ERIC Educational Resources Information Center

    Childers, Thomas

    This study was the first phase of a multiple phase project to generate knowledge about the creation and rapid growth of information and referral (I&R) services in public libraries in the United States in the late 1960s and the 1970s. I&R service is defined as facilitating the link between a person with a need and the resources outside a library to…

  12. 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

  13. Practice variation in physician referral for allogeneic hematopoietic cell transplantation.

    PubMed

    Pidala, J; Craig, B M; Lee, S J; Majhail, N; Quinn, G; Anasetti, C

    2013-01-01

    Hematological malignancy patients not referred by their primary hematologist/medical oncologist suffer disparate access to allogeneic hematopoietic cell transplantation (HCT). However, investigation into physician, system and patient factors relevant to this decision making is lacking. We surveyed a national randomized sample of practicing hematologists/medical oncologists identified through the AMA (American Medical Association) masterfile. A modified Dillman approach was utilized to encourage survey response. From 1200 surveyed, a total of 113 physicians responded. In all, 68% were male, 62% identified as White/non-Hispanic, 79% practiced in non-academic settings and 80% reported spending 75-100% of their professional effort in clinical care. Using clinical vignettes, we detected significantly increased odds for HCT non-referral according to age (age 60 vs 30, odds ratio (OR) 8.3, 95% confidence interval (CI): 5.9-11.7, P<0.0001), insurance coverage (no coverage vs coverage, OR 6.9, 95% CI: 5.2-9.1, P<0.0001) and race (African-American vs Caucasian, OR 2.4, 95% CI: 1.9-2.9, P<0.0001). Physician (perception of HCT risks), system (insurance coverage) and patient (age, social support and co-morbid illness) factors were strongly endorsed by respondents as important determinants of their HCT referral practices. These data speak to important factors relevant to HCT referral practices, and highlight several opportunities for education and intervention to reduce current disparities.

  14. 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.

  15. NFPA 110 and its impact on transfer switching of emergency and standby power

    SciTech Connect

    Pukash, S. ); Castenschiold, R. )

    1989-05-01

    In 1985, following lengthy public and committee development, the National Fire Protection Association adopted and issued NFPA 110, a new standard for emergency and standby power systems. A review of this important document with particular emphasis on transfer switching is presented. The authors point out how this standard is now leading to safer and more reliable emergency and standby power installations.

  16. 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

  17. Recognition and management of adrenal emergencies.

    PubMed

    Torrey, Susan P

    2005-08-01

    Although clinical conditions associated with dysfunction of the ad-renal gland are often subtle, even insidious, in their presentation,and diagnosis and treatment usually are confined to outpatient clinics and offices, there are several situations that warrant the attention of emergency physicians. Recognition of the spectrum of presentations of pheochromocytoma, adrenal insufficiency, and pituitary apoplexy, and the sequelae of corticosteroid therapy and withdrawal, are critically important areas to emergency medicine. Prompt diagnosis with appropriate treatment and referral will reduce morbidity and mortality in many patients each year. A related topic pertinent to emergency physicians is the management of incidental adrenal masses that are discovered on abdominal radio-logic imaging.

  18. 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.

  19. 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.

  20. Summary of findings from the evaluation of a pilot medically supervised safer injecting facility.

    PubMed

    Wood, Evan; Tyndall, Mark W; Montaner, Julio S; Kerr, Thomas

    2006-11-21

    In many cities, infectious disease and overdose epidemics are occurring among illicit injection drug users (IDUs). To reduce these concerns, Vancouver opened a supervised safer injecting facility in September 2003. Within the facility, people inject pre-obtained illicit drugs under the supervision of medical staff. The program was granted a legal exemption by the Canadian government on the condition that a 3-year scientific evaluation of its impacts be conducted. In this review, we summarize the findings from evaluations in those 3 years, including characteristics of IDUs at the facility, public injection drug use and publicly discarded syringes, HIV risk behaviour, use of addiction treatment services and other community resources, and drug-related crime rates. Vancouver's safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts. These findings should be useful to other cities considering supervised injecting facilities and to governments considering regulating their use.

  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. PMID:27270594

  2. 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…

  3. Transcription of Case Report Forms from Unstructured Referral Letters: A Semantic Text Analytics Approach.

    PubMed

    Abidi, Syed Sibte Raza; Singh, Abhinav Kumar; Christie, Sean

    2016-01-01

    In this paper we present a framework for the semi-automatic extraction of medical entities from referral letters and use them to transcribe a case report form. Our framework offers the functionality to: (a) extract the medical entity from the unstructured referral letters, (b) classify them according to their semantic type, and (c) transcribe a case report form based on the extracted information from the referral letter. We take a semantic text analytics approach where SNOMED-CT ontology is used to both classify referral concepts and to establish semantic similarities between referral concepts and CRF elements. We used 100 spine injury referral letters, and a standard case report form used by Association of Dalhousie Neurosurgeons, Dalhousie University.

  4. Transcription of Case Report Forms from Unstructured Referral Letters: A Semantic Text Analytics Approach.

    PubMed

    Abidi, Syed Sibte Raza; Singh, Abhinav Kumar; Christie, Sean

    2016-01-01

    In this paper we present a framework for the semi-automatic extraction of medical entities from referral letters and use them to transcribe a case report form. Our framework offers the functionality to: (a) extract the medical entity from the unstructured referral letters, (b) classify them according to their semantic type, and (c) transcribe a case report form based on the extracted information from the referral letter. We take a semantic text analytics approach where SNOMED-CT ontology is used to both classify referral concepts and to establish semantic similarities between referral concepts and CRF elements. We used 100 spine injury referral letters, and a standard case report form used by Association of Dalhousie Neurosurgeons, Dalhousie University. PMID:27577396

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

    PubMed

    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.

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

    PubMed

    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

  7. 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

  8. 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

  9. 24 CFR 576.102 - Emergency shelter component.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) Providing information and referrals to other providers; (G) Providing ongoing risk assessment and safety... resources. (v) Outpatient health services. Eligible costs are for the direct outpatient treatment of medical conditions and are provided by licensed medical professionals. Emergency Solutions Grant (ESG) funds may...

  10. Impact of Emergency Department Intimate Partner Violence Intervention

    ERIC Educational Resources Information Center

    Kendall, Jayne; Pelucio, Maria Tereza; Casaletto, Jennifer; Thompson, Karen Parker; Barnes, Sherry; Pettit, Erin; Aldrich, Mae

    2009-01-01

    The objective of the study is to assess the impact of emergency department (ED) intimate partner violence (IPV) counseling and resource referrals on patient-perceived safety and safety planning. ED patients with risk factors were offered consultation with trained IPV advocacy counselors who completed safety assessments, provided resource…

  11. Suicide Prevention Referrals in a Mobile Health Smoking Cessation Intervention.

    PubMed

    Christofferson, Dana E; Hamlett-Berry, Kim; Augustson, Erik

    2015-08-01

    Automated mobile health (mHealth) programs deliver effective smoking cessation interventions through text message platforms. Smoking is an independent risk factor for suicide, so the Department of Veterans Affairs incorporated information about the Veterans Crisis Line into its SmokefreeVET smoking cessation text messaging program. Almost 7% of all SmokefreeVET enrollees have accessed this information. Because of the reach and automated nature of this and similar programs, we recommend including a referral to a suicide prevention hotline for all smoking cessation mHealth interventions. PMID:26066949

  12. Pediatric hematology providers on referral for transplant evaluation for sickle cell disease: a regional perspective.

    PubMed

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

    2014-10-01

    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 anonymously 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, χ 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). Northeastern 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.

  13. 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.

  14. GP referral to an eating disorder service: why the wide variation?

    PubMed Central

    Hugo, P; Kendrick, T; Reid, F; Lacey, H

    2000-01-01

    BACKGROUND: Early detection and management of patients with eating disorders is thought to improve prognosis, yet little is known about the factors associated with referral of these patients to treatment centres. AIM: To calculate general practitioner (GP) referral rates to a specialist eating disorder service and determine the association between referral rate and general practice and practitioner factors. METHOD: Referral rate was calculated from a database of routine referrals to St George's Hospital Eating Disorder Service from January 1990 to May 1996 and correlated with practice and practitioner details obtained from medical directories and health authority data. RESULTS: There was a wide variation in referral rates. A higher referral rate was found to be associated with practice size, proximity to the clinic, female GPs, GPs having the MRCGP qualification, being United Kingdom qualified, and offering full contraceptive services. Fundholding was associated with lower rates of referral. CONCLUSION: Patients with eating disorders may be at a disadvantage in certain practices. Educational interventions could be targeted towards low referrals. PMID:10897535

  15. 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…

  16. METHODS OF PROMOTING SAFER SEX BEHAVIORS UTILIZED BY MEN WHO HAVE SEX WITH MALE CASUAL SEX PARTNERS

    PubMed Central

    Serovich, Julianne M.; Craft, Shonda M.; McDowell, Tiffany L.; Grafsky, Erika L.; Andrist, David

    2009-01-01

    The purpose of this article is to report results of a qualitative investigation into the methods that HIV-positive men who have sex with men (MSM) use to initiate safer sex with casual sexual partners. In-depth, qualitative interviews were conducted with 57 HIV-positive adult MSM living in a large midwestern city. Using an inductive approach to data analysis, participants revealed a typology of safer sex strategies that can be placed into four primary categorizations: having a nonnegotiable sexual behavior policy, behaviorally controlling the interaction, being verbally direct, and being verbally indirect. Strategies varied by degree of explicitness and partner involvement. Men in this study often employed multiple strategies if their partner was not initially receptive to engaging in safer sex behaviors. The strategies described can be especially beneficial to those working in the area of HIV prevention. Providing MSM a variety of options to initiate safer sex may enhance current prevention efforts. PMID:19243227

  17. 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.

  18. 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.

  19. Surfing Stark II: prohibition against self-referrals.

    PubMed

    Swibel, H J; Zaremski, M J

    1995-02-01

    In 1989, the Chairman of the House Ways and Means Subcommittee on Health, Fortney (Pete) Stark (D.-Calif.), turned the health care industry on its ear by introducing the "Ethics in Patient Referrals Act" to Congress. The bill, commonly known as "Stark I," prohibited physician referrals to entities in which they held a financial interest. As Stark's bill made its way through Congress, its substance was dramatically reduced by the legislative process. Ultimately, the law was incorporated as part of the Omnibus Budget Reconciliation Act of 1990. Stark I's main thrust is that it bars physicians from referring Medicare patients to clinical laboratories with which they have a financial relationship. Furthermore, laboratories providing those services must report information concerning any ownership arrangements between the referring physician and the laboratory. Now, to complicate the picture, providers must contend with amendments to the original law that extend the reach of its prohibitions. Called "Stark II," these amendments took effect on January 1, 1995. In this article, guidelines for dealing successfully with the requirements of the law are outlined.

  20. Neuropathic pain referrals to a multidisciplinary pediatric cancer pain service.

    PubMed

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

    2014-03-01

    Neuropathic pain (NP) in children with cancer is not well characterized. In a retrospective review of patient data from a 3.5-year period, 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. 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 1,401 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 consultation (p = .008) and significantly more days of pain service follow-up (p < .001) than did other patients. The most common cause of NP was cancer treatment rather than the underlying malignancy. Pharmacologic management of NP was complex, often comprising three medications. Nonpharmacologic approaches were used for 57.6% of NP referrals. Neuropathic pain 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 pharmacologic management, and the frequent addition of nonpharmacologic interventions.

  1. 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…

  2. 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...

  3. 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...

  4. 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...

  5. Community Determinants of Substance Abuse Treatment Referrals from Juvenile Courts: Do Rural Youths Have Equal Access?

    ERIC Educational Resources Information Center

    Pullmann, Michael D.; Heflinger, Craig Anne

    2009-01-01

    Many youths in juvenile justice are in need of substance use services, yet referral to services is often inadequate. This study examines the ecological factors related to substance use service referrals made through Tennessee's juvenile courts. A series of hierarchical binomial logistic models indicated that individual-level factors accounted for…

  6. 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…

  7. 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…

  8. 21 CFR 20.51 - Referral to primary source of records.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Referral to primary source of records. 20.51 Section 20.51 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PUBLIC INFORMATION Procedures and Fees § 20.51 Referral to primary source of records. Upon receipt of...

  9. 7 CFR 1403.20 - Referral of debts to private collection agencies.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS AND POLICIES DEBT SETTLEMENT POLICIES AND PROCEDURES § 1403.20 Referral of debts to private collection agencies. If CCC's collection efforts... 7 Agriculture 10 2010-01-01 2010-01-01 false Referral of debts to private collection...

  10. 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 =…

  11. 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…

  12. 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"…

  13. 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...

  14. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  15. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  16. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  17. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  18. 7 CFR 1.630 - What will OALJ do with a case referral?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... FERC Hydropower Licenses General Provisions Related to Hearings § 1.630 What will OALJ do with a case referral? Within 5 days after issuance of the referral notice under § 1.625(c), 43 CFR 45.25(c), or 50...

  19. 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

    ... of the Secretary 32 CFR Part 199 RIN 0720-AB36 TRICARE: Non-Physician Referrals for Physical Therapy, Occupational Therapy, and Speech Therapy AGENCY: Office of the Secretary, Department of Defense. ACTION: Final... engage in referrals of beneficiaries to the Military Health System for physical therapy,...

  20. 36 CFR 1260.46 - How does the Department of Defense process referrals?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... National Declassification Center (NDC) § 1260.46 How does the Department of Defense process referrals? (a) The Department of Defense (DOD) established the Joint Referral Center (JRC) to review DOD agencies... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false How does the Department...

  1. 36 CFR 1260.46 - How does the Department of Defense process referrals?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... National Declassification Center (NDC) § 1260.46 How does the Department of Defense process referrals? (a) The Department of Defense (DOD) established the Joint Referral Center (JRC) to review DOD agencies... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false How does the Department...

  2. 36 CFR 1260.46 - How does the Department of Defense process referrals?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... National Declassification Center (NDC) § 1260.46 How does the Department of Defense process referrals? (a) The Department of Defense (DOD) established the Joint Referral Center (JRC) to review DOD agencies... 36 Parks, Forests, and Public Property 3 2013-07-01 2012-07-01 true How does the Department...

  3. 6 CFR 13.11 - Referral of Complaint and answer to the ALJ.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 6 Domestic Security 1 2012-01-01 2012-01-01 false Referral of Complaint and answer to the ALJ. 13.11 Section 13.11 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY PROGRAM FRAUD CIVIL REMEDIES § 13.11 Referral of Complaint and answer to the ALJ. Upon receipt of an answer,...

  4. 6 CFR 13.11 - Referral of Complaint and answer to the ALJ.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 6 Domestic Security 1 2011-01-01 2011-01-01 false Referral of Complaint and answer to the ALJ. 13.11 Section 13.11 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY PROGRAM FRAUD CIVIL REMEDIES § 13.11 Referral of Complaint and answer to the ALJ. Upon receipt of an answer,...

  5. 32 CFR 757.6 - Waiver, compromise, and referral of claims.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... accordance with 31 CFR part 904 shall be forwarded through the Judge Advocate General (Claims and Tort... AFFIRMATIVE CLAIMS REGULATIONS Property Damage Claims § 757.6 Waiver, compromise, and referral of claims. (a... 32 National Defense 5 2010-07-01 2010-07-01 false Waiver, compromise, and referral of claims....

  6. 32 CFR 757.6 - Waiver, compromise, and referral of claims.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... accordance with 31 CFR part 904 shall be forwarded through the Judge Advocate General (Claims and Tort... AFFIRMATIVE CLAIMS REGULATIONS Property Damage Claims § 757.6 Waiver, compromise, and referral of claims. (a... 32 National Defense 5 2012-07-01 2012-07-01 false Waiver, compromise, and referral of claims....

  7. 32 CFR 757.6 - Waiver, compromise, and referral of claims.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... accordance with 31 CFR part 904 shall be forwarded through the Judge Advocate General (Claims and Tort... AFFIRMATIVE CLAIMS REGULATIONS Property Damage Claims § 757.6 Waiver, compromise, and referral of claims. (a... 32 National Defense 5 2011-07-01 2011-07-01 false Waiver, compromise, and referral of claims....

  8. 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....

  9. 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...

  10. 42 CFR 411.370 - Advisory opinions relating to physician referrals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Advisory opinions relating to physician referrals. 411.370 Section 411.370 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... Advisory opinions relating to physician referrals. (a) Period during which CMS accepts requests....

  11. 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…

  12. Referral Rates of Senior Family Practice Residents in an Ambulatory Care Clinic.

    ERIC Educational Resources Information Center

    Lawler, Frank H.

    1987-01-01

    A study of patterns in second- and third-year family practice residents' requests for referrals found higher rates for the senior students, suggesting possible differences in approach to case management, lack of experience in referral among younger students, and differences in case mix. (MSE)

  13. 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...

  14. 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...

  15. 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...

  16. Contemporary Practices in School Psychology: A National Survey of Roles and Referral Problems.

    ERIC Educational Resources Information Center

    Bramlett, Ronald K.; Murphy, John J.; Johnson, Jenna; Wallingsford, Leah; Hall, John D.

    2002-01-01

    School psychologists (N=370) from a national organization were surveyed about their roles, types of referrals, consultation practices, and crisis team involvement. Assessment was the most common role. Most referrals were for academic problems. Behavioral consultation was the most common model. The majority of respondents had some involvement in…

  17. Evaluating racial disparity in referral source and successful completion of substance abuse treatment.

    PubMed

    Sahker, Ethan; Toussaint, Maisha N; Ramirez, Marizen; Ali, Saba R; Arndt, Stephan

    2015-09-01

    Health disparity is a significant problem in the United States, and particularly for substance abuse treatment programs. A better understanding of racial differences in treatment pathways associated with successful treatment completion is needed to reduce the existing health disparities. Referral source is a strong predictor of treatment success and most research on health disparities has focused on the criminal justice referrals. However, little research has examined other types of referral sources, and the interaction with race. The current study sought to compare the effect of referral sources on national substance abuse successful treatment completion rates between Black clients (n=324,625) and White clients (n=1,060,444) by examining the interaction of race on referral source and successful treatment completion. Race significantly moderated the difference between referral source and successful treatment completion (Wald χ(2)=1477.73, df=6, p<0.0001). Employment referral was associated with the greatest percentage of successful treatment completion for Black clients. Criminal justice referral was associated with the greatest percentage of successful treatment completion for White clients. Results from the present study support a reevaluation of incentives leading to successful treatment completion with a multicultural perspective.

  18. 42 CFR 411.353 - Prohibition on certain referrals by physicians and limitations on billing.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... entity that furnishes DHS is not imputed to his or her group practice or its members or its staff. However, a referral made by a physician's group practice, its members, or its staff may be imputed to the physician if the physician directs the group practice, its members, or its staff to make the referral or...

  19. 49 CFR 1018.72 - Referral to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... prescribed by 4 CFR 105.2. Care must be taken to preserve all files, records, and exhibits on claims referred... 49 Transportation 8 2012-10-01 2012-10-01 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...

  20. 31 CFR 904.4 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 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....

  1. 7 CFR 1403.17 - Referral of debts to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 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....

  2. 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...

  3. 49 CFR 1018.72 - Referral to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... prescribed by 4 CFR 105.2. Care must be taken to preserve all files, records, and exhibits on claims referred... 49 Transportation 8 2014-10-01 2014-10-01 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...

  4. 7 CFR 1403.17 - Referral of debts to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 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....

  5. 29 CFR 100.625 - Referral of a claim to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... contained if 31 CFR parts 900-904 and, in any event, well within the period for initiating timely lawsuits... 29 Labor 2 2014-07-01 2014-07-01 false Referral of a claim to the Department of Justice. 100.625... REGULATIONS Debt Collection Procedures § 100.625 Referral of a claim to the Department of Justice. The...

  6. 22 CFR 213.37 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 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...

  7. 49 CFR 1018.72 - Referral to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... prescribed by 4 CFR 105.2. Care must be taken to preserve all files, records, and exhibits on claims referred... 49 Transportation 8 2013-10-01 2013-10-01 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...

  8. 49 CFR 1018.72 - Referral to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... prescribed by 4 CFR 105.2. Care must be taken to preserve all files, records, and exhibits on claims referred... 49 Transportation 8 2011-10-01 2011-10-01 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...

  9. 24 CFR 17.75 - Referral to GAO or Justice Department.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... General Provisions § 17.75 Referral to GAO or Justice Department. (a) Claims referred. Claims which cannot be collected, compromised, or terminated in accordance with 4 CFR parts 101 to 105 will be referred... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Referral to GAO or...

  10. 7 CFR 792.18 - Referral of debts to Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 7 2011-01-01 2011-01-01 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...

  11. 7 CFR 792.18 - Referral of debts to Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 7 2013-01-01 2013-01-01 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...

  12. 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....

  13. 22 CFR 213.37 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 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...

  14. 29 CFR 100.625 - Referral of a claim to the Department of Justice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... contained if 31 CFR parts 900-904 and, in any event, well within the period for initiating timely lawsuits... 29 Labor 2 2013-07-01 2013-07-01 false Referral of a claim to the Department of Justice. 100.625... REGULATIONS Debt Collection Procedures § 100.625 Referral of a claim to the Department of Justice. The...

  15. 24 CFR 17.75 - Referral to GAO or Justice Department.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... General Provisions § 17.75 Referral to GAO or Justice Department. (a) Claims referred. Claims which cannot be collected, compromised, or terminated in accordance with 4 CFR parts 101 to 105 will be referred... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to GAO or...

  16. 31 CFR 904.4 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 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....

  17. 49 CFR 1018.72 - Referral to the Department of Justice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... prescribed by 4 CFR 105.2. Care must be taken to preserve all files, records, and exhibits on claims referred... 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...

  18. 29 CFR 100.625 - Referral of a claim to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... contained if 31 CFR parts 900-904 and, in any event, well within the period for initiating timely lawsuits... 29 Labor 2 2012-07-01 2012-07-01 false Referral of a claim to the Department of Justice. 100.625... REGULATIONS Debt Collection Procedures § 100.625 Referral of a claim to the Department of Justice. The...

  19. 41 CFR 105-55.034 - Minimum amount of referrals to the Department of Justice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... referrals to the Department of Justice. 105-55.034 Section 105-55.034 Public Contracts and Property....034 Minimum amount of referrals to the Department of Justice. (a) The General Services Administration... Department of Justice (DOJ) will notify GSA if the Attorney General changes this minimum amount. (b) GSA...

  20. 22 CFR 213.37 - Referrals to the Department of Justice.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 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...