Psychosocial impacts of the lack of access to water and sanitation in low- and middle-income countries: a scoping review.

PubMed

Bisung, Elijah; Elliott, Susan J

2017-02-01

The lack of access to safe water and adequate sanitation has implications for the psychosocial well-being of individuals and households. To review the literature on psychosocial impacts, we completed a scoping review of the published literature using Medline, Embase, and Scopus. Fifteen studies met the inclusion criteria and were reviewed in detail. Of the included studies, six were conducted in India, one in Nepal, one in Mexico, one in Bolivia, two in Ethiopia, one in Zimbabwe, one in South Africa, and two in Kenya. Four interrelated groups of stressors emerged from the review: physical stressors, financial stressors, social stressors, and stressors related to (perceived) inequities. Further, gender differences were observed, with women carrying a disproportionate psychosocial burden. We argue that failure to incorporate psychosocial stressors when estimating the burden or benefits of safe water and sanitation may mask an important driver of health and well-being for many households in low- and middle-income countries. We propose further research on water-related stressors with particular attention to unique cultural norms around water and sanitation, short and long term psychosocial outcomes, and individual and collective coping strategies. These may help practitioners better understand cumulative impacts and mechanisms for addressing water and sanitation challenges.

Orphaned female elephant social bonds reflect lack of access to mature adults.

PubMed

Goldenberg, Shifra Z; Wittemyer, George

2017-10-31

Compensatory social behavior in nonhuman animals following maternal loss has been documented, but understanding of how orphans allocate bonding to reconstruct their social networks is limited. Successful social integration may be critical to survival and reproduction for highly social species and, therefore, may be tied to population persistence. We examined the social partners involved in affiliative interactions of female orphans and non-orphans in an elephant population in Samburu, northern Kenya that experienced heightened adult mortality driven by drought and intense ivory poaching. We contrasted partners across different competitive contexts to gain insight to the influence of resource availability on social interactions. Though the number of partners did not differ between orphans and non-orphans, their types of social partners did. Orphans interacted with sisters and matriarchs less while feeding than did non-orphans, but otherwise their affiliates were similar. While resting under spatially concentrated shade, orphans had markedly less access to mature adults but affiliated instead with sisters, bulls, and age mates. Orphan propensity to strengthen bonds with non-dominant animals appears to offer routes to social integration following maternal loss, but lack of interaction with adult females suggests orphans may experience decreased resource access and associated fitness costs in this matriarchal society.

[Lack of access to information on oral health problems among adults: an approach based on the theoretical model for literacy in health].

PubMed

Roberto, Luana Leal; Noronha, Daniele Durães; Souza, Taiane Oliveira; Miranda, Ellen Janayne Primo; Martins, Andréa Maria Eleutério de Barros Lima; Paula, Alfredo Maurício Batista De; Ferreira, Efigênia Ferreira E; Haikal, Desirée Sant'ana

2018-03-01

This study sought to investigate factors associated with the lack of access to information on oral health among adults. It is a cross-sectional study, carried out among 831 adults (35-44 years of age). The dependent variable was access to information on how to avoid oral problems, and the independent variables were gathered into subgroups according to the theoretical model for literacy in health. Binary logistic regression was carried out, and results were corrected by the design effect. It was observed that 37.5% had no access to information about dental problems. The lack of access was higher among adults who had lower per capita income, were dissatisfied with the dental services provided, did not use dental floss, had unsatisfactory physical control of the quality of life, and self-perceived their oral health as fair/poor/very poor. The likelihood of not having access to information about dental problems among those dissatisfied with the dental services used was 3.28 times higher than for those satisfied with the dental services used. Thus, decreased access to information was related to unfavorable conditions among adults. Health services should ensure appropriate information to their users in order to increase health literacy levels and improve satisfaction and equity.

Unmet need for family planning in Ghana: the shifting contributions of lack of access and attitudinal resistance.

PubMed

Machiyama, Kazuyo; Cleland, John

2014-06-01

In Ghana, despite a 38 percent decline in the total fertility rate from 1988 to 2008, unmet need for family planning among married women exposed to pregnancy risk declined only modestly in this period: from 50 percent to 42 percent. Examining data from the five DHS surveys conducted in Ghana during these years, we find that the relative contribution to unmet need of lack of access to contraceptive methods has diminished, whereas attitudinal resistance has grown. In 2008, 45 percent of women with unmet need experienced no apparent obstacles associated with access or attitude, 32 percent had access but an unfavorable attitude, and 23 percent had no access. Concerns regarding health as a reason for nonuse have been reported in greater numbers over these years and are now the dominant reason, followed by infrequent sex. An enduring resistance to hormonal methods, much of it based on prior experience of side effects, may lead many Ghanaian women, particularly the educated in urban areas, to use periodic abstinence or reduced coital frequency as an alternative to modern contraception. © 2013 The Population Council, Inc.

Time trends in socio-economic inequalities in the lack of access to dental services among children in Spain 1987-2011.

PubMed

Pinilla, Jaime; Negrín-Hernández, Miguel A; Abásolo, Ignacio

2015-01-31

Adult oral health is predicted by oral health in childhood. Prevention improves oral health in childhood and, consequently in adulthood, so substantial cost savings can be derived from prevention. The burden of oral disease is particularly high for disadvantaged and poor population groups in both developing and developed countries. Therefore, an appropriate and egalitarian access to dental care becomes a desirable objective if children's dental health is to be promoted irrespective of socioeconomic status. The aim of this research is to analyse inequalities in the lack of access to dental care services for children in the Spanish National Health System by socio-economic group over the period 1987-2011. Pooled data from eight editions of the Spanish National Health Survey for the years 1987-2011, as well as contextual data on state dental programmes are used. Logistic regressions are used to examine the related factors to the probability of not having ever visited the dentist among children between 6 and 14 years old. Our lack of access variable pays particular attention to the socioeconomic level of children's household. The mean probability of having never been to the dentist falls considerably from 49.5% in 1987 to 8.4% in 2011. Analysis by socioeconomic level indicates that, in 1987, the probability of not having ever gone to the dentist is more than two times higher for children in the unskilled manual social class than for those in the upper non-manual social class (odds ratio 2.35). And this difference is not reduced significantly throughout the period analysed, rather it increases as in 1993 (odds of 2.39) and 2006 (odds of 3.03) to end in 2011 slightly below than in 1987 (odds ratio 1.80). There has been a reduction in children's lack of access to dentists in Spain over the period 1987-2011. However, this reduction has not corrected the socioeconomic inequalities in children's access to dentists in Spain.

Barriers to accessing adequate maternal care in Central and Eastern European countries: A systematic literature review.

PubMed

Miteniece, Elina; Pavlova, Milena; Rechel, Bernd; Groot, Wim

2017-03-01

Maternal health outcomes in Central and Eastern Europe (CEE) compare unfavorable with those in Western Europe, despite macro-indicators that suggest well-designed maternal care systems. However, macro-indicators at the system level only capture capacity, funding and utilization of care and not the actual allocation of financial and human resources, the quality of care and access to it. It is these latter which are problematic in the CEE region. In this study service-related indicators of access to maternal care in CEE are examined. These include availability, appropriateness, affordability, approachability and acceptability of maternal care. This study uses a qualitative systematic literature review, analyzing information of peer-reviewed articles published since 2004. Other inclusion criteria included language, setting and publication purpose. The included articles were analyzed using a framework analysis technique and quality was assessed using standardized evaluation checklists. Results indicate improvements in maternal care. However, availability of care is limited by outdated equipment and training curricula, and the lack of professionals and pharmaceuticals. Geographical distance to healthcare institutions, inappropriate communication of providers and waiting times are the main approachability barriers. Some mothers are unaware of the importance of care or are discouraged to utilize healthcare services because of cultural aspects. Finally, a major barrier in accessing maternal care in the CEE is the inability to pay for it. Our findings indicate that major gaps in evidence exist and that more representative and better quality data should be collected. Governments in CEE countries need to establish a reliable system for measuring and monitoring a suitable set of indicators, as well as deal with the general social and economic problem of informality. Medical curricula in the CEE region need to be overhauled and there should be a focus on improving the

Analysing the lack of Demand Organisation

NASA Astrophysics Data System (ADS)

Boxer, Philip; Cohen, Bernard

1998-07-01

We seek to develop means of intervention in Enterprises that will enable them to react in an effective, sustainable and timely fashion to changes in the ways that markets and demand are organized; that is, to act strategically. We take an enterprise to be some entity that seeks to provide its clients with services that they value while maintaining its ability to do so in the face of changes in the demands of its clients and in the resources at its disposal. The services that clients value form around what the organization of their demands lack. The concept of strategy therefore rests on critically evaluating the ontology and semantics of the Enterprise in relation to these holes in demand organization. We access ontology and semantics by constructing and manipulating hypothetical, first-order, mathematical models of the Enterprise's services and of its value-adding processes. Because an enterprise is an anticipatory system, its semantic domain must include representations of the enterprise's model of itself and of the market and demand organizations within which it competes. First-order (set) theory provides adequate expressive power here, but alternative, higher order, mathematical frameworks, such as Dubois' hyperincursion, provide inadequate power, particularly in relation to the analysis of the properties of emergence. Knowing exactly why and where this mathematical lack manifests in the analysis process enables effective collaboration between systems analysts and psychoanalysts, and suggest directions for mathematical research.

42 CFR 438.207 - Assurances of adequate capacity and services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Access Standards § 438.207 Assurances of adequate capacity and services. (a) Basic rule. The State... with the State's requirements for availability of services, as set forth in § 438.206. (e) CMS' right...

Calculation of the Cost of an Adequate Education in Kentucky: A Professional Judgment Approach

ERIC Educational Resources Information Center

Verstegen, Deborah A.

2004-01-01

What is an adequate education and how much does it cost? In 1989, Kentucky's State Supreme Court found the entire system of education unconstitutional--"all of its parts and parcels". The Court called for all children to have access to an adequate education, one that is uniform and has as its goal the development of seven capacities,…

42 CFR 438.207 - Assurances of adequate capacity and services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... enrollment in its service area in accordance with the State's standards for access to care under this subpart... 42 Public Health 4 2014-10-01 2014-10-01 false Assurances of adequate capacity and services. 438.207 Section 438.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

42 CFR 438.207 - Assurances of adequate capacity and services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... enrollment in its service area in accordance with the State's standards for access to care under this subpart... 42 Public Health 4 2011-10-01 2011-10-01 false Assurances of adequate capacity and services. 438.207 Section 438.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

42 CFR 438.207 - Assurances of adequate capacity and services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... enrollment in its service area in accordance with the State's standards for access to care under this subpart... 42 Public Health 4 2012-10-01 2012-10-01 false Assurances of adequate capacity and services. 438.207 Section 438.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

Access to essential drugs in Guyana: a public health challenge.

PubMed

Seoane-Vazquez, Enrique; Rodriguez-Monguio, Rosa

2010-01-01

Guyana's pharmaceutical sector faces major challenges that limit access to essential drugs. This study analyzes Guyana's drug policy and regulation, public financing, and drug procurement and delivery. The study also identifies main barriers to drug access and proposes alternatives to strengthen the country's public health functions. Data were collected from the country's regulatory agencies, public procurement agency, pharmacies, wholesalers, and pharmaceutical companies. The information was supplemented with interviews with a convenient sample of Guyanese health authorities and stakeholders. Data were also compiled from scientific databases, and web pages of the country's Ministries of Health, Commerce and Finance, the Bureau of Statistics, and international organizations. Major barriers to drug access include: (1) lack of national drug policy and regulation, and limited role of the regulatory authority; (2) inefficient drug selection and irrational drug use; (3) insufficient financial resources and lack of drug pricing policy; (4) inefficient planning and managing public supply system; (5) deficient epidemiological and information systems; and (6) inadequate infrastructures and human resources shortage. Improving drug access in Guyana requires the strengthening of the country's public health functions and the implementation of a national drug policy and pricing policy, streamlining the drug financing, procurement, and planning and managing drug supply; and adequate infrastructures and human resources. Copyright 2008 John Wiley & Sons, Ltd.

Army General Fund Adjustments Not Adequately Documented or Supported

DTIC Science & Technology

2016-07-26

compilation process. Finding The Office of the Assistant Secretary of the Army (Financial Management & Comptroller) (OASA[FM&C]) and the Defense Finance and...statements were unreliable and lacked an adequate audit trail. Furthermore, DoD and Army managers could not rely on the data in their accounting...systems when making management and resource decisions. Until the Army and DFAS Indianapolis correct these control deficiencies, there is considerable

[Accessibility of legal benefits available in Rio de Janeiro for physically handicapped people].

PubMed

Elias, Margareth Pereira; Monteiro, Lúcia Maria Costa; Chaves, Celia Regina

2008-01-01

According to PAHO, only 2 % of Latin America's 85 million disabled people receive adequate medical care. Ten percent of the world's population lives with disabilities without having access to their constitutional rights. Disability must be addressed on several levels: medical, rehabilitative, social and political. Disability is strongly linked to poverty. Stigma, discrimination and inability to pay limit access to health services and education and ill-health increases the treatment cost, creating a vicious circle that must be broken. Although the Constitution grants rights to disabled persons including access to health and education, these legal benefits are not always obtained or respected. To better understand and address the problem, the process for obtaining three of these legal benefits was studied among disabled pediatric patients with myelomeningocele in a specialized Institute in Rio de Janeiro. Results show a low achievement rate. Bureaucracy and the expenses with locomotion were main constrains worsened by lack of time and resources in families struggling with poverty. Other difficulties were lack of professional attention and confidence in the system, problems related to documents, unqualified educational system and locomotion constrains.

Exploring barriers to and enablers of adequate healthcare for Indigenous Australian prisoners with cancer: a scoping review drawing on evidence from Australia, Canada and the United States.

PubMed

Olds, Jessica; Reilly, Rachel; Yerrell, Paul; Stajic, Janet; Micklem, Jasmine; Morey, Kim; Brown, Alex

International frameworks supported by national principles in Australia stipulate that prisoners should be provided with health services equivalent to those provided in the general community. However, a number of barriers unique to the prison system may hinder the provision of equitable healthcare for this population. In Australia, Indigenous people carry a greater burden of cancer mortality, which the Cancer Data and Aboriginal Disparities (CanDAD) project is seeking to address. During the course of recruiting participants to the CanDAD study, Indigenous Australian prisoners with cancer emerged as an important, under-researched but difficult to access sub-group. This scoping review sought to identify barriers and facilitators of access to adequate and equitable healthcare for Indigenous Australian prisoners with cancer in Australia. This review demonstrated a lack of research and, as such, the scoping review was extended to prisoners with cancer in Australia, New Zealand, the United States and Canada. This approach was taken in order to summarise the existing body of evidence regarding the barriers and facilitators of access to adequate and equitable healthcare for those who are incarcerated and suffering from cancer, and highlight areas that may require further investigation. Eight studies or commentaries were found to meet the inclusion criteria. This limited set of findings pointed to a range of possible barriers faced by prisoners with cancer, including a tension between the prisons' concern with security versus the need for timely access to medical care. Findings identified here offer potential starting points for research and policy development. Further research is needed to better elucidate how barriers to adequate cancer care for prisoners may be identified and overcome, in Australia and internationally. Furthermore, given Indigenous Australians' over-burden of cancer mortality and over-representation in the prison system, further research is needed to

Lack of proportionality. Seven specifications of public interest that override post-approval commercial interests on limited access to clinical data.

PubMed

Strech, Daniel; Littmann, Jasper

2012-07-02

For the protection of commercial interests, licensing bodies such as the EMA and health technology assessment institutions such as NICE restrict full access to unpublished evidence. Their respective policies on data transparency, however, lack a systematic account of (1) what kinds of commercial interests remain relevant after market approval has been granted, (2) what the specific types of public interest are that may override these commercial interests post approval, and, most importantly, (3) what criteria guide the trade-off between public interest and legitimate measures for the protection of commercial interest. Comparing potential commercial interests with seven specifications of relevant public interest reveals the lack of proportionality inherent in the current practices of EMA and NICE.

Perceptions of emergency care in Kenyan communities lacking access to formalised emergency medical systems: a qualitative study

PubMed Central

Broccoli, Morgan C; Calvello, Emilie J B; Skog, Alexander P; Wachira, Benjamin; Wallis, Lee A

2015-01-01

Objectives We undertook this study in Kenya to understand the community's emergency care needs and barriers they face when trying to access care, and to seek community members’ thoughts regarding high impact solutions to expand access to essential emergency services. Design We used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated and analysed using the content analysis approach. Setting Participants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley and Western), with equal rural and urban community representation. Results Socioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies, and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care—a lack of: system structure, resources, transportation, trained healthcare providers and initial care at the scene. Conclusions Access to emergency care in Kenya can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the pre-hospital care system, improving emergency care delivery at health facilities and creating new policies at a national level. These community-generated solutions likely have a wider applicability in the region. PMID:26586324

Improving Access to Medicines in Low and Middle Income Countries: Corporate Responsibilities in Context

PubMed Central

Leisinger, Klaus Michael; Garabedian, Laura Faden; Wagner, Anita Katharina

2012-01-01

More than two billion people in low- and middle-income countries (LMIC) lack adequate access to essential medicines. In this paper, we make strong public health, human rights and economic arguments for improving access to medicines in LMIC and discuss the different roles and responsibilities of key stakeholders, including national governments, the international community, and non-governmental organizations (NGOs). We then establish a framework of pharmaceutical firms’ corporate responsibilities - the “must,” the “ought to,” and the “can” dimensions - and make recommendations for actionable business strategies for improving access to medicines. We discuss controversial topics, such as pharmaceutical profits and patents, with the goal of building consensus around facts and working towards a solution. We conclude that partnerships and collaboration among multiple stakeholders are urgently needed to improve equitable access to medicines in LMIC. PMID:23535994

Racial/Ethnic Differences in Cigarette Use: The Roles of Mental Illness and Health-Care Access/Utilization.

PubMed

Lo, Celia C; Yang, Fan; Ash-Houchen, William; Cheng, Tyrone C

2018-06-07

Empirical evidence supports a hypothesis that cigarettes may be used to cope with mental illness. Little research, however, addresses how race/ethnicity is linked to mental health and cigarette use. This study applied the self-medication hypothesis. It asked whether mental status was associated, via health-care access/utilization, with the cigarette use outcomes of four racial/ethnic groups. It also tested whether race/ethnicity moderated any such associations. We used nationally representative data from the 2009-2010 and 2011-2012 National Health and Nutrition Examination Surveys to link cigarette use to mental status and health-care access/utilization. The final sample included 3827 White respondents, 1635 African-American respondents, 1144 Mexican-American respondents, and 781 Hispanic American (other than Mexican-American) respondents. Consistent with earlier research and the self-medication hypothesis, we observed a positive relationship between cigarette use and mental status. Associations of cigarette use and health-care access/utilization sometimes failed to take expected directions. We concluded from the findings that race/ethnicity's moderating role in associations between cigarette use and health-care access was generally more advantageous to Whites than other groups examined. Where treatment is delayed by lack of access to, or lack of trust in, care providers, mental health may worsen-and it is often minority Americans who lack access and trust. If minority Americans' health is to improve, shrinking racial health disparities, then access to adequate health care must be available to them, facilitating prompt treatment of mental and other illness.

Confidence in the Knowledge Base of English Language Learners Studying Science: Using Agency to Compensate for the Lack of Adequate Linguistic Identity

NASA Astrophysics Data System (ADS)

Hayes, Aneta L.; Mansour, Nasser

2017-04-01

Changes in the cultural and linguistic environments of learners are often associated with identity shifts. The aim of this study was to explore what identity shifts occur when science students from Bahraini national schools transition to an international university. The role of two aspects of learner identity—that is, English proficiency and science background knowledge, was examined in this study. Focus groups and semi-structured interviews were conducted with students and with university lecturers. The analysis suggested three conceptual themes of (1) reliance on science knowledge, (2) the auxiliary role of professional language and (3) adequacy of student learning strategies, demonstrating what subjective meanings the participants ascribe to the interplay between science knowledge and linguistic ability. The findings suggest that despite the lack of adequate linguistic attributes, the students are still able to successfully learn science in the context of language change. It is also implied that through strategically utilising their academic background in science, students preserve their identity as successful learners from school through to university. We conclude that agency plays a separate role in transition and is not a sole function of identity. We also contest the idea of language as a necessary attribute of one's identity as it was perceived by our participants to be an advantage and an auxiliary tool rather than a requirement.

Patients struggle to access effective health care due to ongoing violence, distance, costs and health service performance in Afghanistan.

PubMed

Nic Carthaigh, Niamh; De Gryse, Benoit; Esmati, Abdul Sattar; Nizar, Barak; Van Overloop, Catherine; Fricke, Renzo; Bseiso, Jehan; Baker, Corinne; Decroo, Tom; Philips, Mit

2015-05-01

The Afghan population suffers from a long standing armed conflict. We investigated patients' experiences of their access to and use of the health services. Data were collected in four clinics from different provinces. Mixed methods were applied. The questions focused on access obstacles during the current health problem and health seeking behaviour during a previous illness episode of a household member. To access the health facilities 71.8% (545/759) of patients experienced obstacles. The combination of long distances, high costs and the conflict deprived people of life-saving healthcare. The closest public clinics were underused due to perceptions regarding their lack of availability or quality of staff, services or medicines. For one in five people, a lack of access to health care had resulted in death among family members or close friends within the last year. Violence continues to affect daily life and access to healthcare in Afghanistan. Moreover, healthcare provision is not adequately geared to meet medical and emergency needs. Impartial healthcare tailored to the context will be vital to increase access to basic and life-saving healthcare. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Patients struggle to access effective health care due to ongoing violence, distance, costs and health service performance in Afghanistan

PubMed Central

Nic Carthaigh, Niamh; De Gryse, Benoit; Esmati, Abdul Sattar; Nizar, Barak; Van Overloop, Catherine; Fricke, Renzo; Bseiso, Jehan; Baker, Corinne; Decroo, Tom; Philips, Mit

2015-01-01

Background The Afghan population suffers from a long standing armed conflict. We investigated patients’ experiences of their access to and use of the health services. Methods Data were collected in four clinics from different provinces. Mixed methods were applied. The questions focused on access obstacles during the current health problem and health seeking behaviour during a previous illness episode of a household member. Results To access the health facilities 71.8% (545/759) of patients experienced obstacles. The combination of long distances, high costs and the conflict deprived people of life-saving healthcare. The closest public clinics were underused due to perceptions regarding their lack of availability or quality of staff, services or medicines. For one in five people, a lack of access to health care had resulted in death among family members or close friends within the last year. Conclusions Violence continues to affect daily life and access to healthcare in Afghanistan. Moreover, healthcare provision is not adequately geared to meet medical and emergency needs. Impartial healthcare tailored to the context will be vital to increase access to basic and life-saving healthcare. PMID:25492948

Assessing access to surgical care in Nepal via a cross-sectional, countrywide survey.

PubMed

Boeck, Marissa A; Nagarajan, Neeraja; Gupta, Shailvi; Varadaraj, Varshini; Groen, Reinou S; Shrestha, Sunil; Gurung, Susant; Kushner, Adam L; Nwomeh, Benedict; Swaroop, Mamta

2016-08-01

Adequate surgical care is lacking in many low- and middle-income countries because of diverse barriers preventing patients from reaching providers. We sought to assess perceived difficulties to accessing surgical care in Nepal using the Surgeons OverSeas Assessment of Surgical Need tool. Fifteen of 75 Nepali districts were selected proportionate to the population, with 1,350 households surveyed. Household heads answered questions regarding access to health facilities, and 2 household members were interviewed for medical history. Continuous and categorical variables were analyzed via Wilcoxon rank sum test and Pearson χ(2) test. Multivariable logistic regressions for independent predictors of care access were performed controlling for age, sex, location, and literacy. Of respondents with a surgical condition (n = 1,342), 650 (48.4%) accessed care and 237 (17.7%) did not. Unadjusted analyses showed greater median travel times to all facilities (P < .001) and median transport costs to secondary and tertiary centers (P < .001) for those who did not access care versus those who did. Literate respondents were more likely to access care across all facilities and access variables in adjusted models (odds ratio 1.66-1.80, P < .01). Those without transport money were less likely to access care at any facility in all analyses (P < .01). The data project that at least 2.4 million individuals lack access to needed surgical care in Nepal during their lifetimes, with those not accessing health facilities having lower literacy rates and fewer transport resources. Promoting education, outreach programs, and transportation access could lessen barriers but will require further exploration. Copyright © 2016 Elsevier Inc. All rights reserved.

Enhancing access to health information in Africa: a librarian's perspective.

PubMed

Gathoni, Nasra

2012-01-01

In recent years, tremendous progress has been made toward providing health information in Africa, in part because of technological advancements. Nevertheless, ensuring that information is accessible, comprehensible, and usable remains problematic, and there remain needs in many settings to address issues such as computer skills, literacy, and the infrastructure to access information. To determine how librarians might play a more strategic role in meeting information needs of health professionals in Africa, the author reviewed key components of information systems pertinent to knowledge management for the health sector, including access to global online resources, capacity to use computer technology for information retrieval, information literacy, and the potential for professional networks to play a role in improving access to and use of information. The author concluded that, in regions that lack adequate information systems, librarians could apply their knowledge and skills to facilitate access and use by information seekers. Ensuring access to and use of health information can also be achieved by engaging organizations and associations working to enhance access to health information, such as the Association for Health Information and Libraries in Africa. These groups can provide assistance through training, dissemination, information repackaging, and other approaches known to improve information literacy.

Access and adequate utilization of malaria control interventions in rural Malawi: a descriptive quantitative study.

PubMed

Kabaghe, Alinune Nathanael; Chipeta, Michael Give; McCann, Robert Sean; Terlouw, Dianne Jean; Tizifa, Tinashe; Truwah, Zinenani; Phiri, Kamija Samuel; van Vugt, Michèle

2018-03-06

Despite the availability of cost effective malaria control interventions, such as insecticide-treated bed nets (ITN), diagnosis and effective treatment of malaria, and intermittent preventive treatment during pregnancy (IPTp), the lack of equitable access and coverage affect utilization of these interventions in rural communities. Aggregated rates of access and utilization of malaria interventions in national surveys mask substantial variations in intervention coverage. Utilization of interventions and factors affecting utilization need investigation in rural communities. One year of quantitative data collected from a rolling Malaria Indicator Survey (April 2015-April 2016) in Chikhwawa District, Malawi, before the ITN distribution campaign, were analysed. Univariate analyses were used to quantify rates of ITN usage, care-seeking for fever in children aged 6-59 months and women aged 15-49 years and IPTp uptake (for women aged 15-49 years with a recent delivery). Results were compared to national survey estimates; factors associated with these outcomes were determined using multivariate regression models. A total of 2046 participants were included from 1328 households; 56.6% were women aged 15-49 years and 43.4% were children aged 6-59 months. Reported ownership of at least one ITN per household and under-five children ITN use the previous night were 35.3 and 33.5% compared to 70.2 and 67.1%, respectively, in the national survey; ITN use was higher in high wealth quintile households than low quintile ones. For participants with recent fever, 37.6 and 19.5% sought care and sought care within 24 h, respectively. Care-seeking was lower for febrile women than febrile children [aOR, 95% CI 0.53 (0.35-0.81)]. Uptake of two and three or more doses of IPTp were 40.6 and 15.0%, respectively, among women with a pregnancy in the last 2 years. To achieve effective malaria control, fine-scale or district-based surveillance should be used to identify and target communities

The impact of urban gardens on adequate and healthy food: a systematic review.

PubMed

Garcia, Mariana T; Ribeiro, Silvana M; Germani, Ana Claudia Camargo Gonçalves; Bógus, Cláudia M

2018-02-01

To examine the impacts on food and nutrition-related outcomes resulting from participation in urban gardens, especially on healthy food practices, healthy food access, and healthy food beliefs, knowledge and attitudes. The systematic review identified studies by searching the PubMed, ERIC, LILACS, Web of Science and Embase databases. An assessment of quality and bias risk of the studies was carried out and a narrative summary was produced. Studies published as original articles in peer-reviewed scientific journals in English, Spanish or Portuguese between 2005 and 2015 were included. The studies included were based on data from adult participants in urban gardens. Twenty-four studies were initially selected based on the eligibility criteria, twelve of which were included. There was important heterogeneity of settings, population and assessment methods. Assessment of quality and bias risk of the studies revealed the need for greater methodological rigour. Most studies investigated community gardens and employed a qualitative approach. The following were reported: greater fruit and vegetable consumption, better access to healthy foods, greater valuing of cooking, harvest sharing with family and friends, enhanced importance of organic production, and valuing of adequate and healthy food. Thematic patterns related to adequate and healthy food associated with participation in urban gardens were identified, revealing a positive impact on practices of adequate and healthy food and mainly on food perceptions.

Healthcare Needs of and Access Barriers for Brazilian Transgender and Gender Diverse People.

PubMed

Costa, Angelo Brandelli; da Rosa Filho, Heitor Tome; Pase, Paola Fagundes; Fontanari, Anna Martha Vaitses; Catelan, Ramiro Figueiredo; Mueller, Andressa; Cardoso, Dhiordan; Soll, Bianca; Schwarz, Karine; Schneider, Maiko Abel; Gagliotti, Daniel Augusto Mori; Saadeh, Alexandre; Lobato, Maria Inês Rodrigues; Nardi, Henrique Caetano; Koller, Silvia Helena

2018-02-01

Transgender and gender diverse people (TGD) have specific healthcare needs and struggles with access barriers that should be addressed by public health systems. Our study aimed to address this topic in the Brazilian context. A hospital and web-based cross-sectional survey built with input from the medical and transgender communities was developed to assess TGD healthcare needs of and access barriers in two Brazilian states. Although services that assist this population have existed in Brazil since the 1990s, TGD have difficulty accessing these services due to discrimination, lack of information and a policy design that does not meet the needs of TGD. A history of discrimination was associated with a 6.72-fold increase in the frequency of health service avoidance [95% CI (4.5, 10.1)]. This article discusses the urgent necessity for adequate health policies and for the training of professionals regarding the needs of Brazilian TGD.

Environmental, parental, and personal influences on food choice, access, and overweight status among homeless children.

PubMed

Richards, Rickelle; Smith, Chery

2007-10-01

In-depth interviews were conducted with homeless children (n=56, aged 6-13 years) in an urban center in Minnesota, USA, to determine factors influencing food choice, food access, and weight status, with interview questions developed using the Social Cognitive Theory. Interview transcripts were coded and then evaluated both collectively and by weight status (<85th percentile=normal weight vs. > or = 85th percentile=overweight). Forty-five percent of children were overweight. Environmental, parental, and personal factors emerged as common themes influencing food access and choice. Despite children's personal food preferences, homelessness and the shelter environment created restrictive conditions that influenced food choice and access. Shelter rules, lack of adequate storage and cooking facilities, and limited food stores near the shelter, impacted the type and quality of food choices, ultimately affecting hunger, weight status, and perceived health.

Public opinion towards castration without anaesthesia and lack of access to pasture in beef cattle production.

PubMed

Lemos Teixeira, Dayane; Larraín, Rafael; Melo, Oscar; Hötzel, María José

2018-01-01

Recent publications have shown that citizens in developing nations are gaining interest in farm animal welfare. The aims of this study were to assess the opinion of Chilean citizens about surgical castration without anaesthesia and lack of access to pasture in beef cattle production, to investigate how involvement in livestock production influences opinions, and to evaluate if different types of information would affect their opinion towards these management practices. The study was carried out in the Metropolitan Region of Santiago, Chile, and consisted of two surveys with 400 participants in each study. The first one used an online, self-administered questionnaire and the second one used a face to face questionnaire. The second questionnaire had four information treatments assigned randomly to survey participants (no information; negative information; negative and positive information; positive information). Most participants were aware that the two management practices are common in beef production systems and were opposed to them. Involvement in animal production was associated with greater acceptance of both management practices and participants that had visited a beef production farm before the study were more likely to support castration without anaesthesia in Survey 1. Belonging to any socioeconomic group and providing negative or positive information had no impact on participants' opinion. The results show a disconnection between the views of participants recruited for this study and beef production systems that do not provide pain control for male cattle surgical castration or provide little or no access to pasture.

Public opinion towards castration without anaesthesia and lack of access to pasture in beef cattle production

PubMed Central

Larraín, Rafael; Melo, Oscar; Hötzel, María José

2018-01-01

Recent publications have shown that citizens in developing nations are gaining interest in farm animal welfare. The aims of this study were to assess the opinion of Chilean citizens about surgical castration without anaesthesia and lack of access to pasture in beef cattle production, to investigate how involvement in livestock production influences opinions, and to evaluate if different types of information would affect their opinion towards these management practices. The study was carried out in the Metropolitan Region of Santiago, Chile, and consisted of two surveys with 400 participants in each study. The first one used an online, self-administered questionnaire and the second one used a face to face questionnaire. The second questionnaire had four information treatments assigned randomly to survey participants (no information; negative information; negative and positive information; positive information). Most participants were aware that the two management practices are common in beef production systems and were opposed to them. Involvement in animal production was associated with greater acceptance of both management practices and participants that had visited a beef production farm before the study were more likely to support castration without anaesthesia in Survey 1. Belonging to any socioeconomic group and providing negative or positive information had no impact on participants’ opinion. The results show a disconnection between the views of participants recruited for this study and beef production systems that do not provide pain control for male cattle surgical castration or provide little or no access to pasture. PMID:29304181

Rural women and violence situation: access and accessibility limits to the healthcare network.

PubMed

Costa, Marta Cocco da; Silva, Ethel Bastos da; Soares, Joannie Dos Santos Fachinelli; Borth, Luana Cristina; Honnef, Fernanda

2017-07-13

To analyze the access and accessibility to the healthcare network of women dwelling in rural contexts undergoing violence situation, as seen from the professionals' speeches. A qualitative, exploratory, descriptive study with professionals from the healthcare network services about coping with violence in four municipalities in the northern region of Rio Grande do Sul. The information derived from interviews, which have been analyzed by thematic modality. (Lack of) information of women, distance, restricted access to transportation, dependence on the partner and (lack of) attention by professionals to welcome women undergoing violence situation and (non)-articulation of the network are factors that limit the access and, as a consequence, they result in the lack of confrontation of this problem. To bring closer the services which integrate the confrontation network of violence against women and to qualify professionals to welcome these situations are factors that can facilitate the access and adhesion of rural women to the services.

HSQC-1,n-ADEQUATE: a new approach to long-range 13C-13C correlation by covariance processing.

PubMed

Martin, Gary E; Hilton, Bruce D; Willcott, M Robert; Blinov, Kirill A

2011-10-01

Long-range, two-dimensional heteronuclear shift correlation NMR methods play a pivotal role in the assembly of novel molecular structures. The well-established GHMBC method is a high-sensitivity mainstay technique, affording connectivity information via (n)J(CH) coupling pathways. Unfortunately, there is no simple way of determining the value of n and hence no way of differentiating two-bond from three- and occasionally four-bond correlations. Three-bond correlations, however, generally predominate. Recent work has shown that the unsymmetrical indirect covariance or generalized indirect covariance processing of multiplicity edited GHSQC and 1,1-ADEQUATE spectra provides high-sensitivity access to a (13)C-(13) C connectivity map in the form of an HSQC-1,1-ADEQUATE spectrum. Covariance processing of these data allows the 1,1-ADEQUATE connectivity information to be exploited with the inherent sensitivity of the GHSQC spectrum rather than the intrinsically lower sensitivity of the 1,1-ADEQUATE spectrum itself. Data acquisition times and/or sample size can be substantially reduced when covariance processing is to be employed. In an extension of that work, 1,n-ADEQUATE spectra can likewise be subjected to covariance processing to afford high-sensitivity access to the equivalent of (4)J(CH) GHMBC connectivity information. The method is illustrated using strychnine as a model compound. Copyright © 2011 John Wiley & Sons, Ltd.

Implementation of selective prevention for cardiometabolic diseases; are Dutch general practices adequately prepared?

PubMed

Stol, Daphne M; Hollander, Monika; Nielen, Markus M J; Badenbroek, Ilse F; Schellevis, François G; de Wit, Niek J

2018-03-01

Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general practices are adequately prepared. Therefore, the aim of this study is to assess the organizational preparedness of Dutch general practices and the facilitators and barriers for performing CMD-prevention in practices currently implementing selective CMD-prevention. Observational study. Dutch primary care. General practices. Organizational characteristics. General practices implementing selective CMD-prevention are more often organized as a group practice (49% vs. 19%, p = .000) and are better organized regarding chronic disease management compared to reference practices. They are motivated for performing CMD-prevention and can be considered as 'frontrunners' of Dutch general practices with respect to their practice organization. The most important reported barriers are a limited availability of staff (59%) and inadequate funding (41%). The organizational infrastructure of Dutch general practices is considered adequate for performing most steps of selective CMD-prevention. Implementation of prevention programs including easily accessible lifestyle interventions needs attention. All stakeholders involved share the responsibility to realize structural funding for programmed CMD-prevention. Aforementioned conditions should be taken into account with respect to future implementation of selective CMD-prevention. Key Points   There is need for adequate CMD prevention. Little is known about the organization of selective CMD prevention in general practices.   • The organizational infrastructure of Dutch general practices is adequate for performing most steps of selective CMD prevention.   • Implementation of selective CMD prevention programs including easily accessible

GAIN Premix Facility: an innovative approach for improving access to quality vitamin and mineral premix in fortification initiatives.

PubMed

Guinot, Philippe; Jallier, Vincent; Blasi, Alessandro; Guyondet, Christophe; Van Ameringen, Marc

2012-12-01

Vitamin and mineral premix is one of the most significant recurring input costs for large-scale food fortification programs. A number of barriers exist to procuring adequate quality premix, including accessing suppliers, volatile prices for premix, lack of quality assurance and monitoring of delivered products, and lack of funds to purchase premix. To develop and test a model to procure premix through a transparent and efficient process in which an adequate level of quality is guaranteed and a financial mechanism is in place to support countries or specific target groups when there are insufficient resources to cover the cost of premix. Efforts focused on premixes used to fortify flour, such as wheat or maize (iron, zinc, B vitamins, and vitamin A), edible oils (vitamins A and D), and other food vehicles, such as fortified complementary foods, complementary food supplements, and condiments. A premix procurement model was set up with three distinct components: a certification process that establishes industry-wide standards and guidelines for premix, a procurement facility that makes premix more accessible to countries and private industry engaged in fortification, and a credit facility mechanism that helps projects finance premix purchases. After three years of operation, 15 premix suppliers and 29 micronutrient manufacturers have been certified, and more than US$23 million worth of premix that met quality standards has been supplied in 34 countries in Africa, Central and Southern Asia, and Eastern Europe, reaching an estimated 242 million consumers. The Premix Facility demonstrated its effectiveness in ensuring access to high-quality premixes, therefore enabling the success of various fortification programs.

Public Finance Policy Strategies to Increase Access to Preconception Care

PubMed Central

2006-01-01

Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15–44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states’ experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs. PMID:16802188

Public finance policy strategies to increase access to preconception care.

PubMed

Johnson, Kay A

2006-09-01

Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15-44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states' experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs.

Social capital, collective action and access to water in rural Kenya.

PubMed

Bisung, Elijah; Elliott, Susan J; Schuster-Wallace, Corinne J; Karanja, Diana M; Bernard, Abudho

2014-10-01

Globally, an estimated 748 million people remain without access to improved sources of drinking water and close to 1 billion people practice open defecation (WHO/UNICEF, 2014). The lack of access to safe water and adequate sanitation presents significant health and development challenges to individuals and communities, especially in low and middle income countries. Recent research indicates that aside from financial challenges, the lack of social capital is a barrier to collective action for community based water and sanitation initiatives (Levison et al., 2011; Bisung and Elliott, 2014). This paper reports results of a case study on the relationships between elements of social capital and participation in collective action in the context of addressing water and sanitation issues in the lakeshore village of Usoma, Western Kenya. The paper uses household data (N=485, 91% response rate) collected using a modified version of the social capital assessment tool (Krishna and Shrader, 2000). Findings suggest that investment in building social capital may have some contextual benefits for collective action to address common environmental challenges. These findings can inform policy interventions and practice in water and sanitation delivery in low and middle income countries, environmental health promotion and community development. Copyright © 2014 Elsevier Ltd. All rights reserved.

Is a vegetarian diet adequate for children.

PubMed

Hackett, A; Nathan, I; Burgess, L

1998-01-01

The number of people who avoid eating meat is growing, especially among young people. Benefits to health from a vegetarian diet have been reported in adults but it is not clear to what extent these benefits are due to diet or to other aspects of lifestyles. In children concern has been expressed concerning the adequacy of vegetarian diets especially with regard to growth. The risks/benefits seem to be related to the degree of restriction of he diet; anaemia is probably both the main and the most serious risk but this also applies to omnivores. Vegan diets are more likely to be associated with malnutrition, especially if the diets are the result of authoritarian dogma. Overall, lacto-ovo-vegetarian children consume diets closer to recommendations than omnivores and their pre-pubertal growth is at least as good. The simplest strategy when becoming vegetarian may involve reliance on vegetarian convenience foods which are not necessarily superior in nutritional composition. The vegetarian sector of the food industry could do more to produce foods closer to recommendations. Vegetarian diets can be, but are not necessarily, adequate for children, providing vigilance is maintained, particularly to ensure variety. Identical comments apply to omnivorous diets. Three threats to the diet of children are too much reliance on convenience foods, lack of variety and lack of exercise.

7 CFR 3017.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Adequate evidence. 3017.900 Section 3017.900 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER... Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

29 CFR 98.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 1 2012-07-01 2012-07-01 false Adequate evidence. 98.900 Section 98.900 Labor Office of the Secretary of Labor GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 98.900 Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

29 CFR 98.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 1 2011-07-01 2011-07-01 false Adequate evidence. 98.900 Section 98.900 Labor Office of the Secretary of Labor GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 98.900 Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

29 CFR 98.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 1 2013-07-01 2013-07-01 false Adequate evidence. 98.900 Section 98.900 Labor Office of the Secretary of Labor GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 98.900 Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

2 CFR 180.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false Adequate evidence. 180.900 Section 180.900 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF... Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

2 CFR 180.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 2 Grants and Agreements 1 2012-01-01 2012-01-01 false Adequate evidence. 180.900 Section 180.900 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF... Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

Assessment of the vaccine industry in Iran in context of accession to WTO: a survey study

PubMed Central

2012-01-01

Background The vaccine industry is one of the most important health-related industries. It can be affected by accession to the World Trade Organization (WTO) because of probable dramatic changes in the business environment. Iran has already initiated accession negotiations. Purpose of the study In this paper, we investigate the position of, challenges to, and opportunities for vaccine manufacturing in Iran with regard to accession to the WTO. Methods This is a qualitative and cross sectional study. To collect information, we designed a questionnaire and interviewed some of the vaccine industry’s key opinion leaders in Iran. Before the interviews were conducted, the questionnaires were sent to these individuals by email. Results According to the interviewees, the country’s main challenges with regard to accession to the WTO are the lack of firm internal intellectual property (IP) rules, not being recognized as pre-qualified by the World Health Organization (WHO), the use of old equipment, and a lack of cooperation with global vaccine companies. Major conclusions Iran’s local vaccine industry, with a long history and international reputation that could be used as an advantage, is faced with several challenges, such as problems with keeping up with Current Good Manufacturing Practice (cGMP), a lack of adequate and meaningful investment in research and development (R&D), and limitations on private sector participation in the production of vaccines. Gradual privatization of the industry, improved international relations, utilization of the R&D power of small hi-tech companies, consistent education of human resources, and modernization of infrastructures and equipment are among the suggested solutions. PMID:23351841

Lack of Privileged Access to Awareness for Rewarding Social Scenes in Autism Spectrum Disorder.

PubMed

Gray, Katie L H; Haffey, Anthony; Mihaylova, Hristina L; Chakrabarti, Bhismadev

2018-05-04

Reduced social motivation is hypothesised to underlie social behavioural symptoms of Autism Spectrum Disorder (ASD). The extent to which rewarding social stimuli are granted privileged access to awareness in ASD is currently unknown. We use continuous flash suppression to investigate whether individuals with and without ASD show privileged access to awareness for social over nonsocial rewarding scenes that are closely matched for stimulus features. Strong evidence for a privileged access to awareness for rewarding social over nonsocial scenes was observed in neurotypical adults. No such privileged access was seen in ASD individuals, and moderate support for the null model was noted. These results suggest that the purported deficits in social motivation in ASD may extend to early processing mechanisms.

[The human right to adequate food: an urban vision].

PubMed

Casemiro, Juliana Pereira; Valla, Victor Vincent; Guimarães, Maria Beatriz Lisboa

2010-07-01

The human right to adequate food is comprehended in two dimensions: being free of hunger and denutrition and having access to an adequate food. The urban context, in which the possession of food is done primarily through merchandising because of its strong consuming appealing, became a big challenge to debate this topic in poor districts today. Here we combine considerations of a qualitative study carried out in São João de Meriti, Rio de Janeiro State, joining leaders from Pastoral da Criança in focal group sessions. The unemployment, the sub-employment and the difficulty in reaching the public health system, the social assistance and basic sanitation were presented as the major obstacles to bring into effect the human right to food. It was possible to determine that, among the strategies to fight the poverty and hunger, a big highlight is the establishment of mutual help mechanisms. The social support, generosity and religiousness were presented as the most important categories among the thoughts of the leaders. Facing a reality in which poverty and hunger appear as something inherent or become a mechanism of change during elections, the issue of the clienteles appears as a huge concern and challenge for those leaders.

How Much and What Kind? Identifying an Adequate Technology Infrastructure for Early Childhood Education. Policy Brief

ERIC Educational Resources Information Center

Daugherty, Lindsay; Dossani, Rafiq; Johnson, Erin-Elizabeth; Wright, Cameron

2014-01-01

To realize the potential benefits of technology use in early childhood education (ECE), and to ensure that technology can help to address the digital divide, providers, families of young children, and young children themselves must have access to an adequate technology infrastructure. The goals for technology use in ECE that a technology…

Pharmaceutical companies and global lack of access to medicines: strengthening accountability under the right to health.

PubMed

Grover, Anand; Citro, Brian; Mankad, Mihir; Lander, Fiona

2012-01-01

Many medicines currently available on the market are simply too expensive for millions around the world to afford. Many medicines available in the developing world are only available to a small percentage of the population due to economic inequities. The profit-seeking behavior of pharmaceutical companies exacerbates this problem. In most cases, the price reductions required to make drugs affordable to a broader class of people in the developing world are not offset by the resultant increase in sales volume. Simply stated, in most of the developing world, it is more profitable to sell drugs to the very wealthy at high prices than it is to sell cheaper drugs to a greater number of people. As a result, medicines remain unaffordable for the vast majority of people in many parts of the world. While this might be an acceptable outcome for certain commodities, such as luxury goods, it is completely unacceptable for life-saving medicines. Therefore, in order to effectively address the global lack of access to medicines, the role pharmaceutical companies play in the international intellectual property regime must be critically examined. © 2012 American Society of Law, Medicine & Ethics, Inc.

Recommendations to Facilitate Expanded Access to Investigational Therapies for Seriously Ill Patients

PubMed Central

Jerome, Rebecca N.; Edwards, Terri L.; Boswell, Haley C.; Bernard, Gordon R.; Harris, Paul A.; Pulley, Jill M.

2015-01-01

When clinical trial enrollment is not an option for seriously ill patients whose illnesses have not responded to approved treatment options, those patients and their physicians may consider gaining access to investigational therapies through a pathway established by the Food and Drug Administration (FDA) called expanded access. However, recent events have highlighted the challenging dynamics involved in accessing investigational therapies through expanded access that include a complex interplay of factors involving the patient, physician, drug company, FDA, and, increasingly, social media. The authors offer several potential strategies to streamline what is otherwise an arduous process for all involved. (1) The drug company should prospectively determine whether it will establish an expanded access program for specific drugs. (2) A central clearinghouse for companies should support registration of expanded access drugs for suitable patients. (3) The determination of whether a patient fits criteria would be made by an independent review board of clinicians. (4) An independent coordinating center is needed; academic health centers are ideally suited for that role. (5) Adequate financing of the costs of therapy need to be in place to make expanded access a reality, given frequent lack of payor coverage for therapies. (6) Further enhancement of regulatory pathways, approaches, or rules would promote expanded access. (7) Patients should explicitly acknowledge the limited data available. (8) There should be a shared, secure, technical platform to facilitate expanded access. All the authors’ strategies present important prospects for improving treatment options for the most seriously ill patients. PMID:26445080

Disruptive technological advances in vascular access for dialysis: an overview.

PubMed

Yeo, Wee-Song; Ng, Qin Xiang

2017-11-29

End-stage kidney disease (ESKD), one of the most prevalent diseases in the world and with increasing incidence, is associated with significant morbidity and mortality. Current available modes of renal replacement therapy (RRT) include dialysis and renal transplantation. Though renal transplantation is the preferred and ideal mode of RRT, this modality may not be available to all patients with ESKD. Moreover, renal transplant recipients are constantly at risk of complications associated with immunosuppression and immunosuppressant use, and posttransplant lymphoproliferative disorder. Dialysis may be the only available modality in certain patients. However, dialysis has its limitations, which include issues associated with lack of vascular access, risks of infections and vascular thrombosis, decreased quality of life, and absence of biosynthetic functions of the kidney. In particular, the creation and maintenance of hemodialysis vascular access in children poses a unique set of challenges to the pediatric nephrologist owing to the smaller vessel diameters and vascular hyperreactivity compared with adult patients. Vascular access issues continue to be one of the major limiting factors prohibiting the delivery of adequate dialysis in ESKD patients and is the Achilles' heel of hemodialysis. This review aims to provide a critical overview of disruptive technological advances and innovations for vascular access. Novel strategies in preventing neointimal hyperplasia, novel bioengineered products, grafts and devices for vascular access will be discussed. The potential impact of these solutions on improving the morbidity encountered by dialysis patients will also be examined.

Accessibility and content of individualized adult reconstructive hip and knee/musculoskeletal oncology fellowship web sites.

PubMed

Young, Bradley L; Cantrell, Colin K; Patt, Joshua C; Ponce, Brent A

2018-06-01

Accessible, adequate online information is important to fellowship applicants. Program web sites can affect which programs applicants apply to, subsequently altering interview costs incurred by both parties and ultimately impacting rank lists. Web site analyses have been performed for all orthopaedic subspecialties other than those involved in the combined adult reconstruction and musculoskeletal (MSK) oncology fellowship match. A complete list of active programs was obtained from the official adult reconstruction and MSK oncology society web sites. Web site accessibility was assessed using a structured Google search. Accessible web sites were evaluated based on 21 previously reported content criteria. Seventy-four adult reconstruction programs and 11 MSK oncology programs were listed on the official society web sites. Web sites were identified and accessible for 58 (78%) adult reconstruction and 9 (82%) MSK oncology fellowship programs. No web site contained all content criteria and more than half of both adult reconstruction and MSK oncology web sites failed to include 12 of the 21 criteria. Several programs participating in the combined Adult Reconstructive Hip and Knee/Musculoskeletal Oncology Fellowship Match did not have accessible web sites. Of the web sites that were accessible, none contained comprehensive information and the majority lacked information that has been previously identified as being important to perspective applicants.

Which Food Security Determinants Predict Adequate Vegetable Consumption among Rural Western Australian Children?

PubMed Central

Godrich, Stephanie L.; Lo, Johnny; Davies, Christina R.; Darby, Jill; Devine, Amanda

2017-01-01

Improving the suboptimal vegetable consumption among the majority of Australian children is imperative in reducing chronic disease risk. The objective of this research was to determine whether there was a relationship between food security determinants (FSD) (i.e., food availability, access, and utilisation dimensions) and adequate vegetable consumption among children living in regional and remote Western Australia (WA). Caregiver-child dyads (n = 256) living in non-metropolitan/rural WA completed cross-sectional surveys that included questions on FSD, demographics and usual vegetable intake. A total of 187 dyads were included in analyses, which included descriptive and logistic regression analyses via IBM SPSS (version 23). A total of 13.4% of children in this sample had adequate vegetable intake. FSD that met inclusion criteria (p ≤ 0.20) for multivariable regression analyses included price; promotion; quality; location of food outlets; variety of vegetable types; financial resources; and transport to outlets. After adjustment for potential demographic confounders, the FSD that predicted adequate vegetable consumption were, variety of vegetable types consumed (p = 0.007), promotion (p = 0.017), location of food outlets (p = 0.027), and price (p = 0.043). Food retail outlets should ensure that adequate varieties of vegetable types (i.e., fresh, frozen, tinned) are available, vegetable messages should be promoted through food retail outlets and in community settings, towns should include a range of vegetable purchasing options, increase their reliance on a local food supply and increase transport options to enable affordable vegetable purchasing. PMID:28054955

Which Food Security Determinants Predict Adequate Vegetable Consumption among Rural Western Australian Children?

PubMed

Godrich, Stephanie L; Lo, Johnny; Davies, Christina R; Darby, Jill; Devine, Amanda

2017-01-03

Improving the suboptimal vegetable consumption among the majority of Australian children is imperative in reducing chronic disease risk. The objective of this research was to determine whether there was a relationship between food security determinants (FSD) (i.e., food availability, access, and utilisation dimensions) and adequate vegetable consumption among children living in regional and remote Western Australia (WA). Caregiver-child dyads ( n = 256) living in non-metropolitan/rural WA completed cross-sectional surveys that included questions on FSD, demographics and usual vegetable intake. A total of 187 dyads were included in analyses, which included descriptive and logistic regression analyses via IBM SPSS (version 23). A total of 13.4% of children in this sample had adequate vegetable intake. FSD that met inclusion criteria ( p ≤ 0.20) for multivariable regression analyses included price; promotion; quality; location of food outlets; variety of vegetable types; financial resources; and transport to outlets. After adjustment for potential demographic confounders, the FSD that predicted adequate vegetable consumption were, variety of vegetable types consumed ( p = 0.007), promotion ( p = 0.017), location of food outlets ( p = 0.027), and price ( p = 0.043). Food retail outlets should ensure that adequate varieties of vegetable types (i.e., fresh, frozen, tinned) are available, vegetable messages should be promoted through food retail outlets and in community settings, towns should include a range of vegetable purchasing options, increase their reliance on a local food supply and increase transport options to enable affordable vegetable purchasing.

[Factors associated with difficulty of access of the elderly with disabilities to the health services].

PubMed

Amaral, Fabienne Louise Juvêncio dos Santos; Motta, Márcia Heloyse Alves; da Silva, Laíla Pereira Gomes; Alves, Simone Bezerra

2012-11-01

This study seeks to analyze which are the variables associated with the difficulty of elderly people with disabilities gaining access to the health services. This is an observational study of an analytical cross-sectional nature, with a sample of 244 elderly people with disabilities. Data relating to socio-economic profile, the nature of the disability, and the conditions of access to health services were gathered. Version 11.0 of the Statistical Package for the Social Sciences software was used for descriptive, statistical and analytical assessment of the data. The protection variables for difficulties in being treated in the health services were: the lack of drains, culverts, trash, bags of refuse, or irregular floor surfaces; the absence of ramps on sidewalks and pavements; the availability of transport; ease in scheduling appointments; and the length of the waiting period to be attended. The number of factors listed shows that the architectonic barriers and the current situation of healthcare need to be adequate in order to ensure full access and use by the elderly with disabilities to the health services.

Rural Veteran Access to Healthcare Services: Investigating the Role of Information and Communication Technologies in Overcoming Spatial Barriers

PubMed Central

Schooley, Benjamin L; Horan, Thomas A; Lee, Pamela W; West, Priscilla A

2010-01-01

This multimethod pilot study examined patient and practitioner perspectives on the influence of spatial barriers to healthcare access and the role of health information technology in overcoming these barriers. The study included a survey administered to patients attending a Department of Veterans Affairs (VA) health visit, and a focus group with VA care providers. Descriptive results and focus group findings are presented. Spatial distance is a significant factor for many rural veterans when seeking healthcare. For this sample of rural veterans, a range of telephone, computer, and Internet technologies may become more important for accessing care as Internet access becomes more ubiquitous and as younger veterans begin using the VA health system. The focus group highlighted the negative impact of distance, economic considerations, geographic barriers, and specific medical conditions on access to care. Lack of adequate technology infrastructure was seen as an obstacle to utilization. This study discusses the need to consider distance, travel modes, age, and information technology infrastructure and adoption when designing health information technology to care for rural patients. PMID:20697468

5 CFR 919.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Adequate evidence. 919.900 Section 919.900 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

5 CFR 919.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Adequate evidence. 919.900 Section 919.900 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

5 CFR 919.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Adequate evidence. 919.900 Section 919.900 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

5 CFR 919.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Adequate evidence. 919.900 Section 919.900 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

5 CFR 919.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Adequate evidence. 919.900 Section 919.900 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review.

PubMed

Koffel, Erin; Bramoweth, Adam D; Ulmer, Christi S

2018-04-04

The American College of Physicians (ACP) recently identified cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for insomnia. Although CBT-I improves sleep outcomes and reduces the risks associated with reliance on hypnotics, patients are rarely referred to this treatment, especially in primary care where most insomnia treatment is provided. We reviewed the evidence about barriers to CBT-I referrals and efforts to increase the use of CBT-I services. PubMed, PsycINFO, and Embase were searched on January 11, 2018; additional titles were added based on a review of bibliographies and expert opinion and 51 articles were included in the results of this narrative review. Implementation research testing specific interventions to increase routine and sustained use of CBT-I was lacking. Most research focused on pre-implementation work that revealed the complexity of delivering CBT-I in routine healthcare settings due to three distinct categories of barriers. First, system barriers result in limited access to CBT-I and behavioral sleep medicine (BSM) providers. Second, primary care providers are not adequately screening for sleep issues and referring appropriately due to a lack of knowledge, treatment beliefs, and a lack of motivation to assess and treat insomnia. Finally, patient barriers, including a lack of knowledge, treatment beliefs, and limited access, prevent patients from engaging in CBT-I. These findings are organized using a conceptual model to represent the many challenges inherent in providing guideline-concordant insomnia care. We conclude with an agenda for future implementation research to systematically address these challenges.

Barriers to accessing palliative care for pediatric patients with cancer: A review of the literature.

PubMed

Haines, Emily R; Frost, A Corey; Kane, Heather L; Rokoske, Franziska S

2018-06-01

Although many of the 16,000 children in the United States diagnosed who are with cancer each year could benefit from pediatric palliative care, these services remain underused. Evidence regarding the barriers impeding access to comprehensive palliative care is dispersed in the literature, and evidence specific to pediatric oncology remains particularly sparse. The purpose of the current review was to synthesize the existing literature regarding these barriers and the strategies offered to address them. The authors completed a literature search using the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science databases. In total, 71 articles were reviewed. Barriers to accessing pediatric palliative care were categorized according to the 4 levels of a modified socioecological model (ie, barriers related to policy/payment, health systems, organizations, and individuals). Major themes identified at each level included: 1) the lack of consistent and adequate funding mechanisms at the policy/payment level, 2) the lack of pediatric palliative care programs and workforce at the health systems level, 3) difficulties integrating palliative care into existing pediatric oncology care models at the organizational level, and 4) the lack of knowledge about pediatric palliative care, discomfort with talking about death, and cultural differences between providers and patients and their families at the individual level. Recommendations to address each of the barriers identified in the literature are included. Cancer 2018;124:2278-88. © 2018 American Cancer Society. © 2018 American Cancer Society.

Maternal Health of Undocumented Women With and Without Medicaid Access in Nebraska, 2007-2011.

PubMed

Atkins, Danielle N; Barroso, Cristina S; Anderson, Amy J; Meadows, J Thomas; Lindley, Lisa C

2017-03-01

Four million infants are born in the United States to undocumented mothers. Nebraska granted Medicaid access to undocumented pregnant women from 1996 to 2010 and then discontinued access from 2010 to 2012. However, little is known about the maternal health of these undocumented women. The purpose of this study was to compare maternal health of undocumented women with and without access to Medicaid in Nebraska from 2007 to 2011. A retrospective, longitudinal cohort design was conducted with 2007 to 2011 Nebraska birth certificate data. Study participants were 6,262 undocumented women. Groups of measures were created for demographics, prenatal, pregnancy, and delivery characteristics. Descriptive statistics were calculated and comparisons were conducted between women with and without access to Medicaid using chi-square and Student t tests. More than 60% of undocumented women had access to Medicaid, while 32% had no access to Medicaid. Undocumented women were predominately Hispanic (73.32%) and did not have a high school education (68.77%). The comparison of undocumented women with and without Medicaid revealed that women with Medicaid access had more than adequate prenatal care (17.86% vs. 14.80%) and a higher frequency of infant born with abnormal conditions (6.26% vs. 8.03%). Women without access to Medicaid more often had inadequate prenatal care (10.28% vs. 6.94%) and were obese prior to pregnancy (19.37% vs. 17.37%). Undocumented women who are prenatally obese and lack access to prenatal care may be at increased risk for poor maternal outcomes.

2 CFR 180.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false Adequate evidence. 180.900 Section 180.900 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

2 CFR 180.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 2 Grants and Agreements 1 2011-01-01 2011-01-01 false Adequate evidence. 180.900 Section 180.900 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

Competency to stand trial and defendants who lack insight into their mental illness.

PubMed

Reisner, Andrew D; Piel, Jennifer; Makey, Miller

2013-01-01

Forensic evaluators often assess patients who lack insight into their mental illnesses. This lack of insight can have a significant impact on the defendant's ability to make legal strategy decisions that rely on their acceptance of their mental illness. In this article, the relationship between refusing an insanity plea and competency to stand trial will be explored in the context of defendants who lack insight into their mental illness. The authors argue that an adequate competency assessment should take into account the defendant's ability to consider his available pleas rationally. Such evaluations may have the effect of negating the necessity of a Frendak inquiry in those jurisdictions that can impose the insanity defense on defendants.

Management of end-stage central venous access in children referred for possible small bowel transplantation.

PubMed

Rodrigues, A F; van Mourik, I D M; Sharif, K; Barron, D J; de Giovanni, J V; Bennett, J; Bromley, P; Protheroe, S; John, P; de Ville de Goyet, J; Beath, S V

2006-04-01

liver and SBTx nearly 3 years after presenting with end-stage central venous access, because attempts to achieve independence from parenteral nutrition had failed. The other child died immediately after a transhepatic venous catheter placement, possibly from a nutritional depletion syndrome as no physical cause of death was found. Direct intra-atrial catheters in transplanted children proved to be adequate for the management of uncomplicated transplantation, although the usual infusion protocol had to be modified considerably, and the lack of access would have been critical if massive blood transfusion had been required during the transplant procedure. It was possible to reestablish central venous access in all cases. However, this was time consuming and difficult to assemble a skilled team consisting of one of more: surgeon, cardiologist, interventional radiologist, and transplant anesthetist. Small bowel transplantation is easier and safer with adequate central venous access, and we advocate liaison with an SBTx center at an early stage.

Access control design on highway interchanges.

DOT National Transportation Integrated Search

2008-01-01

The adequate spacing and design of access to crossroads in the vicinity of freeway ramps are critical to the safety and traffic operations of both the freeway and the crossroad. The research presented in this report develops a methodology to evaluate...

Access to Health Care: Does Neighborhood Residential Instability Matter?

ERIC Educational Resources Information Center

Kirby, James B.; Kaneda, Toshiko

2006-01-01

Many Americans do not have access to adequate medical care. Previous research on this problem focuses primarily on individual-level determinants of access such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed medical care, however, has not received much attention. We…

Policy Issues in Computer Networks: Multi-Access Information Systems.

ERIC Educational Resources Information Center

Lyons, Patrice A.

As computer databases become more publicly accessible through public networks, there is a growing need to provide effective protection for proprietary information. Without adequate assurances that their works will be protected, authors and other copyright owners may be reluctant to allow the full text of their works to be accessed through computer…

41 CFR 105-68.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Adequate evidence. 105-68.900 Section 105-68.900 Public Contracts and Property Management Federal Property Management... evidence. Adequate evidence means information sufficient to support the reasonable belief that a particular...

41 CFR 105-68.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Adequate evidence. 105-68.900 Section 105-68.900 Public Contracts and Property Management Federal Property Management... evidence. Adequate evidence means information sufficient to support the reasonable belief that a particular...

41 CFR 105-68.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false Adequate evidence. 105-68.900 Section 105-68.900 Public Contracts and Property Management Federal Property Management... evidence. Adequate evidence means information sufficient to support the reasonable belief that a particular...

41 CFR 105-68.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false Adequate evidence. 105-68.900 Section 105-68.900 Public Contracts and Property Management Federal Property Management... evidence. Adequate evidence means information sufficient to support the reasonable belief that a particular...

41 CFR 105-68.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false Adequate evidence. 105-68.900 Section 105-68.900 Public Contracts and Property Management Federal Property Management... evidence. Adequate evidence means information sufficient to support the reasonable belief that a particular...

Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study

PubMed Central

Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

2015-01-01

Background The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. Methods A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. Results A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Conclusions Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. PMID:25387852

Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study.

PubMed

Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

2015-03-01

The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. © 2014 International Hepato-Pancreato-Biliary Association.

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 32 2013-07-01 2013-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 31 2014-07-01 2014-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 32 2012-07-01 2012-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 31 2011-07-01 2011-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

Cancer education and effective dissemination: information access is not enough.

PubMed

Ousley, Anita L; Swarz, Jeffrey A; Milliken, Erin L; Ellis, Steven

2010-06-01

Education is the main avenue for disseminating new research findings into clinical practice. Understanding factors that affect translation of research into practice may help cancer educators design programs that facilitate the time it takes for research-indicated practices to become standard care. To understand various factors, the National Cancer Institute (NCI) Office of Education and Special Initiatives (OESI)(1) with individual cooperation from Oncology Nursing Society (ONS), American Society of Clinical Oncology (ASCO), and Association of Oncology Social Work (AOSW) administered a Practitioner Information Needs survey to five different types of practitioners involved in cancer care. While most of the 2,864 practitioners (83%) agreed they had access to current practice information, practitioners in large practice settings were more likely to report having access to research than those small practice settings. However, only 33% indicated that they had adequate time to access the information. Colleagues or experts within the organization were cited as the most frequently relied on information resource (60%), and peer-reviewed journals were cited as second (57%). Overall, 66% strongly or somewhat agreed that their organizations exhibit effective change management practices. A majority (69%) agreed that implementation of new practices is hindered by the lack of available staff time. Financial factors and the characteristics of the information presented were also believed to be factors contributing to research implementation. Group differences were observed among practitioner groups and practice settings for some factors.

Health Literacy and Access to Care

PubMed Central

Janke, Alex

2016-01-01

Despite well-documented links between low health literacy, low rates of health insurance coverage, and poor health outcomes, there has been almost no research on the relationship between low health literacy and self-reported access to care. This study analyzed a large, nationally representative sample of community-dwelling adults ages 50 and older to estimate the relationship between low health literacy and self-reported difficulty obtaining care. We found that individuals with low health literacy were significantly more likely than individuals with adequate health literacy to delay or forego needed care or to report difficulty finding a provider, even after controlling for other factors including health insurance coverage, employment, race/ethnicity, poverty, and general cognitive function. They were also more likely to lack a usual source of care, although this result was only marginally significant after controlling for other factors. The results show that in addition to any obstacles that low health literacy creates within the context of the clinical encounter, low health literacy also reduces the probability that people get in the door of the health care system in a timely way. PMID:27043757

Adequate supervision for children and adolescents.

PubMed

Anderst, James; Moffatt, Mary

2014-11-01

Primary care providers (PCPs) have the opportunity to improve child health and well-being by addressing supervision issues before an injury or exposure has occurred and/or after an injury or exposure has occurred. Appropriate anticipatory guidance on supervision at well-child visits can improve supervision of children, and may prevent future harm. Adequate supervision varies based on the child's development and maturity, and the risks in the child's environment. Consideration should be given to issues as wide ranging as swimming pools, falls, dating violence, and social media. By considering the likelihood of harm and the severity of the potential harm, caregivers may provide adequate supervision by minimizing risks to the child while still allowing the child to take "small" risks as needed for healthy development. Caregivers should initially focus on direct (visual, auditory, and proximity) supervision of the young child. Gradually, supervision needs to be adjusted as the child develops, emphasizing a safe environment and safe social interactions, with graduated independence. PCPs may foster adequate supervision by providing concrete guidance to caregivers. In addition to preventing injury, supervision includes fostering a safe, stable, and nurturing relationship with every child. PCPs should be familiar with age/developmentally based supervision risks, adequate supervision based on those risks, characteristics of neglectful supervision based on age/development, and ways to encourage appropriate supervision throughout childhood. Copyright 2014, SLACK Incorporated.

Improving Web Accessibility in a University Setting

ERIC Educational Resources Information Center

Olive, Geoffrey C.

2010-01-01

Improving Web accessibility for disabled users visiting a university's Web site is explored following the World Wide Web Consortium (W3C) guidelines and Section 508 of the Rehabilitation Act rules for Web page designers to ensure accessibility. The literature supports the view that accessibility is sorely lacking, not only in the USA, but also…

Increasing access and support for emergency management higher education programs.

PubMed

Cwiak, Carol L

2014-01-01

The number of emergency management higher education programs has grown dramatically since 1994 when the FEMA Higher Education Program was created to propagate and support such growth. Data collected annually since 2007 from emergency management higher education programs shows that these programs face some consistent challenges. These challenges were coupled with annual data on program access and support indicators via dimensional analysis to answer the questions: To what extent are the challenges linked to a lack of access or support? If there is linkage, what can be gleaned from these linkages that can help address the challenges through improving access and support? The analysis showed that lack of access to funding and resources, and lack of support from partner organizations, has an impact on emergency management higher education. Discussion of that impact is followed with detailed recommendations that are focused on strengthening both internal and external access and support relationships for emergency management higher education programs.

Expanding Access

ERIC Educational Resources Information Center

Roach, Ronald

2007-01-01

There is no question that the United States lags behind most industrialized nations in consumer access to broadband Internet service. For many policy makers and activists, this shortfall marks the latest phase in the struggle to overcome the digital divide. To remedy this lack of broadband affordability and availability, one start-up firm--with…

10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining adequate...

10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining adequate...

10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining adequate...

10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining adequate...

Are community-level financial data adequate to assess population health investments?

PubMed

Casper, Tim; Kindig, David A

2012-01-01

The variation in health outcomes among communities results largely from different levels of financial and nonfinancial policy investments over time; these natural experiments should offer investment and policy guidance for a business model on population health. However, little such guidance exists. We examined the availability of data in a sample of Wisconsin counties for expenditures in selected categories of health care, public health, human services, income support, job development, and education. We found, as predicted by the National Committee on Vital and Health Statistics in 2002, that availability is often limited by the challenges of difficulty in locating useable data, a lack of resources among public agencies to upgrade information technology systems for making data more usable and accessible to the public, and a lack of enterprise-wide coordination and geographic detail in data collection efforts. These challenges must be overcome to provide policy-relevant information for optimal population health resource allocation.

Adequate number of clinicians on usability tests lacking, says study.

PubMed

2015-12-01

A new study reveals that some of the largest EMR vendors failed to meet certification standards, specifying that they state their user-centered design processes, and that they include at least 15 representative end-user participants in their usability tests. It is not clear why these vendors were certified despite not meeting the standards established by Office of the National Coordinator for Health Information Technology (ONC), but investigators suggest that emergency clinicians and administrators should engage with vendors early on, querying them about their user-centered processes. An analysis of the usability tests performed by 41 of some the largest EMR vendors found that 34% of them did not meet certification standards, specifying that they state their user-centered design process. Also, 63% of the vendors failed to include at least 15 representative end-users in their usability tests. Only 15% of the vendors used at least 15 participants who had clinical backgrounds in their usability tests. Experts urge clinicians to engage with EMR user groups to share best practices for optimizing specific EMR products.

Realization of the right to adequate food and the nutritional status of land evictees: a case for mothers/caregivers and their children in rural Central Uganda.

PubMed

Nahalomo, Aziiza; Iversen, Per Ole; Rukundo, Peter Milton; Kaaya, Archileo; Kikafunda, Joyce; Eide, Wenche Barth; Marais, Maritha; Wamala, Edward; Kabahenda, Margaret

2018-05-24

In developing countries like Uganda, the human right to adequate food (RtAF) is inextricably linked to access to land for households to feed themselves directly through production or means for its procurement. Whether RtAF is enjoyed among Ugandan land evictees, is unknown. We therefore explored this among land evictees (rights-holders) in Wakiso and Mpigi districts in rural Central Uganda. We assessed food accessibility and related coping strategies, diet quality and nutritional status of children 6-59 months old, and their caregivers. Effectiveness of the complaint and redress mechanisms in addressing RtAF violations was also explored. In this cross-sectional study, quantitative data was collected using a structured questionnaire, with food security and nutritional assessment methods from a total of 215 land evictees including 187 children aged 6-59 months. Qualitative data was collected by reviewing selected national and international documents on the RtAF and key informant interviews with 15 purposively sampled duty-bearers. These included individuals or representatives of the Uganda Human Rights Commission, Resident District Commissioner, Sub-county Chiefs, and local Council leaders. We found that 78% of land evictees had insufficient access to food while 69.4% had consumed a less diversified diet. A majority of evictees (85.2%) relied on borrowing food or help from others to cope with food shortages. Of the 187 children assessed, 9.6% were wasted, 18.2% were underweight and 34.2% were stunted. Small, but significant associations, were found between food accessibility, diet quality, food insecurity coping strategies; and the nutritional status of evictees. We observed that administrative, quasi-judicial and judicial mechanisms to provide adequate legal remedies regarding violations of the RtAF among evictees in Uganda are in place, but not effective in doing so. Land eviction without adequate legal remedies is a contributor to food insecurity and

Water access, water scarcity, and climate change.

PubMed

Mukheibir, Pierre

2010-05-01

This article investigates the approaches of the various discourses operating in the water sector and how they address the issues of scarcity and equitable access under projected climate change impacts. Little synergy exists between the different approaches dealing with these issues. Whilst being a sustainable development and water resources management issue, a holistic view of access, scarcity and the projected impacts of climate change is not prevalent in these discourses. The climate change discourse too does not adequately bridge the gap between these issues. The projected impacts of climate change are likely to exacerbate the problems of scarcity and equitable access unless appropriate adaptation strategies are adopted and resilience is built. The successful delivery of accessible water services under projected climate change impacts therefore lies with an extension of the adaptive water management approach to include equitable access as a key driver.

Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans.

PubMed

Haeder, Simon F; Weimer, David L; Mukamel, Dana B

2016-07-01

The adequacy of provider networks for plans sold through insurance Marketplaces established under the Affordable Care Act has received much scrutiny recently. Various studies have established that networks are generally narrow. To learn more about network adequacy and access to care, we investigated two questions. First, no matter the nominal size of a network, can patients gain access to primary care services from providers of their choice in a timely manner? Second, how does access compare to plans sold outside insurance Marketplaces? We conducted a "secret shopper" survey of 743 primary care providers from five of California's nineteen insurance Marketplace pricing regions in the summer of 2015. Our findings indicate that obtaining access to primary care providers was generally equally challenging both inside and outside insurance Marketplaces. In less than 30 percent of cases were consumers able to schedule an appointment with an initially selected physician provider. Information about provider networks was often inaccurate. Problems accessing services for patients with acute conditions were particularly troubling. Effectively addressing issues of network adequacy requires more accurate provider information. Project HOPE—The People-to-People Health Foundation, Inc.

Lacking "Lack": A Reply to Joldersma

ERIC Educational Resources Information Center

Marshall, James D.

2007-01-01

First I would like to thank Clarence Joldersma for his review of our "Poststructuralism, Philosophy, Pedagogy" (Marshall, 2004-PPP). In particular, I would thank him for his opening sentence: "[t]his book is a response to a lack." It is the notion of a lack, noted again later in his review, which I wish to take up mainly in this response. Rather…

Access to the Common Core for All

ERIC Educational Resources Information Center

McLaughlin, Margaret J.

2012-01-01

Too often under the various state-developed standards and assessments, accommodations for students with disabilities--a heterogeneous group with varied characteristics and needs--have not been adequately addressed or have been ignored. The Common Core State Standards (CCSS) initiative provides an historic opportunity to improve access to rigorous…

Selecting Lentil Accessions for Global Selenium Biofortification.

PubMed

Thavarajah, Dil; Abare, Alex; Mapa, Indika; Coyne, Clarice J; Thavarajah, Pushparajah; Kumar, Shiv

2017-08-26

The biofortification of lentil ( Lens culinaris Medikus.) has the potential to provide adequate daily selenium (Se) to human diets. The objectives of this study were to (1) determine how low-dose Se fertilizer application at germination affects seedling biomass, antioxidant activity, and Se uptake of 26 cultivated lentil genotypes; and (2) quantify the seed Se concentration of 191 lentil wild accessions grown in Terbol, Lebanon. A germination study was conducted with two Se treatments [0 (control) and 30 kg of Se/ha] with three replicates. A separate field study was conducted in Lebanon for wild accessions without Se fertilizer. Among cultivated lentil accessions, PI533690 and PI533693 showed >100% biomass increase vs. Se addition significantly increased seedling Se uptake, with the greatest uptake (6.2 µg g -1 ) by PI320937 and the least uptake (1.1 µg g -1 ) by W627780. Seed Se concentrations of wild accessions ranged from 0 to 2.5 µg g -1 ; accessions originating from Syria (0-2.5 µg g -1 ) and Turkey (0-2.4 µg g -1 ) had the highest seed Se. Frequency distribution analysis revealed that seed Se for 63% of accessions was between 0.25 and 0.75 µg g -1 , and thus a single 50 g serving of lentil has the potential to provide adequate dietary Se (20-60% of daily recommended daily allowance). As such, Se application during plant growth for certain lentil genotypes grown in low Se soils may be a sustainable Se biofortification solution to increase seed Se concentration. Incorporating a diverse panel of lentil wild germplasm into Se biofortification programs will increase genetic diversity for effective genetic mapping for increased lentil seed Se nutrition and plant productivity.

Selecting Lentil Accessions for Global Selenium Biofortification

PubMed Central

Thavarajah, Dil; Abare, Alex; Mapa, Indika; Coyne, Clarice J.; Thavarajah, Pushparajah; Kumar, Shiv

2017-01-01

The biofortification of lentil (Lens culinaris Medikus.) has the potential to provide adequate daily selenium (Se) to human diets. The objectives of this study were to (1) determine how low-dose Se fertilizer application at germination affects seedling biomass, antioxidant activity, and Se uptake of 26 cultivated lentil genotypes; and (2) quantify the seed Se concentration of 191 lentil wild accessions grown in Terbol, Lebanon. A germination study was conducted with two Se treatments [0 (control) and 30 kg of Se/ha] with three replicates. A separate field study was conducted in Lebanon for wild accessions without Se fertilizer. Among cultivated lentil accessions, PI533690 and PI533693 showed >100% biomass increase vs. controls. Se addition significantly increased seedling Se uptake, with the greatest uptake (6.2 µg g−1) by PI320937 and the least uptake (1.1 µg g−1) by W627780. Seed Se concentrations of wild accessions ranged from 0 to 2.5 µg g−1; accessions originating from Syria (0–2.5 µg g−1) and Turkey (0–2.4 µg g−1) had the highest seed Se. Frequency distribution analysis revealed that seed Se for 63% of accessions was between 0.25 and 0.75 µg g−1, and thus a single 50 g serving of lentil has the potential to provide adequate dietary Se (20–60% of daily recommended daily allowance). As such, Se application during plant growth for certain lentil genotypes grown in low Se soils may be a sustainable Se biofortification solution to increase seed Se concentration. Incorporating a diverse panel of lentil wild germplasm into Se biofortification programs will increase genetic diversity for effective genetic mapping for increased lentil seed Se nutrition and plant productivity. PMID:28846602

40 CFR 51.354 - Adequate tools and resources.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 2 2014-07-01 2014-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain... assurance, data analysis and reporting, and the holding of hearings and adjudication of cases. A portion of...

40 CFR 51.354 - Adequate tools and resources.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 2 2011-07-01 2011-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain... assurance, data analysis and reporting, and the holding of hearings and adjudication of cases. A portion of...

40 CFR 51.354 - Adequate tools and resources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 2 2012-07-01 2012-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain... assurance, data analysis and reporting, and the holding of hearings and adjudication of cases. A portion of...

40 CFR 51.354 - Adequate tools and resources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 2 2013-07-01 2013-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain... assurance, data analysis and reporting, and the holding of hearings and adjudication of cases. A portion of...

What does 'access to health care' mean?

PubMed

Gulliford, Martin; Figueroa-Munoz, Jose; Morgan, Myfanwy; Hughes, David; Gibson, Barry; Beech, Roger; Hudson, Meryl

2002-07-01

Facilitating access is concerned with helping people to command appropriate health care resources in order to preserve or improve their health. Access is a complex concept and at least four aspects require evaluation. If services are available and there is an adequate supply of services, then the opportunity to obtain health care exists, and a population may 'have access' to services. The extent to which a population 'gains access' also depends on financial, organisational and social or cultural barriers that limit the utilisation of services. Thus access measured in terms of utilisation is dependent on the affordability, physical accessibility and acceptability of services and not merely adequacy of supply. Services available must be relevant and effective if the population is to 'gain access to satisfactory health outcomes'. The availability of services, and barriers to access, have to be considered in the context of the differing perspectives, health needs and material and cultural settings of diverse groups in society. Equity of access may be measured in terms of the availability, utilisation or outcomes of services. Both horizontal and vertical dimensions of equity require consideration. Copyright The Royal Society of Medicine Press Ltd 2002.

Three-Dimensional Printing: An Aid to Epidural Access for Neuromodulation.

PubMed

Taverner, Murray G; Monagle, John P

2017-08-01

The case report details to use of three-dimensional (3D) printing as an aid to neuromodulation. A patient is described in whom previous attempts at spinal neuromodulation had failed due to lack of epidural or intrathecal access, and the use of a 3D printed model allowed for improved planning and ultimately, success. Successful spinal cord stimulation was achieved with the plan developed by access to a 3D model of the patient's spine. Neuromodulation techniques can provide the optimal analgesic techniques for individual patients. At times these can fail due to lack of access to the site for intervention, in this case epidural access. 3D printing may provide additional information to improve the likelihood of access when anatomy is distorted and standard approaches prove difficult. © 2017 International Neuromodulation Society.

Adequately Addressing Pediatric Obesity: Challenges Faced by Primary Care Providers.

PubMed

Shreve, Marilou; Scott, Allison; Vowell Johnson, Kelly

2017-07-01

To assess the challenges primary care providers encounter when providing counseling for pediatric patients identified as obese. A survey assessed the current challenges and barriers to the screening and treatment of pediatric obesity for providers in northwest Arkansas who provide care to families. The survey consisted of 15 Likert scale questions and 4 open-ended questions. Time, resources, comfort, and cultural issues were reported by providers as the biggest barriers in screening and the treatment of pediatric obesity. All providers reported lack of time as a barrier to providing the care needed for obese children. Cultural barriers of both the provider and client were identified as factors, which negatively affect the care and treatment of obese children. Primary care providers continue to experience challenges when addressing pediatric obesity. In this study, a lack of adequate time to address obesity was identified as the most significant current barrier and may likely be tied to physician resources. Although reimbursement for obesity is increasing, the level of reimbursement does not support the time or the resources needed to treat patients. Many providers reported their patients' cultural view of obesity influenced how they counsel their patients. Increasing providers' knowledge concerning differences in how weight is viewed or valued may assist them in the assessment and care of obese pediatric patients. The challenges identified in previous research continue to limit providers when addressing obesity. Although progress has been made regarding knowledge of guidelines, continuing effort is needed to tackle the remaining challenges. This will allow for earlier identification and intervention, resulting in improved outcomes in pediatric obesity.

A Qualitative Study of Barriers to Accessing Water, Sanitation and Hygiene for Disabled People in Malawi.

PubMed

White, Sian; Kuper, Hannah; Itimu-Phiri, Ambumulire; Holm, Rochelle; Biran, Adam

2016-01-01

Globally, millions of people lack access to improved water, sanitation and hygiene (WASH). Disabled people, disadvantaged both physically and socially, are likely to be among those facing the greatest inequities in WASH access. This study explores the WASH priorities of disabled people and uses the social model of disability and the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to look at the relationships between impairments, contextual factors and barriers to WASH access. 36 disabled people and 15 carers from urban and rural Malawi were purposively selected through key informants. The study employed a range of qualitative methods including interviews, emotion mapping, free-listing of priorities, ranking, photo voice, observation and WASH demonstrations. A thematic analysis was conducted using nVivo 10. WASH access affected all participants and comprised almost a third of the challenges of daily living identified by disabled people. Participants reported 50 barriers which related to water and sanitation access, personal and hand hygiene, social attitudes and participation in WASH programs. No two individuals reported facing the same set of barriers. This study found that being female, being from an urban area and having limited wealth and education were likely to increase the number and intensity of the barriers faced by an individual. The social model proved useful for classifying the majority of barriers. However, this model was weaker when applied to individuals who were more seriously disabled by their body function. This study found that body function limitations such as incontinence, pain and an inability to communicate WASH needs are in and of themselves significant barriers to adequate WASH access. Understanding these access barriers is important for the WASH sector at a time when there is a global push for equitable access.

A Qualitative Study of Barriers to Accessing Water, Sanitation and Hygiene for Disabled People in Malawi

PubMed Central

Kuper, Hannah; Itimu-Phiri, Ambumulire; Holm, Rochelle; Biran, Adam

2016-01-01

Globally, millions of people lack access to improved water, sanitation and hygiene (WASH). Disabled people, disadvantaged both physically and socially, are likely to be among those facing the greatest inequities in WASH access. This study explores the WASH priorities of disabled people and uses the social model of disability and the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework to look at the relationships between impairments, contextual factors and barriers to WASH access. 36 disabled people and 15 carers from urban and rural Malawi were purposively selected through key informants. The study employed a range of qualitative methods including interviews, emotion mapping, free-listing of priorities, ranking, photo voice, observation and WASH demonstrations. A thematic analysis was conducted using nVivo 10. WASH access affected all participants and comprised almost a third of the challenges of daily living identified by disabled people. Participants reported 50 barriers which related to water and sanitation access, personal and hand hygiene, social attitudes and participation in WASH programs. No two individuals reported facing the same set of barriers. This study found that being female, being from an urban area and having limited wealth and education were likely to increase the number and intensity of the barriers faced by an individual. The social model proved useful for classifying the majority of barriers. However, this model was weaker when applied to individuals who were more seriously disabled by their body function. This study found that body function limitations such as incontinence, pain and an inability to communicate WASH needs are in and of themselves significant barriers to adequate WASH access. Understanding these access barriers is important for the WASH sector at a time when there is a global push for equitable access. PMID:27171520

Predictors of adequate depression treatment among Medicaid-enrolled adults.

PubMed

Teh, Carrie Farmer; Sorbero, Mark J; Mihalyo, Mark J; Kogan, Jane N; Schuster, James; Reynolds, Charles F; Stein, Bradley D

2010-02-01

To determine whether Medicaid-enrolled depressed adults receive adequate treatment for depression and to identify the characteristics of those receiving inadequate treatment. Claims data from a Medicaid-enrolled population in a large mid-Atlantic state between July 2006 and January 2008. We examined rates and predictors of minimally adequate psychotherapy and pharmacotherapy among adults with a new depression treatment episode during the study period (N=1,098). Many depressed adults received either minimally adequate psychotherapy or pharmacotherapy. Black individuals and individuals who began their depression treatment episode with an inpatient psychiatric stay for depression were markedly less likely to receive minimally adequate psychotherapy and more likely to receive inadequate treatment. Racial minorities and individuals discharged from inpatient treatment for depression are at risk for receiving inadequate depression treatment.

10 CFR 503.31 - Lack of alternate fuel supply for the first 10 years of useful life.

Code of Federal Regulations, 2014 CFR

2014-01-01

... useful life. 503.31 Section 503.31 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS NEW FACILITIES... useful life. (a) Eligibility. Section 212(a)(1)(A)(i) of the Act provides for a permanent exemption due to lack of an adequate and reliable supply of alternate fuel within the first 10 years of useful life...

10 CFR 503.31 - Lack of alternate fuel supply for the first 10 years of useful life.

Code of Federal Regulations, 2011 CFR

2011-01-01

... useful life. 503.31 Section 503.31 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS NEW FACILITIES... useful life. (a) Eligibility. Section 212(a)(1)(A)(i) of the Act provides for a permanent exemption due to lack of an adequate and reliable supply of alternate fuel within the first 10 years of useful life...

10 CFR 503.31 - Lack of alternate fuel supply for the first 10 years of useful life.

Code of Federal Regulations, 2013 CFR

2013-01-01

... useful life. 503.31 Section 503.31 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS NEW FACILITIES... useful life. (a) Eligibility. Section 212(a)(1)(A)(i) of the Act provides for a permanent exemption due to lack of an adequate and reliable supply of alternate fuel within the first 10 years of useful life...

10 CFR 503.31 - Lack of alternate fuel supply for the first 10 years of useful life.

Code of Federal Regulations, 2010 CFR

2010-01-01

... useful life. 503.31 Section 503.31 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS NEW FACILITIES... useful life. (a) Eligibility. Section 212(a)(1)(A)(i) of the Act provides for a permanent exemption due to lack of an adequate and reliable supply of alternate fuel within the first 10 years of useful life...

10 CFR 503.31 - Lack of alternate fuel supply for the first 10 years of useful life.

Code of Federal Regulations, 2012 CFR

2012-01-01

... useful life. 503.31 Section 503.31 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS NEW FACILITIES... useful life. (a) Eligibility. Section 212(a)(1)(A)(i) of the Act provides for a permanent exemption due to lack of an adequate and reliable supply of alternate fuel within the first 10 years of useful life...

Access to dental care among adults with physical and intellectual disabilities: residence factors.

PubMed

Pradhan, A; Slade, G D; Spencer, A J

2009-09-01

There is limited information about access and barriers to dental care among adults with disabilities. A mailed questionnaire survey of carers of 18-44-year-old South Australians with physical and intellectual disabilities (care recipients; n = 485) in family homes, community housing and institutions. Bivariate associations were tested using chi-square tests. Odds ratios (ORs) and 95 per cent confidence intervals (CI) were estimated for irregular dental visits (IDV). Carers from family homes and community housing were more likely to report problems in obtaining dental care than those at institutions (p < 0.001). Lack of dentists with adequate skills in special needs dentistry (SND) was the most frequently reported problem for carers from family homes and community housing. IDV were less likely (p < 0.01) for care recipients in institutions and community housing than in family homes. After adjusting for care recipients' age, gender and disability, odds of IDV was lower in community housing (OR = 0.2, 95% CI = 0.1, 0.3) and in institutions (OR = 0.1, 95% CI = 0.04, 0.3) relative to family homes. Care recipients in institutions and community housing had better access to dental care than those at family homes. The shortage of dentists in SND and treatment costs needs to be addressed.

Orphan care in Botswana's working households: growing responsibilities in the absence of adequate support.

PubMed

Miller, Candace M; Gruskin, Sofia; Subramanian, S V; Rajaraman, Divya; Heymann, S Jody

2006-08-01

Botswana has one of the world's highest HIV-prevalence rates and the world's highest percentages of orphaned children among its population. We assessed the ability of income-earning households in Botswana to adequately care for orphans. We used data from the Botswana Family Health Needs Study (2002), a sample of 1033 working adults with caregiving responsibilities who used public services, to assess whether households with orphan-care responsibilities encountered financial and other difficulties. Thirty-seven percent of respondents provided orphan care, usually to extended family members. We applied logistic regression models to determine the factors associated with experiencing problems related to orphan caregiving. Nearly half of working households with orphan-care responsibilities reported experiencing financial and other difficulties because of orphan care. Issues of concern included caring for multiple orphans, caring for sick adults and orphans simultaneously, receiving no assistance, and low income. The orphan crisis is impoverishing even working households, where caregivers lack sufficient resources to provide basic needs. Neither the public sector nor communities provide adequate safety nets. International assistance is critical to build capacity within the social welfare infrastructure and to fund community-level activities that support households. Lessons from Botswana's orphan crisis can provide valuable insights to policymakers throughout sub-Saharan Africa.

Pressure and judgement within a dichotomous landscape of infant feeding: a grounded theory study to explore why breastfeeding women do not access peer support provision.

PubMed

Hunt, Louise; Thomson, Gill

2017-04-01

Lack of support is reported as a key reason for early breastfeeding cessation. While breastfeeding peer support (BPS) is a recommended intervention to increase breastfeeding rates, a number of studies identify that engagement with BPS is problematic. Due to paucity of research in this area, this study explores why breastfeeding women do not access BPS in South-West England. Utilising a constructionist grounded theory approach, 33 participants (women (n = 13), health professionals (n = 6) and peer supporters (n = 14)) participated in a semi-structured interview (n = 22) or focus group (n = 11). Analysis involved open coding, constant comparisons and focussed coding. One core category and three main themes explicating non-access were identified. The core category concerns women's experiences of pressure and judgement around their feeding decisions within a dichotomous landscape of infant feeding language and support. Theme one, 'place and space of support', describes the contrast between perceived pressure to breastfeed and a lack of adequate and appropriate support. Theme two, 'one way or no way', outlines the rules-based approach to breastfeeding adopted by some health professionals and how women avoided BPS due to anticipating a similar approach. Theme three, 'it must be me', concerns how lack of embodied insights could lead to 'breastfeeding failure' identities. A background of dichotomised language, pressure and moral judgement, combined with the organisation of post-natal care and the model of breastfeeding adopted by health professionals, may inhibit women's access to BPS. A socio-cultural model of breastfeeding support providing clear messages regarding the value and purpose of BPS should be adopted. © 2016 John Wiley & Sons Ltd.

Ergonomics and accessibility for people with visual impairment in hotels.

PubMed

Dos Santos, Larissa Nascimento; de Carvalho, Ricardo José Matos

2012-01-01

This article presents a diagnosis of luxury or superior hotels in the city of Natal, located in the state of Rio Grande do Norte, in northeastern Brazil, in what concerns accessibility to the visually impaired. The main objective is to present the guiding principles to design actions and interventions that must be considered in the preparation or revision of technical standards and manuals of good practice in accessibility related to people with visual impairments who are hotel users. The survey showed that the hotels do not meet the normative indications of accessibility, their facilities are in-accessible (have prevented access) or of reduced accessibility and its employees are not prepared to provide adequate hospital services for people with visual impairment. It was concluded that some of the accessibility problems faced by people with visual impairments are also faced by people in general.

Gender dynamics affecting maternal health and health care access and use in Uganda.

PubMed

Morgan, Rosemary; Tetui, Moses; Muhumuza Kananura, Rornald; Ekirapa-Kiracho, Elizabeth; George, A S

2017-12-01

Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women's access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women's lack of access, including those related to gender. In an effort to examine ways to sustain the intervention beyond external financial resources, project implementers conducted a follow-up qualitative study to explore the root causes of women's lack of maternal health care access and utilization. Based on emergent findings, a gender analysis of the data was conducted to identify key gender dynamics affecting maternal health and maternal health care. This paper reports the key gender dynamics identified during the analysis, by detailing how gender power relations affect maternal health care access and utilization in relation to: access to resources; division of labour, including women's workload during and after pregnancy and lack of male involvement at health facilities; social norms, including perceptions of women's attitudes and behaviour during pregnancy, men's attitudes towards fatherhood, attitudes towards domestic violence, and health worker attitudes and behaviour; and decision-making. It concludes by discussing the need for integrating gender into maternal health care interventions if they are to address the root causes of barriers to maternal health access and utilization and improve access to and use of maternal health

Association of State Access Standards With Accessibility to Specialists for Medicaid Managed Care Enrollees.

PubMed

Ndumele, Chima D; Cohen, Michael S; Cleary, Paul D

2017-10-01

Medicaid recipients have consistently reported less timely access to specialists than patients with other types of coverage. By 2018, state Medicaid agencies will be required by the Center for Medicare and Medicaid Services (CMS) to enact time and distance standards for managed care organizations to ensure an adequate supply of specialist physicians for enrollees; however, there have been no published studies of whether these policies have significant effects on access to specialty care. To compare ratings of access to specialists for adult Medicaid and commercial enrollees before and after the implementation of specialty access standards. We used Consumer Assessment of Healthcare Providers and Systems survey data to conduct a quasiexperimental difference-in-differences (DID) analysis of 20 163 nonelderly adult Medicaid managed care (MMC) enrollees and 54 465 commercially insured enrollees in 5 states adopting access standards, and 37 290 MMC enrollees in 5 matched states that previously adopted access standards. Reported access to specialty care in the previous 6 months. Seven thousand six hundred ninety-eight (69%) Medicaid enrollees and 28 423 (75%) commercial enrollees reported that it was always or usually easy to get an appointment with a specialist before the policy implementation (or at baseline) compared with 11 889 (67%) of Medicaid enrollees in states that had previously implemented access standards. Overall, there was no significant improvement in timely access to specialty services for MMC enrollees in the period following implementation of standard(s) (adjusted difference-in-differences, -1.2 percentage points; 95% CI, -2.7 to 0.1), nor was there any impact of access standards on insurance-based disparities in access (0.6 percentage points; 95% CI, -4.3 to 5.4). There was heterogeneity across states, with 1 state that implemented both time and distance standards demonstrating significant improvements in access and reductions in disparities

Rebuilding Haiti's Educational Access: A Phenomenological Study of Technology Use in Education Delivery

ERIC Educational Resources Information Center

Sandiford, Gladwyn A.

2013-01-01

There is a lack of access to technology blended with face-to-face instruction and learning in Haiti. Despite this lack of access, some Haitian college students have nevertheless leveraged technology to overcome the obstacles of poverty and obtain a higher education. This phenomenological study explored the lived experiences of 20 adult…

ClimatePipes: User-Friendly Data Access, Manipulation, Analysis & Visualization of Community Climate Models

NASA Astrophysics Data System (ADS)

Chaudhary, A.; DeMarle, D.; Burnett, B.; Harris, C.; Silva, W.; Osmari, D.; Geveci, B.; Silva, C.; Doutriaux, C.; Williams, D. N.

2013-12-01

The impact of climate change will resonate through a broad range of fields including public health, infrastructure, water resources, and many others. Long-term coordinated planning, funding, and action are required for climate change adaptation and mitigation. Unfortunately, widespread use of climate data (simulated and observed) in non-climate science communities is impeded by factors such as large data size, lack of adequate metadata, poor documentation, and lack of sufficient computational and visualization resources. We present ClimatePipes to address many of these challenges by creating an open source platform that provides state-of-the-art, user-friendly data access, analysis, and visualization for climate and other relevant geospatial datasets, making the climate data available to non-researchers, decision-makers, and other stakeholders. The overarching goals of ClimatePipes are: - Enable users to explore real-world questions related to climate change. - Provide tools for data access, analysis, and visualization. - Facilitate collaboration by enabling users to share datasets, workflows, and visualization. ClimatePipes uses a web-based application platform for its widespread support on mainstream operating systems, ease-of-use, and inherent collaboration support. The front-end of ClimatePipes uses HTML5 (WebGL, Canvas2D, CSS3) to deliver state-of-the-art visualization and to provide a best-in-class user experience. The back-end of the ClimatePipes is built around Python using the Visualization Toolkit (VTK, http://vtk.org), Climate Data Analysis Tools (CDAT, http://uv-cdat.llnl.gov), and other climate and geospatial data processing tools such as GDAL and PROJ4. ClimatePipes web-interface to query and access data from remote sources (such as ESGF). Shown in the figure is climate data layer from ESGF on top of map data layer from OpenStreetMap. The ClimatePipes workflow editor provides flexibility and fine grained control, and uses the VisTrails (http

Health Care Access and Utilization after the 2010 Pakistan Floods.

PubMed

Jacquet, Gabrielle A; Kirsch, Thomas; Durrani, Aqsa; Sauer, Lauren; Doocy, Shannon

2016-10-01

Introduction The 2010 floods submerged more than one-fifth of Pakistan's land area and affected more than 20 million people. Over 1.6 million homes were damaged or destroyed and 2,946 direct injuries and 1,985 deaths were reported. Infrastructure damage was widespread, including critical disruptions to the power and transportation networks. Hypothesis Damage and loss of critical infrastructure will affect the population's ability to seek and access adequate health care for years to come. This study sought to evaluate factors associated with access to health care in the aftermath of the 2010 Pakistan floods. A population-proportional, randomized cluster-sampling survey method with 80 clusters of 20 (1,600) households of the flood-affected population was used. Heads of households were surveyed approximately six months after flood onset. Multivariate analysis was used to determine significance. A total of 77.8% of households reported needing health services within the first month after the floods. Household characteristics, including rural residence location, large household size, and lower pre- and post-flood income, were significantly associated (P<.05) with inadequate access to health care after the disaster. Households with inadequate access to health care were more likely to have a death or injury in the household. Significantly higher odds of inadequate access to health care were observed in rural populations (adjusted OR 4.26; 95% CI, 1.89-9.61). Adequate health care access after the 2010 Pakistani floods was associated with urban residence location, suggesting that locating health care providers in rural areas may be difficult. Access to health services also was associated with post-flood income level, suggesting health resources are not readily available to households suffering great income losses. Jacquet GA , Kirsch T , Durrani A , Sauer L , Doocy S . Health care access and utilization after the 2010 Pakistan floods. Prehosp Disaster Med. 2016;31(5):485-491.

22 CFR 1006.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Adequate evidence. 1006.900 Section 1006.900 Foreign Relations INTER-AMERICAN FOUNDATION GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT... reasonable belief that a particular act or omission has occurred. ...

22 CFR 1508.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Adequate evidence. 1508.900 Section 1508.900 Foreign Relations AFRICAN DEVELOPMENT FOUNDATION GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT... reasonable belief that a particular act or omission has occurred. ...

A Program to Improve Access to Health Care Among Mexican Immigrants in Rural Colorado

ERIC Educational Resources Information Center

Diaz-Perez, Maria de Jesus; Farley, Tillman; Cabanis, Clara Martin

2004-01-01

Migration to the United States from Mexico is increasing every year. Mexican immigrants tend to be poor, uninsured, monolingual Spanish speakers without adequate access to appropriate medical care. As a further barrier, many are also undocumented. This article describes a program developed to improve access to health care among Mexican immigrants…

22 CFR 208.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Adequate evidence. 208.900 Section 208.900 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

22 CFR 208.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Adequate evidence. 208.900 Section 208.900 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

A Systematic Content Analysis of Policy Barriers Impeding Access to Opioid Medication in Central and Eastern Europe: Results of ATOME.

PubMed

Larjow, Eugenia; Papavasiliou, Evangelia; Payne, Sheila; Scholten, Willem; Radbruch, Lukas

2016-01-01

Reliable access to opioid medication is critical to delivering effective pain management, adequate treatment of opioid dependence, and quality palliative care. However, more than 80% of the world population is estimated to be inadequately treated for pain because of difficulties in accessing opioids. Although barriers to opioid access are primarily associated with restrictive laws, regulations, and licensing requirements, a key problem that significantly limits opioid access relates to policy constraints. To identify and explore policy barriers to opioid access in 12 Eastern and Central European countries involved in the Access to Opioid Medication in Europe project, funded by the European Community's Seventh Framework (FP7/2007-2013, no. 222994) Programme. A systematic content analysis of texts retrieved from documents (e.g., protocols of national problem analyses, strategic planning worksheets, and executive summaries) compiled, reviewed, approved, and submitted by either the Access to Opioid Medication in Europe consortium or the national country teams (comprising experts in pain management, harm reduction, and palliative care) between September 2011 and April 2014 was performed. Twenty-five policy barriers were identified (e.g., economic crisis, bureaucratic issues, lack of training initiatives, stigma, and discrimination), classified under four predetermined categories (financial/economic aspects and governmental support, formularies, education and training, and societal attitudes). Key barriers related to issues of funding allocation, affordability, knowledge, and fears associated with opioids. Reducing barriers and improving access to opioids require policy reform at the governmental level with a set of action plans being formulated and concurrently implemented and aimed at different levels of social, education, and economic policy change. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

10 CFR 503.35 - Inability to obtain adequate capital.

Code of Federal Regulations, 2010 CFR

2010-01-01

... capital investment, through tariffs, without unreasonably adverse economic effect on its service area... 10 Energy 4 2010-01-01 2010-01-01 false Inability to obtain adequate capital. 503.35 Section 503... New Facilities § 503.35 Inability to obtain adequate capital. (a) Eligibility. Section 212(a)(1)(D) of...

"Something Adequate"? In Memoriam Seamus Heaney, Sister Quinlan, Nirbhaya

ERIC Educational Resources Information Center

Parker, Jan

2014-01-01

Seamus Heaney talked of poetry's responsibility to represent the "bloody miracle", the "terrible beauty" of atrocity; to create "something adequate". This article asks, what is adequate to the burning and eating of a nun and the murderous gang rape and evisceration of a medical student? It considers Njabulo Ndebele's…

2 CFR 180.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Adequate evidence. 180.900 Section 180.900 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS... belief that a particular act or omission has occurred. ...

Gaps in the Digital Divide in Higher Education: Economically Disadvantaged Students and a Lack of Access and Skills

ERIC Educational Resources Information Center

Chappell, Timothy P.

2012-01-01

The digital divide between students who have access to and skills with information technology resources and those who do not is growing wider. This dissertation documents a quantitative study on the effect and relationship between age, gender, ethnicity and low economic status on students' access to computers and the Internet, as well as…

21 CFR 1404.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 9 2011-04-01 2011-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

29 CFR 1471.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 4 2011-07-01 2011-07-01 false Adequate evidence. 1471.900 Section 1471.900 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE GOVERNMENTWIDE DEBARMENT... information sufficient to support the reasonable belief that a particular act or omission has occurred. ...

21 CFR 1404.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 9 2014-04-01 2014-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

29 CFR 1471.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 4 2014-07-01 2014-07-01 false Adequate evidence. 1471.900 Section 1471.900 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE GOVERNMENTWIDE DEBARMENT... information sufficient to support the reasonable belief that a particular act or omission has occurred. ...

29 CFR 1471.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 4 2012-07-01 2012-07-01 false Adequate evidence. 1471.900 Section 1471.900 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE GOVERNMENTWIDE DEBARMENT... information sufficient to support the reasonable belief that a particular act or omission has occurred. ...

21 CFR 1404.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 9 2013-04-01 2013-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

21 CFR 1404.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 9 2012-04-01 2012-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

29 CFR 1471.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 4 2010-07-01 2010-07-01 false Adequate evidence. 1471.900 Section 1471.900 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE GOVERNMENTWIDE DEBARMENT... information sufficient to support the reasonable belief that a particular act or omission has occurred. ...

21 CFR 1404.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

29 CFR 1471.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 4 2013-07-01 2013-07-01 false Adequate evidence. 1471.900 Section 1471.900 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE GOVERNMENTWIDE DEBARMENT... information sufficient to support the reasonable belief that a particular act or omission has occurred. ...

Venous Access Devices: Clinical Rounds

PubMed Central

Matey, Laurl; Camp-Sorrell, Dawn

2016-01-01

Nursing management of venous access devices (VADs) requires knowledge of current evidence, as well as knowledge of when evidence is limited. Do you know which practices we do based on evidence and those that we do based on institutional history or preference? This article will present complex VAD infection and occlusion complications and some of the controversies associated with them. Important strategies for identifying these complications, troubleshooting, and evaluating the evidence related to lack of blood return, malposition, infection, access and maintenance protocols, and scope of practice issues are presented. PMID:28083553

Chromatin accessibility prediction via a hybrid deep convolutional neural network.

PubMed

Liu, Qiao; Xia, Fei; Yin, Qijin; Jiang, Rui

2018-03-01

A majority of known genetic variants associated with human-inherited diseases lie in non-coding regions that lack adequate interpretation, making it indispensable to systematically discover functional sites at the whole genome level and precisely decipher their implications in a comprehensive manner. Although computational approaches have been complementing high-throughput biological experiments towards the annotation of the human genome, it still remains a big challenge to accurately annotate regulatory elements in the context of a specific cell type via automatic learning of the DNA sequence code from large-scale sequencing data. Indeed, the development of an accurate and interpretable model to learn the DNA sequence signature and further enable the identification of causative genetic variants has become essential in both genomic and genetic studies. We proposed Deopen, a hybrid framework mainly based on a deep convolutional neural network, to automatically learn the regulatory code of DNA sequences and predict chromatin accessibility. In a series of comparison with existing methods, we show the superior performance of our model in not only the classification of accessible regions against background sequences sampled at random, but also the regression of DNase-seq signals. Besides, we further visualize the convolutional kernels and show the match of identified sequence signatures and known motifs. We finally demonstrate the sensitivity of our model in finding causative noncoding variants in the analysis of a breast cancer dataset. We expect to see wide applications of Deopen with either public or in-house chromatin accessibility data in the annotation of the human genome and the identification of non-coding variants associated with diseases. Deopen is freely available at https://github.com/kimmo1019/Deopen. ruijiang@tsinghua.edu.cn. Supplementary data are available at Bioinformatics online. © The Author (2017). Published by Oxford University Press. All rights

31 CFR 19.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Adequate evidence. 19.900 Section 19.900 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE DEBARMENT AND... sufficient to support the reasonable belief that a particular act or omission has occurred. ...

31 CFR 19.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Adequate evidence. 19.900 Section 19.900 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE DEBARMENT AND... sufficient to support the reasonable belief that a particular act or omission has occurred. ...

34 CFR 85.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false Adequate evidence. 85.900 Section 85.900 Education Office of the Secretary, Department of Education GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT... reasonable belief that a particular act or omission has occurred. (Authority: E.O. 12549 (3 CFR, 1986 Comp...

31 CFR 19.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Adequate evidence. 19.900 Section 19.900 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE DEBARMENT AND... sufficient to support the reasonable belief that a particular act or omission has occurred. ...

31 CFR 19.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Adequate evidence. 19.900 Section 19.900 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE DEBARMENT AND... sufficient to support the reasonable belief that a particular act or omission has occurred. ...

34 CFR 85.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Adequate evidence. 85.900 Section 85.900 Education Office of the Secretary, Department of Education GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT... reasonable belief that a particular act or omission has occurred. Authority: E.O. 12549 (3 CFR, 1986 Comp., p...

31 CFR 19.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false Adequate evidence. 19.900 Section 19.900 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE DEBARMENT AND... sufficient to support the reasonable belief that a particular act or omission has occurred. ...

Estimation of Premature Deaths From Lack of Access to Anti-HER2 Therapy for Advanced Breast Cancer in the Brazilian Public Health System.

PubMed

Debiasi, Márcio; Reinert, Tomás; Kaliks, Rafael; Amorim, Gilberto; Caleffi, Maira; Sampaio, Carlos; Fernandes, Gustavo Dos Santos; Barrios, Carlos H

2017-06-01

Patients with human epidermal growth factor receptor 2 (HER2) -positive metastatic tumors treated in the public health system in Brazil do not have access to trastuzumab. This study aimed to estimate the impact of the lack of access to anti-HER2 therapies on the mortality of these patients. On the basis of published data, the number of patients with HER2-positive advanced breast cancer in 2016 who should receive anti-HER2 targeted therapy was estimated. Three different treatment groups were considered for this hypothetical cohort: chemotherapy alone, chemotherapy plus trastuzumab, and chemotherapy plus trastuzumab and pertuzumab. The number of patients alive after 2 years of follow-up was estimated on the basis of the efficacy results of the pivotal trials considering these interventions. It was calculated that 2,008 women will be diagnosed with advanced HER2-positive breast cancer in Brazil in 2016. It was estimated that only 808 women would be alive in 2018 if they receive only chemotherapy (which is the treatment offered by the public health system). On the other hand, the bar rises to 1,408 women alive in 2018 if they receive chemotherapy plus trastuzumab and 1,576 women alive in 2018 if they receive the gold standard of chemotherapy plus trastuzumab and pertuzumab. Trastuzumab is included in the WHO's list of essential medications, but the Brazilian public health system does not yet provide this treatment to its population with advanced disease. The introduction of trastuzumab and pertuzumab would have a positive effect, preventing premature deaths in women with metastatic HER2-positive breast cancer in Brazil.

Estimation of Premature Deaths From Lack of Access to Anti-HER2 Therapy for Advanced Breast Cancer in the Brazilian Public Health System

PubMed Central

Debiasi, Márcio; Reinert, Tomás; Kaliks, Rafael; Amorim, Gilberto; Caleffi, Maira; Sampaio, Carlos; Fernandes, Gustavo dos Santos

2017-01-01

Purpose Patients with human epidermal growth factor receptor 2 (HER2) -positive metastatic tumors treated in the public health system in Brazil do not have access to trastuzumab. This study aimed to estimate the impact of the lack of access to anti-HER2 therapies on the mortality of these patients. Methods On the basis of published data, the number of patients with HER2-positive advanced breast cancer in 2016 who should receive anti-HER2 targeted therapy was estimated. Three different treatment groups were considered for this hypothetical cohort: chemotherapy alone, chemotherapy plus trastuzumab, and chemotherapy plus trastuzumab and pertuzumab. The number of patients alive after 2 years of follow-up was estimated on the basis of the efficacy results of the pivotal trials considering these interventions. Results It was calculated that 2,008 women will be diagnosed with advanced HER2-positive breast cancer in Brazil in 2016. It was estimated that only 808 women would be alive in 2018 if they receive only chemotherapy (which is the treatment offered by the public health system). On the other hand, the bar rises to 1,408 women alive in 2018 if they receive chemotherapy plus trastuzumab and 1,576 women alive in 2018 if they receive the gold standard of chemotherapy plus trastuzumab and pertuzumab. Conclusion Trastuzumab is included in the WHO’s list of essential medications, but the Brazilian public health system does not yet provide this treatment to its population with advanced disease. The introduction of trastuzumab and pertuzumab would have a positive effect, preventing premature deaths in women with metastatic HER2-positive breast cancer in Brazil. PMID:28717761

A cross-sectional study of parental awareness of and reasons for lack of health insurance among minority children, and the impact on health, access to care, and unmet needs.

PubMed

Flores, Glenn; Lin, Hua; Walker, Candy; Lee, Michael; Portillo, Alberto; Henry, Monica; Fierro, Marco; Massey, Kenneth

2016-03-22

Minority children have the highest US uninsurance rates; Latino and African-American children account for 53 % of uninsured American children, despite comprising only 48 % of the total US child population. The study aim was to examine parental awareness of and the reasons for lacking health insurance in Medicaid/CHIP-eligible minority children, and the impact of the children's uninsurance on health, access to care, unmet needs, and family financial burden. For this cross-sectional study, a consecutive series of uninsured, Medicaid/CHIP-eligible Latino and African-American children was recruited at 97 urban Texas community sites, including supermarkets, health fairs, and schools. Measures/outcomes were assessed using validated instruments, and included sociodemographic characteristics, uninsurance duration, reasons for the child being uninsured, health status, special healthcare needs, access to medical and dental care, unmet needs, use of health services, quality of care, satisfaction with care, out-of-pocket costs of care, and financial burden. The mean time uninsured for the 267 participants was 14 months; 5 % had never been insured. The most common reason for insurance loss was expired and never reapplied (30 %), and for never being insured, high insurance costs. Only 49 % of parents were aware that their uninsured child was Medicaid/CHIP eligible. Thirty-eight percent of children had suboptimal health, and 2/3 had special healthcare needs, but 64 % have no primary-care provider; 83 % of parents worry about their child's health more than others. Unmet healthcare needs include: healthcare, 73 %; mental healthcare, 70 %; mobility aids/devices, 67 %; dental, 61 %; specialty care, 57 %; and vision, 46 %. Due to the child's health, 35 % of parents had financial problems, 23 % cut work hours, and 10 % ceased work. Higher proportions of Latinos lack primary-care providers, and higher proportions of African-Americans experience family financial burden. Half of parents

Beyond the Blueprints: Enhancing Access to Materials in Remote Storage

ERIC Educational Resources Information Center

Kruger, Betsy

2003-01-01

For most research libraries, remote storage of significant portions of their print collections has become an economic necessity. Historically, user objections to remote storage have focused on access-related issues: i.e., lack of browsability, cumbersome requesting procedures, lengthy retrieval times, and lack of content information about…

Funding the Formula Adequately in Oklahoma

ERIC Educational Resources Information Center

Hancock, Kenneth

2015-01-01

This report is a longevity, simulational study that looks at how the ratio of state support to local support effects the number of school districts that breaks the common school's funding formula which in turns effects the equity of distribution to the common schools. After nearly two decades of adequately supporting the funding formula, Oklahoma…

Perceptions on the right to adequate food after a major landslide disaster: a cross-sectional survey of two districts in Uganda.

PubMed

Rukundo, Peter M; Iversen, Per O; Andreassen, Bård A; Oshaug, Arne; Kikafunda, Joyce; Rukooko, Byaruhanga

2015-04-25

Despite the instruments on the right to adequate food adopted by the United Nations, there exists limited information on how this right is perceived. Following a major 2010 landslide disaster in the Bududa district of Eastern Uganda and the resettlement of some affected households into the Kiryandongo district in Western Uganda, we surveyed both districts to explore perceptions about the right to adequate food among households with different experiences; disaster-affected and controls. We deployed qualitative and quantitative techniques to a cross-sectional survey. The index respondent was the head of each randomly selected household from the landslide affected communities and controls from a bordering sub-county. Data was collected by interviews and focus group discussions (FGDs). Structured entries were tested statistically to report associations using Pearson's Chi-square at the 95% CI. Information from FGDs was transcribed, coded, sequenced and patterned. Findings from both techniques were triangulated to facilitate interpretations. Analysis included 1,078 interview entries and 12 FGDs. Significant differences between the affected and control households (P < 0.05) were observed with: age; education level; religious affiliation; existence of assets that complement food source; and having received relief food. Analysis between groups showed differences in responses on: whether everyone has a right to adequate food; who was supposed to supply relief food; whether relief food was adequate; and preferred choice on the means to ensure the right to adequate food. FGDs emphasized that access to land was the most important means to food and income. Affected households desired remedial interventions especially alternative land for livelihood. Despite the provision of adequate relief food being a state's obligation, there was no opportunity to exercise choice and preference. Comprehension and awareness of accountability and transparency issues was also low. Though a

The U.S. Air Force Academy Lacked Effective Controls Over Heritage Assets and Guest House Inventories, and Inappropriately Solicited and Accepted Monetary Gifts

DTIC Science & Technology

2013-09-23

during that time frame. Finding B 10 │ DODIG-2013-138 Finding B USAFA Heritage Program Lacked Adequate Controls USAFA officials did not have effective ...E M B E R 2 3 , 2 0 1 3 Report No. DODIG-2013-138 The U.S. Air Force Academy Lacked Effective Controls Over Heritage Assets and Guest House...for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

Code of Federal Regulations, 2010 CFR

2010-01-01

... veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE... adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall provide adequate veterinary care to its animals in compliance with this section: (1) Each research facility shall...

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

Code of Federal Regulations, 2011 CFR

2011-01-01

... veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE... adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall provide adequate veterinary care to its animals in compliance with this section: (1) Each research facility shall...

Apathy in aging: are lack of interest and lack of initiative dissociable?

PubMed

Esposito, Fabienne; Rochat, Lucien; Juillerat Van der Linden, Anne-Claude; Lekeu, Françoise; Charnallet, Annik; Van der Linden, Martial

2014-01-01

Apathy is common in aging and generally defined on the basis of three dimensions: lack of initiative, lack of interest and emotional blunting. Curiously, no study until now has examined the associations and dissociations between these dimensions in elderly people (with or without dementia). These questions were addressed in two studies. In the first study, we explored the distribution of scores and the relationships between the three dimensions of apathy in 56 patients with dementia, focusing mainly on lack of initiative and lack of interest. Apathy was hetero-evaluated with the Apathy Inventory (AI), a scale widely used to assess the apathy dimensions in aging. In the second study, given the AI's limitations, we investigated in more detail the relationship between lack of initiative and interest in 115 elderly people using a new questionnaire specifically designed to assess these two dimensions. Results showed that lack of initiative was closely related to lack of interest (Study 1). Although we used a more specific questionnaire, these facets of apathy did not constitute two separable dimensions, but reflected a common main factor of apathy in aging (Study 2). Thus, the distinction between lack of initiative and lack of interest seems questionable. Only a multifactorial approach that includes the various psychological factors involved in apathy would enable one to gain a better understanding of the different manifestations of apathy and to highlight possible dissociations between them. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Does Medicaid Insurance Confer Adequate Access to Adult Orthopaedic Care in the Era of the Patient Protection and Affordable Care Act?

PubMed

Labrum, Joseph T; Paziuk, Taylor; Rihn, Theresa C; Hilibrand, Alan S; Vaccaro, Alexander R; Maltenfort, Mitchell G; Rihn, Jeffrey A

2017-06-01

A current appraisal of access to orthopaedic care for the adult patient receiving Medicaid is important, since Medicaid expansion was written into law by the Patient Protection and Affordable Care Act (PPACA). (1) Do orthopaedic practices provide varying access to orthopaedic care for simulated patients with Medicaid insurance versus private insurance in a blinded survey? (2) What are the surveyed state-by-state Medicaid acceptance rates for adult orthopaedic practices in the current era of Medicaid expansion set forth by the PPACA? (3) Do surveyed rates of access to orthopaedic care in the adult patient population vary across practice setting (private vs academic) or vary with different Medicaid physician reimbursement rates? (4) Are there differences in the surveyed Medicaid acceptance rates for adult orthopaedic practices in states that have expanded Medicaid coverage versus states that have foregone expansion? Simulated Patient Survey: We performed a telephone survey study of orthopaedic offices in four states with Medicaid expansion. In the survey, the caller assumed a fictitious identity as a 38-year-old male who experienced an ankle fracture 1 day before calling, and attempted to secure an appointment within 2 weeks. During initial contact, the fictitious patient reported Medicaid insurance status. One month later, the fictitious patient contacted the same orthopaedic practice and reported private insurance coverage status. National Orthopaedic Survey: Private and academic orthopaedic practices operating in each state in the United States were called and asked to complete a survey assessing their practice model of Medicaid insurance acceptance. State reimbursement rates for three different Current Procedural Terminology (CPT ®) codes were collected from state Medicaid agencies. Results Simulated Patient Survey: Offices were less likely to accept Medicaid than commercial insurance (30 of 64 [47%] versus 62 of 64 [97%]; odds ratio [OR], 0.0145; 95% CI, 0

Free access to hypertension and diabetes medicines among the elderly: a reality yet to be constructed.

PubMed

Paniz, Vera Maria Vieira; Fassa, Anaclaudia Gastal; Facchini, Luiz Augusto; Piccini, Roberto Xavier; Tomasi, Elaine; Thumé, Elaine; da Silveira, Denise Silva; Rodrigues, Maria Aparecida; Domingues, Marlos Rodrigues; Bertoldi, Andréa Dâmaso

2010-06-01

The study evaluated free access to hypertension and diabetes medicines and the reasons reported for lack of access. The sample included 4,003 elderly people living in Primary Care Unit coverage areas from 41 Southern and Northeastern Brazilian cities. Free access was higher in the Northeast (62.4%). The strategy of the Family Health Program (Programa Saúde da Família - PSF) was more effective in providing access than the traditional model, with higher results in the Northeast (61.2%) than in the South (39.6%). Around 20% of medicines included in the Hypertension and Diabetes Program and 26% of those included in the National Essential Medicines List (RENAME) were paid out of pocket. In the Northeast, 25% of insulin and 32% of oral antidiabetics were paid out of pocket. Unavailability in the public sector and a lack of money determined the lack of access. Although the PSF, Hypertension and Diabetes Program and RENAME expanded free access, supplies were insufficient. A greater connection between programs and a clear definition of responsibilities can improve medicine acquisition process, increasing the effectiveness of pharmaceutical assistance.

Limited School Drinking Water Access for Youth.

PubMed

Kenney, Erica L; Gortmaker, Steven L; Cohen, Juliana F W; Rimm, Eric B; Cradock, Angie L

2016-07-01

Providing children and youth with safe, adequate drinking water access during school is essential for health. This study used objectively measured data to investigate the extent to which schools provide drinking water access that meets state and federal policies. We visited 59 middle and high schools in Massachusetts during spring 2012. Trained research assistants documented the type, location, and working condition of all water access points throughout each school building using a standard protocol. School food service directors (FSDs) completed surveys reporting water access in cafeterias. We evaluated school compliance with state plumbing codes and federal regulations and compared FSD self-reports of water access with direct observation; data were analyzed in 2014. On average, each school had 1.5 (standard deviation: .6) water sources per 75 students; 82% (standard deviation: 20) were functioning and fewer (70%) were both clean and functioning. Less than half of the schools met the federal Healthy Hunger-Free Kids Act requirement for free water access during lunch; 18 schools (31%) provided bottled water for purchase but no free water. Slightly over half (59%) met the Massachusetts state plumbing code. FSDs overestimated free drinking water access compared to direct observation (96% FSD reported vs. 48% observed, kappa = .07, p = .17). School drinking water access may be limited. In this study, many schools did not meet state or federal policies for minimum student drinking water access. School administrative staff may not accurately report water access. Public health action is needed to increase school drinking water access. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Limited school drinking water access for youth

PubMed Central

Kenney, Erica L.; Gortmaker, Steven L.; Cohen, Juliana F.W.; Rimm, Eric B.; Cradock, Angie L.

2016-01-01

PURPOSE Providing children and youth with safe, adequate drinking water access during school is essential for health. This study utilized objectively measured data to investigate the extent to which schools provide drinking water access that meets state and federal policies. METHODS We visited 59 middle and high schools in Massachusetts during spring 2012. Trained research assistants documented the type, location, and working condition of all water access points throughout each school building using a standard protocol. School food service directors (FSDs) completed surveys reporting water access in cafeterias. We evaluated school compliance with state plumbing codes and federal regulations and compared FSD self-reports of water access with direct observation; data were analyzed in 2014. RESULTS On average, each school had 1.5 (SD: 0.6) water sources per 75 students; 82% (SD: 20) were functioning, and fewer (70%) were both clean and functioning. Less than half of the schools met the federal Healthy Hunger Free Kids Act requirement for free water access during lunch; 18 schools (31%) provided bottled water for purchase but no free water. Slightly over half (59%) met the Massachusetts state plumbing code. FSDs overestimated free drinking water access compared to direct observation (96% FSD-reported versus 48% observed, kappa=0.07, p=0.17). CONCLUSIONS School drinking water access may be limited. In this study, many schools did not meet state or federal policies for minimum student drinking water access. School administrative staff may not accurately report water access. Public health action is needed to increase school drinking water access. IMPLICATIONS AND CONTRIBUTIONS Adolescents’ water consumption is lower than recommended. In a sample of Massachusetts middle and high schools, about half did not meet federal and state minimum drinking water access policies. Direct observation may improve assessments of drinking water access and could be integrated into routine

Upper limb grafts for hemodialysis access.

PubMed

Shemesh, David; Goldin, Ilya; Verstandig, Anthony; Berelowitz, Daniel; Zaghal, Ibrahim; Olsha, Oded

2015-01-01

Arteriovenous (AV) grafts are required for hemodialysis access when options for native fistulas have been fully exhausted, where they continue to play an important role in hemodialysis patients, offering a better alternative to central vein catheters. When planning autogenous accesses using Doppler ultrasound, adequate arterial inflow and venous outflow must be consciously preserved for future access creation with grafts. Efforts to improve graft patency include changing graft configuration, graft biology and hemodynamics. Industry offers early cannulation grafts to reduce central catheter use and a bioengineered graft is undergoing clinical studies. Although the outcome of AV grafts is inferior to fistulas, grafts can provide long-term hemodialysis access that is a better alternative to central venous catheters. AV grafts have significant drawbacks, mainly poor patency, infection and cost but also have some advantages: early maturation, ease of creation and needling and widespread availability. The outcome of AV graft surgery is variable from center to center. The primary patency rate for AV grafts is 58% at 6 months and the secondary patency rate is 76% at 6 months and 55% at 18 months. There are centers of excellence that report a 1 year secondary patency rate of up to 91%. In this review of the use of AV grafts for hemodialysis access in the upper extremities, technical issues involved in planning the access and performing the surgery in its different configurations are discussed and the role of surveillance and maintenance with their attendant surgical and radiological interventions is described.

The iodized salt programme in Bangalore, India provides adequate iodine intakes in pregnant women and more-than-adequate iodine intakes in their children.

PubMed

Jaiswal, Nidhi; Melse-Boonstra, Alida; Sharma, Surjeet Kaur; Srinivasan, Krishnamachari; Zimmermann, Michael B

2015-02-01

To compare the iodine status of pregnant women and their children who were sharing all meals in Bangalore, India. A cross-sectional study evaluating demographic characteristics, household salt iodine concentration and salt usage patterns, urinary iodine concentrations (UIC) in women and children, and maternal thyroid volume (ultrasound). Antenatal clinic of an urban tertiary-care hospital, which serves a low-income population. Healthy pregnant women in all trimesters, aged 18-35 years, who had healthy children aged 3-15 years. Median (range) iodine concentrations of household powdered and crystal salt were 55·9 (17·2-65·9) ppm and 18·9 (2·2-68·2) ppm, respectively. The contribution of iodine-containing supplements and multi-micronutrient powders to iodine intake in the families was negligible. Adequately iodized salt, together with small amounts of iodine in local foods, were providing adequate iodine during pregnancy: (i) the overall median (range) UIC in women was 172 (5-1024) µg/l; (ii) the median UIC was >150 µg/l in all trimesters; and (iii) thyroid size was not significantly different across trimesters. At the same time, the median (range) UIC in children was 220 (10-782) µg/l, indicating more-than-adequate iodine intake at this age. Median UIC was significantly higher in children than in their mothers (P=0·008). In this selected urban population of southern India, the iodized salt programme provides adequate iodine to women throughout pregnancy, at the expense of higher iodine intake in their children. Thus we suggest that the current cut-off for median UIC in children indicating more-than-adequate intake, recommended by the WHO/UNICEF/International Council for the Control of Iodine Deficiency Disorders may, need to be reconsidered.

Access and use of human tissues from the developing world: ethical challenges and a way forward using a tissue trust

PubMed Central

2011-01-01

Background Scientists engaged in global health research are increasingly faced with barriers to access and use of human tissues from the developing world communities where much of their research is targeted. In part, the problem can be traced to distrust of researchers from affluent countries, given the history of 'scientific-imperialism' and 'biocolonialism' reflected in past well publicized cases of exploitation of research participants from low to middle income countries. Discussion To a considerable extent, the failure to adequately engage host communities, the opacity of informed consent, and the lack of fair benefit-sharing have played a significant role in eroding trust. These ethical considerations are central to biomedical research in low to middle income countries and failure to attend to them can inadvertently contribute to exploitation and erode trust. A 'tissue trust' may be a plausible means for enabling access to human tissues for research in a manner that is responsive to the ethical challenges considered. Summary Preventing exploitation and restoring trust while simultaneously promoting global health research calls for innovative approaches to human tissues research. A tissue trust can reduce the risk of exploitation and promote host capacity as a key benefit. PMID:21266076

Specialty-care access for community health clinic patients: processes and barriers.

PubMed

Ezeonwu, Mabel C

2018-01-01

Community health clinics/centers (CHCs) comprise the US's core health-safety net and provide primary care to anyone who walks through their doors. However, access to specialty care for CHC patients is a big challenge. In this descriptive qualitative study, semistructured interviews of 37 referral coordinators of CHCs were used to describe their perspectives on processes and barriers to patients' access to specialty care. Analysis of data was done using content analysis. The process of coordinating care referrals for CHC patients is complex and begins with a provider's order for consultation and ends when the referring provider receives the specialist's note. Poverty, specialist and referral coordinator shortages, lack of insurance, insurance acceptability by providers, transport and clinic-location factors, lack of clinic-hospital affiliations, and poor communication between primary and specialty providers constitute critical barriers to specialty-care access for patients. Understanding the complexities of specialty-care coordination processes and access helps determine the need for comprehensive and uninterrupted access to quality health care for vulnerable populations. Guaranteed access to primary care at CHCs has not translated into improved access to specialty care. It is critical that effective policies be pursued to address the barriers and minimize interruptions in care, and to ensure continuity of care for all patients needing specialty care.

How Drug Control Policy and Practice Undermine Access to Controlled Medicines

PubMed Central

Csete, Joanne; Wilson, Duncan; Fox, Edward; Wolfe, Daniel; Rasanathan, Jennifer J. K.

2017-01-01

Abstract Drug conventions serve as the cornerstone for domestic drug laws and impose a dual obligation upon states to prevent the misuse of controlled substances while ensuring their adequate availability for medical and scientific purposes. Despite the mandate that these obligations be enforced equally, the dominant paradigm enshrined in the drug conventions is an enforcement-heavy criminal justice response to controlled substances that prohibits and penalizes their misuse. Prioritizing restrictive control is to the detriment of ensuring adequate availability of and access to controlled medicines, thereby violating the rights of people who need them. This paper argues that the drug conventions’ prioritization of criminal justice measures—including efforts to prevent non-medical use of controlled substances—undermines access to medicines and infringes upon the right to health and the right to enjoy the benefits of scientific progress. While the effects of criminalization under drug policy limit the right to health in multiple ways, we draw on research and documented examples to highlight the impact of drug control and criminalization on access to medicines. The prioritization and protection of human rights—specifically the right to health and the right to enjoy the benefits of scientific progress—are critical to rebalancing drug policy. PMID:28630556

How Drug Control Policy and Practice Undermine Access to Controlled Medicines.

PubMed

Burke-Shyne, Naomi; Csete, Joanne; Wilson, Duncan; Fox, Edward; Wolfe, Daniel; Rasanathan, Jennifer J K

2017-06-01

Drug conventions serve as the cornerstone for domestic drug laws and impose a dual obligation upon states to prevent the misuse of controlled substances while ensuring their adequate availability for medical and scientific purposes. Despite the mandate that these obligations be enforced equally, the dominant paradigm enshrined in the drug conventions is an enforcement-heavy criminal justice response to controlled substances that prohibits and penalizes their misuse. Prioritizing restrictive control is to the detriment of ensuring adequate availability of and access to controlled medicines, thereby violating the rights of people who need them. This paper argues that the drug conventions' prioritization of criminal justice measures-including efforts to prevent non-medical use of controlled substances-undermines access to medicines and infringes upon the right to health and the right to enjoy the benefits of scientific progress. While the effects of criminalization under drug policy limit the right to health in multiple ways, we draw on research and documented examples to highlight the impact of drug control and criminalization on access to medicines. The prioritization and protection of human rights-specifically the right to health and the right to enjoy the benefits of scientific progress-are critical to rebalancing drug policy.

Did Universal Access to ARVT in Mexico Impact Suboptimal Antiretroviral Prescriptions?

PubMed Central

Caro-Vega, Yanink; Sierra-Madero, Juan; Colchero, M. Arantxa; Crabtree-Ramírez, Brenda; Bautista-Arredondo, Sergio

2013-01-01

Background. Universal access to antiretroviral therapy (ARVT) started in Mexico in 2001; no evaluation of the features of ARVT prescriptions over time has been conducted. The aim of the study is to document trends in the quality of ARVT-prescription before and after universal access. Methods. We describe ARVT prescriptions before and after 2001 in three health facilities from the following subsystems: the Mexican Social Security (IMSS), the Ministry of Health (SSA), and National Institutes of Health (INS). Combinations of drugs and reasons for change were classified according to current Mexican guidelines and state-of-the-art therapy. Comparisons were made using χ 2 tests. Results. Before 2001, 29% of patients starting ARVT received HAART; after 2001 it increased to 90%. The proportion of adequate prescriptions decreased within the two periods of study in all facilities (P value < 0.01). The INS and SSA were more likely to be prescribed adequately (P value < 0.01) compared to IMSS. The distribution of reasons for change was not significantly different during this time for all facilities (P value > 0.05). Conclusions. Universal ARVT access in Mexico was associated with changes in ARVT-prescription patterns over time. Health providers' performance improved, but not homogeneously. Training of personnel and guidelines updating is essential to improve prescription. PMID:24396592

Designing Out the Play: Accessibility and Playfulness in Inclusive Play.

PubMed

Holt, Raymond; Beckett, Angharad

2017-01-01

Play is an important part of child development, yet disabled children are often excluded from the opportunity to play, either due to lack of accessible toys and games, or social pressures. This paper presents a case study reflecting on the development of Button Bash: a switch accessible game intended to encourage inclusive play between disabled and non-disabled children. In particular, the paper focuses on how changes intended to make the game more accessible tended to make it less playful, and reflects on the relationship between playfulness and accessibility.

Access to Safe Water and Personal Hygiene Practices in the Kulandia Refugee Camp (Jerusalem).

PubMed

Issa, Mohamad; McHenry, Michael; Issa, Abdul Aziz; Blackwood, R Alexander

2015-12-22

Diarrheal illness, frequently associated with fecal-oral transmission, is one of the leading causes of death worldwide. It is commonly preventable through the implementation of safe water practices. This experiment concerns how to best implement safe water practices in a quasi-permanent refugee camp setting with limited ability for structural changes. Specifically, we explore how health promotion activities that help identify target groups for hygiene interventions can play a role in disease prevention. An anonymous survey was conducted at the United Nations Relief and Works Agency Health Clinic in the Kulandia refugee camp to assess the safe water and personal hygiene practices. Demographic and social characteristics, accessible water and personal hygiene characteristics, and gastrointestinal (GI) burden for individuals and their households were assessed. A total of 96 individuals were enrolled; 62 females and 34 males. Approximately 58% of the sample had soap available and washed hands before and after eating and when preparing food. Piped water was the main source of drinking water (62%), while 31% of our sample utilized tanker-trucks. 93% of participants had access to toilet facilities, with 86% of these facilities being private households. 55% practice extra water hygiene measures on their household drinking water source. 51.3% considered vendor cleanliness when they were buying food. 51% had received formal health education. 68.8% had been taught by their parents, but only 55.2% were teaching their children and 15.6% had consistent access to a health professional for hygiene inquiries. Individual variables and hygiene practices associated with lower rates of diarrheal illnesses included having water piped into the home, proper hand washing, adequate soap availability, proper consideration of vendor cleanliness, higher income, levels of education, health hygiene education, and having access to healthcare professions to discuss hygiene related matters. This is

The maxillary molar endodontic access opening: A microscope-based approach

PubMed Central

Mamoun, John Sami

2016-01-01

This article reviews the basic clinical techniques of performing a maxillary molar endodontic access opening, starting from the initial access opening into the pulp chamber, to the point where a size #10 file has been advanced to the apices of all three or four (or more) canals. The article explains how the use of the dental surgical operating microscope or microscope-level loupes magnification of ×6–8 or greater, combined with head-mounted or coaxial illumination, improve the ability of a dentist to identify microscopic root canal orifices, which facilitates the efficient creation of conservative access openings with adequate straight-line access in maxillary molars. Magnified photos illustrate various microscopic anatomical structures or landmarks of the initial access opening. Techniques are explored for implementing an access opening for teeth with vital versus necrotic pulpal tissues. The article also explores the use of piezoelectric or ultrasonic instruments for revealing root canal orifices and for removing pulp stones or calcified pulpal tissue inside the pulp chamber. PMID:27403069

Access to Education: An Assessment of the Situation in Russia

ERIC Educational Resources Information Center

Pinskaia, M. A.; Kosaretskii, S. G.; Iiastrebov, G. A.; Grunicheva, I. G.

2014-01-01

The emergence of many new types of school in post-Soviet Russia raises issues of inequalities in access to quality education. The performance of schools is very uneven, many are failing to provide adequate education, and those that admit their students from the poorer parts of the population need special help and extra resources if they are to…

Barriers and facilitators to accessing skilled birth attendants in Afar region, Ethiopia.

PubMed

King, Rosemary; Jackson, Ruth; Dietsch, Elaine; Hailemariam, Asseffa

2015-05-01

to explore barriers and facilitators that enable women to access skilled birth attendance in Afar Region, Ethiopia. researchers used a Key Informant Research approach (KIR), whereby Health Extension Workers participated in an intensive training workshop and conducted interviews with Afar women in their communities. Data was also collected from health-care workers through questionnaires, interviews and focus groups. fourteen health extension workers were key informants and interviewers; 33 women and eight other health-care workers with a range of experience in caring for Afar childbearing women provided data as individuals and in focus groups. participants identified friendly service, female skilled birth attendants (SBA) and the introduction of the ambulance service as facilitators to SBA. There are many barriers to accessing SBA, including women׳s low status and restricted opportunities for decision making, lack of confidence in health-care facilities, long distances, cost, domestic workload, and traditional practices which include a preference for birthing at home with a traditional birth attendant. many Afar men and women expressed a lack of confidence in the services provided at health-care facilities which impacts on skilled birth attendance utilisation. ambulance services that are free of charge to women are effective as a means to transfer women to a hospital for emergency care if required and expansion of ambulance services would be a powerful facilitator to increasing institutional birth. Skilled birth attendants working in institutions need to ensure their practice is culturally, physically and emotionally safe if more Afar women are to accept their midwifery care. Adequate equipping and staffing of institutions providing emergency obstetric and newborn care will assist in improving community perceptions of these services. Most importantly, mutual respect and collaboration between traditional birth attendants (Afar women׳s preferred caregiver), health

Locally Sourced Capital for Small Businesses in Rural Communities

ERIC Educational Resources Information Center

Tampien, Jordan

2016-01-01

Lack of adequate access to capital is a major barrier for rural entrepreneurs. Washington State University Extension and the Association of Washington Cities partnered to explore and test an innovative local investment approach that provides access to capital and engages the community in the success of individual businesses. The approach offers…

Scrambling for access: availability, accessibility, acceptability and quality of healthcare for lesbian, gay, bisexual and transgender people in South Africa.

PubMed

Müller, Alex

2017-05-30

Sexual orientation and gender identity are social determinants of health for people identifying as lesbian, gay, bisexual and transgender (LGBT), and health disparities among sexual and gender minority populations are increasingly well understood. Although the South African constitution guarantees sexual and gender minority people the right to non-discrimination and the right to access to healthcare, homo- and transphobia in society abound. Little is known about LGBT people's healthcare experiences in South Africa, but anecdotal evidence suggests significant barriers to accessing care. Using the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, this study analyses the experiences of LGBT health service users using South African public sector healthcare, including access to HIV counselling, testing and treatment. A qualitative study comprised of 16 semi-structured interviews and two focus group discussions with LGBT health service users, and 14 individual interviews with representatives of LGBT organisations. Data were thematically analysed within the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, focusing on availability, accessibility, acceptability and quality of care. All interviewees reported experiences of discrimination by healthcare providers based on their sexual orientation and/or gender identity. Participants recounted violations of all four elements of the UN General Comment 14: 1) Availability: Lack of public health facilities and services, both for general and LGBT-specific concerns; 2) Accessibility: Healthcare providers' refusal to provide care to LGBT patients; 3) Acceptability: Articulation of moral judgment and disapproval of LGBT patients' identity, and forced subjection of patients to religious practices; 4) Quality: Lack of knowledge about LGBT identities and health needs, leading to poor-quality care. Participants had delayed or

Improving Access to Emergency Contraception Pills through Strengthening Service Delivery and Demand Generation: A Systematic Review of Current Evidence in Low and Middle-Income Countries

PubMed Central

Dawson, Angela; Tran, Nguyen-Toan; Westley, Elizabeth; Mangiaterra, Viviana; Festin, Mario

2014-01-01

Objectives Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP. Methods A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping. Findings Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. Conclusion There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP. PMID:25285438

Temporal trends in receipt of adequate lymphadenectomy in bladder cancer 1988 to 2010.

PubMed

Cole, Alexander P; Dalela, Deepansh; Hanske, Julian; Mullane, Stephanie A; Choueiri, Toni K; Meyer, Christian P; Nguyen, Paul L; Menon, Mani; Kibel, Adam S; Preston, Mark A; Bellmunt, Joaquim; Trinh, Quoc-Dien

2015-12-01

The importance of pelvic lymphadenectomy (LND) for diagnostic and therapeutic purposes at the time of radical cystectomy (RC) for bladder cancer is well documented. Although some debate remains on the optimal number of lymph nodes removed, 10 nodes has been proposed as constituting an adequate LND. We used data from the Surveillance, Epidemiology, and End Results database to examine predictors and temporal trends in the receipt of an adequate LND at the time of RC for bladder cancer. Within the Surveillance, Epidemiology, and End Results database, we extracted data on all patients with nonmetastatic bladder cancer receiving RC in the years 1988 to 2010. First, we assess the proportion of individuals undergoing RC who received an adequate LND (≥10 nodes removed) over time. Second, we calculate odds ratios (ORs) of receiving an adequate LND using logistic regression modeling to compare study periods. Covariates included sex, race, age, region, tumor stage, urban vs. rural location, and insurance status. Among the 5,696 individuals receiving RC during the years 1988 to 2010, 2,576 (45.2%) received an adequate LND. Over the study period, the proportion of individuals receiving an adequate LND increased from 26.4% to 61.3%. The odds of receiving an adequate LND increased over the study period; a patient undergoing RC in 2008 to 2010 was over 4-fold more likely to receive an adequate LND relative to a patient treated in 1988 to 1991 (OR = 4.63, 95% CI: 3.32-6.45). In addition to time of surgery, tumor stage had a positive association with receipt of adequate LND (OR = 1.49 for stage IV [T4 N1 or N0] vs. stage I [T1 or Tis], 95% CI: 1.22-1.82). Age, sex, marital status, and race were not significant predictors of adequate LND. Adequacy of pelvic LND remains an important measure of surgical quality in bladder cancer. Our data show that over the years 1988 to 2010, the likelihood of receiving an adequate LND has increased substantially; however, a substantial minority of

‘Scared of going to the clinic’: Contextualising healthcare access for men who have sex with men, female sex workers and people who use drugs in two South African cities

PubMed Central

2018-01-01

Background Men who have sex with men (MSM), sex workers (SW) and people who use drugs (PWUD) are at increased risk for HIV because of multiple socio-structural barriers and do not have adequate access to appropriate HIV prevention, diagnosis and treatment services. Objective To examine the context of access to healthcare experienced by these three ‘Key Populations’, we conducted a qualitative study in two South African cities: Bloemfontein in the Free State province and Mafikeng in the North West province. Method We carried out in-depth interviews to explore healthcare workers’ perceptions, beliefs and attitudes towards Key Populations. Focus group discussions were also conducted with members of Key Populations exploring their experiences of accessing healthcare. Results Healthcare workers described their own attitudes towards Key Populations and demonstrated a lack of relevant knowledge, skills and training to manage the particular health needs and vulnerabilities facing Key Populations. Female SW, MSM and PWUD described their experiences of stigmatisation, and of being made to feel guilt, shame and a loss of dignity as a result of the discrimination by healthcare providers and other community. members. Our findings suggest that the uptake and effectiveness of health services amongst Key Populations in South Africa is limited by internalised stigma, reluctance to seek care, unwillingness to disclose risk behaviours to healthcare workers, combined with a lack of knowledge and understanding on the part of the broader community members, including healthcare workers. Conclusion This research highlights the need to address the broader healthcare provision environment, improving alignment of policies and programming in order to strengthen provision of effective health services that people from Key Populations will be able to access. PMID:29568645

Region 8: Colorado Adequate Letter (10/29/2001)

EPA Pesticide Factsheets

This letter from EPA to Colorado Department of Public Health and Environment determined Denvers' particulate matter (PM10) maintenance plan for Motor Vehicle Emissions Budgets adequate for transportation conformity purposes.

Effects of subdivision and access restrictions on private land recreation opportunities

Treesearch

H. Ken Cordell; Donald B.K. English; Sharon A. Randall

1993-01-01

Continuing conversion of woodlands, greater restrictions on recreational access, and subdivision are trends seeming to have important implicaitons for future public recreation supply. The nature of these implicaitons has not been adequately explored in previous research, a void that has led to questions about the actual effects these factors have on future recreational...

Assessing internet access and use in a medically underserved population: implications for providing enhanced health information services.

PubMed

Zach, Lisl; Dalrymple, Prudence W; Rogers, Michelle L; Williver-Farr, Heather

2012-03-01

The relationship between health information seeking, patient engagement and health literacy is not well understood. This is especially true in medically underserved populations, which are often viewed as having limited access to health information. To improve communication between an urban health centre and the community it serves, a team of library and information science researchers undertook an assessment of patients' level and methods of access to and use of the Internet. Data were collected in 53 face-to-face anonymous interviews with patients at the centre. Interviews were tape-recorded for referential accuracy, and data were analysed to identify patterns of access and use. Seventy-two percentage of study participants reported having access to the Internet through either computers or cell phones. Barriers to Internet access were predominantly lack of equipment or training rather than lack of interest. Only 21% of those with Internet access reported using the Internet to look for health information. The findings suggest that lack of access to the Internet in itself is not the primary barrier to seeking health information in this population and that the digital divide exists not at the level of information access but rather at the level of information use. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

Lack of dental insurance is correlated with edentulism.

PubMed

Simon, Lisa; Nalliah, Romesh P; Seymour, Brittany

2015-01-01

The correlation between insurance status and edentulism has not previously been reported in a population with known access to a dentist, and little is known about patient demographics in corporate dental settings. This study investigated patient demographics of a former dental franchise in Chicopee, Massachusetts, and examined a correlation between dental insurance and edentulism in this group. The correlation of edentulism with age, gender, and dental risk factors (diabetes, temporomandibular disorder, trouble with previous dental work, or oral sores and ulcers) was also examined. This was a retrospective case study. Age, gender, and presence of dental risk factors were recorded from the patient medical history intake form. Dentate status was recorded from patient odontograms. Dental insurance status was obtained from billing records. Data was aggregated and deidentified. Descriptive and bivariate statistics and logistic regression models were used to identify associations (p-value ≤ 0.05 significance). Of 1,123 records meeting inclusion criteria, 52.54 percent of patients had dental insurance, 26.27 percent had at least one dental risk factor, and 18.17 percent were edentulous. Age and insurance status were significantly correlated with edentulism. Correcting for age, individuals without insurance were 1.56 times as likely to be edentulous. This case study provides insight into patient demographics that might seek care in a corporate setting and suggests that access to a dentist alone may not be adequate in preserving the adult dentition; dental insurance may also be important to health. As the corporate dental practice model continues to grow, these topics deserve further study.

Region 1: Connecticut Adequate Letter (6/14/2017)

EPA Pesticide Factsheets

Letter from Office of Ecosystem Protection to Connecticut Department of Energy & Environmental Protection determined submitted 2017 Motor Vehicle Emissions Budgets adequate for transportation conformity purposes, Greater Connecticut area. (March 20, 2017)

Region 8: Utah Adequate Letter (6/10/2005)

EPA Pesticide Factsheets

This letter from EPA to Utah Department of Environmental Quality determined Salt Lake Citys' and Ogdens' Carbon Monoxide (CO) maintenance plan for Motor Vehicle Emissions Budgets adequate for transportation conformity purposes.

Indonesian infertility patients’ health seeking behaviour and patterns of access to biomedical infertility care: an interviewer administered survey conducted in three clinics

PubMed Central

2012-01-01

Background Indonesia has high levels of biological need for infertility treatment, great sociological and psychological demand for children, and yet existing infertility services are underutilized. Access to adequate comprehensive reproductive health services, including infertility care, is a basic reproductive right regardless of the economic circumstances in which individuals are born into. Thus, identifying and implementing strategies to improve access to assisted reproductive technology (ART) in Indonesia is imperative. The principle objectives of this article are to improve our understanding of infertility patients’ patterns of health seeking behaviour and their patterns of access to infertility treatment in Indonesia, in order to highlight the possibilities for improving access. Methods An interviewer-administered survey was conducted with 212 female infertility patients recruited through three Indonesian infertility clinics between July and September 2011. Participants were self-selected and data was subject to descriptive statistical analysis. Results Patients identified a number of barriers to access, including: low confidence in infertility treatment and high rates of switching between providers due to perceived treatment failure; the number and location of clinics; the lack of a well established referral system; the cost of treatment; and patients also experienced fear of receiving a diagnosis of sterility, of vaginal examinations and of embarrassment. Women’s age of marriage and the timing of their initial presentation to gynaecologists were not found to be barriers to timely access to infertility care. Conclusions The findings based on the responses of 212 female infertility patients indicated four key areas of opportunity for improving access to infertility care. Firstly, greater patient education about the nature and progression of infertility care was required among this group of women. Secondly, increased resources in terms of the number and

Generating Innovative Strategies for Healthy Infants and Children. Hearing before the Select Committee on Children, Youth, and Families. House of Representatives, One Hundred Second Congress, First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Select Committee on Children, Youth, and Families.

In this report of a hearing on infants' and children's health, two factsheets present information on the lack of recent progress in reducing infant mortality rates; the accessibility of prenatal care; low birthweight; nutrition; inadequate child health care; health risks for low-income children; the lack of adequate health insurance; the health…

Factors affecting access to head and neck cancer care after a natural disaster: a post-Hurricane Katrina survey.

PubMed

Loehn, Bridget; Pou, Anna M; Nuss, Daniel W; Tenney, Justin; McWhorter, Andrew; DiLeo, Michael; Kakade, Anagha C; Walvekar, Rohan R

2011-01-01

Our aim was to survey the factors affecting access to cancer care in patients with head and neck cancer after Hurricane Katrina. In this cross-sectional survey, 207 patients with head and neck cancer were identified post-Hurricane Katrina, but only 83 patients completed the questionnaires and were analyzed. Clinical, demographic, and socioeconomic data were recorded. Chi-square test and t test were used for comparisons. Patients who felt that there was a lack of access to cancer care would have sought treatment earlier had they had better access to cancer care (chi-square[1] = 32; p < .0001). Patients who felt that there was a lack of access to cancer care also had difficulty receiving treatment (chi-square[1] = 48; p < .0001). Availability of transportation affected access to cancer care in patients with early-stage cancers (chi-square[1] = 4; p < .035). In the postdisaster environment, patients who felt the lack of access to cancer care post-Hurricane Katrina would have sought treatment earlier with better access to cancer care. These patients also reported difficulty obtaining cancer treatment. Availability of transportation affected access to cancer care in patients with early-stage cancers. Clinical, demographic, and socioeconomic factors did not influence access to cancer care. © 2010 Wiley Periodicals, Inc. Head Neck, 2011.

Specialty-care access for community health clinic patients: processes and barriers

PubMed Central

Ezeonwu, Mabel C

2018-01-01

Introduction Community health clinics/centers (CHCs) comprise the US’s core health-safety net and provide primary care to anyone who walks through their doors. However, access to specialty care for CHC patients is a big challenge. Materials and methods In this descriptive qualitative study, semistructured interviews of 37 referral coordinators of CHCs were used to describe their perspectives on processes and barriers to patients’ access to specialty care. Analysis of data was done using content analysis. Results The process of coordinating care referrals for CHC patients is complex and begins with a provider’s order for consultation and ends when the referring provider receives the specialist’s note. Poverty, specialist and referral coordinator shortages, lack of insurance, insurance acceptability by providers, transport and clinic-location factors, lack of clinic–hospital affiliations, and poor communication between primary and specialty providers constitute critical barriers to specialty-care access for patients. Conclusion Understanding the complexities of specialty-care coordination processes and access helps determine the need for comprehensive and uninterrupted access to quality health care for vulnerable populations. Guaranteed access to primary care at CHCs has not translated into improved access to specialty care. It is critical that effective policies be pursued to address the barriers and minimize interruptions in care, and to ensure continuity of care for all patients needing specialty care. PMID:29503559

Measurement and analysis of inequality of opportunity in access of maternal and child health care in Togo.

PubMed

Sanoussi, Yacobou

2017-12-04

Access to maternal and child health care in low- and middle-income countries such as Togo is characterized by significant inequalities. Most studies in the Togolese context have examined the total inequality of health and the determinants of individuals' health. Few empirical studies in Togo have focused on inequalities of opportunity in maternal and child health. To fill this gap, we estimated changes in inequality of opportunity in access to maternal and child health services between 1998 and 2013 using data from Togo Demographic and Health Surveys (DHS). We computed the Human Opportunity Index (HOI)-a measure of how individual, household, and geographic characteristics like sex and place of residence can affect individuals' access to services or goods that should be universal-using five indicators of access to healthcare and one composite indicator of access to adequate care for children. The five indicators of access were: birth in a public or private health facility; whether the child had received any vaccinations; access to prenatal care; prenatal care given by qualified staff; and having at least four antenatal visits. We then examined differences across the two years. Between 1998 and 2013, inequality of opportunities decreased for four out of six indicators. However, inequalities increased in access to antenatal care provided by qualified staff (5.9% to 12.5%) and access to adequate care (27.7% to 28.6%). Although inequality of opportunities reduced between 1998 and 2013 for some of the key maternal and child health indicators, the average coverage and access rates underscore the need for sustained efforts to ensure equitable access to primary health care for mothers and children.

Full-band TDM-OPDMA for OBI-reduced simultaneous multiple access in a single-wavelength optical access network.

PubMed

Jung, Sun-Young; Kim, Chang-Hun; Han, Sang-Kook

2018-05-14

Simultaneous multiple access (MA) within a single wavelength can increase the data rate and split ratio in a passive optical network while optical beat interference (OBI) becomes serious in the uplink. Previous techniques to reduce OBI were limited by their complexity and lack of extendibility; as well, bandwidth allocation among MA signals is needed for single photo diode (PD) detection. We proposed and experimentally demonstrated full-band optical pulse division multiplexing-based MA (OPDMA) in an optical access network, which can effectively reduce OBI with extendibility and fully utilize frequency resources of optical modulator without bandwidth allocation in a single-wavelength MA.

Web Accessibility in Europe and the United States: What We Are Doing to Increase Inclusion

ERIC Educational Resources Information Center

Wheaton, Joseph; Bertini, Patrizia

2007-01-01

Accessibility is hardly a new problem and certainly did not originate with the Web. Lack of access to buildings long preceded the call for accessible Web content. Although it is unlikely that rehabilitation educators look at Web page accessibility with indifference, many may also find it difficult to implement. The authors posit three reasons why…

Access, attitudes and training in information technologies and evidence-based medicine among medical students at University of Zimbabwe College of Health Sciences.

PubMed

Parve, Swapnil; Ershadi, Ali; Karimov, Alexandr; Dougherty, Anne; Ndhlovu, Chiratidzo E; Chidzonga, Midion M; Sadigh, Majid

2016-09-01

The Medical Education Partnership Initiative, has helped to mitigate the digital divide in Africa. The aim of the study was to assess the level of access, attitude, and training concerning meaningful use of electronic resources and EBM among medical students at an African medical school. The study involved medical students at the University of Zimbabwe College of Health Sciences, Harare. The needs assessment tool consisted of a 21-question, paper-based, voluntary and anonymous survey. A total of 61/67 (91%), responded to the survey. 60% of the medical students were 'third-year medical students'. Among medical students, 85% of responders had access to digital medical resources, but 54% still preferred printed medical textbooks. Although 25% of responders had received training in EBM, but only 7% found it adequate. 98% of the participants did not receive formal training in journal club presentation or analytical reading of medical literature, but 77 % of them showed interest in learning these skills. Lack of training in EBM, journal club presentation and analytical reading skills have limited the impact of upgraded technology in enhancing the level of knowledge. This impact can be boosted by developing a curriculum with skills necessary in using EBM.

On the lack of consensus over the meaning of openness: an empirical study.

PubMed

Grubb, Alicia M; Easterbrook, Steve M

2011-01-01

This study set out to explore the views and motivations of those involved in a number of recent and current advocacy efforts (such as open science, computational provenance, and reproducible research) aimed at making science and scientific artifacts accessible to a wider audience. Using a exploratory approach, the study tested whether a consensus exists among advocates of these initiatives about the key concepts, exploring the meanings that scientists attach to the various mechanisms for sharing their work, and the social context in which this takes place. The study used a purposive sampling strategy to target scientists who have been active participants in these advocacy efforts, and an open-ended questionnaire to collect detailed opinions on the topics of reproducibility, credibility, scooping, data sharing, results sharing, and the effectiveness of the peer review process. We found evidence of a lack of agreement on the meaning of key terminology, and a lack of consensus on some of the broader goals of these advocacy efforts. These results can be explained through a closer examination of the divergent goals and approaches adopted by different advocacy efforts. We suggest that the scientific community could benefit from a broader discussion of what it means to make scientific research more accessible and how this might best be achieved.

On the Lack of Consensus over the Meaning of Openness: An Empirical Study

PubMed Central

Grubb, Alicia M.; Easterbrook, Steve M.

2011-01-01

This study set out to explore the views and motivations of those involved in a number of recent and current advocacy efforts (such as open science, computational provenance, and reproducible research) aimed at making science and scientific artifacts accessible to a wider audience. Using a exploratory approach, the study tested whether a consensus exists among advocates of these initiatives about the key concepts, exploring the meanings that scientists attach to the various mechanisms for sharing their work, and the social context in which this takes place. The study used a purposive sampling strategy to target scientists who have been active participants in these advocacy efforts, and an open-ended questionnaire to collect detailed opinions on the topics of reproducibility, credibility, scooping, data sharing, results sharing, and the effectiveness of the peer review process. We found evidence of a lack of agreement on the meaning of key terminology, and a lack of consensus on some of the broader goals of these advocacy efforts. These results can be explained through a closer examination of the divergent goals and approaches adopted by different advocacy efforts. We suggest that the scientific community could benefit from a broader discussion of what it means to make scientific research more accessible and how this might best be achieved. PMID:21858110

Region 9: Nevada Adequate Letter (3/30/2006)

EPA Pesticide Factsheets

This is a letter from Deborah Jordan, Director, to Leo M. Drozdoff regarding Nevada's motor vehicle emissions budgets in the 2005 Truckee Meadows CO Redesignation Request and Maintenance Plan are adequate for transportation conformity decisions.

Region 6: Texas Adequate Letter (4/16/2010)

EPA Pesticide Factsheets

This letter from EPA to Texas Commission on Environmental Quality determined 2021 motor vehicle emission budgets for nitrogen oxides (NOx) and volatile organic compounds (VOCs) for Beaumont/Port Arthur area adequate for transportation conformity purposes

Region 6: Texas Adequate Letter (6/21/17)

EPA Pesticide Factsheets

Letter from EPA approves Motor Vehicle Emissions Budgets contained in latest revisions to Houston/Galveston/Brazoria (HGB) 2008 8-hour Ozone State Implementation Plan, adequate for transportation conformity purposes and announced in the Federal Register.

Access to water

NASA Astrophysics Data System (ADS)

Stein, Robyn; Niklaas, Lindie

This paper will examine the legal implications of the South African Constitutional judgement of Government of the Republic of South Africa and others vs Grootboom and others (2001(1) SA 46 (CC)) in view of the developing debate on socio-economic rights under the constitution on the constitutional right of access to sufficient water. It will look at the manner in which effect is being given to this right at municipal level through the provision of free water and the constitutional implications of an adequate basic minimum level set by the State and local authorities. The paper will also explore the implications of relevant legislation, which enables local authorities to cut off water supplies as well as the implications of the Grootboom decision for communities facing water cut-offs.

Region 8: Colorado Adequate Letter (1/20/2004)

EPA Pesticide Factsheets

This letter from EPA to Colorado Department of Public Health and Environment determined Greeleys' Carbon Monoxide (CO) maintenance plan for Motor Vehicle Emissions Budgets adequate for transportation conformity purposes and will be announced in the FR.

Region 4: Tennessee Adequate Letter (9/30/2010)

EPA Pesticide Factsheets

This letter acknowledges that the EPA has reviewed Tennessee's Knoxville Area redesignation request and maintenace plan, as well as the motor vehicle emissions budgets (MVEBs) and have determined that these MVEBs are adequate for transportation conformity

Region 9: California Adequate Letter (7/14/2017)

EPA Pesticide Factsheets

EPA approves California Air Resources Board Motor Vehicle Emissions Budgets in San Joaquin Valley Unified Air Pollution Control Districts 2016 Plan for 2008 8-Hour Ozone Standard adequate for transportation conformity purposes announced in Federal Register

Region 9: Arizona Adequate Letter (10/14/2003)

EPA Pesticide Factsheets

This is a letter from Jack P. Broadben,. Director, to Nancy Wrona and Dennis Smith informing them that Maricopa County's motor vehicle emissions budgets in the 2003 MAGCO Maintenance Plan are adequate for transportation conformity purposes.

Relationship between household access to food and malnutrition in eastern and southern Africa.

PubMed

Mwadime, R K; Baldwin, S L

1994-09-01

This review paper gives an overview of the relationship between household access to food and malnutrition using national level data in the Eastern and Southern Africa Region. The overall prevalence of malnutrition amongst the under-five population have not changed significantly over the decade and, in some cases, have deteriorated. The situation of household access to food differs between economies and production systems, but most households (average of 80%) in the region do not have access to adequate food. A preliminary analysis of the determinants of malnutrition at country level pointed to the importance of: financial access to food (an indicator of household access to food) and; access to safe water (an indicator of household healthy environment), as the most significant variables predicting rates of malnutrition. Several areas for action by governments in the region and for further study within the subject of household access to food are delineated. These are: more clear determination of the relative contribution of household access to food, to the nutritional status of women and children and, improved analysis of indicators of household access to food.

Role of Primary Health Care in Ensuring Access to Medicines

PubMed Central

Sambala, Evanson Z; Sapsed, Susan; Mkandawire, Mercy L

2010-01-01

To examine ways of ensuring access to health services within the framework of primary health care (PHC), since the goal of PHC to make universal health care available to all people has become increasingly neglected amid emerging themes of globalization, trade, and foreign policy. From a public health point of view, we argue that the premise of PHC can unlock barriers to health care services and contribute greatly to determining collective health through the promotion of universal basic health services. PHC has the most sophisticated and organized infrastructure, theories, and political principles, with which it can deal adequately with the issues of inequity, inequality, and social injustice which emerge from negative economic externalities and neo-liberal economic policies. Addressing these issues, especially the complex social and political influences that restrict access to medicines, may require the integration of different health initiatives into PHC. Based on current systems, PHC remains the only conventional health delivery service that can deal with resilient public health problems adequately. However, to strengthen its ability to do so, we propose the revitalization of PHC to incorporate scholarship that promotes human rights, partnerships, research and development, advocacy, and national drug policies. The concept of PHC can improve access; however, this will require the urgent interplay among theoretical, practical, political, and sociological influences arising from the economic, social, and political determinants of ill health in an era of globalization. PMID:20564760

Reduced alcohol consumption in mice lacking preprodynorphin.

PubMed Central

Blednov, Yuri A.; Walker, Danielle; Martinez, Marni; Harris., R. Adron

2007-01-01

Many studies suggest a role for endogenous opioid peptides and their receptors in regulation of ethanol intake. It is commonly accepted that the κ-opioid receptors and their endogenous ligands, dynorphins, produce a dysphoric state and therefore may be responsible for avoidance of alcohol. We used mutant mice lacking preprodynorphin in a variety of behavioral tests of alcohol actions. Null mutant female, but not male, mice showed significantly lower preference for alcohol and consumed lower amounts of alcohol in a two-bottle choice test as compared with wild-type littermates. In the same test, knockout mice of both sexes showed a strong reduction of preference for saccharin compared to control mice. In contrast, under conditions of limited (4 hours) access (light phase of the light/dark cycle), null mutant mice did not show any differences in consumption of saccharin but they showed significantly reduced intake of sucrose. To determine the possible cause for reduction of ethanol preference and intake, we studied other ethanol-related behaviors in mice lacking the preprodynorphin gene. There were no differences between null mutant and wild type mice in ethanol-induced loss of righting reflex, acute ethanol withdrawal, ethanol-induced conditioned place preference or conditioned taste aversion to ethanol. These results indicate that deletion of preprodynorphin leads to substantial reduction of alcohol intake in female mice, and suggest thath this is caused by decreased orosensory reward of alcohol (sweet taste and/or palatability). PMID:17307643

Reduced alcohol consumption in mice lacking preprodynorphin.

PubMed

Blednov, Yuri A; Walker, Danielle; Martinez, Marni; Harris, R Adron

2006-10-01

Many studies suggest a role for endogenous opioid peptides and their receptors in regulation of ethanol intake. It is commonly accepted that the kappa-opioid receptors and their endogenous ligands, dynorphins, produce a dysphoric state and therefore may be responsible for avoidance of alcohol. We used mutant mice lacking preprodynorphin in a variety of behavioral tests of alcohol actions. Null mutant female, but not male, mice showed significantly lower preference for alcohol and consumed lower amounts of alcohol in a two-bottle choice test as compared with wild-type littermates. In the same test, knockout mice of both sexes showed a strong reduction of preference for saccharin compared to control mice. In contrast, under conditions of limited (4 h) access (light phase of the light/dark cycle), null mutant mice did not show any differences in consumption of saccharin, but they showed significantly reduced intake of sucrose. To determine the possible cause for reduction of ethanol preference and intake, we studied other ethanol-related behaviors in mice lacking the preprodynorphin gene. There were no differences between null mutant and wild-type mice in ethanol-induced loss of righting reflex, acute ethanol withdrawal, ethanol-induced conditioned place preference, or conditioned taste aversion to ethanol. These results indicate that deletion of preprodynorphin leads to substantial reduction of alcohol intake in female mice, and suggest that this is caused by decreased orosensory reward of alcohol (sweet taste and/or palatability).

Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study.

PubMed

Treacy, Laura; Bolkan, Håkon A; Sagbakken, Mette

2018-01-01

Sierra Leone has one of the highest maternal mortality ratios in the world. Efforts to reduce maternal mortality have included initiatives to encourage more women to deliver at health facilities. Despite the introduction of the free health care initiative for pregnant women, many women still continue to deliver at home, with few having access to a skilled birth attendant. In addition, inequalities between rural and urban areas in accessing and utilising health facilities persist. Further insight into how and why women make decisions around childbirth will help guide future plans and initiatives in improving maternal health in Sierra Leone. The objective of this study was to explore the perceptions and decision-making processes of women and their communities during childbirth in rural Sierra Leone. Data were collected through seven focus group discussions and 22 in-depth interviews with recently pregnant women and their community members in two rural villages. Data were analysed using systematic text condensation. Findings revealed that decision-making processes during childbirth are dynamic, intricate and need to be understood within the broader social context that they take place. Factors such as distance and lack of transport, perceived negative behaviour of hospital staff, direct and indirect financial obstacles, as well as the position of women in society all interact and influence how and what decisions are made. Pregnant women face multiple interacting vulnerabilities that influence their healthcare-seeking decisions during pregnancy and childbirth. Future initiatives to improve access and utilisation of safe healthcare services for pregnant women need to be based on adequate knowledge of structural constraints and health inequities that affect women in rural Sierra Leone.

Region 5: Wisconsin Adequate Letter (4/16/2015)

EPA Pesticide Factsheets

This March 13, 2015 letter from EPA approves Wisconsins Kenosha and Sheboygan counties Early Progress Plan for year 2015 Motor Vehicle Emissions Budgets (MVEBs) for VOC and NOx finding them adequate for transportation conformity purposes and will be announ

Accessibility of Home Blood Pressure Monitors for Blind and Visually Impaired People

PubMed Central

Uslan, Mark M.; Burton, Darren M.; Wilson, Thomas E.; Taylor, Steven; Chertow, Bruce S.; Terry, Jack E.

2007-01-01

Background The prevalence of hypertension comorbid with diabetes is a significant health care issue. Use of the home blood pressure monitor (HBPM) for aiding in the control of hypertension is noteworthy because of benefits that accrue from following a home measurement regimen. To be usable by blind and visually impaired patients, HBPMs must have speech output to convey all screen information, an easily readable visual display, identifiable controls that are easy to use, and an accessible user manual. Methods Data on the physical aspects and the features and functions of nine Food and Drug Administration-approved HBPMs (eight of which were recommended by the British Hypertension Society) were tabulated and analyzed for usability by blind and visually impaired individuals. Video Electronics Standards Association standards were used to measure contrast modulation in the displays of the HBPMs. Ten persons who are blind or visually impaired and who have diabetes were surveyed to determine how they monitor their blood pressure and to learn their ideas for improvements in usability. Results Physical controls were found to be easy to identify, and operating procedures were found to be relatively simple on all of the HBPMs, but user manuals were either inaccessible or minimally accessible to blind persons. The two HBPMs that have speech output do not voice all of the information that is displayed on the screen. Some functions that are standard in the HBPMs without speech output, such as the feature for automatically setting cuff inflation volume and memory, were lacking in the HBPMs with speech output. These features were mentioned as desirable in interviews with legally blind persons who are diabetic and who monitor their blood pressure at home. Visual display output was large and adequate in all of the HBPMs. Michelson contrast for numeric digits in the HBPM displays was also measured, ranging from 55 to 75% for characters with dominant spatial frequency components lying

Region 8: Colorado Adequate Letter (8/17/2011)

EPA Pesticide Factsheets

This March 4, 2011 letter from EPA to Chistopher E. Urbina M.D., MPH, Colorado Department of Public Health and Environment states that EPA has found that the Greeley, CO second 10 year Limited Maintenance Plan (LMP) adequate for transportation conformity

Region 8: Colorado Adequate Letter (6/11/2012)

EPA Pesticide Factsheets

This August 9, 2011 letter from EPA to Chistopher E. Urbina M.D., MPH, Colorado Department of Public Health and Environment states that EPA has found that the Fort Collins, CO second 10 year Limited Maintenance Plan (LMP) adequate for transportation

Using Multitheory Model of Health Behavior Change to Predict Adequate Sleep Behavior.

PubMed

Knowlden, Adam P; Sharma, Manoj; Nahar, Vinayak K

The purpose of this article was to use the multitheory model of health behavior change in predicting adequate sleep behavior in college students. A valid and reliable survey was administered in a cross-sectional design (n = 151). For initiation of adequate sleep behavior, the construct of behavioral confidence (P < .001) was found to be significant and accounted for 24.4% of the variance. For sustenance of adequate sleep behavior, changes in social environment (P < .02), emotional transformation (P < .001), and practice for change (P < .001) were significant and accounted for 34.2% of the variance.

Barriers to health service access among female migrant Ugandan sex workers in Guangzhou, China.

PubMed

Davis, Alissa; Meyerson, Beth E; Aghaulor, Blessing; Brown, Katherine; Watson, Adisyn; Muessig, Kathryn E; Yang, Ligang; Tucker, Joseph D

2016-10-14

Increased trade between China and Uganda has fueled trafficking of female Ugandans into China. These women may face challenges accessing health services. This study focused on examining barriers to health care access among female Ugandan sex workers in China. In 2014, we undertook in-depth interviews with 19 female Ugandan sex workers in Guangzhou, China. Interviews focused on barriers to health service access and were analyzed using an a priori coding framework followed by open-coding to capture emergent themes. Out of 19 women, 12 women reported a history of being trafficked into China. None of the women had a valid Chinese visa. Fear of being arrested for lack of documentation discouraged women in this sample from accessing hospital services. Low pay, housing exploitation, and remittances contributed to participants' lack of financial resources, which further inhibited their ability to access health services. Participants expressed feeling social isolation from the local community and reported mistrust of local individuals and organizations, including hospitals. Ugandan sex workers in China faced substantial structural barriers that limited health service access. Policy changes and the development of new programs are urgently needed to ensure these women have improved access to health services.

Cancer Deaths due to Lack of Universal Access to Radiotherapy in the Brazilian Public Health System.

PubMed

Mendez, L C; Moraes, F Y; Fernandes, G Dos S; Weltman, E

2018-01-01

Radiotherapy plays a fundamental role in the treatment of cancer. Currently, the Brazilian public health system cannot match the national radiotherapy demand and many patients requiring radiotherapy are never exposed to this treatment. This study estimated the number of preventable deaths in the public health system if access to radiotherapy was universal. Incidence rates for the year 2016 provided by Instituto Nacional de Cancer were used in this analysis. The number of untreated patients requiring radiotherapy was obtained through the difference between the total number of patients requiring radiotherapy and the total amount of delivered radiotherapy treatments in the public health system. The number of deaths for the three most common cancers in each gender due to radiotherapy shortage was calculated. Initially, the total number of patients per cancer type was divided in stages using Brazilian epidemiological data. Subsequently, previously published tree arm diagrams were used to define the rate of patients requiring radiotherapy in each specific clinical setting. Finally, the clinical benefit of radiotherapy in overall survival was extracted from studies with level 1 evidence. Over 596 000 cancer cases were expected in Brazil in 2016. The public health system covers more than 75% of the Brazilian population and an estimated 111 432 patients who required radiotherapy in 2016 did not receive this treatment. Breast, colorectal and cervix cancers are the most frequent malignant tumours in women and prostate, lung and colorectal in men. The number of deaths due to a radiotherapy shortage in the year 2016 for these types of cancer were: (i) breast: 1011 deaths in 10 years; (ii) cervix: 2006 deaths in 2 years; (iii) lung: 1206 deaths in 2 years; (iv) prostate, intermediate risk: 562 deaths in 13 years; high risk: 298 deaths in 10 years; (v) colorectal: 0 deaths, as radiotherapy has no proven benefit in overall survival. Thousands of cancer patients requiring

Region 8: Colorado Adequate Letter (6/11/2012)

EPA Pesticide Factsheets

This August 11, 2011 letter from EPA to Chistopher E. Urbina M.D., MPH, Colorado Department of Public Health and Environment states that EPA has found that the Aspen PM10 maintenance plan and the 2023 motor vehicle emissions budget (MVEB) adequate

Region 9: Arizona Adequate Letter (11/1/2001)

EPA Pesticide Factsheets

This is a letter from Jack P. Broadbent, Director, Air Division to Nancy Wrona and James Bourney informing them of the adequacy of Revised MAG 1999 Serious Area Carbon Monoxide Plan and that the MAG CO Plan is adequate for Maricopa County.

Region 9: California Adequate Letter (1/22/2018)

EPA Pesticide Factsheets

This December 19, 2017 letter form EPA, finding adequate certain motor vehicle emissions budgets for the 2006 fine particulate matter (PM2.5) National Ambient Air Quality Standars in the Final 2016 Air Quality Managemnet Plan for the South Coast area (2016

Beyond the Millennium Development Goals: public health challenges in water and sanitation.

PubMed

Rheingans, R; Dreibelbis, R; Freeman, M C

2006-01-01

Over 1 billion people lack access to improved water sources and 2.6 billion lack access to appropriate sanitation, greatly contributing to the global burden of disease. The international community has committed to reducing by half the proportion of the world's population lacking access to water and sanitation as a part of the Millennium Development Goals (MDGs). However, the disease burden due to poor access, is borne primarily by the poorest countries and the poorest people within them. Simply reducing the proportion of people without adequate access will not automatically result in proportional reductions in the related disease burden. The public health challenge inherent in meeting the MDG targets is ensuring that improvements result in access to water and sanitation for the critical at-risk populations. Innovative approaches are required to ensure the availability of low-cost, simple, and locally acceptable water and sanitation interventions and integrating these approaches into existing social institutions, such as schools, markets, and health facilities.

Food Access Patterns and Barriers among Midlife and Older Adults with Mobility Disabilities

PubMed Central

Huang, Deborah L.; Rosenberg, Dori E.; Simonovich, Shannon D.; Belza, Basia

2012-01-01

We examined where midlife and older adults with a mobility disability accessed food outside the home in King County, Washington, USA, how they travelled to these food destinations, and facilitators and barriers to food access using qualitative interviews. Thirty-five adults aged ≥50 years with a mobility disability (defined as use of an assistive device for mobility) were interviewed. Supplemental objective information was obtained from a Global Positioning System device worn by participants for 3 days. Participants primarily accessed food at grocery stores, restaurants, and coffee shops/cafés. The most common transportation modes were walking, obtaining a ride from friends, motorized chair/scooter, and public transit. Location and proximity of food destinations were factors affecting participants' ability to access these destinations. Adequate space, ease of entry, available amenities such as restrooms, and helpful people were facilitators for participants to access food outside the home. PMID:23056944

The Importance of Process-Oriented Accessibility Guidelines for Web Developers.

PubMed

Steen-Hansen, Linn; Fagernes, Siri

2016-01-01

Current accessibility research shows that in the web development, the process itself may lead to inaccessible web sites and applications. Common practices typically do not allow sufficient testing. The focus is mainly on complying with minimum standards, and treating accessibility compliance as a sort of bug-fixing process, missing the user perspective. In addition, there is an alarming lack of knowledge and experience with accessibility issues. It has also been argued that bringing accessibility into the development process at all stages is the only way to achieve the highest possible level of accessibility. The work presented in this paper is based on a previous project focusing on guidelines for developing accessible rich Internet applications. The guidelines were classified as either process-oriented or technology-oriented. In this paper, we examine the process-oriented guidelines and give a practical perspective on how these guidelines will make the development process more accessibility-friendly.

Perceived rules and accessibility: measurement and mediating role in the association between parental education and vegetable and soft drink intake.

PubMed

Gebremariam, Mekdes K; Lien, Nanna; Torheim, Liv Elin; Andersen, Lene F; Melbye, Elisabeth L; Glavin, Kari; Hausken, Solveig E S; Sleddens, Ester F C; Bjelland, Mona

2016-08-17

The existence of socioeconomic differences in dietary behaviors is well documented. However, studies exploring the mechanisms behind these differences among adolescents using comprehensive and reliable measures of mediators are lacking. The aims of this study were (a) to assess the psychometric properties of new scales assessing the perceived rules and accessibility related to the consumption of vegetables and soft drinks and (b) to explore their mediating role in the association between parental education and the corresponding dietary behaviors. A cross-sectional survey including 440 adolescents from three counties in Norway (mean age 14.3 years (SD = 0.6)) was conducted using a web-based questionnaire. Principal component analysis, test-retest and internal reliability analysis were conducted. The mediating role of perceived accessibility and perceived rules in the association between parental education and the dietary behaviors was explored using linear regression analyses. Factor analyses confirmed two separate subscales, named "accessibility" and "rules", both for vegetables and soft drinks (factor loadings >0.60). The scales had good internal consistency reliability (0.70-0.87). The test-retest reliability of the scales was moderate to good (0.44-0.62). Parental education was inversely related to the consumption of soft drinks and positively related to the consumption of vegetables. Perceived accessibility and perceived rules related to soft drink consumption were found to mediate the association between parental education and soft drink consumption (47.5 and 8.5 % of total effect mediated). Accessibility of vegetables was found to mediate the association between parental education and the consumption of vegetables (51 % of total effect mediated). The new scales developed in this study are comprehensive and have adequate validity and reliability; they are therefore considered appropriate for use among 13-15 year-olds. Parents, in particular those with a

Advancing Long Tail Data Capture and Access Through Trusted, Community-Driven Data Services at the IEDA Data Facility

NASA Astrophysics Data System (ADS)

Lehnert, K. A.; Carbotte, S. M.; Ferrini, V.; Hsu, L.; Arko, R. A.; Walker, J. D.; O'hara, S. H.

2012-12-01

Substantial volumes of data in the Earth Sciences are collected in small- to medium-size projects by individual investigators or small research teams, known as the 'Long Tail' of science. Traditionally, these data have largely stayed 'in the dark', i.e. they have not been properly archived, and have therefore been inaccessible and underutilized. The primary reason has been the lack of appropriate infrastructure, from adequate repositories to resources and support for investigators to properly manage their data, to community standards and best practices. Lack of credit for data management and for the data themselves has contributed to the reluctance of investigators to share their data. IEDA (Integrated Earth Data Applications), a NSF-funded data facility for solid earth geoscience data, has developed a comprehensive suite of data services that are designed to address the concerns and needs of investigators. IEDA's data publication service registers datasets with DOI and ensures their proper citation and attribution. IEDA is working with publishers on advanced linkages between datasets in the IEDA repository and scientific online articles to facilitate access to the data, enhance their visibility, and augment their use and citation. IEDA's investigator support ranges from individual support for data management to tools, tutorials, and virtual or face-to-face workshops that guide and assist investigators with data management planning, data submission, and data documentation. A critical aspect of IEDA's concept has been the disciplinary expertise within the team and its strong liaison with the science community, as well as a community-based governance. These have been fundamental to gain the trust and support of the community that have lead to significantly improved data preservation and access in the communities served by IEDA.

[The impact of subsidized healthcare insurance on access to cervical cytology in Medellin, Colombia].

PubMed

Atehortúa, Sara C; Palacio-Mejía, Lina S

2014-01-01

Assessing the impact of subsidized healthcare insurance on access to cervical cytology in Medellin, Colombia. Propensity score matching (PSM) was used with 2008 Life Quality Survey in Colombia figures to obtain a control group comparable to a treatment group. This involved using stratification estimates, the k-nearest-neighbor algorithm and kernel density for calculating impact size Access to cytology for 19 to 49 year-old women having subsidized healthcare insurance were 2.2 % to 2.9 % lower compared to women who did not have any healthcare insurance. Estimates were not statistically significant for women over 50 years-old. Women lacking healthcare insurance having increased access to cytology could be explained by charities or social programs aiding the population lacking healthcare insurance.

Robotic single-access splenectomy using the Da Vinci Single-Site® platform: a case report.

PubMed

Corcione, Francesco; Bracale, Umberto; Pirozzi, Felice; Cuccurullo, Diego; Angelini, Pier Luigi

2014-03-01

Single-access laparoscopic splenectomy can offer patients some advantages. It has many difficulties, such as instrument clashing, lack of triangulation, odd angles and lack of space. The Da Vinci Single-Site® robotic surgery platform could decrease these difficulties. We present a case of single-access robotic splenectomy using this device. A 37 year-old female with idiopathic thrombocytopenic purpura was operated on with a single-site approach, using the Da Vinci Single-Site robotic surgery device. The procedure was successfully completed in 140 min. No intraoperative and postoperative complications occurred. The patient was discharged from hospital on day 3. Single-access robotic splenectomy seems to be feasible and safe using the new robotic single-access platform, which seems to overcome certain limits of previous robotic or conventional single-access laparoscopy. We think that additional studies should also be performed to explore the real cost-effectiveness of the platform. Copyright © 2013 John Wiley & Sons, Ltd.

13 CFR 107.200 - Adequate capital for Licensees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... operate actively in accordance with your Articles and within the context of your business plan, as... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Adequate capital for Licensees. 107.200 Section 107.200 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS...

42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417... health care industry. (b) Provision of data. (1) The HMO or CMP must provide adequate cost and... 42 Public Health 3 2012-10-01 2012-10-01 false Adequate financial records, statistical data, and...

42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.568 Adequate... definitions and accounting, statistics, and reporting practices that are widely accepted in the health care... 42 Public Health 3 2010-10-01 2010-10-01 false Adequate financial records, statistical data, and...

42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.568 Adequate... definitions and accounting, statistics, and reporting practices that are widely accepted in the health care... 42 Public Health 3 2011-10-01 2011-10-01 false Adequate financial records, statistical data, and...

Accessibility Guidelines for Astronomy and Astrophysics Meetings

NASA Astrophysics Data System (ADS)

Monkiewicz, Jacqueline; Murphy, Nicholas; Diaz-Merced, Wanda Liz; Aarnio, Alicia; Knierman, Karen; AAS Working Group for Accessibility and Disability

2018-01-01

Attendance at meetings and conferences is a critical component of an astronomer's professional life, providing opportunities for presenting one's work, staying current in the field, career networking, and scientific collaboration. Exclusion from these gatherings due to lack of accessibility and accommodation failure is a reality for disabled astronomers, and contributes substantially to low levels of representation in the senior-most levels of the field. We present a preview of the AAS Working Group for Accessibility and Disability's best practice recommendations for meetings accessibility. Applying the principles of universal access and barrier-free design, we model a paradigm of anticipating and removing accessibility barriers in advance, rather than putting the burden of requesting accommodation solely on disabled astronomers and students. We cite several professional and nonprofessional societies identified as meetings accessibility exemplars, and model our guidelines on their best practices. We establish standards for accessibility budgeting, venue choice, publication of policies online, designating point persons, and identifying barriers. We make recommendations for oral and poster presentations, event registration, receptions and banquets, excursions, and other typical conference activities. For meetings which are constrained by fixed budgets and venue choice, we identify a number of low cost/high reward accessibility steps which might still have a large beneficial impact. We likewise provide adapted recommendations for low budget meetings. THIS IS A POSTER LOCATED IN THE AAS BOOTH

Racial Disparities In Geographic Access To Primary Care In Philadelphia.

PubMed

Brown, Elizabeth J; Polsky, Daniel; Barbu, Corentin M; Seymour, Jane W; Grande, David

2016-08-01

Primary care is often thought of as the gateway to improved health outcomes and can lead to more efficient use of health care resources. Because of primary care's cardinal importance, adequate access is an important health policy priority. In densely populated urban areas, spatial access to primary care providers across neighborhoods is poorly understood. We examined spatial variation in primary care access in Philadelphia, Pennsylvania. We calculated ratios of adults per primary care provider for each census tract and included buffer zones based on prespecified drive times around each tract. We found that the average ratio was 1,073; the supply of primary care providers varied widely across census tracts, ranging from 105 to 10,321. We identified six areas of Philadelphia that have much lower spatial accessibility to primary care relative to the rest of the city. After adjustment for sociodemographic and insurance characteristics, the odds of being in a low-access area were twenty-eight times greater for census tracts with a high proportion of African Americans than in tracts with a low proportion of African Americans. Project HOPE—The People-to-People Health Foundation, Inc.

Community-aware charging station network design for electrified vehicles in urban areas : reducing congestion, emissions, improving accessibility, and promoting walking, bicycling, and use of public transportation.

DOT National Transportation Integrated Search

2016-08-31

A major challenge for achieving large-scale adoption of EVs is an accessible infrastructure for the communities. The societal benefits of large-scale adoption of EVs cannot be realized without adequate deployment of publicly accessible charging stati...

Reply to "transforming oncology care": advancing value, accessing innovation.

PubMed

Paradis, Rebecca

2015-09-01

Alternative payment models in oncology are already successfully standardizing care, curbing costs, and improving the patient experience. Yet, it is unclear whether decision makers are adequately considering patient access to innovation when creating these models, which could have severe consequences for a robust innovation ecosystem and the lives of afflicted patients. The suggested chart includes recommendations on: Allowing for the adoption of new, promising therapies; Promoting the measurement of patient-centered outcomes; and Providing support for personalized medicine.

The impact of health service variables on healthcare access in a low resourced urban setting in the Western Cape, South Africa.

PubMed

Scheffler, Elsje; Visagie, Surona; Schneider, Marguerite

2015-06-19

Health care access is complex and multi-faceted and, as a basic right, equitable access and services should be available to all user groups. The aim of this article is to explore how service delivery impacts on access to healthcare for vulnerable groups in an urban primary health care setting in South Africa. A descriptive qualitative study design was used. Data were collected through semi-structured interviews with purposively sampled participants and analysed through thematic content analysis. Service delivery factors are presented against five dimensions of access according to the ACCESS Framework. From a supplier perspective, the organisation of care in the study setting resulted in available, accessible, affordable and adequate services as measured against the DistrictHealth System policies and guidelines. However, service providers experienced significant barriers in provision of services, which impacted on the quality of care, resulting in poor client and provider satisfaction and ultimately compromising acceptability of service delivery. Although users found services to be accessible, the organisation of services presented them with challenges in the domains of availability, affordability and adequacy, resulting in unmet needs, low levels of satisfaction and loss of trust. These challenges fuelled perceptions of unacceptable services. Well developed systems and organisation of services can create accessible, affordable and available primary healthcare services, but do not automatically translate into adequate and acceptable services. Focussing attention on how services are delivered might restore the balance between supply (services) and demand (user needs) and promote universal and equitable access.

Broadband Optical Access Technologies to Converge towards a Broadband Society in Europe

NASA Astrophysics Data System (ADS)

Coudreuse, Jean-Pierre; Pautonnier, Sophie; Lavillonnière, Eric; Didierjean, Sylvain; Hilt, Benoît; Kida, Toshimichi; Oshima, Kazuyoshi

This paper provides insights on the status of broadband optical access market and technologies in Europe and on the expected trends for the next generation optical access networks. The final target for most operators, cities or any other player is of course FTTH (Fibre To The Home) deployment although we can expect intermediate steps with copper or wireless technologies. Among the two candidate architectures for FTTH, PON (Passive Optical Network) is by far the most attractive and cost effective solution. We also demonstrate that Ethernet based optical access network is very adequate to all-IP networks without any incidence on the level of quality of service. Finally, we provide feedback from a FTTH pilot network in Colmar (France) based on Gigabit Ethernet PON technology. The interest of this pilot lies on the level of functionality required for broadband optical access networks but also on the development of new home network configurations.

Child malnutrition and mortality among families not utilizing adequately iodized salt in Indonesia.

PubMed

Semba, Richard D; de Pee, Saskia; Hess, Sonja Y; Sun, Kai; Sari, Mayang; Bloem, Martin W

2008-02-01

Salt iodization is the main strategy for reducing iodine deficiency disorders worldwide. Characteristics of families not using iodized salt need to be known to expand coverage. The objective was to determine whether families who do not use iodized salt have a higher prevalence of child malnutrition and mortality and to identify factors associated with not using iodized salt. Use of adequately iodized salt (>or =30 ppm), measured by rapid test kits, was assessed between January 1999 and September 2003 in 145 522 and 445 546 families in urban slums and rural areas, respectively, in Indonesia. Adequately iodized salt was used by 66.6% and 67.2% of families from urban slums and rural areas, respectively. Among families who used adequately iodized salt, mortality in neonates, infants, and children aged <5 y was 3.3% compared with 4.2%, 5.5% compared with 7.1%, and 6.9% compared with 9.1%, respectively (P < 0.0001 for all), in urban slums; among families who did not use adequately iodized salt, the respective values were 4.2% compared with 6.3%, 7.1% compared with 11.2%, and 8.5% compared with 13.3% (P < 0.0001 for all) in rural areas. Families not using adequately iodized salt were more likely to have children who were stunted, underweight, and wasted. In multivariate analyses that controlled for potential confounders, low maternal education was the strongest factor associated with not using adequately iodized salt. In Indonesia, nonuse of adequately iodized salt is associated with a higher prevalence of child malnutrition and mortality in neonates, infants, and children aged <5 y. Stronger efforts are needed to expand salt iodization in Indonesia.

Keeping the Promise: 2011 Annual Report

ERIC Educational Resources Information Center

Children's Aid Society, 2011

2011-01-01

No child should be born into poverty, but as we know all too well, millions are. In New York City, nearly one out of every three children is poor. It is the city's highest rate of child poverty in three decades. Poverty is more complex than the lack of financial resources--the most vulnerable children often lack access to adequate food, shelter,…

Region 6: New Mexico Adequate Letter (8/21/2003)

EPA Pesticide Factsheets

This is a letter from Carl Edlund, Director, to Alfredo Santistevan regarding MVEB's contained in the latest revision to the Albuquerque Carbon Monoxide State Implementation Plan (SIP) are adequate for transportation conformity purposes.

Region 10: Oregon Oakridge Adequate Letter (6/21/2017)

EPA Pesticide Factsheets

EPA approves motor vehicle emissions budget in the Oakridge-Westfir PM2.5 Attainment State Implementation Plan for the 2006 PM2.5 national ambient air quality standard, adequate for transportation conformity purposes.

Understanding Your Adequate Yearly Progress (AYP), 2011-2012

ERIC Educational Resources Information Center

Missouri Department of Elementary and Secondary Education, 2011

2011-01-01

The "No Child Left Behind Act (NCLB) of 2001" requires all schools, districts/local education agencies (LEAs) and states to show that students are making Adequate Yearly Progress (AYP). NCLB requires states to establish targets in the following ways: (1) Annual Proficiency Target; (2) Attendance/Graduation Rates; and (3) Participation…

Access to transportation for Chittenden County Vermont older adults.

PubMed

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

2016-08-01

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

Issues in access to safe drinking water and basic hygiene for persons with physical disabilities in rural Cambodia.

PubMed

MacLeod, Marin; Pann, Mala; Cantwell, Ray; Moore, Spencer

2014-12-01

An estimated 1.6 million people die from diarrheal diseases each year due to lack of access to safe water and sanitation, and persons with physical disabilities face additional barriers. In Cambodia, approximately 5% of the population is disabled, presenting substantial obstacles in accessing these basic services. The purpose of this study was twofold: first, to identify the challenges facing persons with physical disabilities in accessing safe household water and basic hygiene in rural Cambodia; and, second, to use these results to generate policy and practice recommendations for the water and sanitation hygiene sector implementing water treatment system interventions in rural settings. Fifteen field interviews were conducted with persons with physical disabilities. Thematic analysis was used to identify six main themes. The results indicated that environmental barriers to access were greater in the workplace than household settings and those persons with disabilities had greater awareness about safe drinking water compared to basic hygiene. Additionally, lack of physical strength, distance to water, and lack of financial means were noted as common access barriers. The findings support ongoing research and offer insight into the particular challenges facing persons with physical disabilities in rural areas in accessing safe drinking water and basic hygiene.

Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China.

PubMed

Zhang, Xufan; Dupre, Matthew E; Qiu, Li; Zhou, Wei; Zhao, Yuan; Gu, Danan

2017-07-19

Studies have shown that inadequate access to healthcare is associated with lower levels of health and well-being in older adults. Studies have also shown significant urban-rural differences in access to healthcare in developing countries such as China. However, there is limited evidence of whether the association between access to healthcare and health outcomes differs by urban-rural residence at older ages in China. Four waves of data (2005, 2008/2009, 2011/2012, and 2014) from the largest national longitudinal survey of adults aged 65 and older in mainland China (n = 26,604) were used for analysis. The association between inadequate access to healthcare (y/n) and multiple health outcomes were examined-including instrumental activities of daily living (IADL) disability, ADL disability, cognitive impairment, and all-cause mortality. A series of multivariate models were used to obtain robust estimates and to account for various covariates associated with access to healthcare and/or health outcomes. All models were stratified by urban-rural residence. Inadequate access to healthcare was significantly higher among older adults in rural areas than in urban areas (9.1% vs. 5.4%; p < 0.01). Results from multivariate models showed that inadequate access to healthcare was associated with significantly higher odds of IADL disability in older adults living in urban areas (odds ratio [OR] = 1.58-1.79) and rural areas (OR = 1.95-2.30) relative to their counterparts with adequate access to healthcare. In terms of ADL disability, we found significant increases in the odds of disability among rural older adults (OR = 1.89-3.05) but not among urban older adults. Inadequate access to healthcare was also associated with substantially higher odds of cognitive impairment in older adults from rural areas (OR = 2.37-3.19) compared with those in rural areas with adequate access to healthcare; however, no significant differences in cognitive impairment were found among older

Traditional and market food access in Arctic Canada is affected by economic factors.

PubMed

Lambden, Jill; Receveur, Olivier; Marshall, Joan; Kuhnlein, Harriet V

2006-09-01

This study aimed to evaluate the access that Indigenous women have to traditional and market foods in 44 communities across Arctic Canada. This secondary data analysis used a cross-sectional survey of 1771 Yukon First Nations, Dene/Métis and Inuit women stratified by age. Socio-cultural questionnaires were used to investigate food access and chi-square testing was used to ascertain the distribution of subject responses by age and region. There was considerable regional variation in the ability to afford adequate food, with between 40% and 70% saying they could afford enough food. Similarly, regional variation was reflected in the percentage of the population who could afford, or had access to, hunting or fishing equipment. Up to 50% of the responses indicated inadequate access to fishing and hunting equipment, and up to 46% of participants said they could not afford to go hunting or fishing. Affordability of market food and accessibility to hunting and fishing in Arctic Canada were major barriers to Indigenous women's food security.

Helpful advice and hidden expertize: pharmacy users' experiences of community pharmacy accessibility.

PubMed

Lindsey, Laura; Husband, Andy; Steed, Liz; Walton, Robert; Todd, Adam

2017-09-01

In recent years community pharmacies have emerged as strategically important settings to deliver services aimed at promoting public health. In order to develop evidence-based approaches to public health interventions that exploit the unique accessibility of community pharmacies, it is important to determine how people experience care in this context. This study, therefore, aimed to describe how care is perceived and experienced in community pharmacies with particular focus on community pharmacy access. In-depth semi-structured interviews were used to explore the perceptions and experiences' of people using community pharmacies. A total of 30 participants were interviewed. Themes specifically emerged in relation to community pharmacy access; these fell into four main categories: relationships; time; lack of awareness; and empowerment. The experience of developing a trusting relationship with the pharmacist is an important consideration in the context of community pharmacy accessibility. This could be an important consideration when a person uses a community pharmacy to access a public health service. There is also a perceived lack of awareness among the general public about the extended role of community pharmacy; this is a potential barrier toward people using them. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Concept analysis: lack of anonymity.

PubMed

Swan, Marilyn A; Hobbs, Barbara B

2017-05-01

To re-examine and expand understanding of the concept 'lack of anonymity' as a component of rural nursing theory. Early healthcare literature reports lack of anonymity as part of social and working environments, particularly rural nursing. Rural nursing theory included the first published concept analysis on lack of anonymity but lacked empirical referents. Workforce, societal and rural healthcare changes support an updated analysis. To further understand lack of anonymity, its present day use and applicability to diverse environments, research from multiple disciplines was reviewed. Concept analysis. A literature search using eight terms in eleven databases was conducted of literature published between 2008-2013. Walker and Avant's concept analysis methodology guided the analysis. The previous concept analysis is supported in part by current literature. The defining attributes, 'identifiable', 'establishing boundaries for public and private self and interconnectedness' in a community were updated. Updated antecedents include: (i) environmental context; (ii) opportunities to become visible; (iii) developing relationships and (iv) unconscious or limited awareness of public or personal privacy. Consequences are: (i) familiarity; (ii) visibility; (iii) awareness of privacy and (iv) manage or balance of lack of anonymity. Cases were constructed and empirical referents identified. The concept of lack of anonymity was updated; portions of the original definition remain unchanged. Empirical referents reveal the defining attributes in daily life and may guide future research on the effect of lack of anonymity on nursing practice. This analysis advances the conceptual understanding of rural nursing theory. © 2016 John Wiley & Sons Ltd.

Predictors for achieving adequate protein and energy intake in nursing home rehabilitation patients.

PubMed

van Zwienen-Pot, J I; Visser, M; Kruizenga, H M

2018-07-01

Adequate energy and protein intake could be essential for contributing significantly to the rehabilitations process. Data on the actual nutritional intake of older nursing home rehabilitation patients have not yet been investigated. To investigate the nutritional intake and predictors for achieving protein and energy requirements on the 14th day of admission in nursing home rehabilitation patients. Fifty-nine patients aged 65+ years newly admitted to nursing home rehabilitation wards were included. Data on potential variables were collected on admission. On the fourteenth day nutritional intake was assessed. Intake was considered 'adequate' if patients had achieved ≥ 1.2 g of protein/kg bodyweight and ≥ 85% of their energy needs according to Harris and Benedict + 30%. Multiple logistic regression analyses were performed to select predictors for adequate intake. Protein and energy intake was assessed in 79 patients [67% female, mean age 82 ± (SD) 8 years, BMI 25 ± 6 kg/m 2 ]. Mean energy intake was 1677 kcal (± 433) and mean protein intake was 68 g (± 20). Fourteen patients (18%) achieved an adequate protein and energy intake. Predictors for adequate intake were use of sip/tube feeding (OR = 7.7; 95% CI = 1.35-44.21), BMI (0.68; 0.53-0.87) and nausea (8.59; 1.42-52.01). Only 18% of older nursing home rehabilitation patients had an adequate protein and energy intake at 14 days after admission. Patients with higher BMI were less likely, while those using sip/tube feeding or feeling nauseous were more likely to achieve an adequate protein and energy intake.

13 CFR 119.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... lacks adequate access to capital or other resources essential for business success, or is economically... enterprise system has been impaired due to diminished capital and credit opportunities as compared to others... social service organizations, that provides services to disadvantaged microentrepreneurs. Qualified...

Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach

PubMed Central

Topp, Stephanie M.; Moonga, Clement N.; Luo, Nkandu; Kaingu, Michael; Chileshe, Chisela; Magwende, George; Heymann, S. Jody; Henostroza, German

2016-01-01

Background Prison populations in sub-Saharan Africa (SSA) experience a high burden of disease and poor access to health care. Although it is generally understood that environmental conditions are dire and contribute to disease spread, evidence of how environmental conditions interact with facility-level social and institutional factors is lacking. This study aimed to unpack the nature of interactions and their influence on health and healthcare access in the Zambian prison setting. Methods We conducted in-depth interviews of a clustered random sample of 79 male prisoners across four prisons, as well as 32 prison officers, policy makers and health care workers. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems. Results A majority of inmates, as well as facility-based officers reported anxiety linked to overcrowding, sanitation, infectious disease transmission, nutrition and coercion. Due in part to differential wealth of inmates and their support networks on entering prison, and in part to the accumulation of authority and material wealth within prison, we found enormous inequity in the standard of living among prisoners at each site. In the context of such inequities, failure of the Zambian prison system to provide basic necessities (including adequate and appropriate forms of nutrition, or access to quality health care) contributed to high rates of inmate-led and officer-led coercion with direct implications for health and access to healthcare. Conclusions This systems-oriented analysis provides a more comprehensive picture of the way resource shortages and human interactions within Zambian prisons interact and affect inmate and officer health. While not a panacea, our findings highlight some strategic entry-points for important upstream and downstream reforms including urgent improvement in the availability of human resources for health; strengthening of

[Adolescents' access to contraception: perceptions of health workers in Huechuraba, Chile].

PubMed

Ramírez, Giovanna Rojas; Bravo, Pamela Eguiguren; Vivaldi, María Isabel Matamala; Manríquez, Irma Palma; Pérez, Thelma Gálvez

2017-06-08

Identify difficulties in adolescents' access to contraceptive care and information, based on perceptions and experiences of health workers in Huechuraba, in the Metropolitan Region of Chile. This qualitative, descriptive study incorporated principles of participatory action research, involving health care teams in the survey and data analysis, and generating proposals for improvement. Seventeen (17) semi-structured individual interviews and one group interview were conducted with professionals and technical personnel involved in adolescent care in the commune's health centers. Health workers perceived that adolescents were having difficulties reaching the centers due to cultural factors, lack of information, lack of health activities in the community, while administrative requirements and procedures hindered access to care. Shortcomings were evident in the management and interpretation of fertility regulation standards and of current legislation, and in the absence of explanatory frameworks recognizing adolescents' gender, sexual, and reproductive rights. Adolescents and their needs have a low profile and there are conflicts between theory and practice regarding access to contraception and counseling, with a lack of definitions or agreements that take into account social and cultural contexts. It is urgent to provide health workers with training on gender and sexual and reproductive rights, together with opportunities for reflection in order to generate coordinated and effective approaches. Efforts are required to disseminate the program and organize activities in community spaces, together with other community sectors.

34 CFR 200.20 - Making adequate yearly progress.

Code of Federal Regulations, 2014 CFR

2014-07-01

... adequate yearly progress. A school or LEA makes AYP if it complies with paragraph (c) and with either paragraph (a) or (b) of this section separately in reading/language arts and in mathematics. (a)(1) A school... school or LEA, respectively, meets or exceeds the State's other academic indicators under § 200.19. (2...

34 CFR 200.20 - Making adequate yearly progress.

Code of Federal Regulations, 2013 CFR

2013-07-01

... adequate yearly progress. A school or LEA makes AYP if it complies with paragraph (c) and with either paragraph (a) or (b) of this section separately in reading/language arts and in mathematics. (a)(1) A school... school or LEA, respectively, meets or exceeds the State's other academic indicators under § 200.19. (2...

34 CFR 200.20 - Making adequate yearly progress.

Code of Federal Regulations, 2012 CFR

2012-07-01

... adequate yearly progress. A school or LEA makes AYP if it complies with paragraph (c) and with either paragraph (a) or (b) of this section separately in reading/language arts and in mathematics. (a)(1) A school... school or LEA, respectively, meets or exceeds the State's other academic indicators under § 200.19. (2...

34 CFR 200.20 - Making adequate yearly progress.

Code of Federal Regulations, 2011 CFR

2011-07-01

... adequate yearly progress. A school or LEA makes AYP if it complies with paragraph (c) and with either paragraph (a) or (b) of this section separately in reading/language arts and in mathematics. (a)(1) A school... school or LEA, respectively, meets or exceeds the State's other academic indicators under § 200.19. (2...

Comparability and Reliability Considerations of Adequate Yearly Progress

ERIC Educational Resources Information Center

Maier, Kimberly S.; Maiti, Tapabrata; Dass, Sarat C.; Lim, Chae Young

2012-01-01

The purpose of this study is to develop an estimate of Adequate Yearly Progress (AYP) that will allow for reliable and valid comparisons among student subgroups, schools, and districts. A shrinkage-type estimator of AYP using the Bayesian framework is described. Using simulated data, the performance of the Bayes estimator will be compared to…

Wheelchair accessibility to public buildings in Istanbul.

PubMed

Evcil, A Nilay

2009-03-01

Accessibility to public environment is the human right and basic need of each citizen and is one of the fundamental considerations for urban planning. The aim of this study is to determine the compliance of public buildings in central business districts (CBD) of Istanbul, Turkey, to wheelchair accessibility to the guidelines of the instrument and identify architectural barriers faced by wheelchair users. This is a descriptive study of 26 public buildings in CBD of Istanbul. The instrument used is the adapted Useh, Moyo and Munyonga questionnaire to collect the data from direct observation and measurement. Descriptive statistics of simple percentages and means are used to explain the compliance to the guidelines of the instrument and wheelchair accessibility. The descriptive survey results indicate that wheelchair users experience many accessibility problems in public environment of the most urbanised city (cultural capital of Europe in 2010) in a developing country. It is found that the major architectural barrier is the public transportation items with the lowest mean compliance (25%). Beside this, the most compliant to the instrument is entrance to building items with 79% as mean percentage. It is also found that there is an intention to improve accessibility when building construction period is investigated. This article describes the example of the compliance of public buildings accessibility when the country has legislation, but lacking regulations about accessibility for the wheelchair users.

40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 24 2014-07-01 2014-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The pesticides...

40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 25 2013-07-01 2013-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The pesticides...

40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 25 2012-07-01 2012-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The pesticides...

Region 1: New Hampshire Adequate Letter (8/12/2008)

EPA Pesticide Factsheets

This July 9, 2008 letter from EPA to the New Hampshire Department of Environmental Services, determined the 2009 Motor Vehicle Emissions Budgets (MVEBs) are adequate for transportation conformity purposes and will be announced in the Federal Register (FR).

Region 6: Texas Austin Adequate Letter (11/23/2016)

EPA Pesticide Factsheets

EPA letter approves the Motor Vehicle Emissions Budgets contained in the latest revision to Dallas/Fort Worth 2008 8-hour Ozone State Implementation Plan, finding them adequate for transportation conformity purposes to be announced in the Federal Register.

Gender and care: access to HIV testing, care, and treatment.

PubMed

Remien, Robert H; Chowdhury, Jenifar; Mokhbat, Jacques E; Soliman, Cherif; Adawy, Maha El; El-Sadr, Wafaa

2009-07-01

HIV transmission and occurrence of AIDS in the Middle East and North Africa region (MENA) is increasing, while access to ART in the region lags behind most low to middle-income countries. Like in other parts of the world, there is a growing feminization of the epidemic, and men and women each confront unique barriers to adequate HIV prevention and treatment services, while sharing some common obstacles as well. This paper focuses on important gender dimensions of access to HIV testing, care and treatment in the MENA region, including issues related to stigma, religion and morality, gender power imbalances, work status, and migration. Culturally specific policy and programmatic recommendations for improving HIV prevention and treatment in the MENA region are offered.

Region 1: New Hampshire Adequate Letter (5/29/2012)

EPA Pesticide Factsheets

This April 25, 2012 letter from EPA to the New Hampshire Department of Environmental Services, determined the 2008 and 2022 Motor Vehicle Emissions Budgets (MVEBs) are adequate for transportation conformity purposes and will be announced in the Federal Reg

Region 5: Ohio Columbus Adequate Letter (8/23/2016)

EPA Pesticide Factsheets

Letter from EPA to State of Ohio determined the 2008 8-hour ozone standard plan for years 2020 and 2030 Motor Vehicle Emissions Budgets for volatile organic compounds and nitrogen oxides for Columbus area adequate for transportation conformity purposes.

Region 8: Colorado Springs Adequate Letter (8/17/2011)

EPA Pesticide Factsheets

This March 3, 2011 letter from EPA to Chistopher E. Urbina M.D., MPH, Colorado Department of Public Health and Environment states that EPA has found that the Colorado Springs, CO second 10 year Limited Maintenance Plan (LMP) adequate for transportation

Minimum requirements for adequate nighttime conspicuity of highway signs

DOT National Transportation Integrated Search

1988-02-01

A laboratory and field study were conducted to assess the minimum luminance levels of signs to ensure that they will be detected and identified at adequate distances under nighttime driving conditions. A total of 30 subjects participated in the field...

Inferential Processing among Adequate and Struggling Adolescent Comprehenders and Relations to Reading Comprehension

PubMed Central

Barth, Amy E.; Barnes, Marcia; Francis, David J.; Vaughn, Sharon; York, Mary

2015-01-01

Separate mixed model analyses of variance (ANOVA) were conducted to examine the effect of textual distance on the accuracy and speed of text consistency judgments among adequate and struggling comprehenders across grades 6–12 (n = 1203). Multiple regressions examined whether accuracy in text consistency judgments uniquely accounted for variance in comprehension. Results suggest that there is considerable growth across the middle and high school years, particularly for adequate comprehenders in those text integration processes that maintain local coherence. Accuracy in text consistency judgments accounted for significant unique variance for passage-level, but not sentence-level comprehension, particularly for adequate comprehenders. PMID:26166946

Gold or green: the debate on open access policies.

PubMed

Abadal, Ernest

2013-09-01

The movement for open access to science seeks to achieve unrestricted and free access to academic publications on the Internet. To this end, two mechanisms have been established: the gold road, in which scientific journals are openly accessible, and the green road, in which publications are self-archived in repositories. The publication of the Finch Report in 2012, advocating exclusively the adoption of the gold road, generated a debate as to whether either of the two options should be prioritized. The recommendations of the Finch Report stirred controversy among academicians specialized in open access issues, who felt that the role played by repositories was not adequately considered and because the green road places the burden of publishing costs basically on authors. The Finch Report's conclusions are compatible with the characteristics of science communication in the UK and they could surely also be applied to the (few) countries with a powerful publishing industry and substantial research funding. In Spain, both the current national legislation and the existing rules at universities largely advocate the green road. This is directly related to the structure of scientific communication in Spain, where many journals have little commercial significance, the system of charging a fee to authors has not been adopted, and there is a good repository infrastructure. As for open access policies, the performance of the scientific communication system in each country should be carefully analyzed to determine the most suitable open access strategy.

Access to Health Care Services among Young People Exchanging Sex in Detroit.

PubMed

Knittel, Andrea K; Graham, Louis F; Peterson, Jerry; Lopez, William; Snow, Rachel C

2018-04-05

Within the related epidemics of sex exchange, drug use, and poverty, access to health care is shaped by intersecting identities, policy, and infrastructure. This study uses a unique survey sample of young adults in Detroit, who are exchanging sex on the street, in strip clubs, and at after-hours parties and other social clubs. Factors predicting access to free or affordable health care services, such as venue, patterns of sexual exchange influence, drug use and access to transportation, were examined using multivariable logistic regression and qualitative comparative analysis. The most significant predictors of low access to health care services were unstable housing and lack of access to reliable transportation. In addition, working on the street was associated with decreased access to services. Coordinated policy and programming changes are needed to increase health care access to this group, including improved access to transportation, housing, and employment, and integration of health care services.

Internet Access and Usage in Improving Students' Self-Directed Learning in Indonesia Open University

ERIC Educational Resources Information Center

Rahardjo, Djoko; Sumardjo; Lubis, Djuara P.; Harijati, Sri Ir.

2016-01-01

Internet is well known nowadays, however higher distance education students who live in remote rural areas still have not been able to take advantages of this medium optimally for their learning process. For accessing the internet the students have to be available with the minimum prerequisites: the existence of adequate devices and the sufficient…

Lessons from Helen Keller: How to Make the Comics Accessible?

PubMed

Dupire, Jérôme; Boude, Yvan

2017-01-01

This paper addresses the lack of accessibility of the comics for deaf or hard-of-hearing readers. Comics are a major cultural object, used in many different contexts with, as much as different purposes (leisure, education, advertising, etc.). We report here the results of an experimentation during a communication operation, including a regular exhibition made of panels and a digital mirroring of the contents, with extra materials and information. This digital part, accessible through our institution website, is the basement of this paper.

Region 8: Colorado Telluride Adequate Letter (8/17/2011)

EPA Pesticide Factsheets

This March 4, 2011 letter from EPA to Chistopher E. Urbina M.D., MPH, Colorado Department of Public Health and Environment states that EPA has found that the Telluride, CO PM10 maintenance plan and the 2021 motor vehicle emisssions budget (MVEB) adequate

Vascular access in patients receiving hemodialysis in Libya.

PubMed

Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W

2012-01-01

A native arteriovenous fistula (AVF) represents the optimal form of Vascular Access (VA) for patients receiving hemodialysis (HD). In Libya there are several barriers to AVF creation including lack of adequate preparation for dialysis and surgical services. We aimed to conduct the first comprehensive study of VA utilisation in HD patients in Libya. A prospective observational study included all adult patients receiving HD treatment in 25 HD facilities in Libya from May 2009 to Nov 2011. Researchers gathered data regarding VA through interviews with staff and patients as well as medical records. Patients with definitive VA were re-interviewed after 1 year. At baseline the majority of patients (91.9%; n=1573) were using permanent VA in the form of AVF or arteriovenous graft. Patients with permanent VA were more likely to be male and less likely to be diabetic than those with CVCs. Most patients had commenced HD using a temporary CVC (91.8%). VA-related complications were: thrombosis (46.7%), aneurysm (22.6%), infection (11.5%) and haemorrhage (10.2%). Incident VA thrombosis was reported by 14.7% in 1 year. Independent risk factors for incident thrombosis were female gender and diabetes. Hospitalisation for VA related complications was reported by 31.4%. Few patients in Libya initiate HD with definitive VA, but most achieve it thereafter. Improved dialysis preparation and increased provision of surgical services are required to increase the proportion of patients initiating HD with definitive VA and should be a priority in rebuilding health services in Libya after the recent conflict.

Insurance + Access ≠ Health Care: Typology of Barriers to Health Care Access for Low-Income Families

PubMed Central

DeVoe, Jennifer E.; Baez, Alia; Angier, Heather; Krois, Lisa; Edlund, Christine; Carney, Patricia A.

2007-01-01

PURPOSE Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers. METHODS A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, “Is there anything else you would like to tell us?” Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries. RESULTS Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families. CONCLUSIONS Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere. PMID:18025488

Accelerators/decelerators of achieving universal access to sexual and reproductive health services: a case study of Iranian health system

PubMed Central

2013-01-01

Background At the 1994 International Conference on Population and Development (ICPD), held in Cairo, the global community agreed to the goal of achieving universal access to sexual and reproductive health (SRH) and rights by 2015. This research explores the accelerators and decelerators of achieving universal access to the sexual and reproductive health targets and accordingly makes some suggestions. Method We have critically reviewed the latest national reports and extracted the background data on each SRH indicator. The key stakeholders, both national and international, were visited and interviewed at two sites. A total of 55 in-depth interviews were conducted with religious leaders, policy-makers, senior managers, senior academics, and health care managers. Six focus-group discussions were also held among health care providers. The study was qualitative in nature. Results Obstacles on the road to achieving universal access to SRH can be viewed from two perspectives. One gap exists between current achievements and the targets. The other gap arises due to age, marital status, and residency status. The most recently observed trends in the indicators of the universal access to SRH shows that the achievements in the “unmet need for family planning” have been poor. Unmet need for family planning could directly be translated to unwanted pregnancies and unwanted childbirths; the former calls for sexual education to underserved people, including adolescents; and the latter calls for access to safe abortion. Local religious leaders have not actively attended international goal-setting programs. Therefore, they usually do not presume a positive attitude towards these goals. Such negative attitudes seem to be the most important factors hindering the progress towards universal access to SRH. Lack of international donors to fund for SRH programs is also another barrier. In national levels both state and the society are interactively playing their roles. We have used a

Accelerators/decelerators of achieving universal access to sexual and reproductive health services: a case study of Iranian health system.

PubMed

Akbari, Nahid; Ramezankhani, Ali; Pazargadi, Mehrnoosh

2013-07-01

At the 1994 International Conference on Population and Development (ICPD), held in Cairo, the global community agreed to the goal of achieving universal access to sexual and reproductive health (SRH) and rights by 2015. This research explores the accelerators and decelerators of achieving universal access to the sexual and reproductive health targets and accordingly makes some suggestions. We have critically reviewed the latest national reports and extracted the background data on each SRH indicator. The key stakeholders, both national and international, were visited and interviewed at two sites. A total of 55 in-depth interviews were conducted with religious leaders, policy-makers, senior managers, senior academics, and health care managers. Six focus-group discussions were also held among health care providers. The study was qualitative in nature. Obstacles on the road to achieving universal access to SRH can be viewed from two perspectives. One gap exists between current achievements and the targets. The other gap arises due to age, marital status, and residency status. The most recently observed trends in the indicators of the universal access to SRH shows that the achievements in the "unmet need for family planning" have been poor. Unmet need for family planning could directly be translated to unwanted pregnancies and unwanted childbirths; the former calls for sexual education to underserved people, including adolescents; and the latter calls for access to safe abortion. Local religious leaders have not actively attended international goal-setting programs. Therefore, they usually do not presume a positive attitude towards these goals. Such negative attitudes seem to be the most important factors hindering the progress towards universal access to SRH. Lack of international donors to fund for SRH programs is also another barrier. In national levels both state and the society are interactively playing their roles. We have used a cascade model for presenting the

Barriers to access to infertility care and assisted reproductive technology within the public health sector in Brazil.

PubMed

Makuch, M Y; Bahamondes, L

2012-01-01

In Brazil, access to infertility care, including assisted reproductive technologies (ARTs), is restricted. This is the third report of a study on access to infertility care and ARTs within the public sector, focusing on the barriers to these services. The study was anchored on quantitative and qualitative methods. For the quantitative study interviews were conducted with health authorities in each of the 26 states, the Federal District, the state capitals and 16 cities with ≥ 500,000 inhabitants and directors of infertility referral centres within the public sector. Qualitative case studies-- were conducted in five ART centres. Overall, 63.5% of the authorities reported that complex infertility treatments were unavailable. Barriers identified consisted of "lack of political decision to implement them", and "lack of financial resources". In addition, 75% reported to have "no plans to implement them over the next 12 months". At the facilities offering ART, the barriers to these procedures were the high costs, long waiting times, complex scheduling processes and lack of initiative to implement low cost ARTs. Infertile couples' access to ART procedures is restricted due to the insufficient services and lack of political commitment to support existing and new services..

Household food insecurity access scale (HFIAS).

PubMed

Salvador Castell, Gemma; Pérez Rodrigo, Carmen; Ngo de la Cruz, Joy; Aranceta Bartrina, Javier

2015-02-26

In 1996, the World Food Summit reaffirmed the inalienable right that each person across the globe has to access safe, adequate and nutritious food. At that time a goal was established to reduce by half the number of undernourished persons worldwide by 2015, in other words the year that we are now commencing. Different countries and organisations considered the necessity of reaching consensus and developing indicators for measuring household food insecurity. The availability of a simple but evidence-based measurement method to identify nutritionally at-risk population groups constitutes an essential instrument for implementing strategies that effectively address relevant key issues. Copyright AULA MEDICA EDICIONES 2015. Published by AULA MEDICA. All rights reserved.

9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

Code of Federal Regulations, 2010 CFR

2010-01-01

... veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT... and Adequate Veterinary Care § 2.40 Attending veterinarian and adequate veterinary care (dealers and... veterinary care to its animals in compliance with this section. (1) Each dealer and exhibitor shall employ an...

9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

Code of Federal Regulations, 2011 CFR

2011-01-01

... veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT... and Adequate Veterinary Care § 2.40 Attending veterinarian and adequate veterinary care (dealers and... veterinary care to its animals in compliance with this section. (1) Each dealer and exhibitor shall employ an...

Two signs indicative of successful access in nuclear medicine cerebrospinal fluid diversionary shunt studies.

PubMed

Bermo, Mohammed S; Khalatbari, Hedieh; Parisi, Marguerite T

2018-05-08

Successful shunt access is the first step in a properly performed nuclear medicine cerebrospinal fluid (CSF) shunt study. To determine the significance of the radiotracer configuration at the injection site during initial nuclear medicine CSF shunt imaging and the lack of early systemic radiotracer activity as predictors of successful shunt access. With Institutional Review Board approval, three nuclear medicine physicians performed a retrospective review of all consecutive CSF shunt studies performed in children at our institution in 2015. Antecedent nuclear medicine CSF shunt studies in these patients were also assessed and included in the review. The appearance of the reservoir site immediately after radiotracer injection was classified as either figure-of-eight or round/ovoid configuration. The presence or absence of early systemic distribution of the tracer on the 5-min static images was noted and separately evaluated. A total of 98 nuclear medicine ventriculoperitoneal CSF shunt studies were evaluated. Figure-of-eight configuration was identified in 87% of studies and, when present, had 93% sensitivity, 78% specificity, 92% accuracy, 98% positive predictive value (PPV) and 54% negative predictive value (NPV) as a predictor of successful shunt access. Early systemic activity was absent in 89 of 98 studies. Lack of early systemic distribution of the radiotracer had 98% sensitivity, 78% specificity, 96% accuracy, 98% PPV and 78% NPV as a predictor of successful shunt access. Figure-of-eight configuration in conjunction with the absence of early systemic tracer activity had 99% PPV for successful shunt access. Figure-of-eight configuration at the injection site or lack of early systemic radiotracer activity had moderate specificity for successful shunt access. Specificity and PPV significantly improved when both signs were combined in assessment.

Disability and employee benefits receipt: evidence from the U.S. Vocational Rehabilitation Services Program.

PubMed

Sosulski, Marya R; Donnell, Chandra; Kim, Woo Jong

2012-01-01

Studies indicate positive effects of the U.S. Vocational Rehabilitation Services (VRS) in assisting people with disabilities to find independent employment. Underemployment continues to impact access to adequate health care and other benefits. Workers with disabilities receive fewer benefits, overall. With data from the Longitudinal Study of Vocational Rehabilitation Services Program (LSVRSP), the authors compare the rates of receipt of 6 types of benefits for people with physical, mental, and sensory impairments. Although those with physical disabilities are most likely to receive benefits, all groups lack adequate access to health care, sick leave, and vacation. The authors discuss implications for services provision in the current job market.

Current strategies for the restoration of adequate lordosis during lumbar fusion

PubMed Central

Barrey, Cédric; Darnis, Alice

2015-01-01

Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery. PMID:25621216

Effect of Poor Access to Water and Sanitation As Risk Factors for Soil-Transmitted Helminth Infection: Selectiveness by the Infective Route.

PubMed

Echazú, Adriana; Bonanno, Daniela; Juarez, Marisa; Cajal, Silvana P; Heredia, Viviana; Caropresi, Silvia; Cimino, Ruben O; Caro, Nicolas; Vargas, Paola A; Paredes, Gladys; Krolewiecki, Alejandro J

2015-09-01

Soil-transmitted helminth (STH) infections are a public health problem in resource-limited settings worldwide. Chronic STH infection impairs optimum learning and productivity, contributing to the perpetuation of the poverty-disease cycle. Regular massive drug administration (MDA) is the cardinal recommendation for its control; along with water, sanitation and hygiene (WASH) interventions. The impact of joint WASH interventions on STH infections has been reported; studies on the independent effect of WASH components are needed to contribute with the improvement of current recommendations for the control of STH. The aim of this study is to assess the association of lacking access to water and sanitation with STH infections, taking into account the differences in route of infection among species and the availability of adequate water and sanitation at home. Cross-sectional study, conducted in Salta province, Argentina. During a deworming program that enrolled 6957 individuals; 771 were randomly selected for stool/serum sampling for parasitological and serological diagnosis of STH. Bivariate stratified analysis was performed to explore significant correlations between risk factors and STH infections grouped by mechanism of entry as skin-penetrators (hookworms and Strongyloides stercoralis) vs. orally-ingested (Ascaris lumbricoides and Trichuris trichiura). After controlling for potential confounders, unimproved sanitation was significantly associated with increased odds of infection of skin-penetrators (adjusted odds ratio [aOR] = 3.9; 95% CI: 2.6-5.9). Unimproved drinking water was significantly associated with increased odds of infection of orally-ingested (aOR = 2.2; 95% CI: 1.3-3.7). Lack of safe water and proper sanitation pose a risk of STH infections that is distinct according to the route of entry to the human host used by each of the STH species. Interventions aimed to improve water and sanitation access should be highlighted in the recommendations for the

Effect of Poor Access to Water and Sanitation As Risk Factors for Soil-Transmitted Helminth Infection: Selectiveness by the Infective Route

PubMed Central

Echazú, Adriana; Bonanno, Daniela; Juarez, Marisa; Cajal, Silvana P.; Heredia, Viviana; Caropresi, Silvia; Cimino, Ruben O.; Caro, Nicolas; Vargas, Paola A.; Paredes, Gladys; Krolewiecki, Alejandro J.

2015-01-01

Background Soil-transmitted helminth (STH) infections are a public health problem in resource-limited settings worldwide. Chronic STH infection impairs optimum learning and productivity, contributing to the perpetuation of the poverty-disease cycle. Regular massive drug administration (MDA) is the cardinal recommendation for its control; along with water, sanitation and hygiene (WASH) interventions. The impact of joint WASH interventions on STH infections has been reported; studies on the independent effect of WASH components are needed to contribute with the improvement of current recommendations for the control of STH. The aim of this study is to assess the association of lacking access to water and sanitation with STH infections, taking into account the differences in route of infection among species and the availability of adequate water and sanitation at home. Methods and Findings Cross-sectional study, conducted in Salta province, Argentina. During a deworming program that enrolled 6957 individuals; 771 were randomly selected for stool/serum sampling for parasitological and serological diagnosis of STH. Bivariate stratified analysis was performed to explore significant correlations between risk factors and STH infections grouped by mechanism of entry as skin-penetrators (hookworms and Strongyloides stercoralis) vs. orally-ingested (Ascaris lumbricoides and Trichuris trichiura). After controlling for potential confounders, unimproved sanitation was significantly associated with increased odds of infection of skin-penetrators (adjusted odds ratio [aOR] = 3.9; 95% CI: 2.6–5.9). Unimproved drinking water was significantly associated with increased odds of infection of orally-ingested (aOR = 2.2; 95% CI: 1.3–3.7). Conclusions Lack of safe water and proper sanitation pose a risk of STH infections that is distinct according to the route of entry to the human host used by each of the STH species. Interventions aimed to improve water and sanitation access should

Kenya's Constituency Development Fund, Free Secondary Education Policy, and Access to Secondary Education

ERIC Educational Resources Information Center

Nzuki, Charles Kyalo

2018-01-01

The effects of the Constituency Development Fund (CDF) and the Free Secondary Education Policy (FSEP) on access to secondary school education in Kenya's Yatta sub-county have not been adequately explored in available public policy literature. Hence, this qualitative multiple-case study was designed to understand the effects of the 2 policies on…

4 CFR 200.14 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2010 CFR

2010-01-01

... identifiable personal data and automated systems shall be adequately trained in the security and privacy of... the security and privacy of such records. (5) The disposal and destruction of identifiable personal....14 Section 200.14 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PRIVACY ACT OF 1974 § 200...

4 CFR 200.14 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2011 CFR

2011-01-01

... identifiable personal data and automated systems shall be adequately trained in the security and privacy of....14 Section 200.14 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PRIVACY ACT OF 1974 § 200... records in which identifiable personal data are processed or maintained, including all reports and output...

Contraceptive Methods Accessed in Volta Region, Ghana, 2009-2014.

PubMed

Wilson, Himiede W; Ameme, Donne K; Ilesanmi, Olayinka Stephen

2017-01-01

In 2016, Volta Region was one of the two regions in Ghana that recorded a high prevalence of teenage pregnancy, accounting for 15.5% of all adolescent pregnancies in the country. This study aimed to determine the prevalence of contraceptive methods accessed by person, place, and time in Volta Region, Ghana, 2009-2014. We carried out a secondary analysis of contraceptive use data derived from the District Health Information Management System (DHIMS) 2 for Volta Region, between 2009 and 2014. We calculated proportions and described trends. Over the five-year period, there were 673,409 (75.0%) acceptors of family planning out of a total 897, 645 males and females of reproductive age. The proportion of family planning acceptors increased gradually from 18% in 2009 to 23% in 2014. Contraceptive methods were most commonly accessed by male and female between 20 and 29 years. The most common methods of contraceptives accessed were injectables among females accounting for about 70% and condoms accounting for over 90% among males. All the districts in Volta Region did not access contraceptives adequately. The Volta Regional Health Directorate should encourage and support research to ascertain factors influencing uptake of contraceptive methods in all the districts.

Barriers to help-seeking, detection, and adequate treatment for anxiety and mood disorders: implications for health care policy.

PubMed

Mechanic, David

2007-01-01

Recently, the focus of health policies and initiatives has been directed toward mental health. More precisely, depressive and anxiety disorders have received particular attention because of their disabling outcomes and prevalence among most populations. Despite this increased interest, numerous issues regarding patients' willingness to seek treatment and the adequate recognition and treatment of these disorders by clinicians remain to be addressed. This article considers the factors that influence patients and physicians in their reticence to acknowledge and adequately treat depression and anxiety disorders. It also reviews the impact of society and the media, together with other factors relating to health care organization and administration that affect the treatment of depression and anxiety. In view of the multifaceted challenge involved, efforts to achieve a consensus in determining treatment for those with depressive and anxiety disorders are essential. A consensus will require easy, measurable, and reliable disability indicators; evidence that treatment of patients with varying levels of need is cost effective; and that persons who most need and would benefit from care can be reliably identified among the highly prevalent population of persons with more transient symptoms. Governments and other policymakers should be encouraged to provide appropriate coverage for access to primary and secondary care, the treatments required, and sufficient resources so that care is available when necessary. An important aspect of the challenge is to incorporate these efforts within the realistic constraints of primary care.

Free internet access, the digital divide, and health information.

PubMed

Wagner, Todd H; Bundorf, M Kate; Singer, Sara J; Baker, Laurence C

2005-04-01

The Internet has emerged as a valuable tool for health information. Half of the U.S. population lacked Internet access in 2001, creating concerns about those without access. Starting in 1999, a survey firm randomly invited individuals to join their research panel in return for free Internet access. This provides a unique setting to study the ways that people who had not previously obtained Internet access use the Internet when it becomes available to them. In 2001-2002, we surveyed 12,878 individuals 21 years of age and older on the research panel regarding use of the Internet for health; 8935 (69%) responded. We analyzed respondents who had no prior Internet access, and then compared this group to those who had prior Internet access. Among those newly provided free Internet access, 24% had used the Internet for health information in the past year, and users reported notable benefits, such as improved knowledge and self-care abilities. Not surprisingly, the no-prior-Internet group reported lower rates of using the Internet (24%) than the group that had obtained Internet access prior to joining the research panel (40%), but the 2 groups reported similar perceptions of the Internet and self-reported effects. Those who obtained Internet access for the first time by joining the panel used the Internet for health and appeared to benefit from it. Access helps explain the digital divide, although most people given free access do not use the Internet for health information.

Cognitive Attributes of Adequate and Inadequate Responders to Reading Intervention in Middle School

ERIC Educational Resources Information Center

Miciak, Jeremy; Stuebing, Karla K.; Vaughn, Sharon; Roberts, Greg; Barth, Amy E.; Fletcher, Jack M.

2014-01-01

No studies have investigated the cognitive attributes of middle school students who are adequate and inadequate responders to Tier 2 reading intervention. We compared students in Grades 6 and 7 representing groups of adequate responders (n = 77) and inadequate responders who fell below criteria in (a) comprehension (n = 54); (b) fluency (n = 45);…

Lack of chart reminder effectiveness on family medicine resident JNC-VI and NCEP III guideline knowledge and attitudes.

PubMed

Echlin, Paul S; Upshur, Ross E G; Markova, Tsveti P

2004-07-05

The literature demonstrates that medical residents and practicing physicians have an attitudinal-behavioral discordance concerning their positive attitudes towards clinical practice guidelines (CPG), and the implementation of these guidelines into clinical practice patterns. A pilot study was performed to determine if change in a previously identified CPG compliance factor (accessibility) would produce a significant increase in family medicine resident knowledge and attitude toward the guidelines. The primary study intervention involved placing a summary of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) and the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP III) CPGs in all patient (>18 yr.) charts for a period of three months. The JNC VI and NCEP III CPGs were also distributed to each Wayne State family medicine resident, and a copy of each CPG was placed in the preceptor's area of the involved clinics. Identical pre- and post- intervention questionnaires were administered to all residents concerning CPG knowledge and attitude. Post-intervention analysis failed to demonstrate a significant difference in CPG knowledge. A statistically significant post-intervention difference was found in only on attitude question. The barriers to CPG compliance were identified as 1) lack of CPG instruction; 2) lack of critical appraisal ability; 3) insufficient time; 4) lack of CPG accessibility; and 5) lack of faculty modeling. This study demonstrated no significant post intervention changes in CPG knowledge, and only one question that reflected attitude change. Wider resident access to dedicated clinic time, increased faculty modeling, and the implementation of an electronic record/reminder system that uses a team-based approach are compliance factors that should be considered for further investigation. The

Access to medical care reported by Asians and Pacific Islanders in a West Coast physician group association.

PubMed

Snyder, R E; Cunningham, W; Nakazono, T T; Hays, R D

2000-06-01

This study examines access to medical care for Asians and Pacific Islanders in the United States, using a survey of patients receiving care provided by a physician group practice association concentrated on the West Coast. Asians and Pacific Islanders who had used their health plan in the past year had worse access to health care than whites, blacks, Hispanics, and Native American or other ethnicities. The odds that Asians reported that they had adequate access ranged from about one quarter to three quarters that of whites, depending on the measure. Cultural differences and associated communication problems may explain the access problems experienced by Asians. Interventions need to be developed to address the problems with access to services, and better translation services may play an important role in improving access to care for Asians. Future studies need to clarify why Asians were more vulnerable to the access problems examined than other ethnic groups that might experience similar barriers.

Deaf women: experiences and perceptions of healthcare system access.

PubMed

Steinberg, Annie G; Wiggins, Erin A; Barmada, Carlin Henry; Sullivan, Vicki Joy

2002-10-01

The authors investigated the knowledge, attitudes, and healthcare experiences of Deaf women. Interviews with 45 deaf women who participated in focus groups in American Sign Language were translated, transcribed, and analyzed. Deaf women's understanding of women's health issues, knowledge of health vocabulary in both English and American Sign Language, common health concerns among Deaf women, and issues of access to information, including pathways and barriers, were examined. As a qualitative study, the results of this investigation are limited and should be viewed as exploratory. A lack of health knowledge was evident, including little understanding of the meaning or value of cancer screening, mammography, or Pap smears; purposes of prescribed medications, such as hormone replacement therapy (HRT); or necessity for other medical or surgical interventions. Negative experiences and avoidance or nonuse of health services were reported, largely due to the lack of a common language with healthcare providers. Insensitive behaviors were also described. Positive experiences and increased access to health information were reported with practitioners who used qualified interpreters. Providers who demonstrated minimal signing skills, a willingness to use paper and pen, and sensitivity to improving communication were appreciated. Deaf women have unique cultural and linguistic issues that affect healthcare experiences. Improved access to health information may be achieved with specialized resource materials, improved prevention and targeted intervention strategies, and self-advocacy skills development. Healthcare providers must be trained to become more effective communicators with Deaf patients and to use qualified interpreters to assure access to healthcare for Deaf women.

Transcolonic Perirectal NOTES Access (PNA): A feasibility study with survival in swine model.

PubMed

Oliveira, André L A; Zorron, Ricardo; Oliveira, Flavio M M DE; Santos, Marcelo B Dos; Scheffer, Jussara P; Rios, Marcelo; Antunes, Fernanda

2017-05-01

Transrectal access still has some unsolved issues such as spatial orientation, infection, access and site closure. This study presents a simple technique to perform transcolonic access with survival in a swine model series. A new technique for NOTES perirectal access to perform retroperitoneoscopy, peritoneoscopy, liver and lymphnode biopsies was performed in 6 pigs, using Totally NOTES technique. The specimens were extracted transanally. The flexible endoscope was inserted through a posterior transmural incision and the retrorectal space. Cultures of bacteria were documented for the retroperitoneal space and intra abdominal cavity after 14 days. Rectal site was closed using non-absorbable sutures. There was no bowel cleansing, nor preoperative fasting. The procedures were performed in 6 pigs through transcolonic natural orifice access using available endoscopic flexible instruments. All animals survived 14 days without complications, and cultures were negative. Histopathologic examination of the rectal closure site showed adequate healing of suture line and no micro abscesses. The results of feasibility and safety of experimental Transcolonic NOTES potentially brings new frontiers and future wider applications for minimally invasive surgery. The treatment of colorectal, abdominal and retroperitoneal diseases through a flexible Perirectal NOTES Access (PNA) is a promising new approach.

34 CFR 200.14 - Components of Adequate Yearly Progress.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Components of Adequate Yearly Progress. 200.14 Section 200.14 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION TITLE I-IMPROVING THE ACADEMIC ACHIEVEMENT OF THE DISADVANTAGED...

13 CFR 108.200 - Adequate capital for NMVC Companies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Adequate capital for NMVC Companies. 108.200 Section 108.200 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications for the NMVC Program Capitalizing A Nmvc Company § 108.200...

Internet access and use by COPD patients in the National Emphysema/COPD Association Survey

PubMed Central

2014-01-01

Background Technology offers opportunities to improve healthcare, but little is known about Internet use by COPD patients. We tested two hypotheses: Internet access is associated with socio-demographic disparities and frequency of use is related to perceived needs. Methods We analyzed data from a 2007–2008 national convenience sample survey of COPD patients to determine the relationship between Internet access and frequency of use with demographics, socio-economic status, COPD severity, and satisfaction with healthcare. Results Among survey respondents (response rate 7.2%; n = 914, 59.1% women, mean age 71.2 years), 34.2% reported lack of Internet access, and an additional 49% had access but used the Internet less than weekly. Multivariate models showed association between lack of access and older age (OR 1.10, 95% CI 1.07, 1.13), lower income (income below $30,000 OR 2.47, 95% CI 1.63, 3.73), less education (high school highest attainment OR 2.30, 95% CI 1.54, 3.45), comorbid arthritis or mobility-related disease (OR 1.56, 95% CI 1.05, 2.34). More frequent use (at least weekly) was associated with younger age (OR 0.95, 95% CI 0.93, 0.98), absence of cardiovascular disease (OR 0.48, 95% CI 0.29, 0.78), but with perception of needs insufficiently met by the healthcare system, including diagnostic delay (OR 1.72, 95% CI 1.06, 2.78), feeling treated poorly (OR 2.46, 95% CI 1.15, 5.24), insufficient physician time (OR 2.29, 95% CI 1.02, 5.13), and feeling their physician did not listen (OR 3.14, 95% CI 1.42, 6.95). Conclusions An analysis of the characteristics associated with Internet access and use among COPD patients identified two different patient populations. Lack of Internet access was a marker of socioeconomic disparity and mobility-associated diseases, while frequent Internet use was associated with less somatic disease but dissatisfaction with care. PMID:24755090

Getting back on tap: the policy context and cost of ensuring access to low-cost drinking water in Massachusetts schools.

PubMed

Cradock, Angie L; Wilking, Cara L; Olliges, Sarah A; Gortmaker, Steven L

2012-09-01

Adequate water intake may have important health benefits for schoolchildren. Layers of federal, state, and local policy are relevant to provision of water within schools. Recently passed state and federal laws require free drinking-water access for students during mealtimes. To review Massachusetts local district wellness policies related to water access, provide estimates of costs for three water-provision strategies, and discuss implications for policy relevant to adequate drinking-water access. Legal research was conducted using the LexisNexis legal database and government websites. Local wellness policies were double-coded using existing research tools. Costs of three water-delivery options were estimated using a 10-year school-district perspective. Prior to 2010, most Massachusetts public school district wellness policies (92%-94%) did not address access to free drinking water. Ten-year costs per school for providing water during mealtimes to students, including dispenser unit, installation, water testing, water, cups, and labor, range between $12,544 and $27,922 (depending on water-delivery option) assuming the average Massachusetts school enrollment. Water-provision strategies relying on tap water are more economical than bottled water in the long term. Policy recommendations and cost considerations deserve attention at the local, state, and federal levels. Recommendations are discussed to ensure access to safe, free drinking water for all students. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Inequity of access to ACE inhibitors in Swedish heart failure patients: a register-based study

PubMed Central

Lindahl, Bertil; Hanning, Marianne; Westerling, Ragnar

2016-01-01

Background Several international studies suggest inequity in access to evidence-based heart failure (HF) care. Specifically, studies of ACE inhibitors (ACEIs) point to reduced ACEI access related to female sex, old age and socioeconomic position. Thus far, most studies have either been rather small, lacking diagnostic data, or lacking the possibility to account for several individual-based sociodemographic factors. Our aim was to investigate differences, which could reflect inequity in access to ACEIs based on sex, age, socioeconomic status or immigration status in Swedish patients with HF. Methods Individually linked register data for all Swedish adults hospitalised for HF in 2005–2010 (n=93 258) were analysed by multivariate regression models to assess the independent risk of female sex, high age, low employment status, low income level, low educational level or foreign country of birth, associated with lack of an ACEI dispensation within 1 year of hospitalisation. Adjustment for possible confounding was made for age, comorbidity, Angiotensin receptor blocker therapy, period and follow-up time. Results Analysis revealed an adjusted OR for no ACEI dispensation for women of 1.31 (95% CI 1.27 to 1.35); for the oldest patients of 2.71 (95% CI 2.53 to 2.91); and for unemployed patients of 1.59 (95% CI 1.46 to 1.73). Conclusions Access to ACEI treatment was reduced in women, older patients and unemployed patients. We conclude that access to ACEIs is inequitable among Swedish patients with HF. Future studies should include clinical data, as well as mortality outcomes in different groups. PMID:26261264

A rapid appraisal of access to and utilisation of psychotropic medicines in Bihar, India

PubMed Central

2014-01-01

Background A major aspect of providing mental healthcare is access to and use of psychotropic medications. Bihar is a state in northeast India with limited mental healthcare provision; consequently access to and utilisation of psychotropic medications are likely to be limited. However, to date there has been no research assessing the situation. This study therefore aims to analyse the psychotropic medications management cycle (selection, procurement, distribution and use), and identify the barriers to access and utilisation, and their underlying causes. Method A rapid appraisal method was used in which primary and secondary data sources were collected and analysed. Semi-structured interviews were conducted with twenty-two stakeholders and twenty-one service users from the government, non-governmental organisation (NGO) and private sectors. The qualitative data collected was analysed using a comparative thematic approach. The research was supported by the NGOs BasicNeeds and Nav Bharat Jagriti Kendra. Results Availability, distance and cost were the main barriers to access and utilisation. At the medical college hospital level a lack of supply appears to be due to a discrepancy between orders made by the hospital and medications supplied by the manufacturers. At the primary health centre and district hospital level the main barrier is a cycle between lack of demand for treatments for mental illness by doctors and patients. Conclusion Further investigation and monitoring is necessary to ensure the availability of psychotropic medications at the medical college hospital level. In addition, implementation of the District Mental Health Programme is likely to address the access and utilisation barriers due to its potential to break the current cycle of lack of demand. PMID:25053976

Access to healthcare and alternative health-seeking strategies among undocumented migrants in Denmark

PubMed Central

2011-01-01

Background As in many European countries, undocumented migrants in Denmark have restricted access to healthcare. The aim of this study is to describe and analyse undocumented migrants' experiences of access to healthcare, use of alternative health-seeking strategies; and ER nurses' experiences in encounters with undocumented migrants. Methods Qualitative design using semi-structured interviews and observations. The participants included ten undocumented South Asian migrants and eight ER nurses. Results Undocumented migrants reported difficulties accessing healthcare. The barriers to healthcare were: limited medical rights, arbitrariness in healthcare professionals' attitudes, fear of being reported to the police, poor language skills, lack of network with Danish citizens, lack of knowledge about the healthcare system and lack of knowledge about informal networks of healthcare professionals. These barriers induced alternative health-seeking strategies, such as self-medication, contacting doctors in home countries and borrowing health insurance cards from Danish citizens. ER nurses expressed willingness to treat all patients regardless of their migratory status, but also reported challenges in the encounters with undocumented migrants. The challenges for ER nurses were: language barriers, issues of false identification, insecurities about the correct standard procedures and not always being able to provide appropriate care. Conclusions Undocumented migrants face formal and informal barriers to the Danish healthcare system, which lead to alternative health-seeking strategies that may have adverse effects on their health. This study shows the need for policies and guidelines, which in accordance with international human rights law, ensure access to healthcare for undocumented migrants and give clarity to healthcare professionals. PMID:21752296

Free space optical wireless (FSOW) for broadband access

NASA Astrophysics Data System (ADS)

Khan, David A.

2002-05-01

The dramatic growth of the Internet and the optical core network that supports it has recently slowed down in spite of a growing appetite for bandwidth-hungry services and applications, particularly those with video content. One of the major reasons for the pause is the lack of affordable broadband access transport facilities extending optical rate connectivity over the last mile.

Region 9: California Adequate / Inadequate Letter Attachment (5/30/2008)

EPA Pesticide Factsheets

This is a document that states that it has been found adequate for transportation conformitypurposes certain 8-hour ozone and PM2.5 motor vehicleemissions budgets in the 2007 South Coast StateImplementation Plan.

10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the security and privacy of personal data. (4) The disposal and disposition of identifiable personal... contained in a system of records are adequately trained to protect the security and privacy of such records....114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.114...

Is the Stock of VET Skills Adequate? Assessment Methodologies.

ERIC Educational Resources Information Center

Blandy, Richard; Freeland, Brett

In Australia and elsewhere, four approaches have been used to determine whether stocks of vocational education and training (VET) skills are adequate to meet industry needs. The four methods are as follows: (1) the manpower requirements approach; (2) the international, national, and industry comparisons approach; (3) the labor market analysis…

Adequate sleep among adolescents is positively associated with health status and health-related behaviors.

PubMed

Chen, Mei-Yen; Wang, Edward K; Jeng, Yi-Jong

2006-03-08

Amount of sleep is an important indicator of health and well-being in children and adolescents. Adequate sleep (AS: adequate sleep is defined as 6-8 hours per night regularly) is a critical factor in adolescent health and health-related behaviors. The present study was based on a health promotion project previously conducted on adolescents in Tao-Yuan County, Taiwan. The aim was to examine the relationship between AS during schooldays and excessive body weight, frequency of visiting doctors and health-related behaviors among Taiwanese adolescents. A cross-sectional study design, categorical and multivariate data analyses were used. The hypotheses investigated were: high frequency of AS is positively associated with lack of obesity and less frequent visits to doctors; and high frequency AS is positively associated with health-related behavior. A total of 656 boys (53.2%) and girls (46.8%), ranging in age from 13-18 years were studied between January and June 2004. Three hundred and fifty seven subjects (54%) reported that they slept less than the suggested 6-8 hours on schooldays. A significant negative association was found between low sleep and of the following health-related behaviors: (1) life appreciation; (2) taking responsibility for health; (3) adopting healthy diet; (4) effective stress management; (5) regular exercise; and (6) total AHP score. High frequency AS was associated with low frequencies of obesity after potential confounding factors were controlled. Junior high school adolescents reported significantly higher frequencies of AS than high school participants. Gender, family structure, home location and frequency of television watching or computer use were not significantly associated with AS. These findings support the proposition that AS is associated with good health status and high-frequency adoption of health-related behavior. Furthermore, these findings suggest that inadequate sleep may be a screening indicator for an unhealthy lifestyle and

Access to Food for Homeless and Highly Mobile Students. Best Practices in Interagency Collaboration Brief Series

ERIC Educational Resources Information Center

National Center for Homeless Education at SERVE, 2012

2012-01-01

Homelessness is a lack of fixed, regular, and adequate housing often resulting from extreme poverty; economic hardship due to job loss, illness, or a similar reason; or devastation following a natural disaster. According to the Urban Institute, the mean income of families experiencing homelessness is less than half the federal poverty line. This…

Self-taught axillary vein access without venography for pacemaker implantation: prospective randomized comparison with the cephalic vein access.

PubMed

Squara, Fabien; Tomi, Julien; Scarlatti, Didier; Theodore, Guillaume; Moceri, Pamela; Ferrari, Emile

2017-12-01

Axillary vein access for pacemaker implantation is uncommon in many centres because of the lack of training in this technique. We assessed whether the introduction of the axillary vein technique was safe and efficient as compared with cephalic vein access, in a centre where no operators had any previous experience in axillary vein puncture. Patients undergoing pacemaker implantation were randomized to axillary or cephalic vein access. All three operators had no experience nor training in axillary vein puncture, and self-learned the technique by reading a published review. Axillary vein puncture was fluoroscopy-guided without contrast venography. Cephalic access was performed by dissection of delto-pectoral groove. Venous access success, venous access duration (from skin incision to guidewire or lead in superior vena cava), procedure duration, X-ray exposure, and peri-procedural (1 month) complications were recorded. results We randomized 74 consecutive patients to axillary (n = 37) or cephalic vein access (n = 37). Axillary vein was successfully accessed in 30/37 (81.1%) patients vs. 28/37 (75.7%) of cephalic veins (P = 0.57). Venous access time was shorter in axillary group than in cephalic group [5.7 (4.4-8.3) vs. 12.2 (10.5-14.8) min, P < 0.001], as well as procedure duration [34.8 (30.6-38.4) vs. 42.0 (39.1-46.6) min, P = 0.043]. X-ray exposure and peri-procedural overall complications were comparable in both groups. Axillary puncture was safe and faster than cephalic access even for the five first procedures performed by each operator. Self-taught axillary vein puncture for pacemaker implantation seems immediately safe and faster than cephalic vein access, when performed by electrophysiologists trained to pacemaker implantation but not to axillary vein puncture. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

The U.S. Rural Population and Scheduled Intercity Transportation in 2010 : A Five-Year Decline in Transportation Access.

DOT National Transportation Integrated Search

2011-02-01

Between 2005 and 2010, 3.5 million rural residents lost access to scheduled intercity transportation, increasing the percent of rural residents without access to intercity transportation from 7 to 11 percent. In 2005, 5.4 million rural residents lack...

Higher Education for Refugees: Lessons from a 4-Year Pilot Project

ERIC Educational Resources Information Center

Crea, Thomas M.; McFarland, Mary

2015-01-01

Refugees experience limited access to adequate education at all levels, but opportunities for higher education are especially lacking. Yet, evidence suggests that education plays an important protective role in helping refugee individuals and communities cope with their daily existence during protracted waiting periods, and the United Nations…

SOCIAL CAPITAL AND HEALTH CARE ACCESS: A SYSTEMATIC REVIEW

PubMed Central

Derose, Kathryn Pitkin; Varda, Danielle M.

2017-01-01

A growing interest in community-level characteristics such as social capital and their relationship to healthcare access is evident. To assess the rigor with which this construct has been empirically applied in research on healthcare access, we conducted a systematic review. A total of 2396 abstracts were reviewed, with 21 ultimately meeting our criteria of examining some measure of social capital and its effects on healthcare access. Our review found a lack of congruence in how social capital was measured and interpreted and a general inconsistency in findings, which made it difficult to draw firm conclusions about the effects of social capital on healthcare access. Insights from the social network literature can help improve the conceptual and measurement problems. We recommend that future work distinguish between bonding, bridging, and linking social capital and their sources and benefits, and that perhaps three dimensions of social capital actually exist –cognitive, behavioral, and structural. PMID:19174538

The impact of free access to the scientific literature: a review of recent research.

PubMed

Davis, Philip M; Walters, William H

2011-07-01

The paper reviews recent studies that evaluate the impact of free access (open access) on the behavior of scientists as authors, readers, and citers in developed and developing nations. It also examines the extent to which the biomedical literature is used by the general public. The paper is a critical review of the literature, with systematic description of key studies. Researchers report that their access to the scientific literature is generally good and improving. For authors, the access status of a journal is not an important consideration when deciding where to publish. There is clear evidence that free access increases the number of article downloads, although its impact on article citations is not clear. Recent studies indicate that large citation advantages are simply artifacts of the failure to adequately control for confounding variables. The effect of free access on the general public's use of the primary medical literature has not been thoroughly evaluated. Recent studies provide little evidence to support the idea that there is a crisis in access to the scholarly literature. Further research is needed to investigate whether free access is making a difference in non-research contexts and to better understand the dissemination of scientific literature through peer-to-peer networks and other informal mechanisms.

The impact of free access to the scientific literature: a review of recent research

PubMed Central

Walters, William H

2011-01-01

Objectives: The paper reviews recent studies that evaluate the impact of free access (open access) on the behavior of scientists as authors, readers, and citers in developed and developing nations. It also examines the extent to which the biomedical literature is used by the general public. Method: The paper is a critical review of the literature, with systematic description of key studies. Results: Researchers report that their access to the scientific literature is generally good and improving. For authors, the access status of a journal is not an important consideration when deciding where to publish. There is clear evidence that free access increases the number of article downloads, although its impact on article citations is not clear. Recent studies indicate that large citation advantages are simply artifacts of the failure to adequately control for confounding variables. The effect of free access on the general public's use of the primary medical literature has not been thoroughly evaluated. Conclusions: Recent studies provide little evidence to support the idea that there is a crisis in access to the scholarly literature. Further research is needed to investigate whether free access is making a difference in non-research contexts and to better understand the dissemination of scientific literature through peer-to-peer networks and other informal mechanisms. PMID:21753913

Repeated or long-duration TASER electronic control device exposures: acidemia and lack of respiration.

PubMed

Jauchem, James R

2010-03-01

Conducted energy weapons (CEWs), such as TASER devices, may be applied to subjects in repeated or long-duration modes. Such applications may result in more potentially harmful effects (as reflected in blood factor changes) than shorter exposures. In this review, results from a number of studies of repeated and long-duration CEW exposures in an animal model are examined. Additionally, a few limited investigations of shorter CEW applications to human subjects are considered. Specifically, in anesthetized swine, increased blood acidity (acidemia) and lack of effective respiration were found to be common during or immediately after CEW exposure. The acidemia could have been due to both metabolic and respiratory acidosis. A relatively rapid recovery toward baseline pH levels occurred. The lack of effective respiration has not been verified in experiments of CEW applications to human subjects; however, in some incidents of human deaths after CEW exposures subjects have been reported to stop breathing immediately after the exposure. It is not known if all human subjects exposed to CEW applications in the field (often "on drugs" or "in excited delirium") would be able to maintain adequate breathing. Since a limited number of short CEW applications would be less likely to cause adverse effects, however, CEWs can still be a valuable tool for law enforcement activities.

Better gas tight access doors for power plants

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

Rutledge, C.K.; Emsbo, J.

1996-12-31

This paper presents useful information concerning access doors for equipment at power plants and similar industries. Such doors are used for: Boilers and Boiler Penthouses Economizers and Air Heaters Gas Ducts and Precipitators Baghouses, Absorbers and Stacks. Easy access into such equipment by personnel enhances the speed and thoroughness with which inspections and maintenance tasks are performed. This paper shows how to select and correctly install new doors or replace older models which may cumbersome to operate or unable to seal properly. Good, gas tight access doors should not be overlooked as a contributor to top performance at power plants.more » Loss of efficiency or interior deterioration due to leakage are obvious targets and should be of prime concern. However, the ease of access may be equally important. Lasting reliability of any type of industrial equipment is usually a function of two things: First, the quality and care in design, manufacture and installation. Second, the ability and dedication to maintain the equipment. If the ability or dedication to maintain the equipment is diminished it will impact on the lasting reliability of even the best designed equipment. Extensive engineering efforts, many pages of specifications and large sums of money are used on new power plants to assure practical, adequate and safe access to all parts of the equipment. Many times this is in stark contrast to the money and efforts used on the access doors, through which personnel has to enter for inspection and maintenance. This paper highlights the basic functions which should be expected from all types of access doors. The special functions which should be expected from all types of access doors. The special functions required by individual door types are also explained. This includes all the door types serving the different applications all the way along the gas passage from the high temperature boiler doors to the corrosion resistant doors for absorbers and

Energy access and sustainable development

NASA Astrophysics Data System (ADS)

Kammen, Daniel M.; Alstone, Peter; Gershenson, Dimitry

2015-03-01

With 1.4 billion people lacking electricity to light their homes and provide other basic services, or to conduct business, and all of humanity (and particularly the poor) are in need of a decarbonized energy system can close the energy access gap and protect the global climate system. With particular focus on addressing the energy needs of the underserved, we present an analytical framework informed by historical trends and contemporary technological, social, and institutional conditions that clarifies the heterogeneous continuum of centralized on-grid electricity, autonomous mini- or community grids, and distributed, individual energy services. We find that the current day is a unique moment of innovation in decentralized energy networks based on super-efficient end-use technology and low-cost photovoltaics, supported by rapidly spreading information technology, particularly mobile phones. Collectively these disruptive technology systems could rapidly increase energy access, contributing to meeting the Millennium Development Goals for quality of life, while simultaneously driving action towards low-carbon, Earth-sustaining, energy systems.

Do Beginning Teachers Receive Adequate Support from Their Headteachers?

ERIC Educational Resources Information Center

Menon, Maria Eliophotou

2012-01-01

The article examines the problems faced by beginning teachers in Cyprus and the extent to which headteachers are considered to provide adequate guidance and support to them. Data were collected through interviews with 25 school teachers in Cyprus, who had recently entered teaching (within 1-5 years) in public primary schools. According to the…

Management of hemodialysis access infections.

PubMed

Ryan, Sean V; Calligaro, Keith D; Dougherty, Matthew J

2004-03-01

Management of hemodialysis (HD) access infection is one of the most challenging and most common problems faced by surgeons, interventional radiologists, and nephrologists. The goal to eradicate infection is often at odds with the need to maintain access. Patients on HD are immunocompromised and typically have significant comorbid conditions placing them at high risk for the occurrence of access infection. Infection is most common with central-vein catheter access, followed by prosthetic arteriovenous grafts (AVG) and is rare with autogenous fistulas. The diagnosis is usually evident on physical exam, but it is not uncommon for these patients to present with atypical symptoms and lack of clinical findings. Although Staphylococcal species are the most common organism to cause infection, early empiric antimicrobial therapy should also include coverage for Gram-negative organisms. Management of central-vein catheter infection includes removal and delayed replacement or, in patients with mild clinical symptoms, catheter exchange over a guide wire. Our management of AVG infection includes total graft excision when patients present with sepsis or the entire graft is bathed in pus, subtotal graft excision when all of the graft is removed except a small oversewn cuff of prosthetic material on an underlying patent artery, and partial graft excision when only a limited infected portion of the graft is removed and a new graft is rerouted in adjacent sterile tissue to maintain patency of the original graft. This strategy has proven to be highly successful in the management of these complicated cases.

Perspectives in understanding open access to research data - infrastructure and technology challenges

NASA Astrophysics Data System (ADS)

Bigagli, Lorenzo; Sondervan, Jeroen

2014-05-01

The Policy RECommendations for Open Access to Research Data in Europe (RECODE) project, started in February 2013 with a duration of two years, has the objective to identify a series of targeted and over-arching policy recommendations for Open Access to European research data, based on existing good practice and addressing such hindering factors as stakeholder fragmentation, technical and infrastructural issues, ethical and legal issues, and financial and institutional policies. In this work we focus on the technical and infrastructural aspect, where by "infrastructure" we mean the technological assets (hardware and software), the human resources, and all the policies, processes, procedures and training for managing and supporting its continuous operation and evolution. The context targeted by RECODE includes heterogeneous networks, initiatives, projects and communities that are fragmented by discipline, geography, stakeholder category (publishers, academics, repositories, etc.) as well as other boundaries. Many of these organizations are already addressing key technical and infrastructural barriers to Open Access to research data. Such barriers may include: lack of automatic mechanisms for policy enforcement, lack of metadata and data models supporting open access, obsolescence of infrastructures, scarce awareness about new technological solutions, lack of training and/or expertise on IT and semantics aspects. However, these organizations are often heterogeneous and fragmented by discipline, geography, stakeholder category (publishers, academics, repositories, etc.) as well as other boundaries, and often work in isolation, or with limited contact with one another. RECODE has addressed these challenges, and the possible solutions to mitigate them, engaging all the identified stakeholders in a number of ways, including an online questionnaire, case studies interviews, literature review, a workshop. The conclusions have been validated by the RECODE Advisory Board and

47 CFR 1.1403 - Duty to provide access; modifications; notice of removal, increase or modification; petition for...

Code of Federal Regulations, 2010 CFR

2010-10-01

... reasons of safety, reliability and generally applicable engineering purposes. (b) Requests for access to a... and information relate to a denial of access for reasons of lack of capacity, safety, reliability or engineering standards. (c) A utility shall provide a cable television system operator or telecommunications...

Insurance + access not equal to health care: typology of barriers to health care access for low-income families.

PubMed

Devoe, Jennifer E; Baez, Alia; Angier, Heather; Krois, Lisa; Edlund, Christine; Carney, Patricia A

2007-01-01

Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers. A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, "Is there anything else you would like to tell us?" Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries. Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families. Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere.

Access to Education and Employment Opportunities: Implications for Poverty Reduction

ERIC Educational Resources Information Center

Adewale, T. M.

2011-01-01

The study examined the linkages between Education and poverty and the possibility of poverty reduction through access to education and better employment opportunities. The paper also stressed that poverty acts as both cause and effect on lack of education. In particular the paper examined whether education is contributing to poverty reduction…

Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study.

PubMed

Ganle, John Kuumuori; Otupiri, Easmon; Obeng, Bernard; Edusie, Anthony Kwaku; Ankomah, Augustine; Adanu, Richard

2016-01-01

While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana. A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling's thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers' insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability. Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and patient-centred training for healthcare

Teaching the Gifted in an Inclusion Classroom: Activities that Work

ERIC Educational Resources Information Center

Callard-Szulgit, Rosemary

2005-01-01

As the educational system extends its resources and efforts to help make schools and classrooms more accessible to handicapped and special education students, teachers are finding themselves overwhelmed with increased demands, overcrowding, and lack of adequate training in managing all the necessary demands of an inclusion classroom.…

Computer Aided Instruction: A Study of Student Evaluations and Academic Performance

ERIC Educational Resources Information Center

Collins, David; Deck, Alan; McCrickard, Myra

2008-01-01

Computer aided instruction (CAI) encompasses a broad range of computer technologies that supplement the classroom learning environment and can dramatically increase a student's access to information. Criticism of CAI generally focuses on two issues: it lacks an adequate foundation in educational theory and the software is difficult to implement…

[Physiotherapy Education in Germany: Ready for Direct Access?

PubMed

Konrad, R; Konrad, A; Geraedts, M

2017-07-01

Objective: The aim of this study is to investigate whether the curricula for physiotherapy education in Germany conform to standards recommended in the World Confederation for Physical Therapy (WCPT) guideline for physical therapist professional entry-level education, published by the WCPT. This Guideline specifies education standards for physical therapists that are able to act as independent practitioners, without referral from another health care professional. Methods: To assess the German curricula of physical therapist education, a list of assessment dimensions was derived from the WCPT-Guideline by means of content analysis. The content validity of this list was estimated by nine experts using Lawshe's method. The German Training and Examination Regulations for Physiotherapists (PhysTh-AprV) and all available regional curricula were studied. All documents were evaluated by 2 independent coders who rated the conformity of the documents with the assessment dimensions. Results: Based on the Lawshe procedure, the whole test content validity index of the 61 out of 67 examined assessment dimensions was 0,84. Cohen's kappa coefficient for intercoder reliability was 0,71-0,97. The German curricula showed high correlation with the WCPT Guideline on many theoretical basic subjects. Fulfillment of some of the requirements showed heterogeneous results. Autonomous practitioners largely lacked special competencies. Conclusions: None of the German educational standards meets the expectations of the WCPT Guideline in terms of direct access. Considering the deficits of the German educational standards and the release date of some of them, a continuous development of the German education does not appear to be adequate. This issue needs to be addressed in the current debate on health policy. © Georg Thieme Verlag KG Stuttgart · New York.

Are minidisc recorders adequate for the study of respiratory sounds?

PubMed

Kraman, Steve S; Wodicka, George R; Kiyokawa, Hiroshi; Pasterkamp, Hans

2002-01-01

Digital audio tape (DAT) recorders have become the de facto gold standard recording devices for lung sounds. Sound recorded on DAT is compact-disk (CD) quality with adequate sensitivity from below 20 Hz to above 20 KHz. However, DAT recorders have drawbacks. Although small, they are relatively heavy, the recording mechanism is complex and delicate, and finding one desired track out of many is inconvenient. A more recent development in portable recording devices is the minidisc (MD) recorder. These recorders are widely available, inexpensive, small and light, rugged, mechanically simple, and record digital data in tracks that may be named and accessed directly. Minidiscs hold as much recorded sound as a compact disk but in about 1/5 of the recordable area. The data compression is achieved by use of a technique known as adaptive transform acoustic coding for minidisc (ATRAC). This coding technique makes decisions about what components of the sound would not be heard by a human listener and discards the digital information that represents these sounds. Most of this compression takes place on sounds above 5.5 KHz. As the intended use of these recorders is the storage and reproduction of music, it is unknown whether ATRAC will discard or distort significant portions of typical lung sound signals. We determined the suitability of MD recorders for respiratory sound research by comparing a variety of normal and pathologic lung sounds that were digitized directly into a computer and also after recording by a DAT recorder and 2 different MD recorders (Sharp and Sony). We found that the frequency spectra and waveforms of respiratory sounds were not distorted in any important way by recording on the two MD recorders tested.

Global access to surgical care: a modelling study.

PubMed

Alkire, Blake C; Raykar, Nakul P; Shrime, Mark G; Weiser, Thomas G; Bickler, Stephen W; Rose, John A; Nutt, Cameron T; Greenberg, Sarah L M; Kotagal, Meera; Riesel, Johanna N; Esquivel, Micaela; Uribe-Leitz, Tarsicio; Molina, George; Roy, Nobhojit; Meara, John G; Farmer, Paul E

2015-06-01

More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission's vision. We modelled access to surgical services in 196 countries with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. We built a chance tree for each country to model the probability of surgical access with respect to each dimension, and from this we constructed a statistical model to estimate the proportion of the population in each country that does not have access to surgical services. We accounted for uncertainty with one-way sensitivity analyses, multiple imputation for missing data, and probabilistic sensitivity analysis. At least 4·8 billion people (95% posterior credible interval 4·6-5·0 [67%, 64-70]) of the world's population do not have access to surgery. The proportion of the population without access varied widely when stratified by epidemiological region: greater than 95% of the population in south Asia and central, eastern, and western sub-Saharan Africa do not have access to care, whereas less than 5% of the population in Australasia, high-income North America, and western Europe lack access. Most of the world's population does not have access to surgical care, and access is inequitably distributed. The near absence of access in many low-income and middle-income countries represents a crisis, and as the global health community continues to support the advancement of universal health coverage, increasing access to surgical services will play a central role in ensuring health care for all. None. Copyright © 2015 Alkire et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

The Medicaid personal care services program: implications for social work practice.

PubMed

Oktay, J S; Palley, H A

1991-05-01

Results of a survey of Medicaid personal care programs in 15 states and the District of Columbia in 1987 show that these programs suffer from many problems. Low wages and slow payment make recruitment and retention of qualified workers difficult. Other problems include lack of coordination among agencies, lack of adequate standards for training or supervision of workers, unequal access to programs, and inequities among states. Implications for social workers are discussed.

Region 8: Colorado Canon City Adequate Letter (8/17/2011)

EPA Pesticide Factsheets

This May 4, 2011 letter from EPA to Chistopher E. Urbina M.D., MPH, Colorado Department of Public Health and Environment states that EPA has found that the Canon City PM10 maintenance plan and the 2020 motor vehicle emissions budget (MVEB) adequate

Developing a model for the adequate description of electronic communication in hospitals.

PubMed

Saboor, Samrend; Ammenwerth, Elske

2011-01-01

Adequate information and communication systems (ICT) can help to improve the communication in hospitals. Changes to the ICT-infrastructure of hospitals must be planed carefully. In order to support a comprehensive planning, we presented a classification of 81 common errors of the electronic communication on the MIE 2008 congress. Our objective now was to develop a data model that defines specific requirements for an adequate description of electronic communication processes We first applied the method of explicating qualitative content analysis on the error categorization in order to determine the essential process details. After this, we applied the method of subsuming qualitative content analysis on the results of the first step. A data model for the adequate description of electronic communication. This model comprises 61 entities and 91 relationships. The data model comprises and organizes all details that are necessary for the detection of the respective errors. It can be for either used to extend the capabilities of existing modeling methods or as a basis for the development of a new approach.

Improving Nigerian health policymakers' capacity to access and utilize policy relevant evidence: outcome of information and communication technology training workshop.

PubMed

Uneke, Chigozie Jesse; Ezeoha, Abel Ebeh; Uro-Chukwu, Henry; Ezeonu, Chinonyelum Thecla; Ogbu, Ogbonnaya; Onwe, Friday; Edoga, Chima

2015-01-01

Information and communication technology (ICT) tools are known to facilitate communication and processing of information and sharing of knowledge by electronic means. In Nigeria, the lack of adequate capacity on the use of ICT by health sector policymakers constitutes a major impediment to the uptake of research evidence into the policymaking process. The objective of this study was to improve the knowledge and capacity of policymakers to access and utilize policy relevant evidence. A modified "before and after" intervention study design was used in which outcomes were measured on the target participants both before the intervention is implemented and after. A 4-point likert scale according to the degree of adequacy; 1 = grossly inadequate, 4 = very adequate was employed. This study was conducted in Ebonyi State, south-eastern Nigeria and the participants were career health policy makers. A two-day intensive ICT training workshop was organized for policymakers who had 52 participants in attendance. Topics covered included: (i). intersectoral partnership/collaboration; (ii). Engaging ICT in evidence-informed policy making; use of ICT for evidence synthesis; (iv) capacity development on the use of computer, internet and other ICT. The pre-workshop mean of knowledge and capacity for use of ICT ranged from 2.19-3.05, while the post-workshop mean ranged from 2.67-3.67 on 4-point scale. The percentage increase in mean of knowledge and capacity at the end of the workshop ranged from 8.3%-39.1%. Findings of this study suggest that policymakers' ICT competence relevant to evidence-informed policymaking can be enhanced through training workshop.

How Does Organisational Literacy Impact Access to Health Care for Homeless Individuals?

PubMed

Hughes, Naomi Rebecca

2017-03-01

This article describes a study that examined the experiences of 27 individuals who frequented an Open Access homeless shelter in Toronto, Canada. The overarching aim of this study was to map the social organisation of health care in Toronto, with particular regards to the ways in which literacy, or the lack of literacy, mediates the experiences of homeless individuals attempting to gain access to health care. While terms such as "literate" or "illiterate" might be seen to reflect an individual's level of acquired education or competence, critical social theorists argue that such terms instead more accurately reflect an individual's relative class or position within the social hierarchy. Individuals who possess literacy are able to read into texts for their implicit understandings, directives, and power structures. Furthermore, they are able to translate and decode texts as potential pretexts for coordination or control. This study draws on a Freirean critical standpoint, which acknowledges that knowledge and power are inextricably interconnected. This study asked: How does literacy, or the lack of literacy, facilitate or impede access to health care for homeless individuals? What are the social consequences of illiteracy?

Exploring Possibilities for Transforming Established Subscription-based Scientific Journals into Open Access Journals. Present Situation, Transformation Criteria, and Exemplary Implementation within Trans-O-MIM.

PubMed

Haux, Reinhold; Kuballa, Stefanie; Schulze, Mareike; Böhm, Claudia; Gefeller, Olaf; Haaf, Jan; Henning, Peter; Mielke, Corinna; Niggemann, Florian; Schürg, Andrea; Bergemann, Dieter

2016-12-07

Based on today's information and communication technologies the open access paradigm has become an important approach for adequately communicating new scientific knowledge. Summarizing the present situation for journal transformation. Presenting criteria for adequate transformation as well as a specific approach for it. Describing our exemplary implementation of such a journal transformation. Studying the respective literature as well as discussing this topic in various discussion groups and meetings (primarily of editors and publishers, but also of authors and readers), with long term experience as editors and /or publishers of scientific publications as prerequisite. There is a clear will, particularly of political and funding organizations, towards open access publishing. In spite of this, there is still a large amount of scientific knowledge, being communicated through subscription-based journals. For successfully transforming such journals into open access, sixteen criteria for a goal-oriented, stepwise, sustainable, and fair transformation are suggested. The Tandem Model as transformation approach is introduced. Our exemplary implementation is done in the Trans-O-MIM project. It is exploring strategies, models and evaluation metrics for journal transformation. As instance the journal Methods of Information in Medicine will apply the Tandem Model from 2017 onwards. Within Trans-O-MIM we will reach at least nine of the sixteen criteria for adequate transformation. It was positive to implement Trans-O-MIM as international research project. After first steps for transforming Methods have successfully been made, challenges will remain, among others, in identifying appropriate incentives for open access publishing in order to support its transformation.

Orthopedic workforce planning in Germany – an analysis of orthopedic accessibility

PubMed Central

Müller, Peter; Maier, Werner; Groneberg, David A.

2017-01-01

In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the ‘official degree of care provision’. However, with geographic information systems (GIS), more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility) with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population) lived in an area with significant low orthopedic accessibility (average z-score = -4.0), whereas 31,748,161 people (39.0% of total population) lived in an area with significant high orthopedic accessibility (average z-score = 8.0). Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001) and the official degree of care provision (r = 0.33; p<0.001) and negatively correlated with regional social deprivation (r = -0.47; p<0.001). Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas. PMID:28178335

Access to and Satisfaction with Prenatal Care Among Pregnant Women with Physical Disabilities: Findings from a National Survey.

PubMed

Mitra, Monika; Akobirshoev, Ilhom; Moring, Nechama Sammet; Long-Bellil, Linda; Smeltzer, Suzanne C; Smith, Lauren D; Iezzoni, Lisa I

2017-12-01

Previous qualitative studies suggest that women with physical disabilities face disability-specific barriers and challenges related to prenatal care accessibility and quality. This study aims to examine the pregnancy and prenatal care experiences and needs of U.S. mothers with physical disabilities and their perceptions of their interactions with their maternity care clinicians. We conducted the first survey of maternity care access and experiences of women with physical disabilities from 37 states. The survey was disseminated in partnership with disability community agencies and via social media and targeted U.S. women with a range of physical disabilities who had given birth in the past 10 years. The survey included questions regarding prenatal care quality and childbirth and labor experiences. A total of 126 women with various physical disability types from 37 states completed the survey. Almost half of the respondents (53.2%) reported that their physical disability was a big factor in their selection of a maternity care provider and 40.3% of women reported that their prenatal care provider knew little or nothing about the impact of their physical disability on their pregnancy. Controlling for maternal demographic characteristics and use of mobility equipment, women who reported that their prenatal care provider lacked knowledge of disability and those who felt they were not given adequate information were more likely to report unmet needs for prenatal care. The findings from this study suggest the need for training and education for clinicians regarding the prenatal care needs of women with physical disabilities.

Perceived and geographic food access and food security status among households with children.

PubMed

Ma, Xiaoguang; Liese, Angela D; Bell, Bethany A; Martini, Lauren; Hibbert, James; Draper, Carrie; Burke, Michael P; Jones, Sonya J

2016-10-01

To examine the association of both perceived and geographic neighbourhood food access with food security status among households with children. This was a cross-sectional study in which participants' perceptions of neighbourhood food access were assessed by a standard survey instrument, and geographic food access was evaluated by distance to the nearest supermarket. Multinomial logistic regression models were used to examine the associations. The Midlands Family Study included 544 households with children in eight counties in South Carolina, USA. Food security status among participants was classified into three categories: food secure (FS), food insecure (FI) and very low food security among children (VLFS-C). Compared with FS households, VLFS-C households had lower odds of reporting easy access to adequate food shopping. VLFS-C households also had lower odds of reporting neighbourhood access to affordable fruits and vegetables compared with FS households and reported worse selection of fruits and vegetables, quality of fruits and vegetables, and selection of low-fat products. FI households had lower odds of reporting fewer opportunities to purchase fast food. None of the geographic access measures was significantly associated with food security status. Caregivers with children who experienced hunger perceived that they had less access to healthy affordable food in their community, even though grocery stores were present. Approaches to improve perceived access to healthy affordable food should be considered as part of the overall approach to improving food security and eliminating child hunger.

Perceived and Geographic Food Access and Food Security Status among Households with Children

PubMed Central

Ma, Xiaoguang; Liese, Angela D.; Bell, Bethany; Martini, Lauren; Hibbert, James; Draper, Carrie; Jones, Sonya J.

2017-01-01

Objective To examine the association of both perceived and geographic neighborhood food access with food security status among households with children. Design This was a cross-sectional study in which participants’ perceptions of neighborhood food access were assessed by a standard survey instrument, and geographic food access was evaluated by distance to the nearest supermarket. Multinomial logistic regression models were used to examine the associations. Subjects The Midlands Family Study included 544 households with children in eight counties in South Carolina. Food security status among participants was classified into three categories: food secure (FS), food insecure (FI) and very low food security among children (VLFS-C). Results Compared to FS households, VLFS-C households had lower odds of reporting easy access to adequate food shopping. VLFS-C households also had lower odds of reporting neighborhood access to affordable fruits and vegetables compared to FS households and reported worse selection of fruits and vegetables, quality of fruits and vegetables and selection of low-fat products. FI households had lower odds of reporting fewer opportunities to purchase fast food. None of the geographic access measures was significantly associated with food security status. Conclusions Caregivers with children that experienced hunger perceived that they had less access to healthy affordably food in their community, even though grocery stores were present. Approaches to improve perceived access to healthy affordable food should be considered as part of the overall approach to improving food security and eliminating child hunger. PMID:27133939

Health System Barriers to Access and Use of Magnesium Sulfate for Women with Severe Pre-Eclampsia and Eclampsia in Pakistan: Evidence for Policy and Practice

PubMed Central

Bigdeli, Maryam; Zafar, Shamsa; Assad, Hafeez; Ghaffar, Adbul

2013-01-01

Severe pre-eclampsia and eclampsia are rare but serious complications of pregnancy that threaten the lives of mothers during childbirth. Evidence supports the use of magnesium sulfate (MgSO4) as the first line treatment option for severe pre-eclampsia and eclampsia. Eclampsia is the third major cause of maternal mortality in Pakistan. As in many other Low- and Middle-Income Countries (LMIC), it is suspected that MgSO4 is critically under-utilized in the country. There is however a lack of information on context-specific health system barriers that prevent optimal use of this life-saving medicine in Pakistan. Combining quantitative and qualitative methods, namely policy document review, key informant interviews, focus group discussions and direct observation at health facility, we explored context-specific health system barriers and enablers that affect access and use of MgSO4 for severe pre-eclampsia and eclampsia in Pakistan. Our study finds that while international recommendations on MgSO4 have been adequately translated in national policies in Pakistan, the gap remains in implementation of national policies into practice. Barriers to access to and effective use of MgSO4 occur at health facility level where the medicine was not available and health staff was reluctant to use it. Low price of the medicine and the small market related to its narrow indications acted as disincentives for effective marketing. Results of our survey were further discussed in a multi-stakeholder round-table meeting and an action plan for increasing access to this life-saving medicine was identified. PMID:23555626

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

Code of Federal Regulations, 2013 CFR

2013-01-01

... animal health, behavior, and well-being is conveyed to the attending veterinarian; (4) Guidance to... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE...

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

Code of Federal Regulations, 2012 CFR

2012-01-01

... animal health, behavior, and well-being is conveyed to the attending veterinarian; (4) Guidance to... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE...

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

Code of Federal Regulations, 2014 CFR

2014-01-01

... animal health, behavior, and well-being is conveyed to the attending veterinarian; (4) Guidance to... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE...

12 CFR 1229.5 - Capital distributions for adequately capitalized Banks.

Code of Federal Regulations, 2010 CFR

2010-01-01

... CAPITAL CLASSIFICATIONS AND PROMPT CORRECTIVE ACTION Federal Home Loan Banks § 1229.5 Capital... classification of adequately capitalized. A Bank may not make a capital distribution if such distribution would... redeem its shares of stock if the transaction is made in connection with the issuance of additional Bank...

Region 10: Idaho Northern Ada County Adequate Letter (6/21/2013)

EPA Pesticide Factsheets

EPA approves motor vehicle emissions budget in the Northern Ada County PM10 State Implementation Plan, Maintenance Plan: Ten-Year Update for PM10 national ambient air quality standard, adequate for transportation conformity purposes.

Balancing Open Access with Academic Standards: Implications for Community College Faculty

ERIC Educational Resources Information Center

Gabbard, Anita; Mupinga, Davison M.

2013-01-01

Community colleges act as the gateway for students to higher education. Many of these colleges realize this mission through open-door policies where students lacking in basic reading, writing, and mathematics skills can enroll. But, this open-access policy often creates challenges when meeting academic standards. Based on data collected from…

Socioeconomic Inequalities in Green Space Quality and Accessibility-Evidence from a Southern European City.

PubMed

Hoffimann, Elaine; Barros, Henrique; Ribeiro, Ana Isabel

2017-08-15

Background : The provision of green spaces is an important health promotion strategy to encourage physical activity and to improve population health. Green space provision has to be based on the principle of equity. This study investigated the presence of socioeconomic inequalities in geographic accessibility and quality of green spaces across Porto neighbourhoods (Portugal). Methods : Accessibility was evaluated using a Geographic Information System and all the green spaces were audited using the Public Open Space Tool. Kendall's tau-b correlation coefficients and ordinal regression were used to test whether socioeconomic differences in green space quality and accessibility were statistically significant. Results : Although the majority of the neighbourhoods had an accessible green space, mean distance to green space increased with neighbourhood deprivation. Additionally, green spaces in the more deprived neighbourhoods presented significantly more safety concerns, signs of damage, lack of equipment to engage in active leisure activities, and had significantly less amenities such as seating, toilets, cafés, etc. Conclusions : Residents from low socioeconomic positions seem to suffer from a double jeopardy; they lack both individual and community resources. Our results have important planning implications and might contribute to understanding why deprived communities have lower physical activity levels and poorer health.

Cognitive Attributes of Adequate and Inadequate Responders to Reading Intervention in Middle School

PubMed Central

Miciak, Jeremy; Stuebing, Karla K.; Vaughn, Sharon; Roberts, Greg; Barth, Amy Elizabeth; Fletcher, Jack M.

2016-01-01

No studies have investigated the cognitive attributes of middle school students who are adequate and inadequate responders to Tier 2 reading intervention. We compared students in Grades 6 and 7 representing groups of adequate responders (n = 77) and inadequate responders who fell below criteria in (a) comprehension (n = 54); (b) fluency (n = 45); and (c) decoding, fluency, and comprehension (DFC; n = 45). These students received measures of phonological awareness, listening comprehension, rapid naming, processing speed, verbal knowledge, and nonverbal reasoning. Multivariate comparisons showed a significant Group-by-Task interaction: the comprehension-impaired group demonstrated primary difficulties with verbal knowledge and listening comprehension, the DFC group with phonological awareness, and the fluency-impaired group with phonological awareness and rapid naming. A series of regression models investigating whether responder status explained unique variation in cognitive skills yielded largely null results consistent with a continuum of severity associated with level of reading impairment, with no evidence for qualitative differences in the cognitive attributes of adequate and inadequate responders. PMID:28579668

Cognitive Attributes of Adequate and Inadequate Responders to Reading Intervention in Middle School.

PubMed

Miciak, Jeremy; Stuebing, Karla K; Vaughn, Sharon; Roberts, Greg; Barth, Amy Elizabeth; Fletcher, Jack M

2014-12-01

No studies have investigated the cognitive attributes of middle school students who are adequate and inadequate responders to Tier 2 reading intervention. We compared students in Grades 6 and 7 representing groups of adequate responders ( n = 77) and inadequate responders who fell below criteria in (a) comprehension ( n = 54); (b) fluency ( n = 45); and (c) decoding, fluency, and comprehension (DFC; n = 45). These students received measures of phonological awareness, listening comprehension, rapid naming, processing speed, verbal knowledge, and nonverbal reasoning. Multivariate comparisons showed a significant Group-by-Task interaction: the comprehension-impaired group demonstrated primary difficulties with verbal knowledge and listening comprehension, the DFC group with phonological awareness, and the fluency-impaired group with phonological awareness and rapid naming. A series of regression models investigating whether responder status explained unique variation in cognitive skills yielded largely null results consistent with a continuum of severity associated with level of reading impairment, with no evidence for qualitative differences in the cognitive attributes of adequate and inadequate responders.

42 CFR 413.24 - Adequate cost data and cost finding.

Code of Federal Regulations, 2013 CFR

2013-10-01

... familiar with the laws and regulations regarding the provision of health care services, and that the... 42 Public Health 2 2013-10-01 2013-10-01 false Adequate cost data and cost finding. 413.24 Section 413.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

42 CFR 413.24 - Adequate cost data and cost finding.

Code of Federal Regulations, 2012 CFR

2012-10-01

... familiar with the laws and regulations regarding the provision of health care services, and that the... 42 Public Health 2 2012-10-01 2012-10-01 false Adequate cost data and cost finding. 413.24 Section 413.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

Habitat characteristics at marten subnivean access sites

USGS Publications Warehouse

Corn, Janelle G.; Raphael, Martin G.

1992-01-01

The occurrence of coarse woody debris (CWD) at sites of subnivean (under snow) access by martens (Martes americana) has not been quantified adequately, and must be better understood to provide suitable winter habitat management for the species. Consequently, we studied subnivean activity of martens in a subalpine forest in southern Wyoming to determine how subnivean space was accessed, and to examine microhabitat characteristics around entry sites. Martens used existing openings in snow, created primarily by logs at low snow depths and by small live spruce and fir trees at greater snow depths. Sites of marten subnivean entry had greater percent cover (P ≤ 0.01) and total volume of CWD (P ≤ 0.01), greater numbers of log layers (all P ≤ 0.02), greater volume of undecayed (P ≤ 0.05) and moderately decayed logs (P ≤ 0.02), less volume of very decayed logs (P ≤ 0.001), and fewer small root masses (P ≤ 0.001) than surrounding forest stands. Provision of sufficient CWD in winter habitat of martens may require specific effort, particularly in managed forests of the central Rocky Mountains.

Developing a framework for understanding doctors' health access: a qualitative study of Australian GPs.

PubMed

Kay, Margaret; Mitchell, Geoffrey; Clavarino, Alexandra; Frank, Erica

2012-01-01

Health access behaviours of doctors need to be understood if the profession is to adequately respond to concerns raised about doctors' health. There has been limited investigation of these issues and most qualitative studies have focussed on doctors who have been seriously unwell. This research project was designed to explore doctors' attitudes to health access and the barriers they experience using six independently facilitated focus groups (37 general practitioners) in Brisbane, Australia. Themes that emerged using inductive thematic analysis were grouped into three key categories. The findings challenge current representations of doctors' health within the medical literature. Doctors in this study reported positive attitudes towards their own health care. Health access, however, was difficult because of the barriers they encountered. These barriers are described in detail revealing the rationale used by doctors seeking care. A framework of patient, provider and profession barrier domains is developed to enable a comparison between the health access barriers of the doctor and those experienced by the general community. The complexity is highlighted as the socio-cultural factors woven through these barrier domains are recognised. The potential for this framework to provide a structure for future interventions to enhance doctors' health access is discussed.

Assessing the Impact of Leveraging Traditional Leadership on Access to Sanitation in Rural Zambia.

PubMed

Tiwari, Amy; Russpatrick, Scott; Hoehne, Alexandra; Matimelo, Selma M; Mazimba, Sharon; Nkhata, Ilenga; Osbert, Nicolas; Soloka, Geoffrey; Winters, Anna; Winters, Benjamin; Larsen, David A

2017-11-01

Open defecation is practiced by more than one billion people throughout the world and leads to significant public health issues including infectious disease transmission and stunted growth in children. Zambia implemented community-led total sanitation (CLTS) as an intervention to eliminate open defecation in rural areas. To support CLTS and the attainment of open defecation free communities, chiefs were considered key agents of change and were empowered to drive CLTS and improve sanitation for their chiefdom. Chiefs were provided with data on access to sanitation in the chiefdom during chiefdom orientations prior to the initiation of CLTS within each community and encouraged to make goals of universal sanitation access within the community. Using a survival regression, we found that where chiefs were orientated and mobilized in CLTS, the probability that a village would achieve 100% coverage of adequate sanitation increased by 23% (hazard ratio = 1.263, 95% confidence interval = 1.080-1.478, P = 0.003). Using an interrupted time series, we found a 30% increase in the number of individuals with access to adequate sanitation following chiefdom orientations (95% confidence interval = 28.8-32.0%). The mobilization and support of chiefs greatly improved the uptake of CLTS, and empowering them with increased CLTS knowledge and authority of the program in their chiefdom allowed chiefs to closely monitor village sanitation progress and follow-up with their headmen/headwomen. These key agents of change are important facilitators of public health goals such as the elimination of open defecation in Zambia by 2020.

Limited accessibility to HIV services for persons with disabilities living with HIV in Ghana, Uganda and Zambia.

PubMed

Tun, Waimar; Okal, Jerry; Schenk, Katie; Esantsi, Selina; Mutale, Felix; Kyeremaa, Rita Kusi; Ngirabakunzi, Edson; Asiah, Hilary; McClain-Nhlapo, Charlotte; Moono, Grimond

2016-01-01

Knowledge about experiences in accessing HIV services among persons with disabilities who are living with HIV in sub-Saharan Africa is limited. Although HIV transmission among persons with disabilities in Africa is increasingly acknowledged, there is a need to bring to life the experiences and voices from persons with disabilities living with HIV to raise awareness of programme implementers and policy makers about their barriers in accessing HIV services. This paper explores how the barriers faced by persons with disabilities living with HIV impede their ability to access HIV-related services and manage their disease. We conducted focus group discussions with 76 persons (41 females; 35 males) with physical, visual and/or hearing impairments who were living with HIV in Ghana, Uganda and Zambia (2012-2013). We explored challenges and facilitators at different levels (individual, psychosocial and structural) of access to HIV services. Transcripts were analyzed using a framework analysis approach. Persons with disabilities living with HIV encountered a wide variety of challenges in accessing HIV services. Delays in testing for HIV were common, with most waiting until they were sick to be tested. Reasons for delayed testing included challenges in getting to the health facilities, lack of information about HIV and testing, and HIV- and disability-related stigma. Barriers to HIV-related services, including care and treatment, at health facilities included lack of disability-friendly educational materials and sign interpreters, stigmatizing treatment by providers and other patients, lack of skills to provide tailored services to persons with disabilities living with HIV and physically inaccessible infrastructure, all of which make it extremely difficult for persons with disabilities to initiate and adhere to HIV treatment. Accessibility challenges were greater for women than men due to gender-related roles. Challenges were similar across the three countries. Favourable

Limited accessibility to HIV services for persons with disabilities living with HIV in Ghana, Uganda and Zambia

PubMed Central

Tun, Waimar; Okal, Jerry; Schenk, Katie; Esantsi, Selina; Mutale, Felix; Kyeremaa, Rita Kusi; Ngirabakunzi, Edson; Asiah, Hilary; McClain-Nhlapo, Charlotte; Moono, Grimond

2016-01-01

Introduction Knowledge about experiences in accessing HIV services among persons with disabilities who are living with HIV in sub-Saharan Africa is limited. Although HIV transmission among persons with disabilities in Africa is increasingly acknowledged, there is a need to bring to life the experiences and voices from persons with disabilities living with HIV to raise awareness of programme implementers and policy makers about their barriers in accessing HIV services. This paper explores how the barriers faced by persons with disabilities living with HIV impede their ability to access HIV-related services and manage their disease. Methods We conducted focus group discussions with 76 persons (41 females; 35 males) with physical, visual and/or hearing impairments who were living with HIV in Ghana, Uganda and Zambia (2012–2013). We explored challenges and facilitators at different levels (individual, psychosocial and structural) of access to HIV services. Transcripts were analyzed using a framework analysis approach. Results Persons with disabilities living with HIV encountered a wide variety of challenges in accessing HIV services. Delays in testing for HIV were common, with most waiting until they were sick to be tested. Reasons for delayed testing included challenges in getting to the health facilities, lack of information about HIV and testing, and HIV- and disability-related stigma. Barriers to HIV-related services, including care and treatment, at health facilities included lack of disability-friendly educational materials and sign interpreters, stigmatizing treatment by providers and other patients, lack of skills to provide tailored services to persons with disabilities living with HIV and physically inaccessible infrastructure, all of which make it extremely difficult for persons with disabilities to initiate and adhere to HIV treatment. Accessibility challenges were greater for women than men due to gender-related roles. Challenges were similar across the

Ethanol consumption in mice lacking CD14, TLR2, TLR4, or MyD88

PubMed Central

Blednov, Yuri A.; Black, Mendy; Chernis, Julia; Da Costa, Adriana; Mayfield, Jody; Harris, R. Adron

2016-01-01

Background Molecular and behavioral studies support a role for innate immune proinflammatory pathways in mediating the effects of alcohol. Increased levels of Toll-like receptors (TLRs) have been observed in animal models of alcohol consumption and in human alcoholics, and many of these TLRs signal via the MyD88-dependent pathway. We hypothesized that this pathway is involved in alcohol drinking and examined some of its key signaling components. Methods Different ethanol drinking paradigms were studied in male and female control C57BL/6J mice vs. mice lacking CD14, TLR2, TLR4 (C57BL/10ScN), or MyD88. We studied continuous and intermittent access two-bottle choice (2BC) and one-bottle and 2BC drinking-in-the-dark (DID) tests as well as preference for saccharin, quinine, and NaCl. Results In the 2BC continuous access test, ethanol intake decreased in male TLR2 knockout (KO) mice, and we previously reported reduced 2BC drinking in male and female CD14 KO mice. In the intermittent access 2BC test, ethanol intake decreased in CD14 KO male and female mice, whereas drinking increased in MyD88 KO male mice. In the 2BC-DID test, ethanol drinking decreased in male and female mice lacking TLR2, whereas drinking increased in MyD88 KO male mice. In the one-bottle DID test, ethanol intake decreased in female TLR2 KO mice. TLR2 KO and CD14 KO mice did not differ in saccharin preference but showed reduced preference for NaCl. MyD88 KO mice showed a slight reduction in preference for saccharin. Conclusions Deletion of key components of the MyD88-dependent pathway produced differential effects on ethanol intake by decreasing (TLR2 KO and CD14 KO) or increasing (MyD88 KO) drinking, while deletion of TLR4 had no effect. Some of the drinking effects depended on the sex of the mice and/or the ethanol-drinking model. PMID:28146272

Arterioarterial Prosthetic Loop as an Alternative Approach for Hemodialysis Access.

PubMed

Lei, Wenhui; Ji, Jiansong; Wang, Jian; Jin, Lie; Zou, Hai

2015-10-01

In the present study, we performed an arterioarterial prosthetic loop (AAPL) between the femoral artery and deep femoral artery as a new access in patients who did not have adequate vascular conditions for creating an arteriovenous fistula or graft.Between April 2005 and June 2014, 18 patients received AAPL as a vascular access. During the procedure, a polytetrafluoroethylene graft was anastomosed to the femoral artery and deep femoral artery and looped on the thigh. We assessed the reliability and safety of AAPLs by analyzing complication, primary and secondary patency rates, and postoperative blood flow.Eighteen patients (median age, 66 years; range, 43-96 years) underwent AAPL access placement under the general or local anesthesia. All patients were followed up for 3 to 38 months (mean, 24 months). Primary and secondary patency rates at 6 months were 94.5% and 88.8%, respectively, and at 3 years were 61% and 72%, respectively. After operation, one patient had infection, and another one had fat necrosis at the surgical incision site. To maintain the AAPL function, 5 surgical procedures in 4 grafts, including revision, thrombectomy, excision, and repair for bleeding were performed. More than 5000 hemodialyses were performed efficiently in our center.Our study shows that AAPL loop is an unusual but effective and safe procedure that may be a good alternative for the patients who do not allow the conventional hemodialysis access.

Decriminalization and Women’s Access to Abortion in Australia

PubMed Central

2017-01-01

Abstract This article considers the relationship between the decriminalization of abortion and women’s access to abortion services. It focuses on the four Australian jurisdictions which are, with Canada, the only jurisdictions in the world where abortion has been removed from the criminal law. This paper draws on documentary evidence and an oral history project to give a “before and after” account of each jurisdiction. The paper assumes that the meaning and impact of decriminalization must be assessed in each local context. Understanding the conditions that shape access must incorporate analysis of the broader social, political and economic environment as well as the law. The article finds that decriminalization does not necessarily deliver any improvement in women’s access to abortion, at least in the short term. Further, it is not inconsistent with the neoliberal policy environment that characterizes the provision of abortion care in Australia, where most abortions are provided through the private sector at financial cost to women. If all women are to enjoy their human rights to full reproductive health care, the public health system must take responsibility for the adequate provision of abortion services; ongoing and vigilant activism is central if this is to be achieved. PMID:28630552

48 CFR 52.216-29 - Time-and-Materials/Labor-Hour Proposal Requirements-Non-Commercial Item Acquisition With Adequate...

Code of Federal Regulations, 2010 CFR

2010-10-01

...-Hour Proposal Requirements-Non-Commercial Item Acquisition With Adequate Price Competition. 52.216-29... Proposal Requirements—Non-Commercial Item Acquisition With Adequate Price Competition (FEB 2007) (a) The... Time-and-Materials/Labor-Hour Proposal Requirements—Non-Commercial Item Acquisition With Adequate Price...

Lack of nephrotoxicity of gadodiamide in unselected hospitalized patients.

PubMed

Trivedi, Hariprasad; Raman, Lakshmi; Benjamin, Heather; Batwara, Ruchika

2009-09-01

The nephrotoxicity of gadolinium-based magnetic resonance contrast media has not been adequately studied. We evaluated the nephrotoxicity of gadolinium-based contrast media in hospitalized patients who underwent magnetic resonance imaging (MRI) as part of routine clinical care. Subjects who had a serum creatinine measurement during the 7 days before MRI and at least 1 other measurement 2 to 3 days after MRI were included. Patients who underwent noncontrasted MRI served as controls. There were 162 subjects (mean age, 57.8 +/- 16.9 years; 91 men and 71 women) and 125 controls (mean age, 64.6 +/- 18 years; 62 men and 63 women). All contrast-enhanced MRI studies utilized gadodiamide (Omniscan; GE Healthcare, Waukesha, WI). Subjects who received gadodiamide showed no difference in the incidence of acute renal insufficiency compared with controls (increase in serum creatinine >or= 25%, 11.1% vs 12.9%, respectively; P = 0.6; increase in serum creatinine by 0.5 mg/dL, 5.6% vs 3.2%, respectively; P = 0.4). There was no significant increase in serum creatinine baseline versus 48 hours in either the subjects who received gadodiamide (0.95 +/- 0.58 vs 0.96 +/- 0.65 mg/dL; P = 0.7) or controls (0.96 +/- 0.65 vs 0.88 +/- 0.43 mg/dL; P = 0.7). Our findings showed a lack of significant nephrotoxicity of gadodiamide in unselected hospitalized patients.

42 CFR 413.24 - Adequate cost data and cost finding.

Code of Federal Regulations, 2014 CFR

2014-10-01

... provision of health care services, and that the services identified in this cost report were provided in... 42 Public Health 2 2014-10-01 2014-10-01 false Adequate cost data and cost finding. 413.24 Section 413.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

The impact of health and health insurance literacy on access to care for Hispanic/Latino communities.

PubMed

Edward, Jean; Morris, Sarah; Mataoui, Fatma; Granberry, Phillip; Williams, Mark V; Torres, Idali

2018-05-01

The aim of this study was to assess the impact of health literacy (HL) and health insurance literacy (HIL) on health insurance status and access to health care services for Spanish-speaking communities living in Massachusetts. A total of 139 surveys (descriptive, knowledge-based HIL questions, and Short Assessment of Health Literacy in Spanish) and 30 semi-structured interviews were collected and analyzed using chi-square, Mann-Whitney U test, and logistic regression analysis. The majority of participants had inadequate HL (56%) and HIL (93%). There were differences in HL scores (t = 4.1; p < .0001) between the insured (M = 12.3, SD = 5.7) and uninsured (M = 7.9, SD = 6.7) and differences (t = 1.9; p = .05) between those with adequate HIL (M = 14.3, SD = 4.3) and inadequate HIL (M = 10.2, SD = 6.6). Participants who were uninsured (MW U = 37.6; p < .0001) and who had inadequate HL (MW U = 5.2; p = .02) were more likely to have never accessed health care in the U.S. Participants who had never accessed health care were 93% less likely to be insured and those with adequate HL were three times more likely to be insured. Health literacy and HIL are closely associated with insurance status and access to health care for Spanish-speaking communities, indicating the need for further research and enhanced public health efforts to improve knowledge and awareness around navigating health care systems. © 2018 Wiley Periodicals, Inc.

Barriers and facilitators to intraosseous access in adult resuscitations when peripheral intravenous access is not achievable.

PubMed

James Cheung, Warren; Rosenberg, Hans; Vaillancourt, Christian

2014-03-01

care, and was associated with a low complication rate. Conversely, the perception that nurses are not familiar or supportive of IO access and a lack of physician confidence regarding the appropriate indications for IO access were barriers to use. These data are an important step in the knowledge-to-action process, as they identify specific factors associated with physician use of IO access. Interventions addressing these actionable facilitators and barriers are likely to have a positive effect on increasing the appropriate physician use of this potentially life-saving technique in adult patients requiring emergent vascular access. © 2014 by the Society for Academic Emergency Medicine.

Electronic doors to education: study of high school website accessibility in Iowa.

PubMed

Klein, David; Myhill, William; Hansen, Linda; Asby, Gary; Michaelson, Susan; Blanck, Peter

2003-01-01

The Americans with Disabilities Act (ADA), and Sections 504 and 508 of the Rehabilitation Act, prohibit discrimination against people with disabilities in all aspects of daily life, including education, work, and access to places of public accommodations. Increasingly, these antidiscrimination laws are used by persons with disabilities to ensure equal access to e-commerce, and to private and public Internet websites. To help assess the impact of the anti-discrimination mandate for educational communities, this study examined 157 website home pages of Iowa public high schools (52% of high schools in Iowa) in terms of their electronic accessibility for persons with disabilities. We predicted that accessibility problems would limit students and others in obtaining information from the web pages as well as limiting ability to navigate to other web pages. Findings show that although many web pages examined included information in accessible formats, none of the home pages met World Wide Web Consortium (W3C) standards for accessibility. The most frequent accessibility problem was lack of alternative text (ALT tags) for graphics. Technical sophistication built into pages was found to reduce accessibility. Implications are discussed for schools and educational institutions, and for laws, policies, and procedures on website accessibility. Copyright 2003 John Wiley & Sons, Ltd.

Lack of agreement over the use and ownership of the internationally shared resources (such as air space, outer space and the oceans) leading to international conflict

NASA Technical Reports Server (NTRS)

1975-01-01

The lack of adequate institutional mechanisms to regulate, monitor and govern the use of commonly owned world resources appears to be politically destabilizing and subject to socioeconomic pressures of overpopulation, food shortages, cartelism, terrorism, and wealth distribution to developing countries. The capacity and propensity to wage war and its potential consequences are elaborated. It is shown that technology is one of the dominant factors affecting the exploration and management of commonly shared resources.

Adequate sleep moderates the prospective association between alcohol use and consequences.

PubMed

Miller, Mary Beth; DiBello, Angelo M; Lust, Sarah A; Carey, Michael P; Carey, Kate B

2016-12-01

Inadequate sleep and heavy alcohol use have been associated with negative outcomes among college students; however, few studies have examined the interactive effects of sleep and drinking quantity in predicting alcohol-related consequences. This study aimed to determine if adequate sleep moderates the prospective association between weekly drinking quantity and consequences. College students (N=568) who were mandated to an alcohol prevention intervention reported drinks consumed per week, typical sleep quantity (calculated from sleep/wake times), and perceptions of sleep adequacy as part of a larger research trial. Assessments were completed at baseline and one-, three-, and five-month follow-ups. Higher baseline quantities of weekly drinking and inadequate sleep predicted alcohol-related consequences at baseline and one-month follow-up. Significant interactions emerged between baseline weekly drinking quantity and adequate sleep in the prediction of alcohol-related consequences at baseline, one-, three-, and five-month assessments. Simple slopes analyses revealed that weekly drinking quantity was positively associated with alcohol-related consequences for those reporting both adequate and inadequate sleep, but this association was consistently stronger among those who reported inadequate sleep. Subjective evaluation of sleep adequacy moderates both the concurrent and prospective associations between weekly drinking quantity and consequences, such that heavy-drinking college students reporting inadequate sleep experience more consequences as a result of drinking. Research needs to examine the mechanism(s) by which inadequate sleep affects alcohol risk among young adults. Copyright © 2016 Elsevier Ltd. All rights reserved.

Immigration, health care access, and recent cancer tests among Mexican-Americans in California.

PubMed

Breen, Nancy; Rao, Sowmya R; Meissner, Helen I

2010-08-01

Immigrants' lower rates of cancer testing may be due to lack of fluency in English and other skills and knowledge about navigating US health care markets, lack of access to health services, or both. We analyzed 9,079 Mexican-American respondents to the 2001 California Health Interview Survey (CHIS) grouped as born in the US, living in the US 10 or more years, or living in the US less than 10 years. The CHIS provides the largest Mexican-American sample in a US survey. Access to care meant having health insurance coverage and a usual source of care. English proficiency meant the respondent took the interview in English. Multivariate logistic regression was used to predict outcomes. Respondents reporting more time in the US were more likely to report access to medical care and to report getting a cancer screening exam. Regardless of time in the US, respondents reporting access had similar test rates. Regression results indicate that time in the US and primary language were not significant relative to use of cancer screening tests, but access to care was. Cancer screening tests that are covered by Every Woman Counts, California's breast and cervical cancer early detection program, had smaller gaps among groups than colorectal cancer screening which is not covered by a program. California is the only state with a survey able to monitor changes in small population groups. Understanding barriers specific to subgroups is key to developing appropriate policy and interventions to increase use of cancer screening exams.

Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study

PubMed Central

Ganle, John Kuumuori; Otupiri, Easmon; Obeng, Bernard; Edusie, Anthony Kwaku; Ankomah, Augustine; Adanu, Richard

2016-01-01

Background While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana. Methods and Findings A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling’s thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers’ insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability. Conclusions Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and

Converting Optically Scanned Regular or Irregular Tables to a Standardised Markup Format to Be Accessible to Vision-Impaired

ERIC Educational Resources Information Center

Nazemi, Azadeh; Murray, Iain; Fernaando, Chandrika; McMeekin, David A.

2016-01-01

Documents use tables to communicate multidimensional information clearly, summarise and present data in an easy-to-interpret way. Tabular information in scanned PDF due to its nature without further processing is not accessible for vision-impaired people who use assistive technology such as screen readers. The lack of access to table contents…

Establishing a Secure Data Center with Remote Access: Preprint

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

Gonder, J.; Burton, E.; Murakami, E.

2012-04-01

Access to existing travel data is critical for many analysis efforts that lack the time or resources to support detailed data collection. High-resolution data sets provide particular value, but also present a challenge for preserving the anonymity of the original survey participants. To address this dilemma of providing data access while preserving privacy, the National Renewable Energy Laboratory and the U.S. Department of Transportation have launched the Transportation Secure Data Center (TSDC). TSDC data sets include those from regional travel surveys and studies that increasingly use global positioning system devices. Data provided by different collecting agencies varies with respect tomore » formatting, elements included and level of processing conducted in support of the original purpose. The TSDC relies on a number of geospatial and other analysis tools to ensure data quality and to generate useful information outputs. TSDC users can access the processed data in two different ways. The first is by downloading summary results and second-by-second vehicle speed profiles (with latitude/longitude information removed) from a publicly-accessible website. The second method involves applying for a remote connection account to a controlled-access environment where spatial analysis can be conducted, but raw data cannot be removed.« less

Spatial access to inpatient health care in northern rural India.

PubMed

Ranga, Vikram; Panda, Pradeep

2014-05-01

Access to health care in rural areas is a major concern for local populations as well as for policy makers in developing countries. This paper examines spatial access to in-patient health care in northern rural India. In order to measure spatial access, impedance-based competition using the Three-Step floating Catchment Area (3SFCA) method, a modification of the simple gravity model, was used. 3SFCA was chosen for the study of the districts of Pratapgarh and Kanpur Dehat in the Uttar Pradesh state and Vaishali in the Bihar state, two of India's poorest states. This approach is based on discrete distance decay and also considers more parameters than other available methods, hence is believed to be a robust methodology. It was found that Vaishali district has the highest spatial access to in-patient health care followed by Pratapgarh and Kanpur Dehat. There is serious lack of health care, in Pratapgarh and Kanpur Dehat with 40% and 90% of the villages having shortage of in-patient care facilities in these respective districts. The most important factor affecting spatial access was found to be the distance to the nearest major urban agglomeration.

“It’s Like a Phantom Disease”: Patient Perspectives on Access to Treatment for Chagas Disease in the United States

PubMed Central

Forsyth, Colin J.; Hernandez, Salvador; Flores, Carmen A.; Roman, Mario F.; Nieto, J. Maribel; Marquez, Grecia; Sequeira, Juan; Sequeira, Harry; Meymandi, Sheba K.

2018-01-01

Abstract. Chagas disease (CD) affects > 6 million people globally, including > 300,000 in the United States. Although early detection and etiological treatment prevents chronic complications from CD, < 1% of U.S. cases have been diagnosed and treated. This study explores access to etiological treatment from the perspective of patients with CD. In semi-structured interviews with 50 Latin American–born patients of the Center of Excellence for Chagas Disease at the Olive View–UCLA Medical Center, we collected demographic information and asked patients about their experiences managing the disease and accessing treatment. Patients were highly marginalized, with 63.4% living below the U.S. poverty line, 60% lacking a high school education, and only 12% with private insurance coverage. The main barriers to accessing health care for CD were lack of providers, precarious insurance coverage, low provider awareness, transportation difficulties, and limited time off. Increasing access to diagnosis and treatment will not only require a dramatic increase in provider and public education, but also development of programs which are financially, linguistically, politically, and geographically accessible to patients. PMID:29380723

Formal and Informal Early Education of Turkish-Origin Children in Germany

ERIC Educational Resources Information Center

Becker, Birgit; Boldin, Elena; Klein, Oliver

2016-01-01

A lack of adequate German language skills is often discussed as a major reason for the disadvantage of children of immigrants in the German educational system. This article analyses the access to formal and informal early education of Turkish-origin children in Germany and the influence of these early education contexts on the children's German…

Reports of Insurance-Based Discrimination in Health Care and Its Association With Access to Care

PubMed Central

Call, Kathleen Thiede; Pintor, Jessie Kemmick; Alarcon-Espinoza, Giovann; Simon, Alisha Baines

2015-01-01

Objectives. We examined reports of insurance-based discrimination and its association with insurance type and access to care in the early years of the Patient Protection and Affordable Care Act. Methods. We used data from the 2013 Minnesota Health Access Survey to identify 4123 Minnesota adults aged 18 to 64 years who reported about their experiences of insurance-based discrimination. We modeled the association between discrimination and insurance type and predicted odds of having reduced access to care among those reporting discrimination, controlling for sociodemographic factors. Data were weighted to represent the state’s population. Results. Reports of insurance-based discrimination were higher among uninsured (25%) and publicly insured (21%) adults than among privately insured adults (3%), which held in the regression analysis. Those reporting discrimination had higher odds of lacking a usual source of care, lacking confidence in getting care, forgoing care because of cost, and experiencing provider-level barriers than those who did not. Conclusions. Further research and policy interventions are needed to address insurance-based discrimination in health care settings. PMID:25905821

Reports of insurance-based discrimination in health care and its association with access to care.

PubMed

Han, Xinxin; Call, Kathleen Thiede; Pintor, Jessie Kemmick; Alarcon-Espinoza, Giovann; Simon, Alisha Baines

2015-07-01

We examined reports of insurance-based discrimination and its association with insurance type and access to care in the early years of the Patient Protection and Affordable Care Act. We used data from the 2013 Minnesota Health Access Survey to identify 4123 Minnesota adults aged 18 to 64 years who reported about their experiences of insurance-based discrimination. We modeled the association between discrimination and insurance type and predicted odds of having reduced access to care among those reporting discrimination, controlling for sociodemographic factors. Data were weighted to represent the state's population. Reports of insurance-based discrimination were higher among uninsured (25%) and publicly insured (21%) adults than among privately insured adults (3%), which held in the regression analysis. Those reporting discrimination had higher odds of lacking a usual source of care, lacking confidence in getting care, forgoing care because of cost, and experiencing provider-level barriers than those who did not. Further research and policy interventions are needed to address insurance-based discrimination in health care settings.

Accessibility and usability of parks and playgrounds.

PubMed

Perry, Meredith A; Devan, Hemakumar; Fitzgerald, Harry; Han, Karen; Liu, Li-Ting; Rouse, Jack

2018-04-01

Public parks and playgrounds are an environment for leisure activity, which all generations can enjoy at low or no financial cost. Evaluating the accessibility and usability of parks and playgrounds is crucial because their design, environment (natural and built) and safety could restrict participation of persons with disabilities. To evaluate the accessibility and usability of 21 public parks and playgrounds in three metropolitan cities of New Zealand. Secondary aims were to compare the accessibility and usability by park type (destination or neighborhood) and deprivation level (high and low). Twenty-one parks were evaluated. A stratified random sampling was used to select 18 parks (six from each city). Three additional parks were purposely selected (one from each city) at the request of each respective city council. The parks and playgrounds were evaluated using a customized tool. Data were analyzed using descriptive statistics. None of the parks we evaluated met the national standards and/or international guidelines for park and playground design. We identified potential accessibility and usability issues with car parking spaces, path surfaces and play equipment as well as lack of lighting and fencing. The presence of amenities (e.g. toilets and drinking fountains) was more common in destination parks. Fewer parks in areas of higher deprivation had accessible car parking spaces and main paths wider than 1.5 m. Our evaluation identified potential design, environmental and safety barriers to park and playground based participation for persons with disabilities across the lifespan. A larger, more comprehensive evaluation of parks and playgrounds is required. Copyright © 2017 Elsevier Inc. All rights reserved.

Pace: Privacy-Protection for Access Control Enforcement in P2P Networks

NASA Astrophysics Data System (ADS)

Sánchez-Artigas, Marc; García-López, Pedro

In open environments such as peer-to-peer (P2P) systems, the decision to collaborate with multiple users — e.g., by granting access to a resource — is hard to achieve in practice due to extreme decentralization and the lack of trusted third parties. The literature contains a plethora of applications in which a scalable solution for distributed access control is crucial. This fact motivates us to propose a protocol to enforce access control, applicable to networks consisting entirely of untrusted nodes. The main feature of our protocol is that it protects both sensitive permissions and sensitive policies, and does not rely on any centralized authority. We analyze the efficiency (computational effort and communication overhead) as well as the security of our protocol.

Improving Nigerian health policymakers’ capacity to access and utilize policy relevant evidence: outcome of information and communication technology training workshop

PubMed Central

Uneke, Chigozie Jesse; Ezeoha, Abel Ebeh; Uro-Chukwu, Henry; Ezeonu, Chinonyelum Thecla; Ogbu, Ogbonnaya; Onwe, Friday; Edoga, Chima

2015-01-01

Information and communication technology (ICT) tools are known to facilitate communication and processing of information and sharing of knowledge by electronic means. In Nigeria, the lack of adequate capacity on the use of ICT by health sector policymakers constitutes a major impediment to the uptake of research evidence into the policymaking process. The objective of this study was to improve the knowledge and capacity of policymakers to access and utilize policy relevant evidence. A modified “before and after” intervention study design was used in which outcomes were measured on the target participants both before the intervention is implemented and after. A 4-point likert scale according to the degree of adequacy; 1 = grossly inadequate, 4 = very adequate was employed. This study was conducted in Ebonyi State, south-eastern Nigeria and the participants were career health policy makers. A two-day intensive ICT training workshop was organized for policymakers who had 52 participants in attendance. Topics covered included: (i). intersectoral partnership/collaboration; (ii). Engaging ICT in evidence-informed policy making; use of ICT for evidence synthesis; (iv) capacity development on the use of computer, internet and other ICT. The pre-workshop mean of knowledge and capacity for use of ICT ranged from 2.19-3.05, while the post-workshop mean ranged from 2.67-3.67 on 4-point scale. The percentage increase in mean of knowledge and capacity at the end of the workshop ranged from 8.3%-39.1%. Findings of this study suggest that policymakers’ ICT competence relevant to evidence-informed policymaking can be enhanced through training workshop. PMID:26448807

Technology solutions to support supervisory activities and also to provide information access to the society

NASA Astrophysics Data System (ADS)

Paladini, D.; Mello, A. B.

2016-07-01

Inmetro's data about the conformity of certificated products, process and services are, usually, displayed at fragmented databases of difficult access for several reasons, for instance, the lack of computational solutions which allow this kind of access to its users. A discussion about some of the technological solutions to support supervisory activities by the appropriate regulatory bodies and also to provide information access to society in general is herein presented, along with a theoretical explanation of the pros and cons of such technologies to the conclusion that a mobile platform seems to be the best tool for the requirements of Inmetro.

[Can court injunctions guarantee access to medicines in the public sector? The experience in the State of Rio de Janeiro, Brazil].

PubMed

Messeder, Ana Márcia; Osorio-de-Castro, Claudia Garcia Serpa; Luiza, Vera Lucia

2005-01-01

There are increasing numbers of legal suits concerning access to medicines brought against the Rio de Janeiro State Health Department. The situation indicated the need for a study to clarify the underlying issues. A sample of 389 court suits from January 1991 to December 2001 (stratified by year) was used. A cross-sectional design was used to describe and analyze the legal suits in relation to the responsibilities defined under the Unified National Health System (SUS). Results suggest major delays in court decisions. Most suits are filed by the Public Defender's Office for users of the National Health System. The most frequent cases involve medicines for the cardiovascular and nervous systems, many of which involve continuous use. Prescribing practices are institutionalized through the inclusion of the most frequently prescribed drugs in public financing lists, which makes rational drug use difficult to achieve. Municipalities are not fulfilling their responsibility to supply medicines to users, and the State is thus encumbered with these responsibilities. However, the State does not adequately supply medicines to the municipalities. The apparent lack of awareness among both lawyers and clients generates stress between the Executive and Judiciary branches and limits the resources for collective pharmaceutical services.

45 CFR 1159.15 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

Code of Federal Regulations, 2010 CFR

2010-10-01

... disclosure or destruction of manual and automatic record systems. These security safeguards shall apply to... use of records contained in a system of records are adequately trained to protect the security and... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of...

Access to a scale and self-weighing habits among public housing residents.

PubMed

Bramante, C T; Clark, J M; Gudzune, K A

2018-05-31

Having access to a scale is essential for individuals to engage in self-weighing; however, few studies examine scale access, particularly among low-income individuals. Our objectives were to (i) determine how many public housing residents have access to a scale and (ii) describe their self-weighing habits. We conducted a cross-sectional survey of public housing residents in Baltimore, MD, from August 2014 to August 2015. Participants answered questions about their access to a scale ('yes'/'no') and daily self-weighing habits ('no scale/never or hardly ever' vs. 'some/about half/much of the time/always'). We used t-tests or chi-square tests to examine the association of scale access with respondent characteristics. Overall, 266 adults participated (48% response rate). Mean age was 45 years with 86% women, 95% black and 54% with obesity. Only 32% had access to a scale; however, 78% of those with this access reported engaging in some self-weighing. Residents who lacked access to a scale were younger (P = 0.03), and more likely to be unemployed/disabled (P = 0.01) or food insecure (P < 0.01). While few public housing residents have access to a scale, those who do report daily self-weighing with some regularity. Financial hardship may influence scale access in this population, as potential proxies of this status were associated with no scale access. © 2018 World Obesity Federation.

Promoting Food Security for All Children.

PubMed

2015-11-01

Sixteen million US children (21%) live in households without consistent access to adequate food. After multiple risk factors are considered, children who live in households that are food insecure, even at the lowest levels, are likely to be sick more often, recover from illness more slowly, and be hospitalized more frequently. Lack of adequate healthy food can impair a child's ability to concentrate and perform well in school and is linked to higher levels of behavioral and emotional problems from preschool through adolescence. Food insecurity can affect children in any community, not only traditionally underserved ones. Pediatricians can play a central role in screening and identifying children at risk for food insecurity and in connecting families with needed community resources. Pediatricians should also advocate for federal and local policies that support access to adequate healthy food for an active and healthy life for all children and their families. Copyright © 2015 by the American Academy of Pediatrics.

Geographic access to high capability severe acute respiratory failure centers in the United States.

PubMed

Wallace, David J; Angus, Derek C; Seymour, Christopher W; Yealy, Donald M; Carr, Brendan G; Kurland, Kristen; Boujoukos, Arthur; Kahn, Jeremy M

2014-01-01

Optimal care of adults with severe acute respiratory failure requires specific resources and expertise. We sought to measure geographic access to these centers in the United States. Cross-sectional analysis of geographic access to high capability severe acute respiratory failure centers in the United States. We defined high capability centers using two criteria: (1) provision of adult extracorporeal membrane oxygenation (ECMO), based on either 2008-2013 Extracorporeal Life Support Organization reporting or provision of ECMO to 2010 Medicare beneficiaries; or (2) high annual hospital mechanical ventilation volume, based 2010 Medicare claims. Nonfederal acute care hospitals in the United States. We defined geographic access as the percentage of the state, region and national population with either direct or hospital-transferred access within one or two hours by air or ground transport. Of 4,822 acute care hospitals, 148 hospitals met our ECMO criteria and 447 hospitals met our mechanical ventilation criteria. Geographic access varied substantially across states and regions in the United States, depending on center criteria. Without interhospital transfer, an estimated 58.5% of the national adult population had geographic access to hospitals performing ECMO and 79.0% had geographic access to hospitals performing a high annual volume of mechanical ventilation. With interhospital transfer and under ideal circumstances, an estimated 96.4% of the national adult population had geographic access to hospitals performing ECMO and 98.6% had geographic access to hospitals performing a high annual volume of mechanical ventilation. However, this degree of geographic access required substantial interhospital transfer of patients, including up to two hours by air. Geographic access to high capability severe acute respiratory failure centers varies widely across states and regions in the United States. Adequate referral center access in the case of disasters and pandemics will

Durable medical equipment recycling: a pilot program.

PubMed

Wright, Aaron J

2012-01-01

Our unfunded trauma patients often lack the access to adequate health care services and equipment after hospital discharge. We have developed and implemented a pilot program to provide reclaimed durable medical equipment to medically indigent trauma patients. Our program includes the reuse of items such as front-wheeled walkers, bedside commodes, shower chairs, crutches, and canes.

The Online Catalog: Exceeding Our Grasp.

ERIC Educational Resources Information Center

Lipow, Anne Grodzins

1989-01-01

Discusses two problems related to the use of online catalogs: (1) staff training has not kept pace with new catalogs, resulting in a lack of search expertise in staff and patrons; and (2) users expect instant access to materials found in the catalog. It is argued that these problems must be addressed to adequately serve library patrons. (CLB)

Going "social" to access experimental and potentially life-saving treatment: an assessment of the policy and online patient advocacy environment for expanded access.

PubMed

Mackey, Tim K; Schoenfeld, Virginia J

2016-02-02

Social media is fundamentally altering how we access health information and make decisions about medical treatment, including for terminally ill patients. This specifically includes the growing phenomenon of patients who use online petitions and social media campaigns in an attempt to gain access to experimental drugs through expanded access pathways. Importantly, controversy surrounding expanded access and "compassionate use" involves several disparate stakeholders, including patients, manufacturers, policymakers, and regulatory agencies-all with competing interests and priorities, leading to confusion, frustration, and ultimately advocacy. In order to explore this issue in detail, this correspondence article first conducts a literature review to describe how the expanded access policy and regulatory environment in the United States has evolved over time and how it currently impacts access to experimental drugs. We then conducted structured web searches to identify patient use of online petitions and social media campaigns aimed at compelling access to experimental drugs. This was carried out in order to characterize the types of communication strategies utilized, the diseases and drugs subject to expanded access petitions, and the prevalent themes associated with this form of "digital" patient advocacy. We find that patients and their families experience mixed results, but still gravitate towards the use of online campaigns out of desperation, lack of reliable information about treatment access options, and in direct response to limitations of the current fragmented structure of expanded access regulation and policy currently in place. In response, we discuss potential policy reforms to improve expanded access processes, including advocating greater transparency for expanded access programs, exploring use of targeted economic incentives for manufacturers, and developing systems to facilitate patient information about existing treatment options. This includes

Access to New Zealand Sign Language interpreters and quality of life for the deaf: a pilot study.

PubMed

Henning, Marcus A; Krägeloh, Christian U; Sameshima, Shizue; Shepherd, Daniel; Shepherd, Gregory; Billington, Rex

2011-01-01

This paper aims to: (1) explore usage and accessibility of sign language interpreters, (2) appraise the levels of quality of life (QOL) of deaf adults residing in New Zealand, and (3) consider the impact of access to and usage of sign language interpreters on QOL. Sixty-eight deaf adults living in New Zealand participated in this study. Two questionnaires were employed: a 12-item instrument about access and use of New Zealand sign language interpreters and the abbreviated version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). The results showed that 39% of this sample felt that they were unable to adequately access interpreting services. Moreover, this group scored significantly lower than a comparable hearing sample on all four WHOQOL-BREF domains. Finally, the findings revealed that access to good quality interpreters were associated with access to health services, transport issues, engagement in leisure activities, gaining more information, mobility and living in a healthy environment. These findings have consequences for policy makers and agencies interested in ensuring that there is an equitable distribution of essential services for all groups within New Zealand which inevitably has an impact on the health of the individual.

Region 8: Colorado Lamar and Steamboat Springs Adequate Letter (11/12/2002)

EPA Pesticide Factsheets

This letter from EPA to Colorado Department of Public Health and Environment determined Lamar and Steamboat Springs particulate matter (PM10) maintenance plan for Motor Vehicle Emissions Budgets adequate for transportation conformity purposes

Availability and acceptability of HIV counselling and testing services. A qualitative study comparing clients' experiences of accessing HIV testing at public sector primary health care facilities or non-governmental mobile services in Cape Town, South Africa.

PubMed

Meehan, Sue-Ann; Leon, Natalie; Naidoo, Pren; Jennings, Karen; Burger, Ronelle; Beyers, Nulda

2015-09-02

The South African government is striving for universal access to HIV counselling and testing (HCT), a fundamental component of HIV care and prevention. In the Cape Town district, Western Cape Province of South Africa, HCT is provided free of charge at publically funded primary health care (PHC) facilities and through non-governmental organizations (NGOs). This study investigated the availability and accessibility of HCT services; comparing health seeking behaviour and client experiences of HCT across public PHC facilities (fixed sites) and NGO mobile services. This qualitative study used semi-structured interviews. Systematic sampling was used to select 16 participants who accessed HCT in either a PHC facility (8) or a NGO mobile service (8). Interviews, conducted between March and June 2011, were digitally recorded, transcribed and where required, translated into English. Constant comparative and thematic analysis was used to identify common and divergent responses and themes in relation to the key questions (reasons for testing, choice of service provider and experience of HCT). The sample consisted of 12 females and 4 males with an age range of 19-60 years (median age 28 years). Motivations for accessing health facilities and NGO services were similar; opportunity to test, being affected by HIV and a perceived personal risk for contracting HIV. Participants chose a particular service provider based on accessibility, familiarity with and acceptability of that service. Experiences of both services were largely positive, though instances of poor staff attitude and long waiting times were reported at PHC facilities. Those attending NGO services reported shorter waiting times and overall positive testing experiences. Concerns about lack of adequate privacy and associated stigma were expressed about both services. Realised access to HCT is dependent on availability and acceptability of HCT services. Those who utilised either a NGO mobile service or a public PHC

Indigence and access to health care in sub-Saharan Africa.

PubMed

Stierle, F; Kaddar, M; Tchicaya, A; Schmidt-Ehry, B

1999-01-01

Access to health care services for the poor and indigent is hampered by current policies of health care financing in sub-Saharan Africa. This paper reviews the issue as it is discussed in the international literature. No real strategies seem to exist for covering the health care of the indigent. Frequently, definitions of poverty and indigence are imprecise, the assessment of indigence is difficult for conceptual and technical reasons, and, therefore, the actual extent of indigence in Africa is not well known. Explicit policies rarely exist, and systematic evaluation of experiences is scarce. Results in terms of adequately identifying the indigent, and of mechanisms to improve indigents' access to health care, are rather deceiving. Policies to reduce poverty, and improve indigents' access to health care, seem to pursue strategies of depoliticizing the issue of social injustice and inequities. The problem is treated in a 'technical' manner, identifying and implementing 'operational' measures of social assistance. This approach, however, cannot resolve the problem of social exclusion, and, consequently, the problem of excluding large parts of African populations from modern health care. Therefore, this approach has to be integrated into a more 'political' approach which is interested in the process of impoverishment, and which addresses the macro-economic and social causes of poverty and inequity.

Web Accessibility and Accessibility Instruction

ERIC Educational Resources Information Center

Green, Ravonne A.; Huprich, Julia

2009-01-01

Section 508 of the Americans with Disabilities Act (ADA) mandates that programs and services be accessible to people with disabilities. While schools of library and information science (SLIS*) and university libraries should model accessible Web sites, this may not be the case. This article examines previous studies about the Web accessibility of…

Accessibility, Textbooks, and Access Services

ERIC Educational Resources Information Center

Kahler, Janice E.

2017-01-01

Putting access in Access Services is the goal. The Course Reserves unit is the place. Textbooks are the focus. Electronic technologies are the future. Patron-centric services will be our standard. Access to textbooks by all patrons will be the achievement. Course Reserves located in Library West at the University of Florida George A. Smathers…

Making ecological models adequate

USGS Publications Warehouse

Getz, Wayne M.; Marshall, Charles R.; Carlson, Colin J.; Giuggioli, Luca; Ryan, Sadie J.; Romañach, Stephanie; Boettiger, Carl; Chamberlain, Samuel D.; Larsen, Laurel; D'Odorico, Paolo; O'Sullivan, David

2018-01-01

Critical evaluation of the adequacy of ecological models is urgently needed to enhance their utility in developing theory and enabling environmental managers and policymakers to make informed decisions. Poorly supported management can have detrimental, costly or irreversible impacts on the environment and society. Here, we examine common issues in ecological modelling and suggest criteria for improving modelling frameworks. An appropriate level of process description is crucial to constructing the best possible model, given the available data and understanding of ecological structures. Model details unsupported by data typically lead to over parameterisation and poor model performance. Conversely, a lack of mechanistic details may limit a model's ability to predict ecological systems’ responses to management. Ecological studies that employ models should follow a set of model adequacy assessment protocols that include: asking a series of critical questions regarding state and control variable selection, the determinacy of data, and the sensitivity and validity of analyses. We also need to improve model elaboration, refinement and coarse graining procedures to better understand the relevancy and adequacy of our models and the role they play in advancing theory, improving hind and forecasting, and enabling problem solving and management.

Fiscal Year 2011 Afghanistan Infrastructure Fund Projects Are Behind Schedule and Lack Adequate Sustainment Plans

DTIC Science & Technology

2012-07-30

interconnected subset ofUSATD Economic Support Fund ( ESl -") projects, which arc essential to meet program ol~jcctives. Under the program, DOS and US AID...with conunent: The congressional reporting requirements in the KDAA cover AIF funded projects, whether executed hy DoD or DOS. ESl ’-tunded projects

Turning Access into a web-enabled secure information system for clinical trials.

PubMed

Dongquan Chen; Chen, Wei-Bang; Soong, Mayhue; Soong, Seng-Jaw; Orthner, Helmuth F

2009-08-01

Organizations that have limited resources need to conduct clinical studies in a cost-effective, but secure way. Clinical data residing in various individual databases need to be easily accessed and secured. Although widely available, digital certification, encryption, and secure web server, have not been implemented as widely, partly due to a lack of understanding of needs and concerns over issues such as cost and difficulty in implementation. The objective of this study was to test the possibility of centralizing various databases and to demonstrate ways of offering an alternative to a large-scale comprehensive and costly commercial product, especially for simple phase I and II trials, with reasonable convenience and security. We report a working procedure to transform and develop a standalone Access database into a secure Web-based secure information system. For data collection and reporting purposes, we centralized several individual databases; developed, and tested a web-based secure server using self-issued digital certificates. The system lacks audit trails. The cost of development and maintenance may hinder its wide application. The clinical trial databases scattered in various departments of an institution could be centralized into a web-enabled secure information system. The limitations such as the lack of a calendar and audit trail can be partially addressed with additional programming. The centralized Web system may provide an alternative to a comprehensive clinical trial management system.

State Implementation Plans (SIP): Submissions that EPA has Found Adequate or Inadequate

EPA Pesticide Factsheets

EPA/OTAQ’s State and Local Transportation Resources are for air quality and transportation government and community leaders. Information on state implementation plans (SIPs) that EPA has found either adequate or inadequate is provided here.

Access to properly fitting personal protective equipment for female construction workers.

PubMed

Onyebeke, Lynn C; Papazaharias, Demetrios M; Freund, Alice; Dropkin, Jonathan; McCann, Michael; Sanchez, Sadie H; Hashim, Dana; Meyer, John D; Lucchini, Roberto G; Zuckerman, Norman C

2016-11-01

Previous literature suggests that most personal protective equipment (PPE) for construction is designed for males and does not accommodate female anthropometry. We conducted a pilot study to identify whether female construction workers currently have adequate access to properly fitting PPE. Semi-structured focus group interviews were conducted with union female carpenters, laborers, and ironworkers. Researchers coded focus group transcriptions and extracted major themes using thematic framework analysis. Participants (n = 23) had a mean of 15.1 years of construction experience (range 3-34.5 years). A majority reported fit problems for many types of PPE (gloves, harnesses, safety vests, work boots, outerwear), generally noting that the equipment provided by contractors was too large. Other emergent themes included female workers purchasing their own PPE, exposure to various safety hazards from poorly fitted PPE, and perceived indifferent safety culture. Female construction workers continue to have difficulty accessing properly fitting PPE. Am. J. Ind. Med. 59:1032-1040, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Do Current Fortification and Supplementation Programs Assure Adequate Intake of Fat-Soluble Vitamins in Belgian Infants, Toddlers, Pregnant Women, and Lactating Women?

PubMed

Moyersoen, Isabelle; Lachat, Carl; Cuypers, Koenraad; Ridder, Karin De; Devleesschauwer, Brecht; Tafforeau, Jean; Vandevijvere, Stefanie; Vansteenland, Margot; De Meulenaer, Bruno; Van Camp, John; Van Oyen, Herman

2018-02-16

Abstracts: Adequate intakes of fat-soluble vitamins are essential to support the growth and development of the foetus, the neonate, and the young child. By means of an online self-administered frequency questionnaire, this study aimed to evaluate the intake of vitamins A, D, E, and K in Belgian infants ( n = 455), toddlers ( n = 265), pregnant women ( n = 161), and lactating women ( n = 165). The contribution of foods, fortified foods, and supplements on the total intake was quantified. 5% of toddlers, 16% of pregnant women, and 35% of lactating women had an inadequate vitamin A intake. Conversely, excessive vitamin A intakes were associated with consumption of liver (products). Furthermore, 22% of infants were at risk for inadequate vitamin D intake due to the lack of prophylaxis, while consumption of highly dosed supplements posed a risk for excessive intakes in 6%-26% of infants. Vitamin D intake in pregnant women and lactating women was inadequate (median of 51%, respectively, 60% of the adequate intake). In all groups, the risk for inadequate intake of vitamin E and K was low. Contribution of fortified foods to vitamin A, D, E, and K intake was minor, except in toddlers. National fortification strategies should be investigated as an alternative or additional strategy to prevent vitamin D and A deficiency. There is a need to revise and set uniform supplement recommendations. Finally, non-users of vitamin D prophylaxis need to be identified for targeted treatment.

Financing Adult Education: How Adequate Are Current Sources in Facilitating Access and Participation in Centres in Murang'a South Sub-County, Murang'a County, Kenya?

ERIC Educational Resources Information Center

Maina, Ndonga James; Orodho, John Aluko

2016-01-01

The thrust of this study was to examine the level of adequacy of current sources in facilitating access and participation in adult education centres in Murang'a South Sub-County, Murang'a County, Kenya. The study adopted the descriptive survey design. Combinations of purposive and stratified random sampling techniques were used to select 82…

Barriers to access to care reported by women living with HIV across 27 countries.

PubMed

Johnson, Margaret; Samarina, Anna; Xi, He; Valdez Ramalho Madruga, José; Hocqueloux, Laurent; Loutfy, Mona; Fournelle, Marie-Josée; Norton, Michael; Van Wyk, Jean; Zachry, Woodie; Martinez, Marisol

2015-01-01

Increased access to successful antiretroviral therapy (ART) is necessary in order to achieve an AIDS-free generation. Importantly, slightly over half of the people living with HIV are women. Small studies have described many barriers to accessing treatment and care among women living with HIV. This cross-sectional, non-interventional, epidemiological study assessed the prevalence of barriers to accessing care for women living with HIV across 27 countries, divided into four global regions. HIV-positive women attending routine clinical visits were offered the opportunity to participate in the study. Data describing the study sites and demographic characteristics of the participating women were collected. Participating women filled out questionnaires including the Barriers to Care Scale (BACS) questionnaire, on which they reported the extent to which they found each of the 12 potential barriers to accessing health care problematic. A total of 1931 women living with HIV were included in the study: 760 from Western Europe and Canada (WEC), 532 from Central and Eastern Europe (CEE), 519 from Latin America (LA), and 120 from China. The mean age of participating women was 40.1 ± 11.4 years. A total of 88.2% were currently taking ART. A total of 81.8% obtained HIV treatment under a government health plan. The most prevalent barrier to care was community HIV/AIDS stigma. Community HIV/AIDS knowledge, lack of supportive/understanding work environments, lack of employment opportunities, and personal financial resources were also highly prevalent barriers to accessing care. These findings indicate that, more than 30 years after the start of the AIDS epidemic, stigma is still a major issue for women living with HIV. Continued efforts are needed to improve community education on HIV/AIDS in order to maximize access to health care among women living with HIV.

Barriers to access to care reported by women living with HIV across 27 countries

PubMed Central

Johnson, Margaret; Samarina, Anna; Xi, He; Valdez Ramalho Madruga, José; Hocqueloux, Laurent; Loutfy, Mona; Fournelle, Marie-Josée; Norton, Michael; Van Wyk, Jean; Zachry, Woodie; Martinez, Marisol

2015-01-01

Increased access to successful antiretroviral therapy (ART) is necessary in order to achieve an AIDS-free generation. Importantly, slightly over half of the people living with HIV are women. Small studies have described many barriers to accessing treatment and care among women living with HIV. This cross-sectional, non-interventional, epidemiological study assessed the prevalence of barriers to accessing care for women living with HIV across 27 countries, divided into four global regions. HIV-positive women attending routine clinical visits were offered the opportunity to participate in the study. Data describing the study sites and demographic characteristics of the participating women were collected. Participating women filled out questionnaires including the Barriers to Care Scale (BACS) questionnaire, on which they reported the extent to which they found each of the 12 potential barriers to accessing health care problematic. A total of 1931 women living with HIV were included in the study: 760 from Western Europe and Canada (WEC), 532 from Central and Eastern Europe (CEE), 519 from Latin America (LA), and 120 from China. The mean age of participating women was 40.1 ± 11.4 years. A total of 88.2% were currently taking ART. A total of 81.8% obtained HIV treatment under a government health plan. The most prevalent barrier to care was community HIV/AIDS stigma. Community HIV/AIDS knowledge, lack of supportive/understanding work environments, lack of employment opportunities, and personal financial resources were also highly prevalent barriers to accessing care. These findings indicate that, more than 30 years after the start of the AIDS epidemic, stigma is still a major issue for women living with HIV. Continued efforts are needed to improve community education on HIV/AIDS in order to maximize access to health care among women living with HIV. PMID:26168817

The gap between coverage and care-what can Canadian paediatricians do about access to health services for refugee claimant children?

PubMed

Rink, N; Muttalib, F; Morantz, G; Chase, L; Cleveland, J; Rousseau, C; Li, P

2017-11-01

In June 2012, the government of Canada severely restricted the scope of the Interim Federal Health Program that had hitherto provided coverage for the health care needs of refugee claimants. The Quebec government decided to supplement coverage via the provincial health program. Despite this, we hypothesized that refugee claimant children in Montreal would continue to experience significant difficulties in accessing basic health care. (1) Report the narrative experiences of refugee claimant families who were denied health care services in Montreal following June 2012, (2) describe the predominant barriers to accessing health care services and understanding their impact using thematic analysis and (3) derive concrete recommendations for child health care providers to improve access to care for refugee claimant children. Eleven parents recruited from two sites in Montreal participated in semi-structured interviews designed to elicit a narrative account of their experiences seeking health care. Interviews were recorded, transcribed, coded using NVivo software and subjected to thematic analysis. Thematic analysis of the data revealed five themes concerning barriers to health care access: lack of continuous health coverage, health care administrators/providers' lack of understanding of Interim Federal Health Program coverage, refusal of services or fees charged, refugee claimants' lack of understanding about health care rights and services and language barriers, and four themes concerning the impact of denial of care episodes: potential for adverse health outcomes, psychological distress, financial burden and social stigma. We propose eight action points for advocacy by Canadian paediatricians to improve access to health care for refugee claimant children in their communities and institutions.

Telemental health technology in deaf and general mental-health services: access and use.

PubMed

Austen, Sally; McGrath, Melissa

2006-01-01

Long-distance travel to provide mental health services for deaf people has implications for efficiency, safety, and equality of service. However, uptake of Telemental Health (TMH) has been slow in both deaf and general mental health services. A quantitative study was used to investigate access to TMH and whether staff confidence, experience, or demographics affect TMH use. It was concluded that staff in neither deaf mental health services nor general mental health services had adequate knowledge of or access to TMH. Staff expressed concerns over TMH's appropriateness in their work. Previous use of videoconferencing was assosciated significantly with confidence, but previous use of videophones was not. Neither staff in deaf services nor deaf staff were more experienced with or more confident about videoconferencing, whereas, within deaf services, deaf staff were significantly more confident about videophone use. Training implications are discussed.

Negotiating boundaries: Accessing donor gametes in India.

PubMed

Widge, A; Cleland, J

2011-01-01

This paper documents how couples and providers access donor materials for conception in the Indian context and perceptions about using them. The objective is to facilitate understanding of critical issues and relevant concerns. A postal survey was conducted with a sample of 6000 gynaecologists and in-depth interviews were -conducted with 39 gynaecologists in four cities. Donor gametes are relatively more acceptable than a few years ago, especially if confidentiality can be -maintained, though lack of availability of donor materials is sometimes an impediment to infertility treatment. Donor sperms are usually accessed from in-house or commercial sperm banks, pathology laboratories, IVF centres, -professional donors, relatives or friends. There is scepticism about screening procedures of sperm banks. Donor eggs are usually accessed from voluntary donors, friends, relatives, egg sharing programmes, donation from other patients, advertising and commercial donors. There are several concerns regarding informed consent for using donated gametes, using -relatives and friends gametes, the unregulated use of gametes and embryos, record keeping and documentation, -unethical and corrupt practices and commercialisation. These issues need to be addressed by patients, providers and regulatory authorities by providing -information, counselling, ensuring informed consent, addressing exploitation and commercialisation, ensuring -monitoring, proper documentation and transparency.

Negotiating boundaries: Accessing donor gametes in India

PubMed Central

Widge, A.; Cleland, J.

2011-01-01

Background: This paper documents how couples and providers access donor materials for conception in the Indian context and perceptions about using them. The objective is to facilitate understanding of critical issues and relevant concerns. Methods: A postal survey was conducted with a sample of 6000 gynaecologists and in-depth interviews were conducted with 39 gynaecologists in four cities. Results: Donor gametes are relatively more acceptable than a few years ago, especially if confidentiality can be maintained, though lack of availability of donor materials is sometimes an impediment to infertility treatment. Donor sperms are usually accessed from in-house or commercial sperm banks, pathology laboratories, IVF centres, professional donors, relatives or friends. There is scepticism about screening procedures of sperm banks. Donor eggs are usually accessed from voluntary donors, friends, relatives, egg sharing programmes, donation from other patients, advertising and commercial donors. There are several concerns regarding informed consent for using donated gametes, using relatives and friends gametes, the unregulated use of gametes and embryos, record keeping and documentation, unethical and corrupt practices and commercialisation. Conclusion: These issues need to be addressed by patients, providers and regulatory authorities by providing information, counselling, ensuring informed consent, addressing exploitation and commercialisation, ensuring monitoring, proper documentation and transparency. PMID:24753849

[Illegitimate patients: Undocumented immigrants' access to health care in Chile].

PubMed

Concha, Nanette Liberona; Mansilla, Miguel Ángel

2017-01-01

In recent decades, Chile has become a destination for immigrants from other South American countries, which has significantly impacted public services - particularly the public health system - at the economic, social, and cultural levels. The aim of this paper is to provide substantiated information on issues concerning undocumented immigrants' access to health care in Chile. A qualitative methodology, fundamentally an ethnography of the clinical setting, was used. Results were then analyzed in relation to theories of power asymmetries and interethnic relations. The research results highlight the lack of compliance with existing regulations and the exercise of discretionary personal judgment as barriers to access. It is concluded that in Chile immigrants in general, and undocumented immigrants in particular, are considered to be illegitimate patients.

Medication coverage for lawmakers may worsen access for everyone else.

PubMed

Taglione, Michael S; Boozary, Andrew; Persaud, Nav

2018-03-01

Despite numerous recommendations for universal public coverage of prescription drugs in Canada based on evidence that millions of Canadians cannot afford medications, no province or territory has adopted first dollar coverage for all residents. However, one group unaffected by the lack of public coverage are lawmakers. Lawmakers receive excellent drug coverage plans for themselves and their immediate families. Evidence suggests that lawmakers' decisions are influenced by their personal circumstances; in this case, they are insulated from the effects of poor access to medications by their drug coverage plans. In contrast, a patchwork system of 46 programs across Canada provides some drug coverage to vulnerable populations. Reducing the disparity in prescription drug access between Canadian lawmakers and the public may promote progress towards better medication access for everyone. This could be achieved either by reducing lawmaker coverage or improving upon the public patchwork system. Since the goal should be to improve the overall access of medications for all Canadians, lawmakers included, the latter method is preferred. A universal drug plan with first dollar coverage could replace the current patchwork system and expand coverage to all Canadians. Copyright © 2017 Elsevier Inc. All rights reserved.

Consent-based access to core EHR information. Collaborative approaches in Norway.

PubMed

Heimly, Vigdis; Berntsen, Kirsti E

2009-01-01

Lack of access to updated drug information is a challenge for healthcare providers in Norway. Drug charts are updated in separate EHR systems but exchange of drug information between them is lacking. In order to provide ready access to updated medication information, a project for consent-based access to a core EHR has been established. End users have developed requirements for additions to the medication modules in the EHR systems in cooperation with vendors, researchers and standardization workers. The modules are then implemented by the vendors, tested in the usability lab, and finally tested by the national testing and approval service before implementation. An ethnographic study, with focus on future users and their interaction with other actors regarding medicines and medication, has included semi-/unstructured interviews with the involved organizational units. The core EHR uses the EHR kept by the patient's regular GP as the main source of information. A server-based solution has been chosen in order to keep the core EHR accessible outside the GP's regular work hours. The core EHR is being tested, and the EHR-vendors are implementing additions to their systems in order to facilitate communication with the core EHR. All major EHR-system vendors in Norway participate in the project. The core EHR provides a generic basis that may be used as a pilot for a national patient summary. Examples of a wider use of the core EHR can be: shared individual plans to support continuity of care, summary of the patient's contacts with health providers in different organizations, and core EHR information such as important diagnoses, allergies and contact information. Extensive electronic cooperation and communication requires that all partners adjust their documentation practices to fit with other actors' needs. The implementation effects on future work practices will be followed by researchers.

[A particular anthropometric method for the study of accessibility of a workstation].

PubMed

Molinaro, V; Del Ferraro, S

2008-01-01

One of the main factors which can involve musculo-skeletal disorders is the assumption of awkward postures. These lasts can be caused, in some cases, by a no-suitable collocation of some devices which are indispensable for the work. It is possible to evaluate if the chosen collocation is adequate or not by studying the accessibility of the workstation with a special regard for the accessibility of the devices placed inside the workstation. EN ISO 14738:2002 is a specific standard which has been adopted in Italy as UNI EN ISO 14738:2004. This standard gives some useful requirements, in terms of accessibility, to design a workstation at no-mobile machinery. In this study, the authors have analyzed a check out workstation by following the requirements described in UNI EN ISO 14738:2004. Critical aspects, related to the organization both of the work activities either of the workstation, have been highlighted taking into account standard criteria. Finally the authors make a new design of the check out workstation trying to optimize device collocation in order to reduce awkward postures. The new configuration has been investigated by applying the criteria mentioned in the standard.

Accessing Quality Apps to Promote Basic Relational Concepts Acquisition among Young Children with Autism

ERIC Educational Resources Information Center

Mykyta, Anne D.; Zhou, Zheng

2017-01-01

Mobile applications (apps) are increasingly being used with children with autism spectrum disorder (ASD) to supplement their intervention packages; however, the Apps' educational utility is not yet understood. The lack of such knowledge results in young children's inequity of accessing quality intervention. The present qualitative study addressed…

Macronutrient supplementation for malnourished HIV-infected adults: a review of the evidence in resource-adequate and resource-constrained settings.

PubMed

Koethe, John R; Chi, Benjamin H; Megazzini, Karen M; Heimburger, Douglas C; Stringer, Jeffrey S A

2009-09-01

Access to antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has expanded rapidly throughout sub-Saharan Africa, but malnutrition and food insecurity have emerged as major barriers to the success of ART programs. Protein-calorie malnutrition (a common form of malnutrition in the region) hastens HIV disease progression, and food insecurity is a barrier to medication adherence. Analyses of patient outcomes have identified a low body mass index after the start of ART as an independent predictor of early mortality, but the causes of a low body mass index are multifactorial (eg, normal anthropometric variation, chronic inadequate food intake, and/or wasting associated with HIV infection and other infectious diseases). Although there is much information on population-level humanitarian food assistance, few data exist to measure the effectiveness of macronutrient supplementation or to identify individuals most likely to benefit. In this report, we review the current evidence supporting macronutrient supplementation for HIV-infected adults, we report on clinical trials in resource-adequate and resource-constrained settings, and we highlight priority areas for future research.

Diagnostic games: from adequate formalization of clinical experience to structure discovery.

PubMed

Shifrin, Michael A; Kasparova, Eva I

2008-01-01

A method of obtaining well-founded and reproducible results in clinical decision making is presented. It is based on "diagnostic games", a procedure of elicitation and formalization of experts' knowledge and experience. The use of this procedure allows formulating decision rules in the terms of an adequate language, that are both unambiguous and clinically clear.

Human milk feeding supports adequate growth in infants

USDA-ARS?s Scientific Manuscript database

Despite current nutritional strategies, premature infants remain at high risk for extrauterine growth restriction. The use of an exclusive human milk-based diet is associated with decreased incidence of necrotizing enterocolitis (NEC), but concerns exist about infants achieving adequate growth. The ...

Patients, care partners, and shared access to the patient portal: online practices at an integrated health system.

PubMed

Wolff, Jennifer L; Berger, Andrea; Clarke, Deserae; Green, Jamie A; Stametz, Rebecca; Yule, Christina; Darer, Jonathan D

2016-11-01

To describe the characteristics and online practices of patients and "care partners" who share explicit access to a patient portal account at a large integrated health system that implemented shared access functionality in 2003. Survey of 323 patients and 389 care partners at Geisinger Health System with linked information regarding access and use of patient portal functionality. Few (0.4%) registered adult patient portal users shared access to their account. Patients varied in age (range: 18-102); more than half had a high school education or less (53.6%). Patient motivations for sharing access included: to help manage care (41.9%), for emergency reasons (29.7%), lack of technology experience (18.4%), or care partner request (10.0%). Care partners were parents (39.8%), adult children (27.9%), spouses (26.2%), and other relatives (6.1%). Patients were more likely than care partners to have inadequate health literacy (54.8% versus 8.8%, P < .001) and less confident in their ability to manage their care (53.0% versus 88.1%; P < .001). Care partners were more likely than patients to perform health management activities electronically (95.5% versus 48.4%; P < .001), access the patient portal (89.2% versus 30.3%; P < .001), and use patient portal functionality such as secure messaging (39.6% versus 13.9%; P < .001). Care partners used their own credentials (89.1%) and patient credentials (23.3%) to access the patient portal. Shared access is an underused strategy that may bridge patients' health literacy deficits and lack of technology experience and that helps but does not fully resolve concerns regarding patient and care partner identity credentials. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Content and Accessibility of Shoulder and Elbow Fellowship Web Sites in the United States.

PubMed

Young, Bradley L; Oladeji, Lasun O; Cichos, Kyle; Ponce, Brent

2016-01-01

Increasing numbers of training physicians are using the Internet to gather information about graduate medical education programs. The content and accessibility of web sites that provide this information have been demonstrated to influence applicants' decisions. Assessments of orthopedic fellowship web sites including sports medicine, pediatrics, hand and spine have found varying degrees of accessibility and material. The purpose of this study was to evaluate the accessibility and content of the American Shoulder and Elbow Surgeons (ASES) fellowship web sites (SEFWs). A complete list of ASES programs was obtained from a database on the ASES web site. The accessibility of each SEFWs was assessed by the existence of a functioning link found in the database and through Google®. Then, the following content areas of each SEFWs were evaluated: fellow education, faculty/previous fellow information, and recruitment. At the time of the study, 17 of the 28 (60.7%) ASES programs had web sites accessible through Google®, and only five (17.9%) had functioning links in the ASES database. Nine programs lacked a web site. Concerning web site content, the majority of SEFWs contained information regarding research opportunities, research requirements, case descriptions, meetings and conferences, teaching responsibilities, attending faculty, the application process, and a program description. Fewer than half of the SEFWs provided information regarding rotation schedules, current fellows, previous fellows, on-call expectations, journal clubs, medical school of current fellows, residency of current fellows, employment of previous fellows, current research, and previous research. A large portion of ASES fellowship programs lacked functioning web sites, and even fewer provided functioning links through the ASES database. Valuable information for potential applicants was largely inadequate across present SEFWs.

Does the public deserve free access to climate system science?

NASA Astrophysics Data System (ADS)

Grigorov, Ivo

2010-05-01

Some time ago it was the lack of public access to medical research data that really stirred the issue and gave inertia for legislation and a new publishing model that puts tax payer-funded medical research in the hands of those who fund it. In today's age global climate change has become the biggest socio-economic challenge, and the same argument resonates: climate affects us all and the publicly-funded science quantifying it should be freely accessible to all stakeholders beyond academic research. Over the last few years the ‘Open Access' movement to remove as much as possible subscription, and other on-campus barriers to academic research has rapidly gathered pace, but despite significant progress, the climate system sciences are not among the leaders in providing full access to their publications and data. Beyond the ethical argument, there are proven and tangible benefits for the next generation of climate researchers to adapt the way their output is published. Through the means provided by ‘open access', both data and ideas can gain more visibility, use and citations for the authors, but also result in a more rapid exchange of knowledge and ideas, and ultimately progress towards a sought solution. The presentation will aim to stimulate discussion and seek progress on the following questions: Should free access to climate research (& data) be mandatory? What are the career benefits of using ‘open access' for young scientists? What means and methods should, or could, be incorporated into current European graduate training programmes in climate research, and possible ways forward?

One-fifth of nonelderly Californians do not have access to job-based health insurance coverage.

PubMed

Lavarreda, Shana Alex; Cabezas, Livier

2010-11-01

Lack of job-based health insurance does not affect just workers, but entire families who depend on job-based coverage for their health care. This policy brief shows that in 2007 one-fifth of all Californians ages 0-64 who lived in households where at least one family member was employed did not have access to job-based coverage. Among adults with no access to job-based coverage through their own or a spouse's job, nearly two-thirds remained uninsured. In contrast, the majority of children with no access to health insurance through a parent obtained public health insurance, highlighting the importance of such programs. Low-income, Latino and small business employees were more likely to have no access to job-based insurance. Provisions enacted under national health care reform (the Patient Protection and Affordable Care Act of 2010) will aid some of these populations in accessing health insurance coverage.

Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency.

PubMed

Lee, Jonathan S; Pérez-Stable, Eliseo J; Gregorich, Steven E; Crawford, Michael H; Green, Adrienne; Livaudais-Toman, Jennifer; Karliner, Leah S

2017-08-01

Language barriers disrupt communication and impede informed consent for patients with limited English proficiency (LEP) undergoing healthcare procedures. Effective interventions for this disparity remain unclear. Assess the impact of a bedside interpreter phone system intervention on informed consent for patients with LEP and compare outcomes to those of English speakers. Prospective, pre-post intervention implementation study using propensity analysis. Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors. Installation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters. Primary predictor: pre- vs. post-implementation group; secondary predictor: post-implementation patients with LEP vs. English speakers. Primary outcomes: three central informed consent elements, patient-reported understanding of the (1) reasons for and (2) risks of the procedure and (3) having had all questions answered. We considered consent adequately informed when all three elements were met. We enrolled 152 Chinese- and Spanish-speaking patients with LEP (84 pre- and 68 post-implementation) and 86 English speakers. Post-implementation (vs. pre-implementation) patients with LEP were more likely to meet criteria for adequately informed consent (54% vs. 29%, p = 0.001) and, after propensity score adjustment, had significantly higher odds of adequately informed consent (AOR 2.56; 95% CI, 1.15-5.72) as well as of each consent element individually. However, compared to post-implementation English speakers, post-implementation patients with LEP had significantly lower adjusted odds of adequately informed consent (AOR, 0.38; 95% CI, 0.16-0.91). A bedside interpreter phone system intervention to increase rapid access to professional interpreters was associated with improvements in patient-reported informed consent and should be considered by hospitals seeking to improve

Assessing Health Care Access and Use among Indigenous Peoples in Alberta: a Systematic Review.

PubMed

Nader, Forouz; Kolahdooz, Fariba; Sharma, Sangita

2017-01-01

Alberta's Indigenous population is growing, yet health care access may be limited. This paper presents a comprehensive review on health care access among Indigenous populations in Alberta with a focus on the health care services use and barriers to health care access. Scientific databases (PubMed, EMBASE, CINAHL, and PsycINFO) and online search engines were systematically searched for studies and grey literature published in English between 2000 and 2013 examining health care services access, use and barriers to access among Indigenous populations in Alberta. Information on health care services use and barriers to use or access was synthesized based on the MOOSE guidelines. Overall, compared to non-Indigenous populations, health care use rates for hospital/emergency room services were higher and health care services use of outpatient specialists was lower among Indigenous peoples. Inadequate numbers of Indigenous health care professionals; a lack of cross-cultural training; fear of foreign environments; and distance from family and friends were barriers to health care use and access. Inequity in social determinants of health among Indigenous peoples and inadequate "health services with prevention approaches," may contribute to present health disparities between Indigenous and non-Indigenous populations in the province.

Adequate antiplatelet regimen in patients on chronic anti-vitamin K treatment undergoing percutaneous coronary intervention

PubMed Central

Brugaletta, Salvatore; Martin-Yuste, Victoria; Ferreira-González, Ignacio; Cola, Clarissa; Alvarez-Contreras, Luis; Antonio, Marta De; Garcia-Moll, Xavier; García-Picart, Joan; Martí, Vicens; Balcells-Iranzo, Jordi; Sabaté, Manel

2011-01-01

AIM: To investigate the impact of dual antiplatelet therapy (DAT) in patients on anti-vitamin K (AVK) regimen requiring percutaneous coronary intervention (PCI). METHODS: Between February 2006 and February 2008, 138 consecutive patients under chronic AVK treatment were enrolled in this registry. Of them, 122 received bare metal stent implantation and 16 received drug eluting stent implantation. The duration of DAT, on top of AVK treatment, was decided at the discretion of the clinician. Adequate duration of DAT was defined according to type of stent implanted and to its clinical indication. RESULTS: The baseline clinical characteristics of patients reflect their high risk, with high incidence of comorbid conditions (Charlson score ≥ 3 in 89% of the patients). At a mean follow-up of 17 ± 11 mo, 22.9% of patients developed a major adverse cardiac event (MACE): 12.6% died from cardiovascular disease and almost 6% had an acute myocardial infarction. Major hemorrhagic events were observed in 7.4%. Adequate DAT was obtained in only 44% of patients. In the multivariate analysis, no adequate DAT and Charlson score were the only independent predictors of MACE (both P = 0.02). CONCLUSION: Patients on chronic AVK therapy represent a high risk population and suffer from a high MACE rate after PCI. An adequate DAT regimen and absence of comorbid conditions are strongly associated with better clinical outcomes. PMID:22125672

Incorporating BIRD-based homodecoupling in the dual-optimized, inverted 1 JCC 1,n-ADEQUATE experiment.

PubMed

Saurí, Josep; Bermel, Wolfgang; Parella, Teodor; Thomas Williamson, R; Martin, Gary E

2018-03-13

1,n-ADEQUATE is a powerful NMR technique for elucidating the structure of proton-deficient small molecules that can help establish the carbon skeleton of a given molecule by providing long-range three-bond 13 C─ 13 C correlations. Care must be taken when using the experiment to identify the simultaneous presence of one-bond 13 C─ 13 C correlations that are not filtered out, unlike the HMBC experiment that has a low-pass J-filter to filter 1 J CH responses out. Dual-optimized, inverted 1 J CC 1,n-ADEQUATE is an improved variant of the experiment that affords broadband inversion of direct responses, obviating the need to take additional steps to identify these correlations. Even though ADEQUATE experiments can now be acquired in a reasonable amount of experimental time if a cryogenic probe is available, low sensitivity is still the main impediment limiting the application of this elegant experiment. Here, we wish to report a further refinement that incorporates real-time bilinear rotation decoupling-based homodecoupling methodology into the dual-optimized, inverted 1 J CC 1,n-ADEQUATE pulse sequence. Improved sensitivity and resolution are achieved by collapsing homonuclear proton-proton couplings from the observed multiplets for most spin systems. The application of the method is illustrated with several model compounds. Copyright © 2018 John Wiley & Sons, Ltd.

Rectal cancer delivery of radiotherapy in adequate time and with adequate dose is influenced by treatment center, treatment schedule, and gender and is prognostic parameter for local control: Results of study CAO/ARO/AIO-94

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

Fietkau, Rainer; Roedel, Claus; Hohenberger, Werner

2007-03-15

Purpose: The impact of the delivery of radiotherapy (RT) on treatment results in rectal cancer patients is unknown. Methods and Materials: The data from 788 patients with rectal cancer treated within the German CAO/AIO/ARO-94 phase III trial were analyzed concerning the impact of the delivery of RT (adequate RT: minimal radiation RT dose delivered, 4300 cGy for neoadjuvant RT or 4700 cGy for adjuvant RT; completion of RT in <44 days for neoadjuvant RT or <49 days for adjuvant RT) in different centers on the locoregional recurrence rate (LRR) and disease-free survival (DFS) at 5 years. The LRR, DFS, andmore » delivery of RT were analyzed as endpoints in multivariate analysis. Results: A significant difference was found between the centers and the delivery of RT. The overall delivery of RT was a prognostic factor for the LRR (no RT, 29.6% {+-} 7.8%; inadequate RT, 21.2% {+-} 5.6%; adequate RT, 6.8% {+-} 1.4%; p = 0.0001) and DFS (no RT, 55.1% {+-} 9.1%; inadequate RT, 57.4% {+-} 6.3%; adequate RT, 69.1% {+-} 2.3%; p = 0.02). Postoperatively, delivery of RT was a prognostic factor for LRR on multivariate analysis (together with pathologic stage) but not for DFS (independent parameters, pathologic stage and age). Preoperatively, on multivariate analysis, pathologic stage, but not delivery of RT, was an independent prognostic parameter for LRR and DFS (together with adequate chemotherapy). On multivariate analysis, the treatment center, treatment schedule (neoadjuvant vs. adjuvant RT), and gender were prognostic parameters for adequate RT. Conclusion: Delivery of RT should be regarded as a prognostic factor for LRR in rectal cancer and is influenced by the treatment center, treatment schedule, and patient gender.« less

You cannot prevent a disease; you only treat diseases when they occur: knowledge, attitudes and practices to water-health in a rural Kenyan community.

PubMed

Levison, M M; Elliott, S J; Karanja, D M S; Schuster-Wallace, C J; Harrington, D W

2011-06-01

Almost 1 billion individuals lack access to improved water supplies, with 2.6 billion lacking adequate sanitation. This leads to the propagation of multiple waterborne diseases. The objective of this study was to explore local knowledge, attitudes and practices to understand the mechanisms and pre-conditions for sustainable uptake and use of these facilities. Data collection took place in a rural Kenyan community in September 2009. A qualitative approach was taken, with 4 focus groups and 25 in-depth interviews conducted. Participant characteristics varied by age, gender, education, marital status, employment and community standing. Few participants reported current access to improved water and sanitation facilities. Though they expressed desire for latrines and water sources, barriers including lack of funds and social capital, decrease the ability for installation. Participants understood that there was a link between the quality of water and their health, however, perceived benefits of current contaminated sources outweigh the potential health impacts and proliferate their continued use. While water-health links are understood to varying degrees within the community, contextual (physical environment), compositional (individual) and collective (community) factors interact to influence health. Community challenges, such as lack of unity, lack of education and lack control were identified as the main barriers to initiating change, despite a desire for increased access to safe water and sanitation.

Use of Critical Access Hospital Emergency Rooms by Patients with Mental Health Symptoms

ERIC Educational Resources Information Center

Hartley, David; Ziller, Erika C.; Loux, Stephenie L.; Gale, John A.; Lambert, David; Yousefian, Anush E.

2007-01-01

Context: National data demonstrate that mental health (MH) visits to the emergency room (ER) comprise a small, but not inconsequential, proportion of all visits; however, we lack a rural picture of this issue. Purpose: This study investigates the use of critical access hospital (CAH) ERs by patients with MH problems to understand the role these…

Access to safe legal abortion in Malaysia: women's insights and health sector response.

PubMed

Low, Wah-Yun; Tong, Wen-Ting; Wong, Yut-Lin; Jegasothy, Ravindran; Choong, Sim-Poey

2015-01-01

Malaysia has an abortion law, which permits termination of pregnancy to save a woman's life and to preserve her physical and mental health (Penal Code Section 312, amended in 1989). However, lack of clear interpretation and understanding of the law results in women facing difficulties in accessing abortion information and services. Some health care providers were unaware of the legalities of abortion in Malaysia and influenced by their personal beliefs with regard to provision of abortion services. Accessibility to safer abortion techniques is also an issue. The development of the 2012 Guidelines on Termination of Pregnancy and Guidelines for Management of Sexual and Reproductive Health among Adolescents in Health Clinics by the Ministry of Health, Malaysia, is a step forward toward increasing women's accessibility to safe abortion services in Malaysia. This article provides an account of women's accessibility to abortion in Malaysia and the health sector response in addressing the barriers. © 2014 APJPH.

Factors Affecting the Presence of Adequately Iodized Salt at Home in Wolaita, Southern Ethiopia: Community Based Study.

PubMed

Kumma, Wondimagegn Paulos; Haji, Yusuf; Abdurahmen, Junayde; Mehretie Adinew, Yohannes

2018-01-01

Universal use of iodized salt is a simple and inexpensive method to prevent and eliminate iodine deficiency disorders like mental retardation. However, little is known about the level of adequately iodized salt consumption in the study area. Therefore, the study was aimed at assessing the proportion of households having adequately iodized salt and associated factors in Wolaita Sodo town and its peripheries, Southern Ethiopia. A cross-sectional study was conducted from May 10 to 20, 2016, in 441 households in Sodo town and its peripheries. Samples were selected using the systematic sampling technique. An iodometric titration method (AOAC, 2000) was used to analyze the iodine content of the salt samples. Data entry and analysis were done using Epi Info version 3.5.1 and SPSS version 16, respectively. The female to male ratio of the respondents was 219. The mean age of the respondents was 30.2 (±7.3 SD). The proportion of households having adequately iodized salt was 37.7%, with 95% CI of 33.2% to 42.2%. Not exposing salt to sunlight with [OR: 3.75; 95% CI: 2.14, 6.57], higher monthly income [OR: 3.71; 95% CI: 1.97-7.01], and formal education of respondents with [OR: 1.75; 95% CI: 1.14, 2.70] were found associated with the presence of adequately iodized salt at home. This study revealed low levels of households having adequately iodized salt in Wolaita Sodo town and its peripheries. The evidence here shows that there is a need to increase the supply of adequately iodized salt to meet the goal for monitoring progress towards sustainable elimination of IDD.

Factors Affecting the Presence of Adequately Iodized Salt at Home in Wolaita, Southern Ethiopia: Community Based Study

PubMed Central

Abdurahmen, Junayde

2018-01-01

Background Universal use of iodized salt is a simple and inexpensive method to prevent and eliminate iodine deficiency disorders like mental retardation. However, little is known about the level of adequately iodized salt consumption in the study area. Therefore, the study was aimed at assessing the proportion of households having adequately iodized salt and associated factors in Wolaita Sodo town and its peripheries, Southern Ethiopia. Methods A cross-sectional study was conducted from May 10 to 20, 2016, in 441 households in Sodo town and its peripheries. Samples were selected using the systematic sampling technique. An iodometric titration method (AOAC, 2000) was used to analyze the iodine content of the salt samples. Data entry and analysis were done using Epi Info version 3.5.1 and SPSS version 16, respectively. Result The female to male ratio of the respondents was 219. The mean age of the respondents was 30.2 (±7.3 SD). The proportion of households having adequately iodized salt was 37.7%, with 95% CI of 33.2% to 42.2%. Not exposing salt to sunlight with [OR: 3.75; 95% CI: 2.14, 6.57], higher monthly income [OR: 3.71; 95% CI: 1.97–7.01], and formal education of respondents with [OR: 1.75; 95% CI: 1.14, 2.70] were found associated with the presence of adequately iodized salt at home. Conclusion This study revealed low levels of households having adequately iodized salt in Wolaita Sodo town and its peripheries. The evidence here shows that there is a need to increase the supply of adequately iodized salt to meet the goal for monitoring progress towards sustainable elimination of IDD. PMID:29765978

Accessing directorships: comparison of views of Canadian and Australian women directors.

PubMed

Sheridan, Alison

2002-02-01

Compared are views of Canadian and Australian women directors concerning the difficulties women face in accessing the most privileged level of management-directorships of companies. The Canadian data are from a study of 278 women directors of corporate boards in Canada while the Australian results are from a study of 47 women directors of publicly listed companies in Australia. Despite the different time periods and geographical locations in which the studies were carried out, the profiles and responses of the two groups are quite similar. Both groups believe the current mix of directors is not adequate and that barriers still exist in nominating women to boards.

Prenatal zinc supplementation of zinc-adequate rats adversely affects immunity in offspring

USDA-ARS?s Scientific Manuscript database

We previously showed that zinc (Zn) supplementation of Zn-adequate dams induced immunosuppressive effects that persist in the offspring after weaning. We investigated whether the immunosuppressive effects were due to in utero exposure and/or mediated via milk using a cross-fostering design. Pregnant...

Fast access to the CMS detector condition data employing HTML5 technologies

NASA Astrophysics Data System (ADS)

Pierro, Giuseppe Antonio; Cavallari, Francesca; Di Guida, Salvatore; Innocente, Vincenzo

2011-12-01

This paper focuses on using HTML version 5 (HTML5) for accessing condition data for the CMS experiment, evaluating the benefits and risks posed by the use of this technology. According to the authors of HTML5, this technology attempts to solve issues found in previous iterations of HTML and addresses the needs of web applications, an area previously not adequately covered by HTML. We demonstrate that employing HTML5 brings important benefits in terms of access performance to the CMS condition data. The combined use of web storage and web sockets allows increasing the performance and reducing the costs in term of computation power, memory usage and network bandwidth for client and server. Above all, the web workers allow creating different scripts that can be executed using multi-thread mode, exploiting multi-core microprocessors. Web workers have been employed in order to substantially decrease the web page rendering time to display the condition data stored in the CMS condition database.

Lateral-access Class II restoration using resin-modified glass-ionomer or silver-cermet cement.

PubMed

Croll, T P

1995-02-01

Direct-access preparation of a carious proximal surface is perhaps the most conservative approach to restoration. Physical properties and handling characteristics of silver amalgam and of resin composite and lack of fluoride ion release make these materials unsuitable for direct buccal- or lingual-access proximal restoration. Insufficient strengths and radiolucency of self-hardening glass-ionomer cements preclude their use for Class II restorations. However, glass-ionomer silver-cermet cement and some resin-modified glass-ionomer materials are proving useful for non-stress-bearing Class II restorations and may have applications in preventive dentistry. This article describes lateral-access Class II restoration with modified glass-ionomer cements. Emphasis is placed on careful handling of materials, maintenance of an ideal operative field, and conservation of tooth structure.

Transportation Limitation Access to the Small Islands (Case Study: Banggai Laut Regency)

NASA Astrophysics Data System (ADS)

Sunarti, S.

2018-02-01

Indonesia is as an archipelago and maritime country, the large number of Islands owned and scattered in all directions makes a challenge for the Government in equitable development. Development in Indonesia has not been spread evenly and tends to focus on the big island, while the smaller islands are still far behind and lack of government attention. One of them is the lack of infrastructure especially the access to the small islands. Among the small islands in Indonesia with minimal maritime infrastructure or transportation is Banggai Laut Regency, Central Sulawesi Province. This Regency is a new regency that separate itself from its previous regency that is Banggai Kepulauan Regency in about 4 years ago. For the development of the Banggai Laut Regency, access to reach that regency is quite difficult. Therefore, the aim of this research is to find infrastructure development strategy to support the development of Banggai Laut Regency. The research method used was the concurrent model mixed method. Data collection method was done with primary data through field observation and interview, secondary data through literature and document review. Analytical techniques used are qualitative descriptive and Map Overlay techniques using GIS to describe the characteristics of study areas and spatial relationships between islands. The results of this research conclude that the Banggai Laut Regency requires infrastructure development particularly maritime transportation to enhance accessibility of the community headed to Banggi Laut Regency or headed to another island from the Banggai Laut Regency.

Disclosure, stigma of HIV positive child and access to early infant diagnosis in the rural communities of OR Tambo District, South Africa: a qualitative exploration of maternal perspective.

PubMed

Adeniyi, Vincent Oladele; Thomson, Elza; Ter Goon, Daniel; Ajayi, Idowu Anthony

2015-08-26

Despite the overwhelming evidence confirming the morbidity and mortality benefits of early initiation of highly active anti-retroviral therapy (HAART) in HIV-infected infants, some children are still disadvantaged from gaining access to care. The understanding of the maternal perspective on early infant HIV diagnosis and prompt initiation of HAART has not been adequately explored, especially in the rural communities of South Africa. This study explores the perspectives of mothers of HIV-exposed infants with regard to early infant diagnosis (EID) through a lens of social and structural barriers to accessing primary healthcare in OR Tambo district, Eastern Cape Province, South Africa. In this qualitative study, we conducted semi-structured interviews at two primary healthcare centres in the King Sabata Dalindyebo Municipality of the OR Tambo district, South Africa. Twenty-four purposive sample of mothers of HIV-exposed infants took part in the study. Interviews were tape-recorded, transcribed and field notes were obtained. The findings were triangulated with two focus group discussions in order to enrich and validate the qualitative data. Thematic content analysis was employed to analyse the data. The participants have fairly good knowledge of mother-to-child transmission of HIV and the risks during pregnancy, delivery and breastfeeding. The majority of participants were confident of the protection offered by anti-retroviral drugs provided during pregnancy, however, lack knowledge of optimal time for early infant diagnosis of HIV. Reasons for not accessing EID included fear of finding out that their child is HIV positive, feelings of guilt and/or shame and embarrassment with respect to raising an HIV infected infant. Personal experiences of HIV diagnosis and HAART were associated with participants' attitudes and beliefs toward care-seeking behaviours. Stigma resulting from their own disclosure to others reduced their likelihood of recommending EID to other members of

Balancing investments in Federally Qualified Health Centers and Medicaid for improved access and coverage in Pennsylvania.

PubMed

Griffin, Paul M; Lee, Hyunji; Scherrer, Christina; Swann, Julie L

2014-12-01

Two common health disparities in the US include a lack of access to care and a lack of insurance coverage. To help address these disparities, healthcare reform will provide $11B to expand Federally Qualified Health Centers (FQHCs) over the next 5 years. In 2014, Medicaid rules will be modified so that more people will become eligible. There are, however, important tradeoffs in the investment in these two programs. We find a balanced investment between FQHC expansion and relaxing Medicaid eligibility to improve both access (by increasing the number of FQHCs) and coverage (by FQHC and Medicaid expansion) for the state of Pennsylvania. The comparison is achieved by integrating multi-objective mathematical models with several public data sets that allow for specific estimations of healthcare need. Demand is estimated based on current access and coverage status in order to target groups to be considered preferentially. Results show that for Pennsylvania, FQHCs are more cost effective than Medicaid if we invest all of the resources in just one policy. However, we find a better investment point balancing those two policies. This point is approximately where the additional expenses incurred from relaxing Medicaid eligibility equals the investment in FQHC expansion.

Protecting Patient Records from Unwarranted Access

NASA Astrophysics Data System (ADS)

Gardner, Ryan; Garera, Sujata; Rubin, Aviel D.; Rajan, Anand; Rozas, Carlos V.; Sastry, Manoj

Securing access to medical information is vital to protecting patient privacy. However, Electronic Patient Record (EPR) systems are vulnerable to a number of inside and outside threats. Adversaries can compromise EPR client machines to obtain a variety of highly sensitive information including valid EPR login credentials, without detection. Furthermore, medical staff can covertly view records of their choosing for personal interest or more malicious purposes. In particular, we observe that the lack of integrity measurement and auditability in these systems creates a potential threat to the privacy of patient information. We explore the use of virtualization and trusted computing hardware to address these problems. We identify open problems and encourage further research in the area.

'Predatory' open access: a longitudinal study of article volumes and market characteristics.

PubMed

Shen, Cenyu; Björk, Bo-Christer

2015-10-01

A negative consequence of the rapid growth of scholarly open access publishing funded by article processing charges is the emergence of publishers and journals with highly questionable marketing and peer review practices. These so-called predatory publishers are causing unfounded negative publicity for open access publishing in general. Reports about this branch of e-business have so far mainly concentrated on exposing lacking peer review and scandals involving publishers and journals. There is a lack of comprehensive studies about several aspects of this phenomenon, including extent and regional distribution. After an initial scan of all predatory publishers and journals included in the so-called Beall's list, a sample of 613 journals was constructed using a stratified sampling method from the total of over 11,000 journals identified. Information about the subject field, country of publisher, article processing charge and article volumes published between 2010 and 2014 were manually collected from the journal websites. For a subset of journals, individual articles were sampled in order to study the country affiliation of authors and the publication delays. Over the studied period, predatory journals have rapidly increased their publication volumes from 53,000 in 2010 to an estimated 420,000 articles in 2014, published by around 8,000 active journals. Early on, publishers with more than 100 journals dominated the market, but since 2012 publishers in the 10-99 journal size category have captured the largest market share. The regional distribution of both the publisher's country and authorship is highly skewed, in particular Asia and Africa contributed three quarters of authors. Authors paid an average article processing charge of 178 USD per article for articles typically published within 2 to 3 months of submission. Despite a total number of journals and publishing volumes comparable to respectable (indexed by the Directory of Open Access Journals) open access

"I just answer 'yes' to everything they say": access to health care for deaf people in Worcester, South Africa and the politics of exclusion.

PubMed

Kritzinger, Janis; Schneider, Marguerite; Swartz, Leslie; Braathen, Stine Hellum

2014-03-01

To explore whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients. Qualitative methodology using semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa. Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, overprotectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services. These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients. Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Access to and use of research by rural nurses.

PubMed

Winters, C A; Lee, H J; Besel, J; Strand, A; Echeverri, R; Jorgensen, K P; Dea, J E

2007-01-01

participated in the study. The nurses' ages ranged from 31-72 years and their experience in nursing spanned 3-50 years with a range of 1 to 35 years in rural nursing. The interviews revealed that most of the nurses used the term 'research' to mean 'gathering information'. When asked how often they used 'research' the responses ranged from 2-3 times per day to 2-3 times per month. The preferred means of obtaining information was asking a colleague. Additional resources included work-place journals, books, in-services, conferences and the internet. Twenty-three of the nurses reported having internet access at work; 25 had internet access at home. Supportive supervisors and articles in general nursing journals were identified as helpful. Barriers to using research included: lack of knowledge of research methods; lack of time at work or at home to look up information; and the lack of computers and internet access on the nursing units. When computers were available, the nurses reported that poor computer literacy decreased their ability to quickly find and evaluate information. Additional barriers included diminishing financial support from employers and the long travel distances required to attend conferences. The nurses reported finding little clinical research specifically related to rural practice. Education and mentorship is needed about how to evaluate the types and strength of evidence, access research using the internet, interpret findings, and incorporate evidence in clinical practice. Interventions that foster the appreciation and use of research by staff nurses and managers are needed in order to build an evidence based culture. Research is needed, specifically as related to rural clinical practice.

High prevalence of iodine deficiency in pregnant women living in adequate iodine area

PubMed Central

Mioto, Verônica Carneiro Borges; Monteiro, Ana Carolina de Castro Nassif Gomes; de Camargo, Rosalinda Yossie Asato; Borel, Andréia Rodrigues; Catarino, Regina Maria; Kobayashi, Sergio; Chammas, Maria Cristina; Marui, Suemi

2018-01-01

Objectives Iodine deficiency during pregnancy is associated with obstetric and neonatal adverse outcomes. Serum thyroglobulin (sTg) and thyroid volume (TV) are optional tools to urinary iodine concentration (UIC) for defining iodine status. This cross-sectional study aims to evaluate the iodine status of pregnant women living in iodine-adequate area by spot UIC and correlation with sTg, TV and thyroid function. Methods Two hundred and seventy-three pregnant women were evaluated at three trimesters. All had no previous thyroid disease, no iodine supplementation and negative thyroperoxidase and thyroglobulin antibodies. Thyroid function and sTg were measured using electrochemiluminescence immunoassays. TV was determined by ultrasonography; UIC was determined using a modified Sandell–Kolthoff method. Results Median UIC was 146 µg/L, being 52% iodine deficient and only 4% excessive. TSH values were 1.50 ± 0.92, 1.50 ± 0.92 and 1.91 ± 0.96 mIU/L, respectively, in each trimester (P = 0.001). sTg did not change significantly during trimesters with median 11.2 ng/mL and only 3.3% had above 40 ng/mL. Mean TV was 9.3 ± 3.4 mL, which positively correlated with body mass index, but not with sTg. Only 4.5% presented with goitre. When pregnant women were categorized as iodine deficient (UIC < 150 µg/L), adequate (≥150 and <250 µg/L) and excessive (≥250 µg/L), sTg, thyroid hormones and TV at each trimester showed no statistical differences. Conclusions Iodine deficiency was detected frequently in pregnant women living in iodine-adequate area. sTg concentration and TV did not correlate to UIC. Our observation also demonstrated that the Brazilian salt-iodization programme prevents deficiency, but does not maintain iodine status within adequate and recommended ranges for pregnant women. PMID:29700098

High prevalence of iodine deficiency in pregnant women living in adequate iodine area.

PubMed

Mioto, Verônica Carneiro Borges; Monteiro, Ana Carolina de Castro Nassif Gomes; de Camargo, Rosalinda Yossie Asato; Borel, Andréia Rodrigues; Catarino, Regina Maria; Kobayashi, Sergio; Chammas, Maria Cristina; Marui, Suemi

2018-05-01

Iodine deficiency during pregnancy is associated with obstetric and neonatal adverse outcomes. Serum thyroglobulin (sTg) and thyroid volume (TV) are optional tools to urinary iodine concentration (UIC) for defining iodine status. This cross-sectional study aims to evaluate the iodine status of pregnant women living in iodine-adequate area by spot UIC and correlation with sTg, TV and thyroid function. Two hundred and seventy-three pregnant women were evaluated at three trimesters. All had no previous thyroid disease, no iodine supplementation and negative thyroperoxidase and thyroglobulin antibodies. Thyroid function and sTg were measured using electrochemiluminescence immunoassays. TV was determined by ultrasonography; UIC was determined using a modified Sandell-Kolthoff method. Median UIC was 146 µg/L, being 52% iodine deficient and only 4% excessive. TSH values were 1.50 ± 0.92, 1.50 ± 0.92 and 1.91 ± 0.96 mIU/L, respectively, in each trimester ( P  = 0.001). sTg did not change significantly during trimesters with median 11.2 ng/mL and only 3.3% had above 40 ng/mL. Mean TV was 9.3 ± 3.4 mL, which positively correlated with body mass index, but not with sTg. Only 4.5% presented with goitre.When pregnant women were categorized as iodine deficient (UIC < 150 µg/L), adequate (≥150 and <250 µg/L) and excessive (≥250 µg/L), sTg, thyroid hormones and TV at each trimester showed no statistical differences. Iodine deficiency was detected frequently in pregnant women living in iodine-adequate area. sTg concentration and TV did not correlate to UIC. Our observation also demonstrated that the Brazilian salt-iodization programme prevents deficiency, but does not maintain iodine status within adequate and recommended ranges for pregnant women. © 2018 The authors.

Factors that impact access to ongoing health care for First Nation children with a chronic condition.

PubMed

Coombes, Julieann; Hunter, Kate; Mackean, Tamara; Holland, Andrew J A; Sullivan, Elizabeth; Ivers, Rebecca

2018-06-14

Access to multidisciplinary health care services for First Nation children with a chronic condition is critical for the child's health and well-being, but disparities and inequality in health care systems have been almost impossible to eradicate for First Nation people globally. The objective of this review is to identify the factors that impact access and ongoing care for First Nation children globally with a chronic condition. An extensive systematic search was conducted of nine electronic databases to identify primary studies that explored factors affecting access to ongoing services for First Nation children with a chronic disease or injury. Due to the heterogeneity of included studies the Mixed Method Appraisal Tool (MMAT) was used to assess study quality. A total of six studies from Australia, New Zealand and Canada were identified and included in this review. Four studies applied qualitative approaches using in-depth semi structured interviews, focus groups and community fora. Two of the six studies used quantitative approaches. Facilitators included the utilisation of First Nation liaison workers or First Nation Health workers. Key barriers that emerged included lack of culturally appropriate health care, distance, language and cultural barriers, racism, the lack of incorporation of First Nation workers in services, financial difficulties and transport issues. There are few studies that have identified positive factors that facilitate access to health care for First Nation children. There is an urgent need to develop programs and processes to facilitate access to appropriate health care that are inclusive of the cultural needs of First Nation children.

Adequate trust avails, mistaken trust matters: on the moral responsibility of doctors as proxies for patients' trust in biobank research.

PubMed

Johnsson, Linus; Helgesson, Gert; Hansson, Mats G; Eriksson, Stefan

2013-11-01

In Sweden, most patients are recruited into biobank research by non-researcher doctors. Patients' trust in doctors may therefore be important to their willingness to participate. We suggest a model of trust that makes sense of such transitions of trust between domains and distinguishes adequate trust from mistaken trust. The unique position of doctors implies, we argue, a Kantian imperfect duty to compensate for patients' mistaken trust. There are at least three kinds of mistaken trust, each of which requires a different set of countermeasures. First, trust is mistaken when necessary competence is lacking; the competence must be developed or the illusion dispelled. Second, trust is irrational whenever the patient is mistaken about his actual reasons for trusting. Care must therefore be taken to support the patient's reasoning and moral agency. Third, some patients inappropriately trust doctors to recommend only research that will benefit them directly. Such trust should be counteracted by nurturing a culture where patients expect to be asked occasionally to contribute to the common good. © 2012 John Wiley & Sons Ltd.

Rethinking ADA signage standards for low-vision accessibility.

PubMed

Arditi, Aries

2017-05-01

Americans With Disabilities Act (ADA) and International Code Council (ICC) standards for accessible buildings and facilities affect design and construction of all new and renovated buildings throughout the United States, and form the basis for compliance with the ADA. While these standards may result in acceptable accessibility for people who are fully blind, they fall far short of what they could and should accomplish for those with low vision. In this article I critique the standards, detailing their lack of evidence base and other shortcomings. I suggest that simply making existing requirements stricter (e.g., by mandating larger letter size or higher contrasts) will not ensure visual accessibility and therefore cannot act as a valid basis for compliance with the law. I propose two remedies. First, requirements for visual characteristics of signs intended to improve access for those with low vision should be expressed not in terms of physical features, such as character height and contrast, but rather in terms of the distance at which a sign can be read by someone with nominally normal (20/20) visual acuity under expected lighting conditions for the installed environment. This would give sign designers greater choice in design parameters but place on them the burden of ensuring legibility. Second, mounting of directional signs, which are critical for effective and efficient wayfinding, should be required to be in consistent and approachable locations so that those with reduced acuity may view them at close distance.

Rethinking ADA signage standards for low-vision accessibility

PubMed Central

Arditi, Aries

2017-01-01

Americans With Disabilities Act (ADA) and International Code Council (ICC) standards for accessible buildings and facilities affect design and construction of all new and renovated buildings throughout the United States, and form the basis for compliance with the ADA. While these standards may result in acceptable accessibility for people who are fully blind, they fall far short of what they could and should accomplish for those with low vision. In this article I critique the standards, detailing their lack of evidence base and other shortcomings. I suggest that simply making existing requirements stricter (e.g., by mandating larger letter size or higher contrasts) will not ensure visual accessibility and therefore cannot act as a valid basis for compliance with the law. I propose two remedies. First, requirements for visual characteristics of signs intended to improve access for those with low vision should be expressed not in terms of physical features, such as character height and contrast, but rather in terms of the distance at which a sign can be read by someone with nominally normal (20/20) visual acuity under expected lighting conditions for the installed environment. This would give sign designers greater choice in design parameters but place on them the burden of ensuring legibility. Second, mounting of directional signs, which are critical for effective and efficient wayfinding, should be required to be in consistent and approachable locations so that those with reduced acuity may view them at close distance. PMID:28510625

Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys.

PubMed

Knowles, Jacky M; Garrett, Greg S; Gorstein, Jonathan; Kupka, Roland; Situma, Ruth; Yadav, Kapil; Yusufali, Rizwan; Pandav, Chandrakant; Aaron, Grant J

2017-05-01

Background: Household coverage with iodized salt was assessed in 10 countries that implemented Universal Salt Iodization (USI). Objective: The objective of this paper was to summarize household coverage data for iodized salt, including the relation between coverage and residence type and socioeconomic status (SES). Methods: A review was conducted of results from cross-sectional multistage household cluster surveys with the use of stratified probability proportional to size design in Bangladesh, Ethiopia, Ghana, India, Indonesia, Niger, the Philippines, Senegal, Tanzania, and Uganda. Salt iodine content was assessed with quantitative methods in all cases. The primary indicator of coverage was percentage of households that used adequately iodized salt, with an additional indicator for salt with some added iodine. Indicators of risk were SES and residence type. We used 95% CIs to determine significant differences in coverage. Results: National household coverage of adequately iodized salt varied from 6.2% in Niger to 97.0% in Uganda. For salt with some added iodine, coverage varied from 52.4% in the Philippines to 99.5% in Uganda. Coverage with adequately iodized salt was significantly higher in urban than in rural households in Bangladesh (68.9% compared with 44.3%, respectively), India (86.4% compared with 69.8%, respectively), Indonesia (59.3% compared with 51.4%, respectively), the Philippines (31.5% compared with 20.2%, respectively), Senegal (53.3% compared with 19.0%, respectively), and Tanzania (89.2% compared with 57.6%, respectively). In 7 of 8 countries with data, household coverage of adequately iodized salt was significantly higher in high- than in low-SES households in Bangladesh (58.8% compared with 39.7%, respectively), Ghana (36.2% compared with 21.5%, respectively), India (80.6% compared with 70.5%, respectively), Indonesia (59.9% compared with 45.6%, respectively), the Philippines (39.4% compared with 17.3%, respectively), Senegal (50.7% compared

Access to Orthopaedic Surgical Care in Northern Tanzania: A Modelling Study.

PubMed

Premkumar, Ajay; Ying, Xiaohan; Mack Hardaker, W; Massawe, Honest H; Mshahaba, David J; Mandari, Faiton; Pallangyo, Anthony; Temu, Rogers; Masenga, Gileard; Spiegel, David A; Sheth, Neil P

2018-04-25

The global burden of musculoskeletal disease and resulting disability is enormous and is expected to increase over the next few decades. In the world's poorest regions, the paucity of information defining and quantifying the current state of access to orthopaedic surgical care is a major problem in developing effective solutions. This study estimates the number of individuals in Northern Tanzania without adequate access to orthopaedic surgical services. A chance tree was created to model the probability of access to orthopaedic surgical services in the Northern Tanzanian regions of Arusha, Kilimanjaro, Tanga, Singida, and Manyara, with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. Timeliness was estimated by the proportion of people living within a 4-h driving distance from a hospital with an orthopaedic surgeon, capacity by comparing number of surgeries performed to the number of surgeries indicated, safety by applying WHO Emergency and Essential Surgical Care infrastructure and equipment checklists, and affordability by approximating the proportion of the population protected from catastrophic out-of-pocket healthcare expenditure. We accounted for uncertainty in our model with one-way and probabilistic sensitivity analyses. Data sources included the Tanzanian National Bureau of Statistics and Ministry of Finance, World Bank, World Health Organization, New Zealand Ministry of Health, Google Corporation, NASA population estimator, and 2015 hospital records from Kilimanjaro Christian Medical Center, Machame Hospital, Nkoroanga Hospital, Mt. Meru Hospital, and Arusha Lutheran Medical Center. Under the most conservative assumptions, more than 90% of the Northern Tanzanian population does not have access to orthopaedic surgical services. There is a near absence of access to orthopaedic surgical care in Northern Tanzania. These findings utilize more precise country and region-specific data and are consistent with prior published

Waiting for attention and care: birthing accounts of women in rural Tanzania who developed obstetric fistula as an outcome of labour.

PubMed

Mselle, Lilian T; Kohi, Thecla W; Mvungi, Abu; Evjen-Olsen, Bjørg; Moland, Karen Marie

2011-10-21

Obstetric fistula is a physically and socially disabling obstetric complication that affects about 3,000 women in Tanzania every year. The fistula, an opening that forms between the vagina and the bladder and/or the rectum, is most frequently caused by unattended prolonged labour, often associated with delays in seeking and receiving appropriate and adequate birth care. Using the availability, accessibility, acceptability and quality of care (AAAQ) concept and the three delays model, this article provides empirical knowledge on birth care experiences of women who developed fistula after prolonged labour. We used a mixed methods approach to explore the birthing experiences of women affected by fistula and the barriers to access adequate care during labour and delivery. Sixteen women were interviewed for the qualitative study and 151 women were included in the quantitative survey. All women were interviewed at the Comprehensive Community Based Rehabilitation Tanzania in Dar es Salaam and Bugando Medical Centre in Mwanza. Women experienced delays both before and after arriving at a health facility. Decisions on where to seek care were most often taken by husbands and mothers-in-law (60%). Access to health facilities providing emergency obstetric care was inadequate and transport was a major obstacle. About 20% reported that they had walked or were carried to the health facility. More than 50% had reported to a health facility after two or more days of labour at home. After arrival at a health facility women experienced lack of supportive care, neglect, poor assessment of labour and lack of supervision. Their birth accounts suggest unskilled birth care and poor referral routines. This study reveals major gaps in access to and provision of emergency obstetric care. It illustrates how poor quality of care at health facilities contributes to delays that lead to severe birth injuries, highlighting the need to ensure women's rights to accessible, acceptable and adequate

Waiting for attention and care: birthing accounts of women in rural Tanzania who developed obstetric fistula as an outcome of labour

PubMed Central

2011-01-01

Background Obstetric fistula is a physically and socially disabling obstetric complication that affects about 3,000 women in Tanzania every year. The fistula, an opening that forms between the vagina and the bladder and/or the rectum, is most frequently caused by unattended prolonged labour, often associated with delays in seeking and receiving appropriate and adequate birth care. Using the availability, accessibility, acceptability and quality of care (AAAQ) concept and the three delays model, this article provides empirical knowledge on birth care experiences of women who developed fistula after prolonged labour. Methods We used a mixed methods approach to explore the birthing experiences of women affected by fistula and the barriers to access adequate care during labour and delivery. Sixteen women were interviewed for the qualitative study and 151 women were included in the quantitative survey. All women were interviewed at the Comprehensive Community Based Rehabilitation Tanzania in Dar es Salaam and Bugando Medical Centre in Mwanza. Results Women experienced delays both before and after arriving at a health facility. Decisions on where to seek care were most often taken by husbands and mothers-in-law (60%). Access to health facilities providing emergency obstetric care was inadequate and transport was a major obstacle. About 20% reported that they had walked or were carried to the health facility. More than 50% had reported to a health facility after two or more days of labour at home. After arrival at a health facility women experienced lack of supportive care, neglect, poor assessment of labour and lack of supervision. Their birth accounts suggest unskilled birth care and poor referral routines. Conclusions This study reveals major gaps in access to and provision of emergency obstetric care. It illustrates how poor quality of care at health facilities contributes to delays that lead to severe birth injuries, highlighting the need to ensure women's rights to

Survey Instruments to Assess Patient Experiences With Access and Coordination Across Health Care Settings: Available and Needed Measures.

PubMed

Quinn, Martha; Robinson, Claire; Forman, Jane; Krein, Sarah L; Rosland, Ann-Marie

2017-07-01

Improving access can increase the providers a patient sees, and cause coordination challenges. For initiatives that increase care across health care settings, measuring patient experiences with access and care coordination will be crucial. Map existing survey measures of patient experiences with access and care coordination expected to be relevant to patients accessing care across settings. Preliminarily examine whether aspects of access and care coordination important to patients are represented by existing measures. Structured literature review of domains and existing survey measures related to access and care coordination across settings. Survey measures, and preliminary themes from semistructured interviews of 10 patients offered VA-purchased Community Care, were mapped to identified domains. We identified 31 existing survey instruments with 279 items representing 6 access and 5 care coordination domains relevant to cross-system care. Domains frequently assessed by existing measures included follow-up coordination, primary care access, cross-setting coordination, and continuity. Preliminary issues identified in interviews, but not commonly assessed by existing measures included: (1) acceptability of distance to care site given patient's clinical situation; (2) burden on patients to access and coordinate care and billing; (3) provider familiarity with Veteran culture and VA processes. Existing survey instruments assess many aspects of patient experiences with access and care coordination in cross-system care. Systems assessing cross-system care should consider whether patient surveys accurately reflect the level of patients' concerns with burden to access and coordinate care, and adequately reflect the impact of clinical severity and cultural familiarity on patient preferences.

Poor drug adherence and lack of awareness of hypertension among hypertensive stroke patients in Kampala, Uganda: a cross sectional study.

PubMed

Mugwano, Isaac; Kaddumukasa, Mark; Mugenyi, Levi; Kayima, James; Ddumba, Edward; Sajatovic, Martha; Sila, Cathy; DeGeorgia, Michael; Katabira, Elly

2016-01-02

Raised blood pressure (BP) remains an important risk factor for cardiovascular diseases such as stroke. Adherence to therapeutic recommendations especially antihypertensive drugs is important in BP control. The aim of the study was to assess the stroke risk factors and levels of adherence among hypertensive patients with stroke in Kampala Uganda. In a cross-sectional study we describe 112 hypertensive subjects with stroke from two Kampala city hospitals. A standardized pre-tested questionnaire was used to collect medical history, clinical details, radiological findings and laboratory data. A total of 112 hypertensive subjects with stroke were enrolled between May 2013 and April 2014. The median ages were 63.5 years (52.5-75.0) for the cases. Seventy percent (78/112) of the study participants had ischemic strokes. Only 17% were adherent to anti-hypertensive medications. The main cause of non-adherence appears to be lack of knowledge. Poor adherence of anti-hypertensive medications among hypertensive patients remains a big challenge in our setting. This has been attributed to lack of adequate knowledge and cost of the prescribed drugs. There is therefore an urgent need to promptly diagnose and educate hypertensive patients with emphasis on adherence to anti hypertensive drugs.

General physicians do not take adequate travel histories.