Are regulations more consumer-friendly when boards of nursing are the sole regulators of nurse practitioners?

PubMed

Rudner Lugo, Nancy; O'Grady, Eileen T; Hodnicki, Donna; Hanson, Charlene

2010-01-01

The widely varied regulations in the 50 states often limit consumer access to nurse practitioners (NPs). In 22 states, the Board of Nursing (BON) must share NP regulatory authority with another profession, usually physicians. This study examines the relationship between the BON as the sole authority regulating NPs or sharing that authority with another profession and the NP regulatory environment. Independent t tests compared the NP regulatory environments for consumer access and choice in states with sole BON regulation with those in states with involvement of another profession. The states' NP regulatory environments were quantified with an 11-measure tool assessing domains of consumer access to NPs, NP patients' access to service, and NP patients' access to prescription medications. BON-regulated states were less restrictive (P < .01, effect size 1.02) and supported NP professional autonomy. Entry into practice regulations did not differ in the two groups of states. Having another profession involved in regulation correlates with more restrictions on consumer access to NPs and more restrictions to the full deployment of NPs. Copyright 2010 Elsevier Inc. All rights reserved.

School Location and Teacher Supply: Understanding the Distribution of Teacher Effects

ERIC Educational Resources Information Center

Gagnon, Douglas

2015-01-01

The U.S. Department of Education has recently called on all states to create plans to ensure equal access to excellent teachers. Although there are numerous limitations in using VAM [value-added modeling] in high-stakes contexts such as teacher evaluation, such techniques offer promise in helping states grapple with issues in equitable access.…

State medicaid coverage for tobacco cessation treatments and barriers to coverage - United States, 2008-2014.

PubMed

Singleterry, Jennifer; Jump, Zach; Lancet, Elizabeth; Babb, Stephen; MacNeil, Allison; Zhang, Lei

2014-03-28

Medicaid enrollees have a higher smoking prevalence than the general population (30.1% of adult Medicaid enrollees aged <65 years smoke, compared with 18.1% of U.S. adults of all ages), and smoking-related disease is a major contributor to increasing Medicaid costs. Evidence-based cessation treatments exist, including individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications. A Healthy People 2020 objective (TU-8) calls for all state Medicaid programs to adopt comprehensive coverage of these treatments. However, most states do not provide such coverage. To monitor trends in state Medicaid cessation coverage, the American Lung Association collected data on coverage of all evidence-based cessation treatments except telephone counseling by state Medicaid programs (for a total of nine treatments), as well as data on barriers to accessing these treatments (such as charging copayments or limiting the number of covered quit attempts) from December 31, 2008, to January 31, 2014. As of 2014, all 50 states and the District of Columbia cover some cessation treatments for at least some Medicaid enrollees, but only seven states cover all nine treatments for all enrollees. Common barriers in 2014 include duration limits (40 states for at least some populations or plans), annual limits (37 states), prior authorization requirements (36 states), and copayments (35 states). Comparing 2008 with 2014, 33 states added treatments to coverage, and 22 states removed treatments from coverage; 26 states removed barriers to accessing treatments, and 29 states added new barriers. The evidence from previous analyses suggests that states could reduce smoking-related morbidity and health-care costs among Medicaid enrollees by providing Medicaid coverage for all evidence-based cessation treatments, removing all barriers to accessing these treatments, promoting the coverage, and monitoring its use.

Tightening Quantum Speed Limits for Almost All States.

PubMed

Campaioli, Francesco; Pollock, Felix A; Binder, Felix C; Modi, Kavan

2018-02-09

Conventional quantum speed limits perform poorly for mixed quantum states: They are generally not tight and often significantly underestimate the fastest possible evolution speed. To remedy this, for unitary driving, we derive two quantum speed limits that outperform the traditional bounds for almost all quantum states. Moreover, our bounds are significantly simpler to compute as well as experimentally more accessible. Our bounds have a clear geometric interpretation; they arise from the evaluation of the angle between generalized Bloch vectors.

33 CFR 107.200 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... United States; or (iv) A corporation, partnership, association, trust, joint venture, limited liability company, limited liability partnership, or any other legal entity, created and authorized to own vessels... NATIONAL VESSEL AND FACILITY CONTROL MEASURES AND LIMITED ACCESS AREAS Unauthorized Entry Into Cuban...

Developing and Deploying Multihop Wireless Networks for Low-Income Communities

ERIC Educational Resources Information Center

Camp, Joseph D.; Knightly, Edward W.; Reed, William S.

2006-01-01

In most middle- and upper-income homes across the United States, children, youth, and their families have access to the world's information-technology resources at their fingertips, while in low-income communities, access to technology and the opportunities it provides are often limited to brief periods of computer use and Internet access at…

Limited License Legal Technician. Washington's Community and Technical Colleges

ERIC Educational Resources Information Center

Washington State Board for Community and Technical Colleges, 2014

2014-01-01

A landmark state Supreme Court rule that promises to create new jobs and expand public access to legal help is coming to life at Washington's community and technical colleges. Four colleges--Highline, Edmonds, Tacoma, and Spokane--started training students to become "Limited License Legal Technicians" (LLLTs) in 2014. The state Supreme…

78 FR 25426 - Privacy Act of 1974, as Amended

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

... on behalf of the CFPB or Federal Government and who have a need to access the information in the... based on these types of frauds. Access to the records will be limited to state and federal agencies for... agency to: (a) Permit a decision as to access, amendment or correction of records to be made in...

Expanding oral care opportunities: direct access care provided by dental hygienists in the United States.

PubMed

Naughton, Doreen K

2014-06-01

Dental hygienists expand access to oral care in the United States. Many Americans have access to oral health care in traditional dental offices however millions of Americans have unmet dental needs. For decades dental hygienists have provided opportunities for un-served and under-served Americans to receive preventive services in a variety of alternate delivery sites, and referral to licensed dentists for dental care needs. Publications, state practice acts, state public health departments, the American Dental Hygienists' Association, and personal interviews of dental hygiene practitioners were accessed for information and statistical data. Dental hygienists in 36 states can legally provide direct access care. Dental hygienists are providing preventive services in a variety of settings to previously un-served and under-served Americans, with referral to dentists for dental needs. Dental hygienists have provided direct access to care in the United States for decades. The exact number of direct access providers in the United States is unknown. Limited research and anecdotal information demonstrate that direct access care has facilitated alternate entry points into the oral health systems for thousands of previously un-served and underserved Americans. Older adults, persons with special needs, children in schools, pregnant women, minority populations, rural populations, and others have benefited from the availability of many services provided by direct access dental hygienists. Legislatures and private groups are becoming increasingly aware of the impact that direct access has made on the delivery of oral health care. Many factors continue to drive the growth of direct access care. Additional research is needed to accumulate qualitative and quantitative outcome data related to direct access care provided by dental hygienists and other mid level providers of oral health services. Copyright © 2014 Elsevier Inc. All rights reserved.

State Legislative Approach to Enumerating Behavioral Health Workforce Shortages: Lessons Learned in New Mexico.

PubMed

Altschul, Deborah B; Bonham, Caroline A; Faulkner, Martha J; Farnbach Pearson, Amy W; Reno, Jessica; Lindstrom, Wayne; Alonso-Marsden, Shelley M; Crisanti, Annette; Salvador, Julie G; Larson, Richard

2018-06-01

Nationally, the behavioral health workforce is in crisis because of a lack of resources, culturally responsive services, quality clinical supervision, sufficient training in evidence-based practices, and targeted recruitment and retention. Disparities in access to behavioral health care are particularly significant in New Mexico, where 25% of the population live in rural areas, and behavioral health shortages are among the highest in the nation. Additionally, as a Medicaid expansion state, New Mexico providers experience increased demand for services at a time when the state is challenged with limited workforce capacity. To address this issue, the Health Care Work Force Data Collection, Analysis and Policy Act was legislatively enacted in 2011 to systematically survey all state licensed health professionals to determine reasons for the healthcare shortage and address the shortage through policy. The Act was amended in 2012 to transfer all data to the University of New Mexico Health Sciences Center. In 2015, a total of 4,488 behavioral health providers completed a survey as a mandatory part of their license renewal. Findings from the survey indicate a dearth of licensed behavioral health providers representative of the populations served, limited access to services via Medicaid and Medicare payer sources, limited access to providers working in public health settings, and limited access to Health Information Technology. This paper describes the workforce context in New Mexico, the purpose of the legislation, the analytic findings from the survey, the policies implemented as a result of these efforts, lessons learned, and a discussion of the relevancy of the New Mexico model for other states. This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Perceived impact and feasibility of strategies to improve access to healthy foods in Washington State, USA.

PubMed

Johnson, Donna B; Quinn, Emilee L; Podrabsky, Mary; Beckwith-Stanley, Nadia; Chan, Nadine; Ellings, Amy; Kovacs, Tricia; Lane, Claire

2013-12-01

The present study measured the perceived impact and political and implementation feasibility of state-level policy strategies related to increasing access to healthy foods and limiting unhealthy foods. Potential state-level policy strategies to improve access to healthy foods were identified through a review of evidence-based literature and policy recommendations. Respondents rated the perceived impact and political and implementation feasibility of each policy on a five-point scale using online surveys. Washington State policy process. Forty-nine content experts (national researchers and subject experts), forty policy experts (state elected officials or their staff, gubernatorial or legislative policy analysts) and forty-five other stakeholders (state-level advocates, programme administrators, food producers). In aggregate, respondents rated policy impact and implementation feasibility higher than political feasibility. Policy experts rated policy strategies as less politically feasible compared with content experts (P < 0·02) or other stakeholders (P < 0·001). Eight policy strategies were rated above the median for impact and political and implementation feasibility. These included policies related to nutrition standards in schools and child-care facilities, food distribution systems, urban planning projects, water availability, joint use agreements and breast-feeding supports. Although they may be perceived as potentially impactful, some policies will be more difficult to enact than others. Information about the potential feasibility of policies to improve access to healthy foods can be used to focus limited policy process resources on strategies with the highest potential for enactment, implementation and impact.

Regulation profiles of e-cigarettes in the United States: a critical review with qualitative synthesis.

PubMed

Tremblay, Marie-Claude; Pluye, Pierre; Gore, Genevieve; Granikov, Vera; Filion, Kristian B; Eisenberg, Mark J

2015-06-03

Electronic cigarettes (e-cigarettes) have been steadily increasing in popularity since their introduction to US markets in 2007. Debates surrounding the proper regulatory mechanisms needed to mitigate potential harms associated with their use have focused on youth access, their potential for nicotine addiction, and the renormalization of a smoking culture. The objective of this study was to describe the enacted and planned regulations addressing this novel public health concern in the US. We searched LexisNexis Academic under Federal Regulations and Registers, as well as State Administrative Codes and Registers. This same database was also used to find information about planned regulations in secondary sources. The search was restricted to US documents produced between January 1(st), 2004, and July 14(th), 2014. We found two planned regulations at the federal level, and 74 enacted and planned regulations in 44 states. We identified six state-based regulation types, including i) access, ii) usage, iii) marketing and advertisement, iv) packaging, v) taxation, and vi) licensure. These were further classified into 10 restriction subtypes: sales, sale to minors, use in indoor public places, use in limited venues, use by minors, licensure, marketing and advertising, packaging, and taxation. Most enacted restrictions aimed primarily to limit youth access, while few regulations enforced comprehensive restrictions on product use and availability. Current regulations targeting e-cigarettes in the US are varied in nature and scope. There is greater consensus surrounding youth protection (access by minors and/or use by minors, and/or use in limited venues), with little consensus on multi-level regulations, including comprehensive use bans in public spaces.

75 FR 64955 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Correction to Cod...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-21

...; Correction to Cod Landing Limit for Handgear A Vessels in the Common Pool Fishery AGENCY: National Marine... multispecies limited access Handgear A (HA) permitted vessels fishing in the common pool fishery for the... vessels fishing under common pool regulations at Sec. 648.82(b)(6) state that ``The [300 lb (136.1 kg...

Research Investigation of Information Access Methods

ERIC Educational Resources Information Center

Heinrichs, John H.; Sharkey, Thomas W.; Lim, Jeen-Su

2006-01-01

This study investigates the satisfaction of library users at Wayne State University who utilize alternative information access methods. The LibQUAL+[TM] desired and perceived that satisfaction ratings are used to determine the user's "superiority gap." By focusing limited library resources to address "superiority gap" issues identified by each…

An overview of Compassionate Use Programs in the European Union member states.

PubMed

Balasubramanian, Gayathri; Morampudi, Suman; Chhabra, Pankdeep; Gowda, Arun; Zomorodi, Behsad

2016-11-01

The past decade witnessed rapid development of novel drugs and therapeutic biological agents. The marketing authorization for novel therapies is often time consuming and distressing for patients. Earlier clinical trials were the only way to access new drugs under development. However, not every patient meets the enrolment criteria, and participation is difficult for patients with life-threatening, long-lasting or seriously debilitating diseases like rare diseases. Early access programs like "Compassionate Use Program (CUP)" have generated alternative channels for such patients. The European Medical Agency provides regulations and recommendations for compassionate use, upon which every European Union (EU) member state has developed its own rules and regulations. Despite previous reviews and studies, the available information is limited and gaps exist. This literature review explores CUP in 28 EU member states. Data was collected through literature review and use of country-specific search terms from the healthcare domain. Data sources were not limited to databases and articles published in journals, but also included grey literature. The results implied that CUP was present in 20 EU member states (71%). Of 28 EU states, 18 (∼64%) had nationalized regulations and processes were well-defined. Overall, this review identified CUP and its current status and legislation in 28 EU member states. The established legislation for CUP in the EU member states suggest their willingness to adopt processes that facilitate earlier and better access to new medicines. Further research and periodic reviews are warranted to understand the contemporary and future regulatory trends in early access programs.

Medicaid expansion and access to care among cancer survivors: a baseline overview.

PubMed

Tarazi, Wafa W; Bradley, Cathy J; Harless, David W; Bear, Harry D; Sabik, Lindsay M

2016-06-01

Medicaid expansion under the Affordable Care Act facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Medicaid expansions may provide increased access to care for cancer survivors, a growing population with chronic conditions. We compare access to health care services among cancer survivors living in non-expansion states to those living in expansion states, prior to Medicaid expansion under the Affordable Care Act. We use the 2012 and 2013 Behavioral Risk Factor Surveillance System to estimate multiple logistic regression models to compare inability to see a doctor because of cost, having a personal doctor, and receiving an annual checkup in the past year between cancer survivors who lived in non-expansion states and survivors who lived in expansion states. Cancer survivors in non-expansion states had statistically significantly lower odds of having a personal doctor (adjusted odds ratio [AOR] 0.76, 95 % confidence interval [CI] 0.63-0.92, p < 0.05) and higher odds of being unable to see a doctor because of cost (AOR 1.14, 95 % CI 0.98-1.31, p < 0.10). Statistically significant differences were not found for annual checkups. Prior to the passage of the Affordable Care Act, cancer survivors living in expansion states had better access to care than survivors living in non-expansion states. Failure to expand Medicaid could potentially leave many cancer survivors with limited access to routine care. Existing disparities in access to care are likely to widen between cancer survivors in Medicaid non-expansion and expansion states.

Pressures on safety net access: the level of managed care penetration and uninsurance rate in a community.

PubMed

Cunningham, P J

1999-04-01

To examine the effects of managed care penetration and the uninsurance rate in an area on access to care of low-income uninsured persons and to compare differences in access between low-income insured and uninsured persons across these different market areas. Primarily the Community Tracking Study household survey. Other market-level data were obtained from the Community Tracking Study physician survey, American Hospital Association annual survey of hospitals, Area Resource File, HCFA Administrative Data, Bureau of Primary Care data on Community Health Centers. Individuals are grouped based on the level of managed care penetration and uninsurance rate in the site where they reside. Measures of managed care include overall managed care penetration in the site, and the level of Medicaid managed care penetration in the state. Uninsurance rate is defined as the percentage of people uninsured in the site. Measures of access include the percentage with a usual source of care, percentage with any ambulatory care use, and percentage of persons who reported unmet medical care needs. Estimates are adjusted to control for other confounding factors, including both individual and market-level characteristics. A survey, primarily telephoned, of households concentrated in 60 sites, defined as metropolitan statistical areas and nonmetropolitan areas. Access to care for low-income uninsured persons is lower in states with high Medicaid managed care penetration, compared to uninsured persons in states with low Medicaid managed care penetration. Access to care for low-income uninsured persons is also lower in areas with high uninsurance rates. The "access gap" (differences in access between insured and uninsured persons) is also larger in areas with high Medicaid managed care penetration and areas with high uninsurance rates. Efforts to achieve cost savings under managed care may result in financial pressures that limit cross-subsidization of care to the medically indigent, particularly for those providers who are heavily dependent on Medicaid revenue. High demand for care (as reflected in high uninsurance rates) may further strain limited resources for indigent care, further limiting access to care for uninsured persons.

50 CFR Table 5 (south) to Part 660... - 2009-2010 Trip Limits for Open Access Gears South of 40°10′ N. Lat.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false 2009-2010 Trip Limits for Open Access Gears South of 40°10ⲠN. Lat. 5 Table 5 (South) to Part 660, Subpart G Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES OFF WEST COAST STATES Pt....

50 CFR Table 5 (north) to Part 660... - 2009-2010 Trip Limits for Open Access Gears North of 40°10′ N. Lat.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false 2009-2010 Trip Limits for Open Access Gears North of 40°10ⲠN. Lat. 5 Table 5 (North) to Part 660, Subpart G Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES OFF WEST COAST STATES Pt....

The New York State Mentoring Program.

ERIC Educational Resources Information Center

Cuomo, Matilda R.

This conference address discusses New York State programs for children and families, focusing on a mentoring program. New York State has 44 rural counties, which comprise 80% of the state's total area. Rural schools face limited financial resources and access to services. Rural school children are more likely to face failure than urban or suburban…

Physical principles and current status of emerging non-volatile solid state memories

NASA Astrophysics Data System (ADS)

Wang, L.; Yang, C.-H.; Wen, J.

2015-07-01

Today the influence of non-volatile solid-state memories on persons' lives has become more prominent because of their non-volatility, low data latency, and high robustness. As a pioneering technology that is representative of non-volatile solidstate memories, flash memory has recently seen widespread application in many areas ranging from electronic appliances, such as cell phones and digital cameras, to external storage devices such as universal serial bus (USB) memory. Moreover, owing to its large storage capacity, it is expected that in the near future, flash memory will replace hard-disk drives as a dominant technology in the mass storage market, especially because of recently emerging solid-state drives. However, the rapid growth of the global digital data has led to the need for flash memories to have larger storage capacity, thus requiring a further downscaling of the cell size. Such a miniaturization is expected to be extremely difficult because of the well-known scaling limit of flash memories. It is therefore necessary to either explore innovative technologies that can extend the areal density of flash memories beyond the scaling limits, or to vigorously develop alternative non-volatile solid-state memories including ferroelectric random-access memory, magnetoresistive random-access memory, phase-change random-access memory, and resistive random-access memory. In this paper, we review the physical principles of flash memories and their technical challenges that affect our ability to enhance the storage capacity. We then present a detailed discussion of novel technologies that can extend the storage density of flash memories beyond the commonly accepted limits. In each case, we subsequently discuss the physical principles of these new types of non-volatile solid-state memories as well as their respective merits and weakness when utilized for data storage applications. Finally, we predict the future prospects for the aforementioned solid-state memories for the next generation of data-storage devices based on a comparison of their performance. [Figure not available: see fulltext.

Effects of raising and lowering speed limits on selected roadway sections

DOT National Transportation Integrated Search

1997-01-01

The objective of this research was to examine the effects of raising and lowering posted speed limits on driver behavior for urban and rural nonlimited access highways. Sites selected for study were furnished by the participating States. The study wa...

Disparities and access to healthy food in the United States: A review of food deserts literature.

PubMed

Walker, Renee E; Keane, Christopher R; Burke, Jessica G

2010-09-01

Increasingly, studies are focusing on the role the local food environment plays in residents' ability to purchase affordable, healthy and nutritious foods. In a food desert, an area devoid of a supermarket, access to healthy food is limited. We conducted a systematic review of studies that focused on food access and food desert research in the United States. The 31 studies identified utilized 9 measures to assess food access. Results from these studies can be summarized primarily into four major statements. Findings from other countries offer insight into ways, in which future research, policy development and program implementation in the U.S. may continue to be explored. Copyright 2010 Elsevier Ltd. All rights reserved.

Data Use "Multi-State" Spotlight: Using Data Fidelity Tools to Improve Data Quality. Transforming State Systems to Improve Outcomes for Children with Disabilities

ERIC Educational Resources Information Center

Ruedel, Kristin; Nelson, Gena; Bailey, Tessie

2018-01-01

To evaluate interim progress toward the State-identified Measurable Result (SIMR), states require access to high-quality data from local education agencies (LEAs) and early intervention service providers. In a review of 2017 Phase III State Systemic Improvement Plans (SSIP), 43 Part C states noted limitations or concerns related to data and…

36 CFR 13.1144 - How often will commercial fishing lifetime access permit be renewed?

Code of Federal Regulations, 2014 CFR

2014-07-01

... fishing lifetime access permit be renewed? 13.1144 Section 13.1144 Parks, Forests, and Public Property...-Glacier Bay National Park and Preserve Commercial Fishing § 13.1144 How often will commercial fishing... for the lifetime of a permittee who continues to hold a valid State limited entry commercial fishing...

36 CFR 13.1144 - How often will commercial fishing lifetime access permit be renewed?

Code of Federal Regulations, 2012 CFR

2012-07-01

... fishing lifetime access permit be renewed? 13.1144 Section 13.1144 Parks, Forests, and Public Property...-Glacier Bay National Park and Preserve Commercial Fishing § 13.1144 How often will commercial fishing... for the lifetime of a permittee who continues to hold a valid State limited entry commercial fishing...

36 CFR 13.1144 - How often will commercial fishing lifetime access permit be renewed?

Code of Federal Regulations, 2011 CFR

2011-07-01

... fishing lifetime access permit be renewed? 13.1144 Section 13.1144 Parks, Forests, and Public Property...-Glacier Bay National Park and Preserve Commercial Fishing § 13.1144 How often will commercial fishing... for the lifetime of a permittee who continues to hold a valid State limited entry commercial fishing...

Free and Compulsory School Age Requirements. ECS 50-State Reviews

ERIC Educational Resources Information Center

Aragon, Stephanie

2015-01-01

Policymakers across the nation continue to push for expanded free and compulsory school age requirements. More states are considering granting students earlier access to a free education so that they can begin their academic pursuits earlier in life. Similarly, every year a number of states consider extending the upper limit for compulsory school…

The dream of health information for all

PubMed Central

Proaño, Alvaro; Ruiz, Eloy F; Porudominsky, Ruben; Tapia, Jose Carlos

2016-01-01

In 2004, an influential report in The Lancet suggested that open health information for all could be achieved by 2015. Unfortunately, this goal has not yet been accomplished. Despite progress in obtaining quality scientific articles in Latin America, it remains difficult to reliably access new and cutting-edge research. As graduating Peruvian medical students, we have confronted many obstacles in obtaining access to quality and up-to-date information and a constant tension between accessing "what is available" rather than "what we need". As we have learned, these limitations affect not only our own education but also the choices we make in the management of our patients. In the following article, we state our point of view regarding limitations in access to scientific articles in Peru and Latin America. PMID:27081475

Variation in Vaccination Data Available at School Entry Across the United States.

PubMed

Leslie, Timothy F; Street, Erica J; Delamater, Paul L; Yang, Y Tony; Jacobsen, Kathryn H

2016-12-01

To compile substate-level data on US school-age children's vaccination rates. For states that did not have suitable data online, in 2015 we submitted information requests to the state health department and followed up with the state's Freedom of Information Act when necessary. The accessibility, scale, and types of vaccination data varied considerably. Whereas 26 states provided data online, 14 released data only after a Freedom of Information Act request. School or school-district data were available for 24 states, 19 at the county level, 2 at the health department level, and 6 provided no substate-level data. Effective vaccination policy requires a robust understanding of vaccination behavior. Some states make it difficult to access data or provide low-resolution data of limited value for identifying vaccination behavior.

Developing a Multicomponent Model of Nutritious Food Access and Related Implications for Community and Policy Practice.

PubMed

Freedman, Darcy A; Blake, Christine E; Liese, Angela D

2013-01-01

Access to nutritious foods is limited in disenfranchised communities in the United States. Policies are beginning to focus on improving nutritious food access in these contexts; yet, few theories are available to guide this work. We developed a conceptual model of nutritious food access based on the qualitative responses of food consumers in 2 different regions of the American South. Five domains (economic, service delivery, spatial-temporal, social, and personal) and related dimensions of nutritious food access were identified. The conceptual model provides practical guidance to researchers, policy makers, and practitioners working to improve nutritious food access in communities.

Developing a Multicomponent Model of Nutritious Food Access and Related Implications for Community and Policy Practice

PubMed Central

FREEDMAN, DARCY A.; BLAKE, CHRISTINE E.; LIESE, ANGELA D.

2014-01-01

Access to nutritious foods is limited in disenfranchised communities in the United States. Policies are beginning to focus on improving nutritious food access in these contexts; yet, few theories are available to guide this work. We developed a conceptual model of nutritious food access based on the qualitative responses of food consumers in 2 different regions of the American South. Five domains (economic, service delivery, spatial–temporal, social, and personal) and related dimensions of nutritious food access were identified. The conceptual model provides practical guidance to researchers, policy makers, and practitioners working to improve nutritious food access in communities. PMID:24563605

Safeguards Approaches for Black Box Processes or Facilities

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

Diaz-Marcano, Helly; Gitau, Ernest TN; Hockert, John

2013-09-25

The objective of this study is to determine whether a safeguards approach can be developed for “black box” processes or facilities. These are facilities where a State or operator may limit IAEA access to specific processes or portions of a facility; in other cases, the IAEA may be prohibited access to the entire facility. The determination of whether a black box process or facility is safeguardable is dependent upon the details of the process type, design, and layout; the specific limitations on inspector access; and the restrictions placed upon the design information that can be provided to the IAEA. Thismore » analysis identified the necessary conditions for safeguardability of black box processes and facilities.« less

Design and Development of an Identity Management System: The Minnesota State College-Southeast Technical Case Study

ERIC Educational Resources Information Center

Elhindi, Mohamed A.

2010-01-01

Historically, managing access to information systems (ISs) required direct interaction with a limited number of users. Increasingly, managing access involves handling an increased numbers of internal and external students, faculty, and staff as well as partners such as workforce development centers, the U.S. Department of Education, and the…

Echandole Ganas: Undocumented, Latino Students Fighting for Collegiate Survival in Their United States Homeland

ERIC Educational Resources Information Center

Del Razo, Jaime Liborio

2012-01-01

This study examines the college aspirations and access of Latino, undocumented students. In a time when college access is limited and a college education is necessary, the issue of academically qualified, undocumented students trying to enter the higher education system under tremendous odds is one that deserves a closer study. This dissertation…

Pew Memorial Trust policy synthesis: 5. State coverage for organ transplantation: a framework for decision making.

PubMed

Lindsey, P A; McGlynn, E A

1988-02-01

Transplantation of hearts and livers for both adults and children is increasingly viewed as therapeutic and lifesaving, but access to these procedures is impeded by their high cost as well as by a limited supply of organs. In the absence of comprehensive federal coverage, pressure is being brought to bear on states to provide broader access to these procedures. This synthesis provides a framework for the consideration of coverage decisions at the state level. While there are no "right" answers about whether a state should support such coverage, the analytic tools of cost analysis, demand estimation, and assessment of capacity described in this synthesis can better inform the decision-making process.

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

PubMed

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

2015-04-01

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

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

PubMed Central

Hallgren, Emily; Yamada, Seiji

2015-01-01

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

The development of funding recommendations for health technologies at the state level: A South Australian case study.

PubMed

Lambert, Robyn; Carter, Drew; Burgess, Naomi; Haji Ali Afzali, Hossein

2018-04-20

State governments often face capped budgets that can restrict expenditure on health technologies and their evaluation, yet many technologies are introduced to practice through state-funded institutions such as hospitals, rather than through national evaluation mechanisms. This research aimed to identify the criteria, evidence, and standards used by South Australian committee members to recommend funding for high-cost health technologies. We undertook 8 semi-structured interviews and 2 meeting observations with members of state-wide committees that have a mandate to consider the safety, effectiveness, and cost-effectiveness of high-cost health technologies. Safety and effectiveness were fundamental criteria for decision makers, who were also concerned with increasing consistency in care and equitable access to technologies. Committee members often consider evidence that is limited in quantity and quality; however, they perceive evaluations to be rigorous and sufficient for decision making. Precise standards for safety, effective, and cost-effectiveness could not be identified. Consideration of new technologies at the state level is grounded in the desire to improve health outcomes and equity of access for patients. High quality evidence is often limited. The impact funding decisions have on population health is unclear due to limited use of cost-effectiveness analysis and unclear cost-effectiveness standards. Copyright © 2018 John Wiley & Sons, Ltd.

A Qualitative Exploration of Low-Income Women's Experiences Accessing Abortion in Massachusetts.

PubMed

Dennis, Amanda; Manski, Ruth; Blanchard, Kelly

2015-01-01

At a time when most states are working to restrict abortion, Massachusetts stands out as one of the few states with multiple state-level policies in place that support abortion access for low-income women. In 2006, Massachusetts passed health care reform, which resulted in almost all residents having insurance. Also, almost all state-level public and subsidized insurance programs cover abortion and there are fewer restrictions on abortion in Massachusetts compared with other states. We explored low-income women's experiences accessing abortion in Massachusetts through 27 in-depth telephone interviews with a racially diverse sample of low-income women who obtained abortions. Interviews were digitally recorded, transcribed, coded, and analyzed thematically. Most women described having access to timely, conveniently located, affordable, and highly acceptable abortion care. However, a sizable minority of women had difficulty enrolling in or staying on insurance, making abortion expensive. A small minority of women said their abortion care could be improved by increasing emotional support and privacy, and decreasing appointment times. Some limited data also suggest that young women and immigrant women face specific barriers to care. This study provides important, novel information about the need for state-level policies that support access to health insurance and comprehensive abortion coverage. Such policies, along with a well-functioning health care environment, help to ensure that low-income women have access to abortion. However, not all abortion access challenges have been resolved in Massachusetts. More work is needed to ensure that all women can access affordable, confidential care that is responsive to their specific needs and preferences. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

State School Finance Inequities and the Limits of Pursuing Teacher Equity through Departmental Regulation

ERIC Educational Resources Information Center

Baker, Bruce D.; Weber, Mark

2016-01-01

New federal regulations (State Plans to Ensure Equitable Access to Excellent Educators)1 place increased pressure on states and local public school districts to improve their measurement and reporting of gaps in teacher qualifications across schools and the children they serve. Yet a sole focus on resource disparities between schools within a…

A survey of whitewater recreation impacts along five West Virginia rivers

USGS Publications Warehouse

Leung, Y.-F.; Marion, J.L.

1998-01-01

Results are reported from an assessment of whitewater river recreation impacts at river accesses and recreation sites along five West Virginia rivers: the New, Gauley, Cheat, Tygart, and Shenandoah. Procedures were developed and applied to assess resource conditions on 24 river access roads, 68 river accesses, and 151 recreation sites. The majority of river accesses and recreation sites are located on the New and Gauley rivers, which account for most of the state?s whitewater recreation use. Site conditions are variable. While some river accesses and sites are situated on resistant rocky substrates, many are poorly designed and/or located on erodible soil and sand substrates. Recreation site sizes and other areal measures of site disturbance are quite large, coincident with the large group sizes associated with commercially outfitted whitewater rafting trips. Recommendations are offered for managing river accesses and sites and whitewater visitation and the selection of indicators and standards as part of a Limits of Acceptable Change management process. Procedures and recommendations for continued visitor impact monitoring are also offered.

State medical marijuana laws: understanding the laws and their limitations.

PubMed

Pacula, Rosalie Liccardo; Chriqui, Jamie F; Reichmann, Deborah A; Terry-McElrath, Yvonne M

2002-01-01

Significant attention has been given to the debate regarding allowances for medical marijuana use since the 1996 California and Arizona ballot initiatives. State medical marijuana allowances, however, have existed since the mid-1970s. Much of the current debate stems from confusion about the various ways states approach the issue. In this paper, we present original legal research on current state medical marijuana laws identifying four different ways states statutorily enable the medical use of marijuana. We discuss the tension these approaches have with federal law as well as their implications regarding real access for patients. In addition, we present information on how a small number of states are trying to deal with the issue of access within the context of their medical marijuana laws, and discuss the implication of various supply approaches on the enforcement of other state marijuana laws.

7 CFR 274.11 - Issuance and inventory record retention, and forms security.

Code of Federal Regulations, 2010 CFR

2010-01-01

... processed within the State agency. The State agency shall use numbers, batching, inventory control logs, or...) Secure storage; (iii) Access limited to authorized personnel; (iv) Bulk inventory control records; (v... validation of inventory controls and records by parties not otherwise involved in maintaining control records...

75 FR 36559 - Fisheries of the Northeastern United States; Atlantic Sea Scallop Fishery; Framework Adjustment 21

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-28

... Adjustment if Access Area Yellowtail Flounder (YTF) TAC Is Attained Under the Northeast Multispecies FMP, 10..., Delmarva, and NLAA; and limited access DAS vessels will be compensated 0.10 DAS per DAS fished during... one that would result in a 10-percent shift in baseline effort from the Mid-Atlantic during June 15...

Limited ability driven phase transitions in the coevolution process in Axelrod's model

NASA Astrophysics Data System (ADS)

Wang, Bing; Han, Yuexing; Chen, Luonan; Aihara, Kazuyuki

2009-04-01

We study the coevolution process in Axelrod's model by taking into account of agents' abilities to access information, which is described by a parameter α to control the geographical range of communication. We observe two kinds of phase transitions in both cultural domains and network fragments, which depend on the parameter α. By simulation, we find that not all rewiring processes pervade the dissemination of culture, that is, a very limited ability to access information constrains the cultural dissemination, while an exceptional ability to access information aids the dissemination of culture. Furthermore, by analyzing the network characteristics at the frozen states, we find that there exists a stage at which the network develops to be a small-world network with community structures.

Update Your Member Lab Compendium Data

EPA Pesticide Factsheets

The Compendium of Environmental Testing Laboratories is a limited-access online database of environmental laboratories nationwide that is available to EPA; Federal, State, and local emergency responders; laboratory personnel; and water utilities.

33 CFR 165.2030 - Pacific Area.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) PORTS AND WATERWAYS SAFETY REGULATED NAVIGATION AREAS AND LIMITED ACCESS AREAS Protection of Naval... States, whether the large U.S. naval vessel is underway, anchored, moored, or within a floating dry dock...

Reforming Access: Trends in Medicaid Enrollment for New Medicare Beneficiaries, 2008-2011.

PubMed

Keohane, Laura M; Rahman, Momotazur; Mor, Vincent

2016-04-01

To evaluate whether aligning the Part D low-income subsidy and Medicaid program enrollment pathways in 2010 increased Medicaid participation among new Medicare beneficiaries. Medicare enrollment records for years 2007-2011. We used a multinomial logistic model with state fixed effects to examine the annual change in limited and full Medicaid enrollment among new Medicare beneficiaries for 2 years before and after the reforms (2008-2011). We identified new Medicare beneficiaries in the years 2008-2011 and their participation in Medicaid based on Medicare enrollment records. The percentage of beneficiaries enrolling in limited Medicaid at the start of Medicare coverage increased in 2010 by 0.3 percentage points for individuals aging into Medicare and by 1.3 percentage points for those qualifying due to disability (p < .001). There was no significant difference in the size of enrollment increases between states with and without concurrent limited Medicaid eligibility expansions. Our findings suggest that streamlining financial assistance programs may improve Medicare beneficiaries' access to benefits. © Health Research and Educational Trust.

The Rising Price of Inequality: How Inadequate Grant Aid Limits College Access and Persistence. Report to Congress and the Secretary of Education

ERIC Educational Resources Information Center

Advisory Committee on Student Financial Assistance, 2010

2010-01-01

Congress charged the Advisory Committee in the "Higher Education Opportunity Act of 2008" with monitoring and reporting on the condition of college access and persistence for low- and moderate-income students. The law requires provision of analyses and policy recommendations regarding the adequacy of grant aid from all sources--federal, state, and…

Effect of the Economic Recession on Primary Care Access for the Homeless.

PubMed

White, Brandi M; Jones, Walter J; Moran, William P; Simpson, Kit N

2016-01-01

Primary care access (PCA) for the homeless can prove challenging, especially during periods of economic distress. In the United States, the most recent recession may have presented additional barriers to accessing care. Limited safety-net resources traditionally used by the homeless may have also been used by the non-homeless, resulting in delays in seeking treatment for the homeless. Using hospitalizations for ambulatory care sensitivity (ACS) conditions as a proxy measure for PCA, this study investigated the recession's impact on PCA for the homeless and non-homeless in four states. The State Inpatient Databases were used to identify ACS admissions. Findings from this study indicate the recession was a barrier to PCA for homeless people who were uninsured. Ensuring that economically-disadvantaged populations have the ability to obtain insurance coverage is crucial to facilitating PCA. With targeted outreach efforts, the Affordable Care Act provides an opportunity for expanding coverage to the homeless.

Long-lived nuclear spin states in rapidly rotating CH2D groups

NASA Astrophysics Data System (ADS)

Elliott, Stuart J.; Brown, Lynda J.; Dumez, Jean-Nicolas; Levitt, Malcolm H.

2016-11-01

Although monodeuterated methyl groups support proton long-lived states, hindering of the methyl rotation limits the singlet relaxation time. We demonstrate an experimental case in which the rapid rotation of the CH2D group extends the singlet lifetime but does not quench the chemical shift difference between the CH2D protons, induced by the chiral environment. Proton singlet order is accessed using Spin-Lock Induced Crossing (SLIC) experiments, showing that the singlet relaxation time TS is over 2 min, exceeding the longitudinal relaxation time T1 by a factor of more than 10. This result shows that proton singlet states may be accessible and long-lived in rapidly rotating CH2D groups.

75 FR 59154 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Trip Limit...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-27

... the landing limits for Gulf of Maine (GOM) cod to 100 lb (45.4 kg) per days-at-sea (DAS) up to 1000 lb... to 100 lb (45.4 kg) per DAS up to 500 lb (226.8 kg) per trip; expands the trawl gear restriction in... issued a valid limited access NE multispecies permit and fishing under a NE multispecies day- at-sea (DAS...

76 FR 61060 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Correction to Cod...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-03

... Fishery; Correction to Cod Landing Limit for Handgear B Vessels in the Common Pool Fishery AGENCY... multispecies open access Handgear B permitted vessels fishing in the common pool fishery for the remainder of... landing limits for Handgear B (HB) vessels fishing under common pool regulations at Sec. 648.88(a)(1...

75 FR 48613 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Implementation of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-11

... under common pool regulations for the 2010 fishing year (FY). This action also corrects a previously published cod trip limit for common pool vessels fishing under a limited access Handgear A permit. This... common pool (common pool sub-ACL) and underharvesting the sub-ACL for pollock during FY 2010 (May 1, 2010...

State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments - United States, 2015-2017.

PubMed

DiGiulio, Anne; Jump, Zach; Yu, Annie; Babb, Stephen; Schecter, Anna; Williams, Kisha-Ann S; Yembra, Debbie; Armour, Brian S

2018-04-06

Cigarette smoking prevalence among Medicaid enrollees (25.3%) is approximately twice that of privately insured Americans (11.8%), placing Medicaid enrollees at increased risk for smoking-related disease and death (1). Medicaid spends approximately $39 billion annually on treating smoking-related diseases (2). Individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications* are effective in helping tobacco users quit (3). Although state Medicaid coverage of tobacco cessation treatments improved during 2014-2015, coverage was still limited in most states (4). To monitor recent changes in state Medicaid cessation coverage for traditional (i.e., nonexpansion) Medicaid enrollees, the American Lung Association collected data on coverage of a total of nine cessation treatments: individual counseling, group counseling, and seven FDA-approved cessation medications † in state Medicaid programs during July 1, 2015-June 30, 2017. The American Lung Association also collected data on seven barriers to accessing covered treatments, such as copayments and prior authorization. As of June 30, 2017, 10 states covered all nine of these treatments for all enrollees, up from nine states as of June 30, 2015; of these 10 states, Missouri was the only state to have removed all seven barriers to accessing these cessation treatments. State Medicaid programs that cover all evidence-based cessation treatments, remove barriers to accessing these treatments, and promote covered treatments to Medicaid enrollees and health care providers would be expected to reduce smoking, smoking-related disease, and smoking-attributable federal and state health care expenditures (5-7).

Children's mental-health language access laws: state factors influence policy adoption.

PubMed

Schmeida, Mary; McNeal, Ramona

2013-09-01

Despite federal legislation to equalize healthcare for children with limited English language proficiency, some state healthcare agencies and programs fall short in providing children's linguistic services for mental healthcare. While some states have been aggressive in passing cultural and linguistic laws aimed at providing protection for children, other states have not, limiting children of all ages to potential substandard care. This research uses state-level data and multivariate regression analysis to explore why some states are adopting these laws, whereas others are not. We find two dissimilar forces with unrelated goals must work in tandem to bring about policy change-the desire of civil rights and liberty groups to ensure equality in the delivery of healthcare services, and the desire of state legislature to reduce healthcare costs.

Access to benznidazole for Chagas disease in the United States-Cautious optimism?

PubMed

Alpern, Jonathan D; Lopez-Velez, Rogelio; Stauffer, William M

2017-09-01

Drugs for neglected tropical diseases (NTD) are being excessively priced in the United States. Benznidazole, the first-line drug for Chagas disease, may become approved by the Food and Drug Administration (FDA) and manufactured by a private company in the US, thus placing it at risk of similar pricing. Chagas disease is an NTD caused by Trypanosoma cruzi; it is endemic to Latin America, infecting 8 million individuals. Human migration has changed the epidemiology causing nonendemic countries to face increased challenges in diagnosing and managing patients with Chagas disease. Only 2 drugs exist with proven efficacy: benznidazole and nifurtimox. Benznidazole has historically faced supply problems and drug shortages, limiting accessibility. In the US, it is currently only available under an investigational new drug (IND) protocol from the CDC and is provided free of charge to patients. However, 2 companies have stated that they intend to submit a New Drug Application (NDA) for FDA approval. Based on recent history of companies acquiring licensing rights for NTD drugs in the US with limited availability, it is likely that benznidazole will become excessively priced by the manufacturer-paradoxically making it less accessible. However, if the companies can be taken at their word, there may be reason for optimism.

Limits on same-day billing in Medicaid hinders integration of behavioral health into the medical home model.

PubMed

Roby, Dylan H; Jones, Erynne E

2016-02-01

The potential expansion of insurance coverage through the Patient Protection and Affordable Care Act of 2010 can facilitate the reduction of access barriers and improved quality for behavioral health care. More than 5 million of the newly insured are expected to have mental health and substance use disorders. In addition, state and federal efforts to integrate behavioral and medical health needs through patient-centered medical home models and innovations in payment strategies provide an unprecedented opportunity to use federal financial support to improve not only access to care, but also improve quality through active care coordination, use of interdisciplinary teams, colocating services, and engaging in warm hand-offs between providers in the same setting. These potential advances are hindered in 24 different states because of Medicaid payment policy, with 7 explicitly limiting the ability to reimburse for physical health and behavioral health services on the same day for all providers. Without the ability for providers to be reimbursed for different services on the same day to improve behavioral and medical health care coordination, these states could be limited in their ability to improve care via patient-centered approaches and interdisciplinary team-based care that would involve physicians, clinical psychologists, psychiatrists, and other mental health professionals. Limits on same-day billing in Medicaid programs could impact up to 36.7 million people in 24 states, which is approximately 52.6% of all Medicaid enrollees. (c) 2016 APA, all rights reserved).

“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

Medicaid program; revision to Medicaid upper payment limit requirements for hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. Health Care Financing Administration (HCFA), HHS. Final rule.

PubMed

2001-01-12

This final rule modifies the Medicaid upper payment limits for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. For each type of Medicaid inpatient service, existing regulations place an upper limit on overall aggregate payments to all facilities and a separate aggregate upper limit on payments made to State-operated facilities. This final rule establishes an aggregate upper limit that applies to payments made to government facilities that are not State government-owned or operated, and a separate aggregate upper limit on payments made to privately-owned and operated facilities. This rule also eliminates the overall aggregate upper limit that had applied to these services. With respect to outpatient hospital and clinic services, this final rule establishes an aggregate upper limit on payments made to State government-owned or operated facilities, an aggregate upper limit on payments made to government facilities that are not State government-owned or operated, and an aggregate upper limit on payments made to privately-owned and operated facilities. These separate upper limits are necessary to ensure State Medicaid payment systems promote economy and efficiency. We are allowing a higher upper limit for payment to non-State public hospitals to recognize the higher costs of inpatient and outpatient services in public hospitals. In addition, to ensure continued beneficiary access to care and the ability of States to adjust to the changes in the upper payment limits, the final rule includes a transition period for States with approved rate enhancement State plan amendments.

Barriers to the Use of Trastuzumab for HER2+ Breast Cancer and the Potential Impact of Biosimilars: A Physician Survey in the United States and Emerging Markets.

PubMed

Lammers, Philip; Criscitiello, Carmen; Curigliano, Giuseppe; Jacobs, Ira

2014-09-17

Trastuzumab in combination with chemotherapy has become a standard of care for patients with HER2+ breast cancer. The cost of therapy, however, can limit patient access to trastuzumab in areas with limited financial resources for treatment reimbursement. This study examined access to trastuzumab and identified potential barriers to its use in the United States, Mexico, Turkey, Russia and Brazil via physician survey. The study also investigated if the availability of a biosimilar to trastuzumab would improve access to and use of HER2 monoclonal antibody therapy. Across all countries, a subset of oncologists reported barriers to the use of trastuzumab in a neoadjuvant, adjuvant or metastatic setting. Common barriers to the use of trastuzumab included issues related to insurance coverage, drug availability and cost to the patient. Overall, nearly half of oncologists reported that they would increase the use of HER2 monoclonal antibody therapy across all treatment settings if a lower cost biosimilar to trastuzumab were available. We conclude that the introduction of a biosimilar to trastuzumab may alleviate cost-related barriers to treatment and could increase patient access to HER2-directed therapy in all countries examined.

On board processing for future satellite communications systems: Comparison of FDM, TDM and hybrid accessing schemes

NASA Technical Reports Server (NTRS)

Berk, G.; Jean, P. N.; Rotholz, E.

1982-01-01

Several satellite uplink and downlink accessing schemes for customer premises service are compared. Four conceptual system designs are presented: satellite-routed frequency division multiple access (FDMA), satellite-switched time division multiple access (TDMA), processor-routed TDMA, and frequency-routed TDMA, operating in the 30/20 GHz band. The designs are compared on the basis of estimated satellite weight, system capacity, power consumption, and cost. The systems are analyzed for fixed multibeam coverage of the continental United States. Analysis shows that the system capacity is limited by the available satellite resources and by the terminal size and cost.

"Limited Access" Programs: Exceptions that Threaten the Florida Higher Education Articulation Agreement.

ERIC Educational Resources Information Center

Williams, Elizabeth Grace

Florida's Higher Education Articulation Agreement, established in 1959, has long been recognized as a model of a state-coordinated, integrated system of public higher education. But explosive population growth combined with three years of state budget crises, resulting in $155 million of cuts to higher education, have threatened this system of 28…

76 FR 23306 - Takes of Marine Mammals Incidental to Specified Activities; Russian River Estuary Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-26

... disruption of behavioral patterns, including, but not limited to, migration, breathing, nursing, breeding..., Mendocino, and Lake Counties. The mouth of the Russian River is located at Goat Rock State Beach; the... lot of Goat Rock State Park and driven onto the beach via an existing access point. Personnel on the...

Assessing early implementation of state autism insurance mandates.

PubMed

Baller, Julia Berlin; Barry, Colleen L; Shea, Kathleen; Walker, Megan M; Ouellette, Rachel; Mandell, David S

2016-10-01

In the United States, health insurance coverage for autism spectrum disorder treatments has been historically limited. In response, as of 2015, 40 states and Washington, DC, have passed state autism insurance mandates requiring many health plans in the private insurance market to cover autism diagnostic and treatment services. This study examined five states' experiences implementing autism insurance mandates. Semi-structured, key-informant interviews were conducted with 17 participants representing consumer advocacy organizations, provider organizations, and health insurance companies. Overall, participants thought that the mandates substantially affected the delivery of autism services. While access to autism treatment services has increased as a result of implementation of state mandates, states have struggled to keep up with the demand for services. Participants provided specific information about barriers and facilitators to meeting this demand. Understanding of key informants' perceptions about states' experiences implementing autism insurance mandates is useful for other states considering adopting or expanding mandates or other policies to expand access to autism treatment services. © The Author(s) 2015.

Estimating Coherence Measures from Limited Experimental Data Available

NASA Astrophysics Data System (ADS)

Zhang, Da-Jian; Liu, C. L.; Yu, Xiao-Dong; Tong, D. M.

2018-04-01

Quantifying coherence has received increasing attention, and considerable work has been directed towards finding coherence measures. While various coherence measures have been proposed in theory, an important issue following is how to estimate these coherence measures in experiments. This is a challenging task, since the state of a system is often unknown in practical applications and the accessible measurements in a real experiment are typically limited. In this Letter, we put forward an approach to estimate coherence measures of an unknown state from any limited experimental data available. Our approach is not only applicable to coherence measures but can be extended to other resource measures.

Cost estimate modeling of transportation management plans for highway projects.

DOT National Transportation Integrated Search

2012-05-01

Highway rehabilitation and reconstruction projects frequently cause road congestion and increase safety concerns while limiting access for road users. State Transportation Agencies (STAs) are challenged to find safer and more efficient ways to renew ...

Structural barriers in access to medical marijuana in the USA-a systematic review protocol.

PubMed

Valencia, Celina I; Asaolu, Ibitola O; Ehiri, John E; Rosales, Cecilia

2017-08-07

There are 43 state medical marijuana programs in the USA, yet limited evidence is available on the demographic characteristics of the patient population accessing these programs. Moreover, insights into the social and structural barriers that inform patients' success in accessing medical marijuana are limited. A current gap in the scientific literature exists regarding generalizable data on the social, cultural, and structural mechanisms that hinder access to medical marijuana among qualifying patients. The goal of this systematic review, therefore, is to identify the aforementioned mechanisms that inform disparities in access to medical marijuana in the USA. This scoping review protocol outlines the proposed study design for the systematic review and evaluation of peer-reviewed scientific literature on structural barriers to medical marijuana access. The protocol follows the guidelines set forth by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist. The overarching goal of this study is to rigorously evaluate the existing peer-reviewed data on access to medical marijuana in the USA. Income, ethnic background, stigma, and physician preferences have been posited as the primary structural barriers influencing medical marijuana patient population demographics in the USA. Identification of structural barriers to accessing medical marijuana provides a framework for future policies and programs. Evidence-based policies and programs for increasing medical marijuana access help minimize the disparity of access among qualifying patients.

Online Ratings Systems for Physicians and Institutions: Limitations of the Current State of the Art.

PubMed

Daskivich, Timothy J; Spiegel, Brennan; Kim, Hyung L

2017-03-01

Consumers are increasingly using online ratings tools that compare surgeons and institutions to identify high-quality providers. However, concerns regarding their limitations-data quality, validity of statistical comparisons, and impact on access to care-should be considered before full-scale implementation. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Limited access to hepatitis B/C treatment among vulnerable risk populations: an expert survey in six European countries.

PubMed

Falla, Abby M; Veldhuijzen, Irene K; Ahmad, Amena A; Levi, Miriam; Hendrik Richardus, Jan

2017-04-01

To investigate access to treatment for chronic hepatitis B/C among six vulnerable patient/population groups at-risk of infection: undocumented migrants, asylum seekers, people without health insurance, people with state insurance, people who inject drugs (PWID) and people abusing alcohol. An online survey among experts in gastroenterology, hepatology and infectious diseases in 2012 in six EU countries: Germany, Hungary, Italy, the Netherlands, Spain and the UK. A four-point ordinal scale measured access to treatment (no, some, significant or complete restriction). From 235 recipients, 64 responses were received (27%). Differences in access between and within countries were reported for all groups except people with state insurance. Most professionals, other than in Spain and Hungary, reported no or few restrictions for PWID. Significant/complete treatment restriction was reported for all groups by the majority in Hungary and Spain, while Italian respondents reported no/few restrictions. Significant/complete restriction was reported for undocumented migrants and people without health insurance in the UK and Spain. Opinion about undocumented migrants in Germany and the Netherlands was divergent. Although effective chronic hepatitis B/C treatment exists, limited access among vulnerable patient populations was seen in all study countries. Discordance of opinion about restrictions within countries is seen, especially for groups for whom the health care system determines treatment access, such as undocumented migrants, asylum seekers and people without health insurance. This suggests low awareness, or lack, of entitlement guidance among clinicians. Expanding treatment access among risk groups will contribute to reducing chronic viral hepatitis-associated avoidable morbidity and mortality. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association.

Genetic characterization of Vitis germplasm collected from the southwestern US and Mexico to expedite Pierce's disease-resistance breeding.

PubMed

Riaz, S; Huerta-Acosta, K; Tenscher, A C; Walker, M A

2018-04-30

Pierce's disease (PD) limits the cultivation of Vitis vinifera grape cultivars in California, across the southern United States and into South America. Resistance has been well characterized in V. arizonica, and one resistance locus has been identified (PdR1). However, resistance is poorly characterized in most other grape species. We tested a wide range of Vitis species from the southwestern United States for resistance to PD and used nuclear and chloroplast markers to phenotypically and genetically select a diverse set of resistant accessions. Chloroplast SSR markers identified 11 maternal lineage lines within the set of 17 (14 new and three previously identified) PD resistant accessions. A total of 19 breeding populations (F1 and pseudo-BC1) were developed with the 14 PD resistant accessions, and a total of 705 seedlings were analyzed for PD resistance. Using a limited mapping approach, 12 SSR markers, linked to the PdR1 locus, were used to genotype the breeding populations and phenotypic data were analyzed. Nine accessions had a major resistance quantitative trait locus (QTL) within the genomic region containing PdR1. The phenotypic data for these three resistant accessions, ANU67, b41-13, and T03-16, did not associate with PdR1 linked markers, indicating that their resistance is located in other regions of the genome. These three accessions were identified as candidates for use in the development of framework maps with larger populations capable of detecting additional and unique loci for PD resistance breeding and the stacking of PD resistance genes.

Medicaid Waivers and Public Sector Mental Health Service Penetration Rates for Youth.

PubMed

Graaf, Genevieve; Snowden, Lonnie

2018-01-22

To assist families of youth with serious emotional disturbance in financing youth's comprehensive care, some states have sought and received Medicaid waivers. Medicaid waivers waive or relax the Medicaid means test for eligibility to provide insurance coverage to nonpoor families for expensive, otherwise out-of-reach treatment for youth with Serious Emotional Disturbance (SED). Waivers promote treatment access for the most troubled youth, and the present study investigated whether any of several Medicaid waiver options-and those that completely omit the means test in particular-are associated with higher state-wide public sector treatment penetration rates. The investigators obtained data from the U.S. Census, SAMHSA's Uniform Reporting System, and the Centers for Medicare and Medicaid Services. Analysis employed random intercept and random slope linear regression models, controlling for a variety of state demographic and fiscal variables, to determine whether a relationship between Medicaid waiver policies and state-level public sector penetration rates could be observed. Findings indicate that, whether relaxing or completely waiving Medicaid's qualifying income limits, waivers increase public sector penetration rates, particularly for youth under age 17. However, completely waiving Medicaid income limits did not uniquely contribute to penetration rate increases. States offering Medicaid waivers that either relax or completely waive Medicaid's means test to qualify for health coverage present higher public sector treatment rates for youth with behavioral health care needs. There is no evidence that restricting the program to waiving the means test for accessing Medicaid would increase treatment access. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Cost estimate modeling of transportation management plans for highway projects : [research brief].

DOT National Transportation Integrated Search

2012-05-01

Highway rehabilitation and reconstruction projects frequently cause road congestion and increase safety concerns while limiting access for road users. State Transportation Agencies (STAs) are challenged to find safer and more efficient ways to renew ...

Improving the effectiveness of ecological site descriptions: General state-and-transition models and the Ecosystem Dynamics Interpretive Tool (EDIT)

USGS Publications Warehouse

Bestelmeyer, Brandon T.; Williamson, Jeb C.; Talbot, Curtis J.; Cates, Greg W.; Duniway, Michael C.; Brown, Joel R.

2016-01-01

State-and-transition models (STMs) are useful tools for management, but they can be difficult to use and have limited content.STMs created for groups of related ecological sites could simplify and improve their utility. The amount of information linked to models can be increased using tables that communicate management interpretations and important within-group variability.We created a new web-based information system (the Ecosystem Dynamics Interpretive Tool) to house STMs, associated tabular information, and other ecological site data and descriptors.Fewer, more informative, better organized, and easily accessible STMs should increase the accessibility of science information.

State policy and teen childbearing: a review of research studies.

PubMed

Beltz, Martha A; Sacks, Vanessa H; Moore, Kristin A; Terzian, Mary

2015-02-01

Teen childbearing is affected by many individual, family, and community factors; however, another potential influence is state policy. Rigorous studies of the relationship between state policy and teen birth rates are few in number but represent a body of knowledge that can inform policy and practice. This article reviews research assessing associations between state-level policies and teen birth rates, focusing on five policy areas: access to family planning, education, sex education, public assistance, and access to abortion services. Overall, several studies have found that measures related to access to and use of family planning services and contraceptives are related to lower state-level teen birth rates. These include adolescent enrollment in clinics, minors' access to contraception, conscience laws, family planning expenditures, and Medicaid waivers. Other studies, although largely cross-sectional analyses, have concluded that policies and practices to expand or improve public education are also associated with lower teen birth rates. These include expenditures on education, teacher-to-student ratios, and graduation requirements. However, the evidence regarding the role of public assistance, abortion access, and sex education policies in reducing teen birth rates is mixed and inconclusive. These conclusions must be viewed as tentative because of the limited number of rigorous studies that examine the relationship between state policy and teen birth rates over time. Many specific policies have only been analyzed by a single study, and few findings are based on recent data. As such, more research is needed to strengthen our understanding of the role of state policies in teen birth rates. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Application of consumer protection authority in preventing tobacco sales to minors.

PubMed

Krevor, B S; Lieberman, A; Gerlach, K

2002-06-01

In the USA, the enforcement of state sales of tobacco products to minors laws has had only limited impact upon reducing youth access. The application of consumer protection authorities by state attorneys general to alter the sales and promotion practices of tobacco retailers provides a complementary and highly leveraged strategy to increase compliance with tobacco sales to minors laws.

Tales from the Front Line: Teachers' Responses to Somali Bantu Refugee Students

ERIC Educational Resources Information Center

Roxas, Kevin

2011-01-01

This qualitative study identifies the ways in which teachers in an urban school district responded to the specialized educational needs of Somali Bantu refugee students who have recently been relocated to the United States and who have had limited and interrupted access to education prior to their enrollment in public schools in the United States.…

HIV Testing and HIV/AIDS Treatment Services in Rural Counties in 10 Southern States: Service Provider Perspectives

ERIC Educational Resources Information Center

Sutton, Madeline; Anthony, Monique-Nicole; Vila, Christie; McLellan-Lemal, Eleanor; Weidle, Paul J.

2010-01-01

Context: Forty percent of AIDS cases are reported in the southern United States, the region with the largest proportion of HIV/AIDS cases from rural areas. Data are limited regarding provider perspectives of the accessibility and availability of HIV testing and treatment services in southern rural counties. Purpose: We surveyed providers in the…

Geographic Access to US Neurocritical Care Units Registered with the Neurocritical Care Society

PubMed Central

Shutter, Lori A.; Branas, Charles C.; Adeoye, Opeolu; Albright, Karen C.; Carr, Brendan G.

2018-01-01

Background Neurocritical care provides multidisciplinary, specialized care to critically ill neurological patients, yet an understanding of the proportion of the population able to rapidly access specialized Neurocritical Care Units (NCUs) in the United States is currently unknown. We sought to quantify geographic access to NCUs by state, division, region, and for the US as a whole. In addition, we examined how mode of transportation (ground or air ambulance), and prehospital transport times affected population access to NCUs. Methods Data were obtained from the Neurocritical Care Society (NCS), US Census Bureau and the Atlas and Database of Air Medical Services. Empirically derived prehospital time intervals and validated models estimating prehospital ground and air travel times were used to calculate total prehospital times. A discrete total prehospital time interval was calculated for each small unit of geographic analysis (block group) and block group populations were summed to determine the proportion of Americans able to reach a NCU within discrete time intervals (45, 60, 75, and 90 min). Results are presented for different geographies and for different modes of prehospital transport (ground or air ambulance). Results There are 73 NCUs in the US using ground transportation alone, 12.8, 20.5, 27.4, and 32.6% of the US population are within 45, 60, 75, and 90 min of an NCU, respectively. Use of air ambulances increases access to 36.8, 50.4, 60, and 67.3 within 45, 60, 75, and 90 min, respectively. The Northeast has the highest access rates in the US using ground ambulances and for 45, 60, and 75 min transport times with the addition of air ambulances. At 90 min, the West has the highest access rate. The Southern region has the lowest ground and air access to NCUs access rates for all transport times. Conclusions Using NCUs registered with the NCS, current geographic access to NCUs is limited in the US, and geographic disparities in access to care exist. While additional NCUs may exist beyond those identified by the NCS database, we identify geographies with limited access to NCUs and offer a population-based planning perspective on the further development of the US neurocritical care system. PMID:22045246

Temporal and spectral manipulations of correlated photons using a time lens

NASA Astrophysics Data System (ADS)

Mittal, Sunil; Orre, Venkata Vikram; Restelli, Alessandro; Salem, Reza; Goldschmidt, Elizabeth A.; Hafezi, Mohammad

2017-10-01

A common challenge in quantum information processing with photons is the limited ability to manipulate and measure correlated states. An example is the inability to measure picosecond-scale temporal correlations of a multiphoton state, given state-of-the-art detectors have a temporal resolution of about 100 ps. Here, we demonstrate temporal magnification of time-bin-entangled two-photon states using a time lens and measure their temporal correlation function, which is otherwise not accessible because of the limited temporal resolution of single-photon detectors. Furthermore, we show that the time lens maps temporal correlations of photons to frequency correlations and could be used to manipulate frequency-bin-entangled photons. This demonstration opens a new avenue to manipulate and analyze spectral and temporal wave functions of many-photon states.

Undocumented and uninsured: aftereffects of the Patient Protection and Affordable Care Act.

PubMed

Agabin, Nataly; Coffin, Janis

2015-01-01

Although with the implementation of the Patient Protection and Affordable Care Act millions of previously uninsured American residents will gain access to healthcare coverage, millions more will remain uninsured due to the lack of mandatory state Medicaid expansion as well as mandates that forbid undocumented immigrants and legal residents of less than five years from purchasing insurance through the newly available market exchange. With limited options for healthcare coverage due to employment and lack of citizen status, undocumented immigrants rely heavily on funds provided by both Emergency Medicaid and Disproportionate Share Hospital programs. Through reevaluation of current funding, mandates forbidding access to market exchanges, and plans to further enable access to affordable health coverage, states have the unique opportunity to both aid their residents and relieve the financial burden on healthcare facilities and Emergency Medicaid funds.

Interlibrary loan in primary access libraries: challenging the traditional view

PubMed Central

Dudden, Rosalind Farnam; Coldren, Sue; Condon, Joyce Elizabeth; Katsh, Sara; Reiter, Catherine Morton; Roth, Pamela Lynn

2000-01-01

Introduction: Primary access libraries serve as the foundation of the National Network of Libraries of Medicine (NN/LM) interlibrary loan (ILL) hierarchy, yet few published reports directly address the important role these libraries play in the ILL system. This may reflect the traditional view that small, primary access libraries are largely users of ILL, rather than important contributors to the effectiveness and efficiency of the national ILL system. Objective: This study was undertaken to test several commonly held beliefs regarding ILL system use by primary access libraries. Hypotheses: Three hypotheses were developed. H1: Colorado and Wyoming primary access libraries comply with the recommended ILL guideline of adhering to a hierarchical structure, emphasizing local borrowing. H2: The closures of two Colorado Council of Medical Librarians (CCML) primary access libraries in 1996 resulted in twenty-three Colorado primary access libraries' borrowing more from their state resource library in 1997. H3: The number of subscriptions held by Colorado and Wyoming primary access libraries is positively correlated with the number of items they loan and negatively correlated with the number of items they borrow. Methods: The hypotheses were tested using the 1992 and 1997 DOCLINE and OCLC data of fifty-four health sciences libraries, including fifty primary access libraries, two state resource libraries, and two general academic libraries in Colorado and Wyoming. The ILL data were obtained electronically and analyzed using Microsoft Word 98, Microsoft Excel 98, and JMP 3.2.2. Results: CCML primary access libraries comply with the recommended guideline to emphasize local borrowing by supplying each other with the majority of their ILLs, instead of overburdening libraries located at higher levels in the ILL hierarchy (H1). The closures of two CCML primary access libraries appear to have affected the entire ILL system, resulting in a greater volume of ILL activity for the state resource library and other DOCLINE libraries higher up in the ILL hierarchy and highlighting the contribution made by CCML primary access libraries (H2). CCML primary access libraries borrow and lend in amounts that are proportional to their collection size, rather than overtaxing libraries at higher levels in the ILL hierarchy with large numbers of requests (H3). Limitations: The main limitations of this study were the small sample size and the use of data collected for another purpose, the CCML ILL survey. Conclusions: The findings suggest that there is little evidence to support several commonly held beliefs regarding ILL system use by primary access libraries. In addition to validating the important contributions made by primary access libraries to the national ILL system, baseline data that can be used to benchmark current practice performance are provided. PMID:11055297

76 FR 24905 - Privacy Act of 1974; Department of Homeland Security United States Coast Guard-DHS/USCG-007...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-03

... governing local control of communicable diseases, preventive medicine and safety programs, developmental... that is being stored. Access to the computer system containing the records in this system is limited to...

The Employee Polygraph Protection Act of 1988.

ERIC Educational Resources Information Center

Duffy, Patrick J.

1989-01-01

Aspects of the new Employee Polygraph Protection Act are discussed, including exemptions, prohibited devices, limitations, exceptions, injury and access requirements, reasonable suspicion, drug industry investigations, procedural requirements, disclosure, basis for discharge, enforcement and remedies, and preemption and existing state laws. (MSE)

Disaster planning: transportation resources and considerations for managing a burn disaster.

PubMed

Kearns, Randy D; Hubble, Michael W; Holmes, James H; Cairns, Bruce A

2014-01-01

A disaster scenario with a significant number of burn-injured patients creates a tremendous challenge for disaster planners. Directing the transport of patients to the most appropriate receiving facility as soon as reasonably possible remains the aim. This review focused on both the overall process as well as an analysis of one specific state (as an example). This included the capability and limitations of the intrastate and interstate resources should a burn disaster occur. Although the results for one state may be interesting, it is the process that is essential for those involved in burn disaster planning. An overview of the quantity and quality of available ambulances and how to access these resources is provided. Ground-based ambulances have an array of capacities and levels of services ranging from basic life support to advanced (paramedic) services and include ambulance buses. This review also included private and hospital-based specialty care ambulances and aeromedical services. Finally, the review identified military or federal resources that may be an option as well. There are various local, state, and federal resources that can be called upon to meet the transportation needs of these critically injured patients. Yet, there are barriers to access and limitations to their response. It is just as important to know both availability and capability as it is to know how to access these resources. A disaster is not the time to realize these hurdles.

African-American and white head and neck carcinoma patients in a university medical center setting. Are treatments provided and are outcomes similar or disparate?

PubMed

Murdock, J M; Gluckman, J L

2001-01-01

Racial and ethnic disparities occur in many areas of the health care management system in the United States. These disparities include disease incidence, access to health and medical services, treatments provided, and disease outcomes. Health care delivery organizations have limited resources. Encounters between patients and providers in health care delivery organizations typically are cross-cultural. Access to care, quality of care, and equity may be affected by limited resources and cross-cultural encounters. This impacts the diagnosis, treatments provided, and outcomes, with African-American patients faring poorly compared with white patients. African Americans are 15% more likely to develop cancer than whites and are about 34% more likely to die of cancer than whites in the United States. The purpose of this study was to determine and compare the characteristics of African-American patients and white patients with carcinoma of the head and neck at the University of Cincinnati Medical Center, an equal-access facility, reporting similarities and disparities in disease stage at the time of diagnosis, treatment received, and patient outcomes. Copyright 2001 American Cancer Society.

Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States.

PubMed

Levy, Matthew E; Wilton, Leo; Phillips, Gregory; Glick, Sara Nelson; Kuo, Irene; Brewer, Russell A; Elliott, Ayana; Watson, Christopher; Magnus, Manya

2014-05-01

Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed.

Understanding Structural Barriers to Accessing HIV Testing and Prevention Services Among Black Men Who Have Sex with Men (BMSM) in the United States

PubMed Central

Wilton, Leo; Phillips, Gregory; Glick, Sara Nelson; Kuo, Irene; Brewer, Russell A.; Elliott, Ayana; Watson, Christopher; Magnus, Manya

2015-01-01

Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed. PMID:24531769

Security Sector Reform’s Utility in Conflict Prevention

DTIC Science & Technology

2013-12-10

Publications, 1994), 18. 40 Many of these countries in Africa are states in name only due to ill defined borders, fiscal limitations, nomadic ...Security Watch, 12 OCT 2009), Online at http://www.isn.ethz.ch/isn/ Digital -Library/Articles/Detail/?lng= en&id= 108451[accessed on 27 May 2013]. 85...ISN Security Watch, 12 OCT 2009. Online at http://www.isn.ethz.ch/isn/ Digital -Library/Articles/Detail/?lng= en&id= 108451[accessed on 27 May 2013

Identifying Successful Practices to Overcome Access to Care Challenges in Community Health Centers: A "Positive Deviance" Approach.

PubMed

Toscos, Tammy; Carpenter, Maria; Flanagan, Mindy; Kunjan, Kislaya; Doebbeling, Bradley N

2018-01-01

Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These "positive deviant" practices translate into organizational policies to improve health care access and patient experience. To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families. Seven CHC systems, involving over 40 clinics, distributed across one midwestern state in the United States. Ninety-two key informants, comprised of CHC patients (42%) and clinic staff (53%), participated in semi-structured interviews. Interview transcripts were subjected to thematic analysis to identify patient-centered solutions for managing access challenges to primary care for underserved populations. Transcripts were coded using qualitative analytic software. Practices to improve access to care included addressing illiteracy and low health literacy, identifying cost-effective resources, expanding care offerings, enhancing the patient-provider relationship, and cultivating a culture of teamwork and customer service. Helping patients find the least expensive options for transportation, insurance, and medication was the most compelling patient-centered strategy. Appointment reminders and confirmation of patient plans for transportation to appointments reduced no-show rates. We identified nearly 35 practices for improving health care access. These were all patient-centric, uncovered by both clinic staff and patients who had successfully navigated the health care system to improve access.

Driver speed selection on high-speed two-lane highways: Comparing speed profiles between uniform and differential speed limits.

PubMed

Russo, Brendan J; Savolainen, Peter T; Gates, Timothy J; Kay, Jonathan J; Frazier, Sterling

2017-07-04

Although a considerable amount of prior research has investigated the impacts of speed limits on traffic safety and operations, much of this research, and nearly all of the research related to differential speed limits, has been specific to limited access freeways. The unique safety and operational issues on highways without access control create difficulty relating the conclusions from prior freeway-related speed limit research to 2-lane highways, particularly research on differential limits due to passing limitations and subsequent queuing. Therefore, the objective of this study was to assess differences in driver speed selection with respect to the posted speed limit on rural 2-lane highways, with a particular emphasis on the differences between uniform and differential speed limits. Data were collected from nearly 59,000 vehicles across 320 sites in Montana and 4 neighboring states. Differences in mean speeds, 85th percentile speeds, and the standard deviation in speeds for free-flowing vehicles were examined across these sites using ordinary least squares regression models. Ultimately, the results of the analysis show that the mean speed, 85th percentile speed, and variability in travel speeds for free-flowing vehicles on 2-lane highways are generally lower at locations with uniform 65 mph speed limits, compared to locations with differential limits of 70 mph for cars and 60 mph for trucks. In addition to posted speed limits, several site characteristics were shown to influence speed selection including shoulder widths, frequency of horizontal curves, percentage of the segment that included no passing zones, and hourly volumes. Differences in vehicle speed characteristics were also observed between states, indicating that speed selection may also be influenced by local factors, such as driver population or enforcement.

Right and access to healthcare for undocumented children: addressing the gap between international conventions and disparate implementations in North America and Europe.

PubMed

Ruiz-Casares, Mónica; Rousseau, Cécile; Derluyn, Ilse; Watters, Charles; Crépeau, François

2010-01-01

Limited access to healthcare for vulnerable immigrant children in Europe and North America is increasingly worrisome as immigration policies harden. This paper analyzes the gap between States' obligations under international human rights law and the disparate local implementations in diverse countries. Studies that are both multidisciplinary and incorporate micro and macro level indicators are needed to reveal discrepancies between entitlements and access. It is argued that the lack of available data on the magnitude of the problem and on its individual and public health consequences stems from the conflicting situation faced by health institutions required to simultaneously protect the best interest of each child and allocate limited resources. Collaboration in research is urgently needed to assist policy-makers and institutions make informed decisions. Copyright 2009 Elsevier Ltd. All rights reserved.

Preserving the Master Plan: What Is To Be Done in a New Epoch of More Limited Growth of Resources? Report 94-3.

ERIC Educational Resources Information Center

Kerr, Clark

Under the Master Plan of 1960, California was the first state to provide universal access to higher education for all high school graduates. Despite great success at all levels, higher education in California is now facing a crisis. National and state-wide recessions have reduced resources while potential enrollment is sharply increasing from…

Impact of Medicaid Managed Care on Illinois's Acute Health Services Expenditures for Adults with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Yamaki, Kiyoshi; Wing, Coady; Mitchell, Dale; Owen, Randall; Heller, Tamar

2018-01-01

States have increasingly transitioned Medicaid enrollees with disabilities from fee-for-service (FFS) to Medicaid Managed Care (MMC), intending to reduce state Medicaid spending and to provide better access to health services. Yet, previous studies on the impact of MMC are limited and findings are inconsistent. We analyzed the impact of MMC on…

The association between state bans on soda only and adolescent substitution with other sugar-sweetened beverages: a cross-sectional study.

PubMed

Taber, Daniel R; Chriqui, Jamie F; Vuillaume, Renee; Kelder, Steven H; Chaloupka, Frank J

2015-07-27

Across the United States, many states have actively banned the sale of soda in high schools, and evidence suggests that students' in-school access to soda has declined as a result. However, schools may be substituting soda with other sugar-sweetened beverages (SSBs), and national trends indicate that adolescents are consuming more sports drinks and energy drinks. This study examined whether students consumed more non-soda SSBs in states that banned the sale of soda in school. Student data on consumption of various SSBs and in-school access to vending machines that sold SSBs were obtained from the National Youth Physical Activity and Nutrition Study (NYPANS), conducted in 2010. Student data were linked to state laws regarding the sale of soda in school in 2010. Students were cross-classified based on their access to vending machines and whether their state banned soda in school, creating 4 comparison groups. Zero-inflated negative binomial models were used to compare these 4 groups with respect to students’ self-reported consumption of diet soda, sports drinks, energy drinks, coffee/tea, or other SSBs. Students who had access to vending machines in a state that did not ban soda were the reference group. Models were adjusted for race/ethnicity, sex, grade, home food access, state median income, and U.S. Census region. Students consumed more servings of sports drinks, energy drinks, coffee/tea, and other SSBs if they resided in a state that banned soda in school but attended a school with vending machines that sold other SSBs. Similar results were observed where schools did not have vending machines but the state allowed soda to be sold in school. Intake was generally not elevated where both states and schools limited SSB availability – i.e., states banned soda and schools did not have SSB vending machines. State laws that ban soda but allow other SSBs may lead students to substitute other non-soda SSBs. Additional longitudinal research is needed to confirm this. Elevated SSB intake was not observed when both states and schools took steps to remove SSBs from school.

The association between state bans on soda only and adolescent substitution with other sugar-sweetened beverages: a cross-sectional study

PubMed Central

2015-01-01

Background Across the United States, many states have actively banned the sale of soda in high schools, and evidence suggests that students’ in-school access to soda has declined as a result. However, schools may be substituting soda with other sugar-sweetened beverages (SSBs), and national trends indicate that adolescents are consuming more sports drinks and energy drinks. This study examined whether students consumed more non-soda SSBs in states that banned the sale of soda in school. Methods Student data on consumption of various SSBs and in-school access to vending machines that sold SSBs were obtained from the National Youth Physical Activity and Nutrition Study (NYPANS), conducted in 2010. Student data were linked to state laws regarding the sale of soda in school in 2010. Students were cross-classified based on their access to vending machines and whether their state banned soda in school, creating 4 comparison groups. Zero-inflated negative binomial models were used to compare these 4 groups with respect to students’ self-reported consumption of diet soda, sports drinks, energy drinks, coffee/tea, or other SSBs. Students who had access to vending machines in a state that did not ban soda were the reference group. Models were adjusted for race/ethnicity, sex, grade, home food access, state median income, and U.S. Census region. Results Students consumed more servings of sports drinks, energy drinks, coffee/tea, and other SSBs if they resided in a state that banned soda in school but attended a school with vending machines that sold other SSBs. Similar results were observed where schools did not have vending machines but the state allowed soda to be sold in school. Intake was generally not elevated where both states and schools limited SSB availability – i.e., states banned soda and schools did not have SSB vending machines. Conclusion State laws that ban soda but allow other SSBs may lead students to substitute other non-soda SSBs. Additional longitudinal research is needed to confirm this. Elevated SSB intake was not observed when both states and schools took steps to remove SSBs from school. PMID:26221969

A critical review of "Community effects of highways reflected by property values".

DOT National Transportation Integrated Search

1974-01-01

The report reviewed was prepared by Hays Gamble, C. John Langley, Jr., Owen Sauerlender, and other researchers from Pennsylvania State University, who attempted to determine the extent to which certain effects of limited access highways altered the v...

Measuring geographic access to health care: raster and network-based methods

PubMed Central

2012-01-01

Background Inequalities in geographic access to health care result from the configuration of facilities, population distribution, and the transportation infrastructure. In recent accessibility studies, the traditional distance measure (Euclidean) has been replaced with more plausible measures such as travel distance or time. Both network and raster-based methods are often utilized for estimating travel time in a Geographic Information System. Therefore, exploring the differences in the underlying data models and associated methods and their impact on geographic accessibility estimates is warranted. Methods We examine the assumptions present in population-based travel time models. Conceptual and practical differences between raster and network data models are reviewed, along with methodological implications for service area estimates. Our case study investigates Limited Access Areas defined by Michigan’s Certificate of Need (CON) Program. Geographic accessibility is calculated by identifying the number of people residing more than 30 minutes from an acute care hospital. Both network and raster-based methods are implemented and their results are compared. We also examine sensitivity to changes in travel speed settings and population assignment. Results In both methods, the areas identified as having limited accessibility were similar in their location, configuration, and shape. However, the number of people identified as having limited accessibility varied substantially between methods. Over all permutations, the raster-based method identified more area and people with limited accessibility. The raster-based method was more sensitive to travel speed settings, while the network-based method was more sensitive to the specific population assignment method employed in Michigan. Conclusions Differences between the underlying data models help to explain the variation in results between raster and network-based methods. Considering that the choice of data model/method may substantially alter the outcomes of a geographic accessibility analysis, we advise researchers to use caution in model selection. For policy, we recommend that Michigan adopt the network-based method or reevaluate the travel speed assignment rule in the raster-based method. Additionally, we recommend that the state revisit the population assignment method. PMID:22587023

Why build limited access highways?.

DOT National Transportation Integrated Search

1991-01-01

This report first explains what a limited access highway is, then describes the benefits and advantages of limited access highways. As compared with highways with no control of access, limited access highways (especially those with full control) have...

Latino adults' health insurance coverage: an examination of Mexican and Puerto Rican subgroup differences.

PubMed

Vitullo, Margaret Weigers; Taylor, Amy K

2002-11-01

Lack of health insurance is a serious problem in the United States. Using data from the 1996 Medical Expenditure Panel Survey, this paper examines how insurance varies between black, white, and Latino adults. Because Latino subgroups are not homogeneous, the paper also compares the factors associated with health insurance status for Mexican and Puerto Rican adults. Results indicate that access to private health insurance for Latino adults was more closely associated with workplace characteristics than employment itself. Time lived in the United States was a major factor associated with being uninsured for Mexican adults, while language barriers were a major factor limiting Puerto Rican individuals' access to private health insurance. The paper suggests two approaches for decreasing uninsurance among Latino adults: (1) strengthening the link between employment and private health insurance and (2) addressing disparities in access to public coverage for racial and ethnic groups, including recent immigrants.

Financing mental health services for adolescents: a background paper.

PubMed

Kapphahn, Cynthia; Morreale, Madlyn; Rickert, Vaughn I; Walker, Leslie

2006-09-01

Good mental health provides an essential foundation for normal growth and development through adolescence and into adulthood. Many adolescents, however, experience mental health problems that significantly impede the attainment of their full potential. The majority of these adolescents do not receive needed mental health services, in part because of financial obstacles to care. This article reviews the magnitude and impact of mental health problems during adolescence and highlights the importance of insurance coverage in assuring access to mental health services for adolescents. Significant limitations in private health insurance coverage of mental health services are outlined. Recent federal and state efforts to move toward parity in private insurance coverage between mental and physical health services are discussed, including an explanation of the role of Medicaid and the State Children's Health Insurance Program (SCHIP) in providing access to mental health services for adolescents. Finally, other elements that would facilitate financial access to essential mental health services for adolescents are presented.

The modern rotor aerodynamic limits survey: A report and data survey

NASA Technical Reports Server (NTRS)

Cross, J.; Brilla, J.; Kufeld, R.; Balough, D.

1993-01-01

The first phase of the Modern Technology Rotor Program, the Modern Rotor Aerodynamic Limits Survey, was a flight test conducted by the United States Army Aviation Engineering Flight Activity for NASA Ames Research Center. The test was performed using a United States Army UH-60A Black Hawk aircraft and the United States Air Force HH-60A Night Hawk instrumented main-rotor blade. The primary purpose of this test was to gather high-speed, steady-state, and maneuvering data suitable for correlation purposes with analytical prediction tools. All aspects of the data base, flight-test instrumentation, and test procedures are presented and analyzed. Because of the high volume of data, only select data points are presented. However, access to the entire data set is available upon request.

Night Owl: Maryland's After-Hours Reference Service.

ERIC Educational Resources Information Center

Duke, Deborah C.

1994-01-01

Discusses "Night Owl," a Maryland public library's after hours telephone reference service. Issues include project start-up, user profiles, types of questions, volume, after hours reference accessibility, security, costs, service limits, publicity, staffing, and employee turnover. Similar services in other states are cited. (Contains six…

Family, culture, and health practices among migrant farmworkers.

PubMed

Bechtel, G A; Shepherd, M A; Rogers, P W

1995-01-01

Migrant farmworkers and their families have restricted access to health and human services because of their frequent relocation between states, language and cultural barriers, and limited economic and political resources. Living and working in substandard environments, these families are at greater risk for developing chronic and communicable disease. In an assessment of health patterns among 225 migrant workers and their families, using personal observations, unstructured interviews, and individual and state health records, children's immunizations were found to be current, but dental caries and head lice were epidemic. Among adults, almost one third tested positive for tuberculosis exposure. Urinary tract infections were the most common health problem among women. Primary and secondary prevention were almost nonexistent because funds for these services were not readily available. The patriarchal system contributes to these problems by limiting access to family-health and social service needs. Although providing comprehensive health care to migrant communities presents unique challenges, nurses can demonstrate their effectiveness in reducing morbidity through strategic interventions and alternative uses of health delivery systems.

Nursing home bed capacity in the States, 1978-86

PubMed Central

Harrington, Charlene; Swan, James H.; Grant, Leslie A.

1988-01-01

Trends in nursing home bed supply in the States show large variations in beds per population and a gradual decline in supply per aged population. A cross-sectional time-series regression analysis was used to examine some factors associated with nursing home bed supply. Variation was accounted for by economic factors, supply of alternative services, and climate. State Medicaid reimbursement rates had negative coefficients, with supply suggesting States may be increasing rates to improve access where supply is limited. Medicaid waiver policy was not found to be significant. PMID:10312634

Improving access to health care for undocumented immigrants in the United States.

PubMed

Wallace, Steven P; Rodriguez, Michael; Padilla-Frausto, Imelda; Arredondo, Armando; Orozco, Emanuel

2013-01-01

To identify policies that increase access to health care for undocumented Mexican immigrants. Four focus groups (n=34 participants) were conducted with uninsured Mexican immigrants in Los Angeles, California. The feasibility and desirability of different policy proposals for increasing access were discussed by each group. Respondents raised significant problems with policies including binational health insurance, expanded employer-provided health insurance, and telemedicine. The only solution with a consensus that the change would be feasible, result in improved access, and they had confidence in was expanded access to community health centers (CHC's). Given the limited access to most specialists at CHC's and the continued barriers to hospital care for those without health insurance, the most effective way of improving the complete range of health services to undocumented immigrants is through immigration reform that will bring these workers under the other health care reform provisions.

Seat belt use on interstate highways.

PubMed Central

Wells, J K; Williams, A F; Lund, A K

1990-01-01

More than 5,000 miles of limited-access highways in the eastern United States and Canada were traveled to observe seat belt use. Overall belt use was 58 percent in the United States and 79 percent in Canada. The data indicate that belt use in the United States follows a different pattern on interstate highways than on other streets and roads, with relatively high belt use rates (over 50 percent) appearing to be somewhat independent of belt use law provisions. PMID:2343969

Opportunities and limitations for using new media and mobile phones to expand access to sexual and reproductive health information and services for adolescent girls and young women in six Nigerian states.

PubMed

Akinfaderin-Agarau, Fadekem; Chirtau, Manre; Ekponimo, Sylvia; Power, Samantha

2012-06-01

Reproductive health problems are a challenge affecting young people in Nigeria. Education as a Vaccine (EVA) implements the My Question and Answer Service, using mobile phones to provide sexual and reproductive health (SRH) information and services. Use of the service by adolescent girls and young women is low. Focus group discussions were held with 726 females to assess their access to mobile phones, as well as the barriers and limitations to the use of their phones to seek SRH information and services. Results demonstrate high mobile phone access but limited use of phones to access SRH information and services. Barriers to use of these services include cost of service for young female clients, request for socio-demographic information that could break anonymity, poor marketing and publicity, socio-cultural beliefs and expectations of young girls, individual personality and beliefs, as well as infrastructural/network quality. It is therefore recommended that these barriers be adequately addressed to increase the potential use of mobile phone for providing adolescent and young girls with SRH information and services. In addition, further initiatives and research are needed to explore the potentials of social media in meeting this need.

Science and Success: Sex Education and Other Programs That Work to Prevent Teen Pregnancy, HIV, and Sexually Transmitted Infections. Third Edition. Executive Summary

ERIC Educational Resources Information Center

Alford, Sue

2012-01-01

Teen pregnancy in the United States has declined significantly in the last two decades. Despite these declines, rates of teen birth, HIV, and STIs in the United States remain among the highest of any industrialized nation. Socio-economic, cultural and structural factors such as poverty, limited access to health care, racism and unemployment…

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.

The Judicialization of Health and the Quest for State Accountability: Evidence from 1,262 Lawsuits for Access to Medicines in Southern Brazil

PubMed Central

Socal, Mariana P.; Amon, Joseph J.

2016-01-01

Abstract The impact of increasing numbers of lawsuits for access to medicines in Brazil is hotly debated. Government officials and scholars assert that the “judicialization of health” is driven by urban elites and private interests, and is used primarily to access high-cost drugs. Using a systematic sample of 1,262 lawsuits for access to medicines filed against the southern Brazilian state of Rio Grande do Sul, we assess these claims, offering empirical evidence that counters prevailing myths and affirms the heterogeneity of the judicialization phenomenon. Our findings show that the majority of patient-litigants are in fact poor and older individuals who do not live in major metropolitan areas and who depend on the state to provide their legal representation, and that the majority of medicines requested were already on governmental formularies. Our data challenge arguments that judicialization expands inequities and weakens the universal health care system. Our data also suggest that judicialization may serve as a grassroots instrument for the poor to hold the state accountable. Failing to acknowledge regional differences and attempting to fit all data into one singular narrative may be contributing to a biased interpretation of the nature of judicialization, and limiting the understanding of its drivers, consequences, and implications at local levels. PMID:27781011

32 CFR 770.3 - Fishing regulations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Fishing regulations. 770.3 Section 770.3... LIMITING PUBLIC ACCESS TO PARTICULAR INSTALLATIONS Hunting and Fishing at Marine Corps Base, Quantico, Virginia § 770.3 Fishing regulations. (a) All persons possessing the proper state license and Base permit...

32 CFR 770.3 - Fishing regulations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Fishing regulations. 770.3 Section 770.3... LIMITING PUBLIC ACCESS TO PARTICULAR INSTALLATIONS Hunting and Fishing at Marine Corps Base, Quantico, Virginia § 770.3 Fishing regulations. (a) All persons possessing the proper state license and Base permit...

32 CFR 770.3 - Fishing regulations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Fishing regulations. 770.3 Section 770.3... LIMITING PUBLIC ACCESS TO PARTICULAR INSTALLATIONS Hunting and Fishing at Marine Corps Base, Quantico, Virginia § 770.3 Fishing regulations. (a) All persons possessing the proper state license and Base permit...

Real-time information dissemination requirements for Illinois per new federal rule.

DOT National Transportation Integrated Search

2015-02-01

Travelers on U.S. freeways could now be better-informed than ever before, because of a new federal legislation. : The Final Rule 23 CFR 511 has mandated that after November 8, 2014, states provide real-time traveler data : along all limited-access ro...

Identifying Successful Practices to Overcome Access to Care Challenges in Community Health Centers

PubMed Central

Toscos, Tammy; Carpenter, Maria; Flanagan, Mindy; Kunjan, Kislaya; Doebbeling, Bradley N.

2018-01-01

Background: Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These “positive deviant” practices translate into organizational policies to improve health care access and patient experience. Objective: To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families. Participants: Seven CHC systems, involving over 40 clinics, distributed across one midwestern state in the United States. Methods: Ninety-two key informants, comprised of CHC patients (42%) and clinic staff (53%), participated in semi-structured interviews. Interview transcripts were subjected to thematic analysis to identify patient-centered solutions for managing access challenges to primary care for underserved populations. Transcripts were coded using qualitative analytic software. Results: Practices to improve access to care included addressing illiteracy and low health literacy, identifying cost-effective resources, expanding care offerings, enhancing the patient–provider relationship, and cultivating a culture of teamwork and customer service. Helping patients find the least expensive options for transportation, insurance, and medication was the most compelling patient-centered strategy. Appointment reminders and confirmation of patient plans for transportation to appointments reduced no-show rates. Conclusion: We identified nearly 35 practices for improving health care access. These were all patient-centric, uncovered by both clinic staff and patients who had successfully navigated the health care system to improve access. PMID:29552599

It's not as simple as it sounds: Problems and solutions in accessing and using administrative child welfare data for evaluating the impact of early childhood interventions☆

PubMed Central

Green, Beth L.; Ayoub, Catherine; Dym Bartlett, Jessica; Furrer, Carrie; Von Ende, Adam; Chazan-Cohen, Rachel; Klevens, Joanne; Nygren, Peggy

2015-01-01

In recent years, there has been increasing interest in using administrative data collected by state child welfare agencies as a source of information for research and evaluation. The challenges of obtaining access to and using these data, however, have not been well documented. This study describes the processes used to access child welfare records in six different states and the approach to combining and using the information gathered to evaluate the impact of the Early Head Start program on children's involvement with the child welfare system from birth through age eleven. We provide “lessons learned” for researchers who are attempting to use this information, including being prepared for long delays in access to information, the need for deep understanding of how child welfare agencies record and code information, and for considerable data management work for translating agency records into analysis-ready datasets. While accessing and using this information is not easy, and the data have a number of limitations, we suggest that the benefits can outweigh the challenges and that these records can be a useful source of information for policy-relevant child welfare research. PMID:26744551

Barriers to Abortion Care and Their Consequences For Patients Traveling for Services: Qualitative Findings from Two States

PubMed Central

Jerman, Jenna; Frohwirth, Lori; Kavanaugh, Megan L.; Blades, Nakeisha

2018-01-01

CONTEXT Abortion availability and accessibility vary by state. Especially in areas where services are restricted or limited, some women travel to obtain abortion services in other states. Little is known about the experience of travel to obtain abortion. METHODS In January and February 2015, in-depth interviews were conducted with 29 patients seeking abortion services at six facilities in Michigan and New Mexico. Eligible women were 18 or older, spoke English, and had traveled either across state lines or more than 100 miles within the state. Respondents were asked to describe their experience from pregnancy discovery to the day of the abortion procedure. Barriers to accessing abortion care and consequences of these barriers were identified through inductive and deductive analysis. RESULTS Respondents described 15 barriers to abortion care while traveling to obtain services, and three major consequences of experiencing those barriers. Barriers were grouped into five categories: travel-related logistical issues, system navigation issues, limited clinic options, financial issues, and state or clinic restrictions. Consequences were delays in care, negative mental health impacts and considering self-induction. The experience of barriers complicated the process of obtaining an abortion, but the effect of any individual barrier was unclear. Instead, the experience of multiple barriers appeared to have a compounding effect, resulting in negative consequences for women traveling for abortion. CONCLUSION The amalgamation of barriers to abortion care experienced simultaneously can have significant consequences for patients. PMID:28394463

The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly.

PubMed

Peterson, E D; DeLong, E R; Jollis, J G; Muhlbaier, L H; Mark, D B

1998-10-01

The aim of this study was to examine the effects of provider profiling on bypass surgery access and outcomes in elderly patients in New York. Since 1989, New York (NY) has compiled provider-specific bypass surgery mortality reports. While some have proposed that "provider profiling" has led to lower surgical mortality rates, critics have suggested that such programs lower in-state procedural access (increasing out-of-state transfers) without improving patient outcomes. Using national Medicare data, we examined trends in the percentages of NY residents aged 65 years or older receiving out-of-state bypass surgery between 1987 and 1992 (before and after program initiation). We also examined in-state procedure use among elderly myocardial infarction patients during this period. Finally, we compared trends in surgical outcomes in NY Medicare patients with those for the rest of the nation. Between 1987 and 1992, the percentage of NY residents receiving bypass out-of-state actually declined (from 12.5% to 11.3%, p < 0.01 for trend). An elderly patient's likelihood for bypass following myocardial infarction in NY increased significantly since the program's initiation. Between 1987 and 1992, unadjusted 30-day mortality rates following bypass declined by 33% in NY Medicare patients compared with a 19% decline nationwide (p < 0.001). As a result of this improvement, NY had the lowest risk-adjusted bypass mortality rate of any state in 1992. We found no evidence that NY's provider profiling limited procedure access in NY's elderly or increased out-of-state transfers. Despite an increasing preoperative risk profile, procedural outcomes in NY improved significantly faster than the national average.

Options for Optimal Coverage of Free C-Section Services for Poor Mothers in Indian State of Gujarat: Location Allocation Analysis Using GIS.

PubMed

Vora, Kranti Suresh; Yasobant, Sandul; Sengupta, Raja; De Costa, Ayesha; Upadhyay, Ashish; Mavalankar, Dileep V

2015-01-01

Gujarat, a western state of India, has seen a steep rise in the proportion of institutional deliveries over the last decade. However, there has been a limited access to cesarean section (C-Section) deliveries for complicated obstetric cases especially for poor rural women. C-section is a lifesaving intervention that can prevent both maternal and perinatal mortality. Poor women bear a disproportionate burden of maternal mortality, and lack of access to C-section, especially for these women, is an important contributor for high maternal and perinatal mortality in resource limited settings. To improve access for this underserved population in the context of inadequate public provision of emergency obstetric services, the state government of Gujarat initiated a public private partnership program called "Chiranjeevi Yojana" (CY) in 2005 to increase the number of facilities providing free C-section services. This study aimed to analyze the current availability of these services in three districts of Gujarat and to identify the best locations for additional service centres to optimize access to free C-section services using Geographic Information System technology. Supply and demand for obstetric care were calculated using secondary data from sources such as Census and primary data from cross-sectional facility survey. The study is unique in using primary data from facilities, which was collected in 2012-13. Information on obstetric beds and functionality of facilities to calculate supply was collected using pretested questionnaire by trained researchers after obtaining written consent from the participating facilities. Census data of population and birth rates for the study districts was used for demand calculations. Location-allocation model of ArcGIS 10 was used for analyses. Currently, about 50 to 84% of populations in all three study districts have access to free C-section facilities within a 20km radius. The model suggests that about 80-96% of the population can be covered for free C-section services with addition of 4-6 centres in critical but underserved regions. It was also suggested that upgrading of public sector facilities with minimal investment can improve the services. This study highlights utility of Geographic Information System technology for planning service centres to optimize access to vital lifesaving procedure such as C-section. Although the location allocation methodology has been available for decades, it has been used sparsely by public health professionals. This paper makes an important contribution to the literature for use of the method for planning in resource limited settings.

Wag the Dog? Online Conferencing and Teaching.

ERIC Educational Resources Information Center

Ess, Charles

2000-01-01

Describes the successes, limitations, and costs of incorporating Web-accessible conferencing software and discourse ethics in a religious studies class. Suggests that electronic instruction may work for some students but not for all. States that electronic teaching should be viewed as one teaching method among many. Includes references. (CMK)

50 CFR 697.7 - Prohibitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) American lobster. (1) In addition to the prohibitions specified in § 600.725 of this chapter, it is unlawful for any person owning or operating a vessel issued a Federal limited access American lobster permit under § 697.4 or a vessel or person holding a valid State of Maine American lobster permit or...

50 CFR 697.7 - Prohibitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) American lobster. (1) In addition to the prohibitions specified in § 600.725 of this chapter, it is unlawful for any person owning or operating a vessel issued a Federal limited access American lobster permit under § 697.4 or a vessel or person holding a valid State of Maine American lobster permit or...

75 FR 74661 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Emergency Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-01

... rule maintains the new stock status determination criteria for pollock and associated increases in..., address, etc.) voluntarily submitted by the commenter may be publicly accessible. Do not submit... the revised pollock stock status determination and catch limits for FY 2010, as follows: The revised...

Child-Centered Group Play Therapy with African American Boys at the Elementary School Level

ERIC Educational Resources Information Center

Baggerly, Jennifer; Parker, Max

2005-01-01

African American boys face numerous challenges in society within the United States, including prejudice, discrimination, racism, economic hardship, limited access to support services, educational biases, and community violence. According to Pierce (1988), the psychic assault of subtle racism against African American boys erode their…

28 CFR 16.74 - Exemption of National Security Division Systems-limited access.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Privacy Act pursuant to 5 U.S.C. 552a(j)(2), (k)(1), (2) and (5): Foreign Intelligence and... concerning him or her would hinder authorized United States intelligence activities by informing that...) Subsection (d)(1). Disclosure of foreign intelligence and counterintelligence information would interfere...

28 CFR 16.74 - Exemption of National Security Division Systems-limited access.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Privacy Act pursuant to 5 U.S.C. 552a(j)(2), (k)(1), (2) and (5): Foreign Intelligence and... concerning him or her would hinder authorized United States intelligence activities by informing that...) Subsection (d)(1). Disclosure of foreign intelligence and counterintelligence information would interfere...

28 CFR 16.74 - Exemption of National Security Division Systems-limited access.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Privacy Act pursuant to 5 U.S.C. 552a(j)(2), (k)(1), (2) and (5): Foreign Intelligence and... concerning him or her would hinder authorized United States intelligence activities by informing that...) Subsection (d)(1). Disclosure of foreign intelligence and counterintelligence information would interfere...

28 CFR 16.74 - Exemption of National Security Division Systems-limited access.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Privacy Act pursuant to 5 U.S.C. 552a(j)(2), (k)(1), (2) and (5): Foreign Intelligence and... concerning him or her would hinder authorized United States intelligence activities by informing that...) Subsection (d)(1). Disclosure of foreign intelligence and counterintelligence information would interfere...

Long-time atomistic simulations with the Parallel Replica Dynamics method

NASA Astrophysics Data System (ADS)

Perez, Danny

Molecular Dynamics (MD) -- the numerical integration of atomistic equations of motion -- is a workhorse of computational materials science. Indeed, MD can in principle be used to obtain any thermodynamic or kinetic quantity, without introducing any approximation or assumptions beyond the adequacy of the interaction potential. It is therefore an extremely powerful and flexible tool to study materials with atomistic spatio-temporal resolution. These enviable qualities however come at a steep computational price, hence limiting the system sizes and simulation times that can be achieved in practice. While the size limitation can be efficiently addressed with massively parallel implementations of MD based on spatial decomposition strategies, allowing for the simulation of trillions of atoms, the same approach usually cannot extend the timescales much beyond microseconds. In this article, we discuss an alternative parallel-in-time approach, the Parallel Replica Dynamics (ParRep) method, that aims at addressing the timescale limitation of MD for systems that evolve through rare state-to-state transitions. We review the formal underpinnings of the method and demonstrate that it can provide arbitrarily accurate results for any definition of the states. When an adequate definition of the states is available, ParRep can simulate trajectories with a parallel speedup approaching the number of replicas used. We demonstrate the usefulness of ParRep by presenting different examples of materials simulations where access to long timescales was essential to access the physical regime of interest and discuss practical considerations that must be addressed to carry out these simulations. Work supported by the United States Department of Energy (U.S. DOE), Office of Science, Office of Basic Energy Sciences, Materials Sciences and Engineering Division.

The Impact of Exceeding TANF Time Limits on the Access to Healthcare of Low-Income Mothers.

PubMed

Narain, Kimberly; Ettner, Susan

2017-01-01

The objective of this article is to estimate the relationship of exceeding Temporary Assistance for Needy Families (TANF) time limits, with health insurance, healthcare, and health outcomes. The authors use Heckman selection models that exploit variability in state time-limit duration and timing of policy implementation as identifying exclusion restrictions to adjust the effect estimates of exceeding time limits for possible correlations between the probability of exceeding time limits and unobservable factors influencing the outcomes. The authors find that exceeding time limits decreases the predicted probability of Medicaid coverage, increases the predicted probability of being uninsured, and decreases the predicted probability of annual medical provider contact.

Compilation of Abstracts of Theses Submitted by Candidates for Degrees

DTIC Science & Technology

1987-09-30

Paral- lel, Multiple Backend Database Systems Feudo, C.V. Modern Hardware Tochnololies 88 MAJ , USA 8nd. Sof ware Techniques for Online uatabase Storage...and itsApplication in the War- gaming , Reseamth and Analysis (W.A.R.) Lab Waltens erger, G.M. On Limited War, Escalation 524 CPT,, USRF Control, and...TECHNIQIUES FOR ONLINE DATABASE ,TORAGE AND ACCESS Christopher V. Feudo Ma or, United States Army B.S., United States Military Academy# 1972

Planning health education: Internet and computer resources in southwestern Nigeria. 2000-2001.

PubMed

Oyadoke, Adebola A; Salami, Kabiru K; Brieger, William R

The use of the Internet as a health education tool and as a resource in health education planning is widely accepted as the norm in industrialized countries. Unfortunately, access to computers and the Internet is quite limited in developing countries. Not all licensed service providers operate, many users are actually foreign nationals, telephone connections are unreliable, and electricity supplies are intermittent. In this context, computer, e-mail, Internet, and CD-Rom use by health and health education program officers in five states in southwestern Nigeria were assessed to document their present access and use. Eight of the 30 organizations visited were government health ministry departments, while the remainder were non-governmental organizations (NGOs). Six NGOs and four State Ministry of Health (MOH) departments had no computers, but nearly two-thirds of both types of agency had e-mail, less than one-third had Web browsing facilities, and six had CD-Roms, all of whom were NGOs. Only 25 of the 48 individual respondents had computer use skills. Narrative responses from individual employees showed a qualitative difference between computer and Internet access and use and type of agency. NGO staff in organizations with computers indicated having relatively free access to a computer and the Internet and used these for both program planning and administrative purposes. In government offices it appeared that computers were more likely to be located in administrative or statistics offices and used for management tasks like salaries and correspondence, limiting the access of individual health staff. These two different organizational cultures must be considered when plans are made for increasing computer availability and skills for health education planning.

Connecting Hazard Analysts and Risk Managers to Sensor Information.

PubMed

Le Cozannet, Gonéri; Hosford, Steven; Douglas, John; Serrano, Jean-Jacques; Coraboeuf, Damien; Comte, Jérémie

2008-06-11

Hazard analysts and risk managers of natural perils, such as earthquakes, landslides and floods, need to access information from sensor networks surveying their regions of interest. However, currently information about these networks is difficult to obtain and is available in varying formats, thereby restricting accesses and consequently possibly leading to decision-making based on limited information. As a response to this issue, state-of-the-art interoperable catalogues are being currently developed within the framework of the Group on Earth Observations (GEO) workplan. This article provides an overview of the prototype catalogue that was developed to improve access to information about the sensor networks surveying geological hazards (geohazards), such as earthquakes, landslides and volcanoes.

Connecting Hazard Analysts and Risk Managers to Sensor Information

PubMed Central

Le Cozannet, Gonéri; Hosford, Steven; Douglas, John; Serrano, Jean-Jacques; Coraboeuf, Damien; Comte, Jérémie

2008-01-01

Hazard analysts and risk managers of natural perils, such as earthquakes, landslides and floods, need to access information from sensor networks surveying their regions of interest. However, currently information about these networks is difficult to obtain and is available in varying formats, thereby restricting accesses and consequently possibly leading to decision-making based on limited information. As a response to this issue, state-of-the-art interoperable catalogues are being currently developed within the framework of the Group on Earth Observations (GEO) workplan. This article provides an overview of the prototype catalogue that was developed to improve access to information about the sensor networks surveying geological hazards (geohazards), such as earthquakes, landslides and volcanoes. PMID:27879915

Listening to rural Hispanic immigrants in the Midwest: a community-based participatory assessment of major barriers to health care access and use.

PubMed

Cristancho, Sergio; Garces, D Marcela; Peters, Karen E; Mueller, Benjamin C

2008-05-01

Hispanic immigrants are increasingly residing in rural communities, including in the midwestern United States. Limitations in the ability of rural Hispanics to access and utilize health care contribute to patterns of poor health and health disparity. A conceptual model of "vulnerability" guides this community-based participatory assessment project designed to explore rural Hispanics' perceived barriers to accessing and utilizing health care. Findings from a series of 19 focus groups with 181 participants from three communities in the upper Midwest identified perceived barriers at the individual and health care system levels. The most commonly perceived barriers were the lack of and limitations in health insurance coverage, high costs of health care services, communication issues involving patients and providers, legal status/discrimination, and transportation concerns. Findings imply that these barriers could be addressed using multiple educational and health service delivery policy-related strategies that consider the vulnerable nature of this growing population.

75 FR 45661 - Notice of Permanent Closure on Public Lands in Ada County, ID

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

...On April 12, 2010, Higby Cave and all public lands within 1,000 feet of the entrance were permanently closed to vehicle access and public use at all times, due to changes in the cave's structural integrity and related potential hazards. The cave entrance has been gated and access limited to BLM-permitted and administrative activities. Exempt from this order are BLM employees, authorized permittees, and other Federal, State and County employees while on official business of their respective agencies, including associated vehicle use for administrative and emergency purposes.

Mobile medical visual information retrieval.

PubMed

Depeursinge, Adrien; Duc, Samuel; Eggel, Ivan; Müller, Henning

2012-01-01

In this paper, we propose mobile access to peer-reviewed medical information based on textual search and content-based visual image retrieval. Web-based interfaces designed for limited screen space were developed to query via web services a medical information retrieval engine optimizing the amount of data to be transferred in wireless form. Visual and textual retrieval engines with state-of-the-art performance were integrated. Results obtained show a good usability of the software. Future use in clinical environments has the potential of increasing quality of patient care through bedside access to the medical literature in context.

Restricting Access to ART on the Basis of Criminal Record : An Ethical Analysis of a State-Enforced "Presumption Against Treatment" With Regard to Assisted Reproductive Technologies.

PubMed

Thompson, Kara; McDougall, Rosalind

2015-09-01

As assisted reproductive technologies (ART) become increasingly popular, debate has intensified over the ethical justification for restricting access to ART based on various medical and non-medical factors. In 2010, the Australian state of Victoria enacted world-first legislation that denies access to ART for all patients with certain criminal or child protection histories. Patients and their partners are identified via a compulsory police and child protection check prior to commencing ART and, if found to have a previous relevant conviction or child protection order, are given a "presumption against treatment." This article reviews the legislation and identifies arguments that may be used to justify restricting access to ART for various reasons. The arguments reviewed include limitations of reproductive rights, inheriting undesirable genetic traits, distributive justice, and the welfare of the future child. We show that none of these arguments justifies restricting access to ART in the context of past criminal history. We show that a "presumption against treatment" is an unjustified infringement on reproductive freedom and that it creates various inconsistencies in current social, medical, and legal policy. We argue that a state-enforced policy of restricting access to ART based on the non-medical factor of past criminal history is an example of unjust discrimination and cannot be ethically justified, with one important exception: in cases where ART treatment may be considered futile on the basis that the parents are not expected to raise the resulting child.

Assessment of training needs and preferences for geographic information systems (GIS) mapping in state comprehensive cancer-control programs.

PubMed

Hopfer, Suellen; Chadwick, Amy E; Parrott, Roxanne L; Ghetian, Christie B; Lengerich, Eugene J

2009-10-01

Geographic information systems (GIS) mapping technologies have potential to advance public health promotion by mapping regional differences in attributes (e.g., disease burden, environmental exposures, access to health care services) to suggest priorities for public health interventions. Training in GIS for comprehensive cancer control (CCC) has been overlooked. State CCC programs' GIS training needs were assessed by interviewing 49 state CCC directors. A majority perceived a need for GIS training, slightly more than half of state CCC programs had access to geocoded data, and the majority of programs did not require continuing education credits of their staff. CCC directors perceived judging maps and realizing their limitations as important skills and identified epidemiologists, CCC staff, public health officials, policy makers, and cancer coalition members as training audiences. They preferred in-class training sessions that last a few hours to a day. Lessons learned are shared to develop training programs with translatable GIS skills for CCC.

The Erosion of Rights to Abortion Care in the United States: A Call for a Renewed Anthropological Engagement with the Politics of Abortion.

PubMed

Andaya, Elise; Mishtal, Joanna

2017-03-01

Women's rights to legal abortion in the United States are now facing their greatest social and legislative challenges since its 1973 legalization. Legislation restricting rights and access to abortion care has been passed at state and federal levels at an unprecedented rate. Given the renewed vigor of anti-abortion movements, we call on anthropologists to engage with this shifting landscape of reproductive politics. This article examines recent legislation that has severely limited abortion access and maps possible directions for future anthropological analysis. We argue that anthropology can provide unique contributions to broader abortion research. The study of abortion politics in the United States today is not only a rich opportunity for applied and policy-oriented ethnographic research. It also provides a sharply focused lens onto broader theoretical concerns in anthropology and new social formations across moral, medical, political, and scientific fields in 21st-century America. © 2016 by the American Anthropological Association.

Access to and use of infertility services in the United States: framing the challenges.

PubMed

Adashi, Eli Y; Dean, Laura A

2016-05-01

An overview of access to and use of general infertility and assisted reproductive technology (ART) services in the United States (U.S.) shows a declining trend for the ever-use of infertility services. Moreover, the use of ART services lags relative to other member nations of the Organization for Economic Co-operation and Development (OECD). Access to and use of general infertility and ART services is primarily undermined by a severely constrained underwriting universe dominated by self-insured employers and by a finite number of state infertility insurance mandates. The contribution of traditional public and private payers to the underwriting of ART is limited. As compared with OECD member nations wherein the access to and underwriting of general infertility and ART services is universal, the current status quo in the U.S. can only be characterized as dismal. Further, the current state of affairs is socially unjust in that the right to build a family in the face of infertility appears to have become a function of economic prowess. Given the dominance of the self-insured employers as underwriters of general infertility and ART services, advocacy directed at this interest group is likely to prove most productive. Improving the state of underwriting of general infertility and ART services in the U.S. must be embraced as a central moral imperative and as an unwavering strategic goal of the professional societies entrusted with the reproductive health of women and men. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Barriers to patient portal access among veterans receiving home-based primary care: a qualitative study.

PubMed

Mishuris, Rebecca G; Stewart, Max; Fix, Gemmae M; Marcello, Thomas; McInnes, D Keith; Hogan, Timothy P; Boardman, Judith B; Simon, Steven R

2015-12-01

Electronic, or web-based, patient portals can improve patient satisfaction, engagement and health outcomes and are becoming more prevalent with the advent of meaningful use incentives. However, adoption rates are low, particularly among vulnerable patient populations, such as those patients who are home-bound with multiple comorbidities. Little is known about how these patients view patient portals or their barriers to using them. To identify barriers to and facilitators of using My HealtheVet (MHV), the United States Department of Veterans Affairs (VA) patient portal, among Veterans using home-based primary care services. Qualitative study using in-depth semi-structured interviews. We conducted a content analysis informed by grounded theory. Fourteen Veterans receiving home-based primary care, surrogates of two of these Veterans, and three home-based primary care (HBPC) staff members. We identified five themes related to the use of MHV: limited knowledge; satisfaction with current HBPC care; limited computer and Internet access; desire to learn more about MHV and its potential use; and value of surrogates acting as intermediaries between Veterans and MHV. Despite their limited knowledge of MHV and computer access, home-bound Veterans are interested in accessing MHV and using it as an additional point of care. Surrogates are also potential users of MHV on behalf of these Veterans and may have different barriers to and benefits from use. © 2014 John Wiley & Sons Ltd.

A baseline understanding of state laws governing e-cigarettes.

PubMed

Gourdet, C K; Chriqui, J F; Chaloupka, F J

2014-07-01

Electronic cigarettes (e-cigarettes) have been available for purchase in the USA since 2007, and have grown rapidly in popularity. Currently, there are no federal restrictions on e-cigarettes; therefore, any regulations are under the purview of state and/or local governments. This study examines state laws governing e-cigarettes through youth access restrictions, smoke-free air requirements and/or excise taxation. Codified statutory and administrative laws, attorney general opinions, executive orders, and revenue notices and rulings effective as of 15 November 2013 for all 50 states and the District of Columbia, were compiled using Boolean searches in Lexis-Nexis and Westlaw. All laws were analysed by two study authors to determine the presence and components of relevant provisions. Two categories of laws were identified; (1) explicit e-cigarette laws and (2) laws focused on tobacco-derived and/or nicotine-containing products. Thirty-four states' laws address e-cigarettes either explicitly or as part of language applying to tobacco-derived or nicotine-containing products. Laws explicitly addressing e-cigarettes primarily focus on youth access (22 states) or smoke-free air (12 states); only Minnesota imposes an excise tax on e-cigarettes. Similarly, tobacco-derived or nicotine-containing products are primarily regulated through youth access restrictions (6 states), smoke-free air laws (5 states), or excise taxation (2 states). In the current absence of federal law governing e-cigarettes, more than one-half of the states have taken the initiative to regulate these products. The opportunity exists for the remaining states to incorporate e-cigarette-related restrictions into their pre-existing tobacco control laws. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Physics of Imaging with Remote Sensors : Photon State Space & Radiative Transfer

NASA Technical Reports Server (NTRS)

Davis, Anthony B.

2012-01-01

Standard (mono-pixel/steady-source) retrieval methodology is reaching its fundamental limit with access to multi-angle/multi-spectral photo- polarimetry. Next... Two emerging new classes of retrieval algorithm worth nurturing: multi-pixel time-domain Wave-radiometry transition regimes, and more... Cross-fertilization with bio-medical imaging. Physics-based remote sensing: - What is "photon state space?" - What is "radiative transfer?" - Is "the end" in sight? Two wide-open frontiers! center dot Examples (with variations.

Pluck & Tenacity: How Five Private Schools in Ohio Have Adapted to Vouchers

ERIC Educational Resources Information Center

Belcher, Ellen

2014-01-01

State-funded voucher programs have stoked political controversy, culture clashes, and pitched court battles. Sometimes referred to as "scholarships," these vouchers enable students of limited means (or without access to a good public school) to attend a private school. Roughly 30,000 children in Ohio take advantage of a publicly funded…

Frasier v. UNC--A Personal Account

ERIC Educational Resources Information Center

Frasier, Ralph K.

2005-01-01

Like the Brown Decision, Frasier was not simply an action challenging the right of three plaintiffs to attend one of the institutions of higher education within the State of North Carolina which historically had limited access to its undergraduate schools to white citizens. Rather, the suit was one of a series seeking to dismantle a system of…

32 CFR Appendix B to Part 552 - Non-Permit Access Routes

Code of Federal Regulations, 2010 CFR

2010-07-01

... Limits) Lincoln Avenue (Madigan to EH 391179) 3. The Solo Point Road is open to Weyerhauser Corporation... Steilacoom-DuPont Road (EH 286156 to EH 302227). Pacific Highway Southeast (EH 232119 to EH 250141). Washington State Route 507 (EH 363061 to EH 429144). Goodacre (unpaved) and Rice Kandle (paved) Roads (EH...

32 CFR Appendix B to Part 552 - Non-Permit Access Routes

Code of Federal Regulations, 2011 CFR

2011-07-01

... Limits) Lincoln Avenue (Madigan to EH 391179) 3. The Solo Point Road is open to Weyerhauser Corporation... Steilacoom-DuPont Road (EH 286156 to EH 302227). Pacific Highway Southeast (EH 232119 to EH 250141). Washington State Route 507 (EH 363061 to EH 429144). Goodacre (unpaved) and Rice Kandle (paved) Roads (EH...

32 CFR Appendix B to Part 552 - Non-Permit Access Routes

Code of Federal Regulations, 2012 CFR

2012-07-01

... Limits) Lincoln Avenue (Madigan to EH 391179) 3. The Solo Point Road is open to Weyerhauser Corporation... Steilacoom-DuPont Road (EH 286156 to EH 302227). Pacific Highway Southeast (EH 232119 to EH 250141). Washington State Route 507 (EH 363061 to EH 429144). Goodacre (unpaved) and Rice Kandle (paved) Roads (EH...

Possibilities and Limitations of Cable TV for Adult Education.

ERIC Educational Resources Information Center

Niemi, John A.

The paper investigates various organizational models of cable TV ownership and control, legislation in Canada and the United States regarding cable systems, and the potential of cable as an information network for adult education. With a view to giving everyone access to the cable medium and an opportunity to participate, advantages and…

28 CFR 16.81 - Exemption of United States Attorneys Systems-limited access.

Code of Federal Regulations, 2012 CFR

2012-07-01

... DISCLOSURE OF MATERIAL OR INFORMATION Exemption of Records Systems Under the Privacy Act § 16.81 Exemption of... collection of information for law enforcement purposes it is impossible to determine in advance what... collection of information for law enforcement purposes it is impossible to determine in advance what...

28 CFR 16.81 - Exemption of United States Attorneys Systems-limited access.

Code of Federal Regulations, 2011 CFR

2011-07-01

... DISCLOSURE OF MATERIAL OR INFORMATION Exemption of Records Systems Under the Privacy Act § 16.81 Exemption of... collection of information for law enforcement purposes it is impossible to determine in advance what... collection of information for law enforcement purposes it is impossible to determine in advance what...

28 CFR 16.81 - Exemption of United States Attorneys Systems-limited access.

Code of Federal Regulations, 2014 CFR

2014-07-01

... DISCLOSURE OF MATERIAL OR INFORMATION Exemption of Records Systems Under the Privacy Act § 16.81 Exemption of... collection of information for law enforcement purposes it is impossible to determine in advance what... collection of information for law enforcement purposes it is impossible to determine in advance what...

28 CFR 16.81 - Exemption of United States Attorneys Systems-limited access.

Code of Federal Regulations, 2013 CFR

2013-07-01

... DISCLOSURE OF MATERIAL OR INFORMATION Exemption of Records Systems Under the Privacy Act § 16.81 Exemption of... collection of information for law enforcement purposes it is impossible to determine in advance what... collection of information for law enforcement purposes it is impossible to determine in advance what...

78 FR 25591 - Magnuson-Stevens Act Provisions; Fisheries of the Northeastern United States; Northeast...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-02

... details the method for initial ACE sub-allocation to sector members. For FY 2013, each sector has proposed... for the sectors to operate. The NE Multispecies Fishery Management Plan (FMP) allows limited access... accepting additional public comment on the revised explanation of at-sea monitoring (ASM) coverage for FY...

28 CFR 16.97 - Exemption of Bureau of Prisons Systems-limited access.

Code of Federal Regulations, 2012 CFR

2012-07-01

... agencies, Federal and State probation and judicial offices, the disclosure of which may permit a record... progresses or with the passage of time, and could be relevant to future law enforcement decisions. (9) From... applicable exemption may be waived, either partially or totally, by the Office of Internal Affairs (OIA...

28 CFR 16.97 - Exemption of Bureau of Prisons Systems-limited access.

Code of Federal Regulations, 2011 CFR

2011-07-01

... agencies, Federal and State probation and judicial offices, the disclosure of which may permit a record... progresses or with the passage of time, and could be relevant to future law enforcement decisions. (9) From... applicable exemption may be waived, either partially or totally, by the Office of Internal Affairs (OIA...

Mexican Migrant and Seasonal Farmworker Culture, Gender, and Language Ideologies: Platicas de HIV/AIDS

ERIC Educational Resources Information Center

Allison, Donald N.

2013-01-01

Lack of health access and limited health care services are major concerns for those who provide healthcare for marginalized Mexican migrant and seasonal farmworker communities (MMSF). Health risks related to several deadly illnesses generate a significant challenge in providing services to this transnational population. In the United States,…

Higher Education Trends (1997-1999): Finance. ERIC-HE Trends.

ERIC Educational Resources Information Center

Kezar, Adrianna J.

The literature on financial issues in higher education is limited. Six major themes in the literature in l996 include the reduced federal role and increased state role in funding; managing costs, including deferred maintenance and capital spending in times of shrinking resources; concern about rising tuition and its impact on access; concern about…

Specification and Enforcement of Semantic Integrity Constraints in Microsoft Access

ERIC Educational Resources Information Center

Dadashzadeh, Mohammad

2007-01-01

Semantic integrity constraints are business-specific rules that limit the permissible values in a database. For example, a university rule dictating that an "incomplete" grade cannot be changed to an A constrains the possible states of the database. To maintain database integrity, business rules should be identified in the course of database…

Out of the Shoebox: Publishing a Regional Periodical Index Using a Microcomputer.

ERIC Educational Resources Information Center

Schmidt, Jean M.; Wilson, John S.

1988-01-01

Describes production of the Bayou State Periodical Index, an index of Louisiana periodicals designed to provide access to information on local topics, and offers guidelines for producing such an index in a timely fashion with limited funds, using a microcomputer. Planning, procedures, financing, and publicity and marketing are covered. (seven…

Canadian and U.S. Systems of Care for the Mentally Ill Elderly.

ERIC Educational Resources Information Center

Liptzin, Benjamin

1984-01-01

Compares the United States and Canada in the funding and organization of psychiatric services for the elderly. Acute hospital, medical, and nursing home services are more accessible in Canada because of universal health insurance, but in both countries, services are limited by the small number of professionals. (JAC)

Going the Extra Mile: Supporting Distance Education at University of Alaska Fairbanks

ERIC Educational Resources Information Center

Hahn, Suzan; Lehman, Lisa; Dupras, Rheba

2007-01-01

The Elmer E. Rasmuson Library at the University of Alaska Fairbanks has a long history of supporting distance education through state-of-the-art, remote access services. Harsh climate conditions (heavy snowfall and icing, high winds, and extreme temperatures), rugged terrain, limited road and telephone systems, and permafrost that prevents the…

Food access and cost in American Indian communities in Washington State.

PubMed

O'Connell, Meghan; Buchwald, Dedra S; Duncan, Glen E

2011-09-01

Limited access to foods that make up a nutritious diet at minimal cost may influence eating behaviors and, ultimately, obesity. This study examined the number and type of food stores (convenience, grocery, supermarket) on federal reservations in Washington State, and the availability and cost of foods in the US Department of Agriculture Community Food Security Assessment Toolkit market basket, to describe the food environment of American Indians. Stores were identified by telephone survey of tribal headquarters, a commercial database, and on-site visitation. Foods were assessed using a standardized instrument containing 68 items in seven major food groups during April and May 2009. Store type and availability and cost of foods were recorded on a checklist. Fifty stores were identified on 22 American Indian reservations, including 25 convenience, 16 grocery, and 9 supermarkets. Across all stores, about 38% of checklist items were available, with supermarkets having the most and convenience stores the fewest. Foods from the dairy and sugars/sweets groups were the most prevalent, while fresh fruits/vegetables were the least. Cost of the most commonly available items was lowest in supermarkets. Seventeen reservations did not have a supermarket on their reservation, and the nearest off-reservation supermarket was about 10 miles from the tribe's headquarters, which was used as the standard for distance calculations. These results demonstrate that American Indians living on federal reservations in Washington State may have limited access to foods that make up a nutritious diet at minimal cost. Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

Self-Consistent Optimization of Excited States within Density-Functional Tight-Binding.

PubMed

Kowalczyk, Tim; Le, Khoa; Irle, Stephan

2016-01-12

We present an implementation of energies and gradients for the ΔDFTB method, an analogue of Δ-self-consistent-field density functional theory (ΔSCF) within density-functional tight-binding, for the lowest singlet excited state of closed-shell molecules. Benchmarks of ΔDFTB excitation energies, optimized geometries, Stokes shifts, and vibrational frequencies reveal that ΔDFTB provides a qualitatively correct description of changes in molecular geometries and vibrational frequencies due to excited-state relaxation. The accuracy of ΔDFTB Stokes shifts is comparable to that of ΔSCF-DFT, and ΔDFTB performs similarly to ΔSCF with the PBE functional for vertical excitation energies of larger chromophores where the need for efficient excited-state methods is most urgent. We provide some justification for the use of an excited-state reference density in the DFTB expansion of the electronic energy and demonstrate that ΔDFTB preserves many of the properties of its parent ΔSCF approach. This implementation fills an important gap in the extended framework of DFTB, where access to excited states has been limited to the time-dependent linear-response approach, and affords access to rapid exploration of a valuable class of excited-state potential energy surfaces.

An audience research study to disseminate evidence about comprehensive state mental health parity legislation to US State policymakers: protocol.

PubMed

Purtle, Jonathan; Lê-Scherban, Félice; Shattuck, Paul; Proctor, Enola K; Brownson, Ross C

2017-06-26

A large proportion of the US population has limited access to mental health treatments because insurance providers limit the utilization of mental health services in ways that are more restrictive than for physical health services. Comprehensive state mental health parity legislation (C-SMHPL) is an evidence-based policy intervention that enhances mental health insurance coverage and improves access to care. Implementation of C-SMHPL, however, is limited. State policymakers have the exclusive authority to implement C-SMHPL, but sparse guidance exists to inform the design of strategies to disseminate evidence about C-SMHPL, and more broadly, evidence-based treatments and mental illness, to this audience. The aims of this exploratory audience research study are to (1) characterize US State policymakers' knowledge and attitudes about C-SMHPL and identify individual- and state-level attributes associated with support for C-SMHPL; and (2) integrate quantitative and qualitative data to develop a conceptual framework to disseminate evidence about C-SMHPL, evidence-based treatments, and mental illness to US State policymakers. The study uses a multi-level (policymaker, state), mixed method (QUAN→qual) approach and is guided by Kingdon's Multiple Streams Framework, adapted to incorporate constructs from Aarons' Model of Evidence-Based Implementation in Public Sectors. A multi-modal survey (telephone, post-mail, e-mail) of 600 US State policymakers (500 legislative, 100 administrative) will be conducted and responses will be linked to state-level variables. The survey will span domains such as support for C-SMHPL, knowledge and attitudes about C-SMHPL and evidence-based treatments, mental illness stigma, and research dissemination preferences. State-level variables will measure factors associated with C-SMHPL implementation, such as economic climate and political environment. Multi-level regression will determine the relative strength of individual- and state-level variables on policymaker support for C-SMHPL. Informed by survey results, semi-structured interviews will be conducted with approximately 50 US State policymakers to elaborate upon quantitative findings. Then, using a systematic process, quantitative and qualitative data will be integrated and a US State policymaker-focused C-SMHPL dissemination framework will be developed. Study results will provide the foundation for hypothesis-driven, experimental studies testing the effects of different dissemination strategies on state policymakers' support for, and implementation of, evidence-based mental health policy interventions.

Changes in Self-reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act.

PubMed

Sommers, Benjamin D; Gunja, Munira Z; Finegold, Kenneth; Musco, Thomas

2015-07-28

The Affordable Care Act (ACA) completed its second open enrollment period in February 2015. Assessing the law's effects has major policy implications. To estimate national changes in self-reported coverage, access to care, and health during the ACA's first 2 open enrollment periods and to assess differences between low-income adults in states that expanded Medicaid and in states that did not expand Medicaid. Analysis of the 2012-2015 Gallup-Healthways Well-Being Index, a daily national telephone survey. Using multivariable regression to adjust for pre-ACA trends and sociodemographics, we examined changes in outcomes for the nonelderly US adult population aged 18 through 64 years (n = 507,055) since the first open enrollment period began in October 2013. Linear regressions were used to model each outcome as a function of a linear monthly time trend and quarterly indicators. Then, pre-ACA (January 2012-September 2013) and post-ACA (January 2014-March 2015) changes for adults with incomes below 138% of the poverty level in Medicaid expansion states (n = 48,905 among 28 states and Washington, DC) vs nonexpansion states (n = 37,283 among 22 states) were compared using a differences-in-differences approach. Beginning of the ACA's first open enrollment period (October 2013). Self-reported rates of being uninsured, lacking a personal physician, lacking easy access to medicine, inability to afford needed care, overall health status, and health-related activity limitations. Among the 507,055 adults in this survey, pre-ACA trends were significantly worsening for all outcomes. Compared with the pre-ACA trends, by the first quarter of 2015, the adjusted proportions who were uninsured decreased by 7.9 percentage points (95% CI, -9.1 to -6.7); who lacked a personal physician, -3.5 percentage points (95% CI, -4.8 to -2.2); who lacked easy access to medicine, -2.4 percentage points (95% CI, -3.3 to -1.5); who were unable to afford care, -5.5 percentage points (95% CI, -6.7 to -4.2); who reported fair/poor health, -3.4 percentage points (95% CI, -4.6 to -2.2); and the percentage of days with activities limited by health, -1.7 percentage points (95% CI, -2.4 to -0.9). Coverage changes were largest among minorities; for example, the decrease in the uninsured rate was larger among Latino adults (-11.9 percentage points [95% CI, -15.3 to -8.5]) than white adults (-6.1 percentage points [95% CI, -7.3 to -4.8]). Medicaid expansion was associated with significant reductions among low-income adults in the uninsured rate (differences-in-differences estimate, -5.2 percentage points [95% CI, -7.9 to -2.6]), lacking a personal physician (-1.8 percentage points [95% CI, -3.4 to -0.3]), and difficulty accessing medicine (-2.2 percentage points [95% CI, -3.8 to -0.7]). The ACA's first 2 open enrollment periods were associated with significantly improved trends in self-reported coverage, access to primary care and medications, affordability, and health. Low-income adults in states that expanded Medicaid reported significant gains in insurance coverage and access compared with adults in states that did not expand Medicaid.

The Association between State Policy Environments and Self-Rated Health Disparities for Sexual Minorities in the United States.

PubMed

Gonzales, Gilbert; Ehrenfeld, Jesse M

2018-06-01

A large body of research has documented disparities in health and access to care for lesbian, gay, and bisexual (LGB) people in the United States. Less research has examined how the level of legal protection afforded to LGB people (the state policy environment) affects health disparities for sexual minorities. This study used data on 14,687 sexual minority adults and 490,071 heterosexual adults from the 2014⁻2016 Behavioral Risk Factor Surveillance System to document differences in health. Unadjusted state-specific prevalence estimates and multivariable logistic regression models were used to compare poor/fair self-rated health by gender, sexual minority status, and state policy environments (comprehensive versus limited protections for LGB people). We found disparities in self-rated health between sexual minority adults and heterosexual adults in most states. On average, sexual minority men in states with limited protections and sexual minority women in states with either comprehensive or limited protections were more likely to report poor/fair self-rated health compared to their heterosexual counterparts. This study adds new findings on the association between state policy environments and self-rated health for sexual minorities and suggests differences in this relationship by gender. The associations and impacts of state-specific policies affecting LGB populations may vary by gender, as well as other intersectional identities.

Statewide Hospital Discharge Data: Collection, Use, Limitations, and Improvements.

PubMed

Andrews, Roxanne M

2015-08-01

To provide an overview of statewide hospital discharge databases (HDD), including their uses in health services research and limitations, and to describe Agency for Healthcare Research and Quality (AHRQ) Enhanced State Data grants to address clinical and race-ethnicity data limitations. Almost all states have statewide HDD collected by public or private data organizations. Statewide HDD, based on the hospital claim with state variations, contain useful core variables and require minimal collection burden. AHRQ's Healthcare Cost and Utilization Project builds uniform state and national research files using statewide HDD. States, hospitals, and researchers use statewide HDD for many purposes. Illustrating researchers' use, during 2012-2014, HSR published 26 HDD-based articles on health policy, access, quality, clinical aspects of care, race-ethnicity and insurance impacts, economics, financing, and research methods. HDD have limitations affecting their use. Five AHRQ grants focused on enhancing clinical data and three grants aimed at improving race-ethnicity data. ICD-10 implementation will significantly affect the HDD. The AHRQ grants, information technology advances, payment policy changes, and the need for outpatient information may stimulate other statewide HDD changes. To remain a mainstay of health services research, statewide HDD need to keep pace with changing user needs while minimizing collection burdens. © Health Research and Educational Trust.

Statewide Hospital Discharge Data: Collection, Use, Limitations, and Improvements

PubMed Central

Andrews, Roxanne M

2015-01-01

Objectives To provide an overview of statewide hospital discharge databases (HDD), including their uses in health services research and limitations, and to describe Agency for Healthcare Research and Quality (AHRQ) Enhanced State Data grants to address clinical and race–ethnicity data limitations. Principal Findings Almost all states have statewide HDD collected by public or private data organizations. Statewide HDD, based on the hospital claim with state variations, contain useful core variables and require minimal collection burden. AHRQ’s Healthcare Cost and Utilization Project builds uniform state and national research files using statewide HDD. States, hospitals, and researchers use statewide HDD for many purposes. Illustrating researchers’ use, during 2012–2014, HSR published 26 HDD-based articles on health policy, access, quality, clinical aspects of care, race–ethnicity and insurance impacts, economics, financing, and research methods. HDD have limitations affecting their use. Five AHRQ grants focused on enhancing clinical data and three grants aimed at improving race–ethnicity data. Conclusion ICD-10 implementation will significantly affect the HDD. The AHRQ grants, information technology advances, payment policy changes, and the need for outpatient information may stimulate other statewide HDD changes. To remain a mainstay of health services research, statewide HDD need to keep pace with changing user needs while minimizing collection burdens. PMID:26150118

Barriers to Abortion Care and Their Consequences For Patients Traveling for Services: Qualitative Findings from Two States.

PubMed

Jerman, Jenna; Frohwirth, Lori; Kavanaugh, Megan L; Blades, Nakeisha

2017-06-01

Abortion availability and accessibility vary by state. Especially in areas where services are restricted or limited, some women travel to obtain abortion services in other states. Little is known about the experience of travel to obtain abortion. In January and February 2015, in-depth interviews were conducted with 29 patients seeking abortion services at six facilities in Michigan and New Mexico. Eligible women were 18 or older, spoke English, and had traveled either across state lines or more than 100 miles within the state. Respondents were asked to describe their experience from pregnancy discovery to the day of the abortion procedure. Barriers to accessing abortion care and consequences of these barriers were identified through inductive and deductive analysis. Respondents described 15 barriers to abortion care while traveling to obtain services, and three major consequences of experiencing those barriers. Barriers were grouped into five categories: travel-related logistical issues, system navigation issues, limited clinic options, financial issues, and state or clinic restrictions. Consequences were delays in care, negative mental health impacts and considering self-induction. The experience of barriers complicated the process of obtaining an abortion, but the effect of any individual barrier was unclear. Instead, the experience of multiple barriers appeared to have a compounding effect, resulting in negative consequences for women traveling for abortion. The amalgamation of barriers to abortion care experienced simultaneously can have significant consequences for patients. © 2017 The Authors. Perspectives on Sexual and Reproductive Health published by Wiley Periodicals, Inc., on behalf of the Guttmacher Institute.

Open exchange of scientific knowledge and European copyright: The case of biodiversity information

PubMed Central

Egloff, Willi; Patterson, David J.; Agosti, Donat; Hagedorn, Gregor

2014-01-01

Abstract Background. The 7th Framework Programme for Research and Technological Development is helping the European Union to prepare for an integrative system for intelligent management of biodiversity knowledge. The infrastructure that is envisaged and that will be further developed within the Programme “Horizon 2020” aims to provide open and free access to taxonomic information to anyone with a requirement for biodiversity data, without the need for individual consent of other persons or institutions. Open and free access to information will foster the re-use and improve the quality of data, will accelerate research, and will promote new types of research. Progress towards the goal of free and open access to content is hampered by numerous technical, economic, sociological, legal, and other factors. The present article addresses barriers to the open exchange of biodiversity knowledge that arise from European laws, in particular European legislation on copyright and database protection rights. We present a legal point of view as to what will be needed to bring distributed information together and facilitate its re-use by data mining, integration into semantic knowledge systems, and similar techniques. We address exceptions and limitations of copyright or database protection within Europe, and we point to the importance of data use agreements. We illustrate how exceptions and limitations have been transformed into national legislations within some European states to create inconsistencies that impede access to biodiversity information. Conclusions. The legal situation within the EU is unsatisfactory because there are inconsistencies among states that hamper the deployment of an open biodiversity knowledge management system. Scientists within the EU who work with copyright protected works or with protected databases have to be aware of regulations that vary from country to country. This is a major stumbling block to international collaboration and is an impediment to the open exchange of biodiversity knowledge. Such differences should be removed by unifying exceptions and limitations for research purposes in a binding, Europe-wide regulation. PMID:25009418

DAVID-WS: a stateful web service to facilitate gene/protein list analysis

PubMed Central

Jiao, Xiaoli; Sherman, Brad T.; Huang, Da Wei; Stephens, Robert; Baseler, Michael W.; Lane, H. Clifford; Lempicki, Richard A.

2012-01-01

Summary: The database for annotation, visualization and integrated discovery (DAVID), which can be freely accessed at http://david.abcc.ncifcrf.gov/, is a web-based online bioinformatics resource that aims to provide tools for the functional interpretation of large lists of genes/proteins. It has been used by researchers from more than 5000 institutes worldwide, with a daily submission rate of ∼1200 gene lists from ∼400 unique researchers, and has been cited by more than 6000 scientific publications. However, the current web interface does not support programmatic access to DAVID, and the uniform resource locator (URL)-based application programming interface (API) has a limit on URL size and is stateless in nature as it uses URL request and response messages to communicate with the server, without keeping any state-related details. DAVID-WS (web service) has been developed to automate user tasks by providing stateful web services to access DAVID programmatically without the need for human interactions. Availability: The web service and sample clients (written in Java, Perl, Python and Matlab) are made freely available under the DAVID License at http://david.abcc.ncifcrf.gov/content.jsp?file=WS.html. Contact: xiaoli.jiao@nih.gov; rlempicki@nih.gov PMID:22543366

DAVID-WS: a stateful web service to facilitate gene/protein list analysis.

PubMed

Jiao, Xiaoli; Sherman, Brad T; Huang, Da Wei; Stephens, Robert; Baseler, Michael W; Lane, H Clifford; Lempicki, Richard A

2012-07-01

The database for annotation, visualization and integrated discovery (DAVID), which can be freely accessed at http://david.abcc.ncifcrf.gov/, is a web-based online bioinformatics resource that aims to provide tools for the functional interpretation of large lists of genes/proteins. It has been used by researchers from more than 5000 institutes worldwide, with a daily submission rate of ∼1200 gene lists from ∼400 unique researchers, and has been cited by more than 6000 scientific publications. However, the current web interface does not support programmatic access to DAVID, and the uniform resource locator (URL)-based application programming interface (API) has a limit on URL size and is stateless in nature as it uses URL request and response messages to communicate with the server, without keeping any state-related details. DAVID-WS (web service) has been developed to automate user tasks by providing stateful web services to access DAVID programmatically without the need for human interactions. The web service and sample clients (written in Java, Perl, Python and Matlab) are made freely available under the DAVID License at http://david.abcc.ncifcrf.gov/content.jsp?file=WS.html.

Behavioral health problems, ex-offender reentry policies, and the "Second Chance Act".

PubMed

Pogorzelski, Wendy; Wolff, Nancy; Pan, Ko-Yu; Blitz, Cynthia L

2005-10-01

The federal "Second Chance Act of 2005" calls for expanding reentry services for people leaving prison, yet existing policies restrict access to needed services for those with criminal records. We examined the interaction between individual-level characteristics and policy-level restrictions related to criminal conviction, and the likely effects on access to resources upon reentry, using a sample of prisoners with Axis I mental disorders (n=3073). We identified multiple challenges related to convictions, including restricted access to housing, public assistance, and other resources. Invisible punishments embedded within existing policies were inconsistent with the call for second chances. Without modification of federal and state policies, the ability of reentry services to foster behavioral health and community reintegration is limited.

Medication abortion: Potential for improved patient access through pharmacies.

PubMed

Raifman, Sarah; Orlando, Megan; Rafie, Sally; Grossman, Daniel

2018-05-08

To discuss the potential for improving access to early abortion care through pharmacies in the United States. Despite the growing use of medications to induce termination of early pregnancy, pharmacist involvement in abortion care is currently limited. The Food and Drug Administration's Risk Evaluation and Mitigation Strategy (REMS) for Mifeprex® (mifepristone 200 mg), the principal drug used in early medication abortion, prohibits the dispensing of the drug by prescription at pharmacies. This commentary reviews the pharmacology of medication abortion with the use of mifepristone and misoprostol, as well as aspects of service delivery and data on safety, efficacy, and acceptability. Given its safety record, mifepristone no longer fits the profile of a drug that requires an REMS. The recent implementation of pharmacy dispensing of mifepristone in community pharmacies in Australia and some provinces of Canada has improved access to medication abortion by increasing the number of medication abortion providers, particularly in rural areas. Provision of mifepristone in pharmacies, which involves dispensing and patient counseling, would likely improve access to early abortion in the United States without increasing risks to women. Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Solid state oxygen sensor

DOEpatents

Garzon, Fernando H.; Chung, Brandon W.; Raistrick, Ian D.; Brosha, Eric L.

1996-01-01

Solid state oxygen sensors are provided with a yttria-doped zirconia as an electrolyte and use the electrochemical oxygen pumping of the zirconia electrolyte. A linear relationship between oxygen concentration and the voltage arising at a current plateau occurs when oxygen accessing the electrolyte is limited by a diffusion barrier. A diffusion barrier is formed herein with a mixed electronic and oxygen ion-conducting membrane of lanthanum-containing perovskite or zirconia-containing fluorite. A heater may be used to maintain an adequate oxygen diffusion coefficient in the mixed conducting layer.

Purification and switching protocols for dissipatively stabilized entangled qubit states

NASA Astrophysics Data System (ADS)

Hein, Sven M.; Aron, Camille; Türeci, Hakan E.

2016-06-01

Pure dephasing processes limit the fidelities achievable in driven-dissipative schemes for stabilization of entangled states of qubits. We propose a scheme which, combined with already existing entangling methods, purifies the desired entangled state by driving out of equilibrium auxiliary dissipative cavity modes coupled to the qubits. We lay out the specifics of our scheme and compute its efficiency in the particular context of two superconducting qubits in a cavity-QED architecture, where the strongly coupled auxiliary modes provided by collective cavity excitations can drive and sustain the qubits in maximally entangled Bell states with fidelities reaching 90% for experimentally accessible parameters.

Priorities for Action in a Rural Older Adults Study

PubMed Central

Averill, Jennifer B.

2013-01-01

This article reports the findings from a recent study of older adults in the rural southwestern United States and discusses practice and research implications. The aim of the study was to analyze health disparities and strengths in the contexts of rurality, aging, a depressed economy, and limited health resources. Identified themes needing action included sustained access to prescriptions, transportation solutions for older adults in isolated communities, inadequate access to care, poor infrastructure and coordination of services, scarce assisted living and in-home care for frail older adults, and barriers related to culture, language, and economics. PMID:22929381

Policy in Practice: The Implementation of Structured English Immersion in Arizona

ERIC Educational Resources Information Center

Lillie, Karen E.; Markos, Amy; Estrella, Alexandria; Nguyen, Tracy; Trifiro, Anthony; Arias, M. Beatriz; Wiley, Terrence G.; Peer, Karisa; Perez, Karla

2010-01-01

This study examines the implementation and organization of the state mandated curriculum in the 4-hour SEI block in 18 K-12 classrooms in 5 different districts. We focus on the effects of grouping by language proficiency, the delivery of the structure-based ESL curriculum, the provision of resources and limiting of access to grade-level…

Access to Specialty Health Care for Rural American Indians in Two States

ERIC Educational Resources Information Center

Baldwin, Laura-Mae; Hollow, Walter B.; Casey, Susan; Hart, L. Gary; Larson, Eric H.; Moore, Kelly; Lewis, Ervin; Andrilla, C. Holly A.; Grossman, David C.

2008-01-01

Context: The Indian Health Service (IHS), whose per capita expenditure for American Indian and Alaska Native (AI/AN) health services is about half that of the US civilian population, is the only source of health care funding for many rural AI/ANs. Specialty services, largely funded through contracts with outside practitioners, may be limited by…

Improving Parental Involvement in an Inner-City School

ERIC Educational Resources Information Center

Marion, Veronica D.

2017-01-01

A pattern of low parental involvement exists at in an inner-city school in the northeast region of the United States, where 90% of the students are students of color and fewer than 10% of parents attend school-based activities. Low parental involvement at the local school may lead to decreased student achievement and limited access to needed…

On the Capacity of Attention: Its Estimation and Its Role in Working Memory and Cognitive Aptitudes

ERIC Educational Resources Information Center

Cowan, N.; Elliott, E.M.; Scott Saults, J.; Morey, C.C.; Mattox, S.; Hismjatullina, A.; Conway, A.R.A.

2005-01-01

Working memory (WM) is the set of mental processes holding limited information in a temporarily accessible state in service of cognition. We provide a theoretical framework to understand the relation between WM and aptitude measures. The WM measures that have yielded high correlations with aptitudes include separate storage-and-processing task…

Long Distance Relationships: Assessing the Library Service Needs of Rural Students in eLearning Courses

ERIC Educational Resources Information Center

Sterling, Lorelei; McKay, Jennifer; Ericson, Christine

2017-01-01

In states with limited road accessibility, rural students can feel isolated from library services. This article explores the creation, implementation, and results of an on-going longitudinal study assessing the library service needs of rural students in eLearning courses. To align with current practices in online pedagogies, including the…

36 CFR 13.1144 - How often will commercial fishing lifetime access permit be renewed?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false How often will commercial...-Glacier Bay National Park and Preserve Commercial Fishing § 13.1144 How often will commercial fishing... for the lifetime of a permittee who continues to hold a valid State limited entry commercial fishing...

50 CFR 660.333 - Open access non-groundfish trawl fishery-management measures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... engaged in fishing for pink shrimp, ridgeback prawns, California halibut, or sea cucumbers. Trip limits... in the pink shrimp fishery are in Tables 3 (North) and 3 (South) of this subpart. The table also... and Game Code, section 8595, which states: “Prawns or shrimp may be taken for commercial purposes with...

50 CFR 660.333 - Open access non-groundfish trawl fishery-management measures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... engaged in fishing for pink shrimp, ridgeback prawns, California halibut, or sea cucumbers. Trip limits... in the pink shrimp fishery are in Tables 3 (North) and 3 (South) of this subpart. The table also... and Game Code, section 8595, which states: “Prawns or shrimp may be taken for commercial purposes with...

Implementing Oral English Language Acquisition Policy in Career and Technical Education Classes: Changing to a Social Pedagogy Paradigm

ERIC Educational Resources Information Center

Crockett, Kelley E.

2010-01-01

Federal and state policies have long sought to address the social inequities faced by limited English proficient (LEP) students through the improvement of English language acquisition. English language acquisition policy has focused on access to resources, qualified teachers, and instructional methodologies (e.g. pedagogy) that create a learning…

The Experience of Ethnic and Racial Group Membership among Immigrant-Origin Adolescents

ERIC Educational Resources Information Center

Tummala-Narra, Pratyusha; Sathasivam-Rueckert, Nina

2016-01-01

Immigrant-origin adolescents in the United States face a number of stressors across different social contexts (e.g., home, school), and yet, distress related to these stressors often goes unnoticed and access to resources is limited. This study examined how racial minority immigrant-origin adolescents in an urban setting construct and negotiate…

Conflict and Compromise in Public Health Policy: Analysis of Changes Made to Five Competitive Food Legislative Proposals Prior to Adoption

ERIC Educational Resources Information Center

Dinour, Lauren M.

2015-01-01

Competitive foods in schools have historically been scrutinized for their ubiquity and poor nutritional quality, leading many states to enact legislation limiting the availability and accessibility of these items. Evaluations of these policy approaches show their promise in improving the healthfulness of school food environments, considered an…

The Economic Impact of Community College Capacity Development in Developing Countries: A Longitudinal Analysis

ERIC Educational Resources Information Center

Tyndorf, Darryl M., Jr.; Glass, Chris R.

2017-01-01

Developing countries have significantly expanded efforts to import more flexible short-cycle institutions based on the United States community college model. The U.S. community college model addresses human capital needs of the labor market in developing countries by increasing access to an affordable education. However, there is limited research…

Understanding the potential of state-based public health genomics programs to mitigate disparities in access to clinical genetic services.

PubMed

Senier, Laura; Tan, Catherine; Smollin, Leandra; Lee, Rachael

2018-06-12

State health agencies (SHAs) have developed public health genomics (PHG) programs that play an instrumental role in advancing precision public health, but there is limited research on their approaches. This study examines how PHG programs attempt to mitigate or forestall health disparities and inequities in the utilization of genomic medicine. We compared PHG programs in three states: Connecticut, Michigan, and Utah. We analyzed 85 in-depth interviews with SHA internal and external collaborators and program documents. We employed a qualitative coding process to capture themes relating to health disparities and inequities. Each SHA implemented population-level approaches to identify individuals who carry genetic variants that increase risk of hereditary cancers. However, each SHA developed a unique strategy-which we label public health action repertoires-to reach specific subgroups who faced barriers in accessing genetic services. These strategies varied across states given demographics of the state population, state-level partnerships, and availability of healthcare services. Our findings illustrate the imperative of tailoring PHG programs to local demographic characteristics and existing community resources. Furthermore, our study highlights how integrating genomics into precision public health will require multilevel, multisector collaboration to optimize efficacy and equity.

Addressing Data Access Needs of the Long-tail Distribution of Geoscientists

NASA Astrophysics Data System (ADS)

Malik, T.; Foster, I.

2012-12-01

Geoscientists must increasingly consider data from multiple disciplines and make intelligent connections between the data in order to advance research frontiers in mission critical problems. As a first step towards making timely and relevant connections, scientists require data and resource access, made available through simple and efficient protocols and web services that allows them to conveniently transmit, acquire, process, and inspect data and metadata. The last decade witnessed some vital data and resource access barriers being crossed. "Big iron" data infrastructures enabled geoscientists with large volumes of simulation and observational datasets, protocols made data access convenient, and strong governing bodies ensured standards for interoperability, repeatability and auditability. All this remarkable growth in access, however, addresses needs of publishers of large data and ignores consumers of that data. To-date limited access mechanisms exist for the consumers, who fetch subsets, analyze them, and, more often than not, generate new data and analysis, which finally gets published in scientific articles. In this session, we will highlight the data access needs of the long-tail distribution of geoscientists and a state-of-the art cyber-infrastructure approaches proposed to address those needs. The needs and the state-of-the-art arose from discussions held with geoscientists as part of the EarthCube Data Access Workshop, which was coordinated by the authors. Our presentation will summarize the proceedings of the Data Access workshop. It will present qualifying characteristics of solutions that will continue to serve the needs of these scientists in the long-term. Finally, we will present some cyber-infrastructure efforts in building such solutions and also provide a vision of the future CI in which such solutions can be useful.

Maintaining rigor in research: flaws in a recent study and a reanalysis of the relationship between state abortion laws and maternal mortality in Mexico.

PubMed

Darney, Blair G; Saavedra-Avendano, Biani; Lozano, Rafael

2017-01-01

A recent publication [Koch E, Chireau M, Pliego F, Stanford J, Haddad S, Calhoun B, Aracena P, Bravo M, Gatica S, Thorp J. Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states. BMJ Open 2015;5(2):e006013] claimed that Mexican states with more restrictive abortion laws had lower levels of maternal mortality. Our objectives are to replicate the analysis, reanalyze the data and offer a critique of the key flaws of the Koch study. We used corrected maternal mortality data (2006-2013), live births, and state-level indicators of poverty. We replicate the published analysis. We then reclassified state-level exposure to abortion on demand based on actual availability of abortion (Mexico City versus the other 31 states) and test the association of abortion access and the maternal mortality ratio (MMR) using descriptives over time, pooled chi-square tests and regression models. We included 256 state-year observations. We did not find significant differences in MMR between Mexico City (MMR=49.1) and the 31 states (MMR=44.6; p=.44). Using Koch's classification of states, we replicated published differences of higher MMR where abortion is more available. We found a significant, negative association between MMR and availability of abortion in the same multivariable models as Koch, but using our state classification (beta=-22.49, 95% CI=-38.9; -5.99). State-level poverty remains highly correlated with MMR. Koch makes errors in methodology and interpretation, making false causal claims about abortion law and MMR. MMR is falling most rapidly in Mexico City, but our main study limitation is an inability to draw causal inference about abortion law or access and maternal mortality. We need rigorous evidence about the health impacts of increasing access to safe abortion worldwide. Transparency and integrity in research is crucial, as well as perhaps even more in politically contested topics such as abortion. Rigorous evidence about the health impacts of increasing access to safe abortion worldwide is needed. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Online bibliographic sources in hydrology

USGS Publications Warehouse

Wild, Emily C.; Havener, W. Michael

2001-01-01

Traditional commercial bibliographic databases and indexes provide some access to hydrology materials produced by the government; however, these sources do not provide comprehensive coverage of relevant hydrologic publications. This paper discusses bibliographic information available from the federal government and state geological surveys, water resources agencies, and depositories. In addition to information in these databases, the paper describes the scope, styles of citing, subject terminology, and the ways these information sources are currently being searched, formally and informally, by hydrologists. Information available from the federal and state agencies and from the state depositories might be missed by limiting searches to commercially distributed databases.

Implementation of mental health parity: lessons from california.

PubMed

Rosenbach, Margo L; Lake, Timothy K; Williams, Susan R; Buck, Jeffrey A

2009-12-01

This article reports the experiences of health plans, providers, and consumers with California's mental health parity law and discusses implications for implementation of the 2008 federal parity law. This study used a multimodal data collection approach to assess the first five years of California's parity implementation (from 2000 to 2005). Telephone interviews were conducted with 68 state-level stakeholders, and in-person interviews were conducted with 77 community-based stakeholders. Six focus groups included 52 providers, and six included 32 consumers. A semistructured interview protocol was used. Interview notes and transcripts were coded to facilitate analysis. Health plans eliminated differential benefit limits and cost-sharing requirements for certain mental disorders to comply with the law, and they used managed care to control costs. In response to concerns about access to and quality of care, the state expanded oversight of health plans, issuing access-to-care regulations and conducting focused studies. California's parity law applied to a limited list of psychiatric diagnoses. Health plan executives said they spent considerable resources clarifying which diagnoses were covered at parity levels and concluded that the limited diagnosis list was unnecessary with managed care. Providers indicated that the diagnosis list had unintended consequences, including incentives to assign a more severe diagnosis that would be covered at parity levels, rather than a less severe diagnosis that would not be covered at such levels. The lack of consumer knowledge about parity was widely acknowledged, and consumers in the focus groups requested additional information about parity. Experiences in California suggest that implementation of the 2008 federal parity law should include monitoring health plan performance related to access and quality, in addition to monitoring coverage and costs; examining the breadth of diagnoses covered by health plans; and mounting a campaign to educate consumers about their insurance benefits.

Utilization of internet technology by low-income adults: the role of health literacy, health numeracy, and computer assistance.

PubMed

Jensen, Jakob D; King, Andy J; Davis, LaShara A; Guntzviller, Lisa M

2010-09-01

To examine whether low-income adults' utilization of Internet technology is predicted or mediated by health literacy, health numeracy, and computer assistance. Low-income adults (N = 131) from the midwestern United States were surveyed about their technology access and use. Individuals with low health literacy skills were less likely to use Internet technology (e.g., email, search engines, and online health information seeking), and those with low health numeracy skills were less likely to have access to Internet technology (e.g., computers and cell phones). Consistent with past research, males, older participants, and those with less education were less likely to search for health information online. The relationship between age and online health information seeking was mediated by participant literacy. The present study suggests that significant advances in technology access and use could be sparked by developing technology interfaces that are accessible to individuals with limited literacy skills.

Conceptualizing a Human Right to Prevention in Global HIV/AIDS Policy

PubMed Central

Meier, Benjamin Mason; Brugh, Kristen Nichole; Halima, Yasmin

2012-01-01

Given current constraints on universal treatment campaigns, recent advances in public health prevention initiatives have revitalized efforts to stem the tide of HIV transmission. Yet, despite a growing imperative for prevention—supported by the promise of behavioral, structural and biomedical approaches to lower the incidence of HIV—human rights frameworks remain limited in addressing collective prevention policy through global health governance. Assessing the evolution of rights-based approaches to global HIV/AIDS policy, this review finds that human rights have shifted from collective public health to individual treatment access. While the advent of the HIV/AIDS pandemic gave meaning to rights in framing global health policy, the application of rights in treatment access litigation came at the expense of public health prevention efforts. Where the human rights framework remains limited to individual rights enforced against a state duty bearer, such rights have faced constrained application in framing population-level policy to realize the public good of HIV prevention. Concluding that human rights frameworks must be developed to reflect the complementarity of individual treatment and collective prevention, this article conceptualizes collective rights to public health, structuring collective combination prevention to alleviate limitations on individual rights frameworks and frame rights-based global HIV/AIDS policy to assure research expansion, prevention access and health system integration. PMID:23226723

EU Accession and Civil Aviation Regimes: Malta and Cyprus as a Case Study

NASA Technical Reports Server (NTRS)

Papatheodorou, Andreas; Busuttil, Louis

2003-01-01

Aviation deregulation is usually a challenging and demanding task and accession to the European Union requires that all candidate states should harmonize their legislation in the context of the European Common Aviation Area. Malta and Cyprus, the small Mediterranean island-states to join the EU in 2004, will have to abandon any protectionist policies in favour of their flag-carriers and let them survive in a liberal framework. The paper discusses the implications of this regime change for civil aviation in Malta and Cyprus and in addition to the airline industry, it examines the impacts on the complementary tourism sector. Unless carrying capacity limits are understood, the islands may become victims of successful airline liberalisation. The paper concludes by stressing the need for sustainable development and active policy making. Keywords: carrying capacity, Cyprus, air transport deregulation, Malta, tourism

Fermionic entanglement that survives a black hole

NASA Astrophysics Data System (ADS)

Martín-Martínez, Eduardo; León, Juan

2009-10-01

We introduce an arbitrary number of accessible modes when analyzing bipartite entanglement degradation due to Unruh effect between two partners Alice and Rob. Under the single mode approximation (SMA) a fermion field only had a few accessible levels due to Pauli exclusion principle conversely to bosonic fields which had an infinite number of excitable levels. This was argued to justify entanglement survival in the fermionic case in the SMA infinite acceleration limit. Here we relax SMA. Hence, an infinite number of modes are excited as the observer Rob accelerates, even for a fermion field. We will prove that, despite this analogy with the bosonic case, entanglement loss is limited. We will show that this comes from fermionic statistics through the characteristic structure it imposes on the infinite dimensional density matrix for Rob. Surprisingly, the surviving entanglement is independent of the specific maximally entangled state chosen, the kind of fermionic field analyzed, and the number of accessible modes considered. We shall discuss whether this surviving entanglement goes beyond the purely statistical correlations, giving insight concerning the black hole information paradox.

Using Registered Dental Hygienists to Promote a School-Based Approach to Dental Public Health

PubMed Central

Wellever, Anthony; Kelly, Patricia

2017-01-01

We examine a strategy for improving oral health in the United States by focusing on low-income children in school-based settings. Vulnerable children often experience cultural, social, economic, structural, and geographic barriers when trying to access dental services in traditional dental office settings. These disparities have been discussed for more than a decade in multiple US Department of Health and Human Services publications. One solution is to revise dental practice acts to allow registered dental hygienists increased scope of services, expanded public health delivery opportunities, and decreased dentist supervision. We provide examples of how federally qualified health centers have implemented successful school-based dental models within the parameters of two state policies that allow registered dental hygienists varying levels of dentist supervision. Changes to dental practice acts at the state level allowing registered dental hygienists to practice with limited supervision in community settings, such as schools, may provide vulnerable populations greater access to screening and preventive services. We derive our recommendations from expert opinion. PMID:28661808

Policy Dilemmas in Latino Health Care and Implementation of the Affordable Care Act

PubMed Central

Ortega, Alexander N.; Rodriguez, Hector P.; Bustamante, Arturo Vargas

2016-01-01

The changing Latino demographic in the United States presents a number of challenges to health care policy makers, clinicians, organizations, and other stakeholders. Studies have demonstrated that Latinos tend to have worse patterns of access to, and utilization of, health care than other ethnic and racial groups. The implementation of the Affordable Care Act (ACA) of 2010 may ameliorate some of these disparities. However, even with the ACA, it is expected that Latinos will continue to have problems accessing and using high-quality health care, especially in states that are not expanding Medicaid eligibility as provided by the ACA. We identify four current policy dilemmas relevant to Latinos’ health and ACA implementation: (a) the need to extend coverage to the undocumented; (b) the growth of Latino populations in states with limited insurance expansion; (c) demands on public and private systems of care; and (d) the need to increase the number of Latino physicians while increasing the direct patient-care responsibilities of nonphysician Latino health care workers. PMID:25581154

Humanitarian agencies and authoritarian states: a symbiotic relationship?

PubMed

del Valle, Hernan; Healy, Sean

2013-10-01

The relationship between humanitarian agencies and authoritarian states is of growing concern to Médecins Sans Frontières (MSF), given the recurring difficulties experienced in negotiating access and implementing operations in such contexts. The effort to negotiate and gain approval from states to operate on their territory prompts reflection on the sources of legitimacy for action. Drawing on direct field examples in two countries only very rarely examined--Turkmenistan and Uzbekistan--this paper explores MSF's attempts to offer live-saving medical care there. It shows that successful access negotiations hinged heavily on demonstrating added value (medical relevance) while simultaneously building relationships with authorities, identifying possible allies within health ministries, and hoping that such measures could promote a level of acceptance or trust needed to operate. It is clear that the operational space achieved is bound to remain limited and fragile, and that many compromises have to be considered and judged against ethical principles and the overall impact of the intervention. © 2013 The Author(s). Disasters © Overseas Development Institute, 2013.

Suicide Rates and State Laws Regulating Access and Exposure to Handguns

PubMed Central

Anestis, Joye C.

2015-01-01

Objectives. Using previous research, we examined the impact of 4 handgun laws (waiting periods, universal background checks, gun locks, and open carrying regulations) on suicide rates. Methods. We used publicly available databases to collect information on statewide laws, suicide rates, and demographic characteristics for 2013. Results. Each law was associated with significantly lower firearm suicide rates and the proportion of suicides resulting from firearms. In addition, each law, except for that which required a waiting period, was associated with a lower overall suicide rate. Follow-up analyses showed a significant indirect effect on overall suicide rates through the proportion of suicides by firearms, indicating that the reduced overall suicide rate was attributable to fewer suicide attempts, fewer handguns in the home, suicide attempts using less lethal means, or a combination of these factors. States that implemented any of these laws saw a decreased suicide rate in subsequent years, whereas the only state that repealed 1 of these laws saw an increased suicide rate. Conclusions. Our results were supportive of a potentially vital role in suicide prevention for state legislation that limits access and exposure to handguns. PMID:26270305

Impact of Medicaid Expansion on Medicaid-covered Utilization of Buprenorphine for Opioid Use Disorder Treatment.

PubMed

Wen, Hefei; Hockenberry, Jason M; Borders, Tyrone F; Druss, Benjamin G

2017-04-01

Buprenorphine has been proven effective in treating opioid use disorder. However, the high cost of buprenorphine and the limited prescribing capacity may restrict access to this effective medication-assisted treatment for opioid use disorder. To examine whether Medicaid expansion and physician prescribing capacity may have impacted buprenorphine utilization covered by Medicaid. We used a quasi experimental difference-in-differences design to compare the pre-post changes in Medicaid-covered buprenorphine prescriptions and buprenorphine spending between the 26 states that implemented Medicaid expansions under the Affordable Care Act in 2014 and those that did not. All Medicaid enrollees in the expansion states and the nonexpansion and late-expansion states. Quarterly Medicaid prescriptions for buprenorphine and spending on buprenorphine from the Centers for Medicare and Medicaid Services Medicaid Drug Utilization files 2011 to 2014. State implementation of Medicaid expansions in 2014 was associated with a 70% increase (P<0.05) in Medicaid-covered buprenorphine prescriptions and a 50% increase (P<0.05) in buprenorphine spending. Physician prescribing capacity was also associated with increased buprenorphine utilization. Medicaid expansion has the potential to reduce the financial barriers to buprenorphine utilization and improve access to medication-assisted treatment of opioid use disorder. Active physician participation in the provision of buprenorphine is needed for ensuring that Medicaid expansion achieves its full potential in improving treatment access.

Frequency and Risk of Marijuana Use among Substance-Using Health Care Patients in Colorado with and without Access to State Legalized Medical Marijuana.

PubMed

Richmond, Melissa K; Pampel, Fred C; Rivera, Laura S; Broderick, Kerryann B; Reimann, Brie; Fischer, Leigh

2015-01-01

With increasing use of state legalized medical marijuana across the country, health care providers need accurate information on patterns of marijuana and other substance use for patients with access to medical marijuana. This study compared frequency and severity of marijuana use, and use of other substances, for patients with and without state legal access to medical marijuana. Data were collected from 2,030 patients who screened positive for marijuana use when seeking health care services in a large, urban safety-net medical center. Patients were screened as part of a federally funded screening, brief intervention, and referral to treatment (SBIRT) initiative. Patients were asked at screening whether they had a state-issued medical marijuana card and about risky use of tobacco, alcohol, and other illicit substances. A total of 17.4% of marijuana users had a medical marijuana card. Patients with cards had higher frequency of marijuana use and were more likely to screen at moderate than low or high risk from marijuana use. Patients with cards also had lower use of other substances than patients without cards. Findings can inform health care providers of both the specific risks of frequent, long-term use and the more limited risks of other substance use faced by legal medical marijuana users.

Family and medical leave act: unresolved issues.

PubMed

Pyle, Jean L; Pelletier, Marianne S

2003-01-01

The United States' Family and Medical Leave Act (FMLA) of 1993 was an effort to provide national support for families attempting to balance the demands of the workplace and the need to care for a new child, one's own health, or an ill child, spouse, or parent. It is seriously limited, however, in terms of its accessibility for many workers. We briefly compare the FMLA to the substantially broader policies of Western European countries. We highlight its reported benefits to workers but document disparities in employees' use of the FMLA by gender, race, and income level. We evaluate whether employers' fears of higher costs were justified. We point out current challenges that may limit the FMLA further. We close by examining the range of alternative policies in effect at the state level and proposals that would address the current limitations of the FMLA and broaden its coverage.

Geographic Accessibility of Pulmonologists for Adults With COPD: United States, 2013.

PubMed

Croft, Janet B; Lu, Hua; Zhang, Xingyou; Holt, James B

2016-09-01

Geographic clusters in prevalence and hospitalizations for COPD have been identified at national, state, and county levels. The study objective is to identify county-level geographic accessibility to pulmonologists for adults with COPD. Service locations of 12,392 practicing pulmonologists and 248,160 primary care physicians were identified from the 2013 National Provider Identifier Registry and weighted by census block-level populations within a series of circular distance buffer zones. Model-based county-level population counts of US adults ≥ 18 years of age with COPD were estimated from the 2013 Behavioral Risk Factor Surveillance System. The percentages of all estimated adults with potential access to at least one provider type and the county-level ratio of adults with COPD per pulmonologist were estimated for selected distances. Most US adults (100% in urbanized areas, 99.5% in urban clusters, and 91.7% in rural areas) had geographic access to a primary care physician within a 10-mile buffer distance; almost all (≥ 99.9%) had access to a primary care physician within 50 miles. At least one pulmonologist within 10 miles was available for 97.5% of US adults living in urbanized areas, but only for 38.3% in urban clusters and 34.5% in rural areas. When distance increased to 50 miles, at least one pulmonologist was available for 100% in urbanized areas, 93.2% in urban clusters, and 95.2% in rural areas. County-level ratios of adults with COPD per pulmonologist varied greatly across the United States, with residents in many counties in the Midwest having no pulmonologist within 50 miles. County-level geographic variations in pulmonologist access for adults with COPD suggest that those adults with limited access will have to depend on care from primary care physicians. Published by Elsevier Inc.

50 CFR 648.92 - Effort-control program for monkfish limited access vessels.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... Limited access NE multispecies and limited access sea scallop permit holders who also possess a limited... letter or fax to the Regional Administrator within 24 hours after tags have been discovered lost... Aids section of the printed volume and at www.fdsys.gov. ...

50 CFR 648.92 - Effort-control program for monkfish limited access vessels.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... Limited access NE multispecies and limited access sea scallop permit holders who also possess a limited... letter or fax to the Regional Administrator within 24 hours after tags have been discovered lost... Aids section of the printed volume and at www.fdsys.gov. ...

Sci-Hub provides access to nearly all scholarly literature

PubMed Central

Romero, Ariel Rodriguez; Levernier, Jacob G; Munro, Thomas Anthony; McLaughlin, Stephen Reid; Greshake Tzovaras, Bastian

2018-01-01

The website Sci-Hub enables users to download PDF versions of scholarly articles, including many articles that are paywalled at their journal’s site. Sci-Hub has grown rapidly since its creation in 2011, but the extent of its coverage has been unclear. Here we report that, as of March 2017, Sci-Hub’s database contains 68.9% of the 81.6 million scholarly articles registered with Crossref and 85.1% of articles published in toll access journals. We find that coverage varies by discipline and publisher, and that Sci-Hub preferentially covers popular, paywalled content. For toll access articles, we find that Sci-Hub provides greater coverage than the University of Pennsylvania, a major research university in the United States. Green open access to toll access articles via licit services, on the other hand, remains quite limited. Our interactive browser at https://greenelab.github.io/scihub allows users to explore these findings in more detail. For the first time, nearly all scholarly literature is available gratis to anyone with an Internet connection, suggesting the toll access business model may become unsustainable. PMID:29424689

The importance of product definitions in US e-cigarette laws and regulations.

PubMed

Lempert, Lauren K; Grana, Rachel; Glantz, Stanton A

2016-04-01

How electronic cigarettes and similar products (e-cigarettes) are defined affects how they are regulated, particularly whether existing laws for cigarettes apply, including sales and marketing, youth access, smoke-free and taxation laws. We examined the text of 46 bills that define e-cigarettes enacted in 40 states and characterised how e-cigarettes and similar products were defined. States enact laws creating new product categories for e-cigarettes separate from the 'tobacco product' category (eg, 'alternative nicotine product,' 'vapour product,' 'electronic nicotine device'), with four states explicitly excluding e-cigarettes from 'tobacco products.' Twenty-eight states do not include e-cigarettes in their definitions of 'tobacco products' or 'smoking,' eight include e-cigarettes as 'tobacco products,' three include e-cigarettes in 'smoking.' Sixteen states' definitions of e-cigarettes require nicotine, and five states pre-empt more stringent local laws. Tobacco and e-cigarette industry representatives tried to shape laws that benefit their interests. Definitions separating e-cigarettes from other tobacco products are common. Similar to past 'Trojan horse' policies, e-cigarette policies that initially appear to restrict sales (eg, limit youth access) may actually undermine regulation if they establish local pre-emption or create definitions that divide e-cigarettes from other tobacco products. Comparable issues are raised by the European Union Tobacco Products Directive and e-cigarette regulations in other countries. Policymakers should carefully draft legislation with definitions of e-cigarettes that broadly define the products, do not require nicotine or tobacco, do not pre-empt stronger regulations and explicitly include e-cigarettes in smoke-free and taxation laws. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

75 FR 1595 - Pacific Halibut Fisheries; Limited Access for Guided Sport Charter Vessels in Alaska

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

... Halibut Fisheries; Limited Access for Guided Sport Charter Vessels in Alaska AGENCY: National Marine... charter halibut permit under the Limited Access System for Guided Sport Charter Vessels in Alaska... access system for charter vessels in the guided sport fishery for Pacific halibut in waters of...

Spatial versus sequential correlations for random access coding

NASA Astrophysics Data System (ADS)

Tavakoli, Armin; Marques, Breno; Pawłowski, Marcin; Bourennane, Mohamed

2016-03-01

Random access codes are important for a wide range of applications in quantum information. However, their implementation with quantum theory can be made in two very different ways: (i) by distributing data with strong spatial correlations violating a Bell inequality or (ii) using quantum communication channels to create stronger-than-classical sequential correlations between state preparation and measurement outcome. Here we study this duality of the quantum realization. We present a family of Bell inequalities tailored to the task at hand and study their quantum violations. Remarkably, we show that the use of spatial and sequential quantum correlations imposes different limitations on the performance of quantum random access codes: Sequential correlations can outperform spatial correlations. We discuss the physics behind the observed discrepancy between spatial and sequential quantum correlations.

Tri-state resistive switching characteristics of MnO/Ta2O5 resistive random access memory device by a controllable reset process

NASA Astrophysics Data System (ADS)

Lee, N. J.; Kang, T. S.; Hu, Q.; Lee, T. S.; Yoon, T.-S.; Lee, H. H.; Yoo, E. J.; Choi, Y. J.; Kang, C. J.

2018-06-01

Tri-state resistive switching characteristics of bilayer resistive random access memory devices based on manganese oxide (MnO)/tantalum oxide (Ta2O5) have been studied. The current–voltage (I–V) characteristics of the Ag/MnO/Ta2O5/Pt device show tri-state resistive switching (RS) behavior with a high resistance state (HRS), intermediate resistance state (IRS), and low resistance state (LRS), which are controlled by the reset process. The MnO/Ta2O5 film shows bipolar RS behavior through the formation and rupture of conducting filaments without the forming process. The device shows reproducible and stable RS both from the HRS to the LRS and from the IRS to the LRS. In order to elucidate the tri-state RS mechanism in the Ag/MnO/Ta2O5/Pt device, transmission electron microscope (TEM) images are measured in the LRS, IRS and HRS. White lines like dendrites are observed in the Ta2O5 film in both the LRS and the IRS. Poole–Frenkel conduction, space charge limited conduction, and Ohmic conduction are proposed as the dominant conduction mechanisms for the Ag/MnO/Ta2O5/Pt device based on the obtained I–V characteristics and TEM images.

76 FR 39369 - Fisheries of the Northeastern United States; Atlantic Deep-Sea Red Crab Fishery; Amendment 3

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-06

... crab vessels may not deploy parlor traps/pots in water depths greater than 400 meters (219 fathoms... water deeper than 400 m; prohibit a limited access red crab vessel from harvesting red crab in water shallower than 400 m; and prohibit parlor traps from being deployed at water shallower than 400 m. This...

75 FR 12462 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Removal of Gear...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-16

... throughout the Western U.S./Canada Area. In addition, as of March 5, 2010, the catch of Eastern GB cod was 72...; removal of gear restrictions. SUMMARY: This action removes temporary gear restrictions in both the Eastern and Western U.S./Canada Areas for limited access Northeast (NE) multispecies vessels fishing on a NE...

Primary and Specialty Medical Care Among Ethnically Diverse, Older Rural Adults With Type 2 Diabetes: The ELDER Diabetes Study

ERIC Educational Resources Information Center

Bell, Ronny A.; Quandt, Sara A.; Arcury, Thomas A.; Snively, Beverly M.; Stafford, Jeanette M.; Smith, Shannon L.; Skelly, Anne H.

2005-01-01

Purpose: Residents in rural communities in the United States, especially ethnic minority group members, have limited access to primary and specialty health care that is critical for diabetes management. This study examines primary and specialty medical care utilization among a rural, ethnically diverse, older adult population with diabetes.…

Primary and Specialty Medical Care among Ethnically Diverse, Older Rural Adults with Type 2 Diabetes: The ELDER Diabetes Study

ERIC Educational Resources Information Center

Bell, Ronny A.; Quandt, Sara A.; Arcury, Thomas A.; Snively, Beverly M.; Stafford, Jeanette M.; Smith, Shannon L.; Skelly, Anne H.

2005-01-01

Purpose: Residents in rural communities in the United States, especially ethnic minority group members, have limited access to primary and specialty health care that is critical for diabetes management. This study examines primary and specialty medical care utilization among a rural, ethnically diverse, older adult population with diabetes.…

The Nuances and Complexities of Teaching Mathematics for Cultural Relevance and Social Justice

ERIC Educational Resources Information Center

Leonard, Jacqueline; Brooks, Wanda; Barnes-Johnson, Joy; Berry, Robert Q., III.

2010-01-01

Mathematics is not a race-neutral subject. Access and opportunity in mathematics for students of color in the United States continue to be limited. While a great deal of attention has been given to increasing the number of underrepresented minority students in the mathematics pipeline, there is little consideration of who they are as learners or…

32 CFR Appendix B to Subpart M of... - Non-Permit Access Routes

Code of Federal Regulations, 2013 CFR

2013-07-01

... Ave South, ET 423097) Roy Cut-off (Chambers Lake) Road (East Gate Road to Roy City Limits), when open... permit or check-in: I-5. Steilacoom-DuPont Road (ET 286163 or ET 301229). Pacific Highway Southeast (ET 231121 to ET 249143). Washington State Route 507 (ET 363065 to ET 428146). Goodacre and Rice Kandle Roads...

32 CFR Appendix B to Subpart M of... - Non-Permit Access Routes

Code of Federal Regulations, 2012 CFR

2012-07-01

... Ave South, ET 423097) Roy Cut-off (Chambers Lake) Road (East Gate Road to Roy City Limits), when open... permit or check-in: I-5. Steilacoom-DuPont Road (ET 286163 or ET 301229). Pacific Highway Southeast (ET 231121 to ET 249143). Washington State Route 507 (ET 363065 to ET 428146). Goodacre and Rice Kandle Roads...

32 CFR Appendix B to Subpart M of... - Non-Permit Access Routes

Code of Federal Regulations, 2014 CFR

2014-07-01

... Ave South, ET 423097) Roy Cut-off (Chambers Lake) Road (East Gate Road to Roy City Limits), when open... permit or check-in: I-5. Steilacoom-DuPont Road (ET 286163 or ET 301229). Pacific Highway Southeast (ET 231121 to ET 249143). Washington State Route 507 (ET 363065 to ET 428146). Goodacre and Rice Kandle Roads...

Reflections on the Women's Movement: An Assessment of Change and Its Limits.

ERIC Educational Resources Information Center

Epstein, Cynthia Fuchs

Recent changes in the social and economic roles of women are examined. These changes affect the lives of the largest single group in the United States and have resulted from a movement aimed not only at increased access to society's resources and power, but also at a redefinition of the identity of American women. Topics reviewed include women in…

Clinic access and teenage birth rates: Racial/ethnic and spatial disparities in Houston, TX.

PubMed

Wisniewski, Megan M; O'Connell, Heather A

2018-03-01

Teenage motherhood is a pressing issue in the United States, and one that is disproportionately affecting racial/ethnic minorities. In this research, we examine the relationship between the distance to the nearest reproductive health clinic and teenage birth rates across all zip codes in Houston, Texas. Our primary data come from the Texas Department of State Health Services. We use spatial regression analysis techniques to examine the link between clinic proximity and local teenage birth rates for all females aged 15 to 19, and separately by maternal race/ethnicity. We find, overall, limited support for a connection between clinic distance and local teenage birth rates. However, clinics seem to matter most for explaining non-Hispanic white teenage birth rates, particularly in high-poverty zip codes. The racial/ethnic and economic variation in the importance of clinic distance suggests tailoring clinic outreach to more effectively serve a wider range of teenage populations. We argue social accessibility should be considered in addition to geographic accessibility in order for clinics to help prevent teenage pregnancy. Copyright © 2018. Published by Elsevier Ltd.

50 CFR 660.24 - Limited entry and open access fisheries.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 13 2013-10-01 2013-10-01 false Limited entry and open access fisheries... Groundfish Fisheries § 660.24 Limited entry and open access fisheries. (a) General. All commercial fishing for groundfish must be conducted in accordance with the regulations governing limited entry and open...

Local health department translation processes: potential of machine translation technologies to help meet needs.

PubMed

Turner, Anne M; Mandel, Hannah; Capurro, Daniel

2013-01-01

Limited English proficiency (LEP), defined as a limited ability to read, speak, write, or understand English, is associated with health disparities. Despite federal and state requirements to translate health information, the vast majority of health materials are solely available in English. This project investigates barriers to translation of health information and explores new technologies to improve access to multilingual public health materials. We surveyed all 77 local health departments (LHDs) in the Northwest about translation needs, practices, barriers and attitudes towards machine translation (MT). We received 67 responses from 45 LHDs. Translation of health materials is the principle strategy used by LHDs to reach LEP populations. Cost and access to qualified translators are principle barriers to producing multilingual materials. Thirteen LHDs have used online MT tools. Many respondents expressed concerns about the accuracy of MT. Overall, respondents were positive about its potential use, if low costs and quality could be assured.

Local Health Department Translation Processes: Potential of Machine Translation Technologies to Help Meet Needs

PubMed Central

Turner, Anne M.; Mandel, Hannah; Capurro, Daniel

2013-01-01

Limited English proficiency (LEP), defined as a limited ability to read, speak, write, or understand English, is associated with health disparities. Despite federal and state requirements to translate health information, the vast majority of health materials are solely available in English. This project investigates barriers to translation of health information and explores new technologies to improve access to multilingual public health materials. We surveyed all 77 local health departments (LHDs) in the Northwest about translation needs, practices, barriers and attitudes towards machine translation (MT). We received 67 responses from 45 LHDs. Translation of health materials is the principle strategy used by LHDs to reach LEP populations. Cost and access to qualified translators are principle barriers to producing multilingual materials. Thirteen LHDs have used online MT tools. Many respondents expressed concerns about the accuracy of MT. Overall, respondents were positive about its potential use, if low costs and quality could be assured. PMID:24551414

Provision of genetics services on Guam.

PubMed

McWalter, Kirsty; Hasegawa, Lianne; Au, Sylvia Mann

2013-12-01

Guam's geographic isolation and lack of community resources have resulted in unique healthcare needs. In 2006, the Western States Genetic Services Collaborative (WSGSC) conducted a genetics needs assessment and found that professional development is limited, families lack access to genetic services, and improved coverage of genetic testing is needed. With funding from the WSGSC, a Guam genetics outreach clinic was established and staffed by genetic counselors and a medical geneticist from Hawaii. Four clinics have been held to date. Although several challenges have been encountered, including minimal coverage of genetic testing by Guam insurance companies, limited referrals for families with private insurance, and inappropriate referral indications, the outreach clinic has been successful at increasing access to genetic services and improving professional development. With more collaborative work by staff from Guam, Hawaii, and the WSGSC, provision and reimbursement of genetic services and testing will continue to improve.

Lethality of firearms relative to other suicide methods: a population based study.

PubMed

Shenassa, E D; Catlin, S N; Buka, S L

2003-02-01

(1) To quantify lethality of firearms relative to other suicide methods, (2) to quantify the extent to which suicide mortality may be reduced by limiting access to firearms. Data on suicides and hospitalised para-suicides that occurred in the state of Illinois from 1990 to 1997 were combined. Total number of episodes for each suicide method was estimated as the sum of the number of suicides and the number of para-suicides for that method. Gender and suicide method were used as proxies for intention to die, and estimated lethality of suicide methods within method-gender groups (for example, male firearm users). Logistic regression was used to quantify the lethality of firearms relative to other suicide methods. Excess mortality associated with the use of firearms was estimated by conservatively assuming that in the absence of firearms the next most lethal suicide method would be used. From January 1990 to December 1997, among individuals 10 years or older in the state of Illinois, there were 37,352 hospital admissions for para-suicide and 10,287 completed suicides. Firearms are the most lethal suicide method. Episodes involving firearms are 2.6 times (95% CI 2.1 to 3.1) more lethal than those involving suffocation-the second most lethal suicide method. Preventing access to firearms can reduce the proportion of fatal firearms related suicides by 32% among minors, and 6.5% among adults. Limiting access to firearms is a potentially effective means of reducing suicide mortality.

[Access to high-cost drugs in Brazil from the perspective of physicians, pharmacists and patients].

PubMed

Rover, Marina Raijche Mattozo; Vargas-Pelaez, Claudia Marcela; Rocha Farias, Mareni; Nair Leite, Silvana

2016-01-01

To explore perceptions on access to medication supplied by the Specialized Component of Pharmaceutical Assistance (CEAF) within the Brazilian Unified Health System (which includes high-cost drugs) by the actors involved in the healthcare services of this component. A descriptive, qualitative study was carried out by using a focal group with 7 users and 11 semi-structured interviews with health professionals (physicians and pharmacist) in the state of Santa Catarina. According to the participants, access to medicines had improved. Two main perceptions of the CEAF Clinical Guidelines were identified: the requirements constitute a bureaucracy that limits access, and the requisites increase the demand for tests and specialized healthcare services, exceeding the capacity of the healthcare services network. These assumptions generated the search for other means of access that revealed a lack of information and understanding of the right to health among the users. In addition, according to the participants, because of the difficulties of accessing services as a whole, full access to CEAF medicines is a goal that remains to be achieved. Although access to CEAF medicines has improved, there are still some difficulties in guaranteeing treatment access and comprehensiveness. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Public opinion regarding utilization of assisted reproductive technology (ART) in obese women.

PubMed

Shah, Divya K; Ginsburg, Elizabeth S; Correia, Katharine F; Barton, Sara E; Missmer, Stacey A

2013-11-01

There have been calls to restrict access to fertility treatment in women above a certain body mass index (BMI). It is important to consider public expectations before formulating policy. The study objective was to assess public opinion regarding provision of assisted reproductive technology (ART) to obese (BMI>30 kg/m(2)) women in the United States. The study was conducted through an Internet-based survey of U.S. residents ages 18-75. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression to describe predictors of response based on demographic characteristics. Of the 1049 respondents, 60.7% support the use of ART in obese women. Adjusting for age and gender, the odds of support were over twice as high in participants with BMI>40 kg/m(2) as in normal-weight respondents (OR=2.87, 95% CI=1.28-6.44). Fifty-five percent of participants supported a BMI limit for access to ART. Both increasing education (p-value=0.02) and BMI (p-value=0.01) were inversely associated with support of a BMI limit. Individuals who had themselves used ART were also less likely (OR=0.27, 95% CI=0.07--0.99) to support a BMI limit. In an Internet-based survey, participants who are in favor of ART are likely to support its use among obese women. More than 50% of these respondents also support implementation of a BMI limit for access to these services.

Quantifying evenly distributed states in exclusion and nonexclusion processes

NASA Astrophysics Data System (ADS)

Binder, Benjamin J.; Landman, Kerry A.

2011-04-01

Spatial-point data sets, generated from a wide range of physical systems and mathematical models, can be analyzed by counting the number of objects in equally sized bins. We find that the bin counts are related to the Pólya distribution. New measures are developed which indicate whether or not a spatial data set, generated from an exclusion process, is at its most evenly distributed state, the complete spatial randomness (CSR) state. To this end, we define an index in terms of the variance between the bin counts. Limiting values of the index are determined when objects have access to the entire domain and when there are subregions of the domain that are inaccessible to objects. Using three case studies (Lagrangian fluid particles in chaotic laminar flows, cellular automata agents in discrete models, and biological cells within colonies), we calculate the indexes and verify that our theoretical CSR limit accurately predicts the state of the system. These measures should prove useful in many biological applications.

The effect of the global financial crisis on preventable hospitalizations among the homeless in New York State.

PubMed

White, Brandi; Ellis, Charles; Jones, Walter; Moran, William; Simpson, Kit

2018-04-01

Objective Periods of economic instability may increase preventable hospitalizations because of increased barriers to accessing primary care. For underserved populations such as the homeless, these barriers may be more pronounced due to limited resources in the health care safety net. This study examined the impact of the global financial crisis of 2007-2008 on access to care for the homeless in New York State. Methods Hospitalizations for ambulatory care sensitive conditions (ACSCs) were used as a proxy measure for primary care access. Admissions for ACSCs were identified in the New York State Inpatient Database from 2006 to 2012. Hospitalization rates for ACSCs were calculated for the homeless and nonhomeless. Multivariable linear regression was used to investigate the impact of the financial crisis on hospitalization rates for ACSCs. Results The findings indicate that during the financial crisis, homeless adults had significantly higher preventable hospitalizations than nonhomeless adults, and the uninsured homeless had significantly higher preventable hospitalizations when compared to other homeless subgroups. After the financial crisis, preventable hospitalizations for the homeless stabilized but remained at higher rates than those for the nonhomeless. Conclusions These findings are important to developing health policies designed to provide effective care for underserved population such as the homeless.

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

Traveling Towards Disease: Transportation Barriers to Health Care Access

PubMed Central

Gerber, Ben S.; Sharp, Lisa K.

2014-01-01

Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes. PMID:23543372

Traveling towards disease: transportation barriers to health care access.

PubMed

Syed, Samina T; Gerber, Ben S; Sharp, Lisa K

2013-10-01

Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.

Solid state oxygen sensor

DOEpatents

Garzon, F.H.; Chung, B.W.; Raistrick, I.D.; Brosha, E.L.

1996-08-06

Solid state oxygen sensors are provided with a yttria-doped zirconia as an electrolyte and use the electrochemical oxygen pumping of the zirconia electrolyte. A linear relationship between oxygen concentration and the voltage arising at a current plateau occurs when oxygen accessing the electrolyte is limited by a diffusion barrier. A diffusion barrier is formed herein with a mixed electronic and oxygen ion-conducting membrane of lanthanum-containing perovskite or zirconia-containing fluorite. A heater may be used to maintain an adequate oxygen diffusion coefficient in the mixed conducting layer. 4 figs.

African American Women Coping with the Lived Experiences of Limited Mental Healthcare Access in Rural North Carolina

ERIC Educational Resources Information Center

Lesane, Everick S.

2013-01-01

This study examined the impact of lived experiences among African American women with limited mental healthcare access in rural North Carolina. The research examined how those lived experiences-due to limited transportation, low socioeconomic status, and limited healthcare access-further exacerbate emotional challenges among African American…

50 CFR 648.92 - Effort-control program for monkfish limited access vessels.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... Limited access NE multispecies and limited access sea scallop permit holders who also possess a limited... Regional Administrator within 24 hours after tags have been discovered lost, destroyed, or missing. (iv... § 648.92, see the List of CFR Sections Affected, which appears in the Finding Aids section of the...

Floquet Engineering in Quantum Chains

NASA Astrophysics Data System (ADS)

Kennes, D. M.; de la Torre, A.; Ron, A.; Hsieh, D.; Millis, A. J.

2018-03-01

We consider a one-dimensional interacting spinless fermion model, which displays the well-known Luttinger liquid (LL) to charge density wave (CDW) transition as a function of the ratio between the strength of the interaction U and the hopping J . We subject this system to a spatially uniform drive which is ramped up over a finite time interval and becomes time periodic in the long-time limit. We show that by using a density matrix renormalization group approach formulated for infinite system sizes, we can access the large-time limit even when the drive induces finite heating. When both the initial and long-time states are in the gapless (LL) phase, the final state has power-law correlations for all ramp speeds. However, when the initial and final state are gapped (CDW phase), we find a pseudothermal state with an effective temperature that depends on the ramp rate, both for the Magnus regime in which the drive frequency is very large compared to other scales in the system and in the opposite limit where the drive frequency is less than the gap. Remarkably, quantum defects (instantons) appear when the drive tunes the system through the quantum critical point, in a realization of the Kibble-Zurek mechanism.

Not sold here: limited access to legally available syringes at pharmacies in Tijuana, Mexico

PubMed Central

2011-01-01

Background Sterile syringe access is a critical component of HIV prevention programs. Although retail pharmacies provide convenient outlets for syringe access, injection drug users (IDUs) may encounter barriers to syringe purchase even where purchase without a prescription is legal. We sought to obtain an objective measure of syringe access in Tijuana, Mexico, where IDUs report being denied or overcharged for syringes at pharmacies. Methods Trained "mystery shoppers" attempted to buy a 1 cc insulin syringe according to a predetermined script at all retail pharmacies in three Tijuana neighborhoods. The same pharmacies were surveyed by telephone regarding their syringe sales policies. Data on purchase attempts were analyzed using basic statistics to obtain an objective measure of syringe access and compared with data on stated sales policies to ascertain consistency. Results Only 46 (28.4%) of 162 syringe purchase attempts were successful. Leading reasons for unsuccessful attempts were being told that the pharmacy didn't sell syringes (35.3%), there were no syringes in stock (31.0%), or a prescription was required (20.7%). Of 136 pharmacies also surveyed by telephone, a majority (88.2%) reported selling syringes but only one-third (32.5%) had a successful mystery shopper purchase; the majority of unsuccessful purchases were attributed to being told the pharmacy didn't sell syringes. There was similar discordance regarding prescription policies: 74 pharmacies said in the telephone survey that they did not require a prescription for syringes, yet 10 of these pharmacies asked the mystery shopper for a prescription. Conclusions IDUs in Tijuana have limited access to syringes through retail pharmacies and policies and practices regarding syringe sales are inconsistent. Reasons for these restrictive and inconsistent practices must be identified and addressed to expand syringe access, reduce syringe sharing and prevent HIV transmission. PMID:21609471

Not sold here: limited access to legally available syringes at pharmacies in Tijuana, Mexico.

PubMed

Pollini, Robin A; Rosen, Perth C; Gallardo, Manuel; Robles, Brenda; Brouwer, Kimberly C; Macalino, Grace E; Lozada, Remedios

2011-05-24

Sterile syringe access is a critical component of HIV prevention programs. Although retail pharmacies provide convenient outlets for syringe access, injection drug users (IDUs) may encounter barriers to syringe purchase even where purchase without a prescription is legal. We sought to obtain an objective measure of syringe access in Tijuana, Mexico, where IDUs report being denied or overcharged for syringes at pharmacies. Trained "mystery shoppers" attempted to buy a 1 cc insulin syringe according to a predetermined script at all retail pharmacies in three Tijuana neighborhoods. The same pharmacies were surveyed by telephone regarding their syringe sales policies. Data on purchase attempts were analyzed using basic statistics to obtain an objective measure of syringe access and compared with data on stated sales policies to ascertain consistency. Only 46 (28.4%) of 162 syringe purchase attempts were successful. Leading reasons for unsuccessful attempts were being told that the pharmacy didn't sell syringes (35.3%), there were no syringes in stock (31.0%), or a prescription was required (20.7%). Of 136 pharmacies also surveyed by telephone, a majority (88.2%) reported selling syringes but only one-third (32.5%) had a successful mystery shopper purchase; the majority of unsuccessful purchases were attributed to being told the pharmacy didn't sell syringes. There was similar discordance regarding prescription policies: 74 pharmacies said in the telephone survey that they did not require a prescription for syringes, yet 10 of these pharmacies asked the mystery shopper for a prescription. IDUs in Tijuana have limited access to syringes through retail pharmacies and policies and practices regarding syringe sales are inconsistent. Reasons for these restrictive and inconsistent practices must be identified and addressed to expand syringe access, reduce syringe sharing and prevent HIV transmission.

Gun utopias? Firearm access and ownership in Israel and Switzerland.

PubMed

Rosenbaum, Janet E

2012-02-01

The 2011 attempted assassination of a US representative renewed the national gun control debate. Gun advocates claim mass-casualty events are mitigated and deterred with three policies: (a) permissive gun laws, (b) widespread gun ownership, (c) and encouragement of armed civilians who can intercept shooters. They cite Switzerland and Israel as exemplars. We evaluate these claims with analysis of International Crime Victimization Survey (ICVS) data and translation of laws and original source material. Swiss and Israeli laws limit firearm ownership and require permit renewal one to four times annually. ICVS analysis finds the United States has more firearms per capita and per household than either country. Switzerland and Israel curtail off-duty soldiers' firearm access to prevent firearm deaths. Suicide among soldiers decreased by 40 per cent after the Israeli army's 2006 reforms. Compared with the United States, Switzerland and Israel have lower gun ownership and stricter gun laws, and their policies discourage personal gun ownership.

An electronic consumer health library: NetWellness.

PubMed Central

Guard, R; Haag, D; Kaya, B; Marine, S; Morris, T; Schick, L; Shoemaker, S

1996-01-01

NetWellness is a community-based, consumer-defined grant program supporting the delivery of electronic health information to rural residents of southern Ohio and urban and suburban communities in the Greater Cincinnati tri-state region. NetWellness is a collaboratively developed and publicly and privately funded demonstration project. Information is delivered via ISDN, standard dial, dedicated network connections, and the Internet. TriState Online (Greater Cincinnati's Free-Net) and other southern Ohio Free-Nets are key access points in the larger project communities. The other access points are more than forty workstations distributed at public sites throughout the project's primary geographical area. Design strengths and limitations, training initiatives, technical issues, and the project's impact on medical librarianship are examined in this paper. Also discussed are ways of determining community needs and interest, building political alliances, finding and developing funding sources, and overcoming technical obstacles. NetWellness's Internet address is: http:@www.netwellness.org. PMID:8913548

Stimulated Raman adiabatic passage preparation of a coherent superposition of ThO H3Δ1 states for an improved electron electric-dipole-moment measurement

NASA Astrophysics Data System (ADS)

Panda, C. D.; O'Leary, B. R.; West, A. D.; Baron, J.; Hess, P. W.; Hoffman, C.; Kirilov, E.; Overstreet, C. B.; West, E. P.; DeMille, D.; Doyle, J. M.; Gabrielse, G.

2016-05-01

Experimental searches for the electron electric-dipole moment (EDM) probe new physics beyond the standard model. The current best EDM limit was set by the ACME Collaboration [Science 343, 269 (2014), 10.1126/science.1248213], constraining time-reversal symmetry (T ) violating physics at the TeV energy scale. ACME used optical pumping to prepare a coherent superposition of ThO H3Δ1 states that have aligned electron spins. Spin precession due to the molecule's internal electric field was measured to extract the EDM. We report here on an improved method for preparing this spin-aligned state of the electron by using stimulated Raman adiabatic passage (STIRAP). We demonstrate a transfer efficiency of 75 %±5 % , representing a significant gain in signal for a next-generation EDM experiment. We discuss the particularities of implementing STIRAP in systems such as ours, where molecular ensembles with large phase-space distributions are transferred via weak molecular transitions with limited laser power and limited optical access.

Pharmaceutical company payments to physicians: early experiences with disclosure laws in Vermont and Minnesota.

PubMed

Ross, Joseph S; Lackner, Josh E; Lurie, Peter; Gross, Cary P; Wolfe, Sidney; Krumholz, Harlan M

2007-03-21

Recent legislation in 5 states and the District of Columbia mandated state disclosure of payments made to physicians by pharmaceutical companies. In 2 of these states, Vermont and Minnesota, payment disclosures are publicly available. To determine the accessibility and quality of the data available in Vermont and Minnesota and to describe the prevalence and magnitude of disclosed payments. Cross-sectional analysis of publicly available data from July 1, 2002, through June 30, 2004, in Vermont and from January 1, 2002, through December 31, 2004, in Minnesota. Accessibility and quality of disclosure data and the number, value, and type of payments of $100 or more to physicians. Access to payment data required extensive negotiation with the Office of the Vermont Attorney General and manual photocopying of individual disclosure forms at Minnesota's State Board of Pharmacy. In Vermont, 61% of payments were not released to the public because pharmaceutical companies designated them as trade secrets and 75% of publicly disclosed payments were missing information necessary to identify the recipient. In Minnesota, 25% of companies reported in each of the 3 years. In Vermont, among 12,227 payments totaling $2.18 million publicly disclosed, there were 2416 payments of $100 or more to physicians; total, $1.01 million; median payment, $177 (range, $100-$20,000). In Minnesota, among 6946 payments totaling $30.96 million publicly disclosed, there were 6238 payments of $100 or more to physicians; total, $22.39 million; median payment, $1000 (range, $100-$922,239). Physician-specific analyses were possible only in Minnesota, identifying 2388 distinct physicians who received payment of $100 or more; median number of payments received, 1 (range, 1-88) and the median amount received, $1000 (range, $100-$1,178,203). The Vermont and Minnesota laws requiring disclosure of payments do not provide easy access to payment information for the public and are of limited quality once accessed. However, substantial numbers of payments of $100 or more were made to physicians by pharmaceutical companies.

50 CFR 665.801 - Permits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... qualifying for, or renewing, limited access permits. In making such decision, the Administrator will review... American Samoa longline limited access permit initial permit decision, the Regional Administrator will... Hawaii longline limited access permit if that vessel is used: (1) To fish for western Pacific pelagic MUS...

Conduction Mechanism and Improved Endurance in HfO2-Based RRAM with Nitridation Treatment

NASA Astrophysics Data System (ADS)

Yuan, Fang-Yuan; Deng, Ning; Shih, Chih-Cheng; Tseng, Yi-Ting; Chang, Ting-Chang; Chang, Kuan-Chang; Wang, Ming-Hui; Chen, Wen-Chung; Zheng, Hao-Xuan; Wu, Huaqiang; Qian, He; Sze, Simon M.

2017-10-01

A nitridation treatment technology with a urea/ammonia complex nitrogen source improved resistive switching property in HfO2-based resistive random access memory (RRAM). The nitridation treatment produced a high performance and reliable device which results in superior endurance (more than 109 cycles) and a self-compliance effect. Thus, the current conduction mechanism changed due to defect passivation by nitrogen atoms in the HfO2 thin film. At a high resistance state (HRS), it transferred to Schottky emission from Poole-Frenkel in HfO2-based RRAM. At low resistance state (LRS), the current conduction mechanism was space charge limited current (SCLC) after the nitridation treatment, which suggests that the nitrogen atoms form Hf-N-Ox vacancy clusters (Vo +) which limit electron movement through the switching layer.

Patterns and predictors of enactment of state childhood obesity legislation in the United States: 2006-2009.

PubMed

Eyler, Amy A; Nguyen, Leah; Kong, Jooyoung; Yan, Yan; Brownson, Ross

2012-12-01

We developed a content review for state policies related to childhood obesity, and we have quantitatively described the predictors of enactment. We collected an inventory of 2006 through 2009 state legislation on 27 childhood obesity topics from legislative databases. We coded each bill for general information, topic content, and other appropriate components. We conducted a general descriptive analysis and 3 multilevel analyses using bill- and state-level characteristics to predict bill enactment. Common topics in the 27% of the bills that were enacted were community physical activity access, physical education, and school food policy. Committee and bipartisan sponsorship and having term limits significantly predicted enactment in at least 1 model. Bills with safe routes to school or health and nutrition content were twice as likely to be enacted. Bills containing product and menu labeling or soda and snack taxes were significantly less likely to be enacted. Bipartisan and committee support and term limits are important in bill enactment. Advocacy efforts can be tailored to increase awareness and sense of priority among policymakers.

Anti-Stokes resonant x-ray Raman scattering for atom specific and excited state selective dynamics

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

Kunnus, Kristjan; Josefsson, Ida; Rajkovic, Ivan

Here, ultrafast electronic and structural dynamics of matter govern rate and selectivity of chemical reactions, as well as phase transitions and efficient switching in functional materials. Since x-rays determine electronic and structural properties with elemental, chemical, orbital and magnetic selectivity, short pulse x-ray sources have become central enablers of ultrafast science. Despite of these strengths, ultrafast x-rays have been poor at picking up excited state moieties from the unexcited ones. With time-resolved anti-Stokes resonant x-ray Raman scattering (AS-RXRS) performed at the LCLS, and ab initio theory we establish background free excited state selectivity in addition to the elemental, chemical, orbitalmore » and magnetic selectivity of x-rays. This unparalleled selectivity extracts low concentration excited state species along the pathway of photo induced ligand exchange of Fe(CO)5 in ethanol. Conceptually a full theoretical treatment of all accessible insights to excited state dynamics with AS-RXRS with transform-limited x-ray pulses is given—which will be covered experimentally by upcoming transform-limited x-ray sources.« less

Patterns and Predictors of Enactment of State Childhood Obesity Legislation in the United States: 2006–2009

PubMed Central

Nguyen, Leah; Kong, Jooyoung; Yan, Yan; Brownson, Ross

2012-01-01

Objectives. We developed a content review for state policies related to childhood obesity, and we have quantitatively described the predictors of enactment. Methods. We collected an inventory of 2006 through 2009 state legislation on 27 childhood obesity topics from legislative databases. We coded each bill for general information, topic content, and other appropriate components. We conducted a general descriptive analysis and 3 multilevel analyses using bill- and state-level characteristics to predict bill enactment. Results. Common topics in the 27% of the bills that were enacted were community physical activity access, physical education, and school food policy. Committee and bipartisan sponsorship and having term limits significantly predicted enactment in at least 1 model. Bills with safe routes to school or health and nutrition content were twice as likely to be enacted. Bills containing product and menu labeling or soda and snack taxes were significantly less likely to be enacted. Conclusions. Bipartisan and committee support and term limits are important in bill enactment. Advocacy efforts can be tailored to increase awareness and sense of priority among policymakers. PMID:23078482

Anti-Stokes resonant x-ray Raman scattering for atom specific and excited state selective dynamics

DOE PAGES

Kunnus, Kristjan; Josefsson, Ida; Rajkovic, Ivan; ...

2016-10-07

Here, ultrafast electronic and structural dynamics of matter govern rate and selectivity of chemical reactions, as well as phase transitions and efficient switching in functional materials. Since x-rays determine electronic and structural properties with elemental, chemical, orbital and magnetic selectivity, short pulse x-ray sources have become central enablers of ultrafast science. Despite of these strengths, ultrafast x-rays have been poor at picking up excited state moieties from the unexcited ones. With time-resolved anti-Stokes resonant x-ray Raman scattering (AS-RXRS) performed at the LCLS, and ab initio theory we establish background free excited state selectivity in addition to the elemental, chemical, orbitalmore » and magnetic selectivity of x-rays. This unparalleled selectivity extracts low concentration excited state species along the pathway of photo induced ligand exchange of Fe(CO)5 in ethanol. Conceptually a full theoretical treatment of all accessible insights to excited state dynamics with AS-RXRS with transform-limited x-ray pulses is given—which will be covered experimentally by upcoming transform-limited x-ray sources.« less

K-12 Technology Accessibility: The Message from State Governments

ERIC Educational Resources Information Center

Shaheen, Natalie L.; Lazar, Jonathan

2018-01-01

This study examined state education technology plans and technology accessibility statutes to attempt to answer the question--is K-12 instructional technology accessibility discussed in state-level technology accessibility statutes and education technology plans across the 50 United States? When a K-12 school district is planning the construction…

Hospital-Based Outpatient Direct Access to Physical Therapist Services: Current Status in Wisconsin.

PubMed

Boissonnault, William G; Lovely, Karen

2016-11-01

Direct access to physical therapist services is available in all 50 states, with reported benefits including reduced health care costs, enhanced patient satisfaction, and no apparent compromised patient safety. Despite the benefits and legality of direct access, few data exist regarding the degree of model adoption, implementation, and utilization. The purposes of the study were: (1) to investigate the extent of implementation and utilization of direct access to outpatient physical therapist services in Wisconsin hospitals and medical centers, (2) to identify barriers to and facilitators for the provisioning of such services, and (3) to identify potential differences between facilities that do and do not provide direct access services. A descriptive survey was conducted. Eighty-nine survey questionnaires were distributed via email to the directors of rehabilitation services at Wisconsin hospitals and medical centers. The survey investigated facility adoption of the direct access model, challenges to and resources utilized during model implementation, and current barriers affecting model utilization. Forty-seven (52.8%) of the 89 survey questionnaires were completed and returned. Forty-two percent of the survey respondents (20 of 47) reported that their facility offered direct access to physical therapist services, but fewer than 10% of patients were seen via direct access at 95% of the facilities offering such services. The most frequently reported obstacles to model implementation and utilization were lack of health care provider, administrator, and patient knowledge of direct access; its legality in Wisconsin; and physical therapists' differential diagnosis and medical screening abilities. Potential respondent bias and limited generalizability of the results are limitations of the study. These findings apply to hospitals and medical centers located in Wisconsin, not to facilities located in other geographic regions. Respondents representing direct access organizations reported more timely access to physical therapist services, enhanced patient satisfaction, decreased organizational health care costs, and improved efficiency of resource utilization as benefits of model implementation. For organizations without direct access, not being an organizational priority, concerns from referral sources, and concerns that the physician-patient relationship would be negatively affected were noted as obstacles to model adoption. © 2016 American Physical Therapy Association.

Committee Opinion No. 574: Marriage equality for same-sex couples.

PubMed

2013-09-01

Same-sex couples encounter barriers to health care that include concerns about confidentiality and disclosure, stigma and discriminatory attitudes and treatment, limited access to health care and health insurance, and often a limited understanding of their health risks. Same-sex couples and their families are adversely affected by the lack of legal recognition of their relationships, a problem with major implications for the health of same-sex couples and their families. Tangible harm has come from the lack of financial and health care protections granted to legal spouses, and children are harmed by the lack of protections afforded to families in which partners are married. However, the recent Supreme Court ruling, The United States v Windsor, which afforded equal treatment for legally married same-sex couples will provide many important health and financial benefits. Evidence suggests that marriage confers health benefits to individuals and families, yet a sizable proportion of individuals do not experience these health benefits because of their sexual orientation. Additional data suggest that same-sex couples who live in states with bans on same-sex unions experience adverse health outcomes. Civil marriage is currently available to same-sex couples in only thirteen states and the District of Columbia and honored by one state. The American College of Obstetricians and Gynecologists endorses marriage equality for same-sex couples and equal treatment for these couples and their families and applauds the Supreme Court's decision as an important step in improving access to benefits received by legally married same-sex couples. However, additional efforts are necessary to ensure that same-sex couples in every state can receive these same benefits.

Development of a state-wide pediatric palliative care service in Australia: referral and outcomes over two years.

PubMed

Herbert, Anthony; Bradford, Natalie; Donovan, Leigh; Pedersen, Lee-Anne; Irving, Helen

2014-03-01

Pediatric palliative care is an evolving specialty that aims to improve the lives of children with a life-limiting condition. As an emerging specialty, there is much to be learned about service provision and the expected outcomes that can be achieved. Additionally, quantification of the needs for pediatric palliative care is complicated by the uncertainty of defining the population that requires care. Our aim was to define the characteristics of the population cared for by a newly formed state-wide service in Queensland, Australia, and describe the development of the service over a 24-month period. Data on all referrals and outcomes were collected. Descriptive statistics were used to describe patterns including the variation in outcomes between children with oncology and non-oncology diagnoses. Other factors influencing the development of the service including involved health professionals and the model of the Australian health care system are also described. Over a 24-month period, 150 patients were referred of whom 117 subsequently died. There was a wide range of diseases and ages, and significantly, 58% of children were from regional or rural locations where there are can be limited access to specialist pediatric services. The average length of service was 83 days. A variety of factors were identified as being important for providing optimal care including ensuring equity in access, timing of referral, and continuity of care. The importance of a population-based approach to pediatric palliative care in a state that is geographically large and diverse like Queensland is highlighted. This article may provide valuable information to other health care providers who care for children with life-limiting illnesses.

Ion-Pair States in Triplet Molecular Hydrogen

NASA Astrophysics Data System (ADS)

Setzer, W.; Baker, B. C.; Ashman, S.; Morgan, T. J.

2016-05-01

An experimental search is underway to observe the long range triplet ionic states H+ H- of molecular hydrogen. Resonantly enhanced multi-photon ionization of the metastable c 3∏u- 2 pπ state is used access to the R(1)nd1 n = 21 Rydberg state that serves as an intermediate stepping stone state to probe the energy region above the ionization limit with a second tunable laser photon. The metastable state is prepared by electron capture of 6 keV H2+ions in potassium in a molecular beam. Formation of the H+ H- triplet configuration involves triplet excited states of the H- ion, especially the 2p23Pe state, the second bound state of H- predicted to exist with a lifetime long compared to typical auto ionization lifetimes but not yet observed experimentally. Details of the experiment and preliminary results to date will be presented at the conference.

50 CFR 622.19 - South Atlantic rock shrimp limited access off Georgia and Florida.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 10 2011-10-01 2011-10-01 false South Atlantic rock shrimp limited access... CARIBBEAN, GULF, AND SOUTH ATLANTIC Effort Limitations § 622.19 South Atlantic rock shrimp limited access... for rock shrimp in the South Atlantic EEZ off Georgia or off Florida or possess rock shrimp in or from...

50 CFR 622.19 - South Atlantic rock shrimp limited access off Georgia and Florida.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false South Atlantic rock shrimp limited access... CARIBBEAN, GULF, AND SOUTH ATLANTIC Effort Limitations § 622.19 South Atlantic rock shrimp limited access... for rock shrimp in the South Atlantic EEZ off Georgia or off Florida or possess rock shrimp in or from...

50 CFR 622.19 - South Atlantic rock shrimp limited access off Georgia and Florida.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false South Atlantic rock shrimp limited access... CARIBBEAN, GULF, AND SOUTH ATLANTIC Effort Limitations § 622.19 South Atlantic rock shrimp limited access... for rock shrimp in the South Atlantic EEZ off Georgia or off Florida or possess rock shrimp in or from...

Optimization modeling to maximize population access to comprehensive stroke centers

PubMed Central

Branas, Charles C.; Kasner, Scott E.; Wolff, Catherine; Williams, Justin C.; Albright, Karen C.; Carr, Brendan G.

2015-01-01

Objective: The location of comprehensive stroke centers (CSCs) is critical to ensuring rapid access to acute stroke therapies; we conducted a population-level virtual trial simulating change in access to CSCs using optimization modeling to selectively convert primary stroke centers (PSCs) to CSCs. Methods: Up to 20 certified PSCs per state were selected for conversion to maximize the population with 60-minute CSC access by ground and air. Access was compared across states based on region and the presence of state-level emergency medical service policies preferentially routing patients to stroke centers. Results: In 2010, there were 811 Joint Commission PSCs and 0 CSCs in the United States. Of the US population, 65.8% had 60-minute ground access to PSCs. After adding up to 20 optimally located CSCs per state, 63.1% of the US population had 60-minute ground access and 86.0% had 60-minute ground/air access to a CSC. Across states, median CSC access was 55.7% by ground (interquartile range 35.7%–71.5%) and 85.3% by ground/air (interquartile range 59.8%–92.1%). Ground access was lower in Stroke Belt states compared with non–Stroke Belt states (32.0% vs 58.6%, p = 0.02) and lower in states without emergency medical service routing policies (52.7% vs 68.3%, p = 0.04). Conclusion: Optimal system simulation can be used to develop efficient care systems that maximize accessibility. Under optimal conditions, a large proportion of the US population will be unable to access a CSC within 60 minutes. PMID:25740858

Optimization modeling to maximize population access to comprehensive stroke centers.

PubMed

Mullen, Michael T; Branas, Charles C; Kasner, Scott E; Wolff, Catherine; Williams, Justin C; Albright, Karen C; Carr, Brendan G

2015-03-24

The location of comprehensive stroke centers (CSCs) is critical to ensuring rapid access to acute stroke therapies; we conducted a population-level virtual trial simulating change in access to CSCs using optimization modeling to selectively convert primary stroke centers (PSCs) to CSCs. Up to 20 certified PSCs per state were selected for conversion to maximize the population with 60-minute CSC access by ground and air. Access was compared across states based on region and the presence of state-level emergency medical service policies preferentially routing patients to stroke centers. In 2010, there were 811 Joint Commission PSCs and 0 CSCs in the United States. Of the US population, 65.8% had 60-minute ground access to PSCs. After adding up to 20 optimally located CSCs per state, 63.1% of the US population had 60-minute ground access and 86.0% had 60-minute ground/air access to a CSC. Across states, median CSC access was 55.7% by ground (interquartile range 35.7%-71.5%) and 85.3% by ground/air (interquartile range 59.8%-92.1%). Ground access was lower in Stroke Belt states compared with non-Stroke Belt states (32.0% vs 58.6%, p = 0.02) and lower in states without emergency medical service routing policies (52.7% vs 68.3%, p = 0.04). Optimal system simulation can be used to develop efficient care systems that maximize accessibility. Under optimal conditions, a large proportion of the US population will be unable to access a CSC within 60 minutes. © 2015 American Academy of Neurology.

Marine conservation and accession: the future for the Croatian Adriatic.

PubMed

Mackelworth, Peter; Holcer, Draško; Jovanović, Jelena; Fortuna, Caterina

2011-04-01

The European Union (EU) is the world's largest trading bloc and the most influential supra-national organisation in the region. The EU has been the goal for many eastern European States, for Croatia accession remains a priority and underpins many of its national policies. However, entry into the EU requires certain commitments and concessions. In October 2003 the Croatian parliament declared an ecological and fisheries protection zone in the Adriatic. Under pressure the zone was suspended, finally entering into force in March 2008 exempting EU States. There are other marine conflicts between Croatia and the EU, particularly the contested maritime border with Slovenia, and the development of the Croatian fishing fleet in opposition to the Common Fisheries Policy. Conversely, attempts to harmonise Croatian Nature Protection with the EU Habitats Directive, facilitated by pre-accession funding, has galvanised conservation policy. Since 2005 two marine protected areas have been declared, significantly increasing the marine ecosystem under protection. Finally, the development of the Marine Strategy Framework Directive is the latest EU attempt to integrate environmental policy in the maritime realm. This will have an effect not only on member States but neighbouring countries. For marine nature protection to be effective in the region the Adriatic Sea needs to be viewed as a mutually important shared and limited resource not a bargaining chip. Negotiations of the EU and Croatia have been watched closely by the other Balkan States and precedents set in this case have the potential to affect EU expansion to the East.

Marine Conservation and Accession: The Future for the Croatian Adriatic

NASA Astrophysics Data System (ADS)

Mackelworth, Peter; Holcer, Draško; Jovanović, Jelena; Fortuna, Caterina

2011-04-01

The European Union (EU) is the world's largest trading bloc and the most influential supra-national organisation in the region. The EU has been the goal for many eastern European States, for Croatia accession remains a priority and underpins many of its national policies. However, entry into the EU requires certain commitments and concessions. In October 2003 the Croatian parliament declared an ecological and fisheries protection zone in the Adriatic. Under pressure the zone was suspended, finally entering into force in March 2008 exempting EU States. There are other marine conflicts between Croatia and the EU, particularly the contested maritime border with Slovenia, and the development of the Croatian fishing fleet in opposition to the Common Fisheries Policy. Conversely, attempts to harmonise Croatian Nature Protection with the EU Habitats Directive, facilitated by pre-accession funding, has galvanised conservation policy. Since 2005 two marine protected areas have been declared, significantly increasing the marine ecosystem under protection. Finally, the development of the Marine Strategy Framework Directive is the latest EU attempt to integrate environmental policy in the maritime realm. This will have an effect not only on member States but neighbouring countries. For marine nature protection to be effective in the region the Adriatic Sea needs to be viewed as a mutually important shared and limited resource not a bargaining chip. Negotiations of the EU and Croatia have been watched closely by the other Balkan States and precedents set in this case have the potential to affect EU expansion to the East.

Visceral leishmaniasis in Somalia: A review of epidemiology and access to care.

PubMed

Sunyoto, Temmy; Potet, Julien; Boelaert, Marleen

2017-03-01

Somalia, ravaged by conflict since 1991, has areas endemic for visceral leishmaniasis (VL), a deadly parasitic disease affecting the rural poor, internally displaced, and pastoralists. Very little is known about VL burden in Somalia, where the protracted crisis hampers access to health care. We reviewed evidence about VL epidemiology in Somalia and appraised control options within the context of this fragile state's health system. VL has been reported in Somalia since 1934 and has persisted ever since in foci in the southern parts of the country. The only feasible VL control option is early diagnosis and treatment, currently mostly provided by nonstate actors. The availability of VL care in Somalia is limited and insufficient at best, both in coverage and quality. Precarious security remains a major obstacle to reach VL patients in the endemic areas, and the true VL burden and its impact remain unknown. Locally adjusted, innovative approaches in VL care provision should be explored, without undermining ongoing health system development in Somalia. Ensuring VL care is accessible is a moral imperative, and the limitations of the current VL diagnostic and treatment tools in Somalia and other endemic settings affected by conflict should be overcome.

Migration intentions and illicit substance use among youth in central Mexico.

PubMed

Marsiglia, Flavio Francisco; Kulis, Stephen; Hoffman, Steven; Calderón-Tena, Carlos Orestes; Becerra, David; Alvarez, Diana

2011-01-01

This study explored intentions to emigrate and substance use among youth (ages 14-24) from a central Mexico state with high emigration rates. Questionnaires were completed in 2007 by 702 students attending a probability sample of alternative secondary schools serving remote or poor communities. Linear and logistic regression analyses indicated that stronger intentions to emigrate predicted greater access to drugs, drug offers, and use of illicit drugs (marijuana, cocaine, inhalants), but not alcohol or cigarettes. Results are related to the healthy migrant theory and its applicability to youth with limited educational opportunities. The study's limitations are noted.

50 CFR 697.8 - Vessel identification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... limited access American lobster permit and over 25 ft (7.6 m) in registered length must: (1) Have affixed... fishing vessel issued a limited access American lobster permit must display its official number in block... each vessel issued a limited access American lobster permit shall ensure that— (1) The vessel's name...

28 CFR 16.74 - Exemption of National Security Division Systems-limited access.

Code of Federal Regulations, 2010 CFR

2010-07-01

... National Security Division Systems—limited access. (a) The following system of records is exempted from... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Exemption of National Security Division Systems-limited access. 16.74 Section 16.74 Judicial Administration DEPARTMENT OF JUSTICE PRODUCTION OR...

50 CFR 648.87 - Sector allocation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... sector's allocation of the overall ACL available to all vessels issued a limited access NE multispecies... the GB cod ACL available to all vessels issued a limited access NE multispecies permit, that sector... this example, if the overall GB cod ACL available to all vessels issued a limited access NE...

Interlibrary loan in primary access libraries: challenging the traditional view.

PubMed

Dudden, R F; Coldren, S; Condon, J E; Katsh, S; Reiter, C M; Roth, P L

2000-10-01

Primary access libraries serve as the foundation of the National Network of Libraries of Medicine (NN/LM) interlibrary loan (ILL) hierarchy, yet few published reports directly address the important role these libraries play in the ILL system. This may reflect the traditional view that small, primary access libraries are largely users of ILL, rather than important contributors to the effectiveness and efficiency of the national ILL system. This study was undertaken to test several commonly held beliefs regarding ILL system use by primary access libraries. Three hypotheses were developed. HI: Colorado and Wyoming primary access libraries comply with the recommended ILL guideline of adhering to a hierarchical structure, emphasizing local borrowing. H2: The closures of two Colorado Council of Medical Librarians (CCML) primary access libraries in 1996 resulted in twenty-three Colorado primary access libraries' borrowing more from their state resource library in 1997. H3: The number of subscriptions held by Colorado and Wyoming primary access libraries is positively correlated with the number of items they loan and negatively correlated with the number of items they borrow. The hypotheses were tested using the 1992 and 1997 DOCLINE and OCLC data of fifty-four health sciences libraries, including fifty primary access libraries, two state resource libraries, and two general academic libraries in Colorado and Wyoming. The ILL data were obtained electronically and analyzed using Microsoft Word 98, Microsoft Excel 98, and JMP 3.2.2. CCML primary access libraries comply with the recommended guideline to emphasize local borrowing by supplying each other with the majority of their ILLs, instead of overburdening libraries located at higher levels in the ILL hierarchy (H1). The closures of two CCML primary access libraries appear to have affected the entire ILL system, resulting in a greater volume of ILL activity for the state resource library and other DOCLINE libraries higher up in the ILL hierarchy and highlighting the contribution made by CCML primary access libraries (H2). CCML primary access libraries borrow and lend in amounts that are proportional to their collection size, rather than overtaxing libraries at higher levels in the ILL hierarchy with large numbers of requests (H3). The main limitations of this study were the small sample size and the use of data collected for another purpose, the CCML ILL survey. The findings suggest that there is little evidence to support several commonly held beliefs regarding ILL system use by primary access libraries. In addition to validating the important contributions made by primary access libraries to the national ILL system, baseline data that can be used to benchmark current practice performance are provided.

Integrated generation of complex optical quantum states and their coherent control

NASA Astrophysics Data System (ADS)

Roztocki, Piotr; Kues, Michael; Reimer, Christian; Romero Cortés, Luis; Sciara, Stefania; Wetzel, Benjamin; Zhang, Yanbing; Cino, Alfonso; Chu, Sai T.; Little, Brent E.; Moss, David J.; Caspani, Lucia; Azaña, José; Morandotti, Roberto

2018-01-01

Complex optical quantum states based on entangled photons are essential for investigations of fundamental physics and are the heart of applications in quantum information science. Recently, integrated photonics has become a leading platform for the compact, cost-efficient, and stable generation and processing of optical quantum states. However, onchip sources are currently limited to basic two-dimensional (qubit) two-photon states, whereas scaling the state complexity requires access to states composed of several (<2) photons and/or exhibiting high photon dimensionality. Here we show that the use of integrated frequency combs (on-chip light sources with a broad spectrum of evenly-spaced frequency modes) based on high-Q nonlinear microring resonators can provide solutions for such scalable complex quantum state sources. In particular, by using spontaneous four-wave mixing within the resonators, we demonstrate the generation of bi- and multi-photon entangled qubit states over a broad comb of channels spanning the S, C, and L telecommunications bands, and control these states coherently to perform quantum interference measurements and state tomography. Furthermore, we demonstrate the on-chip generation of entangled high-dimensional (quDit) states, where the photons are created in a coherent superposition of multiple pure frequency modes. Specifically, we confirm the realization of a quantum system with at least one hundred dimensions. Moreover, using off-the-shelf telecommunications components, we introduce a platform for the coherent manipulation and control of frequencyentangled quDit states. Our results suggest that microcavity-based entangled photon state generation and the coherent control of states using accessible telecommunications infrastructure introduce a powerful and scalable platform for quantum information science.

Classical distributive justice and the European healthcare system: rethinking the foundations of European health care in an age of crises.

PubMed

Bauzon, Stéphane

2015-04-01

The state subvention and distribution of health care not only jeopardize the financial sustainability of the state, but also restrict without a conclusive rational basis the freedom of patients to decide how much health care and of what quality is worth what price. The dominant biopolitics of European health care supports a healthcare monopoly in the hands of the state and the medical profession, which health care should be (re)opened to the patient's authority to deal directly for better basic health care. In a world where it is impossible for all to receive equal access to the best of basic health care, one must critically examine the plausible scope of the authority of the state to limit access to better basic health care. Classical distributive justice affords a basis for re-examining the current European ideology of equality, human dignity, and solidarity that supports healthcare systems with unsustainable egalitarian concerns. © The Author 2015. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Sci-Hub provides access to nearly all scholarly literature.

PubMed

Himmelstein, Daniel S; Romero, Ariel Rodriguez; Levernier, Jacob G; Munro, Thomas Anthony; McLaughlin, Stephen Reid; Greshake Tzovaras, Bastian; Greene, Casey S

2018-03-01

The website Sci-Hub enables users to download PDF versions of scholarly articles, including many articles that are paywalled at their journal's site. Sci-Hub has grown rapidly since its creation in 2011, but the extent of its coverage has been unclear. Here we report that, as of March 2017, Sci-Hub's database contains 68.9% of the 81.6 million scholarly articles registered with Crossref and 85.1% of articles published in toll access journals. We find that coverage varies by discipline and publisher, and that Sci-Hub preferentially covers popular, paywalled content. For toll access articles, we find that Sci-Hub provides greater coverage than the University of Pennsylvania, a major research university in the United States. Green open access to toll access articles via licit services, on the other hand, remains quite limited. Our interactive browser at https://greenelab.github.io/scihub allows users to explore these findings in more detail. For the first time, nearly all scholarly literature is available gratis to anyone with an Internet connection, suggesting the toll access business model may become unsustainable. © 2018, Himmelstein et al.

Uninsured Migrants: Health Insurance Coverage and Access to Care Among Mexican Return Migrants.

PubMed

Wassink, Joshua

2018-01-01

Despite an expansive body of research on health and access to medical care among Mexican immigrants in the United States, research on return migrants focuses primarily on their labor market mobility and contributions to local development. Motivated by recent scholarship that documents poor mental and physical health among Mexican return migrants, this study investigates return migrants' health insurance coverage and access to medical care. I use descriptive and multivariate techniques to analyze data from the 2009 and 2014 rounds of Mexico's National Survey of Demographic Dynamics (ENADID, combined n=632,678). Analyses reveal a large and persistent gap between recent return migrants and non-migrants, despite rising overall health coverage in Mexico. Multivariate analyses suggest that unemployment among recent arrivals contributes to their lack of insurance. Relative to non-migrants, recently returned migrants rely disproportionately on private clinics, pharmacies, self-medication, or have no regular source of care. Mediation analysis suggests that returnees' high rate of uninsurance contributes to their inadequate access to care. This study reveals limited access to medical care among the growing population of Mexican return migrants, highlighting the need for targeted policies to facilitate successful reintegration and ensure access to vital resources such as health care.

The Picture Plus Discussion Intervention: Text Access for High School Students with Moderate Intellectual Disability

ERIC Educational Resources Information Center

Shurr, Jordan; Taber-Doughty, Teresa

2017-01-01

Students with moderate intellectual disability often experience limited access to age-appropriate texts due to limitations in reading skills, access to instruction and supports, and educator beliefs. Use of text read alouds is an emerging tool for increasing such access; however, supports are often still required for access to age-appropriate…

New views on global child health: global solutions for care of vulnerable children in the United States.

PubMed

Uwemedimo, Omolara T; Arora, Gitanjli; Russ, Christiana M

2016-10-01

This paper provides a brief overview of the current landscape of global child health and the impact of social determinants on the world's children. In the United States (US), global child health (GCH) has increasingly been highlighted as a priority area by national organizations, such as the National Academy of Medicine and American Academy of Pediatrics, as well as individual pediatricians committed to ensuring the health of all children regardless of geographic location. Although GCH is commonly used to refer to the health of children outside of the US, here, we highlight the recent call for GCH to also include care of US vulnerable children. Many of the lessons learned from abroad can be applied to pediatrics domestically by addressing social determinants that contribute to health disparities. Using the 'three-delay' framework, effective global health interventions target delays in seeking, accessing, and/or receiving adequate care. In resource-limited, international settings, novel health system strengthening approaches, such as peer groups, community health workers, health vouchers, cultural humility training, and provision of family-centered care, can mitigate barriers to healthcare and improve access to medical services. The creative use of limited resources for pediatric care internationally may offer insight into effective strategies to address health challenges that children face here in the US. The growing number of child health providers with clinical experience in resource-limited, low-income countries can serve as an unforeseen yet formidable resource for improving pediatric care in underserved US communities.

Behavioral health benefits for public employees: effect of mental health parity legislation.

PubMed

Borzi, P C; Rosenbaum, S

2001-04-01

With the passage of the Mental Health Parity Act of 1996 (MHPA), Congress took an important first step toward equalizing treatment under medical plans between physical and mental illnesses by requiring parity in annual and lifetime dollar limits between physical and mental illness. But the Act was limited in scope: it did not mandate mental health benefits nor prohibit other common types of differentials between physical and mental illnesses, such as higher cost-sharing or lower limits on outpatient visits or inpatient treatments. Before Congress' action in 1996, a few of the states had adopted some type of parity requirement. Since 1996, state parity activity has accelerated.Recently, the Center for Health Services Research and Policy through a grant from the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services, examined contracts providing for mental health benefits for state employees in eight states to assess whether legislative attempts to require parity between physical and mental illnesses resulted in noticeable differences in behavioral health benefits for state employees. We concluded that, except in states that have mandated full parity for some or all types of mental illnesses, behavioral health benefits for state employees have not changed significantly as a result of the state parity laws, since they still remain subject to traditional restrictions, such as higher cost-sharing and greater limitations on outpatient visits and inpatient treatment days, than those imposed on physical illnesses. Thus the considerable state activity surrounding mental health parity may have little effect on state employees' access to mental health services, since although state laws required parity in dollar limitations, they generally permitted the continuation of other plan design features that are more restrictive for mental health coverage. However, many of the contracts we examined were multi-year contract and may not have fully reflected recent state activity. Moreover, if Congress renews the Mental Health Parity Act when it expires in September, 2001, and expands the scope of the Act to cover some of these other plan design features, states with more limited parity laws are likely to follow. In that case, perhaps state employees with mental illnesses may see significant change in the future.

47 CFR 54.601 - Eligibility.

Code of Federal Regulations, 2011 CFR

2011-10-01

...). (2) Internet access and limited toll-free access to internet. (i) For purposes of this subpart, eligible Internet access is an information service that enables rural health care providers to post their...) Internet access shall be eligible for universal service support under § 54.621(a). (iii) Limited toll-free...

50 CFR 622.201 - South Atlantic rock shrimp limited access.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false South Atlantic rock shrimp limited access... SOUTH ATLANTIC Shrimp Fishery of the South Atlantic Region § 622.201 South Atlantic rock shrimp limited access. (a) Commercial Vessel Permits for Rock Shrimp (South Atlantic EEZ). For a person aboard a vessel...

50 CFR 622.201 - South Atlantic rock shrimp limited access.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false South Atlantic rock shrimp limited access... SOUTH ATLANTIC Shrimp Fishery of the South Atlantic Region § 622.201 South Atlantic rock shrimp limited access. (a) Commercial Vessel Permits for Rock Shrimp (South Atlantic EEZ). For a person aboard a vessel...

28 CFR 16.82 - Exemption of the National Drug Intelligence Center Data Base-limited access.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Intelligence Center Data Base-limited access. 16.82 Section 16.82 Judicial Administration DEPARTMENT OF JUSTICE....82 Exemption of the National Drug Intelligence Center Data Base—limited access. (a) The following... Intelligence Center Data Base (JUSTICE/NDIC-001). (2) [Reserved] (b) These exemptions apply only to the extent...

28 CFR 16.82 - Exemption of the National Drug Intelligence Center Data Base-limited access.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Intelligence Center Data Base-limited access. 16.82 Section 16.82 Judicial Administration DEPARTMENT OF JUSTICE....82 Exemption of the National Drug Intelligence Center Data Base—limited access. (a) The following... Intelligence Center Data Base (JUSTICE/NDIC-001). (2) [Reserved] (b) These exemptions apply only to the extent...

28 CFR 16.82 - Exemption of the National Drug Intelligence Center Data Base-limited access.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Intelligence Center Data Base-limited access. 16.82 Section 16.82 Judicial Administration DEPARTMENT OF JUSTICE....82 Exemption of the National Drug Intelligence Center Data Base—limited access. (a) The following... Intelligence Center Data Base (JUSTICE/NDIC-001). (2) [Reserved] (b) These exemptions apply only to the extent...

28 CFR 16.82 - Exemption of the National Drug Intelligence Center Data Base-limited access.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Intelligence Center Data Base-limited access. 16.82 Section 16.82 Judicial Administration DEPARTMENT OF JUSTICE....82 Exemption of the National Drug Intelligence Center Data Base—limited access. (a) The following... Intelligence Center Data Base (JUSTICE/NDIC-001). (2) [Reserved] (b) These exemptions apply only to the extent...

28 CFR 16.82 - Exemption of the National Drug Intelligence Center Data Base-limited access.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Intelligence Center Data Base-limited access. 16.82 Section 16.82 Judicial Administration DEPARTMENT OF JUSTICE....82 Exemption of the National Drug Intelligence Center Data Base—limited access. (a) The following... Intelligence Center Data Base (JUSTICE/NDIC-001). (2) [Reserved] (b) These exemptions apply only to the extent...

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

Welfare reform and elderly immigrants' health insurance coverage: the roles of federal and state medicaid eligibility rules.

PubMed

Nam, Yunju

2011-11-01

Immigrants' access to federally-funded Medicaid became limited after welfare reform imposed restrictive noncitizen eligibility rules. This study used a representative sample from the Current Population Survey (N = 105,873) and state-level data to examine the effects of these policy changes on elderly immigrants. Triple difference-in-differences analyses show that federal restriction of eligibility had a significantly negative association with elderly immigrants' Medicaid coverage, and generous state eligibility had significantly positive relationships with Medicaid and any health insurance coverage. Findings indicate the important role of eligibility on elderly immigrants' health insurance coverage. Results call for social workers' actions to expand elderly immigrants' Medicaid eligibility.

Nationalism: The Media, State, and Public in the Senkaku/Diaoyu Dispute

DTIC Science & Technology

2015-03-01

censorship and resigned in protest. As a result of kisha kurabu, similar coverage, and scandals after the Fukushima nuclear disaster , the Japanese...limited benefits.71 During the media visits to the Fukushima nuclear power plant in 2012, the Japanese government banned foreign journalists during...criticizes the government’s preferential treatment of the kisha kurabu and restricted access for foreign and freelance journalists after the Fukushima

Availability of Drinking Water in California Public Schools. Testimony Presented before the California State Assembly Subcommittee on Education on April 2, 2008

ERIC Educational Resources Information Center

Schuster, Mark A.

2008-01-01

A senior researcher and hospital Chief of General Pediatrics, testifies about his work with a California school district to prevent obesity by developing a middle school program to promote healthy eating and physical activity. A two-year study has found that students have limited access to drinking water, especially at meals. In the schools being…

Stories from the Front Lines of Student Success: The Implementation and Progress of Near Peer Mentoring Programs in Alaska and Idaho. Western Policy Exchanges

ERIC Educational Resources Information Center

Krueger, Carl

2016-01-01

This brief provides an overview of the implementation and impact of near peer mentoring programs in Alaska and Idaho from the standpoint of both existing research and the near peers themselves. While progress is being monitored as part of state College Access Challenge Grant (CACG) program implementation and activity, only limited data on the…

Disparities in Rates of Inpatient Mortality and Adverse Events: Race/Ethnicity and Language as Independent Contributors

PubMed Central

Hines, Anika L.; Andrews, Roxanne M.; Moy, Ernest; Barrett, Marguerite L.; Coffey, Rosanna M.

2014-01-01

Patients with limited English proficiency have known limitations accessing health care, but differences in hospital outcomes once access is obtained are unknown. We investigate inpatient mortality rates and obstetric trauma for self-reported speakers of English, Spanish, and languages of Asia and the Pacific Islands (API) and compare quality of care by language with patterns by race/ethnicity. Data were from the United States Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, 2009 State Inpatient Databases for California. There were 3,757,218 records. Speaking a non-English principal language and having a non-White race/ethnicity did not place patients at higher risk for inpatient mortality; the exception was significantly higher stroke mortality for Japanese-speaking patients. Patients who spoke API languages or had API race/ethnicity had higher risk for obstetric trauma than English-speaking White patients. Spanish-speaking Hispanic patients had more obstetric trauma than English-speaking Hispanic patients. The influence of language on obstetric trauma and the potential effects of interpretation services on inpatient care are discussed. The broader context of policy implications for collection and reporting of language data is also presented. Results from other countries with and without English as a primary language are needed for the broadest interpretation and generalization of outcomes. PMID:25514153

Public Health Practice Report: water supply and sanitation in Chukotka and Yakutia, Russian Arctic.

PubMed

Dudarev, Alexey A

2018-12-01

Information from 2013-2015 have been analysed on water accessibility, types of water service to households, use of water pretreatment, availability of sewerage, use of sewage treatment in Chukotka Autonomous Okrug and Yakutia Republic, based on evaluation information accessible in open sources, such as regional statistics and sanitary-epidemiologic reports. The main causes of the poor state of water supply and sanitation in the study regions include: very limited access to in-home running water (one-quarter of settlements in Chukotka and half of settlements in Yakutia have no regular water supply) and lack of centralised sewerage (78% and 94% of settlements correspondingly have no sewerage); lack of water pretreatment and sewage treatment, outdated technologies and systems; serious deterioration of facilities and networks, frequent accidents; secondary pollution of drinking water. Lack of open objective information on Russian Arctic water supply and sanitation in the materials of the regional and federal statistics hampers the assessment of the real state of affairs. The situation for water and sanitation supply in these Russian Arctic regions remains steadily unfavourable. A comprehensive intervention from national and regional governmental levels is urgently needed.

Public Health Practice Report: water supply and sanitation in Chukotka and Yakutia, Russian Arctic

PubMed Central

Dudarev, Alexey A.

2018-01-01

ABSTRACT Information from 2013–2015 have been analysed on water accessibility, types of water service to households, use of water pretreatment, availability of sewerage, use of sewage treatment in Chukotka Autonomous Okrug and Yakutia Republic, based on evaluation information accessible in open sources, such as regional statistics and sanitary-epidemiologic reports. The main causes of the poor state of water supply and sanitation in the study regions include: very limited access to in-home running water (one-quarter of settlements in Chukotka and half of settlements in Yakutia have no regular water supply) and lack of centralised sewerage (78% and 94% of settlements correspondingly have no sewerage); lack of water pretreatment and sewage treatment, outdated technologies and systems; serious deterioration of facilities and networks, frequent accidents; secondary pollution of drinking water. Lack of open objective information on Russian Arctic water supply and sanitation in the materials of the regional and federal statistics hampers the assessment of the real state of affairs. The situation for water and sanitation supply in these Russian Arctic regions remains steadily unfavourable. A comprehensive intervention from national and regional governmental levels is urgently needed. PMID:29384013

Community-based exercise for chronic disease management: an Italian design for the United States?

PubMed

Weinrich, Michael; Stuart, Mary; Benvenuti, Francesco

2014-10-01

Although only a small proportion of older adults in the United States engage in recommended amounts of physical exercise, the health benefits of exercise for this population and the potential for lowering health care costs are substantial. However, access to regular exercise programs for the frail elderly and individuals with disabilities remains limited. In the context of health reform and emerging opportunities in developing integrated systems of care, the experience in Tuscany in implementing a community-based program of exercise for the elderly should be of interest. © The Author(s) 2014.

Protonation-dependent conformational dynamics of the multidrug transporter EmrE

PubMed Central

Dastvan, Reza; Mishra, Smriti; Meiler, Jens; Mchaourab, Hassane S.

2016-01-01

The small multidrug transporter from Escherichia coli, EmrE, couples the energetically uphill extrusion of hydrophobic cations out of the cell to the transport of two protons down their electrochemical gradient. Although principal mechanistic elements of proton/substrate antiport have been described, the structural record is limited to the conformation of the substrate-bound state, which has been shown to undergo isoenergetic alternating access. A central but missing link in the structure/mechanism relationship is a description of the proton-bound state, which is an obligatory intermediate in the transport cycle. Here we report a systematic spin labeling and double electron electron resonance (DEER) study that uncovers the conformational changes of EmrE subsequent to protonation of critical acidic residues in the context of a global description of ligand-induced structural rearrangements. We find that protonation of E14 leads to extensive rotation and tilt of transmembrane helices 1–3 in conjunction with repacking of loops, conformational changes that alter the coordination of the bound substrate and modulate its access to the binding site from the lipid bilayer. The transport model that emerges from our data posits a proton-bound, but occluded, resting state. Substrate binding from the inner leaflet of the bilayer releases the protons and triggers alternating access between inward- and outward-facing conformations of the substrate-loaded transporter, thus enabling antiport without dissipation of the proton gradient. PMID:26787875

50 CFR 648.15 - Facilitation of enforcement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ocean quahog open access permitted vessels. Vessel owners or operators issued an open access surfclam or ocean quahog open access permit for fishing in the ITQ Program, as specified at § 648.70, are required... limited access permitted vessels. Beginning January 1, 2009, vessel owners or operators issued a limited...

Estimating debt capacity of New York State Health facilities.

PubMed

Hogan, A J

1985-01-01

A measure of the capacity to take on new debt is developed for health facilities. This measure is a function of the current financial position of the facility, future financial market conditions (interest rates and bond/loan maturities), and a policy variable (the debt service coverage ratio) to be set by state health policy makers. The quality of this measure was shown to depend on the quality of current health facility financial accounting data, on the quality of forecasts of interest rates and future cashflow, and on the appropriateness of the criterion debt service coverage ratio. Some of the limitations of the estimate are discussed. Consideration of the debt capacity estimate serves to highlight some crucial issues in imposing capital expenditure limits, namely the interrelationships between financial viability, interest rates and access to capital markets.

Entropy from State Probabilities: Hydration Entropy of Cations

PubMed Central

2013-01-01

Entropy is an important energetic quantity determining the progression of chemical processes. We propose a new approach to obtain hydration entropy directly from probability density functions in state space. We demonstrate the validity of our approach for a series of cations in aqueous solution. Extensive validation of simulation results was performed. Our approach does not make prior assumptions about the shape of the potential energy landscape and is capable of calculating accurate hydration entropy values. Sampling times in the low nanosecond range are sufficient for the investigated ionic systems. Although the presented strategy is at the moment limited to systems for which a scalar order parameter can be derived, this is not a principal limitation of the method. The strategy presented is applicable to any chemical system where sufficient sampling of conformational space is accessible, for example, by computer simulations. PMID:23651109

Economic insecurity and access to the social safety net among Latino farmworker families.

PubMed

Padilla, Yolanda C; Scott, Jennifer L; Lopez, Olivia

2014-04-01

Farmworkers experience pervasive economic insecurity in part because of the seasonal nature of agricultural work and limited employment protections. Yet little is known about the adequacy of the social safety net in responding to farmworker needs. Using data from the 2005-2009 National Agricultural Workers Survey (N = 10,469), the current study analyzed predictors of social welfare participation among Latinos, who represent approximately 80 percent of all farmworkers. Nearly 95 percent are immigrants, although almost half of them have lived in the United States for more than 10 years. Descriptive analyses showed that, even among farmworker households whose income fell below the poverty line or that were headed by legally documented individuals, social services use was very low. Logistic regression analyses revealed that degree of social integration influenced social welfare participation, controlling for education, poverty status, family composition, and employment characteristics. Latino farmworkers who were recent immigrants (that is, in the United States for less than five years) had significantly lower odds of access to social insurance and public assistance programs relative to their U.S.-born counterparts. Low self-reported English ability significantly decreased access to most social insurance programs but not public assistance receipt. The findings indicate the need for social workers to engage in outreach efforts and policy advocacy to improve farmworkers access to social welfare.

"Take the Volume Pledge" may result in disparity in access to care.

PubMed

Blanco, Barbara A; Kothari, Anai N; Blackwell, Robert H; Brownlee, Sarah A; Yau, Ryan M; Attisha, John P; Ezure, Yoshiki; Pappas, Sam; Kuo, Paul C; Abood, Gerard J

2017-03-01

"Take the Volume Pledge" proposes restricting pancreatectomies to hospitals that perform ≥20 per year. Our purpose was to identify those factors that characterize patients at risk for loss of access to pancreatic cancer care with enforcement of volume standards. Using the Healthcare Cost and Utilization Project State Inpatient Database from Florida, we identified patients who underwent pancreatectomy for pancreatic malignancy from 2007-2011. American Hospital Association and United States Census Bureau data were linked to patient-level data. High-volume hospitals were defined as performing ≥20 pancreatic resections per year. Univariable and multivariable statistics compared patient characteristics and utilization of high-volume hospitals. Classification and Regression Tree modeling was used to predict patients at risk for losing access to care. Our study included 1,663 patients. Five high-volume hospitals were identified, and they treated 1,056 (63.5%) patients. Patients residing far from high-volume hospitals, in areas with the highest population density, non-Caucasian ethnicity, and greater income had decreased odds of obtaining care at high-volume hospitals. Using these factors, we developed a Classification and Regression Tree-based predictive tool to identify these patients. Implementation of "Take the Volume Pledge" is an important step toward improving pancreatectomy outcomes; however, policymakers must consider the potential impact on limiting access and possible health disparities that may arise. Copyright © 2016 Elsevier Inc. All rights reserved.

Beyond Roe, after Casey: the present and future of a "fundamental" right.

PubMed

Benshoof, J

1993-01-01

Although the US Supreme Court recently reaffirmed a woman's right to end a pregnancy before viability, many women remain unable to exercise that right because their access to abortion is limited. 83% of the counties in the nation have no abortion providers, and many women must travel hundreds of miles to obtain an abortion. In its Planned Parenthood of Southeastern Pennsylvania vs. Casey decision, the Supreme Court upheld what it felt were the central tenets of Roe vs. Wade but appointed an "undue burden" standard instead of a "strict scrutiny" standard for the courts to use when determining whether or not a state restriction is to be allowed. This means that women must prove "undue" harm from a restriction. 2 other new concepts contained in Casey are that the state has an interest in fetal life throughout a pregnancy and that the government does not have to remain neutral in an abortion case even if it did not involve the issue of funding. This means that states can try to discourage a woman's choice to have an abortion. Since Casey, the Supreme Court has refused to review several abortion cases and federal courts have taken action allowing abortion restrictions to go into effect in Pennsylvania, Utah, South Dakota, North Dakota, and Mississippi. State courts in Ohio, Oklahoma, Tennessee, Alaska, New York, and West Virginia have also heard abortion restriction cases in the past year. These restrictions involved a waiting period, criminalization, a residency requirement, a community hospital's ban on abortions, and state funding for abortion. Following the Casey decision, efforts were made to codify Roe by reintroducing the Freedom of Choice Act in Congress. During the committee process, however, the bill was amended in such a way as to make pro-choice advocates doubt that the amended version will be able to accomplish the aims of the original Act. Because the High Court ruled in Bray vs. Alexandria Women's Health Clinic that the ability of abortion clinics to prevent antichoice blockades is limited since the blockades do not violate civil rights laws, Congress is advancing a measure called "The Freedom of Access to Clinic Entrances Act" to counteract the harassment which occurs outside of the clinics. State legislatures have taken action to impose mandatory delays and biased counseling on abortion-seekers, restrict the access of young women to abortion, prohibit Medicaid funding for abortion, require unnecessary reporting regulations on the part of abortion services, and institute protective measures for reproductive rights. Although the right acknowledged in the Roe vs. Wade decision continues to exist, the struggle for women's reproductive autonomy must go forward to assure constitutional protection for the right to choose and guaranteed access to that right for all women.

Effects of expanded and standard captions on deaf college students' comprehension of educational videos.

PubMed

Stinson, Michael S; Stevenson, Susan

2013-01-01

Twenty-two college students who were deaf viewed one instructional video with standard captions and a second with expanded captions, in which key terms were expanded in the form of vocabulary definitions, labeled illustrations, or concept maps. The students performed better on a posttest after viewing either type of caption than on a pretest; however, there was no difference in comprehension between standard and expanded captions. Camtasia recording software enabled examination of the extent to which the students accessed the expanded captions. The students accessed less than 20% of the available expanded captions. Thus, one explanation for the lack of difference in comprehension between the standard and expanded captions is that the students did not access the expanded captions sufficiently. Despite limited use of the expanded captions, the students stated, when interviewed, that they considered these captions beneficial in learning from the instructional video.

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 depend highly on local and regional care coordination across political boundaries.

28 CFR 16.83 - Exemption of the Executive Office for Immigration Review System-limited access.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Immigration Review System-limited access. 16.83 Section 16.83 Judicial Administration DEPARTMENT OF JUSTICE....83 Exemption of the Executive Office for Immigration Review System—limited access. (a) The following system of records is exempt from 5 U.S.C. 552a(d): (1) The Executive Office for Immigration Review's...

76 FR 19708 - Pacific Halibut Fisheries; Limited Access for Guided Sport Charter Vessels in Alaska

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-08

.... 110325225-1224-02] RIN 0648-BA96 Pacific Halibut Fisheries; Limited Access for Guided Sport Charter Vessels... regulations that apply to vessels operating in the guided sport (charter) fishery for halibut in International... charter vessels in the guided sport fishery, codified at 50 CFR 300.67. Charter Halibut Limited Access...

Access to care issues adversely affect breast cancer patients in Mexico: oncologists' perspective.

PubMed

Chavarri-Guerra, Yanin; St Louis, Jessica; Liedke, Pedro E R; Symecko, Heather; Villarreal-Garza, Cynthia; Mohar, Alejandro; Finkelstein, Dianne M; Goss, Paul E

2014-09-09

Despite recently implemented access to care programs, Mexican breast cancer (BC) mortality rates remain substantially above those in the US. We conducted a survey among Mexican Oncologists to determine whether practice patterns may be responsible for these differences. A web-based survey was sent to 851 oncologists across Mexico using the Vanderbilt University REDCap database. Analyses of outcomes are reported using exact and binomial confidence bounds and tests. 138 participants (18.6% of those surveyed) from the National capital and 26 Mexican states, responded. Respondents reported that 58% of newly diagnosed BC patients present with stage III-IV disease; 63% undergo mastectomy, 52% axillary lymph node dissection (ALND) and 48% sentinel lymph node biopsy (SLNB). Chemotherapy is recommended for tumors > 1 cm (89%), positive nodes (86.5%), triple-negative (TN) (80%) and HER2 positive tumors (58%). Trastuzumab is prescribed in 54.3% and 77.5% for HER2 < 1 cm and > 1 cm tumors, respectively. Tamoxifen is indicated for premenopausal hormone receptor (HR) positive tumors in 86.5% of cases and aromatase inhibitors (AI's) for postmenopausal in 86%. 24% of physicians reported treatment limitations, due to delayed or incomplete pathology reports and delayed or limited access to medications. Even though access to care programs have been recently applied nationwide, women commonly present with advanced BC, leading to increased rates of mastectomy and ALND. Mexican physicians are dissatisfied with access to appropriate medical care. Our survey detects specific barriers that may impact BC outcomes in Mexico and warrant further investigation.

A novel approach for detection of anomalies using measurement data of the Ironton-Russell bridge

NASA Astrophysics Data System (ADS)

Zhang, Fan; Norouzi, Mehdi; Hunt, Victor; Helmicki, Arthur

2015-04-01

Data models have been increasingly used in recent years for documenting normal behavior of structures and hence detect and classify anomalies. Large numbers of machine learning algorithms were proposed by various researchers to model operational and functional changes in structures; however, a limited number of studies were applied to actual measurement data due to limited access to the long term measurement data of structures and lack of access to the damaged states of structures. By monitoring the structure during construction and reviewing the effect of construction events on the measurement data, this study introduces a new approach to detect and eventually classify anomalies during construction and after construction. First, the implementation procedure of the sensory network that develops while the bridge is being built and its current status will be detailed. Second, the proposed anomaly detection algorithm will be applied on the collected data and finally, detected anomalies will be validated against the archived construction events.

A proposed Applications Information System - Concept, implementation, and growth

NASA Technical Reports Server (NTRS)

Mcconnell, Dudley G.; Hood, Carroll A.; Butera, M. Kristine

1987-01-01

This paper describes a newly developed concept within NASA for an Applications Information System (AIS). The AIS would provide the opportunity to the public and private sectors of shared participation in a remote sensing research program directed to a particular set of land-use or environmental problems. Towards this end, the AIS would offer the technological framework and information system resources to overcome many of the deficiencies that end-users have faced over the years such as limited access to data, delay in data delivery, and a limited access to data reduction algorithms and models to convert data to geophysical measurements. In addition, the AIS will take advantage of NASA developments in networking among information systems and use of state of the art technology, such as CD Roms and optical disks for the purpose of increasing the scientific benefits of applied environmental research. The rationale for the establishment of an AIS, a methodology for a step-wise, modular implementation, and the relationship of the AIS to other NASA information systems are discussed.

Caring for Refugee Youth in the School Setting.

PubMed

Johnson, Jennifer Leigh; Beard, Joyce; Evans, Dena

2017-03-01

Annually, over 80,000 refugees enter the United States as a result of political or religious persecution. Of these, approximately 35% to 40% are children and adolescents. Refugees are faced with challenges associated with living conditions, cultural and social norms, and socioeconomic status due to problems occurring in their homelands. These challenges include but are not limited to malnutrition, communicable disease, questionable immunization status, lack of formal education, sexual abuse, violence, torture, human trafficking, homelessness, poverty, and a lack of access to health care. Moreover, the psychological impact of relocation and the stress of acculturation may perpetuate many of these existing challenges, particularly for refugee youth, with limited or underdeveloped coping skills. School nurses are uniquely poised to support refugee youth in the transition process, improve overall health, and facilitate access to primary health services. The purpose of this article is to provide an overview of the unique refugee experience, examine the key health care needs of the population, and present school nurses with timely and relevant resources to assist in caring for refugee youth.

Composite and shaped pulses for efficient and robust pumping of disconnected eigenstates in magnetic resonance

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

Theis, T.; Feng, Y.; Wu, T.

2014-01-07

Hyperpolarization methods, which can enhance nuclear spin signals by orders of magnitude, open up important new opportunities in magnetic resonance. However, many of these applications are limited by spin lattice relaxation, which typically destroys the hyperpolarization in seconds. Significant lifetime enhancements have been found with “disconnected eigenstates” such as the singlet state between a pair of nearly equivalent spins, or the “singlet-singlet” state involving two pairs of chemically equivalent spins; the challenge is to populate these states (for example, from thermal equilibrium magnetization or hyperpolarization) and to later recall the population into observable signal. Existing methods for populating these statesmore » are limited by either excess energy dissipation or high sensitivity to inhomogeneities. Here we overcome the limitations by extending recent work using continuous-wave irradiation to include composite and adiabatic pulse excitations. Traditional composite and adiabatic pulses fail completely in this problem because the interactions driving the transitions are fundamentally different, but the new shapes we introduce can move population between accessible and disconnected eigenstates over a wide range of radio-frequency (RF) amplitudes and offsets while depositing insignificant amounts of power.« less

Do restrictive omnibus immigration laws reduce enrollment in public health insurance by Latino citizen children? A comparative interrupted time series study.

PubMed

Allen, Chenoa D; McNeely, Clea A

2017-10-01

In the United States, there is concern that recent state laws restricting undocumented immigrants' rights could threaten access to Medicaid and the Children's Health Insurance Program (CHIP) for citizen children of immigrant parents. Of particular concern are omnibus immigration laws, state laws that include multiple provisions increasing immigration enforcement and restricting rights for undocumented immigrants. These laws could limit Medicaid/CHIP access for citizen children in immigrant families by creating misinformation about their eligibility and fostering fear and mistrust of government among immigrant parents. This study uses nationally-representative data from the National Health Interview Survey (2005-2014; n = 70,187) and comparative interrupted time series methods to assess whether passage of state omnibus immigration laws reduced access to Medicaid/CHIP for US citizen Latino children. We found that law passage did not reduce enrollment for children with noncitizen parents and actually resulted in temporary increases in coverage among Latino children with at least one citizen parent. These findings are surprising in light of prior research. We offer potential explanations for this finding and conclude with a call for future research to be expanded in three ways: 1) examine whether policy effects vary for children of undocumented parents, compared to children whose noncitizen parents are legally present; 2) examine the joint effects of immigration-related policies at different levels, from the city or county to the state to the federal; and 3) draw on the large social movements and political mobilization literature that describes when and how Latinos and immigrants push back against restrictive immigration laws. Copyright © 2017 Elsevier Ltd. All rights reserved.

Regulation and federalism: legal impediments to state health care reform.

PubMed

Parmet, W E

1993-01-01

In recent years, many states have attempted to address the cost and access problems that face their health care systems. Such efforts, however, are significantly impeded by a variety of federalism doctrines that limit the ability of states to regulate the health care market. This Article surveys some of those federalism barriers, including the constitutional restraints imposed by the Commerce Clause, the Privileges and Immunities Clause, and the Fourteenth Amendment, and the statutory hurdles created by ERISA, the Social Security Act, and the Americans with Disabilities Act of 1990. This Article concludes that the restraints that these doctrines and statutes place on states reflect not only federalism concerns, but also deeper ambivalence about governmental regulation of the health care market. Only when that ambivalence is resolved can a proper division of labor between the states and federal government be determined.

Accessible Information for Equally-Distant Partially-Entangled Alphabet State Resource

NASA Astrophysics Data System (ADS)

Hao, San-Ru; Hou, Bo-Yu; Xi, Xiao-Qiang; Yue, Rui-Hong

2002-02-01

We have proposed a quantum system with equally-distant partially-entangled alphabet states which has the minimal mutual overlap and the highly distinguishability, these quantum states are used as the "signal states" of the quantum communication. We have also constructed the positive operator-valued measure for these "signal states" and discussed their entanglement properties and measurement of entanglement. We calculate the accessible information for these alphabet states and show that the accessible information is closely related to the entanglement of the "signal states": the higher the entanglement of the "signal states", the better the accessible information of the quantum system, and the accessible information reaches its maximal value when the alphabet states have their maximal entanglement. The project supported in part by Foundation of the Science and Technology Committee of China, and Foundation of the Science and Technology Committee of Hunan Province of China under the contract FSTCH-21000205

75 FR 38758 - Pacific Halibut Fisheries; Limited Access for Guided Sport Charter Vessels in Alaska

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-06

.... 100503209-0215-01] RIN 0648-AY85 Pacific Halibut Fisheries; Limited Access for Guided Sport Charter Vessels... that would amend the limited access program for charter vessels in the guided sport fishery for Pacific... 13024). IPHC regulations affecting sport fishing for halibut and charter vessels in IPHC Areas 2C and 3A...

Assessing the effectiveness of minimum legal drinking age and zero tolerance laws in the United States.

PubMed

Voas, Robert B; Tippetts, A Scott; Fell, James C

2003-07-01

The objective of this research was to determine the extent to which the decline in alcohol-related highway deaths among drivers younger than age 21 years can be attributed to raising the minimum legal drinking age (MLDA) and establishing zero tolerance (0.02% blood alcohol concentration (BAC) limit for drivers younger than age 21 years) laws. Data on all drivers younger than age 21 years involved in fatalities in the United States from 1982 to 1997 were used in the study. Quarterly ratios of BAC-positive to BAC-negative drivers in each of the 50 states where analyzed in a pooled cross-sectional time-series analysis. After accounting for differences among the 50 states in various background factors, changes in economic and demographic factors within states over time, and the effects of other related laws, results indicated substantial reductions in alcohol-positive involvement in fatal crashes were associated with the two youth-specific laws. The policy of limiting youth access to alcohol through MLDA laws and reinforcing this action by making it illegal for underage drivers to have any alcohol in their system appears to have been effective in reducing the proportion of fatal crashes involving drinking drivers.

Open Access Journal Policies: A Systematic Analysis of Radiology Journals.

PubMed

Narayan, Anand; Lobner, Katie; Fritz, Jan

2018-02-01

The open access movement has pushed for greater access to scientific knowledge by expanding access to scientific journal articles. There is limited information about the extent to which open access policies have been adopted by radiology journals. We performed a systematic analysis to ascertain the proportion of radiology journals with open access options. A search was performed with the assistance of a clinical informationist. Full and mixed English-language diagnostic and interventional radiology Web of Science journals (impact factors > 1.0) were included. Nuclear medicine, radiation oncology, physics, and solicitation-only journals were excluded. Primary outcome was open access option (yes or no) with additional outcomes including presence or absence of embargo, complete or partial copyright transfer, publication fees, and self-archiving policies. Secondary outcomes included journal citations, journal impact factors, immediacy, Eigenfactor, and article influence scores. Independent double readings were performed with differences resolved by consensus, supplemented by contacting editorial staff at each journal. In all, 125 journals were identified; review yielded 49 journals (39%, mean impact factor of 2.61). Thirty-six of the journals had open access options (73.4%), and four journals were exclusively open access (8.2%). Twelve-month embargoes were most commonly cited (90.6%) with 28.6% of journals stating that they did not require a complete transfer of copyright. Prices for open access options ranged from $750 to $4,000 (median $3,000). No statistically significant differences were found in journal impact measures comparing journals with open access options to journals without open access options. Diagnostic and interventional radiology journals have widely adopted open access options with a few radiology journals being exclusively open access. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

NADA Protocol for Behavioral Health. Putting Tools in the Hands of Behavioral Health Providers: The Case for Auricular Detoxification Specialists.

PubMed

Stuyt, Elizabeth B; Voyles, Claudia A; Bursac, Sara

2018-02-07

Background: The National Acupuncture Detoxification Association (NADA) protocol, a simple standardized auricular treatment has the potential to provide vast public health relief on issues currently challenging our world. This includes but is not limited to addiction, such as the opioid epidemic, but also encompasses mental health, trauma, PTSD, chronic stress, and the symptoms associated with these conditions. Simple accessible tools that improve outcomes can make profound differences. We assert that the NADA protocol can have greatest impact when broadly applied by behavioral health professionals, Auricular Detoxification Specialists (ADSes). Methods: The concept of ADS is described and how current laws vary from state to state. Using available national data, a survey of practitioners in three selected states with vastly different laws regarding ADSes, and interviews of publicly funded programs which are successfully incorporating the NADA protocol, we consider possible effects of ADS-friendly conditions. Results: Data presented supports the idea that conditions conducive to ADS practice lead to greater implementation. Program interviews reflect settings in which adding ADSes can in turn lead to improved outcomes. Discussion: The primary purpose of non-acupuncturist ADSes is to expand the access of this simple but effective treatment to all who are suffering from addictions, stress, or trauma and to allow programs to incorporate acupuncture in the form of the NADA protocol at minimal cost, when and where it is needed. States that have changed laws to allow ADS practice for this standardized ear acupuncture protocol have seen increased access to this treatment, benefiting both patients and the programs.

Remanent Magnetization: Signature of Many-Body Localization in Quantum Antiferromagnets

NASA Astrophysics Data System (ADS)

Ros, V.; Müller, M.

2017-06-01

We study the remanent magnetization in antiferromagnetic, many-body localized quantum spin chains, initialized in a fully magnetized state. Its long time limit is an order parameter for the localization transition, which is readily accessible by standard experimental probes in magnets. We analytically calculate its value in the strong-disorder regime exploiting the explicit construction of quasilocal conserved quantities of the localized phase. We discuss analogies in cold atomic systems.

A Case of TMI (Too Much Information): Improving the Usability of the Library's Website through the Implementation of LibAnswers and the A-Z Database List (LibGuides v2)

ERIC Educational Resources Information Center

Tobias, Christine

2017-01-01

The Michigan State University (MSU) Libraries' Website has a case of TMI: too much information organized by librarians for librarians. Finding relevant information about various library services, including the 24/7 Distance Learning Support Line, and access points to scholarly resources is often cumbersome, and given the limited time and staffing…

Study of the Military Intelligence Support to Domestic Law Enforcement in Counterdrug and Counterterrorism Operations

DTIC Science & Technology

2012-06-08

havens–Southwest Asia, the Horn of Africa, Southeast Asia, and Latin America . This data is collected in military intelligence databases and accessible to...National Security Agency ONDCP Office of National Drug Control Policy ORA Organization Risk Analyzer REMBASS Remotely Monitored Battlefield...The Crime Drop in America .”4 Law enforcement officials the author talked with stated this is a limitation in that police officers remain reactive to

PARCC Accessibility Features and Accommodations Manual: Guidance for Districts and Decision-Making Teams to Ensure that PARCC Mid-Year, Performance-Based, and End-of-Year Assessments Produce Valid Results for All Students. Second Edition

ERIC Educational Resources Information Center

Bowman, Trinell; Wiener, Daniel; Reavis, Tamara; Griswold, Danielle

2013-01-01

Partnership for Assessment of Readiness for College and Careers (PARCC) member states regard assessments as tools for enhancing teaching and learning, and are committed to providing all students, including but not limited to, students with disabilities, English learners, English learners with disabilities, and underserved populations with…

PARCC Accessibility Features and Accommodations Manual: Guidance for Districts and Decision-Making Teams to Ensure That PARCC Mid-Year, Performance-Based, and End-of-Year Assessments Produce Valid Results for All Students. Third Edition

ERIC Educational Resources Information Center

Bowman, Trinell; Wiener, Daniel; Reavis, Tamara; Griswold, Danielle

2014-01-01

Partnership for Assessment of Readiness for College and Careers (PARCC) member states regard assessments as tools for enhancing teaching and learning, and are committed to providing all students, including but not limited to, students with disabilities, English learners, English learners with disabilities, and underserved populations with…

Clinicians' Obligations to Use Qualified Medical Interpreters When Caring for Patients with Limited English Proficiency.

PubMed

Basu, Gaurab; Costa, Vonessa Phillips; Jain, Priyank

2017-03-01

Access to language services is a required and foundational component of care for patients with limited English proficiency (LEP). National standards for medical interpreting set by the US Department of Health and Human Services and by the National Council on Interpreting in Health Care establish the role of qualified medical interpreters in the provision of care in the United States. In the vignette, the attending physician infringes upon the patient's right to appropriate language services and renders unethical care. Clinicians are obliged to create systems and a culture that ensure quality care for patients with LEP. © 2017 American Medical Association. All Rights Reserved.

Migration Intentions and Illicit Substance Use among Youth in Central Mexico

PubMed Central

Marsiglia, Flavio Francisco; Kulis, Stephen; Hoffman, Steven; Calderón-Tena, Carlos Orestes; Becerra, David; Alvarez, Diana

2011-01-01

This study explored intentions to emigrate and substance use among youth (ages 14–24) from a central Mexico state with high emigration rates. Questionnaires were completed in 2007 by 702 students attending a probability sample of alternative secondary schools serving remote or poor communities. Linear and logistic regression analyses indicated that stronger intentions to emigrate predicted greater access to drugs, drug offers, and use of illicit drugs (marijuana, cocaine, inhalants), but not alcohol or cigarettes. Results are related to the healthy migrant theory and its applicability to youth with limited educational opportunities. The study’s limitations are noted. PMID:21955065

An experimental study on PEO polymer electrolyte based all-solid-state supercapacitor

NASA Astrophysics Data System (ADS)

Yijing, Yin

Supercapacitors are one of the most important electrochemical energy storage and conversion devices, however low ionic conductivity of solid state polymer electrolytes and the poor accessibility of the ions to the active sites in the porous electrode will cause low performance for all-solid-state supercapacitors and will limit their application. The objective of the dissertation is to improve the performance of all-solid-state supercapactor by improving electrolyte conductivity and solving accessibility problem of the ions to the active sites. The low ionic conductivity (10-8 S/cm) of poly(ethylene oxide) (PEO) limits its application as an electrolyte. Since PEO is a semicrystal polymer and the ion conduction take place mainly in the amorphous regions of the PEO/Lithium salt complex, improvements in the percentage of amorphous phase in PEO or increasing the charge carrier concentration and mobility could increase the ionic conductivity of PEO electrolyte. Hot pressing along with the additions of different lithium salts, inorganic fillers and plasticizers were applied to improve the ionic conductivity of PEO polymer electrolytes. Four electrode methods were used to evaluate the conductivity of PEO based polymer electrolytes. Results show that adding certain lithium salts, inorganic fillers, and plasticizers could improve the ionic conductivity of PEO electrolytes up 10-4 S/cm. Further hot pressing treatment could improve the ionic conductivity of PEO electrolytes up to 10-3 S/cm. The conductivity improvement after hot pressing treatment is elucidated as that the spherulite crystal phase is convert into the fringed micelle crystal phase or the amorphous phase of PEO electrolytes. PEO electrolytes were added into active carbon as a binder and an ion conductor, so as to provide electrodes with not only ion conduction, but also the accessibility of ion to the active sites of electrodes. The NaI/I 2 mediator was added to improve the conductivity of PEO electrolyte and provide pseudocapacitance for all-solid-state supercapacitors. Impedance, cyclic voltammetry, and gavalnostatic charge/discharge measurements were conducted to evaluate the electrochemical performance of PEO polymer electrolytes based all-solid-state supercapacitors. Results demonstrate that the conductivity of PEO electrolyte could be improved to 0.1 S/cm with a mediator concentration of 50wt%. A high conductivity in the PEO electrolyte with mediator is an indication of a high electron exchange rate between the mediator and mediator. The high electron exchange rates at mediator carbon interface and between mediator and mediator are essential in order to obtain a high response rate and high power. This automatically solves the accessibility problem. With the addition of NaI/I2 mediator, the specific capacitance increased more than 30 folds, specific power increased almost 20 folds, and specific energy increased around 10 folds. Further addition of filler to the electrodes along with the mediator could double the specific capacitor and specific power of the all-solid-state supercapacitor. The stability of the corresponded supercapacitor is good within 2000 cycles.

2007 costs and coverage of antiretrovirals under Medicare Part D for people with HIV/AIDS living in North Carolina.

PubMed

Sengupta, Sohini

2008-01-01

Effective January 1, 2006 Medicare Part D became a new source of prescription drug coverage for people with HIV/AIDS in the United States. The implementation of Part D has affected access to antiretrovirals for people with HIV/AIDS. In North Carolina, access can be difficult because of the state's struggling safety net programs and the growing HIV-infected populations among Blacks and in poor rural counties. This analysis examines Medicare Part D antiretroviral coverage in 2007 for beneficiaries with HIV/AIDS in North Carolina, particularly those who did not qualify as dual eligibles or for a full low-income subsidy. Data describing program coverage were obtained from the Web site www.medicare.gov and descriptive analyses were performed to assess changes in antiretroviral coverage in Part D prescription drug plans in North Carolina. Most of the 26 antiretrovirals are covered in some way by 76 North Carolina prescription drug plans. There may be variability in coverage however associated with (a) antiretroviral classification within formularies; (b) drug premiums; (c) whether premiums can be waived; (d) annual deductibles; and (e) whether coverage is provided in the "doughnut hole." The data may not reflect actual patterns of drug use and realized access to the drugs. The findings are limited to antiretroviral coverage in North Carolina's Part D offerings but could be generalized to other states with similar prescription drug plan costs and coverage. These concerns continue to pose significant challenges to accessing antiretrovirals for Part D beneficiaries with HIV/AIDS in North Carolina. Variability demonstrated within prescription drug plans will continue, and beneficiaries with HIV/AIDS who do not qualify as dual eligibles or for low-income subsidies will need to evaluate these issues when selecting a prescription drug plan in future enrollment periods.

The National Geological and Geophysical Data Preservation Program

NASA Astrophysics Data System (ADS)

Dickinson, T. L.; Steinmetz, J. C.; Gundersen, L. C.; Pierce, B. S.

2006-12-01

The ability to preserve and maintain geoscience data and collections has not kept pace with the growing need for accessible digital information and the technology to make it so. The Nation has lost valuable and unique geologic records and is in danger of losing much more. Many federal and state geological repositories are currently at their capacity for maintaining and storing data or samples. Some repositories are gaining additional, but temporary and substandard space, using transport containers or offsite warehouses where access is limited and storage conditions are poor. Over the past several years, there has been an increasing focus on the state of scientific collections in the United States. For example, the National Geological and Geophysical Data Preservation Program (NGGDPP) Act was passed as part of the Energy Policy Act of 2005, authorizing $30 million in funding for each of five years. The Act directs the U.S. Geological Survey to administer this program that includes a National Digital Catalog and Federal assistance to support our nation's repositories. Implementation of the Program awaits federal appropriations. The NGGDPP is envisioned as a national network of cooperating geoscience materials and data repositories that are operated independently yet guided by unified standards, procedures, and protocols for metadata. The holdings will be widely accessible through a common and mirrored Internet-based catalog (National Digital Catalog). The National Digital Catalog will tie the observations and analyses to the physical materials they come from. Our Nation's geological and geophysical data are invaluable and in some instances irreplaceable due to the destruction of outcrops, urbanization and restricted access. These data will enable the next generation of scientific research and education, enable more effective and efficient research, and may have future economic benefits through the discovery of new oil and gas accumulations, and mineral deposits.

Creativity and Quantum Physics: a New World View Unifying Current Theories of Creativity and Pointing Toward New Research Methodologies.

NASA Astrophysics Data System (ADS)

McCarthy, Kimberly Ann

1990-01-01

Divisions in definitions of creativity have centered primarily on the working definition of discontinuity and the inclusion of intrinsic features such as unconscious processing and intrinsic motivation and reinforcement. These differences generally result from Cohen's two world views underlying theories of creativity: Organismic, oriented toward holism; or mechanistic, oriented toward cause-effect reductionism. The quantum world view is proposed which theoretically and empirically unifies organismic and mechanistic elements of creativity. Based on Goswami's Idealistic Interpretation of quantum physics, the quantum view postulates the mind -brain as consisting of both classical and quantum structures and functions. The quantum domain accesses the transcendent order through coherent superpositions (a state of potentialities), while the classical domain performs the function of measuring apparatus through amplifying and recording the result of the collapse of the pure mental state. A theoretical experiment, based on the 1980 Marcel study of conscious and unconscious word-sense disambiguation, is conducted which compares the predictions of the quantum model with those of the 1975 Posner and Snyder Facilitation and Inhibition model. Each model agrees that while conscious access to information is limited, unconscious access is unlimited. However, each model differently defines the connection between these states: The Posner model postulates a central processing mechanism while the quantum model postulates a self-referential consciousness. Consequently, the two models predict differently. The strength of the quantum model lies in its ability to distinguish between classical and quantum definitions of discontinuity, as well as clarifying the function of consciousness, without added assumptions or ad-hoc analysis: Consciousness is an essential, valid feature of quantum mechanisms independent of the field of cognitive psychology. According to the quantum model, through a cycle of conscious and unconscious processing, various contexts are accessed, specifically, coherent superposition states and the removal of the subject-object dichotomy in unconscious processing. Coupled with a high tolerance for ambiguity, the individual has access not only to an increased quantity of information, but is exposed to this information in the absence of a self-referential or biased context, the result of which is an increase in creative behavior.

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. Specialty access standards did not lead to widespread improvements in access to specialist physicians. Meaningful improvements in access to specialty care for Medicaid recipients may require additional interventions.

The impact of the minimum wage on health.

PubMed

Andreyeva, Elena; Ukert, Benjamin

2018-03-07

This study evaluates the effect of minimum wage on risky health behaviors, healthcare access, and self-reported health. We use data from the 1993-2015 Behavioral Risk Factor Surveillance System, and employ a difference-in-differences strategy that utilizes time variation in new minimum wage laws across U.S. states. Results suggest that the minimum wage increases the probability of being obese and decreases daily fruit and vegetable intake, but also decreases days with functional limitations while having no impact on healthcare access. Subsample analyses reveal that the increase in weight and decrease in fruit and vegetable intake are driven by the older population, married, and whites. The improvement in self-reported health is especially strong among non-whites, females, and married.

Addressing Open Water Data Challenges in the Bureau of Reclamation

NASA Astrophysics Data System (ADS)

Brekke, L. D.; Danner, A.; Nagode, J.; Rocha, J.; Poulton, S.; Anderson, A.

2017-12-01

The Bureau of Reclamation is largest wholesaler of water in the United States. Located in the 17 western states, Reclamation serves water to 31 million people, provides irrigated water to 20 percent of Western farmers, and is the second largest producer of hydroelectric power in the United States. Through these activities, Reclamation generates large amounts of water and water-related data, describing reservoirs and river system conditions, hydropower, environmental compliance activities, infrastructure assets, and other aspects of Reclamation's mission activities. Reclamation aims to make water and water-related data sets more easily found, accessed, and used in decision-making activities in order to benefit the public, private sector, and research communities. Historically, there has not been an integrated, bureau-wide system to store data in machine-readable formats; nor a system to permit centralized browsing, open access, and web-services. Reclamation began addressing these limitations by developing the Reclamation Water Information System (RWIS), released in Spring 2017 (https://water.usbr.gov/). A bureau-wide team contributed to RWIS development, including water data stewards, database administrators, and information technology (IT) specialists. The first RWIS release publishes reservoir time series data from Reclamation's five regions and includes a map interface for sites identification, a query interface for data discovery and access, and web-services for automated retrieval. As RWIS enhancement continues, the development team is developing a companion system - the Reclamation Information Sharing Environment (RISE) - to provide access to the other data subjects and types (geospatial, documents). While RWIS and RISE are promising starts, Reclamation continues to face challenges in addressing open water data goals: making data consolidation and open publishing a value-added activity for programs that publish data locally, going beyond providing open access to also providing decision-support, and scaling up IT solutions for future success - where Reclamation programs increasingly elect to more and more data through RWIS/RISE, thereby creating a big data challenge. This presentation will highlight activities status, lessons learned, and future directions.

Intergenerational equity and environmental restoration cleanup levels.

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

Hocking, E. K.; Environmental Assessment

2001-01-01

The United States Department of Energy environmental restoration program faces difficult decisions about the levels of cleanup to be achieved at its many contaminated sites and has acknowledged the need for considering intergenerational equity in its decision making. Intergenerational equity refers to the fairness of access to resources across generations. Environmental restoration cleanup levels can have unintended and unfair consequences for future generations access to resources. The potentially higher costs associated with using low, non-risk-based cleanup levels for remediation may divert funding from other activities that could have a greater beneficial impact on future generations. Low, non-risk-based cleanup levels couldmore » also result in more damage to the nation's resources than would occur if a higher cleanup level were used. The loss or impairment of these resources could have an inequitable effect on future generations. However, intergenerational inequity could arise if sites are not completely restored and if access to and use of natural and cultural resources are unfairly limited as a result of residual contamination. In addition to concerns about creating possible intergenerational inequities related to selected cleanup levels, the tremendous uncertainties associated with sites and their restoration can lead site planners to rely on stewardship by default. An ill-conceived stewardship program can contribute to intergenerational inequity by limiting access to resources while passing on risks to future generations and not preparing them for those risks. This paper presents a basic model and process for designing stewardship programs that can achieve equity among generations.« less

Access to health care in the Scandinavian countries: ethical aspects.

PubMed

Holm, S; Liss, P E; Norheim, O F

1999-01-01

The health care systems are fairly similar in the Scandinavian countries. The exact details vary, but in all three countries the system is almost exclusively publicly funded through taxation, and most (or all) hospitals are also publicly owned and managed. The countries also have a fairly strong primary care sector (even though it varies between the countries), with family physicians to various degrees acting as gatekeepers to specialist services. In Denmark most of the GP services are free. For the patient in Norway and Sweden there are out-of-pocket co-payments for GP consultations, with upper limits, but consultations for children are free. Hospital treatment is free in Denmark while the other countries use a system with out-of-pocket co-payment. There is a very strong public commitment to access to high quality health care for all. Solidarity and equality form the ideological basis for the Scandinavian welfare state. Means testing, for instance, has been widely rejected in the Scandinavian countries on the grounds that public services should not stigmatise any particular group. Solidarity also means devoting special consideration to the needs of those who have less chance than others of making their voices heard or exercising their rights. Issues of limited access are now, however, challenging the thinking about a health care system based on solidarity.

Does the Sale of Sweetened Beverages at School Affect Children’s Weight?

PubMed Central

Cunningham, Solveig A.; Zavodny, Madeline

2011-01-01

In response to the increase in children’s weight in recent decades, many states, school districts, and schools in the United States have limited or eliminated the sale of sweetened beverages at school. These policies are promoted for their potential to reduce childhood overweight and obesity, but their effectiveness has not been evaluated. Using a large nationally representative longitudinal dataset, the Early Childhood Longitudinal Study-Kindergarten (ECLS-K), this study explores the relationship between children’s access to sweetened beverages at school in 5th and 8th grade, their purchases and total consumption of these beverages, and their weight. We find almost no evidence that availability of sweetened beverages for sale at school leads to heavier weight or greater risk of overweight or obesity among children. We also find limited evidence that availability of sweetened beverages for sale at school leads to higher total consumption of these beverages. PMID:21907477

Does the sale of sweetened beverages at school affect children's weight?

PubMed

Cunningham, Solveig A; Zavodny, Madeline

2011-11-01

In response to the increase in children's weight in recent decades, many states, school districts, and schools in the United States have limited or eliminated the sale of sweetened beverages at school. These policies are promoted for their potential to reduce childhood overweight and obesity, but their effectiveness has not been evaluated. Using a large nationally representative longitudinal dataset, the Early Childhood Longitudinal Study-Kindergarten (ECLS-K), this study explores the relationship between children's access to sweetened beverages at school in 5th and 8th grade, their purchases and total consumption of these beverages, and their weight. We find almost no evidence that availability of sweetened beverages for sale at school leads to heavier weight or greater risk of overweight or obesity among children. We also find limited evidence that availability of sweetened beverages for sale at school leads to higher total consumption of these beverages. Copyright © 2011 Elsevier Ltd. All rights reserved.

On the origin of fluorescence in bacteriophytochrome infrared fluorescent proteins

PubMed Central

Samma, Alex A.; Johnson, Chelsea K.; Song, Shuang; Alvarez, Samuel

2010-01-01

Tsien (Science, 2009, 324, 804-807) has recently reported the creation of the first infrared fluorescent protein (IFP). It was engineered from bacterial phytochrome by removing the PHY and histidine kinase-related domains, by optimizing the protein to prevent dimerization and by limiting the biliverdins conformational freedom, especially around its D ring. We have used database analyses and molecular dynamics simulations with freely rotating chromophoric dihedrals in order to model the dihedral freedom available to the biliverdin D ring in the excited state; to show that the tetrapyrrole ligands in phytochromes are flexible and can adopt many conformations, however their conformational space is limited/defined by the chemospatial characteristics of the protein cavity. Our simulations confirm that the reduced accessibility to conformations geared to an excited state proton transfer may be responsible for the fluorescence in IFP, just as has been suggested by Kennis (PNAS, 2010, 107, 9170-9175) for fluorescent bacteriophytochrome from Rhodopseudomonas palustris. PMID:21047084

The relationship between employment and health and health care among working-age adults with and without disabilities in the United States.

PubMed

Reichard, Amanda; Stransky, Michelle; Brucker, Debra; Houtenville, Andrew

2018-05-20

To better understand the relationship between employment and health and health care for people with disabilities in the United States (US). We pooled US Medical Expenditure Panel Survey (2004-2010) data to examine health status, and access to health care among working-age adults, comparing people with physical disabilities or multiple disabilities to people without disabilities, based on their employment status. Logistic regression and least squares regression were conducted, controlling for sociodemographics, health insurance (when not the outcome), multiple chronic conditions, and need for assistance. Employment was inversely related to access to care, insurance, and obesity. Yet, people with disabilities employed in the past year reported better general and mental health than their peers with the same disabilities who were not employed. Those who were employed were more likely to have delayed/forgone necessary care, across disability groups. Part-time employment, especially for people with multiple limitations, was associated with better health and health care outcomes than full-time employment. Findings highlight the importance of addressing employment-related causes of delayed or foregone receipt of necessary care (e.g., flex-time for attending appointments) that exist for all workers, especially those with physical or multiple disabilities. Implications for rehabilitation These findings demonstrate that rehabilitation professionals who are seeking to support employment for persons with physical limitations need to ensure that overall health concerns are adequately addressed, both for those seeking employment and for those who are currently employed. Assisting clients in prioritizing health equally with employment can ensure that both areas receive sufficient attention. Engaging with employers to develop innovative practices to improve health, health behaviors and access to care for employees with disabilities can decrease turnover, increase productivity, and ensure longer job tenure.

[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.

On the origin of resistive switching volatility in Ni/TiO{sub 2}/Ni stacks

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

Cortese, Simone, E-mail: simone.cortese@soton.ac.uk; Trapatseli, Maria; Khiat, Ali

2016-08-14

Resistive switching and resistive random access memories have attracted huge interest for next generation nonvolatile memory applications, also thought to be able to overcome flash memories limitations when arranged in crossbar arrays. A cornerstone of their potential success is that the toggling between two distinct resistance states, usually a High Resistive State (HRS) and a Low Resistive State (LRS), is an intrinsic non-volatile phenomenon with the two states being thermodynamically stable. TiO{sub 2} is one of the most common materials known to support non-volatile RS. In this paper, we report a volatile resistive switching in a titanium dioxide thin filmmore » sandwiched by two nickel electrodes. The aim of this work is to understand the underlying physical mechanism that triggers the volatile effect, which is ascribed to the presence of a NiO layer at the bottom interface. The NiO layer alters the equilibrium between electric field driven filament formation and thermal enhanced ion diffusion, resulting in the volatile behaviour. Although the volatility is not ideal for non-volatile memory applications, it shows merit for access devices in crossbar arrays due to its high LRS/HRS ratio, which are also briefly discussed.« less

The French health care system: liberal universalism.

PubMed

Steffen, Monika

2010-06-01

This article analyzes the reforms introduced over the last quarter century into the French health care system. A particular public-private combination, rooted in French history and institutionalized through a specific division of the policy field between private doctors and public hospitals, explains the system's core characteristics: universal access, free choice, high quality, and a weak capacity for regulation. The dual architecture of this unique system leads to different reform strategies and outcomes in its two main parts. While the state has leverage in the hospital sector, it has failed repeatedly in attempts to regulate the ambulatory care sector. The first section of this article sets out the main characteristics and historical landmarks that continue to affect policy framing and implementation. Section 2 focuses on the evolution in financing and access, section 3 on management and governance in the (private) ambulatory care sector, and section 4 on the (mainly public) hospital sector. The conclusion compares the French model with those developed in the comparative literature and sets out the terms of the dilemma: a state-run social health insurance that lacks both the legitimacy of Bismarckian systems and the leverages of state-run systems. The French system therefore pursues contradictory policy goals, simultaneously developing universalism and liberalism, which explains both the direct state intervention and its limits.

Subregional Nowcasts of Seasonal Influenza Using Search Trends.

PubMed

Kandula, Sasikiran; Hsu, Daniel; Shaman, Jeffrey

2017-11-06

Limiting the adverse effects of seasonal influenza outbreaks at state or city level requires close monitoring of localized outbreaks and reliable forecasts of their progression. Whereas forecasting models for influenza or influenza-like illness (ILI) are becoming increasingly available, their applicability to localized outbreaks is limited by the nonavailability of real-time observations of the current outbreak state at local scales. Surveillance data collected by various health departments are widely accepted as the reference standard for estimating the state of outbreaks, and in the absence of surveillance data, nowcast proxies built using Web-based activities such as search engine queries, tweets, and access of health-related webpages can be useful. Nowcast estimates of state and municipal ILI were previously published by Google Flu Trends (GFT); however, validations of these estimates were seldom reported. The aim of this study was to develop and validate models to nowcast ILI at subregional geographic scales. We built nowcast models based on autoregressive (autoregressive integrated moving average; ARIMA) and supervised regression methods (Random forests) at the US state level using regional weighted ILI and Web-based search activity derived from Google's Extended Trends application programming interface. We validated the performance of these methods using actual surveillance data for the 50 states across six seasons. We also built state-level nowcast models using state-level estimates of ILI and compared the accuracy of these estimates with the estimates of the regional models extrapolated to the state level and with the nowcast estimates published by GFT. Models built using regional ILI extrapolated to state level had a median correlation of 0.84 (interquartile range: 0.74-0.91) and a median root mean square error (RMSE) of 1.01 (IQR: 0.74-1.50), with noticeable variability across seasons and by state population size. Model forms that hypothesize the availability of timely state-level surveillance data show significantly lower errors of 0.83 (0.55-0.23). Compared with GFT, the latter model forms have lower errors but also lower correlation. These results suggest that the proposed methods may be an alternative to the discontinued GFT and that further improvements in the quality of subregional nowcasts may require increased access to more finely resolved surveillance data. ©Sasikiran Kandula, Daniel Hsu, Jeffrey Shaman. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.11.2017.

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

Not Available

The Low-Level Radioactive Waste Policy Amendments Act of 1985 amends the current act to provide regional facilities established through compacts between two or more states. The Act defines the responsibilities of the federal government and the participating states, and provides for inspection by the Nuclear Regulatory Commission and review by Congress. It also establishes procedures for siting and allocation of facilities during the transition period and the requirements for access to regional facilities, which will have a three-year licensing and construction period. There is a graduated ceiling on surcharges until 1992, when the limit is $40 per cubic foot. Themore » Act lists six compacts which are subject to consent.« less

Identifying and tracking disaster victims: state-of-the-art technology review.

PubMed

Pate, Barbara L

2008-01-01

The failure of our nation to adequately track victims of Hurricane Katrina has been identified as a major weakness of national and local disaster preparedness plans. This weakness has prompted government and private industries to acknowledge that existing paper-based tracking systems are incapable of managing information during a large-scale disaster. In response to this need, efforts are under way to develop new technologies that allow instant access to identity and location information during emergency situations. The purpose of this article is to provide a review of state-of-the-art technologies, with implications and limitations for use during mass casualty incidents.

The State of Transgender Health Care: Policy, Law, and Medical Frameworks

PubMed Central

2014-01-01

I review the current status of transgender people’s access to health care in the United States and analyze federal policies regarding health care services for transgender people and the limitations thereof. I suggest a preliminary outline to enhance health care services and recommend the formulation of explicit federal policies regarding the provision of health care services to transgender people in accordance with recently issued medical care guidelines, allocation of research funding, education of health care workers, and implementation of existing nondiscrimination policies. Current policies denying medical coverage for sex reassignment surgery contradict standards of medical care and must be amended. PMID:24432926

Athletic Training Services in Public Secondary Schools: A Benchmark Study

PubMed Central

Pryor, Riana R.; Casa, Douglas J.; Vandermark, Lesley W.; Stearns, Rebecca L.; Attanasio, Sarah M.; Fontaine, Garrett J.; Wafer, Alex M.

2015-01-01

Context: Authors of the most recent study of athletic training (AT) services have suggested that only 42% of secondary schools have access to athletic trainers. However, this study was limited by a small sample size and was conducted more than 10 years ago. Objective: To determine current AT services in public secondary schools. Design: Cross-sectional study. Setting: Public secondary schools in the United States. Patients or Other Participants: A total of 8509 (57%) of 14 951 secondary schools from all 50 states and Washington, DC, responded to the survey. Main Outcome Measure(s): Data on AT services were collected for individual states, National Athletic Trainers' Association districts, and the nation. Results: Of the 8509 schools that responded, 70% (n = 5930) had AT services, including full-time (n = 3145, 37%), part-time (n = 2619, 31%), and per diem (n = 199, 2%) AT services, and 27% (n = 2299) had AT services from a hospital or physical therapy clinic. A total of 4075 of 8509 schools (48%) provided coverage at all sports practices. Eighty-six percent (2 394 284/2 787 595) of athletes had access to AT services. Conclusions: Since the last national survey, access to AT services increased such that 70% of respondent public secondary schools provided athletic trainers at sports games or practices. Approximately one-third of all public secondary schools had full-time athletic trainers. This number must increase further to provide appropriate medical coverage at athletic practices and games for secondary school athletes. PMID:25689559

[Exercising sexual and reproductive rights: a qualitative study of heterosexual people with HIV in Mexico].

PubMed

Campero, Lourdes; Kendall, Tamil; Caballero, Marta; Mena, Ana Lorena; Herrera, Cristina

2010-01-01

To analyze experiences of heterosexual Mexican people living with HIV (PLWHA) related to the exercise of their sexual and reproductive rights. Qualitative study based on 40 in-depth interviews with PLWHA in four Mexican States. Lack of support and counseling limits the exercise of sexual and reproductive rights by PLWHA, especially women. Principal limitations include feelings of frustration and confusion, fear of re-infection, scanty information, lack of power to negotiate condom use, social stigma and discrimination, and limited access to services and adequate technologies. To increase awareness and exercise of rights by PLWHA it is necessary to: improve sexual education; promote processes of cultural change to combat gender inequality and stigma and discrimination; and provide timely and scientific information about HIV prevention.

Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients With Limited English Proficiency.

PubMed

Karliner, Leah S; Pérez-Stable, Eliseo J; Gregorich, Steven E

2017-03-01

Twenty-five million people in the United States have limited English proficiency (LEP); this growing and aging population experiences worse outcomes when hospitalized. Federal requirements that hospitals provide language access services are very challenging to implement in the fast-paced, 24-hour hospital environment. To determine if increasing access to professional interpreters improves hospital outcomes for older patients with LEP. Natural experiment on a medicine floor of an academic hospital. Patients age 50 years or above discharged between January 15, 2007 and January 15, 2010. Dual-handset interpreter telephone at every bedside July 15, 2008 to Mar 14, 2009. Thirty-day readmission, length of stay, estimated hospital expenditures. Of 8077 discharges, 1963 were for LEP, and 6114 for English proficient patients. There was a significant decrease in observed 30-day readmission rates for the LEP group during the 8-month intervention period compared with 18 months preintervention (17.8% vs. 13.4%); at the same time English proficient readmission rates increased (16.7% vs. 19.7%); results remained significant in adjusted analyses. This improved readmission outcome for the LEP group was not maintained during the subsequent postintervention period when the telephones became less accessible. There was no significant intervention impact on length of stay in either unadjusted or adjusted analyses. After accounting for interpreter services costs, the estimated 119 readmissions averted during the intervention period were associated with estimated monthly hospital expenditure savings of $161,404. Comprehensive language access represents an important, high value service that all medical centers should provide to achieve equitable, quality healthcare for vulnerable LEP populations.

Retail impact of raising tobacco sales age to 21 years.

PubMed

Winickoff, Jonathan P; Hartman, Lester; Chen, Minghua L; Gottlieb, Mark; Nabi-Burza, Emara; DiFranza, Joseph R

2014-11-01

The majority of tobacco use emerges in individuals before they reach 21 years of age, and many adult distributors of tobacco to youths are young adults aged between 18 and 20 years. Raising the tobacco sales minimum age to 21 years across the United States would decrease tobacco retailer and industry sales by approximately 2% but could contribute to a substantial reduction in the prevalence of youths' tobacco use and dependency by limiting access.

Solid state oxygen sensor

DOEpatents

Garzon, Fernando H.; Brosha, Eric L.

1997-01-01

A potentiometric oxygen sensor is formed having a logarithmic response to a differential oxygen concentration while operating as a Nernstian-type sensor. Very thin films of mixed conducting oxide materials form electrode services while permitting diffusional oxygen access to the interface between the zirconia electrolyte and the electrode. Diffusion of oxygen through the mixed oxide is not rate-limiting. Metal electrodes are not used so that morphological changes in the electrode structure do not occur during extended operation at elevated temperatures.

Solid state oxygen sensor

DOEpatents

Garzon, F.H.; Brosha, E.L.

1997-12-09

A potentiometric oxygen sensor is formed having a logarithmic response to a differential oxygen concentration while operating as a Nernstian-type sensor. Very thin films of mixed conducting oxide materials form electrode services while permitting diffusional oxygen access to the interface between the zirconia electrolyte and the electrode. Diffusion of oxygen through the mixed oxide is not rate-limiting. Metal electrodes are not used so that morphological changes in the electrode structure do not occur during extended operation at elevated temperatures. 6 figs.

[A health survey in riverine communities in Amazonas State, Brazil].

PubMed

Gama, Abel Santiago Muri; Fernandes, Tiótrefis Gomes; Parente, Rosana Cristina Pereira; Secoli, Silvia Regina

2018-02-19

Population-based health surveys are important tools for identifying disease determinants, especially in regions with widely dispersed populations and low health system coverage. The aim of this study was to describe the principal methodological aspects and to describe the socioeconomic, demographic, and health characteristics of the riverine populations of Coari, Amazonas State, Brazil. This was a population-based cross-sectional study in river-dwelling communities in the rural area of Coari, from April to July 2015. The probabilistic cluster sample consisted of 492 individuals. The results showed that the majority of the river-dwellers were females (53%), had up to 9 years of schooling (68.5%), and earned a monthly family income equivalent to one-third the minimum wage. The health problems reported in the previous 30 days featured conditions involving pain (45.2%). The main healthcare resources were allopathic medicines (70.3%), exceeding herbal remedies (44.3%). The river-dwellers travel an average of 60.4km and take some 4.2 hours to reach the urban area of Coari. The riverine population generally presents low economic status and limited access to the urban area. Health problems are mostly solved with allopathic medicines. Geographic characteristics, as barriers to access to health services and to improvements in living conditions for the riverine population, can limit the collection of epidemiological data on these populations.

Firearms regulation, violence and the mentally ill: a contemporary Antipodean appraisal.

PubMed

Chappell, Duncan

2014-01-01

As recent cases of mass murder at Utoya Island in Norway, and in the United States (US) at Virginia Tech, Virginia; Tucson, Arizona; Aurora, Colorado; and Newtown, Connecticut all illustrate, acts of extreme violence involving high powered weapons and committed by persons with a presumed or confirmed mental illness tend to arouse intense public and political debates about the efficacy of firearm regulation and control. Following these tragedies, in the US at least, various law reform measures have been proposed and in some cases implemented designed principally to make it more difficult for mentally ill persons to gain access to firearms. In this article it is contended that measures like these are at best tinkering with the margins of gun control and also have the tendency to reinforce the stigma and discrimination experienced by persons with a mental illness, while perpetuating stereotypes of them as dangerous to themselves and others. Despite these limitations, and while firearm regulation policies and practices vary widely across the globe, most nations still seek in some way to limit access to guns by persons with a mental illness. This article explores in more detail how such policies and practices have been applied in the Australian State of New South Wales and the lessons to be learned elsewhere from this experience. Copyright © 2014 Elsevier Ltd. All rights reserved.

Research amongst Physical Therapists in the State of Kuwait: Participation, Perception, Attitude and Barriers

PubMed Central

Aljadi, Sameera H.; Alrowayeh, Hesham N.; Alotaibi, Naser M.; Taaqi, Maqdad M.; Alquraini, Habib; Alshatti, Talal A.

2013-01-01

Objectives The objectives of this descriptive study were to investigate the attitudes and perceptions of physical therapists regarding research, the intention to engage in research and the barriers to participating in research amongst physical therapists in the State of Kuwait. Subjects and Methods A previously validated questionnaire was distributed to 200 non-randomly selected physical therapists. The questionnaire gathered demographic data as well as information regarding research-related activities. Descriptive statistics, frequency and χ2 analyses were used in this study. Results Of the 200 questionnaires distributed to physical therapists 122 (61%) were completed and returned. The physical therapists had a positive attitude towards reading these findings in order to update their knowledge. However, only 16 (17%) of the physical therapists participated in clinical research. The common reasons given were: minimal role and reduced ability, intention and level of engagement in initiating research, probably due to work overload, time constraints and limited access to resources. Conclusions Physical therapists in Kuwait had a positive attitude towards the application of research findings to their practice. However, they were not confident in initiating research due to work overload and lack of time as well as limited access to library resources. Therefore, we recommend stimulation to engage in research activities to be a requirement and to develop a system to improve the skills and knowledge of doing research. PMID:23988758

PCM-Based Durable Write Cache for Fast Disk I/O

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

Liu, Zhuo; Wang, Bin; Carpenter, Patrick

2012-01-01

Flash based solid-state devices (FSSDs) have been adopted within the memory hierarchy to improve the performance of hard disk drive (HDD) based storage system. However, with the fast development of storage-class memories, new storage technologies with better performance and higher write endurance than FSSDs are emerging, e.g., phase-change memory (PCM). Understanding how to leverage these state-of-the-art storage technologies for modern computing systems is important to solve challenging data intensive computing problems. In this paper, we propose to leverage PCM for a hybrid PCM-HDD storage architecture. We identify the limitations of traditional LRU caching algorithms for PCM-based caches, and develop amore » novel hash-based write caching scheme called HALO to improve random write performance of hard disks. To address the limited durability of PCM devices and solve the degraded spatial locality in traditional wear-leveling techniques, we further propose novel PCM management algorithms that provide effective wear-leveling while maximizing access parallelism. We have evaluated this PCM-based hybrid storage architecture using applications with a diverse set of I/O access patterns. Our experimental results demonstrate that the HALO caching scheme leads to an average reduction of 36.8% in execution time compared to the LRU caching scheme, and that the SFC wear leveling extends the lifetime of PCM by a factor of 21.6.« less

A continuum model of transcriptional bursting

PubMed Central

Corrigan, Adam M; Tunnacliffe, Edward; Cannon, Danielle; Chubb, Jonathan R

2016-01-01

Transcription occurs in stochastic bursts. Early models based upon RNA hybridisation studies suggest bursting dynamics arise from alternating inactive and permissive states. Here we investigate bursting mechanism in live cells by quantitative imaging of actin gene transcription, combined with molecular genetics, stochastic simulation and probabilistic modelling. In contrast to early models, our data indicate a continuum of transcriptional states, with a slowly fluctuating initiation rate converting the gene between different levels of activity, interspersed with extended periods of inactivity. We place an upper limit of 40 s on the lifetime of fluctuations in elongation rate, with initiation rate variations persisting an order of magnitude longer. TATA mutations reduce the accessibility of high activity states, leaving the lifetime of on- and off-states unchanged. A continuum or spectrum of gene states potentially enables a wide dynamic range for cell responses to stimuli. DOI: http://dx.doi.org/10.7554/eLife.13051.001 PMID:26896676

Novel circuit design for high-impedance and non-local electrical measurements of two-dimensional materials

NASA Astrophysics Data System (ADS)

De Sanctis, Adolfo; Mehew, Jake D.; Alkhalifa, Saad; Tate, Callum P.; White, Ashley; Woodgate, Adam R.; Craciun, Monica F.; Russo, Saverio

2018-02-01

Two-dimensional materials offer a novel platform for the development of future quantum technologies. However, the electrical characterisation of topological insulating states, non-local resistance, and bandgap tuning in atomically thin materials can be strongly affected by spurious signals arising from the measuring electronics. Common-mode voltages, dielectric leakage in the coaxial cables, and the limited input impedance of alternate-current amplifiers can mask the true nature of such high-impedance states. Here, we present an optical isolator circuit which grants access to such states by electrically decoupling the current-injection from the voltage-sensing circuitry. We benchmark our apparatus against two state-of-the-art measurements: the non-local resistance of a graphene Hall bar and the transfer characteristic of a WS2 field-effect transistor. Our system allows the quick characterisation of novel insulating states in two-dimensional materials with potential applications in future quantum technologies.

Too poor for transplant: finance and insurance issues in transplant ethics.

PubMed

Laurentine, Kyle Alexander; Bramstedt, Katrina A

2010-06-01

Donor organs are a scarce gift. Additionally, transplantation is very expensive and the United States lacks universal health insurance for all citizens. These facts combine to make personal finance and insurance some of the criteria for wait listing at US transplant centers. Previous research has shown that the poor and the uninsured (as well as women and nonwhites) are less likely to receive a transplant. Living donor candidates are also limited by the US insurance system. To determine the effect of finance and insurance variables on access to transplant and living donation. A qualitative descriptive study of ethics consultation data contained in a research registry approved by the institutional review board at California Pacific Medical Center. This study analyzes research registry data from a large community hospital in Northern California that serves patients from California, Oregon, and Nevada. The registry data are derived from transplant ethics consultations occurring between January 1, 2007, and June 30, 2009. This study explores the restriction of access to transplantation and of participation in living donation. More than a quarter of all transplant ethics consultation reports described the restriction of transplant-related treatment for reasons rooted in finance or insurance. Individuals on the recipient side and on the donor side were hindered with regard to access. Insurance status and personal ability to pay significantly affect access to transplantation in the United States, and this theme is a frequent feature of ethics consultations at California Pacific Medical Center.

Effect of expansions in state Medicaid eligibility on access to care and the use of emergency department services for adult Medicaid enrollees.

PubMed

Ndumele, Chima D; Mor, Vincent; Allen, Susan; Burgess, James F; Trivedi, Amal N

2014-06-01

Medicaid enrollees typically report worse access to care than other insured populations. Expansions in Medicaid through less restrictive income eligibility requirements and the resulting influx of new enrollees may further erode access to care for those already enrolled in Medicaid. To assess the effect of previous Medicaid expansions on self-reported access to care and the use of emergency department services by Medicaid enrollees. Quasi-experimental difference-in-differences design among 1714 adult Medicaid enrollees in 10 states that expanded Medicaid between June 1, 2000, and October 1, 2009, and 5097 Medicaid enrollees in 14 bordering control states that did not expand Medicaid. Self-reported access to care and annualized emergency department use. Among states expanding their Medicaid program for adults, the mean income eligibility level increased from 82.6% to 144.2% of the federal poverty level. Income eligibility in matched control states remained constant at 77.1% of the federal poverty level. The proportion of adults reporting being enrolled in Medicaid increased from 7.2% to 8.8% in expansion states and from 6.1% to 6.4% in matched control states. In Medicaid program expansion states, the proportion of Medicaid enrollees reporting poor access to care declined from 8.5% before the expansion to 7.3% after the expansion. In matched control states, the proportion of Medicaid enrollees reporting poor access to care remained constant at 5.3%. The proportion of enrollees reporting any emergency department use decreased from 41.2% to 40.1% in expansion states and from 37.3% to 36.1% in matched control states. In the period following expansions, newly eligible enrollees reported poorer access to care than previously enrolled beneficiaries, although the overall difference between groups did not reach statistical significance. We found no evidence that expanding the number of individuals eligible for Medicaid coverage eroded perceived access to care or increased the use of emergency services among adult Medicaid enrollees.

The right to water in rural Punjab: assessing equitable access to water in the context of the ongoing Punjab Rural Water Supply Proejct.

PubMed

Samra, Shamsher; Crowley, Julia; Smith Fawzi, Mary C

2011-12-15

Although India is poised to meet its Millennium Development Goal for providing access to safe drinking water, there remains a worrying discrepancy in access between urban and rural areas. In 2006, 96% of the urban population versus 86% of the rural population obtained their drinking water from an improved water source. To increase access to potable water in rural areas, the World Bank and the state of Punjab have implemented the Punjab Rural Water Supply and Sanitation Project (PRWSS) to improve or construct water supply systems in 3,000 villages deemed to have inadequate access to clean drinking water. This study aimed to examine whether the right to water was fulfilled in six towns in rural Punjab during implementation of the PRWSS. The normative content of the right to water requires that water be of adequate quantity, safety, accessibility, affordability, and acceptability in terms of quality. While our findings suggest that the PRWSS improved water quality, they also indicate that access to water was limited due to affordability and the low socioeconomic status of some people living in the target communities. Copyright © 2011 Samra, Crowley, and Smith Fawzi. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Association of mandated language access programming and quality of care provided by mental health agencies.

PubMed

McClellan, Sean R; Snowden, Lonnie

2015-01-01

This study examined the association between language access programming and quality of psychiatric care received by persons with limited English proficiency (LEP). In 1999, the California Department of Mental Health required county Medicaid agencies to implement a "threshold language access policy" to meet the state's Title VI obligations. This policy required Medi-Cal agencies to provide language access programming, including access to interpreters and translated written material, to speakers of languages other than English if the language was spoken by at least 3,000, or 5%, of the county's Medicaid population. Using a longitudinal study design with a nonequivalent control group, this study examined the quality of care provided to Spanish speakers with LEP and a severe mental illness before and after implementation of mandatory language access programming. Quality was measured by receipt of at least two follow-up medication visits within 90 days or three visits within 180 days of an initial medication visit over a period of 38 quarter-years. On average, only 40% of Spanish-speaking clients received at least three medication follow-up visits within 180 days. In multivariate analyses, language access programming was not associated with receipt of at least two medication follow-up visits within 90 days or at least three visits within 180 days. This study found no evidence that language access programming led to increased rates of follow-up medication visits for clients with LEP.

Achieving climate connectivity in a fragmented landscape

PubMed Central

Lawler, Joshua J.; McRae, Brad H.; Nuñez, Tristan A.; Theobald, David M.

2016-01-01

The contiguous United States contains a disconnected patchwork of natural lands. This fragmentation by human activities limits species’ ability to track suitable climates as they rapidly shift. However, most models that project species movement needs have not examined where fragmentation will limit those movements. Here, we quantify climate connectivity, the capacity of landscape configuration to allow species movement in the face of dynamically shifting climate. Using this metric, we assess to what extent habitat fragmentation will limit species movements in response to climate change. We then evaluate how creating corridors to promote climate connectivity could potentially mitigate these restrictions, and we assess where strategies to increase connectivity will be most beneficial. By analyzing fragmentation patterns across the contiguous United States, we demonstrate that only 41% of natural land area retains enough connectivity to allow plants and animals to maintain climatic parity as the climate warms. In the eastern United States, less than 2% of natural area is sufficiently connected. Introducing corridors to facilitate movement through human-dominated regions increases the percentage of climatically connected natural area to 65%, with the most impactful gains in low-elevation regions, particularly in the southeastern United States. These climate connectivity analyses allow ecologists and conservation practitioners to determine the most effective regions for increasing connectivity. More importantly, our findings demonstrate that increasing climate connectivity is critical for allowing species to track rapidly changing climates, reconfiguring habitats to promote access to suitable climates. PMID:27298349

Achieving climate connectivity in a fragmented landscape.

PubMed

McGuire, Jenny L; Lawler, Joshua J; McRae, Brad H; Nuñez, Tristan A; Theobald, David M

2016-06-28

The contiguous United States contains a disconnected patchwork of natural lands. This fragmentation by human activities limits species' ability to track suitable climates as they rapidly shift. However, most models that project species movement needs have not examined where fragmentation will limit those movements. Here, we quantify climate connectivity, the capacity of landscape configuration to allow species movement in the face of dynamically shifting climate. Using this metric, we assess to what extent habitat fragmentation will limit species movements in response to climate change. We then evaluate how creating corridors to promote climate connectivity could potentially mitigate these restrictions, and we assess where strategies to increase connectivity will be most beneficial. By analyzing fragmentation patterns across the contiguous United States, we demonstrate that only 41% of natural land area retains enough connectivity to allow plants and animals to maintain climatic parity as the climate warms. In the eastern United States, less than 2% of natural area is sufficiently connected. Introducing corridors to facilitate movement through human-dominated regions increases the percentage of climatically connected natural area to 65%, with the most impactful gains in low-elevation regions, particularly in the southeastern United States. These climate connectivity analyses allow ecologists and conservation practitioners to determine the most effective regions for increasing connectivity. More importantly, our findings demonstrate that increasing climate connectivity is critical for allowing species to track rapidly changing climates, reconfiguring habitats to promote access to suitable climates.

State Medicaid Coverage, ESRD Incidence, and Access to Care

PubMed Central

Goldstein, Benjamin A.; Hall, Yoshio N.; Mitani, Aya A.; Winkelmayer, Wolfgang C.

2014-01-01

The proportion of low-income nonelderly adults covered by Medicaid varies widely by state. We sought to determine whether broader state Medicaid coverage, defined as the proportion of each state’s low-income nonelderly adult population covered by Medicaid, associates with lower state-level incidence of ESRD and greater access to care. The main outcomes were incidence of ESRD and five indicators of access to care. We identified 408,535 adults aged 20–64 years, who developed ESRD between January 1, 2001, and December 31, 2008. Medicaid coverage among low-income nonelderly adults ranged from 12.2% to 66.0% (median 32.5%). For each additional 10% of the low-income nonelderly population covered by Medicaid, there was a 1.8% (95% confidence interval, 1.0% to 2.6%) decrease in ESRD incidence. Among nonelderly adults with ESRD, gaps in access to care between those with private insurance and those with Medicaid were narrower in states with broader coverage. For a 50-year-old white woman, the access gap to the kidney transplant waiting list between Medicaid and private insurance decreased by 7.7 percentage points in high (>45%) versus low (<25%) Medicaid coverage states. Similarly, the access gap to transplantation decreased by 4.0 percentage points and the access gap to peritoneal dialysis decreased by 3.8 percentage points in high Medicaid coverage states. In conclusion, states with broader Medicaid coverage had a lower incidence of ESRD and smaller insurance-related access gaps. PMID:24652791

50 CFR 697.8 - Vessel identification.

Code of Federal Regulations, 2010 CFR

2010-10-01

... access American lobster permit and over 25 ft (7.6 m) in registered length must: (1) Have affixed... fishing vessel issued a limited access American lobster permit must display its official number in block... each vessel issued a limited access American lobster permit shall ensure that— (1) The vessel's name...

State Financial Aid to Students: A Trend Analysis of Access and Choice of Public or Private Colleges.

ERIC Educational Resources Information Center

Fenske, Robert H.; And Others

1979-01-01

Reports trends over a recent nine-year period in student access to and choice of public or private college as related to availability of monetary awards from one of the largest state student financial aid agencies, the Illinois State Scholarship Commission. Survey responses indicate that state awards foster access to Illinois college and…

Limited socioeconomic opportunities and Latina teen childbearing: a qualitative study of family and structural factors affecting future expectations.

PubMed

Minnis, Alexandra M; Marchi, Kristen; Ralph, Lauren; Biggs, M Antonia; Combellick, Sarah; Arons, Abigail; Brindis, Claire D; Braveman, Paula

2013-04-01

The decrease in adolescent birth rates in the United States has been slower among Latinas than among other ethnic/racial groups. Limited research has explored how socioeconomic opportunities influence childbearing among Latina adolescents. We conducted in-depth interviews with 65 pregnant foreign- and US-born Latina women (31 adolescents; 34 adults) in two California counties. We assessed perceived socioeconomic opportunities and examined how family, immigration and acculturation affected the relationships between socioeconomic opportunities and adolescent childbearing. Compared with women who delayed childbearing into adulthood, pregnant adolescents described having few resources for educational and career development and experiencing numerous socioeconomic and social barriers to achieving their goals. Socioeconomic instability and policies limiting access to education influenced childbearing for immigrant adolescents. In contrast, family disintegration tied to poverty figured prominently in US-born adolescents' childbearing. Limited socioeconomic opportunities may play a large role in persistently high pregnancy rates among Latina adolescents.

Web Content Accessibility of Consumer Health Information Web Sites for People with Disabilities: A Cross Sectional Evaluation

PubMed Central

Parmanto, Bambang

2004-01-01

Background The World Wide Web (WWW) has become an increasingly essential resource for health information consumers. The ability to obtain accurate medical information online quickly, conveniently and privately provides health consumers with the opportunity to make informed decisions and participate actively in their personal care. Little is known, however, about whether the content of this online health information is equally accessible to people with disabilities who must rely on special devices or technologies to process online information due to their visual, hearing, mobility, or cognitive limitations. Objective To construct a framework for an automated Web accessibility evaluation; to evaluate the state of accessibility of consumer health information Web sites; and to investigate the possible relationships between accessibility and other features of the Web sites, including function, popularity and importance. Methods We carried out a cross-sectional study of the state of accessibility of health information Web sites to people with disabilities. We selected 108 consumer health information Web sites from the directory service of a Web search engine. A measurement framework was constructed to automatically measure the level of Web Accessibility Barriers (WAB) of Web sites following Web accessibility specifications. We investigated whether there was a difference between WAB scores across various functional categories of the Web sites, and also evaluated the correlation between the WAB and Alexa traffic rank and Google Page Rank of the Web sites. Results We found that none of the Web sites we looked at are completely accessible to people with disabilities, i.e., there were no sites that had no violation of Web accessibility rules. However, governmental and educational health information Web sites do exhibit better Web accessibility than the other categories of Web sites (P < 0.001). We also found that the correlation between the WAB score and the popularity of a Web site is statistically significant (r = 0.28, P < 0.05), although there is no correlation between the WAB score and the importance of the Web sites (r = 0.15, P = 0.111). Conclusions Evaluation of health information Web sites shows that no Web site scrupulously abides by Web accessibility specifications, even for entities mandated under relevant laws and regulations. Government and education Web sites show better performance than Web sites among other categories. Accessibility of a Web site may have a positive impact on its popularity in general. However, the Web accessibility of a Web site may not have a significant relationship with its importance on the Web. PMID:15249268

Data inconsistencies from states with unconventional oil and gas activity.

PubMed

Malone, Samantha; Kelso, Matthew; Auch, Ted; Edelstein, Karen; Ferrar, Kyle; Jalbert, Kirk

2015-01-01

The quality and availability of unconventional oil and gas (O&G) data in the United States have never been compared methodically state-to-state. By conducting such an assessment, this study seeks to better understand private and publicly sourced data variability and to identify data availability gaps. We developed an exploratory data-grading tool - Data Accessibility and Usability Index (DAUI) - to guide the review of O&G data quality. Between July and October 2013, we requested, collected, and assessed 5 categories of unconventional O&G data (wells drilled, violations, production, waste, and Class II disposal wells) from 10 states with active drilling activity. We based our assessment on eight data quality parameters (accessibility, usability, point location, completeness, metadata, agency responsiveness, accuracy, and cost). Using the DAUI, two authors graded the 10 states and then averaged their scores. The average score received across all states, data categories, and parameters was 67.1 out of 100, largely insufficient for proper data transparency. By state, Pennsylvania received the highest average ( = 93.5) and ranked first in all but one data category. The lowest scoring state was Texas ( = 44) largely due to its policy of charging for certain data. This article discusses the various reasons for scores received, as well as methodological limitations of the assessment metrics. We argue that the significant variability of unconventional O&G data-and its availability to the public-is a barrier to regulatory and industry transparency. The lack of transparency also impacts public education and broader participation in industry governance. This study supports the need to develop a set of data best management practices (BMPs) for state regulatory agencies and the O&G industry, and suggests potential BMPs for this purpose.

Exploring the interaction of activity limitations with context, systems, community and personal factors in accessing public health care services: A presentation of South African case studies.

PubMed

Mji, Gubela; Braathen, Stine H; Vergunst, Richard; Scheffler, Elsje; Kritzinger, Janis; Mannan, Hasheem; Schneider, Marguerite; Swartz, Leslie; Visagie, Surona

2017-02-08

There are many factors that influence access to public health services, such as the context people live in, the existing health services, and personal, cultural and community factors. People with disabilities (activity limitations), through their experience of health services, may offer a particular understanding of the performance of the health services, thus exposing health system limitations more clearly than perhaps any other health service user. This article explores how activity limitations interact with factors related to context, systems, community and personal factors in accessing public health care services in South Africa. We present four case studies of people with disabilities from four low-resource diverse contexts in South Africa (rural, semi-rural, farming community and peri-urban) to highlight challenges of access to health services experienced by people with activity limitations in a variety of contexts. One case study of a person with disabilities was chosen from each study setting to build evidence using an intensive qualitative case study methodology to elucidate individual and household experiences of challenges experienced by people with activity limitations when attempting to access public health services. In-depth interviews were used to collect data, using an interview guide. The analysis was conducted in the form of a thematic analysis using the interview topics as a starting point. First, these four case studies demonstrate that equitable access to health services for people with activity limitations is influenced by a complex interplay of a variety of factors for a single individual in a particular context. Secondly, that while problems with access to public health services are experienced by everyone, people with activity limitations are affected in particular ways making them particularly vulnerable in using public health services. The revitalisation of primary health care and the introduction of national health insurance by the Health Department of South Africa open a window of opportunity for policy makers and policy implementers to revisit and address the areas of access to public health services for people with activity limitations.

Examining the potential of information technology to improve public insurance application processes: enrollee assessments from a concurrent mixed method analysis.

PubMed

Mishra, Abhay Nath; Ketsche, Patricia; Marton, James; Snyder, Angela; McLaren, Susan

2014-01-01

To assess the perceived readiness of Medicaid and Children's Health Insurance Program (CHIP) enrollees to use information technologies (IT) in order to facilitate improvements in the application processes for these public insurance programs. We conducted a concurrent mixed method study of Medicaid and CHIP enrollees in a southern state. We conducted focus groups to identify enrollee concerns regarding the current application process and their IT proficiency. Additionally, we surveyed beneficiaries via telephone about their access to and use of the Internet, and willingness to adopt IT-enabled processes. 2013 households completed the survey. We used χ(2) analysis for comparisons across different groups of respondents. A majority of enrollees will embrace IT-enabled enrollment, but a small yet significant group continues to lack access to facilitating technologies. Moreover, a segment of beneficiaries in the two programs continues to place a high value on personal interactions with program caseworkers. IT holds the promise of improving efficiency and reducing barriers for enrollees, but state and federal agencies managing public insurance programs need to ensure access to traditional processes and make caseworkers available to those who require and value such assistance, even after implementing IT-enabled processes. The use of IT-enabled processes is essential for effectively managing eligibility and enrollment determinations for public programs and private plans offered through state or federally operated exchanges. However, state and federal officials should be cognizant of the technological readiness of recipients and provide offline help to ensure broad participation in the insurance market. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Developing a model of limited-access nicotine consumption in C57Bl/6J mice.

PubMed

Kasten, C R; Frazee, A M; Boehm, S L

2016-09-01

Although United States smoking rates have been on the decline over the past few decades, cigarette smoking still poses a critical health and economic threat. Very few treatment options for smoking exist, and many of them do not lead to long-term abstinence. Preclinical models are necessary for understanding the effects of nicotine and developing treatments. Current self-administration models of nicotine intake may require surgical procedures and often result in low levels of intake. Further, they do not lend themselves to investigating treatments. The current study sought to develop a limited-access model of nicotine intake using the Drinking-in-the-Dark paradigm, which results in high levels of binge-like ethanol consumption that can be pharmacologically manipulated. The present study found that mice will consume nicotine under a range of parameters. Intakes under the preferred condition of 0.14mg/ml nicotine in 0.2% saccharin reached over 6mg/kg in two hours and were reduced by an injection of R(+)-baclofen. Mecamylamine did not significantly affect nicotine consumption. As nicotine and ethanol are often co-abused, nicotine intake was also tested in the presence of ethanol. When presented in the same bottle, mice altered nicotine intake under various concentrations to maintain consistent levels of ethanol intake. When nicotine and ethanol were presented in separate bottles, mice greatly reduced their nicotine intake while maintaining ethanol intake. In conclusion, these studies characterize a novel model of limited-access nicotine intake that can be pharmacologically manipulated. Copyright © 2016 Elsevier Inc. All rights reserved.

Systematically excluded: Young women's experiences of accessing child support grants in South Africa.

PubMed

Gibbs, Andrew; Washington, Laura; Jama Shai, Nwabisa; Sikweyiya, Yandisa; Willan, Samantha

2018-03-13

Unconditional cash transfers have risen in prominence for their potential to improve the health of the world's most marginalised and bring them into a relationship with the state. Typically, challenges to accessing grants are described in terms of technical issues such as access to documents and distance to offices. This paper explores the challenges of 30 young, poor, black South African women in accessing the Child Support Grant (CSG), an unconditional cash transfer provided by the South African government. Data suggest that while there were 'technical' issues, young women were systematically excluded from accessing the CSG in two ways. First, women were symbolically marginalised by state officials, who humiliated them, forcing women to sit quietly and acquiesce to state power to access the CSG. Second, there were large distances for women to travel to access state services, despite these being geared to serve the poor. Rather than promoting the active citizenship of the poorest in South Africa, accessing the CSG reinforced marginalisation. Transforming this will not be achieved through technical solutions, rather the barriers to access need to be recognised as political.

Children's Access to Dental Care Affected by Reimbursement Rates, Dentist Density, and Dentist Participation in Medicaid.

PubMed

Chalmers, Natalia I; Compton, Robert D

2017-10-01

To assess the relation between Medicaid reimbursement rates and access to dental care services in the context of dentist density and dentist participation in Medicaid in each state. Data were from Early and Periodic Screening, Diagnostic, and Treatment reports for 2014, Medicaid reimbursement rate in 2013, dentist density in 2014, and dentist participation in Medicaid in 2014. We assessed patterns of mediation or moderation. Reimbursement rates and access to dental care were directly related at the state level, but no evidence indicated that higher reimbursement rates resulted in overuse of dental services for those who had access. The relation between reimbursement rates and access to care was moderated by dentist density and dentist participation in Medicaid. We estimate that more than 1.8 million additional children would have had access to dental care if reimbursement rates were higher in states with low rates. Children who access the dental care system receive care, but reimbursement may significantly affect access. States with low dentist density and low dentist participation in Medicaid may be able to improve access to dental services significantly by increasing reimbursement rates.

Role of the private sector in vaccination service delivery in India: evidence from private-sector vaccine sales data, 2009-12.

PubMed

Sharma, Abhishek; Kaplan, Warren A; Chokshi, Maulik; Zodpey, Sanjay P

2016-09-01

India's Universal Immunization Programme (UIP) provides basic vaccines free-of-cost in the public sector, yet national vaccination coverage is poor. The Government of India has urged an expanded role for the private sector to help achieve universal immunization coverage. We conducted a state-by-state analysis of the role of the private sector in vaccinating Indian children against each of the six primary childhood diseases covered under India's UIP. We analyzed IMS Health data on Indian private-sector vaccine sales, 2011 Indian Census data and national household surveys (DHS/NFHS 2005-06 and UNICEF CES 2009) to estimate the percentage of vaccinated children among the 2009-12 birth cohort who received a given vaccine in the private sector in 16 Indian states. We also analyzed the estimated private-sector vaccine shares as function of state-specific socio-economic status. Overall in 16 states, the private sector contributed 4.7% towards tuberculosis (Bacillus Calmette-Guérin (BCG)), 3.5% towards measles, 2.3% towards diphtheria-pertussis-tetanus (DPT3) and 7.6% towards polio (OPV3) overall (both public and private sectors) vaccination coverage. Certain low income states (Uttar Pradesh, Rajasthan, Madhya Pradesh, Orissa, Assam and Bihar) have low private as well as public sector vaccination coverage. The private sector's role has been limited primarily to the high income states as opposed to these low income states where the majority of Indian children live. Urban areas with good access to the private sector and the ability to pay increases the Indian population's willingness to access private-sector vaccination services. In India, the public sector offers vaccination services to the majority of the population but the private sector should not be neglected as it could potentially improve overall vaccination coverage. The government could train and incentivize a wider range of private-sector health professionals to help deliver the vaccines, especially in the low income states with the largest birth cohorts. We recommend future studies to identify strengths and limitations of the public and private health sectors in each Indian state. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Information Access in Rural Areas of the United States: The Public Library's Role in the Digital Divide and the Implications of Differing State Funding Models

ERIC Educational Resources Information Center

Thiele, Jennifer

2016-01-01

In the United States, individual states have different means of determining and distributing funding. This influences library service and access to information particularly as it pertains to critical Internet access. Funding and service trends have changed, especially as it relates to public libraries, with some modifications working to their…

Surveillance for Health Care Access and Health Services Use, Adults Aged 18-64 Years - Behavioral Risk Factor Surveillance System, United States, 2014.

PubMed

Okoro, Catherine A; Zhao, Guixiang; Fox, Jared B; Eke, Paul I; Greenlund, Kurt J; Town, Machell

2017-02-24

As a result of the 2010 Patient Protection and Affordable Care Act, millions of U.S. adults attained health insurance coverage. However, millions of adults remain uninsured or underinsured. Compared with adults without barriers to health care, adults who lack health insurance coverage, have coverage gaps, or skip or delay care because of limited personal finances might face increased risk for poor physical and mental health and premature mortality. 2014. The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Data are collected from states, the District of Columbia, and participating U.S. territories on health risk behaviors, chronic health conditions, health care access, and use of clinical preventive services (CPS). An optional Health Care Access module was included in the 2014 BRFSS. This report summarizes 2014 BRFSS data from all 50 states and the District of Columbia on health care access and use of selected CPS recommended by the U.S. Preventive Services Task Force or the Advisory Committee on Immunization Practices among working-aged adults (aged 18-64 years), by state, state Medicaid expansion status, expanded geographic region, and federal poverty level (FPL). This report also provides analysis of primary type of health insurance coverage at the time of interview, continuity of health insurance coverage during the preceding 12 months, and other health care access measures (i.e., unmet health care need because of cost, unmet prescription need because of cost, medical debt [medical bills being paid off over time], number of health care visits during the preceding year, and satisfaction with received health care) from 43 states that included questions from the optional BRFSS Health Care Access module. In 2014, health insurance coverage and other health care access measures varied substantially by state, state Medicaid expansion status, expanded geographic region (i.e., states categorized geographically into nine regions), and FPL category. The following proportions refer to the range of estimated prevalence for health insurance and other health care access measures by examined geographical unit (unless otherwise specified), as reported by respondents. Among adults with health insurance coverage, the range was 70.8%-94.5% for states, 78.8%-94.5% for Medicaid expansion states, 70.8%-89.1% for nonexpansion states, 73.3%-91.0% for expanded geographic regions, and 64.2%-95.8% for FPL categories. Among adults who had a usual source of health care, the range was 57.2%-86.6% for states, 57.2%-86.6% for Medicaid expansion states, 61.8%-83.9% for nonexpansion states, 64.4%-83.6% for expanded geographic regions, and 61.0%-81.6% for FPL categories. Among adults who received a routine checkup, the range was 52.1%-75.5% for states, 56.0%-75.5% for Medicaid expansion states, 52.1%-71.1% for nonexpansion states, 56.8%-70.2% for expanded geographic regions, and 59.9%-69.2% for FPL categories. Among adults who had unmet health care need because of cost, the range was 8.0%-23.1% for states, 8.0%-21.9% for Medicaid expansion states, 11.9%-23.1% for nonexpansion states, 11.6%-20.3% for expanded geographic regions, and 5.3%-32.9% for FPL categories. Estimated prevalence of cancer screenings, influenza vaccination, and having ever been tested for human immunodeficiency virus also varied by state, state Medicaid expansion status, expanded geographic region, and FPL category. The prevalence of insurance coverage varied by approximately 25 percentage points among racial/ethnic groups (range: 63.9% among Hispanics to 88.4% among non-Hispanic Asians) and by approximately 32 percentage points by FPL category (range: 64.2% among adults with household income <100% of FPL to 95.8% among adults with household income >400% of FPL). The prevalence of unmet health care need because of cost varied by nearly 14 percentage points among racial/ethnic groups (range: 11.3% among non-Hispanic Asians to 25.0% among Hispanics), by approximately 17 percentage points among adults with and without disabilities (30.8% versus 13.7%), and by approximately 28 percentage points by FPL category (range: 5.3% among adults with household income >400% of FPL to 32.9% among adults with household income <100% of FPL). Among the 43 states that included questions from the optional module, a majority of adults reported private health insurance coverage (63.4%), followed by public health plan coverage (19.4%) and no primary source of insurance (17.1%). Financial barriers to health care (unmet health care need because of cost, unmet prescribed medication need because of cost, and medical bills being paid off over time [medical debt]) were typically lower among adults in Medicaid expansion states than those in nonexpansion states regardless of source of insurance. Approximately 75.6% of adults reported being continuously insured during the preceding 12 months, 12.9% reported a gap in coverage, and 11.5% reported being uninsured during the preceding 12 months. The largest proportion of adults reported ≥3 visits to a health care professional during the preceding 12 months (47.3%), followed by 1-2 visits (37.1%), and no health care visits (15.6%). Adults in expansion and nonexpansion states reported similar levels of satisfaction with received health care by primary source of health insurance coverage and by continuity of health insurance coverage during the preceding 12 months. This report presents for the first time estimates of population-based health care access and use of CPS among adults aged 18-64 years. The findings in this report indicate substantial variations in health insurance coverage; other health care access measures; and use of CPS by state, state Medicaid expansion status, expanded geographic region, and FPL category. In 2014, health insurance coverage, having a usual source of care, having a routine checkup, and not experiencing unmet health care need because of cost were higher among adults living below the poverty level (i.e., household income <100% of FPL) in states that expanded Medicaid than in states that did not. Similarly, estimates of breast and cervical cancer screening and influenza vaccination were higher among adults living below the poverty level in states that expanded Medicaid than in states that did not. These disparities might be due to larger differences to begin with, decreased disparities in Medicaid expansion states versus nonexpansion states, or increased disparities in nonexpansion states. BRFSS data from 2014 can be used as a baseline by which to assess and monitor changes that might occur after 2014 resulting from programs and policies designed to increase access to health care, reduce health disparities, and improve the health of the adult population. Post-2014 changes in health care access, such as source of health insurance coverage, attainment and continuity of coverage, financial barriers, preventive care services, and health outcomes, can be monitored using these baseline estimates.

HIPAA Privacy 101: essentials for case management practice.

PubMed

DiBenedetto, Deborah V

2003-01-01

The Health Insurance Portability and Accountability Act (HIPAA) has significant impact on the delivery of healthcare in the United States. The Administrative Simplification (AS) requirements of HIPAA are aimed at reducing administrative costs and burdens in the healthcare industry. The core components of HIPAA's AS requirements address healthcare transactions, code sets, security, unique identifiers, and privacy of health information. HIPAA's privacy standard limits the nonconsensual use and release of private health information, gives patients new rights to access their medical records and to know who else has accessed them, restricts most disclosure of health information to the minimum needed for the intended purpose, establishes new criminal and civil sanctions for improper use or disclosure, and establishes new requirements for access to records by researchers and others. This article focuses on HIPAA's privacy requirements as related to case management of workers compensation populations, the treatment of protected health information, and how case managers can ensure they provide appropriate services while navigating the requirements of HIPAA's privacy standard.

Design of a patient-centered, multi-institutional healthcare information network using peer-to-peer communication in a highly distributed architecture.

PubMed

Geissbuhler, Antoine; Spahni, Stéphane; Assimacopoulos, André; Raetzo, Marc-André; Gobet, Gérard

2004-01-01

to design a community healthcare information network for all 450,000 citizen in the State of Geneva, Switzerland, connecting public and private healthcare professionals. Requirements include the decentralized storage of information at the source of its production, the creation of a virtual patient record at the time of the consultation, the control by the patient of the access rights to the information, and the interoperability with other similar networks at the national and european level. a participative approach and real-world pilot projects are used to design, test and validate key components of the network, including its technical architecture and the strategy for the management of access rights by the patients. a distributed architecture using peer-to-peer communication of information mediators can implement the various requirements while limiting to an absolute minimum the amount of centralized information. Access control can be managed by the patient with the help of a medical information mediator, the physician of trust.

Accessing and operating agricultural machinery: Advancements in assistive technology for users with impaired mobility.

PubMed

Ehlers, Shawn G; Field, William E

2018-02-14

This research focused on the advancements made in enabling agricultural workers with impaired mobility to access and operate off-road agricultural machinery. Although not a new concept, technological advancements in remote-controlled lifts, electronic actuators, electric over hydraulic controllers, and various modes of hand controls have advanced significantly, allowing operators with limited mobility to resume a high level of productivity in agricultural-related enterprises. In the United States, approximately 1.7% of the population is living with some form of paralysis or significant mobility impairment. When paired with the 2012 USDA Agriculture Census of 3.2 million farmers, it can be extrapolated that these technologies could impact 54,000 agricultural workers who have encountered disabling injuries or disease, which inhibit their ability to access and operate tractors, combines, and other self-propelled agricultural machines. Advancements in agricultural-specific technologies can allow for many of these individuals to regain the ability to effectively operate machinery once more.

Non-inductively driven tokamak plasmas at near-unity βt in the Pegasus toroidal experiment

NASA Astrophysics Data System (ADS)

Reusch, J. A.; Bodner, G. M.; Bongard, M. W.; Burke, M. G.; Fonck, R. J.; Pachicano, J. L.; Perry, J. M.; Pierren, C.; Rhodes, A. T.; Richner, N. J.; Rodriguez Sanchez, C.; Schlossberg, D. J.; Weberski, J. D.

2018-05-01

A major goal of the spherical tokamak (ST) research program is accessing a state of low internal inductance ℓi, high elongation κ, and high toroidal and normalized beta ( βt and βN) without solenoidal current drive. Local helicity injection (LHI) in the Pegasus ST [Garstka et al., Nucl. Fusion 46, S603 (2006)] provides non-solenoidally driven plasmas that exhibit these characteristics. LHI utilizes compact, edge-localized current sources for plasma startup and sustainment. It results in hollow current density profiles with low ℓi. The low aspect ratio ( R0/a ˜1.2 ) of Pegasus allows access to high κ and high normalized plasma currents ( IN=Ip/a BT>14 ). Magnetic reconnection during LHI provides auxiliary ion heating. Together, these features provide access to very high βt plasmas. Equilibrium analyses indicate that βt up to ˜100% is achieved. These high βt discharges disrupt at the ideal no-wall β limit at βN˜7.

Stem cell research funding policies and dynamic innovation: a survey of open access and commercialization requirements.

PubMed

Lévesque, Maroussia; Kim, Jihyun Rosel; Isasi, Rosario; Knoppers, Bartha Maria; Plomer, Aurora; Joly, Yann

2014-08-01

This article compares and contrasts the pressures of both open access data sharing and commercialization policies in the context of publicly funded embryonic stem cell research (SCR). First, normative guidelines of international SCR organizations were examined. We then examined SCR funding guidelines and the project evaluation criteria of major funding organizations in the EU, the United Kingdom (UK), Spain, Canada and the United States. Our survey of policies revealed subtle pressures to commercialize research that include: increased funding availability for commercialization opportunities, assistance for obtaining intellectual property rights (IPRs) and legislation mandating commercialization. In lieu of open access models, funders are increasingly opting for limited sharing models or "protected commons" models that make the research available to researchers within the same region or those receiving the same funding. Meanwhile, there still is need for funding agencies to clarify and standardize terms such as "non-profit organizations" and "for-profit research," as more universities are pursuing for-profit or commercial opportunities.

Exploring visitor acceptability for hardening trails to sustain visitation and minimize impacts

USGS Publications Warehouse

Cahill, K.L.; Marion, J.L.; Lawson, S.R.

2008-01-01

Protected natural area managers are challenged to provide high quality recreation opportunities and ensure the protection of resources from impacts associated with visitation. Development of visitor use facilities and application of site hardening practices are commonly applied tools for achieving these competing management objectives. This study applies stated choice analysis to examine visitor opinions on acceptability when they are asked to make tradeoffs among competing social, resource and management attributes in backcountry and frontcountry settings of Acadia National Park. This study demonstrates that asking visitors about recreation setting attributes uni-dimensionally, a common approach, can yield less informative responses. Analyses that considered direct tradeoffs revealed more divergent opinions on acceptability for setting attributes than a unidimensional approach. Findings revealed that visitors to an accessible and popular attraction feature supported trail development options to protect resource conditions with unrestricted visitor access. In contrast, visitors to a remote undeveloped island expressed stronger support for no or limited trail development and access restrictions to protect resource conditions.

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

Levin, Barnaby D. A.; Padgett, Elliot; Chen, Chien-Chun

Electron tomography in materials science has flourished with the demand to characterize nanoscale materials in three dimensions (3D). Access to experimental data is vital for developing and validating reconstruction methods that improve resolution and reduce radiation dose requirements. This work presents five high-quality scanning transmission electron microscope (STEM) tomography datasets in order to address the critical need for open access data in this field. The datasets represent the current limits of experimental technique, are of high quality, and contain materials with structural complexity. Included are tomographic series of a hyperbranched Co 2 P nanocrystal, platinum nanoparticles on a carbonmore » nanofibre imaged over the complete 180° tilt range, a platinum nanoparticle and a tungsten needle both imaged at atomic resolution by equal slope tomography, and a through-focal tilt series of PtCu nanoparticles. A volumetric reconstruction from every dataset is provided for comparison and development of post-processing and visualization techniques. Researchers interested in creating novel data processing and reconstruction algorithms will now have access to state of the art experimental test data.« less

Perceived Barriers to Information Access Among Medical Residents in Iran: Obstacles to Answering Clinical Queries in Settings with Limited Internet Accessibility

PubMed Central

Mazloomdoost, Danesh; Mehregan, Shervineh; Mahmoudi, Hilda; Soltani, Akbar; Embi, Peter J.

2007-01-01

Studies performed in the US and other Western countries have documented that physicians generate many clinical questions during a typical day and rely on various information sources for answers. Little is known about the information seeking behaviors of physicians practicing in other countries, particularly those with limited Internet connectivity. We conducted this study to document the perceived barriers to information resources used by medical residents in Iran. Our findings reveal that different perceived barriers exist for electronic versus paper-based resources. Notably, paper-based resources are perceived to be limited by resident time-constraints and availability of resources, whereas electronic resources are limited by cost decentralized resources (such as PDAs) and accessibility of centralized, Internet access. These findings add to the limited literature regarding health information-seeking activities in international healthcare settings, particularly those with limited Internet connectivity, and will supplement future studies of and interventions in such settings. PMID:18693891

Perceived barriers to information access among medical residents in Iran: obstacles to answering clinical queries in settings with limited Internet accessibility.

PubMed

Mazloomdoost, Danesh; Mehregan, Shervineh; Mahmoudi, Hilda; Soltani, Akbar; Embi, Peter J

2007-10-11

Studies performed in the US and other Western countries have documented that physicians generate many clinical questions during a typical day and rely on various information sources for answers. Little is known about the information seeking behaviors of physicians practicing in other countries, particularly those with limited Internet connectivity. We conducted this study to document the perceived barriers to information resources used by medical residents in Iran. Our findings reveal that different perceived barriers exist for electronic versus paper-based resources. Notably, paper-based resources are perceived to be limited by resident time-constraints and availability of resources, whereas electronic resources are limited by cost decentralized resources (such as PDAs) and accessibility of centralized, Internet access. These findings add to the limited literature regarding health information-seeking activities in international healthcare settings, particularly those with limited Internet connectivity, and will supplement future studies of and interventions in such settings.

Overview of emerging nonvolatile memory technologies

PubMed Central

2014-01-01

Nonvolatile memory technologies in Si-based electronics date back to the 1990s. Ferroelectric field-effect transistor (FeFET) was one of the most promising devices replacing the conventional Flash memory facing physical scaling limitations at those times. A variant of charge storage memory referred to as Flash memory is widely used in consumer electronic products such as cell phones and music players while NAND Flash-based solid-state disks (SSDs) are increasingly displacing hard disk drives as the primary storage device in laptops, desktops, and even data centers. The integration limit of Flash memories is approaching, and many new types of memory to replace conventional Flash memories have been proposed. Emerging memory technologies promise new memories to store more data at less cost than the expensive-to-build silicon chips used by popular consumer gadgets including digital cameras, cell phones and portable music players. They are being investigated and lead to the future as potential alternatives to existing memories in future computing systems. Emerging nonvolatile memory technologies such as magnetic random-access memory (MRAM), spin-transfer torque random-access memory (STT-RAM), ferroelectric random-access memory (FeRAM), phase-change memory (PCM), and resistive random-access memory (RRAM) combine the speed of static random-access memory (SRAM), the density of dynamic random-access memory (DRAM), and the nonvolatility of Flash memory and so become very attractive as another possibility for future memory hierarchies. Many other new classes of emerging memory technologies such as transparent and plastic, three-dimensional (3-D), and quantum dot memory technologies have also gained tremendous popularity in recent years. Subsequently, not an exaggeration to say that computer memory could soon earn the ultimate commercial validation for commercial scale-up and production the cheap plastic knockoff. Therefore, this review is devoted to the rapidly developing new class of memory technologies and scaling of scientific procedures based on an investigation of recent progress in advanced Flash memory devices. PMID:25278820

Overview of emerging nonvolatile memory technologies.

PubMed

Meena, Jagan Singh; Sze, Simon Min; Chand, Umesh; Tseng, Tseung-Yuen

2014-01-01

Nonvolatile memory technologies in Si-based electronics date back to the 1990s. Ferroelectric field-effect transistor (FeFET) was one of the most promising devices replacing the conventional Flash memory facing physical scaling limitations at those times. A variant of charge storage memory referred to as Flash memory is widely used in consumer electronic products such as cell phones and music players while NAND Flash-based solid-state disks (SSDs) are increasingly displacing hard disk drives as the primary storage device in laptops, desktops, and even data centers. The integration limit of Flash memories is approaching, and many new types of memory to replace conventional Flash memories have been proposed. Emerging memory technologies promise new memories to store more data at less cost than the expensive-to-build silicon chips used by popular consumer gadgets including digital cameras, cell phones and portable music players. They are being investigated and lead to the future as potential alternatives to existing memories in future computing systems. Emerging nonvolatile memory technologies such as magnetic random-access memory (MRAM), spin-transfer torque random-access memory (STT-RAM), ferroelectric random-access memory (FeRAM), phase-change memory (PCM), and resistive random-access memory (RRAM) combine the speed of static random-access memory (SRAM), the density of dynamic random-access memory (DRAM), and the nonvolatility of Flash memory and so become very attractive as another possibility for future memory hierarchies. Many other new classes of emerging memory technologies such as transparent and plastic, three-dimensional (3-D), and quantum dot memory technologies have also gained tremendous popularity in recent years. Subsequently, not an exaggeration to say that computer memory could soon earn the ultimate commercial validation for commercial scale-up and production the cheap plastic knockoff. Therefore, this review is devoted to the rapidly developing new class of memory technologies and scaling of scientific procedures based on an investigation of recent progress in advanced Flash memory devices.

76 FR 70912 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-16

... Access Area from being exceeded during the 2011 fishing year. DATES: Effective November 12, 2011, through... Limited Access General Category IFQ scallop vessels for the remainder of the 2011 fishing year. As of November 12, 2011, no scallop vessel fishing under Limited Access General Category IFQ regulations may...

75 FR 20564 - Dynamic Random Access Memory Semiconductors from the Republic of Korea: Extension of Time Limit...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-20

... DEPARTMENT OF COMMERCE International Trade Administration [C-580-851] Dynamic Random Access Memory Semiconductors from the Republic of Korea: Extension of Time Limit for Preliminary Results of Countervailing Duty... access memory semiconductors from the Republic of Korea, covering the period January 1, 2008 through...

Information Needs Assessment for K-12 School Nurses in Rural Eastern Washington State.

PubMed

Vela, Kathryn

2017-01-01

School nurses are an often-overlooked population of health care professionals who have great importance in rural communities where access to health care is limited. In order to better serve school nurses in rural eastern Washington, an assessment was conducted to determine their information needs, behaviors, and perceptions. Results indicated this population of school nurses searches for multiple types of health information on a daily basis and navigates obstacles to information access using a variety of resources. While largely confident in their searching ability, they are open to learning more about how to find reliable health information to support their daily responsibilities. These results will guide the development of a workshop for school nurses about using reliable health information resources to improve health care in their rural communities.

The Negative Effects of Public Benefits on Individual Employment: A Multilevel Analysis of Work Hours.

PubMed

Nord, Derek; Nye-Lengerman, Kelly

2015-08-01

Public benefits are widely used by people with intellectual and development disabilities (IDD) as crucial financial supports. Using Rehabilitation Service Administration 911 and Annual Review Report datasets to account for individual and state vocational rehabilitation (VR) agency variables, a sample of 21,869 people with IDD were analyzed using hierarchical linear modeling to model the effects of public benefits on hours worked per week. Findings point to associations that indicate that public benefits not only limit access to employment participation, they also have a restricting effect on growth of weekly hours that typically come with higher wage positions, compared those that do not access benefits. The article also lays out important implications and recommendations to increase the inclusion of people with IDD in the workplace.

Energetics of intrinsic defects in NiO and the consequences for its resistive random access memory performance

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

Dawson, J. A., E-mail: jad95@cam.ac.uk; Guo, Y.; Robertson, J.

2015-09-21

Energetics for a variety of intrinsic defects in NiO are calculated using state-of-the-art ab initio hybrid density functional theory calculations. At the O-rich limit, Ni vacancies are the lowest cost defect for all Fermi energies within the gap, in agreement with the well-known p-type behaviour of NiO. However, the ability of the metal electrode in a resistive random access memory metal-oxide-metal setup to shift the oxygen chemical potential towards the O-poor limit results in unusual NiO behaviour and O vacancies dominating at lower Fermi energy levels. Calculated band diagrams show that O vacancies in NiO are positively charged at themore » operating Fermi energy giving it the advantage of not requiring a scavenger metal layer to maximise drift. Ni and O interstitials are generally found to be higher in energy than the respective vacancies suggesting that significant recombination of O vacancies and interstitials does not take place as proposed in some models of switching behaviour.« less

Fluorescent pseudorotaxanes of a quinodicarbocyanine dye with gamma cyclodextrin

NASA Astrophysics Data System (ADS)

Bernstein, Olivia M.; McGee, Tiffany E.; Silzel, Lisa E.; Silzel, John W.

2018-01-01

Spectrophotometric titration of buffered solutions of gamma cyclodextrin (γCD) and 1,1‧-diethyl,2,2‧-dicarbocyanine (DDI) demonstrates extension of the known 1:2 host:guest complex to form a previously unreported 2:2 complex near the γCD solubility limit. Though DDI is predominantly hosted as a non-fluorescent H-aggregate, both complexes exist in respective equilibria with two secondary complexes hosting unaggregated DDI as 1:1 and 2:1 complexes. The 2:1 complex exhibits significant fluorescence emission, with a quantum yield six times that of DDI in organic solvents, but ten times lower than that of an analogous indodicarbocyanine. Fragment Molecular Orbital calculations suggest that the 2:1 complex has the tail-to-tail conformation, and that solvent access to the dye strongly favors photoisomerization. In the host-guest complex, γCD limits solvent access to the dye and hinders rotation of the quinolyl terminal groups, but nevertheless pairwise rotation of methine carbons within the γCD cavity likely remains as a significant nonradiative relaxation pathway for the excited state.

Medical malpractice in American urology: 22-year national review of the impact of caps and implications for contemporary practice.

PubMed

Hsieh, Michael H; Tan, Arthur G; Meng, Maxwell V

2008-05-01

Of the economic pressures on physicians practicing in the United States medical malpractice and associated costs are a major component. State tort reform in the form of caps on noneconomic awards has been pursued to control insurance premiums and improve patient access to care. We comprehensively examined jury verdicts involving urologists and determined the nature of these cases and their relationship to changes in tort reform. We searched the LexisNexis database for all malpractice cases involving urologists using the search terms urologist and malpractice. The query included all cases between 1984 and 2005, which were categorized by state, year, amount and the nature of the injury. We identified 322 jury verdict cases, of which 175 (54%) were in favor of the defendant. In states with caps the median verdict settlement within or outside the periods of caps was $350,000 and $150,000, respectively. States without caps had a median verdict or settlement of $491,500. However, the number of suits and the size of the verdict/settlement in states with and without caps during this period did not appear to be related to tort reform. Common clinical situations, such as prostate cancer and transurethral prostate resection, accounted for most suits. Although the concept and goals of malpractice caps seem desirable, there is little evidence that decreased physician premiums and improved access to care have been achieved via tort reform. Thus, while state and national legislative efforts to limit the economic burden on urologists continue, the specialty of urology must look to other approaches to improve the situation.

Linear Time Algorithms to Restrict Insider Access using Multi-Policy Access Control Systems

PubMed Central

Mell, Peter; Shook, James; Harang, Richard; Gavrila, Serban

2017-01-01

An important way to limit malicious insiders from distributing sensitive information is to as tightly as possible limit their access to information. This has always been the goal of access control mechanisms, but individual approaches have been shown to be inadequate. Ensemble approaches of multiple methods instantiated simultaneously have been shown to more tightly restrict access, but approaches to do so have had limited scalability (resulting in exponential calculations in some cases). In this work, we take the Next Generation Access Control (NGAC) approach standardized by the American National Standards Institute (ANSI) and demonstrate its scalability. The existing publicly available reference implementations all use cubic algorithms and thus NGAC was widely viewed as not scalable. The primary NGAC reference implementation took, for example, several minutes to simply display the set of files accessible to a user on a moderately sized system. In our approach, we take these cubic algorithms and make them linear. We do this by reformulating the set theoretic approach of the NGAC standard into a graph theoretic approach and then apply standard graph algorithms. We thus can answer important access control decision questions (e.g., which files are available to a user and which users can access a file) using linear time graph algorithms. We also provide a default linear time mechanism to visualize and review user access rights for an ensemble of access control mechanisms. Our visualization appears to be a simple file directory hierarchy but in reality is an automatically generated structure abstracted from the underlying access control graph that works with any set of simultaneously instantiated access control policies. It also provide an implicit mechanism for symbolic linking that provides a powerful access capability. Our work thus provides the first efficient implementation of NGAC while enabling user privilege review through a novel visualization approach. This may help transition from concept to reality the idea of using ensembles of simultaneously instantiated access control methodologies, thereby limiting insider threat. PMID:28758045

Compliance with youth access regulations for indoor UV tanning.

PubMed

Hester, Eric J; Heilig, Lauren F; D'Ambrosia, Renee; Drake, Amanda L; Schilling, Lisa M; Dellavalle, Robert P

2005-08-01

To describe youth access to indoor UV tanning and youth discount pricing incentives in 4 states with different age restrictions: Colorado (no age restrictions), Texas (age 13 years), Illinois (age 14 years), and Wisconsin (age 16 years). Cross-sectional telephone survey conducted in October 2003 using a standardized script to assess the practices of randomly selected UV tanning operators. Randomly selected licensed indoor UV tanning facility operators in Colorado, Texas, Illinois, and Wisconsin. Number of facilities (1) complying with indoor UV tanning minimum age regulations for a 12-year-old potential patron and a 15-year-old potential patron and (2) offering youth discounts. For a 12-year-old potential patron, 62% of facilities in states with minimum age restrictions prohibiting 12-year-olds had an operator report that they would not permit indoor tanning (Texas, 23%; Illinois, 74%; and Wisconsin, 89%) compared with 18% in Colorado, a state without youth access regulations. For a 15-year-old patron, most facilities in Wisconsin, the only state with a minimum age restriction for 15-year-olds, prohibited access (77%). Overall, 15% of operators offered youth discounts: Texas, 23%; Illinois, 14%; Wisconsin, 11%; and Colorado, 11%. Tanning facilities in 4 states offered price incentives directed at youths. State youth access regulations were associated with decreased youth access to indoor tanning. High compliance levels in states with long-standing youth access regulations (Illinois and Wisconsin) demonstrate the potential for successful tanning industry youth access regulation.

Access Guide to South Carolina State Parks for People with Special Needs.

ERIC Educational Resources Information Center

South Carolina State Dept. of Parks, Recreation, and Tourism, Columbia. Div. of Engineering and Planning.

The guide was developed to assist physically handicapped persons in using South Carolina State Parks. It describes some of the accessibility problems identified in a 1986 Inventory of Handicapped Accessibility in South Carolina State Parks and Welcome Centers. It is noted that building construction since 1967 has met handicapped design criteria…

Broadband Access for Students at East Tennessee State University

ERIC Educational Resources Information Center

Sawyer, Thomas Scott

2013-01-01

The purpose of this study was to determine the availability of Internet access for students attending East Tennessee State University during the fall semester 2013. It has been unknown to what degree broadband access is available in the East Tennessee State University service area that includes counties in East Tennessee, Southwest Virginia, and…

Medical information, confidentiality, and privacy.

PubMed

Liang, Bryan A

2002-12-01

State laws and accreditation requirements dictate the form, ownership, and substance of medical records, as well as requirements for storage, access, and confidentiality. There are limited exceptions to these requirements but they are highly circumscribed. Federal law also outlines requirements to ensure the privacy of patient-identifiable information. Thus, providers must be aware of these rules both to protect patient information from being abused and to understand the affirmative obligations they have so as to avoid the significant penalties associated with breach of these provisions.

An Overview of Step 2 of the Risk Assessment and Mitigation Framework for Strategic Materials (RAMF-SM)

DTIC Science & Technology

2015-03-01

supply came from a country that is defined as a “foreign market dominator,” which is defined as a country that produces more than half of the global ...production of that particular material.4 The United States competes for access to materials with other countries, and so a “ market share” factor limits...analysis, including scrutinizing macroeconomic trends, global trade, theater- level combat, material science, and international relations. Step 2

Distribution and licensing of drug discovery tools – NIH perspectives

PubMed Central

Kim, J. P.

2009-01-01

Now, more than ever, drug discovery conducted at industrial or academic facilities requires rapid access to state-of-the-art research tools. Unreasonable restrictions or delays in the distribution or use of such tools can stifle new discoveries, thus limiting the development of future biomedical products. In grants and its own research programs the National Institutes of Health (NIH) is implementing its new policy to facilitate the exchanges of these tools for research discoveries and product development. PMID:12546842

Large scale 20mm photography for range resources analysis in the Western United States. [Casa Grande, Arizona, Mercury, Nevada, and Mojave Desert

NASA Technical Reports Server (NTRS)

Tueller, P. T.

1977-01-01

Large scale 70mm aerial photography is a valuable supplementary tool for rangeland studies. A wide assortment of applications were developed varying from vegetation mapping to assessing environmental impact on rangelands. Color and color infrared stereo pairs are useful for effectively sampling sites limited by ground accessibility. They allow an increased sample size at similar or lower cost than ground sampling techniques and provide a permanent record.

Technologies for user-preferred routing

NASA Astrophysics Data System (ADS)

McNally, B. D.; Sridhar, Banavar

1996-05-01

The 1995 report of the RTCA Board of Directors' Select Committee on Free Flight states that 'insufficient capacity, limited access, and excessive operating restrictions have escalated operating costs, increase delays, and decreased efficiency for all users' of the national airspace system. The Air Transport Association estimates the annual loss to be 3.5 billion dollars. The goal of the user preferred routing research is to develop integrated airborne and ground technologies that enable the highest possible level of unconstrained, user-preferred routing in enroute airspace.

Minimizing opportunity costs to aquatic connectivity restoration while controlling an invasive species.

PubMed

Milt, Austin W; Diebel, Matthew W; Doran, Patrick J; Ferris, Michael C; Herbert, Matthew; Khoury, Mary L; Moody, Allison T; Neeson, Thomas M; Ross, Jared; Treska, Ted; O'Hanley, Jesse R; Walter, Lisa; Wangen, Steven R; Yacobson, Eugene; McIntyre, Peter B

2018-03-08

Controlling invasive species is critical for conservation but can have unintended consequences for native species and divert resources away from other efforts. This dilemma occurs on a grand scale in the North American Great Lakes, where dams and culverts block tributary access to habitat of desirable fish species and are a lynchpin of long-standing efforts to limit ecological damage inflicted by the invasive, parasitic sea lamprey (Petromyzon marinus). Habitat restoration and sea-lamprey control create conflicting goals for managing aging infrastructure. We used optimization to minimize opportunity costs of habitat gains for 37 desirable migratory fishes that arose from restricting sea lamprey access (0-25% increase) when selecting barriers for removal under a limited budget (US$1-105 million). Imposing limits on sea lamprey habitat reduced gains in tributary access for desirable species by 15-50% relative to an unconstrained scenario. Additional investment to offset the effect of limiting sea-lamprey access resulted in high opportunity costs for 30 of 37 species (e.g., an additional US$20-80 million for lake sturgeon [Acipenser fulvescens]) and often required ≥5% increase in sea-lamprey access to identify barrier-removal solutions adhering to the budget and limiting access. Narrowly distributed species exhibited the highest opportunity costs but benefited more at less cost when small increases in sea-lamprey access were allowed. Our results illustrate the value of optimization in limiting opportunity costs when balancing invasion control against restoration benefits for diverse desirable species. Such trade-off analyses are essential to the restoration of connectivity within fragmented rivers without unleashing invaders. © 2018 Society for Conservation Biology.

Moving Beyond Salmon Bias: Mexican Return Migration and Health Selection

PubMed Central

Diaz, Christina J.; Koning, Stephanie M.; Martinez-Donate, Ana P.

2017-01-01

Despite having lower levels of education and limited access to health care services, Mexican immigrants report better health outcomes than U.S.-born individuals. Research suggests that the Mexican health advantage may be partially attributable to selective return migration among less healthy migrants—often referred to as “salmon bias.” Our study takes advantage of a rare opportunity to observe the health status of Mexican-origin males as they cross the Mexican border. To assess whether unhealthy migrants are disproportionately represented among those who return, we use data from two California-based studies: the California Health Interview Survey; and the Migrante Study, a survey that samples Mexican migrants entering and leaving the United States through Tijuana. We pool these data sources to look for evidence of health-related return migration. Results provide mixed support for salmon bias. Although migrants who report health limitations and frequent stress are more likely to return, we find little evidence that chronic conditions and self-reported health are associated with higher probabilities of return. Results also provide some indication that limited health care access increases the likelihood of return among the least healthy. This study provides new theoretical considerations of return migration and further elucidates the relationship between health and migration decisions. PMID:27848222

Moving Beyond Salmon Bias: Mexican Return Migration and Health Selection.

PubMed

Diaz, Christina J; Koning, Stephanie M; Martinez-Donate, Ana P

2016-12-01

Despite having lower levels of education and limited access to health care services, Mexican immigrants report better health outcomes than U.S.-born individuals. Research suggests that the Mexican health advantage may be partially attributable to selective return migration among less healthy migrants-often referred to as "salmon bias." Our study takes advantage of a rare opportunity to observe the health status of Mexican-origin males as they cross the Mexican border. To assess whether unhealthy migrants are disproportionately represented among those who return, we use data from two California-based studies: the California Health Interview Survey; and the Migrante Study, a survey that samples Mexican migrants entering and leaving the United States through Tijuana. We pool these data sources to look for evidence of health-related return migration. Results provide mixed support for salmon bias. Although migrants who report health limitations and frequent stress are more likely to return, we find little evidence that chronic conditions and self-reported health are associated with higher probabilities of return. Results also provide some indication that limited health care access increases the likelihood of return among the least healthy. This study provides new theoretical considerations of return migration and further elucidates the relationship between health and migration decisions.

Accessible Buildings for People with Walking and Reaching Limitations.

ERIC Educational Resources Information Center

Steinfeld, Edward; And Others

Research was reviewed and conducted regarding the accessibility of buildings for physically disabled persons. Data was produced regarding anthropometrics (eye level and reach limits for ambulant, semiambulant, and wheelchair bound persons); wheelchair maneuvers; speed and distance (maximum travel distances for people with limitations of stamina);…

Access State Websites | ECHO | US EPA

EPA Pesticide Factsheets

State environmental agencies often maintain additional information about compliance and enforcement (beyond what is reported to EPA systems). Access direct links to state enforcement and compliance data.

Long-Term Impacts of Precolonial Institutions, Geography and Ecological Diversity on Access to Public Infrastructure Services in Nigeria

NASA Astrophysics Data System (ADS)

Archibong, B.

2014-12-01

Do precolonial institutions, geography and ecological diversity affect population access to public infrastructure services over a century later? Can local leaders from historically centralized or 'conqueror' groups still influence access to public goods today? Do precolonial states located in ecologically diverse environments have better access to water, power and sanitation resources today? A growing body of literature examining the sources of the current state of African economic development has cited the enduring impacts of precolonial institutions and geography on contemporary African economic development using large sample cross-sectional analysis. In this paper, I focus on within country effects of local ethnic and political state institutions on access to public infrastructure services in present day Nigeria. Specifically, I combine information on the spatial distribution of ethnic states and ecological diversity in Nigeria circa mid 19th century and political states in Nigeria circa 1785 and 1850 with information, from a novel geocoded survey dataset, on access to public infrastructure at the local government level in present day Nigeria to examine the impact of precolonial state centralization on the current unequal access to public infrastructure services in Nigeria, accounting for the effects of ecological diversity and other geographic covariates. Some preliminary results show evidence for the long-term impacts of institutions, geography and ecological diversity on access to public infrastructure in Nigeria.

50 CFR Table 3 (north) to Part 660... - Non-Trawl Rockfish Conservation Areas and Trip Limits for Open Access Gears North of 40°10′ N. Lat.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 11 2011-10-01 2011-10-01 false Non-Trawl Rockfish Conservation Areas and Trip Limits for Open Access Gears North of 40°10â² N. Lat. 3 Table 3 (North) to Part 660, Subpart F...) to Part 660, Subpart F—Non-Trawl Rockfish Conservation Areas and Trip Limits for Open Access Gears...

50 CFR Table 3 (north) to Part 660... - 2010 Trip Limits for Open Access Gears North of 40°10′ N. Lat.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false 2010 Trip Limits for Open Access Gears North of 40°10â² N. Lat. 3 Table 3 (North) to Part 660, Subpart F Wildlife and Fisheries FISHERY... Limits for Open Access Gears North of 40°10′ N. Lat. ER01OC10.020 ER01OC10.021 ...

50 CFR Table 3 (south) to Part 660... - 2010 Trip Limits for Open Access Gears South of 40°10′ N. Lat.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false 2010 Trip Limits for Open Access Gears South of 40°10â² N. Lat. 3 Table 3 (South) to Part 660, Subpart F Wildlife and Fisheries FISHERY... Limits for Open Access Gears South of 40°10′ N. Lat. ER01OC10.022 ER01OC10.023 ...

50 CFR Table 3 (south) to Part 660... - Non-Trawl Rockfish Conservation Areas and Trip Limits for Open Access Gears South of 40°10′ N. Lat.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 11 2011-10-01 2011-10-01 false Non-Trawl Rockfish Conservation Areas and Trip Limits for Open Access Gears South of 40°10â² N. Lat. 3 Table 3 (South) to Part 660, Subpart F...) to Part 660, Subpart F—Non-Trawl Rockfish Conservation Areas and Trip Limits for Open Access Gears...

Review of manual control methods for handheld maneuverable instruments.

PubMed

Fan, Chunman; Dodou, Dimitra; Breedveld, Paul

2013-06-01

By the introduction of new technologies, surgical procedures have been varying from free access in open surgery towards limited access in minimal access surgery. Improving access to difficult-to-reach anatomic sites, e.g. in neurosurgery or percutaneous interventions, needs advanced maneuverable instrumentation. Advances in maneuverable technology require the development of dedicated methods enabling surgeons to stay in direct, manual control of these complex instruments. This article gives an overview of the state-of-the-art in the development of manual control methods for handheld maneuverable instruments. It categorizes the manual control methods in three levels: a) number of steerable segments, b) number of Degrees Of Freedom (DOF), and c) coupling between control motion of the handle and steering motion of the tip. The literature research was completed by using Web of Science, Scopus and PubMed. The study shows that in controlling single steerable segments, direct as well as indirect control methods have been developed, whereas in controlling multiple steerable segments, a gradual shift can be noticed from parallel and serial control to integrated control. The development of multi-segmented maneuverable instruments is still at an early stage, and an intuitive and effective method to control them has to become a primary focus in the domain of minimal access surgery.

AcconPred: Predicting Solvent Accessibility and Contact Number Simultaneously by a Multitask Learning Framework under the Conditional Neural Fields Model.

PubMed

Ma, Jianzhu; Wang, Sheng

2015-01-01

The solvent accessibility of protein residues is one of the driving forces of protein folding, while the contact number of protein residues limits the possibilities of protein conformations. The de novo prediction of these properties from protein sequence is important for the study of protein structure and function. Although these two properties are certainly related with each other, it is challenging to exploit this dependency for the prediction. We present a method AcconPred for predicting solvent accessibility and contact number simultaneously, which is based on a shared weight multitask learning framework under the CNF (conditional neural fields) model. The multitask learning framework on a collection of related tasks provides more accurate prediction than the framework trained only on a single task. The CNF method not only models the complex relationship between the input features and the predicted labels, but also exploits the interdependency among adjacent labels. Trained on 5729 monomeric soluble globular protein datasets, AcconPred could reach 0.68 three-state accuracy for solvent accessibility and 0.75 correlation for contact number. Tested on the 105 CASP11 domain datasets for solvent accessibility, AcconPred could reach 0.64 accuracy, which outperforms existing methods.

AcconPred: Predicting Solvent Accessibility and Contact Number Simultaneously by a Multitask Learning Framework under the Conditional Neural Fields Model

PubMed Central

Ma, Jianzhu; Wang, Sheng

2015-01-01

Motivation. The solvent accessibility of protein residues is one of the driving forces of protein folding, while the contact number of protein residues limits the possibilities of protein conformations. The de novo prediction of these properties from protein sequence is important for the study of protein structure and function. Although these two properties are certainly related with each other, it is challenging to exploit this dependency for the prediction. Method. We present a method AcconPred for predicting solvent accessibility and contact number simultaneously, which is based on a shared weight multitask learning framework under the CNF (conditional neural fields) model. The multitask learning framework on a collection of related tasks provides more accurate prediction than the framework trained only on a single task. The CNF method not only models the complex relationship between the input features and the predicted labels, but also exploits the interdependency among adjacent labels. Results. Trained on 5729 monomeric soluble globular protein datasets, AcconPred could reach 0.68 three-state accuracy for solvent accessibility and 0.75 correlation for contact number. Tested on the 105 CASP11 domain datasets for solvent accessibility, AcconPred could reach 0.64 accuracy, which outperforms existing methods. PMID:26339631

Model My Watershed - A Robust Online App to Enable Citizen Scientists to Model Watershed Hydrology and Water Quality at Regulatory-Level Standards

NASA Astrophysics Data System (ADS)

Daniels, M.; Kerlin, S.; Arscott, D.

2017-12-01

Citizen-based watershed monitoring has historically lacked scientific rigor and geographic scope due to limitation in access to watershed-level data and the high level skills and resources required to adequately model watershed dynamics. Public access to watershed information is currently routed through a variety of governmental data portals and often requires advanced geospatial skills to collect and present in useable forms. At the same time, tremendous financial resources are being invested in watershed restoration and management efforts, and often these resources pass through local stakeholder groups such as conservation NGO, watershed interest groups, and local municipalities without extensive hydrologic knowledge or access to sophisticated modeling resources. Even governmental agencies struggle to understand how to best steer or prioritize restoration investments. A new app, Model My Watershed, was built to improve access to watershed data and modeling capabilities in a fast, accessible, free web-app format. Working across the contiguous United States, the Model My Watershed app provides land cover, soils, aerial imagery and relief, watershed delineation, and stream network delineation. Users can model watersheds or areas of interest and create management scenarios to evaluate implementation of land cover changes and best management practice implementation with both hydrologic and water quality outputs that meet TMDL regulatory standards.

Summary of available state ambient stream-water-quality data, 1990-98, and limitations for national assessment

USGS Publications Warehouse

Pope, Larry M.; Rosner, Stacy M.; Hoffman, Darren C.; Ziegler, Andrew C.

2004-01-01

The investigation described in this report summarized data from State ambient stream-water-quality monitoring sites for 10 water-quality constituents or measurements (suspended solids, fecal coliform bacteria, ammonia as nitrogen, nitrite plus nitrate as nitrogen, total phosphorus, total arsenic, dissolved solids, chloride, sulfate, and pH). These 10 water-quality constituents or measurements commonly are listed nationally as major contributors to degradation of surface water. Water-quality data were limited to that electronically accessible from the U.S. Environmental Protection Agency Storage and Retrieval System (STORET), the U.S. Geological Survey National Water Information System (NWIS), or individual State databases. Forty-two States had ambient stream-water-quality data electronically accessible for some or all of the constituents or measurements summarized during this investigation. Ambient in this report refers to data collected for the purpose of evaluating stream ecosystems in relation to human health, environmental and ecological conditions, and designated uses. Generally, data were from monitoring sites assessed for State 305(b) reports. Comparisons of monitoring data among States are problematic for several reasons, including differences in the basic spatial design of monitoring networks; water-quality constituents for which samples are analyzed; water-quality criteria to which constituent concentrations are compared; quantity and comprehensiveness of water-quality data; sample collection, processing, and handling; analytical methods; temporal variability in sample collection; and quality-assurance practices. Large differences among the States in number of monitoring sites precluded a general assumption that statewide water-quality conditions were represented by data from these sites. Furthermore, data from individual monitoring sites may not represent water-quality conditions at the sites because sampling conditions and protocols are unknown. Because of these factors, a high level of uncertainty exists in a national assessment of water quality. The purpose of this report is to present a summary of electronically available State ambient stream-water-quality data for 10 selected constituents and measurements from monitoring sites with nine or more analyses for 199098 and to discuss limitations for use of the data for national assessment. These analyses were statistiscally summarized by monitoring site and State, and the results presented in tabular format. Most of the selected constituents or measurements have U.S. Environmental Protection Agency criteria or guidelines for aquatic-life or drinking-water purposes. A significant finding of this investigation is that for a large percentage of monitoring sites in the Nation, there are insufficient data to meet U.S. Environmental Protection Agency recommendations for determining if water-quality conditions are degraded and for making informed decisions regarding total maximum daily loads.

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

Baudry, Laurent; Lukyanchuk, Igor; Vinokur, Valerii M.

Here, the tunability of electrical polarization in ferroelectrics is instrumental to their applications in information-storage devices. The existing ferroelectric memory cells are based on the two-level storage capacity with the standard binary logics. However, the latter have reached its fundamental limitations. Here we propose ferroelectric multibit cells (FMBC) utilizing the ability of multiaxial ferroelectric materials to pin the polarization at a sequence of the multistable states. Employing the catastrophe theory principles we show that these states are symmetry-protected against the information loss and thus realize novel topologically-controlled access memory (TAM). Our findings enable developing a platform for the emergent many-valuedmore » non-Boolean information technology and target challenges posed by needs of quantum and neuromorphic computing.« less

A Unified Theory of Trust and Collaboration

NASA Astrophysics Data System (ADS)

Cai, Guoray; Squicciarini, Anna

We consider a type of applications where collaboration and trust are tightly coupled with the need to protect sensitive information. Existing trust management technologies have been limited to offering generic mechanisms for enforcing access control policies based on exchanged credentials, and rarely deal with the situated meaning of trust in a specific collaborative context. Towards trust management for highly dynamic and collaborative activities, this paper describes a theory of trust intention and semantics that makes explicit connections between collaborative activities and trust. The model supports inferring trust state based on knowledge about state of collaborative activity. It is the first step towards a unified approach for computer-mediated trust communication in the context of collaborative work.

Ferroelectric symmetry-protected multibit memory cell

NASA Astrophysics Data System (ADS)

Baudry, Laurent; Lukyanchuk, Igor; Vinokur, Valerii M.

2017-02-01

The tunability of electrical polarization in ferroelectrics is instrumental to their applications in information-storage devices. The existing ferroelectric memory cells are based on the two-level storage capacity with the standard binary logics. However, the latter have reached its fundamental limitations. Here we propose ferroelectric multibit cells (FMBC) utilizing the ability of multiaxial ferroelectric materials to pin the polarization at a sequence of the multistable states. Employing the catastrophe theory principles we show that these states are symmetry-protected against the information loss and thus realize novel topologically-controlled access memory (TAM). Our findings enable developing a platform for the emergent many-valued non-Boolean information technology and target challenges posed by needs of quantum and neuromorphic computing.

Foreword: function, classification and management of Asian wetlands

USGS Publications Warehouse

Turnipseed, D. Phil; Middleton, Beth A.

2014-01-01

Asian wetland conservation is critical for future environmental protection in the region, but these wetlands are understudied. In particular, there is a lack of research studies published in English due to the limited access of Asian researchers to western scientific journals. This special feature of Wetlands showcases primary research conducted in Asian wetlands and was sponsored by various agencies of the U.S. and Chinese governments including the U.S. Geological Survey, U.S. Department of State, and The State Forestry Administration of the People’s Republic of China. The featured articles should be of great value to wetland scientists, managers and policy-makers with an interest in the conservation of Asian wetlands.

Finland's strategy and implementation of citizens' access to health information.

PubMed

Ruotsalainen, Pekka; Iivari, Anna-Kaisa; Doupi, Persephone

2008-01-01

The strategy for utilizing information technology in the field of social welfare and health care in Finland was published in 1996. It was redefined in the year 2006. This updated strategy defined basic principles how digitized EHRs should be stored, accessed, disclosed and archived. The strategy together with new legislation opened the right to patients and citizens to access their own EHRs, ePrescriptions and audit-logs via the Internet. A national WEB-service platform forms the base for both public and private eHealth applications. National identification and PKI-services cover health professionals, patients and entities. Citizen's consent management is provided at national level. The access to personal health information is managed using rules derived from legislation. The roll-out of the national health information infrastructure with citizen access to personal health information should by law be finalized before the end of 2011. The implementation of the NHII is demanding, but the real challenge is to clearly understand what the impacts of citizen access to personal health information are and to what direction this kind of services should be developed. At the present state, the Finnish EHR-archive contains only information created by a health professional. Citizens' eHealth services can not be limited to the use of regulated EHR data and ePrescriptions. For health promotion, proactive prevention and health prediction more comprehensive information is needed. Therefore the next step is to develop legislation and to build a trusted environment for the use and access of heterogeneous health and welfare information.

78 FR 34349 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-07

... January 1, 2007, shark limited-access and swordfish limited- access permit holders who fish with longline... next permit renewal, must attend a workshop to fish with, or renew, their swordfish and shark limited... for Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and...

78 FR 73500 - Schedules for Atlantic Shark Identification Workshops and Protected Species Safe Handling...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-06

... January 1, 2007, shark limited-access and swordfish limited- access permit holders who fish with longline... next permit renewal, must attend a workshop to fish with, or renew, their swordfish and shark limited... for Atlantic Shark Identification Workshops and Protected Species Safe Handling, Release, and...

75 FR 45098 - Magnuson-Stevens Act Provisions; General Provisions for Domestic Fisheries; Application for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-02

... outside of the limited access scallop days-at-sea (DAS) program and the sea scallop access area...-day trip for 28 total DAS. The vessels would deploy both dredges simultaneously in 12 30-minute tows... commercial fishing vessels to fish outside of the limited access Atlantic sea scallop days at sea (DAS...

Accessibility of School Districts' Web Sites: A Descriptive Study

ERIC Educational Resources Information Center

Bray, Marty; Flowers, Claudia; Gibson, Patricia

2003-01-01

Many school districts (SDs) use the World Wide Web (WWW or Web) to disseminate a wide variety of information about things such as district events, policies, and a wide variety of student information. On-line barriers limit the accessibility of the WWW for persons and students with disabilities and thus can limit their access to vital information.…

Quality of life and economic burdens of malocclusion in U.S. patients enrolled in Medicaid.

PubMed

Bresnahan, Brian W; Kiyak, H Asuman; Masters, Samuel H; McGorray, Susan P; Lincoln, Adam; King, Gregory

2010-10-01

Patients enrolled in Medicaid have limited access to orthodontic services in the United States. No studies are available, to the authors' knowledge, regarding the clinical and psychosocial burdens of malocclusion on these patients from an economic perspective. The authors conducted a systematic review of the relevant economic literature. They identified issues from the perspectives of the various stakeholders (dentists, patients and parents, Medicaid programs) and developed a conceptual model for studying decision making focused on the strategy of providing early interceptive and preventive treatment rather than, or in addition to, comprehensive care in the patient's permanent dentition. Medicaid coverage and reimbursement amounts vary nationwide, and decision making associated with obtaining care can be complex. The perspectives of all relevant stakeholders deserve assessment. A conceptual framework of the cost-effectiveness of interceptive orthodontic treatment compared with comprehensive treatment illustrates the issues to be considered when evaluating these strategies. Policymakers and the dental community should identify creative solutions to addressing low-income families' limited access to orthodontic services and compare them from various perspectives with regard to their relative cost-effectiveness. Dentists should be aware of the multiple problems faced by low-income families in obtaining orthodontic services and the impact of stakeholder issues on access to care; they also should be proactive in helping low-income patients obtain needed orthodontic services.

Decentralized Opportunistic Spectrum Resources Access Model and Algorithm toward Cooperative Ad-Hoc Networks.

PubMed

Liu, Ming; Xu, Yang; Mohammed, Abdul-Wahid

2016-01-01

Limited communication resources have gradually become a critical factor toward efficiency of decentralized large scale multi-agent coordination when both system scales up and tasks become more complex. In current researches, due to the agent's limited communication and observational capability, an agent in a decentralized setting can only choose a part of channels to access, but cannot perceive or share global information. Each agent's cooperative decision is based on the partial observation of the system state, and as such, uncertainty in the communication network is unavoidable. In this situation, it is a major challenge working out cooperative decision-making under uncertainty with only a partial observation of the environment. In this paper, we propose a decentralized approach that allows agents cooperatively search and independently choose channels. The key to our design is to build an up-to-date observation for each agent's view so that a local decision model is achievable in a large scale team coordination. We simplify the Dec-POMDP model problem, and each agent can jointly work out its communication policy in order to improve its local decision utilities for the choice of communication resources. Finally, we discuss an implicate resource competition game, and show that, there exists an approximate resources access tradeoff balance between agents. Based on this discovery, the tradeoff between real-time decision-making and the efficiency of cooperation using these channels can be well improved.

Health and federal budgetary effects of increasing access to antiretroviral medications for HIV by expanding Medicaid.

PubMed

Kahn, J G; Haile, B; Kates, J; Chang, S

2001-09-01

OBJECTIVES. This study modeled the health and federal fiscal effects of expanding Medicaid for HIV-infected people to improve access to highly active antiretroviral therapy. A disease state model of the US HIV epidemic, with and without Medicaid expansion, was used. Eligibility required a CD4 cell count less than 500/mm3 or viral load greater than 10,000, absent or inadequate medication insurance, and annual income less than $10,000. Two benefits were modeled, "full" and "limited" (medications, outpatient care). Federal spending for Medicaid, Medicare, AIDS Drug Assistance Program, Supplemental Security Income, and Social Security Disability Insurance were assessed. An estimated 38,000 individuals would enroll in a Medicaid HIV expansion. Over 5 years, expansion would prevent an estimated 13,000 AIDS diagnoses and 2600 deaths and add 5,816 years of life. Net federal costs for all programs are $739 million (full benefits) and $480 million (limited benefits); for Medicaid alone, the costs are $1.43 and $1.17 billion, respectively. Results were sensitive to awareness of serostatus, highly active antiretroviral therapy cost, and participation rate. Strategies for federal cost neutrality include Medicaid HIV drug price reductions as low as 9% and private insurance buy-ins. Expansion of the Medicaid eligibility to increase access to antiretroviral therapy would have substantial health benefits at affordable costs.

Residential Broadband Access for Students at Walters State Community College

ERIC Educational Resources Information Center

Hurst, Mark A.

2010-01-01

The purpose of this study was to determine the availability of internet access for students attending Walters State Community College during the spring semester 2010. In particular, it is unknown to what degree broadband internet access is available in the counties that Walters State considers the service area of the college. The research was…

Energy Access Solutions Advance Gender Mainstreaming in West African States

Science.gov Websites

| Integrated Energy Solutions | NREL Energy Access Solutions Advance Gender Mainstreaming in West African States Energy Access Solutions Advance Gender Mainstreaming in West African States Under a expertise to an innovative policy that not only supports women in energy, but also helps bring clean energy

From rotating atomic rings to quantum Hall states.

PubMed

Roncaglia, M; Rizzi, M; Dalibard, J

2011-01-01

Considerable efforts are currently devoted to the preparation of ultracold neutral atoms in the strongly correlated quantum Hall regime. However, the necessary angular momentum is very large and in experiments with rotating traps this means spinning frequencies extremely near to the deconfinement limit; consequently, the required control on parameters turns out to be too stringent. Here we propose instead to follow a dynamic path starting from the gas initially confined in a rotating ring. The large moment of inertia of the ring-shaped fluid facilitates the access to large angular momenta, corresponding to giant vortex states. The trapping potential is then adiabatically transformed into a harmonic confinement, which brings the interacting atomic gas in the desired quantum-Hall regime. We provide numerical evidence that for a broad range of initial angular frequencies, the giant-vortex state is adiabatically connected to the bosonic ν = 1/2 Laughlin state.

Single-particle energies and density of states in density functional theory

NASA Astrophysics Data System (ADS)

van Aggelen, H.; Chan, G. K.-L.

2015-07-01

Time-dependent density functional theory (TD-DFT) is commonly used as the foundation to obtain neutral excited states and transition weights in DFT, but does not allow direct access to density of states and single-particle energies, i.e. ionisation energies and electron affinities. Here we show that by extending TD-DFT to a superfluid formulation, which involves operators that break particle-number symmetry, we can obtain the density of states and single-particle energies from the poles of an appropriate superfluid response function. The standard Kohn- Sham eigenvalues emerge as the adiabatic limit of the superfluid response under the assumption that the exchange- correlation functional has no dependence on the superfluid density. The Kohn- Sham eigenvalues can thus be interpreted as approximations to the ionisation energies and electron affinities. Beyond this approximation, the formalism provides an incentive for creating a new class of density functionals specifically targeted at accurate single-particle eigenvalues and bandgaps.

[The Telehealth Network of the Americas and its role in primary health care].

PubMed

Bill, Guillermo; Crisci, Carlos D; Canet, Tomislav

2014-01-01

The need to guarantee equitable access to health regardless of geographic, economic, or technological barriers motivated the Member States of the Organization of American States to create the Telehealth Network of the Americas, coordinated by the Inter-American Telecommunication Committee. The Network focuses on the use of new information and communications technology applied to health, based on the values of respect, equity, and solidarity and mandated by the philosophy of primary health. Its members include government agencies, nongovernmental organizations, university forums, hospital federations, and telecommunications companies, and it has already extended its reach to other continents and to different fields in which telemedicine is being used. Among its first achievements, it has implemented an innovative tool to be used in cases of disaster or limited geographic access. This mobile telemedicine station is housed in a portable case that includes a computer, various digital devices (otoscope, ophthalmoscope, microscope, dermatoscope), a high-resolution digital camera, an X-ray film viewer, and a satellite antenna. With this tool, it is possible to provide specialized support for rural physicians and primary health care workers located far from large urban centers.

New service interface for River Forecasting Center derived quantitative precipitation estimates

USGS Publications Warehouse

Blodgett, David L.

2013-01-01

For more than a decade, the National Weather Service (NWS) River Forecast Centers (RFCs) have been estimating spatially distributed rainfall by applying quality-control procedures to radar-indicated rainfall estimates in the eastern United States and other best practices in the western United States to producea national Quantitative Precipitation Estimate (QPE) (National Weather Service, 2013). The availability of archives of QPE information for analytical purposes has been limited to manual requests for access to raw binary file formats that are difficult for scientists who are not in the climatic sciences to work with. The NWS provided the QPE archives to the U.S. Geological Survey (USGS), and the contents of the real-time feed from the RFCs are being saved by the USGS for incorporation into the archives. The USGS has applied time-series aggregation and added latitude-longitude coordinate variables to publish the RFC QPE data. Web services provide users with direct (index-based) data access, rendered visualizations of the data, and resampled raster representations of the source data in common geographic information formats.

Integration of human pancreatic islet genomic data refines regulatory mechanisms at Type 2 Diabetes susceptibility loci

PubMed Central

Thurner, Matthias; van de Bunt, Martijn; Torres, Jason M; Mahajan, Anubha; Nylander, Vibe; Bennett, Amanda J; Gaulton, Kyle J; Barrett, Amy; Burrows, Carla; Bell, Christopher G; Lowe, Robert; Beck, Stephan; Rakyan, Vardhman K; Gloyn, Anna L

2018-01-01

Human genetic studies have emphasised the dominant contribution of pancreatic islet dysfunction to development of Type 2 Diabetes (T2D). However, limited annotation of the islet epigenome has constrained efforts to define the molecular mechanisms mediating the, largely regulatory, signals revealed by Genome-Wide Association Studies (GWAS). We characterised patterns of chromatin accessibility (ATAC-seq, n = 17) and DNA methylation (whole-genome bisulphite sequencing, n = 10) in human islets, generating high-resolution chromatin state maps through integration with established ChIP-seq marks. We found enrichment of GWAS signals for T2D and fasting glucose was concentrated in subsets of islet enhancers characterised by open chromatin and hypomethylation, with the former annotation predominant. At several loci (including CDC123, ADCY5, KLHDC5) the combination of fine-mapping genetic data and chromatin state enrichment maps, supplemented by allelic imbalance in chromatin accessibility pinpointed likely causal variants. The combination of increasingly-precise genetic and islet epigenomic information accelerates definition of causal mechanisms implicated in T2D pathogenesis. PMID:29412141

Association of CKD with Disability in the United States

PubMed Central

Plantinga, Laura C.; Johansen, Kirsten; Crews, Deidra C.; Shahinian, Vahakn B.; Robinson, Bruce M.; Saran, Rajiv; Burrows, Nilka Rios; Williams, Desmond E.; Powe, Neil R.

2010-01-01

Background Little is known about disability in early-stage chronic kidney disease (CKD). Study Design Cross-sectional national survey (National Health and Nutrition Examination Survey 1999–2006). Setting and Participants Community-based survey of 16,011 non-institutionalized U.S. civilian adults (≥20 years). Predictor CKD, categorized as: no CKD, stages 1 and 2 [albuminuria and estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2], and stages 3 and 4 (eGFR 15–59). Outcome Self-reported disability, defined by limitations in working, walking, and cognition; and difficulties in activities of daily living (ADL), instrumental ADL, leisure and social activities, lower extremity mobility, and general physical activity. Measurements Albuminuria and eGFR assessed from urine and blood samples; disability, demographics, access to care, and comorbid conditions assessed by standardized questionnaire. Results Age-adjusted prevalence of reported limitations was generally significantly greater with CKD: e.g., difficulty with ADLs was reported by 17.6%, 24.7%, and 23.9% of older (≥65 years) and 6.8%, 11.9%, and 11.0% of younger (20–64 years) adults with no CKD, stages 1 and 2, and stages 3 and 4, respectively. CKD was also associated with greater reported limitations and difficulty in other activities after age adjustment, including instrumental ADL, leisure and social activities, lower extremity mobility, and general physical activity. Other demographics, socioeconomic status, and access to care generally only slightly attenuated the observed associations, particularly among older individuals; adjustment for cardiovascular disease, arthritis, and cancer attenuated most associations such that statistical significance was no longer achieved. Limitations Inability to establish causality and possible unmeasured confounding. Conclusion CKD is associated with higher prevalence of disability in the United States. Age and other comorbid conditions account for most, but not all, of this association. PMID:21036441

50 CFR 660.70 - Groundfish conservation areas.

Code of Federal Regulations, 2011 CFR

2011-10-01

... points for the RCAs. (1) Trawl (Limited Entry and Open Access Nongroundfish Trawl Gears) Rockfish....71 through 660.74. (2) Non-Trawl (Limited Entry Fixed Gear and Open Access Non-trawl Gears) Rockfish...

50 CFR 660.322 - Sablefish allocations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... are provided in § 660.385(a). (b) Between the limited entry and open access sectors. Sablefish is allocated between the limited entry and open access fisheries according to the procedure described in § 660...

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.

Food environment of fruits and vegetables in the territory of the Health Academy Program.

PubMed

Costa, Bruna Vieira de Lima; Oliveira, Cláudia Di Lorenzo; Lopes, Aline Cristine Souza

2015-11-01

This study provides a spatial analysis of distribution and access to commercial fruit and vegetable establishments within the territory of a representative sample of public fitness facilities known as the Health Academy Program (HAP) in Belo Horizonte, Minas Gerais State, Brazil. The study evaluated commercial food establishments within a buffer area based on a radius of 1,600 meters around each of 18 randomly selected fitness facilities. Quality of access to fruits and vegetables was assessed by the Healthy Food Store Index (HFSI), consisting of the variables availability, variety, and advertising of fruits, vegetables and ultra-processed foods. The analysis was based on calculation of the Kernel intensity estimator, nearest neighbor method, and Ripley K-function. Of the 336 food establishments, 61.3% were green grocers and open-air markets, with a median HFSI of 11 (5 to 16). In only 17% of the territories, the majority of the "hot area" establishments displayed better access to healthy foods, and only three areas showed a clustering pattern. The study showed limited access to commercial establishments supplying healthy fruits and vegetables within the territory of the public fitness program.

Utilizing Strategic and Operational Methods for Whole-Community Disaster Planning.

PubMed

Franks, Stevee; Seaton, Ellen

2017-12-01

Analysis of response and recovery efforts to disasters over the past 2 decades has identified a consistent gap that plagues the nation in regard to persons with access and functional needs. This gap can be highlighted by Hurricane Katrina, where the majority of those killed were a part of the access and functional needs population. After a disaster, many individuals with access and functional needs require assistance recovering but often have difficulty accessing services and resources. These difficulties are due to a combination of issues, such as health problems and the disruption of community support services. We sought to help bridge this gap by focusing on strategic and operational methods used while planning for the whole community. This article highlights the many partnerships that must be fostered for successful whole-community planning. These partnerships include, but are not limited to, local government departments, health agencies, nonprofit and nongovernmental organizations, and other volunteer organizations. We showcase these methods by using a developmental Post-Disaster Canvassing Plan to highlight planning methods that may aid jurisdictions across the United States in disaster planning for the whole community. (Disaster Med Public Health Preparedness. 2017;11:741-746).

An intellectual property sharing initiative in agricultural biotechnology: development of broadly accessible technologies for plant transformation.

PubMed

Chi-Ham, Cecilia L; Boettiger, Sara; Figueroa-Balderas, Rosa; Bird, Sara; Geoola, Josef N; Zamora, Pablo; Alandete-Saez, Monica; Bennett, Alan B

2012-06-01

The Public Intellectual Property Resource for Agriculture (PIPRA) was founded in 2004 by the Rockefeller Foundation in response to concerns that public investments in agricultural biotechnology benefiting developing countries were facing delays, high transaction costs and lack of access to important technologies due to intellectual property right (IPR) issues. From its inception, PIPRA has worked broadly to support a wide range of research in the public sector, in specialty and minor acreage crops as well as crops important to food security in developing countries. In this paper, we review PIPRA's work, discussing the failures, successes, and lessons learned during its years of operation. To address public sector's limited freedom-to-operate, or legal access to third-party rights, in the area of plant transformation, we describe PIPRA's patent 'pool' approach to develop open-access technologies for plant transformation which consolidate patent and tangible property rights in marker-free vector systems. The plant transformation system has been licensed and deployed for both commercial and humanitarian applications in the United States (US) and Africa, respectively. © 2012 The Authors. Plant Biotechnology Journal © 2012 Society for Experimental Biology, Association of Applied Biologists and Blackwell Publishing Ltd.

Bioethics of organ transplantation.

PubMed

Caplan, Arthur

2014-03-01

As the ability to transplant organs and tissues has grown, the demand for these procedures has increased as well--to the point at which it far exceeds the available supply creating the core ethical challenge for transplantation--rationing. The gap between supply and demand, although large, is worse than it appears to be. There are two key steps to gaining access to a transplant. First, one must gain access to a transplant center. Then, those waiting need to be selected for a transplant. Many potential recipients do not get admitted to a program. They are deemed too old, not of the right nationality, not appropriate for transplant as a result of severe mental impairment, criminal history, drug abuse, or simply because they do not have access to a competent primary care physician who can refer them to a transplant program. There are also financial obstacles to access to transplant waiting lists in the United States and other nations. In many poor nations, those needing transplants simply die because there is no capacity or a very limited capacity to perform transplants. Although the demand for organs now exceeds the supply, resulting in rationing, the size of waiting lists would quickly expand were there to suddenly be an equally large expansion in the number of organs available for transplantation. Still, even with the reality of unavoidable rationing, saving more lives by increasing organ supply is a moral good. Current public policies for obtaining organs from cadavers are not adequate in that they do not produce the number of organs that public polls of persons in the United States indicate people are willing to donate.

Orthodox versus unorthodox care: A qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest, Nigeria.

PubMed

Okafor, I P; Sekoni, A O; Ezeiru, S S; Ugboaja, J O; Inem, V

2014-06-01

Utilization of orthodox health facilities for maternal health services is determined by factors operating at the individual, household, community and state level. The prevalence of small family norm is one of the identified variables operating within the community which influences the decision of where to access care (orthodox/traditional). The objective of the study was to determine the use of orthodox versus unorthodox maternity healthcare and determinants among rural women in southwest Nigeria. A qualitative study was done and involved three focus group discussions. A semi-structured interview guide was used to collect information from women of reproductive age group within a rural Local Government Area in Lagos state. Most of the women access some form of healthcare during pregnancy, orthodox, unorthodox or both. Those who patronize both services concurrently do so to benefit from the two as each has some unique features such as herbal concoctions for traditional, ultrasound and immunization of babies for orthodox. Traditional belief exerts a strong influence on decision of where to access maternal healthcare services. Actual place of delivery is determined by individual and household factors including financial resources. Rural women utilize one or both orthodox and unorthodox maternal health services for different reasons. Ward Development Committees should be strengthened so as to reach the communities, educate and convince women to dispel myths which limit their use of orthodox care. Training and monitoring of Traditional Birth Attendants (TBAs) are vital to eliminate harmful practices. We also recommend improved financial access to orthodox healthcare.

Effects of a statewide carve out on spending and access to substance abuse treatment in Massachusetts, 1992 to 1996.

PubMed

Shepard, D S; Daley, M; Ritter, G A; Hodgkin, D; Beinecke, R H

2001-12-01

We studied the first four years of the statewide carve out for Medicaid enrollees in Massachusetts to assess its effect on access and spending. Using administrative data, we compared the state's fiscal years 1992 (the last year before the carve out) through 1996 (the final year of the state's first carve-out vendor, MHMA). We evaluated the effect on spending by converting expenditures to constant (1996) prices using the medical services component of the Consumer Price Index for Boston and standardizing directly for the changing proportion of Medicaid enrollees who were disabled. We measured access through the penetration rate (proportion of enrollees using at least one substance abuse treatment service in a year . Overall this carve out reduced real adjusted spending per enrollee by 40 percent from 1992 to 1996. At the same time, access improved from 38 to 43 unduplicated users per 1,000 enrollees per year f rom 1992 to 1996, adjusted for changes in Medicaid eligibility. these savings were achieved by a shift in the type of 24-h our services (hospital, detox, and residential treatment ). In 1992, 87 percent of these services were provided in hospital compared to only 1 percent in 1996. the reductions were achieved within the first two years of the carve out and sustained, but not enhanced, in subsequent years. By arranging Medicaid reimbursement for lower levels of care and limiting use of the most expensive settings, managed care achieved substantial cost reductions over the first four years in Massachusetts.

Bioethics of Organ Transplantation

PubMed Central

Caplan, Arthur

2014-01-01

As the ability to transplant organs and tissues has grown, the demand for these procedures has increased as well—to the point at which it far exceeds the available supply creating the core ethical challenge for transplantation—rationing. The gap between supply and demand, although large, is worse than it appears to be. There are two key steps to gaining access to a transplant. First, one must gain access to a transplant center. Then, those waiting need to be selected for a transplant. Many potential recipients do not get admitted to a program. They are deemed too old, not of the right nationality, not appropriate for transplant as a result of severe mental impairment, criminal history, drug abuse, or simply because they do not have access to a competent primary care physician who can refer them to a transplant program. There are also financial obstacles to access to transplant waiting lists in the United States and other nations. In many poor nations, those needing transplants simply die because there is no capacity or a very limited capacity to perform transplants. Although the demand for organs now exceeds the supply, resulting in rationing, the size of waiting lists would quickly expand were there to suddenly be an equally large expansion in the number of organs available for transplantation. Still, even with the reality of unavoidable rationing, saving more lives by increasing organ supply is a moral good. Current public policies for obtaining organs from cadavers are not adequate in that they do not produce the number of organs that public polls of persons in the United States indicate people are willing to donate. PMID:24478386

Strengths and Limitations of Ontario Post-Secondary Education Accessibility Plans: A Review of One University Accessibility Plan

ERIC Educational Resources Information Center

Opini, Bathseba M.

2008-01-01

This paper examines the strengths and limitations of the Ontarians with Disabilities Act (ODA) accessibility plan prepared by one post-secondary education institution in Ontario, Canada, during the 2004/05 academic year. The paper focuses on ways the intersectionality between disability and gender is not voiced in the plan and its implications for…

10 CFR 2.307 - Extension and reduction of time limits; delegated authority to order use of procedures for access...

Code of Federal Regulations, 2010 CFR

2010-01-01

... authority to order use of procedures for access by potential parties to certain sensitive unclassified... authority to order use of procedures for access by potential parties to certain sensitive unclassified... Commission or the presiding officer. (b) If this part does not prescribe a time limit for an action to be...

Beyond Section 508: The Spectrum of Legal Requirements for Accessible e-Government Web Sites in the United States

ERIC Educational Resources Information Center

Jaeger, Paul T.

2004-01-01

In the United States, a number of federal laws establish requirements that electronic government (e-government) information and services be accessible to individuals with disabilities. These laws affect e-government Web sites at the federal, state, and local levels. To this point, research about the accessibility of e-government Web sites has…

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, 0.00088-0.23639; p < 0.001), and patients with Medicaid were less likely to be offered an appointment within 2 weeks (23 of 64 [36%] versus 59 of 64 [89%]; OR, 0.0154; 95% CI, 0.00094- 0.251; p < 0.001). The Medicaid acceptance rates observed across states sampled in the simulated patient survey were 67% (Pennsylvania), 21% (New Jersey), 58% (Delaware), and 50% (Maryland) (p = 0.04). National Orthopaedic Survey: Adult patients with Medicaid insurance had limited access to care in 109 of 342 (32%) orthopaedic practices: 37% of private and 13% of academic practices (p < 0.001). Practices that accepted Medicaid received higher reimbursement for each CPT ®  code relative to those that did not and acceptance of Medicaid became increasingly more likely as reimbursement rates increased (99243: OR, 1.03, 95% CI, 1.02-1.04 per dollar, p < 0.001; 99213: OR, 1.05; 95% CI, 1.03-1.07 per dollar, p < 0.001; 28876: OR, 1.01, 95% CI, 1.00-1.01 per dollar, p < 0.001). For a given reimbursement rate, private practices were less likely to take an adult patient with Medicaid relative to an academic practice (99243: OR, 0.11, 95% CI, 0.04-0.33, p < 0.001; 99213: OR, 0.11, 95% CI, 0.04-0.32, p < 0.001; 27786: OR, 0.12, 95% CI, 0.04-0.35, p < 0.001). No difference was observed when comparing Medicaid acceptance rates for all practice types between states that have expanded their Medicaid program versus those that have not (OR, 1.02; 95% CI 0.62-1.70; p = 0.934). In this two-part survey study, we found that a simulated patient with commercial insurance was more likely to have their insurance accepted and to gain timely access to orthopaedic care than a patient with Medicaid. Academic practice setting and increased Medicaid reimbursement rates were associated with increased access to care for the patient with Medicaid. Inequality in access to orthopaedic care based on health insurance status likely exists for the adult patient with Medicaid. Furthermore, Medicaid expansion has likely realized minimal gains in access to care for the adult orthopaedic patient. Further research is needed in delineating the patient-payer selection criteria used by orthopaedic practices to aid policymakers in reforming the Medicaid program and comprehensibly addressing this access to care disparity. Level II, prognostic study.

50 CFR 697.12 - At-sea sea sampler/observer coverage.

Code of Federal Regulations, 2010 CFR

2010-10-01

... may request any vessel issued a Federal limited access American lobster permit to carry a NMFS... issued a Federal limited access American lobster permit, if requested by the sea sampler/observer also...

50 CFR 697.12 - At-sea sea sampler/observer coverage.

Code of Federal Regulations, 2011 CFR

2011-10-01

... may request any vessel issued a Federal limited access American lobster permit to carry a NMFS... issued a Federal limited access American lobster permit, if requested by the sea sampler/observer also...

Framework for a National STEMI Program: consensus document developed by STEMI INDIA, Cardiological Society of India and Association Physicians of India.

PubMed

Alexander, Thomas; Mullasari, Ajit S; Kaifoszova, Zuzana; Khot, Umesh N; Nallamothu, Brahmajee; Ramana, Rao G V; Sharma, Meenakshi; Subramaniam, Kala; Veerasekar, Ganesh; Victor, Suma M; Chand, Kiran; Deb, P K; Venugopal, K; Chopra, H K; Guha, Santanu; Banerjee, Amal Kumar; Armugam, A Muruganathan; Panja, Manotosh; Wander, Gurpreet Singh

2015-01-01

The health care burden of ST elevation myocardial infarction (STEMI) in India is enormous. Yet, many patients with STEMI can seldom avail timely and evidence based reperfusion treatments. This gap in care is a result of financial barriers, limited healthcare infrastructure, poor knowledge and accessibility of acute medical services for a majority of the population. Addressing some of these issues, STEMI India, a not-for-profit organization, Cardiological Society of India (CSI) and Association Physicians of India (API) have developed a protocol of "systems of care" for efficient management of STEMI, with integrated networks of facilities. Leveraging newly-developed ambulance and emergency medical services, incorporating recent state insurance schemes for vulnerable populations to broaden access, and combining innovative, "state-of-the-art" information technology platforms with existing hospital infrastructure, are the crucial aspects of this system. A pilot program was successfully employed in the state of Tamilnadu. The purpose of this article is to describe the framework and methods associated with this programme with an aim to improve delivery of reperfusion therapy for STEMI in India. This programme can serve as model STEMI systems of care for other low-and-middle income countries. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Equalizing access to pandemic influenza vaccines through optimal allocation to public health distribution points.

PubMed

Huang, Hsin-Chan; Singh, Bismark; Morton, David P; Johnson, Gregory P; Clements, Bruce; Meyers, Lauren Ancel

2017-01-01

Vaccines are arguably the most important means of pandemic influenza mitigation. However, as during the 2009 H1N1 pandemic, mass immunization with an effective vaccine may not begin until a pandemic is well underway. In the U.S., state-level public health agencies are responsible for quickly and fairly allocating vaccines as they become available to populations prioritized to receive vaccines. Allocation decisions can be ethically and logistically complex, given several vaccine types in limited and uncertain supply and given competing priority groups with distinct risk profiles and vaccine acceptabilities. We introduce a model for optimizing statewide allocation of multiple vaccine types to multiple priority groups, maximizing equal access. We assume a large fraction of available vaccines are distributed to healthcare providers based on their requests, and then optimize county-level allocation of the remaining doses to achieve equity. We have applied the model to the state of Texas, and incorporated it in a Web-based decision-support tool for the Texas Department of State Health Services (DSHS). Based on vaccine quantities delivered to registered healthcare providers in response to their requests during the 2009 H1N1 pandemic, we find that a relatively small cache of discretionary doses (DSHS reserved 6.8% in 2009) suffices to achieve equity across all counties in Texas.

Mobile Phones and Psychosocial Therapies with Vulnerable People: a First State of the Art.

PubMed

Vázquez, Maria Yolanda García; Sexto, Carlos Ferrás; Rocha, Álvaro; Aguilera, Adrián

2016-06-01

Mobile phones are becoming a communication tool commonly used by people all over the world; and they are started to be adopted in psychosocial therapies involving vulnerable people. We are herein presenting the results of an academic literature review. We identified scientific papers published between 2006 and 2015 resorting to academic databases available on the Internet, applying a systematic selection method based on quality criteria. Secondly, we analysed contents, highlighting the scarcity of research involving vulnerable people. The available literature specialized in psychosocial therapies offers investigation results which involve mobile phones and patients in general, focusing particularly on the clinical psychology field and, to a lesser extent, on the social work field. Particularly significant are the investigation works developed in the United States. In the present paper we introduce a first "state of the art", identifying opportunities and also the limitations surrounding the use of mobile phones in psychosocial therapies targeting the vulnerable. Issues concerning privacy and data confidentiality, and the access of vulnerable people to mobile phones and how they use them, pose significant challenges; but they offer the opportunity to reach isolated or impoverished populations, or even to facilitate access to social and healthcare services. We close this paper formulating possible orientations, hypotheses and goals to design new investigation works involving vulnerable populations.

Determination of protein folding kinetic types using sequence and predicted secondary structure and solvent accessibility.

PubMed

Zhang, Hua; Zhang, Tuo; Gao, Jianzhao; Ruan, Jishou; Shen, Shiyi; Kurgan, Lukasz

2012-01-01

Proteins fold through a two-state (TS), with no visible intermediates, or a multi-state (MS), via at least one intermediate, process. We analyze sequence-derived factors that determine folding types by introducing a novel sequence-based folding type predictor called FOKIT. This method implements a logistic regression model with six input features which hybridize information concerning amino acid composition and predicted secondary structure and solvent accessibility. FOKIT provides predictions with average Matthews correlation coefficient (MCC) between 0.58 and 0.91 measured using out-of-sample tests on four benchmark datasets. These results are shown to be competitive or better than results of four modern predictors. We also show that FOKIT outperforms these methods when predicting chains that share low similarity with the chains used to build the model, which is an important advantage given the limited number of annotated chains. We demonstrate that inclusion of solvent accessibility helps in discrimination of the folding kinetic types and that three of the features constitute statistically significant markers that differentiate TS and MS folders. We found that the increased content of exposed Trp and buried Leu are indicative of the MS folding, which implies that the exposure/burial of certain hydrophobic residues may play important role in the formation of the folding intermediates. Our conclusions are supported by two case studies.

Partonic structure of neutral pseudoscalars via two photon transition form factors

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

Raya, Khepani; Ding, Minghui; Bashir, Adnan

Here, the γγ* → η c,b transition form factors are computed using a continuum approach to the two valence-body bound-state problem in relativistic quantum field theory, and thereby unified with equivalent calculations of electromagnetic pion elastic and transition form factors. The resulting γγ* → η c form factor, G ηc(Q 2), is consistent with available data; significantly, at accessible momentum transfers, Q 2G ηc(Q 2) lies well below its conformal limit. These observations confirm that the leading-twist parton distribution amplitudes of heavy-heavy bound states are compressed relative to the conformal limit. A clear understanding of the distribution of valence quarksmore » within mesons thus emerges, a picture which connects Goldstone modes, built from the lightest quarks in nature, with systems containing the heaviest valence quarks that can now be studied experimentally, and highlights basic facts about manifestations of mass within the Standard Model.« less

Partonic structure of neutral pseudoscalars via two photon transition form factors

DOE PAGES

Raya, Khepani; Ding, Minghui; Bashir, Adnan; ...

2017-04-10

Here, the γγ* → η c,b transition form factors are computed using a continuum approach to the two valence-body bound-state problem in relativistic quantum field theory, and thereby unified with equivalent calculations of electromagnetic pion elastic and transition form factors. The resulting γγ* → η c form factor, G ηc(Q 2), is consistent with available data; significantly, at accessible momentum transfers, Q 2G ηc(Q 2) lies well below its conformal limit. These observations confirm that the leading-twist parton distribution amplitudes of heavy-heavy bound states are compressed relative to the conformal limit. A clear understanding of the distribution of valence quarksmore » within mesons thus emerges, a picture which connects Goldstone modes, built from the lightest quarks in nature, with systems containing the heaviest valence quarks that can now be studied experimentally, and highlights basic facts about manifestations of mass within the Standard Model.« less

Weak value amplification: a view from quantum estimation theory that highlights what it is and what isn’t

PubMed Central

Torres, Juan P.; Salazar-Serrano, Luis José

2016-01-01

Weak value amplification (WVA) is a concept that has been extensively used in a myriad of applications with the aim of rendering measurable tiny changes of a variable of interest. In spite of this, there is still an on-going debate about its true nature and whether is really needed for achieving high sensitivity. Here we aim at helping to clarify the puzzle, using a specific example and some basic concepts from quantum estimation theory, highlighting what the use of the WVA concept can offer and what it can not. While WVA cannot be used to go beyond some fundamental sensitivity limits that arise from considering the full nature of the quantum states, WVA can notwithstanding enhance the sensitivity of real and specific detection schemes that are limited by many other things apart from the quantum nature of the states involved, i.e. technical noise. Importantly, it can do that in a straightforward and easily accessible manner. PMID:26833327

Access to hospital interpreter services for limited English proficient patients in New Jersey: a statewide evaluation.

PubMed

Flores, Glenn; Torres, Sylvia; Holmes, Linda Janet; Salas-Lopez, Debbie; Youdelman, Mara K; Tomany-Korman, Sandra C

2008-05-01

We surveyed New Jersey (NJ) hospitals to assess current language services and identify policy recommendations on meeting limited English proficiency (LEP) patients' needs. Survey with 37 questions regarding hospital/patient features, interpreter services, and resources/policies needed to provide quality interpreter services. Sixty-seven hospitals responded (55% response rate). Most NJ hospitals have no interpreter services department, 80% provide no staff training on working with interpreters, 31% lack multilingual signs, and 19% offer no written translation services. Only 3% of hospitals have full-time interpreters, a ratio of 1 interpreter:240,748 LEP NJ residents. Most hospitals stated third-party reimbursement for interpreters would be beneficial, by reducing costs, adding interpreters, meeting population growth, and improving communication. Most NJ hospitals have no full-time interpreters, interpreter services department, or staff training on working with interpreters, and deficiencies exist in hospital signage and translation services. Most NJ hospitals stated third-party reimbursement for interpreter services would be beneficial.

Variation in Results Release and Patient Portal Access to Diagnostic Test Results at an Academic Medical Center

PubMed Central

Krasowski, Matthew D.; Grieme, Caleb V.; Cassady, Brian; Dreyer, Nicholas R.; Wanat, Karolyn A.; Hightower, Maia; Nepple, Kenneth G.

2017-01-01

Background: Electronic health records (EHRs) are commonplace in industrialized countries. Many hospitals are granting their patients access to their medical information through online patient portals. In this report, we describe a retrospective analysis of patient access to diagnostic test results released through the patient portal (MyChart; Epic, Inc.) at a state academic medical center. Methods: We analyzed 6 months of data for anatomic pathology, clinical laboratory, and radiology test results to evaluate variations in results release (automated vs. manual) and subsequent patient access to the institutional patient portal. During this period, diagnostic test results were released for all patient encounters including inpatient units, outpatient clinics, and the emergency department. Results: Manual results release by providers before automated release time occurred most commonly in the outpatient setting. The highest rates of access of diagnostic test results occurred for outpatients (about 30% overall view rate), females (two times or more compared to males in nearly every age bracket), and 20–45-year-old. Access rates of diagnostic tests in the emergency department or inpatient units were <10% across all populations. Access of diagnostic test results was very low for 12–17-year-old, likely influenced by institutional policies limiting parental proxy access within this pediatric age range. Approximately 20% of outpatient laboratory results were viewed by patients within 8 h of release from the EHR to the patient portal and 10% within 2 h of release. Conclusions: Patient accessing of diagnostic test results were generally higher for females, outpatients, and 20–45-year-old. Approximately, 20% of outpatient results were viewed quickly by patients after release to the EHR. PMID:29226008

Variation in Results Release and Patient Portal Access to Diagnostic Test Results at an Academic Medical Center.

PubMed

Krasowski, Matthew D; Grieme, Caleb V; Cassady, Brian; Dreyer, Nicholas R; Wanat, Karolyn A; Hightower, Maia; Nepple, Kenneth G

2017-01-01

Electronic health records (EHRs) are commonplace in industrialized countries. Many hospitals are granting their patients access to their medical information through online patient portals. In this report, we describe a retrospective analysis of patient access to diagnostic test results released through the patient portal (MyChart; Epic, Inc.) at a state academic medical center. We analyzed 6 months of data for anatomic pathology, clinical laboratory, and radiology test results to evaluate variations in results release (automated vs. manual) and subsequent patient access to the institutional patient portal. During this period, diagnostic test results were released for all patient encounters including inpatient units, outpatient clinics, and the emergency department. Manual results release by providers before automated release time occurred most commonly in the outpatient setting. The highest rates of access of diagnostic test results occurred for outpatients (about 30% overall view rate), females (two times or more compared to males in nearly every age bracket), and 20-45-year-old. Access rates of diagnostic tests in the emergency department or inpatient units were <10% across all populations. Access of diagnostic test results was very low for 12-17-year-old, likely influenced by institutional policies limiting parental proxy access within this pediatric age range. Approximately 20% of outpatient laboratory results were viewed by patients within 8 h of release from the EHR to the patient portal and 10% within 2 h of release. Patient accessing of diagnostic test results were generally higher for females, outpatients, and 20-45-year-old. Approximately, 20% of outpatient results were viewed quickly by patients after release to the EHR.

22 CFR 1600.149 - Program accessibility: Discrimination prohibited.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Program accessibility: Discrimination prohibited. 1600.149 Section 1600.149 Foreign Relations JAPAN-UNITED STATES FRIENDSHIP COMMISSION ENFORCEMENT... STATES FRIENDSHIP COMMISSION § 1600.149 Program accessibility: Discrimination prohibited. Except as...

Value for the money spent? Exploring the relationship between expenditures, insurance adequacy, and access to care for publicly insured children.

PubMed

Colby, Margaret S; Lipson, Debra J; Turchin, Sarah R

2012-04-01

This study examines the relationship between total state Medicaid spending per child and measures of insurance adequacy and access to care for publicly insured children. Using the 2007 National Survey of Children's Health, seven measures of insurance adequacy and health care access were examined for publicly insured children (n = 19,715). Aggregate state-level measures were constructed, adjusting for differences in demographic, health status, and household characteristics. Per member per month (PMPM) state Medicaid spending on children ages 0-17 was calculated from capitated, fee-for-service, and administrative expenses. Adjusted measures were compared with PMPM state Medicaid spending in scatter plots, and multilevel logistic regression models tested how well state-level expenditures predicted individual adequacy and access measures. Medicaid spending PMPM was a significant predictor of both insurance adequacy and receipt of mental health services. An increase of $50 PMPM was associated with a 6-7 % increase in the likelihood that insurance would always cover needed services and allow access to providers (p = 0.04) and a 19 % increase in the likelihood of receiving mental health services (p < 0.01). For the remaining four measures, PMPM was a consistent (though not statistically significant) positive predictor. States with higher total spending per child appear to assure better access to care for Medicaid children. The policies or incentives used by the few states that get the greatest value--lower-than-median spending and higher-than-median adequacy and access--should be examined for potential best practices that other states could adapt to improve value for their Medicaid spending.

The influence of English proficiency on access to care.

PubMed

Shi, Leiyu; Lebrun, Lydie A; Tsai, Jenna

2009-12-01

The number of individuals with limited English proficiency in the USA is large and rapidly growing. Consequently, addressing language barriers in access to medical care is becoming increasingly important. Previous studies have reported that individuals with limited English proficiency have more difficulty gaining access to care, compared to English-proficient individuals. We assessed the impact of English language proficiency on access to medical care, accounting for health and socioeconomic status, using nationally representative data. Cross-sectional data from the 2006 National Health Interview Survey (n=29,868). The main outcome measures of interest were self-reported delayed medical care, forgone needed care, and visits to a health care professional. In unadjusted analyses, individuals with limited English proficiency were more likely to forgo needed medical care and less likely to have a health care visit, compared to individuals who were proficient in English. There was no significant association between language proficiency and reports of delayed care. After accounting for individuals' health and socioeconomic status, only the relationship between limited English proficiency and health care visits remained statistically significant. Most associations between language proficiency and access to care did not differ across various racial/ethnic groups. Results indicate that the choice of access measure may influence conclusions about language barriers in health care. Given the growing proportion of US residents with limited English proficiency, health care settings need to better address potential language barriers.

Groundwater controls on river channel pattern

NASA Astrophysics Data System (ADS)

Bätz, Nico; Colombini, Pauline; Cherubini, Paolo; Lane, Stuart N.

2017-04-01

Braided rivers are characterized by high rates of morphological change. However, despite the potential for frequent disturbance, vegetated patches may develop within this system and influence long-term channel dynamics and channel patterns through the "engineering effects" of vegetation. The stabilizing effect of developing vegetation on morphological change has been widely shown by flume experiments and (historic) aerial pictures analysis. Thus, there is a balance between disturbance and stabilization, mediated through vegetation, that may determine the long-term geomorphic and biogeomorphic evolution of the river. It follows that with a change in disturbance frequency relative to the rate of vegetation establishment, a systematic geomorphological shift could occur. Research has addressed how changes in disturbance frequency affect river channel pattern, but has rarely addressed the way in which the stabilizing effects of biogeomorphic succession interact with disturbance frequency to maintain a river in a more dynamic or a less dynamic state. Here, we quantify how the interplay between groundwater access, disturbance frequency and vegetation succession, drive changes in channel pattern. We studied this complex interplay on a transitional gravel-bed river system (braided, wandering, meandering) close to Geneva (Switzerland) - the Allondon River. Dendroecological analysis demonstrate that vegetation growth is driven by groundwater access. Groundwater access conditions the rate of vegetation stabilization at the sub-reach scale and, due to a reduction in flood-related disturbance frequency over the last 50 years, drives a change in channel pattern. Where groundwater is shallower, vegetation encroachment rates were high and as flood-related disturbance decreased, the river has shifted towards a meandering state. Where groundwater was deeper, vegetation growth was limited by water-access and thus vegetation encroachment rates were low. Even though there was a reduction in flood disturbance, it was still sufficient to maintain a wandering/braided state. Thus, it appears that access to groundwater can control river channel pattern through its impact upon the "engineering effects" of vegetation. The results are important for river management as they highlight the non-linearity of developing vegetation in dynamic alluvial floodplains and the importance of considering the wider environmental setting and associated feedbacks between biotic and abiotic river components in defining long-term geomorphological river response.

Implementing the Equal Access Act and State Constitutional Provisions.

ERIC Educational Resources Information Center

Bjorklun, Eugene C.

1992-01-01

Examines the issue of whether implementation of the Equal Access Act would violate the constitutions of some states that require a stricter separation of church and state than the federal Constitution. (MLF)

Addressing global health, economic, and environmental problems through family planning.

PubMed

Speidel, J Joseph; Grossman, Richard A

2011-06-01

Although obstetrician-gynecologists recognize the importance of managing fertility for the reproductive health of individuals, many are not aware of the vital effect they can have on some of the world's most pressing issues. Unintended pregnancy is a key contributor to the rapid population growth that in turn impairs social welfare, hinders economic progress, and exacerbates environmental degradation. An estimated 215 million women in developing countries wish to limit their fertility but do not have access to effective contraception. In the United States, half of all pregnancies are unplanned. Voluntary prevention of unplanned pregnancies is a cost-effective, humane way to limit population growth, slow environmental degradation, and yield other health and welfare benefits. Family planning should be a top priority for our specialty.

Vexatious Litigants and the ADA: Strategies to Fairly Address the Need to Improve Access for Individuals with Disabilities.

PubMed

Hull, Helia Garrido

2016-01-01

This Article addresses the need to reform the ADA to prevent vexatious litigation and to promote the underlying goals of the Act. Part I of this Article introduces the topic of vexatious litigation and the importance of remedying the effects of exploitation of the ADA. Part II provides an overview of the ADA and its efforts to increase accessibility to individuals with disabilities, emphasizing the provisions of the Act that create incentives to engage in vexatious litigation. Part III examines and analyzes the judiciary's response to vexatious litigation under the ADA, and sanctions that have been issued to limit exploitation. Finally, Part IV provides recommendations to reform the ADA and state disability law counterparts, suggests corrective actions to address vexatious litigation, and identifies methods to promote equality for individuals with disabilities.

Procedural abortion rights: Ireland and the European Court of Human Rights.

PubMed

Erdman, Joanna N

2014-11-01

The Irish Protection of Life During Pregnancy Act seeks to clarify the legal ground for abortion in cases of risk to life, and to create procedures to regulate women's access to services under it. This article explores the new law as the outcome of an international human rights litigation strategy premised on state duties to implement abortion laws through clear standards and procedural safeguards. It focuses specifically on the Irish law reform and the jurisprudence of the European Court of Human Rights, including A. B. and C. v. Ireland (2010). The article examines how procedural rights at the international level can engender domestic law reform that limits or expands women's access to lawful abortion services, serving conservative or progressive ends. Copyright © 2014 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Building the Coverage Continuum: The Role of State Medicaid Directors and Insurance Commissioners.

PubMed

Ario, Joel; Bachrach, Deborah

2017-02-01

Issue: The Affordable Care Act has expanded coverage to 20 million newly insured individuals, split between state Medicaid programs and commercially insured marketplaces, with limited integration between the two. The seamless continuum of coverage envisioned by the law is central to achieving the full potential of the Affordable Care Act, but it remains an elusive promise. Goals: To examine the historical and cultural differences between state Medicaid agencies and insurance departments that contribute to this lack of coordination. Findings and Conclusions: Historical and cultural differences must be overcome to ensure continuing access to coverage and care. The authors present two opportunities for insurance and Medicaid officials to work together to advance the continuum of coverage: alignment of regulations for insurers participating in both markets and collaboration on efforts to reform the health care delivery system.

Open source Modeling and optimization tools for Planning

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

Peles, S.

Open source modeling and optimization tools for planning The existing tools and software used for planning and analysis in California are either expensive, difficult to use, or not generally accessible to a large number of participants. These limitations restrict the availability of participants for larger scale energy and grid studies in the state. The proposed initiative would build upon federal and state investments in open source software, and create and improve open source tools for use in the state planning and analysis activities. Computational analysis and simulation frameworks in development at national labs and universities can be brought forward tomore » complement existing tools. An open source platform would provide a path for novel techniques and strategies to be brought into the larger community and reviewed by a broad set of stakeholders.« less

Increased ethanol self-administration after a period of imposed ethanol deprivation in rats trained in a limited access paradigm.

PubMed

Heyser, C J; Schulteis, G; Koob, G F

1997-08-01

A predominant feature in human alcohol abuse is the reported desire or "craving" to consume ethanol along with frequent episodes of drinking after periods of abstinence. These and other factors may be responsible for relapse to uncontrolled ethanol drinking. When relapse occurs after a period of abstinence, ethanol drinking has been shown to be temporarily increased. Two aspects of drug dependence could contribute to these increases. One may be the development of a need state; the other may involve changes in the perception of the positive reinforcing effects of ethanol when reinforcer access is limited. To investigate this phenomenon further, the present study was conducted to examine in nondependent rats the effect of forced time-off on oral ethanol self-administration in a limited access paradigm (30 min/day). Male Wistar rats were trained to respond for ethanol (10% w/v) or water in a two-lever, free-choice condition using a saccharin fading procedure. After the establishment of stable baseline responding for ethanol, various ethanol deprivation periods (3, 5, 7, 14, or 28 days) were imposed, during which no ethanol was available. Responding for ethanol increased as a function of the duration of the deprivation period when compared with baseline levels. This increase was temporary and returned to baseline levels within 2 to 3 days. Given that the shortest time-off period was 5 days and the rats showed no signs of withdrawal, this transient increase in ethanol responding does not seem to be related to the manifestation of dependence and withdrawal, and may be related to changes in ethanol's reinforcement properties. These results with rats may provide a useful tool to elucidate mechanisms underlying human alcohol seeking behavior and relapse.

MobileASL: intelligibility of sign language video over mobile phones.

PubMed

Cavender, Anna; Vanam, Rahul; Barney, Dane K; Ladner, Richard E; Riskin, Eve A

2008-01-01

For Deaf people, access to the mobile telephone network in the United States is currently limited to text messaging, forcing communication in English as opposed to American Sign Language (ASL), the preferred language. Because ASL is a visual language, mobile video phones have the potential to give Deaf people access to real-time mobile communication in their preferred language. However, even today's best video compression techniques can not yield intelligible ASL at limited cell phone network bandwidths. Motivated by this constraint, we conducted one focus group and two user studies with members of the Deaf Community to determine the intelligibility effects of video compression techniques that exploit the visual nature of sign language. Inspired by eye tracking results that show high resolution foveal vision is maintained around the face, we studied region-of-interest encodings (where the face is encoded at higher quality) as well as reduced frame rates (where fewer, better quality, frames are displayed every second). At all bit rates studied here, participants preferred moderate quality increases in the face region, sacrificing quality in other regions. They also preferred slightly lower frame rates because they yield better quality frames for a fixed bit rate. The limited processing power of cell phones is a serious concern because a real-time video encoder and decoder will be needed. Choosing less complex settings for the encoder can reduce encoding time, but will affect video quality. We studied the intelligibility effects of this tradeoff and found that we can significantly speed up encoding time without severely affecting intelligibility. These results show promise for real-time access to the current low-bandwidth cell phone network through sign-language-specific encoding techniques.