30 CFR 582.29 - Reports and records.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OPERATIONS IN THE.... The report shall show for each calendar month the location of each mining and processing activity; the... determined from G&G surveys, bottom sampling, drill holes, trenching, dredging, or mining. All excavations...

30 CFR 582.29 - Reports and records.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OPERATIONS IN THE.... The report shall show for each calendar month the location of each mining and processing activity; the... determined from G&G surveys, bottom sampling, drill holes, trenching, dredging, or mining. All excavations...

Differences in the Implementation of Diagnosis-Related Groups across Clinical Departments: A German Hospital Case Study

PubMed Central

Ridder, Hans-Gerd; Doege, Vanessa; Martini, Susanne

2007-01-01

Objective This article aims to examine the implementation process of diagnosis-related groups (DRGs) in the clinical departments of a German hospital group and to explain why some gain competitive advantage while others do not. Study Setting To investigate this research question, we conducted a qualitative study based on primary data obtained in six clinical departments in a German hospital group between 2003 and 2005. Study Design We chose the case study method in order to gain deep insights into the process dynamics of the implementation of DRGs in the six clinical departments. The dynamic capability approach is used as a theoretical foundation. Employing theory-driven categories we focused on idiosyncratic and common patterns of “successful coders” and “unsuccessful coders.” Data Collection To observe the implementation process of DRGs, we conducted 43 semistructured interviews with key persons, carried out direct observations of the monthly meetings of the DRG project group, and sampled written materials. Principal Findings “Successful coders” invest into change resources, demonstrate a high level of acceptance of innovations, and organize effective processes of coordination and learning. Conclusions All clinical departments only put an emphasis on the coding aspects of the DRGs. There is a lack of vision regarding the optimization of patient treatment processes and specialization. Physicians are the most important key actors, rather than the main barriers. PMID:17995556

Evaluation of U.S. Department of Transportation Efforts in the 1990s to Address Operator Fatigue

DTIC Science & Technology

1999-05-01

and crewmembers may be divided, when at sea, into two watches. • On a fish processing vessel, the licensed individuals and deck crew shall be divided...performance and diminished alertness.13 Fatigue can impair information processing and reaction time, increasing the probability of errors and... process . In a response dated February 25, 1999, to the FHWA, the Safety Board expressed disap- pointment that it had taken more than 18 months since

Designing and evaluating a balanced scorecard for a health information management department in a Canadian urban non-teaching hospital.

PubMed

Nippak, Pria Md; Veracion, Julius Isidro; Muia, Maria; Ikeda-Douglas, Candace J; Isaac, Winston W

2016-06-01

This report is a description of a balanced scorecard design and evaluation process conducted for the health information management department at an urban non-teaching hospital in Canada. The creation of the health information management balanced scorecard involved planning, development, implementation, and evaluation of the indicators within the balanced scorecard by the health information management department and required 6 months to complete. Following the evaluation, the majority of members of the health information management department agreed that the balanced scorecard is a useful tool in reporting key performance indicators. These findings support the success of the balanced scorecard development within this setting and will help the department to better align with the hospital's corporate strategy that is linked to the provision of efficient management through the evaluation of key performance indicators. Thus, it appears that the planning and selection process used to determine the key indicators within the study can aid in the development of a balanced scorecard for a health information management department. In addition, it is important to include the health information management department staff in all stages of the balanced scorecard development, implementation, and evaluation phases. © The Author(s) 2014.

Modifying the clinical research infrastructure at a dedicated clinical trials unit: assessment of trial development, activation, and participant accrual

PubMed Central

Tang, Chad; Hess, Kenneth R.; Sanders, Dwana; Davis, Suzanne; Buzdar, Aman; Kurzrock, Razelle; Lee, J. Jack; Meric-Bernstam, Funda; Hong, David

2017-01-01

Purpose Information on processes for trials assessing investigational therapeutics is sparse. We assessed the trial development processes within the Department of Investigational Cancer Therapeutics (ICT) at MD Anderson Cancer Center and analyzed their effects on the trial activation timeline and enrollment. Experimental Design Data were from a prospectively maintained registry that tracks all clinical studies at MD Anderson. From this database we identified 2,261 activated phase I-III trials; 221 were done at the ICT. ICT trials were matched to trials from other MD Anderson departments by phase, sponsorship, and submission year. Trial performance metrics were compared with paired Wilcoxon signed rank tests. Results We identified 3 facets of the ICT research infrastructure: parallel processing of trial approval steps; a physician-led research team; and regular weekly meetings to foster research accountability. Separate analyses were conducted stratified by sponsorship (industry [133 ICT and 133 non-ICT trials] or institutional [68 ICT and 68 non-ICT trials]). ICT trial development was faster from IRB approval to activation (median difference of 1.1 months for industry-sponsored trials vs. 2.3 months for institutional) and from activation to first enrollment (median difference of 0.3 months for industry vs. 1.2 months for institutional) (all matched P<0.05). ICT trials also accrued more patients (median difference of 8 participants for industry vs. 33.5 for institutional) quicker (median difference 4.8 participants/year for industry vs. 11.1 for institutional) (all matched P<0.05). Conclusions Use of a clinical research–focused infrastructure within a large academic cancer center was associated with efficient trial development and participant accrual. PMID:27852698

Modifying the Clinical Research Infrastructure at a Dedicated Clinical Trials Unit: Assessment of Trial Development, Activation, and Participant Accrual.

PubMed

Tang, Chad; Hess, Kenneth R; Sanders, Dwana; Davis, Suzanne E; Buzdar, Aman U; Kurzrock, Razelle; Lee, J Jack; Meric-Bernstam, Funda; Hong, David S

2017-03-15

Purpose: Information on processes for trials assessing investigational therapeutics is sparse. We assessed the trial development processes within the Department of Investigational Cancer Therapeutics (ICT) at MD Anderson Cancer Center (Houston, TX) and analyzed their effects on the trial activation timeline and enrolment. Experimental Design: Data were from a prospectively maintained registry that tracks all clinical studies at MD Anderson. From this database, we identified 2,261 activated phase I-III trials; 221 were done at the ICT. ICT trials were matched to trials from other MD Anderson departments by phase, sponsorship, and submission year. Trial performance metrics were compared with paired Wilcoxon signed rank tests. Results: We identified three facets of the ICT research infrastructure: parallel processing of trial approval steps; a physician-led research team; and regular weekly meetings to foster research accountability. Separate analyses were conducted stratified by sponsorship [industry (133 ICT and 133 non-ICT trials) or institutional (68 ICT and 68 non-ICT trials)]. ICT trial development was faster from IRB approval to activation (median difference of 1.1 months for industry-sponsored trials vs. 2.3 months for institutional) and from activation to first enrolment (median difference of 0.3 months for industry vs. 1.2 months for institutional; all matched P < 0.05). ICT trials also accrued more patients (median difference of 8 participants for industry vs. 33.5 for institutional) quicker (median difference 4.8 participants/year for industry vs. 11.1 for institutional; all matched P < 0.05). Conclusions: Use of a clinical research-focused infrastructure within a large academic cancer center was associated with efficient trial development and participant accrual. Clin Cancer Res; 23(6); 1407-13. ©2016 AACR . ©2016 American Association for Cancer Research.

Improving Emergency Department radiology transportation time: a successful implementation of lean methodology.

PubMed

Hitti, Eveline A; El-Eid, Ghada R; Tamim, Hani; Saleh, Rana; Saliba, Miriam; Naffaa, Lena

2017-09-05

Emergency Department overcrowding has become a global problem and a growing safety and quality concern. Radiology and laboratory turnaround time, ED boarding and increased ED visits are some of the factors that contribute to ED overcrowding. Lean methods have been used in the ED to address multiple flow challenges from improving door-to-doctor time to reducing length of stay. The objective of this study is to determine the effectiveness of using Lean management methods on improving Emergency Department transportation times for plain radiography. We performed a before and after study at an academic urban Emergency Department with 49,000 annual visits after implementing a Lean driven intervention. The primary outcome was mean radiology transportation turnaround time (TAT). Secondary outcomes included overall study turnaround time from order processing to preliminary report time as well as ED length of stay. All ED patients undergoing plain radiography 6 months pre-intervention were compared to all ED patients undergoing plain radiography 6 months post-intervention after a 1 month washout period. Post intervention there was a statistically significant decrease in the mean transportation TAT (mean ± SD: 9.87 min ± 15.05 versus 22.89 min ± 22.05, respectively, p-value <0.0001). In addition, it was found that 71.6% of patients in the post-intervention had transportation TAT ≤ 10 min, as compared to 32.3% in the pre-intervention period, p-value <0.0001, with narrower interquartile ranges in the post-intervention period. Similarly, the "study processing to preliminary report time" and the length of stay were lower in the post-intervention as compared to the pre-intervention, (52.50 min ± 35.43 versus 54.04 min ± 34.72, p-value = 0.02 and 3.65 h ± 5.17 versus 4.57 h ± 10.43, p < 0.0001, respectively), in spite of an increase in the time it took to elease a preliminary report in the post-intervention period. Using Lean change management techniques can be effective in reducing transportation time to plain radiography in the Emergency Department as well as improving process reliability.

9 CFR 351.14 - Processes to be supervised; extent of examinations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... examinations. 351.14 Section 351.14 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT... be at least once a month if the plant consistently handles only raw materials acceptable under § 351... consistently handles some raw materials that are acceptable, and some that are unacceptable, under § 351.3, for...

Development of a Writing Center: A Bright Idea.

ERIC Educational Resources Information Center

McKeague, Patricia M.; Reis, Elizabeth

Recognizing that good writing skills are critical to achieving college and career success, the Communications Department at Moraine Valley Community College (MVCC) initiated a 10-month research and planning process which culminated in the establishment of a Writing Center (WC) in the fall of 1990. The objectives of the WC are to: (1) offer all…

Managing the Alert Process at NewYork-Presbyterian Hospital

PubMed Central

Kuperman, Gilad J; Diamente, Rosanna; Khatu, Vrinda; Chan-Kraushar, Terri; Stetson, Pete; Boyer, Aurelia; Cooper, Mary

2005-01-01

Clinical decision support can improve the quality of care, but requires substantial knowledge management activities. At NewYork-Presbyterian Hospital in New York City, we have implemented a formal alert management process whereby only hospital committees and departments can request alerts. An explicit requestor, who will help resolve the details of the alert logic and the alert message must be identified. Alerts must be requested in writing using a structured alert request form. Alert requests are reviewed by the Alert Committee and then forwarded to the Information Systems department for a software development estimate. The model required that clinical committees and departments become more actively involved in the development of alerts than had previously been necessary. In the 12 months following implementation, 10 alert requests were received. The model has been well received. A lot of the knowledge engineering work has been distributed and burden has been removed from scarce medical informatics resources. PMID:16779073

Emergency department information system implementation and process redesign result in rapid and sustained financial enhancement at a large academic center.

PubMed

Shapiro, Jason S; Baumlin, Kevin M; Chawla, Neal; Genes, Nicholas; Godbold, James; Ye, Fen; Richardson, Lynne D

2010-05-01

The objectives were to measure the financial impact of implementing a fully integrated emergency department information system (EDIS) and determine the length of time to "break even" on the initial investment. A before-and-after study design was performed using a framework of analysis consisting of four 15-month phases: 1) preimplementation, 2) peri-implementation, 3) postimplementation, and 4) sustained effects. Registration and financial data were reviewed. Costs and rates of professional and facility charges and receipts were calculated for the phases in question and compared against monthly averages for covariates such as volume, collections rates, acuity, age, admission rate, and insurance status with an autoregressive time series analysis using a segmented model. The break-even point was calculated by measuring cumulative monthly receipts for the last three study phases in excess of the average monthly receipts from the preimplementation phase, corrected for change in volume, and then plotting this against cumulative overall cost. Time to break even on the initial EDIS investment was less than 8 months. Total revenue enhancement at the end of the 5-year study period was $16,138,953 with an increase of 69.40% in charges and 70.06% in receipts. This corresponds to an increase in receipts per patient from $50 to $90 for professional services and $131 to $183 for facilities charges. Other than volume, there were no significant changes in trends for covariates between the preimplementation and sustained-effects periods. A comprehensive EDIS implementation with process redesign resulted in sustained increases in professional and facility revenues and a rapid initial break-even point. .

Triage: an investigation of the process and potential vulnerabilities.

PubMed

Hitchcock, Maree; Gillespie, Brigid; Crilly, Julia; Chaboyer, Wendy

2014-07-01

To explore and describe the triage process in the Emergency Department to identify problems and potential vulnerabilities that may affect the triage process. Triage is the first step in the patient journey in the Emergency Department and is often the front line in reducing the potential for errors and mistakes. A fieldwork study to provide an in-depth appreciation and understanding of the triage process. Fieldwork included unstructured observer-only observation, field notes, informal and formal interviews that were conducted over the months of June, July and August 2012. Over 170 hours of observation were performed covering day, evening and night shifts, 7 days of the week. Sixty episodes of triage were observed; 31 informal interviews and 14 formal interviews were completed. Thematic analysis was used. Three themes were identified from the analysis of the data and included: 'negotiating patient flow and care delivery through the Emergency Department'; 'interdisciplinary team communicating and collaborating to provide appropriate and safe care to patients'; and 'varying levels of competence of the triage nurse'. In these themes, vulnerabilities and problems described included over and under triage, extended time to triage assessment, triage errors, multiple patients arriving simultaneously, emergency department and hospital overcrowding. Findings suggest that vulnerabilities in the triage process may cause disruptions to patient flow and compromise care, thus potentially impacting nurses' ability to provide safe and effective care. © 2013 John Wiley & Sons Ltd.

Approach to implementing a DICOM network: incorporate both economics and workflow adaptation

NASA Astrophysics Data System (ADS)

Beaver, S. Merritt; Sippel-Schmidt, Teresa M.

1995-05-01

This paper describes an approach to aide in the decision-making process for the justification and design of a digital image and information management system. It identifies key technical and clinical issues that need to be addressed by a healthcare institution during this process. Some issues identified here are very controversial and may take months or years for a department to determine solutions which meet their specific staffing, financial, and technical needs.

Idaho National Laboratory Quarterly Performance Analysis for the 2nd Quarter FY 2015

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

Mitchell, Lisbeth A.

2015-04-01

This report is published quarterly by the Idaho National Laboratory (INL) Quality and Performance Management Organization. The Department of Energy (DOE) Occurrence Reporting and Processing System (ORPS), as prescribed in DOE Order 232.2, “Occurrence Reporting and Processing of Operations Information,” requires a quarterly analysis of events, both reportable and not reportable, for the previous 12 months. This report is the analysis of events for the 2nd Qtr FY-15.

Engineers with nozzles fabricated using a freeform-directed ener

NASA Image and Video Library

2018-03-15

Engineers from NASA Marshall Space Flight Center's Propulsion Department examine nozzles fabricated using a freeform-directed energy wire deposition process. From left are Paul Gradl, Will Brandsmeier, Ian Johnston and Sandy Greene, with the nozzles, which were built using a NASA-patented technology that has the potential to reduce build time from several months to several weeks.

Pathway to Graduation: A Pilot Reading Project for Middle School Students during the Summer Months

ERIC Educational Resources Information Center

Hilsmier, Amanda Strong; Wood, Patricia F.; Wirt, Susan; McTamney, Diane; Malone, Mary Beth; Milstead, Becky

2014-01-01

The purpose of this article is to outline the implementation of a summer reading project targeted at middle school students with identified reading deficits and behavioral concerns called Pathway to Graduation (PTG). The project was a collaborative process between a school district, local university, and department of mental health. The students…

MOnthly TEmperature DAtabase of Spain 1951-2010: MOTEDAS. (1) Quality control

NASA Astrophysics Data System (ADS)

Peña-Angulo, Dhais; Cortesi, Nicola; Simolo, Claudia; Stepanek, Peter; Brunetti, Michele; González-Hidalgo, José Carlos

2014-05-01

The HIDROCAES project (Impactos Hidrológicos del Calentamiento Global en España, Spanish Ministery of Research CGL2011-27574-C02-01) is focused on the high resolution in the Spanish continental land of the warming processes during the 1951-2010. To do that the Department of Geography (University of Zaragoza, Spain), the Hydrometeorological Service (Brno Division, Chezck Republic) and the ISAC-CNR (Bologna, Italy) are developing the new dataset MOTEDAS (MOnthly TEmperature DAtabase of Spain), from which we present a collection of poster to show (1) the general structure of dataset and quality control; (2) the analyses of spatial correlation of monthly mean values of maximum (Tmax) and minimum (Tmin temperature; (3) the reconstruction processes of series and high resolution grid developing; (4) the first initial results of trend analyses of annual, seasonal and monthly range mean values. MOTEDAS has been created after exhaustive analyses and quality control of the original digitalized data of the Spanish National Meteorological Agency (Agencia Estatal de Meteorología, AEMET). Quality control was applied without any prior reconstruction, i.e. on original series. Then, from the total amount of series stored at AEMet archives (more than 4680) we selected only those series with at least 10 years of data (i.e. 120 months, 3066 series) to apply a quality control and reconstruction processes (see Poster MOTEDAS 3). Length of series was Tmin, upper and lower thresholds of absolute data, etc), and by comparison with reference series (see Poster MOTEDAS 3, about reconstruction). Anomalous data were considered when difference between Candidate and Reference series were higher than three times the interquartile distance. The total amount of monthly suspicious data recognized and discarded at the end of this analyses was 7832 data for Tmin, and 8063 for Tmax data; they represent less than 0,8% of original total monthly data, for both Tmax and Tmin. No spatial pattern was detected in the suspicious data; month by month Tmin shows maximum detection in summer months, while Tmax does not show any monthly pattern. Secondly, the homogeneity analyses was performed on the list of series free of anomalous data by using an arrays of test (SNHT, Bivariate, T de Student and Pettit) after new reference series calculated with data free of anomalous. The tests were applied at monthly, seasonal and annual scale (i.e. 17 times per method). Statistical inhomogeneity detections were accepted as follows: Three annual detections (monthly, seasonal, annual) must be found in SNHT or Bivariate test. The total amount of detections by the four tests was greater than 5% of the total possible detection per year. Before any correction we examined the Candidate and reference series chart. Proclim and Anclim software were used during all the processes The total amount of series affected by inhomogeneities was 1013 (Tmax) and 1011 (Tmin), i.e. 1/3 of original series was considered as inhomogeneous. We notice that identified inhomogeneous series in Tmax and Tmin usually do not coincide. This apparently small amount of series compared with previous work could be originated because of the mean length of series is around 15-20 years. References. Stepánek P. 2008a. AnClim - software for time series analysis (for Windows 95/NT). Department of Geography, Faculty of Natural Sciences, MU, Brno, 1.47 B. Stepánek P.. 2008b. ProClimDB - Software for Processing Climatological Datasets. CHMI, Regional office, Brno.

[The experience of implementation of system of quality management in the Department of Laboratory Diagnostic of the N.V. Sklifosofskiy Research Institute of Emergency Care of Moscow Health Department: a lecture].

PubMed

Zenina, L P; Godkov, M A

2013-08-01

The article presents the experience of implementation of system of quality management into the practice of multi-field laboratory of emergency medical care hospital. The analysis of laboratory errors is applied and the modes of their prevention are demonstrated. The ratings of department of laboratory diagnostic of the N. V. Sklifosofskiy research institute of emergency care in the program EQAS (USA) Monthly Clinical Chemistry from 2007 are presented. The implementation of the system of quality management of laboratory analysis into department of laboratory diagnostic made it possible to support physicians of clinical departments with reliable information. The confidence of clinicians to received results increased. The effectiveness of laboratory diagnostic increased due to lowering costs of analysis without negative impact to quality of curative process.

Improving Emergency Department Door to Doctor Time and Process Reliability

PubMed Central

El Sayed, Mazen J.; El-Eid, Ghada R.; Saliba, Miriam; Jabbour, Rima; Hitti, Eveline A.

2015-01-01

Abstract The aim of this study is to determine the effectiveness of using lean management methods on improving emergency department door to doctor times at a tertiary care hospital. We performed a before and after study at an academic urban emergency department with 49,000 annual visits after implementing a series of lean driven interventions over a 20 month period. The primary outcome was mean door to doctor time and the secondary outcome was length of stay of both admitted and discharged patients. A convenience sample from the preintervention phase (February 2012) was compared to another from the postintervention phase (mid-October to mid-November 2013). Individual control charts were used to assess process stability. Postintervention there was a statistically significant decrease in the mean door to doctor time measure (40.0 minutes ± 53.44 vs 25.3 minutes ± 15.93 P < 0.001). The postintervention process was more statistically in control with a drop in the upper control limits from 148.8 to 72.9 minutes. Length of stay of both admitted and discharged patients dropped from 2.6 to 2.0 hours and 9.0 to 5.5 hours, respectively. All other variables including emergency department visit daily volumes, hospital occupancy, and left without being seen rates were comparable. Using lean change management techniques can be effective in reducing door to doctor time in the Emergency Department and improving process reliability. PMID:26496278

76 FR 38745 - Proposed Information Collection (Suspension of Monthly Check); Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

... (Suspension of Monthly Check); Comment Request AGENCY: Department of Veterans Affairs, Veterans Benefits Administration. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA), Department of Veterans.... Kessinger, Veterans Benefits Administration (20M35), Department of Veterans Affairs, 810 Vermont Avenue, NW...

Idaho National Laboratory Quarterly Performance Analysis - 2nd Quarter FY2014

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

Lisbeth A. Mitchell

2014-06-01

This report is published quarterly by the Idaho National Laboratory (INL) Performance Assurance Organization. The Department of Energy Occurrence Reporting and Processing System (ORPS), as prescribed in DOE Order 232.2, “Occurrence Reporting and Processing of Operations Information,” requires a quarterly analysis of events, both reportable and not reportable, for the previous 12 months. This report is the analysis of occurrence reports and other deficiency reports (including not reportable events) identified at INL from January 2014 through March 2014.

Idaho National Laboratory Quarterly Occurrence Analysis - 3rd Quarter FY-2016

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

Mitchell, Lisbeth Ann

This report is published quarterly by the Idaho National Laboratory (INL) Quality and Performance Management Organization. The Department of Energy (DOE) Occurrence Reporting and Processing System (ORPS), as prescribed in DOE Order 232.2, “Occurrence Reporting and Processing of Operations Information,” requires a quarterly analysis of events, both reportable and not reportable, for the previous 12 months. This report is the analysis of 73 reportable events (23 from the 3rd Qtr FY-16 and 50 from the prior three reporting quarters), as well as 45 other issue reports (including events found to be not reportable and Significant Category A and B conditions)more » identified at INL during the past 12 months (16 from this quarter and 29 from the prior three quarters).« less

Idaho National Laboratory Quarterly Occurrence Analysis - 1st Quarter FY 2016

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

Mitchell, Lisbeth Ann

This report is published quarterly by the Idaho National Laboratory (INL) Quality and Performance Management Organization. The Department of Energy (DOE) Occurrence Reporting and Processing System (ORPS), as prescribed in DOE Order 232.2, “Occurrence Reporting and Processing of Operations Information,” requires a quarterly analysis of events, both reportable and not reportable, for the previous 12 months. This report is the analysis of 74 reportable events (16 from the 1st Qtr FY-16 and 58 from the prior three reporting quarters), as well as 35 other issue reports (including events found to be not reportable and Significant Category A and B conditions)more » identified at INL during the past 12 months (15 from this quarter and 20 from the prior three quarters).« less

Idaho National Laboratory Quarterly Occurrence Analysis 4th Quarter FY 2016

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

Mitchell, Lisbeth Ann

This report is published quarterly by the Idaho National Laboratory (INL) Quality and Performance Management Organization. The Department of Energy (DOE) Occurrence Reporting and Processing System, as prescribed in DOE Order 232.2, “Occurrence Reporting and Processing of Operations Information,” requires a quarterly analysis of events, both reportable and not reportable, for the previous 12 months. This report is the analysis of 84 reportable events (29 from the 4th quarter fiscal year 2016 and 55 from the prior three reporting quarters), as well as 39 other issue reports (including events found to be not reportable and Significant Category A and Bmore » conditions) identified at INL during the past 12 months (two from this quarter and 37 from the prior three quarters).« less

Idaho National Laboratory Quarterly Occurrence Analysis

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

Mitchell, Lisbeth Ann

This report is published quarterly by the Idaho National Laboratory (INL) Quality and Performance Management Organization. The Department of Energy (DOE) Occurrence Reporting and Processing System (ORPS), as prescribed in DOE Order 232.2, “Occurrence Reporting and Processing of Operations Information,” requires a quarterly analysis of events, both reportable and not reportable, for the previous 12 months. This report is the analysis of 85 reportable events (18 from the 4th Qtr FY-15 and 67 from the prior three reporting quarters), as well as 25 other issue reports (including events found to be not reportable and Significant Category A and B conditions)more » identified at INL during the past 12 months (8 from this quarter and 17 from the prior three quarters).« less

Prostate Cancer Biorepository Network

DTIC Science & Technology

2017-10-01

Department of the Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704...clinical data including pathology and outcome data are annotated with the biospecimens. Specialized processing consists of tissue microarray design ...Months 1- 6): Completed in 1st quarter Task 5. Report on performance metrics: Ongoing (accrual reports are provided on quarterly basis) Task 6

Informatics in radiology: automated Web-based graphical dashboard for radiology operational business intelligence.

PubMed

Nagy, Paul G; Warnock, Max J; Daly, Mark; Toland, Christopher; Meenan, Christopher D; Mezrich, Reuben S

2009-11-01

Radiology departments today are faced with many challenges to improve operational efficiency, performance, and quality. Many organizations rely on antiquated, paper-based methods to review their historical performance and understand their operations. With increased workloads, geographically dispersed image acquisition and reading sites, and rapidly changing technologies, this approach is increasingly untenable. A Web-based dashboard was constructed to automate the extraction, processing, and display of indicators and thereby provide useful and current data for twice-monthly departmental operational meetings. The feasibility of extracting specific metrics from clinical information systems was evaluated as part of a longer-term effort to build a radiology business intelligence architecture. Operational data were extracted from clinical information systems and stored in a centralized data warehouse. Higher-level analytics were performed on the centralized data, a process that generated indicators in a dynamic Web-based graphical environment that proved valuable in discussion and root cause analysis. Results aggregated over a 24-month period since implementation suggest that this operational business intelligence reporting system has provided significant data for driving more effective management decisions to improve productivity, performance, and quality of service in the department.

Evidence for Ordering of Alzheimer’s Disease Biomarkers

PubMed Central

Jack, Clifford R.; Vemuri, Prashanthi; Wiste, Heather J.; Weigand, Stephen D.; Aisen, Paul S.; Trojanowski, John Q.; Shaw, Leslie M.; Bernstein, Matthew A.; Petersen, Ronald C.; Weiner, Michael W.

2012-01-01

Objective To empirically assess the concept that Alzheimer’s disease (AD) biomarkers significantly depart from normality in a temporally ordered manner. Design Validation sample Setting Multi-site, referral centers Patients We studied 401 elderly cognitively normal (CN), Mild Cognitive Impairment (MCI) and AD dementia subjects from the Alzheimer’s Disease Neuroimaging Initiative. We compared the proportions of three AD biomarkers – CSF Aβ42, CSF total tau (t-tau), and hippocampal volume adjusted by intra-cranial volume (HVa) - that were abnormal as cognitive impairment worsened. Cut-points demarcating normal vs. abnormal for each biomarker were established by maximizing diagnostic accuracy in independent autopsy samples. Interventions None Main Outcome measures AD biomarkers Results Within each clinical group in the entire sample (n=401) CSF Aβ42 was abnormal more often than t-tau or HVa. Among the 298 subjects with both baseline and 12 month data, the proportion of subjects with abnormal Aβ42 did not change from baseline to 12 months in any group. The proportion of subjects with abnormal t-tau increased from baseline to 12 months in CN (p=0.05) but not in MCI or dementia. In 209 subjects with abnormal CSF AB42 at baseline, the percent abnormal HVa, but not t-tau, increased from baseline to 12 months in MCI. Conclusions Reduction in CSF Aβ42 denotes a pathophysiological process that significantly departs from normality (i.e., becomes dynamic) early, while t-tau and HVa are biomarkers of downstream pathophysiological processes. T-tau becomes dynamic before HVa, but HVa is more dynamic in the clinically symptomatic MCI and dementia phases of the disease than t-tau. PMID:21825215

Students paperwork tracking system (SPATRASE)

NASA Astrophysics Data System (ADS)

Ishak, I. Y.; Othman, M. B.; Talib, Rahmat; Ilyas, M. A.

2017-09-01

This paper focused on a system for tracking the status of the paperwork using the Near Field Communication (NFC) technology and mobile apps. Student paperwork tracking system or known as SPATRASE was developed to ease the user to track the location status of the paperwork. The current problem faced by the user is the process of approval paperwork takes around a month or more. The process took around a month to get full approval from the department because of many procedures that need to be done. Nevertheless, the user cannot know the location status of the paperwork immediately because of the inefficient manual system. The submitter needs to call the student affairs department to get the information about the location status of the paperwork. Thus, this project was purposed as an alternative to solve the waiting time of the paperwork location status. The prototype of this system involved the hardware and software. The project consists of NFC tags, RFID Reader, and mobile apps. At each checkpoint, the RFID Reader was placed on the secretary desk. While the system involved the development of database using Google Docs that linked to the web server. After that, the submitter received the URL link and be directed to the web server and mobile apps. This system is capable of checking their location status tracking using mobile apps and Google Docs. With this system, it makes the tracking process become efficient and reliable to know the paperwork at the exact location. Thus, it is preventing the submitter to call the department all the time. Generally, this project is fully functional and we hope it can help Universiti Tun Hussein Onn Malaysia (UTHM) to overcome the problem of paperwork missing and location of the paperwork.

[Quality management in emergency departments: Lack of uniform standards for fact-based controlling].

PubMed

Ries, M; Christ, M

2015-11-01

The general high occupancy of emergency departments during the winter months of 2014/2015 outlined deficits in health politics. Whether on the regional, province, or federal level, verifiable and accepted figures to enable in depth analysis and fact-based controlling of emergency care systems are lacking. As the first step, reasons for the current situation are outlined in order to developed concrete recommendations for individual hospitals. This work is based on a selective literature search with focus on quality management, ratio driven management, and process management within emergency departments as well as personal experience with implementation of a key ratio system in a German maximum care hospital. The insufficient integration of emergencies into the DRG systematic, the role as gatekeeper between inpatient and outpatient care sector, the decentralized organization of emergency departments in many hospitals, and the inconsistent representation within the medical societies can be mentioned as reasons for the lack of key ratio systems. In addition to the important role within treatment procedures, emergency departments also have an immense economic importance. Consequently, the management of individual hospitals should promote implementation of key ratio systems to enable controlling of emergency care processes. Thereby the perspectives finance, employees, processes as well as partners and patients should be equally considered. Within the process perspective, milestones could be used to enable detailed controlling of treatment procedures. An implementation of key ratio systems without IT support is not feasible; thus, existing digital data should be used and future data analysis should already be considered during implementation of new IT systems.

Research and Engineering Operation, Irradiation Processing Department monthly record report, May 1965

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

Ambrose, T.W.

1965-06-04

Process and development activities reported include: depleted uranium irradiations, thoria irradiation, and hot die sizing. Reactor engineering activities include: brittle fracture of 190-C tanks, increased graphite temperature limits for the F reactor, VSR channel caulking, K reactor downcomer flow, zircaloy hydriding, and ribbed zircaloy process tubes. Reactor physics activities include: thoria irradiations, E-D irradiations, boiling protection with the high speed scanner, and in-core flux monitoring. Radiological engineering activities include: radiation control, classification, radiation occurrences, effluent activity data, and well car shielding. Process standards are listed, along with audits, and fuel failure experience. Operational physics and process physics studies are presented.more » Lastly, testing activities are detailed.« less

Lifetime and 12-Month Nonsuicidal Self-Injury and Academic Performance in College Freshmen.

PubMed

Kiekens, Glenn; Claes, Laurence; Demyttenaere, Koen; Auerbach, Randy P; Green, Jennifer G; Kessler, Ronald C; Mortier, Philippe; Nock, Matthew K; Bruffaerts, Ronny

2016-10-01

We examined whether nonsuicidal self-injury (NSSI) is associated with academic performance in college freshmen, using census-based web surveys (N = 7,527; response = 65.4%). NSSI was assessed with items from the Self-Injurious Thoughts and Behaviors Interview and subsequently linked with the administratively recorded academic year percentage (AYP). Freshmen with lifetime and 12-month NSSI showed a reduction in AYP of 3.4% and 5.9%, respectively. The college environment was found to moderate the effect of 12-month NSSI, with more strongly reduced AYPs in departments with higher-than-average mean departmental AYPs. The findings suggest that overall stress and test anxiety are underlying processes between NSSI membership and academic performance. © 2016 The American Association of Suicidology.

Defense.gov Special Report: Women's History Month 2013

Science.gov Websites

Department of Defense Submit Search July 18, 2014 DEPARTMENT OF DEFENSE: Women's History Month 2014 The became the first woman to attain the rank of four-star admiral in the Navy's 238-year history during a at a Women's History Month event at the Pentagon, March 31, 2014. Army Spc. Natasha Schuette wants

22 CFR 19.6-4 - Date of court orders.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Department if it is issued more than 12 months after the divorce becomes final. A court order adjusting the... order issued within 12 months after a divorce becomes final directing payment of a pension to a former... month in which the divorce becomes final if so specified by the court. In such event, the Department...

22 CFR 19.6-4 - Date of court orders.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Department if it is issued more than 12 months after the divorce becomes final. A court order adjusting the... order issued within 12 months after a divorce becomes final directing payment of a pension to a former... month in which the divorce becomes final if so specified by the court. In such event, the Department...

22 CFR 19.6-4 - Date of court orders.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Department if it is issued more than 12 months after the divorce becomes final. A court order adjusting the... order issued within 12 months after a divorce becomes final directing payment of a pension to a former... month in which the divorce becomes final if so specified by the court. In such event, the Department...

22 CFR 19.6-4 - Date of court orders.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Department if it is issued more than 12 months after the divorce becomes final. A court order adjusting the... order issued within 12 months after a divorce becomes final directing payment of a pension to a former... month in which the divorce becomes final if so specified by the court. In such event, the Department...

22 CFR 19.6-4 - Date of court orders.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Department if it is issued more than 12 months after the divorce becomes final. A court order adjusting the... order issued within 12 months after a divorce becomes final directing payment of a pension to a former... month in which the divorce becomes final if so specified by the court. In such event, the Department...

Idaho National Laboratory Quarterly Occurrence Analysis for the 1st Quarter FY2017

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

Mitchell, Lisbeth Ann

This report is published quarterly by the Idaho National Laboratory (INL) Quality and Performance Management Organization. The Department of Energy (DOE) Occurrence Reporting and Processing System (ORPS), as prescribed in DOE Order 232.2, “Occurrence Reporting and Processing of Operations Information,” requires a quarterly analysis of events, both reportable and not reportable, for the previous 12 months. This report is the analysis of 82 reportable events (13 from the 1st quarter (Qtr) of fiscal year (FY) 2017 and 68 from the prior three reporting quarters), as well as 31 other issue reports (including events found to be not reportable and Significantmore » Category A and B conditions) identified at INL during the past 12 months (seven from this quarter and 24 from the prior three quarters).« less

Developing a multidisciplinary approach within the ED towards domestic violence presentations.

PubMed

Basu, Subhashis; Ratcliffe, Giles

2014-03-01

To improve the detection and quality of care of patients who attend the emergency department (ED) with confirmed or suspected domestic abuse (DA). A quality improvement report on the design, implementation and evaluation of a specialised service and structured training programme to detect and manage DA presentations within an emergency medicine department. The study was set in the ED at the Northern General Hospital, Sheffield, UK. Key measures for improvement included introducing a service within the ED to help staff manage DA and coordinate responses; improve staff confidence in detecting DA; develop a structured and consistent process by which to manage DA presentations. An Independent Domestic Violence Advocate service was introduced into the department in July 2011 through a multiagency agreement. A structured training and education programme was delivered to ED staff. A 'communications form' was developed for DA risk assessment and case management. The process was reviewed quarterly. One hundred and seventy-two referrals were made to the service (121 distinct clients) over a 12-month period. Staff reported greater confidence in detecting DA, and community partners highlighted the role the service had in improving DA detection and care quality within the city. Strong leadership and prioritising the issue within the department has facilitated the development of the process and contributed substantially to its success. Support from community partners has been invaluable in tailoring the service and education programme to the needs of staff and patients within the department.

Hanford Works monthly report, October 1952

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

Not Available

1952-11-20

this document presents a summary of work and progress at the Hanford Engineer works for October 1952. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summaries work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Works monthly report, December 1952

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

Not Available

1953-01-23

This document presents a summary of work and progress at the Hanford Engineer Works for December 1952. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Works monthly report, February 1953

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

Not Available

1953-03-18

This document presents a summary of work and progress at the Hanford Engineer Works for February 1953. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summaries work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Service departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Works monthly report, September 1952

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

Not Available

1952-10-20

This document presents a summary of work and progress at the Hanford Engineer Works for September 1952. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summaries work for the Technical Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Idaho National Laboratory Quarterly Event Performance Analysis FY 2013 4th Quarter

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

Mitchell, Lisbeth A.

2013-11-01

This report is published quarterly by the Idaho National Laboratory (INL) Performance Assurance Organization. The Department of Energy Occurrence Reporting and Processing System (ORPS) as prescribed in DOE Order 232.2 “Occurrence Reporting and Processing of Operations Information” requires a quarterly analysis of events, both reportable and not reportable for the previous twelve months. This report is the analysis of occurrence reports and deficiency reports (including not reportable events) identified at the Idaho National Laboratory (INL) during the period of October 2012 through September 2013.

Tracking and sustaining improvement initiatives: leveraging quality dashboards to lead change in a neurosurgical department.

PubMed

McLaughlin, Nancy; Afsar-Manesh, Nasim; Ragland, Victoria; Buxey, Farzad; Martin, Neil A

2014-03-01

Increasingly, hospitals and physicians are becoming acquainted with business intelligence strategies and tools to improve quality of care. In 2007, the University of California Los Angeles (UCLA) Department of Neurosurgery created a quality dashboard to help manage process measures and outcomes and ultimately to enhance clinical performance and patient care. At that time, the dashboard was in a platform that required data to be entered manually. It was then reviewed monthly to allow the department to make informed decisions. In 2009, the department leadership worked with the UCLA Medical Center to align mutual quality-improvement priorities. The content of the dashboard was redesigned to include 3 areas of priorities: quality and safety, patient satisfaction, and efficiency and use. Throughout time, the neurosurgery quality dashboard has been recognized for its clarity and its success in helping management direct improvement strategies and monitor impact. We describe the creation and design of the neurosurgery quality dashboard at UCLA, summarize the evolution of its assembly process, and illustrate how it can be used as a powerful tool of improvement and change. The potential challenges and future directions of this business intelligence tool are also discussed.

WE-G-BRA-03: Developing a Culture of Patient Safety Utilizing the National Radiation Oncology Incident Learning System (ROILS)

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

Hasson, B; Workie, D; Geraghty, C

Purpose: To transition from an in-house incident reporting system to a ROILS standards system with the intent to develop a safety focused culture in the Department and enroll in ROILS. Methods: Since the AAPM Safety Summit (2010) several safety and reporting systems have been implemented within the Department. Specific checklists and SBAR reporting systems were introduced. However, the active learning component was lost due to reporting being viewed with distrust and possible retribution.To Facilitate introducing ROILS each leader in the Department received a copy of the ROILS participation guide. Four specific tasks were assigned to each leader: develop a reportingmore » tree, begin the ROILS based system, facilitate adopting ROILS Terminology, and educate the staff on expectations of safety culture. Next, the ROILS questions were broken down into area specific questions (10–15) per departmental area. Excel spreadsheets were developed for each area and setup for error reporting entries. The Role of the Process Improvement Committee (PI) has been modified to review and make recommendations based on the ROILS entries. Results: The ROILS based Reporting has been in place for 4 months. To date 64 reports have been entered. Since the adoption of ROILS the reporting of incidents has increased from 2/month to 18/month on average. Three reports had a dosimetric effect on the patient (<5%) dose variance. The large majority of entries have been Characterized as Processes not followed or not sure how to Characterize, and Human Behavior. Conclusion: The majority of errors are typo’s that create confusion. The introduction of the ROILS standards has provided a platform for making changes to policies that increase patient safety. The goal is to develop a culture that sees reporting at a national level as a safe and effective way to improve our safety, and to dynamically learn from other institutions reporting.« less

Hanford Works monthly report, August 1952

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

Not Available

1952-09-24

This document presents a summary of work and progress at the Hanford Engineer Works for August 1952. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department` section summaries work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical,Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Real Estatemore » and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, January 1955

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

Not Available

1955-02-21

This document presents a summary of work and progress at the Hanford Engineer Works for January 1955. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical Design, and Project Sections. Costs for the various departments are presented in the Financial department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report for April 1955

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

Not Available

1955-05-23

This document presents a summary of work and progress at the Hanford Engineer Works for April 1955. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Monthly report Hanford Atomic Products Operation, July 1954

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

Not Available

1954-08-20

This document presents a summary of work and progress at the Hanford Engineer Works for July 1954. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services Departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, August 1956

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

Not Available

1956-09-28

This document presents a summary of work and progress at the Hanford Engineer Works for August 1956. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Sciences, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report for May 1956

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

Not Available

1956-06-21

This document presents a summary of work and progress at the Hanford Engineer Works for May, 1956. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, March 1954

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

Not Available

1954-04-23

This document presents a summary of work and progress at the Hanford Engineer Works for March 1954. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summaries work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Service departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, September 1955

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

Not Available

1955-10-27

This document presents a summary of work and progress at the Hanford Engineer Works for September 1955. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, June 1954

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

Not Available

1954-07-26

This document presents a summary of work and progress at the Hanford Engineer Works for June 1954. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summaries work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, March 1955

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

Not Available

1955-04-20

This document presents a summary of work and progress at the Hanford Engineer Works for March 1955. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, November 1955

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

Not Available

1955-12-30

This document presents a summary of work and progress at the Hanford Engineer Works for November 1955. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, August 1955

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

Not Available

1955-09-27

This document presents a summary of work and progress at the Hanford Engineer Works for August 1955. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Sciences, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, May 1954

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

Not Available

1954-06-22

This document presents a summary of work and progress at the Hanford Engineer Works for May 1954. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summaries work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Science, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report for December 1955

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

Not Available

1956-01-30

This document presents a summary of work and progress at the Hanford Engineer Works for December 1955. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, October 1955

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

Not Available

1955-11-30

This document presents a summary of work and progress at the Hanford Engineer works for October, 1955. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products for Operation monthly report, February 1955

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

Not Available

1955-03-18

This document presents a summary of work and progress at the Hanford Engineer Works for February 1955. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, May 1955

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

Not Available

1955-06-23

This document presents a summary of work and progress at the Hanford Engineer Works for May 1955. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, July 1955

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

Not Available

1955-08-26

This document presents a summary of work and progress at the Hanford Engineer Works for July 1955. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, October 1953

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

Not Available

1953-11-20

This document presents a summary of work and progress at the Hanford Engineer Works for October 1953. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summaries work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services. Employee and Public Relations, and Community Realmore » Estate and Service departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, May 1953

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

Not Available

This document presents a summary of work and progress at the Hanford Engineer Works for May 1953. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summaries work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, October 1954

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

Not Available

1954-11-24

This document presents a summary of work and progress at the Hanford Engineer Works for October 1954. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, December 1954

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

Not Available

1955-01-25

This document presents a summary of work and progress at the Hanford Engineer Works for December 1954. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, July 1953

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

Not Available

1953-08-20

This document presents a summary of work and progress at the Hanford Engineer Works for July 1953. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summaries work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, August 1954

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

Not Available

1954-09-17

This document presents a summary of work and progress at the Hanford Engineer Works for August 1954. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department report plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities, and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report for September 1954

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

Not Available

1954-10-25

This document presents a summary of work and progress at the Hanford Engineer Works for September 1954. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summaries work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, June 1953

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

Not Available

1953-07-22

This document presents a summary of work and progress at the Hanford Engineer Works for June 1953. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summaries work the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Real Estatemore » and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, December 1953

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

Not Available

1954-01-22

This document presents a summary of work and progress at the Hanford Engineer Works for December 1953. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summaries work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Hanford Atomic Products Operation monthly report, August 1953

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

Not Available

1953-09-18

This document presents a summary of work and progress at the Hanford Engineer Works for August, 1953. The report is divided into sections by department. A plant wide general summary is included at the beginning of the report, after which the departmental summaries begin. The Manufacturing Department reports plant statistics, and summaries for the Metal Preparation, Reactor and Separation sections. The Engineering Department`s section summarizes work for the Technical, Design, and Project Sections. Costs for the various departments are presented in the Financial Department`s summary. The Medical, Radiological Sciences, Utilities and General Services, Employee and Public Relations, and Community Realmore » Estate and Services departments have sections presenting their monthly statistics, work, progress, and summaries.« less

Effect of Store and Forward Teledermatology on Quality of Life

PubMed Central

Whited, John D.; Warshaw, Erin M.; Edison, Karen E.; Kapur, Kush; Thottapurathu, Lizy; Raju, Srihari; Cook, Bethany; Engasser, Holly; Pullen, Samantha; Parks, Patricia; Sindowski, Tom; Motyka, Danuta; Brown, Rodney; Moritz, Thomas E.; Datta, Santanu K.; Chren, Mary-Margaret; Marty, Lucinda; Reda, Domenic J.

2013-01-01

Importance Although research on quality of life and dermatologic conditions is well represented in the literature, information on teledermatology’s effect on quality of life is virtually absent. Objective To determine the effect of store and forward teledermatology on quality of life. Design Two-site, parallel-group, superiority randomized controlled trial. Setting Dermatology clinics and affiliated sites of primary care at 2 US Department of Veterans Affairs medical facilities. Participants Patients being referred to a dermatology clinic were randomly assigned, stratified by site, to teledermatology or the conventional consultation process. Among the 392 patients who met the inclusion criteria and were randomized, 326 completed the allocated intervention and were included in the analysis. Interventions Store and forward teledermatology (digital images and a standardized history) or conventional text-based consultation processes were used to manage the dermatology consultations. Patients were followed up for 9 months. Main Outcome Measures The primary end point was change in Skindex-16 scores, a skin-specific quality-of-life instrument, between baseline and 9 months. A secondary end point was change in Skindex-16 scores between baseline and 3 months. Results Patients in both randomization groups demonstrated a clinically significant improvement in Skindex-16 scores between baseline and 9 months with no significant difference by randomization group (P=.66, composite score). No significant difference in Skindex-16 scores by randomization group between baseline and 3 months was found (P=.39, composite score). Conclusions Compared with the conventional consultation process, store and forward teledermatology did not result in a statistically significant difference in skin-related quality of life at 3 or 9 months after referral. Trial Registration clinicaltrials.gov Identifier: NCT00488293 PMID:23426111

Oregon department of transportation small business group twice-monthly payments pilot project : summary report.

DOT National Transportation Integrated Search

2008-07-01

Oregon Department of Transportation (ODOT) recently completed a pilot study on small business payment practices. In the study, three pilot projects were tested where payments to small business contractors were changed from a monthly payment to twice-...

Shared leadership and the evolution of "one great department".

PubMed

Casady, Wanda M; Dowd, Terry A

2005-01-01

In 2001, Banner Baywood Medical Center's (BBMC) medical imaging department employed concepts to engage staff in a participative decision-making practice regarding those things that most impacted their jobs. A 5-member Oversight Committee was charged with defining a vision for the department to be achieved by 2005, determining obstacles or challenges that needed to be overcome in order to achieve the vision, and facilitating 12-week teams to find solutions to these obstacles. Several initiatives were implemented to ensure competitive salaries, more effective leadership, and overall greater participation by staff in the decision-making process. Within the project's first 18 months, the department's turnover rate was reduced from 40% to 14.5%. However, as the department continued to grow, it became evident that the structure of the Oversight Committee was no longer sufficient to achieve its goals. The members of the Oversight Committee decided to expand its membership to include a representative from every work group within the department. The new group was called the Strategic Thinking Group (STG). Shared leadership--defined by Conger and Pearce as "a dynamic", interactive process among individuals working in groups in which the objective is to lead one another to the achievement of the group goals--is a vital component of the department's operation. During the past 2 years, BBMC has been actively engaged in creating a workplace environment that promotes shared leadership. BBMC utilizes the Gallup Q12 Workplace Survey and the Press Ganey Patient Satisfaction Survey. These surveys use identical numerical ratings, with "5" (strongly agree/very good) the department's goal for employees and patients. Consequently, the department created a new slogan: "We Strive for 5." The outcomes of shared leadership have proven to have a positive impact on staff retention, the reduction of casual Iabor staff, employee satisfaction, and patient satisfaction.

A novel program to improve patient safety by integrating peer review into the emergency medicine residency curriculum.

PubMed

Strayer, Reuben J; Shy, Bradley D; Shearer, Peter L

2014-12-01

Evaluating the quality of care as part of a quality improvement process is required in many clinical environments by accrediting bodies. It produces metrics used to evaluate department and individual provider performance, provides outcomes-based feedback to clinicians, and identifies ways to reduce error. To improve patient safety and train our residents to perform peer review, we expanded our quality assurance program from a narrow, administrative process carried out by a small number of attendings to an educationally focused activity of much greater scope incorporating all residents on a monthly basis. We developed an explicit system by which residents analyze sets of high-risk cases and record their impressions onto structured databases, which are reviewed by faculty. At monthly meetings, results from the month's case reviews are presented, learning points discussed, and corrective actions are proposed. By integrating Clinical Quality Review (CQR) as a core, continuous component of the residency curriculum, we increased the number of cases reviewed more than 10-fold and implemented a variety of clinical process improvements. An anonymous survey conducted after 2 years of resident-led CQR indicated that residents value their exposure to the peer review process and feel it benefits them as clinicians, but also that the program requires a significant investment of time that can be burdensome. Copyright © 2014 Elsevier Inc. All rights reserved.

Do constructed wetlands remove metals or increase metal bioavailability?

PubMed

Xu, Xiaoyu; Mills, Gary L

2018-07-15

The H-02 wetland was constructed to treat building process water and storm runoff water from the Tritium Processing Facility on the Department of Energy's Savannah River Site (Aiken, SC). Monthly monitoring of copper (Cu) and zinc (Zn) concentrations and water quality parameters in surface waters continued from 2014 to 2016. Metal speciation was modeled at each sampling occasion. Total Cu and Zn concentrations released to the effluent stream were below the NPDES limit, and the average removal efficiency was 65.9% for Cu and 71.1% for Zn. The metal-removal processes were found out to be seasonally regulated by sulfur cycling indicated by laboratory and model results. High temperature, adequate labile organic matter, and anaerobic conditions during the warm months (February to August) favored sulfate reduction that produced sulfide minerals to significantly remove metals. However, the dominant reaction in sulfur cycling shifted to sulfide oxidation during the cool months (September to next March). High concentrations of metal-organic complexes were observed, especially colloidal complexes of metal and fulvic acid (FA), demonstrating adsorption to organic matter became the primary process for metal removal. Meanwhile, the accumulation of metal-FA complexes in the wetland system will cause negative effects to the surrounding environment as they are biologically reactive, highly bioavailable, and can be easily taken up and transferred to ecosystems by trophic exchange. Copyright © 2018 Elsevier Ltd. All rights reserved.

U.S. Department of Education Chapter of Blacks In Government (BIG) in Partnership with the EEOS Office at the U.S. Department of Education 2013 Black History Month Programs

ERIC Educational Resources Information Center

Gill, Wanda E.

2013-01-01

The 2013 Black History Month Programs at the U.S. Department of Education highlighted and celebrated emancipation, Civil Rights, the histories of key Black organizations and the contributions of Historically Black Colleges and Universities through a series of programs offered both in Barnard Auditorium at headquarters on Maryland Avenue, S.W,…

National Native American Heritage Month, 2009

Science.gov Websites

; the U.S. Departments of Defense, Interior, Agriculture, Commerce, Housing and Urban Development . Department of Commerce seal U.S. Department of Agriculture logo U.S. Department of Housing and Urban

32 CFR 584.9 - Involuntary allotments.

Code of Federal Regulations, 2011 CFR

2011-07-01

... National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY PERSONNEL FAMILY SUPPORT, CHILD..., support payments when— (1) The soldier has failed to make payments under a court order for 2 months or in a total amount equal to or in excess of the support obligations for 2 months. (2) Failure to make...

32 CFR 584.9 - Involuntary allotments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY PERSONNEL FAMILY SUPPORT, CHILD..., support payments when— (1) The soldier has failed to make payments under a court order for 2 months or in a total amount equal to or in excess of the support obligations for 2 months. (2) Failure to make...

Department of Defense DOD Freedom of Information Act Program

DTIC Science & Technology

1998-09-01

Enter year. month. end d",r La .. 19971024, the tee nmwa.payeynit was receive. r,. PKIOFISSIOAL HOURS. For each applIcabl activity Toot Collsotabl Cosas ...through the Federal Register, the National Technical Information Service, or the Internet , normally need not be processed under the provisions of the FOIA...court shall evaluate the case de novo (anew) and may elect to examine any requested record in camera (in private) to determine whether the denial was

The Impact of High-Profile Sexual Abuse Cases in the Media on a Pediatric Emergency Department.

PubMed

Flannery, Dustin D; Stephens, Clare L; Thompson, Amy D

2016-01-01

High-profile media cases of sexual abuse may encourage disclosures of abuse from victims of unrelated assaults and also influence parental concerns, leading to increased emergency department visits. In the region of the study authors' institution, there are two recent high-profile sexual abuse cases with media coverage: Earl Bradley, a Delaware pediatrician, and Jerry Sandusky, a Pennsylvania college football coach. This is a retrospective cohort study of children evaluated for sexual abuse at a pediatric emergency department. Patients were classified as either presenting during a media period or non-media period. The media periods were one-month periods immediately following breaking news reports, when the cases were highly publicized in the media. The non-media periods were the 12-month periods directly preceding the first reports. The median number of emergency department visits per month during a non-media period was 9 visits (interquartile range 6-10). There were 11 visits in the month following the Sandusky case and 13 visits following the Bradley case. There was no statistical difference in number of emergency department visits for sexual abuse between the periods (p = .09). These finding have implications regarding use of resources in pediatric EDs after high-profile sexual abuse cases.

Mistakes in a stat laboratory: types and frequency.

PubMed

Plebani, M; Carraro, P

1997-08-01

Application of Total Quality Management concepts to laboratory testing requires that the total process, including preanalytical and postanalytical phases, be managed so as to reduce or, ideally, eliminate all defects within the process itself. Indeed a "mistake" can be defined as any defect during the entire testing process, from ordering tests to reporting results. We evaluated the frequency and types of mistakes found in the "stat" section of the Department of Laboratory Medicine of the University-Hospital of Padova by monitoring four different departments (internal medicine, nephrology, surgery, and intensive care unit) for 3 months. Among a total of 40490 analyses, we identified 189 laboratory mistakes, a relative frequency of 0.47%. The distribution of mistakes was: preanalytical 68.2%, analytical 13.3%, and postanalytical 18.5%. Most of the laboratory mistakes (74%) did not affect patients' outcome. However, in 37 patients (19%), laboratory mistakes were associated with further inappropriate investigations, thus resulting in an unjustifiable increase in costs. Moreover, in 12 patients (6.4%) laboratory mistakes were associated with inappropriate care or inappropriate modification of therapy. The promotion of quality control and continuous improvement of the total testing process, including pre- and postanalytical phases, seems to be a prerequisite for an effective laboratory service.

22 CFR 42.51 - Department control of numerical limitations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... quarters of any fiscal year; and (2) Not to exceed, in any month of a fiscal year, 10% of the world-wide... preceding months in the same fiscal year. (b) Allocation of numbers. Within the foregoing limitations, the... returned to the Department for reallocation within the fiscal year in which the visa was issued when: (1...

22 CFR 42.51 - Department control of numerical limitations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... quarters of any fiscal year; and (2) Not to exceed, in any month of a fiscal year, 10% of the world-wide... preceding months in the same fiscal year. (b) Allocation of numbers. Within the foregoing limitations, the... returned to the Department for reallocation within the fiscal year in which the visa was issued when: (1...

In Final Months, Education Department Seeks Teachers' Advice

ERIC Educational Resources Information Center

Hoff, David J.; Keller, Bess

2008-01-01

This article reports that by next fall--only months before she leaves office--U.S. Secretary of Education Margaret Spellings plans to have five teachers on her staff and set up a group of 20 ad hoc advisers still working in classrooms. Under the Teaching Ambassador Fellowship program the teachers would work at the department for one year starting…

77 FR 33749 - Notice of a Noncompetitive Supplement and a 7-Month Extension of the Period of Support for the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-07

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Notice of a Noncompetitive Supplement and a 7-Month Extension of the Period of Support for the Frontier Extended Stay Clinic... Resources and Services Administration (HRSA), Department of Health and Human Services. ACTION: Notice of a...

Analysis of Government Accountability Office and Department of Defense Inspector General Reports and Commercial Sources on Service Contracts

DTIC Science & Technology

2010-06-01

subway project seven months ahead of the 36 month schedule, saving HK$14.8 million, of which the government and the contractor each benefited by HK...contractors. DoD IG. United States Department of Defense Inspector General. (2003). Report No. D-2003-113, Franchise business activity contracts for medical

[Cost of hospitalization by the Activity Based Costing method in the neonatal department of Principal Hospital of Dakar].

PubMed

Tchamdja, T; Balaka, A; Tchandana, M; Agbétra, A

2015-01-01

To determine the cost of hospitalization per day in the neonatal department of Principal Hospital of Dakar. This prospective study took place during the month of July 2011 in the newborn unit. The activity-based costing method was used to analyze costs. During the study period, 52 newborns were hospitalized for a total of 590 days. The cost of the human resources during that month was 9,907,832 FCFA (US $ 19,815.66), the cost of depreciation of fixed assets was estimated at 571,952 FCFA (US $ 1143.90), and supplies at 112,084 FCFA (US $ 224.17). External services cost 386,753 FCFA (US $ 773.51) and support services 6,917,380.65 FCFA (US $ 13,834.7613). The monthly expenses incurred for the hospitalization of newborns totaled 17,896,002 FCFA (US $ 35,792), for a cost per patient per day of 30,332.20 FCFA (US $ 60.66) and an average cost of hospitalization 334,153.88 FCFA (US $ 668,31). This study is the first of its kind in Senegal and neighboring countries. By applying the ABC approach, we can obtain a more detailed and precise estimate of the cost of activities and services. Process improvements and corrective actions should make it possible to identify cost drivers, such as time.

“Taking a Half Day at a Time:” Patient Perspectives and the HIV Engagement in Care Continuum

PubMed Central

Massey, Amina D.; Lopez, Andrea M.; Geng, Elvin H.; Johnson, Mallory O.; Pilcher, Christopher D.; Fielding, Hegla; Dawson-Rose, Carol

2013-01-01

Abstract The HIV treatment continuum, or “cascade,” outlines key benchmarks in the successful treatment of HIV-infected individuals. However, the cascade fails to capture important dimensions of the patient experience in that it has been constructed from a provider point of view. In order to understand meaningful steps in the HIV care cascade for individuals diagnosed with HIV through expanded, more routine testing, we conducted in-depth interviews (n=34) with three groups of individuals: those diagnosed with HIV in the emergency department/urgent care clinic who linked to HIV care and exhibited 100% appointment adherence in the first 6 months of HIV care; those diagnosed in the emergency department/urgent care clinic who linked to HIV care and exhibited sporadic appointment adherence in the first 6 months of HIV care, and; hospitalized patients with no outpatient HIV care for at least 6 months. This last group was chosen to supplement data from in-care patients. The engagement in care process was defined by a changing perspective on HIV, one's HIV identity, and the role of health care. The linkage to care experience laid the groundwork for subsequent retention. Interventions to support engagement in care should acknowledge that patient concerns change over time and focus on promoting shifts in perspective. PMID:23565926

Environmental Impact Analysis Process. Final Environmental Impact Statement. Supersonic Flight Operations in the Reserve Military Operations Area, Holloman, New Mexico

DTIC Science & Technology

1983-01-01

SUPERSONIC FLIGHT OPERATIONS ’• I • IN THE RESERVE MILITARY OPERATIONS AREA . HOLLOMAN AFB, NE MEXICO ~~DEPARTMENT OF THE AIR FORCE I Environme nta IImpac...Force (b) Proposed Action: Supersonic Flight Operations in the Reserve Mill ary Operations Area in Catron County, New Mexico . (c) Responsible...Abstract: The 49th Tactical Fighter Wing (TFW) at Holloman AFB, New Mexico , proposes to fly approximately 200 supersonic sorties per month in the Reserve

The Design of an Information Management Program for Headquarters, Department of the Army. Phase 2. Management Summary.

DTIC Science & Technology

1980-02-26

months estimated to be required in some areas), and more direct invol ement of information users in long range planning of information requirements (with...most people, there is a definite need to educate the members of the organization as to the implications of the IRM approach. Emphasis should be placed...from information sharing and a coordinated approach. Such an educational process has already begun with the execution of this study, but more must be

Encouraging and supporting women through breast-feeding.

PubMed

Battersby, Sue

2010-01-01

The Department of Health and the World Health Organization recommend that mothers should exclusively breast-feed their infants for the first six months of their lives. Very few mothers in the UK achieve this, but with good support and encouragement from health professionals this could be attained. Health professionals, however, need to have knowledge of the process of breastfeeding and be able to adopt a problem-solving approach to the difficulties mothers encounter, in order to give appropriate evidence-based care.

Process improvement methodologies uncover unexpected gaps in stroke care.

PubMed

Kuner, Anthony D; Schemmel, Andrew J; Pooler, B Dustin; Yu, John-Paul J

2018-01-01

Background The diagnosis and treatment of acute stroke requires timed and coordinated effort across multiple clinical teams. Purpose To analyze the frequency and temporal distribution of emergent stroke evaluations (ESEs) to identify potential contributory workflow factors that may delay the initiation and subsequent evaluation of emergency department stroke patients. Material and Methods A total of 719 sentinel ESEs with concurrent neuroimaging were identified over a 22-month retrospective time period. Frequency data were tabulated and odds ratios calculated. Results Of all ESEs, 5% occur between 01:00 and 07:00. ESEs were most frequent during the late morning and early afternoon hours (10:00-14:00). Unexpectedly, there was a statistically significant decline in the frequency of ESEs that occur at the 14:00 time point. Conclusion Temporal analysis of ESEs in the emergency department allowed us to identify an unexpected decrease in ESEs and through process improvement methodologies (Lean and Six Sigma) and identify potential workflow elements contributing to this observation.

Application of Six Sigma methodology to a diagnostic imaging process.

PubMed

Taner, Mehmet Tolga; Sezen, Bulent; Atwat, Kamal M

2012-01-01

This paper aims to apply the Six Sigma methodology to improve workflow by eliminating the causes of failure in the medical imaging department of a private Turkish hospital. Implementation of the design, measure, analyse, improve and control (DMAIC) improvement cycle, workflow chart, fishbone diagrams and Pareto charts were employed, together with rigorous data collection in the department. The identification of root causes of repeat sessions and delays was followed by failure, mode and effect analysis, hazard analysis and decision tree analysis. The most frequent causes of failure were malfunction of the RIS/PACS system and improper positioning of patients. Subsequent to extensive training of professionals, the sigma level was increased from 3.5 to 4.2. The data were collected over only four months. Six Sigma's data measurement and process improvement methodology is the impetus for health care organisations to rethink their workflow and reduce malpractice. It involves measuring, recording and reporting data on a regular basis. This enables the administration to monitor workflow continuously. The improvements in the workflow under study, made by determining the failures and potential risks associated with radiologic care, will have a positive impact on society in terms of patient safety. Having eliminated repeat examinations, the risk of being exposed to more radiation was also minimised. This paper supports the need to apply Six Sigma and present an evaluation of the process in an imaging department.

Applying Systems Engineering Reduces Radiology Transport Cycle Times in the Emergency Department.

PubMed

White, Benjamin A; Yun, Brian J; Lev, Michael H; Raja, Ali S

2017-04-01

Emergency department (ED) crowding is widespread, and can result in care delays, medical errors, increased costs, and decreased patient satisfaction. Simultaneously, while capacity constraints on EDs are worsening, contributing factors such as patient volume and inpatient bed capacity are often outside the influence of ED administrators. Therefore, systems engineering approaches that improve throughput and reduce waste may hold the most readily available gains. Decreasing radiology turnaround times improves ED patient throughput and decreases patient waiting time. We sought to investigate the impact of systems engineering science targeting ED radiology transport delays and determine the most effective techniques. This prospective, before-and-after analysis of radiology process flow improvements in an academic hospital ED was exempt from institutional review board review as a quality improvement initiative. We hypothesized that reorganization of radiology transport would improve radiology cycle time and reduce waste. The intervention included systems engineering science-based reorganization of ED radiology transport processes, largely using Lean methodologies, and adding no resources. The primary outcome was average transport time between study order and complete time. All patients presenting between 8/2013-3/2016 and requiring plain film imaging were included. We analyzed electronic medical record data using Microsoft Excel and SAS version 9.4, and we used a two-sample t-test to compare data from the pre- and post-intervention periods. Following the intervention, average transport time decreased significantly and sustainably. Average radiology transport time was 28.7 ± 4.2 minutes during the three months pre-intervention. It was reduced by 15% in the first three months (4.4 minutes [95% confidence interval [CI] 1.5-7.3]; to 24.3 ± 3.3 min, P=0.021), 19% in the following six months (5.4 minutes, 95% CI [2.7-8.2]; to 23.3 ± 3.5 min, P=0.003), and 26% one year following the intervention (7.4 minutes, 95% CI [4.8-9.9]; to 21.3 ± 3.1 min, P=0.0001). This result was achieved without any additional resources, and demonstrated a continual trend towards improvement. This innovation demonstrates the value of systems engineering science to increase efficiency in ED radiology processes. In this study, reorganization of the ED radiology transport process using systems engineering science significantly increased process efficiency without additional resource use.

Applying Systems Engineering Reduces Radiology Transport Cycle Times in the Emergency Department

PubMed Central

White, Benjamin A.; Yun, Brian J.; Lev, Michael H.; Raja, Ali S.

2017-01-01

Introduction Emergency department (ED) crowding is widespread, and can result in care delays, medical errors, increased costs, and decreased patient satisfaction. Simultaneously, while capacity constraints on EDs are worsening, contributing factors such as patient volume and inpatient bed capacity are often outside the influence of ED administrators. Therefore, systems engineering approaches that improve throughput and reduce waste may hold the most readily available gains. Decreasing radiology turnaround times improves ED patient throughput and decreases patient waiting time. We sought to investigate the impact of systems engineering science targeting ED radiology transport delays and determine the most effective techniques. Methods This prospective, before-and-after analysis of radiology process flow improvements in an academic hospital ED was exempt from institutional review board review as a quality improvement initiative. We hypothesized that reorganization of radiology transport would improve radiology cycle time and reduce waste. The intervention included systems engineering science-based reorganization of ED radiology transport processes, largely using Lean methodologies, and adding no resources. The primary outcome was average transport time between study order and complete time. All patients presenting between 8/2013–3/2016 and requiring plain film imaging were included. We analyzed electronic medical record data using Microsoft Excel and SAS version 9.4, and we used a two-sample t-test to compare data from the pre- and post-intervention periods. Results Following the intervention, average transport time decreased significantly and sustainably. Average radiology transport time was 28.7 ± 4.2 minutes during the three months pre-intervention. It was reduced by 15% in the first three months (4.4 minutes [95% confidence interval [CI] 1.5–7.3]; to 24.3 ± 3.3 min, P=0.021), 19% in the following six months (5.4 minutes, 95% CI [2.7–8.2]; to 23.3 ± 3.5 min, P=0.003), and 26% one year following the intervention (7.4 minutes, 95% CI [4.8–9.9]; to 21.3 ± 3.1 min, P=0.0001). This result was achieved without any additional resources, and demonstrated a continual trend towards improvement. This innovation demonstrates the value of systems engineering science to increase efficiency in ED radiology processes. Conclusion In this study, reorganization of the ED radiology transport process using systems engineering science significantly increased process efficiency without additional resource use. PMID:28435492

34 CFR Appendix E to Part 674 - Examples for Computing Maximum Penalty Charges (6 Months Unpaid Overdue Payments) on Direct Loans...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Months Unpaid Overdue Payments) on Direct Loans Made for Periods of Enrollment Before January 1, 1986 E Appendix E to Part 674 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION FEDERAL PERKINS LOAN PROGRAM Pt. 674, App. E...

Portland/Vancouver to Boise ITS corridor study : final report

DOT National Transportation Integrated Search

1997-07-01

This 18 month study, which began in September 1995, was initiated as a joint project between the Idaho Transportation Department, Oregon Department of Transportation, and Washington Department of Transportation, in cooperation with the Federal Highwa...

Six easy steps on how to create a lean sigma value stream map for a multidisciplinary clinical operation.

PubMed

Lee, Emily; Grooms, Richard; Mamidala, Soumya; Nagy, Paul

2014-12-01

Value stream mapping (VSM) is a very useful technique to visualize and quantify the complex workflows often seen in clinical environments. VSM brings together multidisciplinary teams to identify parts of processes, collect data, and develop interventional ideas. An example involving pediatric MRI with general anesthesia VSM is outlined. As the process progresses, the map shows a large delay between the fax referral and the date of the scheduled and registered appointment. Ideas for improved efficiency and metrics were identified to measure improvement within a 6-month period, and an intervention package was developed for the department. Copyright © 2014. Published by Elsevier Inc.

Leveraging a Redesigned Morbidity and Mortality Conference That Incorporates the Clinical and Educational Missions of Improving Quality and Patient Safety.

PubMed

Tad-Y, Darlene B; Pierce, Read G; Pell, Jonathan M; Stephan, Lindsie; Kneeland, Patrick P; Wald, Heidi L

2016-09-01

The morbidity and mortality (M&M) conference is a vital event that can affect medical education, quality improvement, and peer review in academic departments. Historically, M&M conferences have emphasized cases that highlight diagnostic uncertainty or complex management conundrums. In this report, the authors describe the development, pilot, and refinement of a systems-based M&M conference model that combines the educational and clinical missions of improving quality and patient safety in the University of Colorado Department of Medicine. In 2011, a focused taskforce completed a literature review that informed the development of a framework for the redesigned systems-based M&M conference. The new model included a restructured monthly conference, longitudinal curriculum for residents, and formal channels for interaction with clinical effectiveness departments. Each conference features an in-depth discussion of an adverse event using specific quality improvement tools. Areas for improvement and suggested action items are identified during the conference and delegated to the relevant clinical departments. The new process has enabled the review of 27 adverse events over two years. Sixty-three action items were identified, and 33 were pursued. An average of 50 to 60 individuals participate in each conference, including interprofessional and interdisciplinary colleagues. Resident and faculty feedback regarding the new format has been positive, and other departments are starting to adopt this model. A more robust process for identifying and selecting cases to discuss is needed, as is a stable, sufficient mechanism to manage the improvement initiatives that come out of each conference.

Process monitoring in modern safeguards applications

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

Ehinger, M.H.

1989-11-01

From the safeguards standpoint, regulatory requirements are finally moving into the modern world of communication and information processing. Gone are the days when the accountant with the green eye shade and arm bands made judgments on the material balance a month after the balance was closed. The most recent Nuclear Regulatory Commission (NRC) regulations and U.S. Department of Energy (DOE) orders have very strict standards for timeliness and sensitivity to loss or removal of material. The latest regulations recognize that plant operators have a lot of information on and control over the location and movement of material within their facilities.more » This information goes beyond that traditionally reported under accountability requirements. These new regulations allow facility operators to take credit for many of the more informal process controls.« less

Applying Lean-Six-Sigma Methodology in radiotherapy: Lessons learned by the breast daily repositioning case.

PubMed

Mancosu, Pietro; Nicolini, Giorgia; Goretti, Giulia; De Rose, Fiorenza; Franceschini, Davide; Ferrari, Chiara; Reggiori, Giacomo; Tomatis, Stefano; Scorsetti, Marta

2018-05-01

Lean Six Sigma Methodology (LSSM) was introduced in industry to provide near-perfect services to large processes, by reducing improbable occurrence. LSSM has been applied to redesign the 2D-2D breast repositioning process (Lean) by the retrospective analysis of the database (Six Sigma). Breast patients with daily 2D-2D matching before RT were considered. The five DMAIC (define, measure, analyze, improve, and control) LSSM steps were applied. The process was retrospectively measured over 30 months (7/2014-12/2016) by querying the RT Record&Verify database. Two Lean instruments (Poka-Yoke and Visual Management) were considered for advancing the process. The new procedure was checked over 6 months (1-6/2017). 14,931 consecutive shifts from 1342 patients were analyzed. Only 0.8% of patients presented median shifts >1 cm. The major observed discrepancy was the monthly percentage of fractions with almost zero shifts (AZS = 13.2% ± 6.1%). Ishikawa fishbone diagram helped in defining the main discrepancy con-causes. Procedure harmonization involving a multidisciplinary team to increase confidence in matching procedure was defined. AZS was reduced to 4.8% ± 0.6%. Furthermore, distribution symmetry improvement (Skewness moved from 1.4 to 1.1) and outlier reduction, verified by Kurtosis diminution, demonstrated a better "normalization" of the procedure after the LSSM application. LSSM was implemented in a RT department, allowing to redesign the breast repositioning matching procedure. Copyright © 2018 Elsevier B.V. All rights reserved.

Discharging patients earlier in the day: a concept worth evaluating.

PubMed

Kravet, Steven J; Levine, Rachel B; Rubin, Haya R; Wright, Scott M

2007-01-01

Patient discharges from the hospital often occur late in the day and are frequently clustered after 4 PM. When inpatients leave earlier in the day, quality is improved because new admissions awaiting beds are able to leave the emergency department sooner and emergency department waiting room backlog is reduced. Nursing staff, whose work patterns traditionally result in high activity of discharge and admission between 5 PM and 8 PM, benefit by spreading out their work across a longer part of the day. Discharging patients earlier in the day also has the potential to increase patient satisfaction. Despite multiple stakeholders in the discharge planning process, physicians play the most important role. Getting physician buy-in requires an ability to teach physicians about the concept of early-in-the-day discharges and their impact on the process. We defined a new physician-centered discharge planning process and introduced it to an internal medicine team with an identical control team as a comparison. Discharge time of day was analyzed for 1 month. Mean time of day of discharge was 13:39 for the intervention group versus 15:45 for the control group (P<.001). If reproduced successfully, this process could improve quality at an important transition point in patient care.

Defense.gov Special Report: African-American History Month

Science.gov Websites

Department of Defense Submit Search African-American History Month: At the Crossroads of Freedom and Equality Links Air Force African-American History Month Special Report Naval History and Heritage Command , African American Navy Experience 2013 African American/Black History Month Tri-signed Letter Presidential

29 CFR 548.3 - Authorized basic rates.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS... section 7(g)(3) of the Act, and § 548.2: (a) A rate per hour which is obtained by dividing a monthly or semi-monthly salary by the number of regular working days in each monthly or semi-monthly period and...

7 CFR 1560.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) FOREIGN AGRICULTURAL SERVICE, DEPARTMENT OF... Foreign Agricultural Service, United States Department of Agriculture. (b) Average Monthly Import Price... the U.S. Customs Service and/or the Bureau of Census, and shall be calculated by dividing the total...

Seasonal Variation in Emergency Department Visits Among Pediatric Headache Patients.

PubMed

Pakalnis, A; Heyer, G L

2016-09-01

To ascertain whether seasonal variation occurs in emergency department (ED) visits for headache among children and adolescents. A retrospective review was conducted using the electronic medical records of ED visits for headache at a tertiary children's hospital through calendar years 2010-2014. Using ICD-9 diagnostic codes for headache and migraine, the numbers of headache visits were determined and compared by season and during school months vs summer months. A total of 6572 headache visits occurred. Headache visits increased during the fall season (133 ± 27 visits per month) compared with other seasons (101 ± 19 visits per month), P ≤ .002, but did not differ when comparing school months (113 ± 25 visits per month) and summer months (100 ± 24 visits per month), P = .1. The corresponding increase in ED visits during the fall season coincides with the start of the school year. Academic stressors and the change in daily schedule may lead to more headaches and more ED headache visits among school-aged youth. © 2016 American Headache Society.

Violence and aggression in the emergency department is under-reported and under-appreciated.

PubMed

Richardson, Sandra K; Grainger, Paula C; Ardagh, Michael W; Morrison, Russell

2018-06-08

To examine levels of reporting of violence and aggression within a tertiary level emergency department in New Zealand, and to explore staff attitudes to violence and reporting. A one-month intensive, prospective audit of the emergency department's violence and aggression reporting was undertaken and compared with previously reported data. There was a significant mismatch between the number of events identified during the campaign month and previously reported instances of violence and aggression. The findings identified that failure to report acts of violence was common. Reports of violence and aggression in the emergency department underestimate the true incidence. Failure to report has potential impacts on organisational recognition of risk and the ability to develop appropriate policy responses.

[Benchmarking of university trauma centers in Germany. Research and teaching].

PubMed

Gebhard, F; Raschke, M; Ruchholtz, S; Meffert, R; Marzi, I; Pohlemann, T; Südkamp, N; Josten, C; Zwipp, H

2011-07-01

Benchmarking is a very popular business process and meanwhile is used in research as well. The aim of the present study is to elucidate key numbers of German university trauma departments regarding research and teaching. The data set is based upon the monthly reports given by the administration in each university. As a result the study shows that only well-known parameters such as fund-raising and impact factors can be used to benchmark university-based trauma centers. The German federal system does not allow a nationwide benchmarking.

Contribution of Dipolar Coupling to the Mechanism of the Triplet-Triplet Energy Transfer Process at Long Distances: A Doluble Resonance and Laser Line Narrowing Study.

DTIC Science & Technology

1986-12-16

COVERED 14. DATE OF REPORT (Year, Month, Day) 15. PAGE COUNT Technical Report FROM TO December 16, 1986 29 16 SUPPLEMENTARY NOTATION Acta Physica ... Polonica , in press. 17. COSATI CODES 18. SUBJECT TERMS (Continue on reverse if inecessary and identify by block number) FIELD GROUP SUB-GROUP Energy Transfer...Chan-Lon Yang and M. A. EI-Sayed Department of Chemistry and Biochemistry University of California Los Angeles, California 90024 Acts Physics Polonica

Noticeable Variations in the Educational Exposure During Residency in Danish Orthopedic Departments.

PubMed

Brand, Eske; Fridberg, Marie; Knudsen, Ulrik Kragegaard; Barfod, Kristoffer Weisskirchner

The objective of the study was to examine the educational exposure during residency in Danish orthopedic departments. Questionnaire-based cross-sectional study. Data were gathered from January 1, 2014 to April 30, 2014 through a nationwide web-based questionnaire containing 15 questions within the areas of workload, surgical procedures, outpatient clinic, and research activities. The residents targeted worked at small-to-large hospitals and in tertiary care centers. Every resident in Denmark (n = 163) with at least 3 active months at a department was included. Questionnaires with less than 80% completion were excluded. In total, 152 entries were registered. Among those, 27 did not meet the inclusion criteria and 29 were excluded, leaving 96 participants, representing 22 of 26 departments, for further analysis. The average number of operative procedures as primary surgeon was 16 (range: 8-35) per month. In all, 18 of 22 (81%) departments offered the possibility to participate in research facilitated by the department and 38 of 96 (40%) worked for free (an average of 10h a month [range: 3-60]) to increase the amount of surgical procedures. A large variation in the educational exposure was found among the Danish orthopedic departments. Numbers indicate that Danish residents, compared with their US counterparts, operate considerably less during residency. Most residents work overtime and many of them work for free to participate in more surgical procedures. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Incident reporting in one UK accident and emergency department.

PubMed

Tighe, Catherine M; Woloshynowych, Maria; Brown, Ruth; Wears, Bob; Vincent, Charles

2006-01-01

Greater focus is needed on improving patient safety in modern healthcare systems and the first step to achieving this is to reliably identify the safety issues arising in healthcare. Research has shown the accident and emergency (A&E) department to be a particularly problematic environment where safety is a concern due to various factors, such as the range, nature and urgency of presenting conditions and the high turnover of patients. As in all healthcare environments clinical incident reporting in A&E is an important tool for detecting safety issues which can result in identifying solutions, learning from error and enhancing patient safety. This tool must be responsive and flexible to the local circumstances and work for the department to support the clinical governance agenda. In this paper, we describe the local processes for reporting and reviewing clinical incidents in one A&E department in a London teaching hospital and report recent changes to the system within the department. We used the historical data recorded on the Trust incident database as a representation of the information that would be available to the department in order to identify the high risk areas. In this paper, we evaluate the internal processes, the information available on the database and make recommendations to assist the emergency department in their internal processes. These will strengthen the internal review and staff feedback system so that the department can learn from incidents in a consistent manner. The process was reviewed by detailed examination of the centrally held electronic record (Datix database) of all incidents reported in a one year period. The nature of the incident and the level and accuracy of information provided in the incident reports was evaluated. There were positive aspects to the established system including evidence of positive changes made as a result of the reporting process, new initiatives to feedback to staff, and evolution of the programme for reporting and discussing the incidents internally. There appeared to be a mismatch between the recorded events and the category allocated to the incident in the historical record. In addition the database did not contain complete information for every incident, contributory factors were rarely recorded and relatively large numbers of incidents were recorded as "other" in the type of incident. There was also observed difficulty in updating the system as there is at least a months time lag between reporting or an incident and discussion/resolution of issues at the local departmental clinical risk management committee meetings. We used Leape's model for assessing the reporting system as a whole and found the system in the department to be relatively safe, fairly easy to use and moderately effective. Recommendations as a result of this study include the introduction of an electronic reporting system, limiting the number of staff who categorise the incidents--using clear definitions for classifications including a structured framework for contributory factors, and a process that allows incidents to be updated on the database locally after the discussion. This research may have implications for the incident reporting process in other specialities as well as in other hospitals.

Workflow Enhancement (WE) Improves Safety in Radiation Oncology: Putting the WE and Team Together

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

Chao, Samuel T., E-mail: chaos@ccf.org; Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio; Meier, Tim

Purpose: To review the impact of a workflow enhancement (WE) team in reducing treatment errors that reach patients within radiation oncology. Methods and Materials: It was determined that flaws in our workflow and processes resulted in errors reaching the patient. The process improvement team (PIT) was developed in 2010 to reduce errors and was later modified in 2012 into the current WE team. Workflow issues and solutions were discussed in PIT and WE team meetings. Due to tensions within PIT that resulted in employee dissatisfaction, there was a 6-month hiatus between the end of PIT and initiation of the renamed/redesigned WEmore » team. In addition to the PIT/WE team forms, the department had separate incident forms to document treatment errors reaching the patient. These incident forms are rapidly reviewed and monitored by our departmental and institutional quality and safety groups, reflecting how seriously these forms are treated. The number of these incident forms was compared before and after instituting the WE team. Results: When PIT was disbanded, a number of errors seemed to occur in succession, requiring reinstitution and redesign of this team, rebranded the WE team. Interestingly, the number of incident forms per patient visits did not change when comparing 6 months during the PIT, 6 months during the hiatus, and the first 6 months after instituting the WE team (P=.85). However, 6 to 12 months after instituting the WE team, the number of incident forms per patient visits decreased (P=.028). After the WE team, employee satisfaction and commitment to quality increased as demonstrated by Gallup surveys, suggesting a correlation to the WE team. Conclusions: A team focused on addressing workflow and improving processes can reduce the number of errors reaching the patient. Time is necessary before a reduction in errors reaching patients will be seen.« less

Implementing Same Day Discharge Following Percutaneous Coronary Intervention: A Process Evaluation.

PubMed

Chen, Yingyan; Lin, Frances; Marshall, Andrea

2018-06-14

The safety and effectiveness of same day discharge (SDD) following percutaneous coronary intervention are well demonstrated; however, the uptake of this model of care is low. The aim was to examine the effectiveness of implementing SDD using a process evaluation methodology. This study was undertaken in a cardiac services department of a tertiary teaching hospital in southeast Queensland, Australia. It was anticipated before the implementation that 120 patients could be discharged the same day in a 6 months' time period. Patient selection process and guideline adherence were assessed along with patients' and relatives' satisfaction. During implementation, 22 patients were discharged home the same day. It was found that staff did not follow the guideline consistently, with an overall adherence of 77.3%. The uptake of SDD was low in this implementation. The study is important as it provides direction for future improvement both in the criteria and the implementation process.

76 FR 1131 - Proposed Information Collection; Comment Request; Monthly Retail Trade Survey

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-07

... monthly retail sales, end-of-month merchandise inventories, and quarterly e- commerce sales of retailers... panel where all cases are requested to report sales, e-commerce sales, and/or inventories each month... each form: Series Description SM-44(06)S Non Department Store/Sales Only/WO E-Commerce. SM-44(06)SE Non...

What makes emergency department patients reduce their alcohol consumption?--a computer-based intervention study in Sweden.

PubMed

Trinks, Anna; Festin, Karin; Bendtsen, Preben; Nilsen, Per

2013-01-01

This study investigates the effectiveness of a computerized emergency department intervention for alcohol consumption and identifies explanation factors associated with reduced alcohol consumption from risk to non-risk drinking. Patients aged 18-69 years registered at the ED triage answered alcohol-related questions on a touch-screen computer. Follow-up data were collected by means of a postal questionnaire that was mailed to the patients 6 months after their ED visit. There were four independent explanations for reduced alcohol consumption: being motivated to reduce alcohol consumption at baseline, influenced by just visiting the emergency department, considering the alcohol-related feedback information and impact from a health care provider. 339 patients could be followed up and of these were 97 categorized as risk drinkers at baseline and 45 became non-risk drinker 6 month later. Being motivated to reduce alcohol consumption at baseline, influenced by just visiting the emergency department, considering the alcohol-related feedback information and impact from a health care provider were predictors for change from risk to non-risk drinking 6 months later. Copyright © 2011 Elsevier Ltd. All rights reserved.

How Compliance Measures, Behavior Modification, and Continuous Quality Improvement Led to Routine HIV Screening in an Emergency Department in Brooklyn, New York.

PubMed

Isaac, Jermel Kyri; Sanchez, Travis H; Brown, Emily H; Thompson, Gina; Sanchez, Christina; Fils-Aime, Stephany; Maria, Jose

2016-01-01

New York State adopted a new HIV testing law in 2010 requiring medical providers to offer an HIV test to all eligible patients aged 13-64 years during emergency room or ambulatory care visits. Since then, Wyckoff Heights Medical Center (WHMC) in Brooklyn, New York, began implementing routine HIV screening organization-wide using a compliance, behavior-modification, and continuous quality-improvement process. WHMC first implemented HIV screening in the emergency department (ED) and evaluated progress with the following monthly indicators: HIV tests offered, HIV tests accepted, HIV tests ordered (starting in December 2013), HIV tests administered, positive HIV tests, and linkage to HIV care. Compliance with the delivery of HIV testing was determined by the proportion of patients who, after accepting a test, received one. During August 2013 through July 2014, of 57,852 eligible patients seen in the WHMC ED, a total of 31,423 (54.3%) were offered an HIV test. Of those, 8,229 (26.2%) patients accepted a test. Of those, 6,114 (74.3%) underwent a test. A total of 26 of the 6,114 patients tested (0.4%) had a positive test, and 24 of the 26 HIV-positive patients were linked to HIV medical care. By July 2014, the monthly proportion of patients offered a test was 62%; the proportion of those offered a test who had a test ordered was 98%, and the proportion of those with a test ordered who were tested was 81%. Testing compliance increased substantially at the WHMC ED, from 77% in December 2013 to >98% in July 2014. Using compliance-monitoring, behavior-modification, and continuous quality-improvement processes produced substantial increases in offers and HIV test completion. WHMC is replicating this approach across departments, and other hospitals implementing routine HIV screening programs should consider this approach as well.

46 CFR 12.607 - Requirements to qualify for an STCW endorsement as rating as able seafarer-engine.

Code of Federal Regulations, 2014 CFR

2014-10-01

... mechanic, or engineman in the engine department, or as an RFPEW for a period of not less than 12 months... Engineman None. Deck Engine Mechanic None. Electrician 6 months.1 Refrigerating Engineer 6 months.1 Pumpman...

40 CFR 61.176 - Recordkeeping requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Arsenic Emissions From Primary Copper Smelters § 61.176 Recordkeeping requirements. (a) Each owner or... each copper converter department, a monthly record of the weight percent of arsenic contained in the..., the monthly calculations of the average annual arsenic charging rate for the preceding 12-month period...

Knowing what to expect, forecasting monthly emergency department visits: A time-series analysis.

PubMed

Bergs, Jochen; Heerinckx, Philipe; Verelst, Sandra

2014-04-01

To evaluate an automatic forecasting algorithm in order to predict the number of monthly emergency department (ED) visits one year ahead. We collected retrospective data of the number of monthly visiting patients for a 6-year period (2005-2011) from 4 Belgian Hospitals. We used an automated exponential smoothing approach to predict monthly visits during the year 2011 based on the first 5 years of the dataset. Several in- and post-sample forecasting accuracy measures were calculated. The automatic forecasting algorithm was able to predict monthly visits with a mean absolute percentage error ranging from 2.64% to 4.8%, indicating an accurate prediction. The mean absolute scaled error ranged from 0.53 to 0.68 indicating that, on average, the forecast was better compared with in-sample one-step forecast from the naïve method. The applied automated exponential smoothing approach provided useful predictions of the number of monthly visits a year in advance. Copyright © 2013 Elsevier Ltd. All rights reserved.

3 CFR 13604 - Executive Order 13604 of March 22, 2012. Improving Performance of Federal Permitting and Review...

Code of Federal Regulations, 2013 CFR

2013-01-01

... United States: (i) the Department of Defense; (ii) the Department of the Interior; (iii) the Department... Dashboard; and (iii) by December 31, 2012, and every 6 months thereafter, report progress to the CPO on... departments and agencies (agencies) take all steps within their authority, consistent with available resources...

Emergency Department Youth Patients With Suicidal Ideation or Attempts: Predicting Suicide Attempts Through 18 Months of Follow-Up.

PubMed

Rosenbaum Asarnow, Joan; Berk, Michele; Zhang, Lily; Wang, Peter; Tang, Lingqi

2017-10-01

This prospective study of suicidal emergency department (ED) patients (ages 10-18) examined the timing, cumulative probability, and predictors of suicide attempts through 18 months of follow-up. The cumulative probability of attempts was as follows: .15 at 6 months, .22 at 1 year, and .24 by 18 months. One attempt was fatal, yielding a death rate of .006. Significant predictors of suicide attempt risk included a suicide attempt at ED presentation (vs. suicidal ideation only), nonsuicidal self-injurious behavior, and low levels of delinquent symptoms. Results underscore the importance of both prior suicide attempts and nonsuicidal self-harm as risk indicators for future and potentially lethal suicide attempts. © 2016 The American Association of Suicidology.

Impact of triage in accident and emergency departments in Bahrain.

PubMed

Fateha, B E; Hamza, A Y

2001-01-01

We aimed to assess the impact of triage by physicians on the workload and expenditure of the Accident and Emergency (AE) Department of Salmaniya Medical Complex, Bahrain. We analysed three sets of data: patient visits to the AE Department over a 9-month period; patient visits 1 year previously; and forecast patient visits over 9 months starting from July 1999. The referral of patients to AE cubicles was reduced by 54.4% after the implementation of the triage, and reduction in the workload was statistically significant. The reduction in health care expenditure was estimated at between 15.3% and 17.3%. We conclude that triage by physicians can be cost-effective and can reduce the AE Department workload, freeing more time to manage life-threatening and urgent cases.

Recruiting Faculty Leaders at U.S. Medical Schools: A Process Without Improvement?

PubMed

Marsh, James D; Chod, Ronald

2017-11-01

Recruiting faculty leaders to work in colleges of medicine is a ubiquitous, time-consuming, costly activity. Little quantitative information is available about contemporary leadership recruiting processes and outcomes. In this article, the authors examine current recruiting methods and outcomes in colleges of medicine and compare academic search approaches with the approaches often employed in intellectual-capital-rich industries.In 2015, the authors surveyed chairs of internal medicine at U.S. medical schools regarding their recruiting practices and outcomes-specifically their selection methods, the duration of searches, the recruitment of women and minorities underrepresented in medicine (URM), and their satisfaction with search outcomes.The authors found that department chairs were extensively engaged in numerous searches for leaders. The recruitment process most commonly required 7 to 12 months from initiation to signed contract. Interestingly, longer searches (19+ months) were much more frequently associated with a recruitment outcome that chairs viewed as unsatisfactory or very unsatisfactory. Most leadership searches produced very few women and URM finalists. The biggest perceived hurdles to successful recruitment were the need to relocate the candidate and family and the shortage of good candidates.The process of recruiting leaders in academic medicine has changed little in more than 25 years. Process improvement is important and should entail carefully structured search processes, including both an overhaul of search committees and further emphasis on leadership development within the college of medicine. The authors propose specific steps to enhance recruitment of members of URM groups and women to leadership positions in academic medicine.

77 FR 59925 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Proposed... requirement for a national evaluation of the Early Head Start program. Child and family assessments were conducted when children were 14 months old, 24 months old, 36 months old, in the spring prior to...

75 FR 30846 - Notice of Proposed Information Collection: Comment Request; Multifamily Project Monthly...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-02

... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5380-N-24] Notice of Proposed Information Collection: Comment Request; Multifamily Project Monthly Accounting Reports AGENCY: Office of the... information: Title of Proposal: Multifamily Project Monthly Accounting Reports. OMB Control Number, if...

Epidemiology of infant ocular and periocular injuries from consumer products in the United States, 2001-2008.

PubMed

Chen, Allison J; Linakis, James G; Mello, Michael J; Greenberg, Paul B

2013-06-01

To quantify and characterize eye injuries related to consumer products in the infant population (0-12 months) treated in United States hospital emergency departments during the period from 2001 to 2008. This study is a descriptive analysis of consumer-product related eye injury data derived from the National Electronic Injury Surveillance System, a probability sample of 100 hospitals nationwide with 24-hour emergency departments. Narrative data were used to assign each case with the consumer products (CPs) causing the eye injury. The proportions of eye injury visits were calculated by age, sex, diagnosis, disposition, locale of incident, and CP categories. We examined the US Consumer Product Safety Commission National Electronic Injury Surveillance System data for all nonfatal eye injuries (853 cases) in the infant population (0-12 months) treated in US emergency departments from 2001 to 2008. These data can be used to project national, annual, weighted estimates of nonfatal injury treated in US emergency departments. There were an estimated 21,271 visits to US emergency departments by patients aged 0-12 months for CP-related eye injuries during the study period. Of these, 63% involved infants aged 9-12 months and 54% involved male patients; 78% of all injuries occurred at home. The CPs causing the most eye injuries belonged to the categories of chemical (46%) and household items (24%). Contusions and abrasions were the leading eye injuries diagnoses (37%). This study suggests that most CP-related infant eye injuries in the United States occur at home and are predominantly caused by chemicals and household products. Published by Mosby, Inc.

Impact of an ABCDE team triage process combined with public guidance on the division of work in an emergency department.

PubMed

Kantonen, Jarmo; Lloyd, Robert; Mattila, Juho; Kauppila, Timo; Menezes, Ricardo

2015-06-01

To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the "right" use of emergency services, on the division of work between ED nurses and general practitioners (GPs). An observational and quasi-experimental study based on before-after comparisons. Implementation of the ABCDE triage system in a Finnish combined ED where secondary care is adjacent, and in a traditional primary care ED where secondary care is located elsewhere. GPs and nurses from two different primary care EDs. Numbers of monthly visits to different professional groups before and after intervention in the studied primary care EDs and numbers of monthly visits to doctors in the local secondary care ED. The beginning of the triage process increased temporarily the number of independent consultations and patient record entries by ED nurses in both types of studied primary care EDs and reduced the number of patient visits to a doctor compared with previous years but had no effect on doctor visits in the adjacent secondary care ED. No further decrease in the number of nurse or GP visits was observed by inhibiting the entrance of non-urgent patients. The ABCDE triage system combined with public guidance may reduce non-urgent patient visits to doctors in different kinds of primary care EDs without increasing visits in the secondary care ED. However, the additional work to implement the ABCDE system is mainly directed to nurses, which may pose a challenge for staffing.

Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness

PubMed Central

Driessen, Maurice T; Anema, Johannes R; Proper, Karin I; Bongers, Paulien M; Beek, Allard J van der

2008-01-01

Background Low back pain (LBP) and neck pain (NP) are a major public health problem with considerable costs for individuals, companies and society. Therefore, prevention is imperative. The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics (PE) to prevent LBP and NP among workers. Methods In a randomised controlled trial (RCT), a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline. The departments consisting of about 150 workers are pre-stratified and randomised. The control departments receive usual practice and the intervention departments receive PE. Within each intervention department a working group is formed including eight workers, a representative of the management, and an occupational health and safety coordinator. During a one day meeting, the working group follows the steps of PE in which the most important risk factors for LBP and NP, and the most adequate ergonomic measures are identified on the basis of group consensus. The implementation of ergonomic measures at the department is performed by the working group. To improve the implementation process, so-called 'ergocoaches' are trained. The primary outcome measure is an episode of LBP and NP. Secondary outcome measures are actual use of ergonomic measures, physical workload, psychosocial workload, intensity of pain, general health status, sick leave, and work productivity. The cost-effectiveness analysis is performed from the societal and company perspective. Outcome measures are assessed using questionnaires at baseline and after 6 and 12 months. Data on the primary outcome as well as on intensity of pain, sick leave, work productivity, and health care costs are collected every 3 months. Discussion Prevention of LBP and NP is beneficial for workers, employers, and society. If the intervention is proven (cost-)effective, the intervention can have a major impact on LBP and NP prevention and, thereby, on work disability prevention. Results are expected in 2010. Trial registration ISRCTN27472278 PMID:18959799

7 CFR 955.142 - Delinquent assessments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE VIDALIA ONIONS GROWN IN GEORGIA... Vidalia Onion Committee on a monthly basis for each month during the fiscal period in which they made...

7 CFR 955.142 - Delinquent assessments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE VIDALIA ONIONS GROWN IN GEORGIA... Vidalia Onion Committee on a monthly basis for each month during the fiscal period in which they made...

7 CFR 955.142 - Delinquent assessments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE VIDALIA ONIONS GROWN IN GEORGIA... Vidalia Onion Committee on a monthly basis for each month during the fiscal period in which they made...

7 CFR 955.142 - Delinquent assessments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE VIDALIA ONIONS GROWN IN GEORGIA... Vidalia Onion Committee on a monthly basis for each month during the fiscal period in which they made...

7 CFR 955.142 - Delinquent assessments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE VIDALIA ONIONS GROWN IN GEORGIA... Vidalia Onion Committee on a monthly basis for each month during the fiscal period in which they made...

75 FR 34303 - 90th Anniversary of the Department of Labor Women's Bureau, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-16

...'s Bureau in the Department of Labor on June 5, 1920, 2 months before women gained the right to vote... Part VI The President Proclamation 8533--90th Anniversary of the Department of Labor Women's... Anniversary of the Department of Labor Women's Bureau, 2010 By the President of the United States of America A...

Assessment of an intervention to train teaching hospital care providers in quality management

PubMed Central

Francois, P; Vinck, D; Labarere, J; Reverdy, T; Peyrin, J

2005-01-01

Background: Successful implementation of continuous quality improvement (CQI) programs in hospitals remains rare in all countries, making it necessary to experiment with implementation methods while considering the cultural factors of resistance to change. Objective: To assess the impact of an educational intervention on involvement of clinical department staff in the quality process. Setting: Twelve voluntary clinical departments (six experimental and six controls) in a French 2000-bed university hospital comprising 40 clinical departments. Intervention: Three day training seminar to a group of 12–20 staff members from each department. Design: Quasi-experimental post-test only design study with control group conducted 12 months after the intervention with a questionnaire completed in a face-to-face interview. Subjects: 98 trained staff and 100 untrained staff from the six experimental departments and 100 staff from the six control departments. Principal measurements: Declared knowledge of the CQI methods and participation in quality management activities. Results: 286 people (96%) were involved in the study. More of the trained staff knew the CQI methods (62.4%) than staff in the control departments (16.5%) (adjusted odds ratio (ORa) = 10.6 (95% CI 4.97 to 22.62)). More trained staff also participated in quality improvement work groups than control department staff (76.3% v 14.0%; ORa = 27.4 (95% CI 11.6 to 64.4)). In the experimental departments the untrained staff's knowledge of CQI methods and their participation in work groups did not differ from that of control department staff. Conclusions: A continuing education intervention can involve care providers in CQI. Dissemination of knowledge from trained personnel to other staff members remains limited. PMID:16076785

49 CFR 1246.1 - Monthly report of number of railroad employees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 9 2010-10-01 2010-10-01 false Monthly report of number of railroad employees... TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION (CONTINUED) ACCOUNTS, RECORDS AND REPORTS NUMBER OF RAILROAD EMPLOYEES § 1246.1 Monthly report of number of railroad employees. Each class I railroad shall file a...

45 CFR 98.71 - Content of reports.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) The total monthly child care copayment by the family; (11) The total expected dollar amount per month to be received by the provider for each child; (12) The total hours per month of such care; (13... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND...

78 FR 66041 - 60-Day Notice of Proposed Information Collection: Multifamily Project Monthly Accounting Reports

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-04

... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5687-N-39] 60-Day Notice of Proposed Information Collection: Multifamily Project Monthly Accounting Reports AGENCY: Office of the Assistant... Collection: Multifamily Project Monthly Accounting Reports. OMB Approval Number: 2502-0108. Type of Request...

Healthy Start, Grow Smart: Your Three-Month-Old.

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

Distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, this pamphlet provides parents with information and advice about their infants in the third month of life. The pamphlet provides information on communicating with the infant through body language, preparing for the 4-month checkup, recordkeeping, infant…

Forecasting Hospitalization and Emergency Department Visit Rates for Chronic Obstructive Pulmonary Disease. A Time-Series Analysis.

PubMed

Gershon, Andrea; Thiruchelvam, Deva; Moineddin, Rahim; Zhao, Xiu Yan; Hwee, Jeremiah; To, Teresa

2017-06-01

Knowing trends in and forecasting hospitalization and emergency department visit rates for chronic obstructive pulmonary disease (COPD) can enable health care providers, hospitals, and health care decision makers to plan for the future. We conducted a time-series analysis using health care administrative data from the Province of Ontario, Canada, to determine previous trends in acute care hospitalization and emergency department visit rates for COPD and then to forecast future rates. Individuals aged 35 years and older with physician-diagnosed COPD were identified using four universal government health administrative databases and a validated case definition. Monthly COPD hospitalization and emergency department visit rates per 1,000 people with COPD were determined from 2003 to 2014 and then forecasted to 2024 using autoregressive integrated moving average models. Between 2003 and 2014, COPD prevalence increased from 8.9 to 11.1%. During that time, there were 274,951 hospitalizations and 290,482 emergency department visits for COPD. After accounting for seasonality, we found that monthly COPD hospitalization and emergency department visit rates per 1,000 individuals with COPD remained stable. COPD prevalence was forecasted to increase to 12.7% (95% confidence interval [CI], 11.4-14.1) by 2024, whereas monthly COPD hospitalization and emergency department visit rates per 1,000 people with COPD were forecasted to remain stable at 2.7 (95% CI, 1.6-4.4) and 3.7 (95% CI, 2.3-5.6), respectively. Forecasted age- and sex-stratified rates were also stable. COPD hospital and emergency department visit rates per 1,000 people with COPD have been stable for more than a decade and are projected to remain stable in the near future. Given increasing COPD prevalence, this means notably more COPD health service use in the future.

77 FR 18885 - Improving Performance of Federal Permitting and Review of Infrastructure Projects

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... equivalent officer of the United States: (i) the Department of Defense; (ii) the Department of the Interior... months thereafter, report progress to the CPO on implementing its Agency Plan, as well as specific... that executive departments and agencies (agencies) take all steps within their authority, consistent...

Nuclear medicine training and practice in Poland.

PubMed

Teresińska, Anna; Birkenfeld, Bożena; Królicki, Leszek; Dziuk, Mirosław

2014-10-01

In Poland, nuclear medicine (NM) has been an independent specialty since 1988. At the end of 2013, the syllabus for postgraduate specialization in NM has been modified to be in close accordance with the syllabus approved by the European Union of Medical Specialists and is expected to be enforced before the end of 2014. The National Consultant in Nuclear Medicine is responsible for the specialization program in NM. The Medical Center of Postgraduate Training is the administrative body which accepts the specialization programs, supervises the training, organizes the examinations, and awards the specialist title. Specialization in NM for physicians lasts for five years. It consists of 36 months of training in a native nuclear medicine department, 12 months of internship in radiology, 3 months in cardiology, 3 months in endocrinology, 3 months in oncology, and 3 months in two other departments of NM. If a NM trainee is a specialist of a clinical discipline and/or is after a long residency in NM departments, the specialization in NM can be shortened to three years. During the training, there are obligatory courses to be attended which include the elements of anatomy imaging in USG, CT, and MR. Currently, there are about 170 active NM specialists working for 38.5 million inhabitants in Poland. For other professionals working in NM departments, it is possible to get the title of a medical physics specialist after completing 3.5 years of training (for those with a master's in physics, technical physics or biomedical engineering) or the title of a radiopharmacy specialist after completing 3 years of training (for those with a master's in chemistry or biology). At present, the specialization program in NM for nurses is being developed by the Medical Centre of Postgraduate Education. Continuing education and professional development are obligatory for all physicians and governed by the Polish Medical Chamber. The Polish Society of Nuclear Medicine (PTMN) organizes regular postgraduate training for physicians working in NM. Educational programs are comprehensive, covering both diagnostics and current forms of radioisotope therapy. They are aimed not only at physicians specialized/specializing in NM, but also at other medical professionals employed in radionuclide departments as well as physicians of other specialties.

Use of Failure Mode and Effects Analysis to Improve Emergency Department Handoff Processes.

PubMed

Sorrentino, Patricia

2016-01-01

The purpose of this article is to describe a quality improvement process using failure mode and effects analysis (FMEA) to evaluate systems handoff communication processes, improve emergency department (ED) throughput and reduce crowding through development of a standardized handoff, and, ultimately, improve patient safety. Risk of patient harm through ineffective communication during handoff transitions is a major reason for breakdown of systems. Complexities of ED processes put patient safety at risk. An increased incidence of submitted patient safety event reports for handoff communication failures between the ED and inpatient units solidified a decision to implement the use of FMEA to identify handoff failures to mitigate patient harm through redesign. The clinical nurse specialist implemented an FMEA. Handoff failure themes were created from deidentified retrospective reviews. Weekly meetings were held over a 3-month period to identify failure modes and determine cause and effect on the process. A functional block diagram process map tool was used to illustrate handoff processes. An FMEA grid was used to list failure modes and assign a risk priority number to quantify results. Multiple areas with actionable failures were identified. A majority of causes for high-priority failure modes were specific to communications. Findings demonstrate the complexity of transition and handoff processes. The FMEA served to identify and evaluate risk of handoff failures and provide a framework for process improvement. A focus on mentoring nurses to quality handoff processes so that it becomes habitual practice is crucial to safe patient transitions. Standardizing content and hardwiring within the system are best practice. The clinical nurse specialist is prepared to provide strong leadership to drive and implement system-wide quality projects.

A Study to Determine the Cost of Quality Assurance to the Department of Surgery at US Army Medical Department Activity. Fort Benning, Georgia

DTIC Science & Technology

1984-07-01

to make maximum use of available time. General Surgery averaged ninety-six operative procedures per month during 1983, ophthalmology averaged fifteen...health care providers 2. Document evaluation of: a) Surgical care review (tissue review) b) Blood utilization c) Antibiotics utilization d) Pharmacy and...21. Number Surgical Procedures Performed 470 470 on Patients Undergoing all Types of Surgery APPENDIX L EXAMPLES OF AUDIT CRITERIA 103 SERVICE MONTH

Monthly streamflow forecasting with auto-regressive integrated moving average

NASA Astrophysics Data System (ADS)

Nasir, Najah; Samsudin, Ruhaidah; Shabri, Ani

2017-09-01

Forecasting of streamflow is one of the many ways that can contribute to better decision making for water resource management. The auto-regressive integrated moving average (ARIMA) model was selected in this research for monthly streamflow forecasting with enhancement made by pre-processing the data using singular spectrum analysis (SSA). This study also proposed an extension of the SSA technique to include a step where clustering was performed on the eigenvector pairs before reconstruction of the time series. The monthly streamflow data of Sungai Muda at Jeniang, Sungai Muda at Jambatan Syed Omar and Sungai Ketil at Kuala Pegang was gathered from the Department of Irrigation and Drainage Malaysia. A ratio of 9:1 was used to divide the data into training and testing sets. The ARIMA, SSA-ARIMA and Clustered SSA-ARIMA models were all developed in R software. Results from the proposed model are then compared to a conventional auto-regressive integrated moving average model using the root-mean-square error and mean absolute error values. It was found that the proposed model can outperform the conventional model.

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

PubMed Central

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

2009-01-01

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

Optimizing MRI Logistics: Focused Process Improvements Can Increase Throughput in an Academic Radiology Department.

PubMed

O'Brien, Jeremy J; Stormann, Jeremy; Roche, Kelli; Cabral-Goncalves, Ines; Monks, Annamarie; Hallett, Donna; Mortele, Koenraad J

2017-02-01

The purpose of this study was to describe and evaluate the effect of focused process improvements on protocol selection and scheduling in the MRI division of a busy academic medical center, as measured by examination and room times, magnet fill rate, and potential revenue increases and cost savings to the department. Focused process improvements, led by a multidisciplinary team at a large academic medical center, were directed at streamlining MRI protocols and optimizing matching protocol ordering to scheduling while maintaining or improving image quality. Data were collected before (June 2013) and after (March 2015) implementation of focused process improvements and divided by subspecialty on type of examination, allotted examination time, actual examination time, and MRI parameters. Direct and indirect costs were compiled and analyzed in consultation with the business department. Data were compared with evaluated effects on selected outcome and efficiency measures, as well as revenue and cost considerations. Statistical analysis was performed using a t test. During the month of June 2013, 2145 MRI examinations were performed at our center; 2702 were performed in March 2015. Neuroradiology examinations were the most common (59% in June 2013, 56% in March 2015), followed by body examinations (25% and 27%). All protocols and parameters were analyzed and streamlined for each examination, with slice thickness, TR, and echo train length among the most adjusted parameters. Mean time per examination decreased from 43.4 minutes to 36.7 minutes, and mean room time per patient decreased from 46.3 to 43.6 minutes (p = 0.009). Potential revenue from increased throughput may yield up to $3 million yearly (at $800 net revenue per scan) or produce cost savings if the facility can reduce staffed scanner hours or the number of scanners in its fleet. Actual revenue and expense impacts depend on the facility's fixed and variable cost structure, payer contracts, MRI fleet composition, and unmet MRI demand. Focused process improvements in selecting MRI protocols and scheduling examinations significantly increased throughput in the MRI division, thereby increasing capacity and revenue. Shorter scan and department times may also improve patient experience.

[Impact of hospitalization of an infant during breast-feeding: mother-child investigation].

PubMed

Courtois, E; Thibault, P

2010-09-01

A real health priority for governments, breastfeeding has prompted WHO and UNICEF to create the "Baby-Friendly Hospital Initiative" for maternity units respecting the "ten steps to successful breastfeeding". This effort does not include pediatric departments. However, as the properties of breast milk enhance recovery of the infant, it is also important to promote breastfeeding in this branch. Furthermore, few studies have analyzed the constraints of hospitalization on the breastfeeding process. The aim of this study is to identify the constraints imposed by hospitalization on the process of breastfeeding in infants aged 29 days to 6 months suffering from acute disease, during hospitalization and within a week following their return home. This prospective study was conducted between October 1st and December 31st, 2008 in a pediatric department through interviews and questionnaires from breastfeeding mothers and health professionals. 51 mother-infant pairs and 35 caregivers were included in the study. During hospitalization; direct breastfeeding was interrupted for 31 mothers. After hospitalization, 3 mothers had weaned their babies, 12 went from exclusive breastfeeding to mixed feeding and 13 had experienced difficulties. Caregivers partially meet WHO's recommendations. The hospitalization of an infant disrupts the continuation of breastfeeding. To overcome this, actions must be taken in relation with hospitals, departments and professionals. The study's small sample does not prove that the original training of caregivers influence theirs practices.

Medical Clowning and Psychosis: A Case Report and Theoretical Review.

PubMed

Gruber, Alex; Levin, Raz; Lichtenberg, Pesach

2015-01-01

The medical clown has become an accepted therapeutic figure in non-psychiatric hospital departments in recent years. However, the potential role of the clown in psychiatry, especially for the treatment of psychosis, has not been investigated. We report here on the functioning of a medical clown in an inpatient psychiatric department. A program using psychodramatic group therapy techniques with the clown serving as moderator was developed. We describe the case of one individual diagnosed with schizophrenia who in the course of four and a half months of group therapy led by the medical clown was able to adopt a succession of surprising roles. This process may have contributed to the patient's remission. We discuss the special capacity of medical clowns to encourage communication and indulge in fantasy while returning to consensual reality. We suggest that this may have particular relevance in work with psychotic individuals.

[Posthumous sperm procurement and use--ethical and legal dilemmas].

PubMed

Crha, I; Dostál, J; Ventruba, P; Kudela, M; Záková, J

2004-07-01

To present a review of bioethical discussion and recommendations concerning posthumous sperm procurement and postmortem parenthood. Review article. Department of Obstetrics and Gynecology, Masaryk University, Brno, Department of Obstetrics and Gynecology, Palacky University, Olomouc. Literature search in Database of Abstracts of Reviews of the Evidence (DARE) and MEDLINEplus. Posthumous sperm procurement and cryopreservation must be performed within 36 hours after death. To established appropriate medical practice, it is important to consider all stakeholders in the decision-making process: the deceased, the requesting party, the child, the physician and the society. There are only few legislative measures concerning postmortem parenthood and posthumous sperm procurement. The essential elements for postmortem reproduction are: judicial order, ethics committee approval, bereavement period of at least 6 month before use. Posthumous sperm procurement is fraught with ethical and legal implications. All stakeholder should be considered. Society for reproductive medicine should prepare acceptable standard protocol.

[Reflections on ethnography in the emergency department].

PubMed

Aredes, Janaína de Souza; Firmo, Josélia Oliveira Araújo; Leibing, Annette; Giacomin, Karla Cristina

2017-09-28

: Ethnography is the principal research method in Anthropology. With a broad scope, it allows using different data collection techniques and incorporates elements observed and obtained in the field into the analysis. In Public Health, it can contribute to understanding the health/disease process and health professionals' and patients' values and attitudes in different healthcare settings. The aim of this article is to present and discuss the ethnographic method based on an empirical study of physicians' hospital work in the face of the limits between life and death. Data collection involved nine months of participant observation and interviews with 43 physicians (25 men and 18 women), 28 to 69 years of age, treating critical patients in different departments of a metropolitan emergency hospital. The various social and cultural aspects experienced by the researcher and obtained from the interlocutors in the field provide a dense description of this hospital ethnography.

Defense.gov Special Report: African American History Month

Science.gov Websites

Department of Defense Submit Search During National African-American History Month, we celebrate the rich In honor of African-American History Month, Fred Moore, the first African-American Tomb Guard history a year later. Story Longest Serving Airman Also Longest in DOD The Air Force's longest serving

Healthy Start, Grow Smart: Your One-Month-Old.

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

This pamphlet, distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, is designed to provide parents with information and advice about their infants in the first month of life. The pamphlet provides information on ways the mother can take care of herself, the one-month checkup, early brain development, infant…

49 CFR 1246.1 - Monthly report of number of railroad employees.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 9 2013-10-01 2013-10-01 false Monthly report of number of railroad employees. 1246.1 Section 1246.1 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION (CONTINUED) ACCOUNTS, RECORDS AND REPORTS NUMBER OF RAILROAD EMPLOYEES § 1246.1 Monthly report of...

38 CFR 17.60 - Extensions of community nursing home care beyond six months.

Code of Federal Regulations, 2013 CFR

2013-07-01

... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for any...

38 CFR 17.60 - Extensions of community nursing home care beyond six months.

Code of Federal Regulations, 2010 CFR

2010-07-01

... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for any...

38 CFR 17.60 - Extensions of community nursing home care beyond six months.

Code of Federal Regulations, 2014 CFR

2014-07-01

... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for any...

38 CFR 17.60 - Extensions of community nursing home care beyond six months.

Code of Federal Regulations, 2011 CFR

2011-07-01

... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for any...

38 CFR 17.60 - Extensions of community nursing home care beyond six months.

Code of Federal Regulations, 2012 CFR

2012-07-01

... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for any...

75 FR 57490 - Notice of Submission of Proposed Information Collection to OMB Multifamily Project Monthly...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-21

... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5376-N-91] Notice of Submission of Proposed Information Collection to OMB Multifamily Project Monthly Accounting Reports AGENCY: Office of the...: Multifamily Project Monthly Accounting Reports. OMB Approval Number: 2502-0108. Form Numbers: HUD-93479, HUD...

The Effect of Availability of Manpower on Trauma Resuscitation Times in a Tertiary Academic Hospital.

PubMed

Tan, Timothy Xin Zhong; Quek, Nathaniel Xin Ern; Koh, Zhi Xiong; Nadkarni, Nivedita; Singaram, Kanageswari; Ho, Andrew Fu Wah; Ong, Marcus Eng Hock; Wong, Ting Hway

2016-01-01

For trauma patients, delays to assessment, resuscitation, and definitive care affect outcomes. We studied the effects of resuscitation area occupancy and trauma team size on trauma team resuscitation speed in an observational study at a tertiary academic institution in Singapore. From January 2014 to January 2015, resuscitation videos of trauma team activated patients with an Injury Severity Score of 9 or more were extracted for review within 14 days by independent reviewers. Exclusion criteria were patients dead on arrival, inter-hospital transfers, and up-triaged patients. Data captured included manpower availability (trauma team size and resuscitation area occupancy), assessment (airway, breathing, circulation, logroll), interventions (vascular access, imaging), and process-of-care time intervals (time to assessment/intervention/adjuncts, time to imaging, and total time in the emergency department). Clinical data were obtained by chart review and from the trauma registry. Videos of 70 patients were reviewed over a 13-month period. The median time spent in the emergency department was 154.9 minutes (IQR 130.7-207.5) and the median resuscitation team size was 7, with larger team sizes correlating with faster process-of-care time intervals: time to airway assessment (p = 0.08) and time to disposition (p = 0.04). The mean resuscitation area occupancy rate (RAOR) was 1.89±2.49, and the RAOR was positively correlated with time spent in the emergency department (p = 0.009). Our results suggest that adequate staffing for trauma teams and resuscitation room occupancy are correlated with faster trauma resuscitation and reduced time spent in the emergency department.

PHASE II CALDERON PROCESS TO PRODUCE DIRECT REDUCED IRON RESEARCH AND DEVELOPMENT PROJECT

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

Albert Calderon

2003-04-28

This project was initially targeted to the making of coke for blast furnaces by using proprietary technology of Calderon in a phased approach, and Phase I was successfully completed. The project was then re-directed to the making of iron units. U.S. Steel teamed up with Calderon for a joint effort which will last 30 months to produce directly reduced iron with the potential of converting it into molten iron or steel consistent with the Roadmap recommendations of 1998 prepared by the Steel Industry in cooperation with the Department of Energy.

PHASE II CALDERON PROCESS TO PRODUCE DIRECT REDUCED IRON RESEARCH AND DEVELOPMENT PROJECT

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

Albert Calderon

2003-01-28

This project was initially targeted to the making of coke for blast furnaces by using proprietary technology of Calderon in a phased approach, and Phase I was successfully completed. The project was then re-directed to the making of iron units. U.S. Steel teamed up with Calderon for a joint effort which will last 30 months to produce directly reduced iron with the potential of converting it into molten iron or steel consistent with the Roadmap recommendations of 1998 prepared by the Steel Industry in cooperation with the Department of Energy.

Influence of growth hormone therapy on selected dental and skeletal system parameters.

PubMed

Partyka, Małgorzata; Chałas, Renata; Dunin-Wilczyńska, Izabella; Drohomyretska, Myroslava; Klatka, Maria

2018-03-14

Growth hormone deficiency (GHD) is one of the main indications for growth hormone therapy. One characteristic of this disease is bone age delay in relation to the chronological age. Pituitary dysfunction negatively affects the growth and development of the jaws and teeth of the child. The secretion of endocrine glands regulates growth, development, and gender differentiation. It also controls the growth of bones and teeth, regulates metabolism of calcium and phosphate, proteins, lipids and carbohydrates. The primary role in the endocrine system is played by the pituitary gland which is responsible for the production of somatotropin [1]. Dysfunction of the pituitary gland has a negative effect on the growth and development of long bones in the body, and may have an adverse effect on the development of maxilla, mandible and dentition of a child. There is some information in the literature that dental age is delayed in short stature children; the replacement of deciduous teeth by permanent teeth is also delayed, and newly erupted permanent teeth often require orthodontic treatment. Applying hormonal therapy positively affects the process of replacement of dentition [2, 3, 4, 5, 6]. The aim of the study was to assess bone and dental age, as well as analyze the state of dentition in children diagnosed with GH deficiency treated with growth hormone, depending on the duration of treatment. The study material consisted of 110 children (27 males, 83 females), hospitalized for somatotropin hypopituitarism in the Department of Paediatric Endocrinology and Diabetology at the Medical University of Lublin, Poland. The mean birth age was 13 years (156 months) with a standard deviation of 2 years and 6 months (30 months). 47 children (43%) started treatment with the growth hormone (group starting treatment) and 63 children (57%) whose treatment was started 2-3 years previously (group in the course of treatment). The control group consisted of 41 generally healthy children (15males, 25 females) with ENT problems, such as hypoacusis and a condition after nasal injury, hospitalized in the Department of Paediatric Otolaryngology at the Medical University of Lublin, Poland. The mean age was 11 years and 5 months (137 months) with standard deviation of 2 years and 5 months (29 months). Informed consent was obtained from the parents. The study was approved by the Bioethical Committee at the Medical University of Lublin (Resolution No. KE-0254 /216 /2012).

Creating pharmacy staffing-to-demand models: predictive tools used at two institutions.

PubMed

Krogh, Paul; Ernster, Jason; Knoer, Scott

2012-09-15

The creation and implementation of data-driven staffing-to-demand models at two institutions are described. Predictive workload tools provide a guideline for pharmacy managers to adjust staffing needs based on hospital volume metrics. At Abbott Northwestern Hospital, management worked with the department's staff and labor management committee to clearly outline the productivity monitoring system and the process for reducing hours. Reference charts describing the process for reducing hours and a form to track the hours of involuntary reductions for each employee were created to further enhance communication, explain the rationale behind the new process, and promote transparency. The University of Minnesota Medical Center-Fairview, found a strong correlation between measured pharmacy workload and an adjusted census formula. If the daily census and admission report indicate that the adjusted census will provide enough workload for the fully staffed department, no further action is needed. If the census report indicates the adjusted census is less than the breakeven point, staff members are asked to leave work, either voluntarily or involuntarily. The opposite holds true for days when the adjusted census is higher than the breakeven point, at which time additional staff are required to synchronize worked hours with predicted workload. Successful staffing-to- demand models were implemented in two hospital pharmacies. Financial savings, as indicated by decreased labor costs secondary to reduction of staffed shifts, were approximately $42,000 and $45,500 over a three-month period for Abbott Northwestern Hospital and the University of Minnesota Medical Center-Fairview, respectively. Maintenance of 100% productively allowed the departments to continue to replace vacant positions and avoid permanent staff reductions.

Confidence level in performing clinical procedures among medical officers in nonspecialist government hospitals in Penang, Malaysia.

PubMed

Othman, Mohamad Sabri; Merican, Hassan; Lee, Yew Fong; Ch'ng, Kean Siang; Thurairatnam, Dharminy

2015-03-01

A prospective cross-sectional study was conducted at 3 government hospitals over 6 months to evaluate the confidence level of medical officers (MOs) to perform clinical procedure in nonspecialist government hospitals in Penang. An anonymous self-administered questionnaire in English was designed based on the elective and emergency procedures stated in the houseman training logbook. The questionnaire was distributed to the MOs from Penang State Health Department through the respective hospital directors and returned to Penang State Health Department on completion. The results showed that there was statistically significant difference between those who had undergone 12 months and 24 months as houseman in performing both elective and emergency procedures. MOs who had spent 24 months as housemen expressed higher confidence level than those who had only 12 months of experience. We also found that the confidence level was statistically and significantly influenced by visiting specialist and working together with cooperative experienced paramedics. © 2013 APJPH.

76 FR 43729 - Notice of Random Assignment Study To Evaluate Workforce Investment Act Adult and Dislocated...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-21

... DEPARTMENT OF LABOR Employment and Training Administration Notice of Random Assignment Study To... interest to use a random assignment impact methodology for the study. In the local workforce investment... study during a 12-18 month period. The Department is soliciting comments concerning the Department's...

Implementing evidence-based recommended practices for the management of patients with mild traumatic brain injuries in Australian emergency care departments: study protocol for a cluster randomised controlled trial

PubMed Central

2014-01-01

Background Mild head injuries commonly present to emergency departments. The challenges facing clinicians in emergency departments include identifying which patients have traumatic brain injury, and which patients can safely be sent home. Traumatic brain injuries may exist with subtle symptoms or signs, but can still lead to adverse outcomes. Despite the existence of several high quality clinical practice guidelines, internationally and in Australia, research shows inconsistent implementation of these recommendations. The aim of this trial is to test the effectiveness of a targeted, theory- and evidence-informed implementation intervention to increase the uptake of three key clinical recommendations regarding the emergency department management of adult patients (18 years of age or older) who present following mild head injuries (concussion), compared with passive dissemination of these recommendations. The primary objective is to establish whether the intervention is effective in increasing the percentage of patients for which appropriate post-traumatic amnesia screening is performed. Methods/design The design of this study is a cluster randomised trial. We aim to include 34 Australian 24-hour emergency departments, which will be randomised to an intervention or control group. Control group departments will receive a copy of the most recent Australian evidence-based clinical practice guideline on the acute management of patients with mild head injuries. The intervention group will receive an implementation intervention based on an analysis of influencing factors, which include local stakeholder meetings, identification of nursing and medical opinion leaders in each site, a train-the-trainer day and standardised education and interactive workshops delivered by the opinion leaders during a 3 month period of time. Clinical practice outcomes will be collected retrospectively from medical records by independent chart auditors over the 2 month period following intervention delivery (patient level outcomes). In consenting hospitals, eligible patients will be recruited for a follow-up telephone interview conducted by trained researchers. A cost-effectiveness analysis and process evaluation using mixed-methods will be conducted. Sample size calculations are based on including 30 patients on average per department. Outcome assessors will be blinded to group allocation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612001286831 (date registered 12 December 2012). PMID:25012235

Improving implementation of infection control guidelines to reduce nosocomial infection rates: pioneering the report card.

PubMed

Yinnon, A M; Wiener-Well, Y; Jerassy, Z; Dor, M; Freund, R; Mazouz, B; Lupyan, T; Shapira, S; Attias, D; Assous, M V; Kopuit, P; Block, C; Raveh, D; Freier-Dror, Y; Moses, A E; Benenson, S

2012-07-01

Two detailed checklists were developed, based on published infection control guidelines, for daily use by infection control practitioners in departments and operating rooms. To assess the impact of the checklists on nosocomial infection rates in three hospitals over the course of one year. The checklists included 20 subheadings (± 150 items). Project nurses conducted rounds in the study (but not control) departments; during each round, the nurses selected 15-20 items for observation, marked the checklists according to appropriateness of observed behaviour and provided on-the-spot corrective education. Rates of adherence to the checklist, antibiotic use, number of obtained and positive cultures, and positive staff hand and patient environment cultures were reported monthly as a report card to relevant personnel and administrators. The rate of nosocomial infections was determined in the first and last months. The baseline nosocomial infection rate was similar in the study and control departments: 37/345 (11%) and 26/270 (10%) respectively. In the last month, the rate in the study department decreased to 16/383 (4%) (P<0.01); in the control it decreased insignificantly to 21/248 (8%) (not significant). No significant trends were detected in the number of obtained cultures, positive cultures, or antibiotic use. Adherence to guidelines ranged from 75% to 94% between the hospitals (P<0.001): the overall rate increased from 80% to 91% (P<0.01). The use of checklists during the conduct of infection control rounds, combined with monthly reports, was associated with a significant decrease in nosocomial infections in study departments. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Violent behavior of patients admitted in emergency following drug suicidal attempt: a specific staff educational crisis intervention.

PubMed

Cailhol, Lionel; Allen, Michael; Moncany, Anne-Hélène; Cicotti, Andrei; Virgillito, Salvatore; Barbe, Rémy P; Lazignac, Coralie; Damsa, Cristian

2007-01-01

In spite of much effort to create guidelines on the management of violent behavior (VB) in emergency departments, little is known about the impact of such guidelines on a real-life emergency environment. The aim of this study is to investigate the impact of a staff educational crisis intervention (SECI) on the reduction of VB in patients admitted to emergency departments following drug suicidal attempt. The impact of a SECI on VB of patient consulting the ER following a drug suicide attempt was assessed by comparing the occurrence of VB before (5 months) and after (5 months) the introduction of a SECI. A significant reduction in VB (from 17.32% to 7.14%) was found with the comparison of two 5-month periods: before (254 patients) and after (224 patients) the introduction of a SECI program (chi(2)=11.238; P=.0008). These preliminary data suggest the need for further prospective randomized studies aiming to prevent VB in emergency departments by developing specific SECI programs.

Delayed neuropsychological sequelae after carbon monoxide poisoning: predictive risk factors in the Emergency Department. A retrospective study.

PubMed

Pepe, Giuseppe; Castelli, Matteo; Nazerian, Peiman; Vanni, Simone; Del Panta, Massimo; Gambassi, Francesco; Botti, Primo; Missanelli, Andrea; Grifoni, Stefano

2011-03-17

Delayed neuropsychological sequelae (DNS) commonly occur after recovery from acute carbon monoxide (CO) poisoning. The preventive role and the indications for hyperbaric oxygen therapy in the acute setting are still controversial. Early identification of patients at risk in the Emergency Department might permit an improvement in quality of care. We conducted a retrospective study to identify predictive risk factors for DNS development in the Emergency Department. We retrospectively considered all CO-poisoned patients admitted to the Emergency Department of Careggi University General Hospital (Florence, Italy) from 1992 to 2007. Patients were invited to participate in three follow-up visits at one, six and twelve months from hospital discharge. Clinical and biohumoral data were collected; univariate and multivariate analysis were performed to identify predictive risk factors for DNS. Three hundred forty seven patients were admitted to the Emergency Department for acute CO poisoning from 1992 to 2007; 141/347 patients participated in the follow-up visit at one month from hospital discharge. Thirty four/141 patients were diagnosed with DNS (24.1%). Five/34 patients previously diagnosed as having DNS presented to the follow-up visit at six months, reporting a complete recovery. The following variables (collected before or upon Emergency Department admission) were associated to DNS development at one month from hospital discharge in the univariate analysis: CO exposure duration >6 hours, a Glasgow Coma Scale (GCS) score <9, seizures, systolic blood pressure <90 mmHg, elevated creatine phosphokinase concentration and leukocytosis. There was no significant correlation with age, sex, voluntary exposure, headache, transient loss of consciousness, GCS between 14 and 9, arterial lactate and carboxyhemoglobin concentration. The multivariate analysis confirmed as independent prognostic factors GCS <9 (OR 7.15; CI 95%: 1.04-48.8) and leukocytosis (OR 3.31; CI 95%: 1.02-10.71). Our study identified several potential predictive risk factors for DNS. Treatment algorithms based on an appropriate risk-stratification of patients in the Emergency Department might reduce DNS incidence; however, more studies are needed. Adequate follow-up after hospital discharge, aimed at correct recognition of DNS, is also important.

Delayed neuropsychological sequelae after carbon monoxide poisoning: predictive risk factors in the Emergency Department. A retrospective study

PubMed Central

2011-01-01

Background Delayed neuropsychological sequelae (DNS) commonly occur after recovery from acute carbon monoxide (CO) poisoning. The preventive role and the indications for hyperbaric oxygen therapy in the acute setting are still controversial. Early identification of patients at risk in the Emergency Department might permit an improvement in quality of care. We conducted a retrospective study to identify predictive risk factors for DNS development in the Emergency Department. Methods We retrospectively considered all CO-poisoned patients admitted to the Emergency Department of Careggi University General Hospital (Florence, Italy) from 1992 to 2007. Patients were invited to participate in three follow-up visits at one, six and twelve months from hospital discharge. Clinical and biohumoral data were collected; univariate and multivariate analysis were performed to identify predictive risk factors for DNS. Results Three hundred forty seven patients were admitted to the Emergency Department for acute CO poisoning from 1992 to 2007; 141/347 patients participated in the follow-up visit at one month from hospital discharge. Thirty four/141 patients were diagnosed with DNS (24.1%). Five/34 patients previously diagnosed as having DNS presented to the follow-up visit at six months, reporting a complete recovery. The following variables (collected before or upon Emergency Department admission) were associated to DNS development at one month from hospital discharge in the univariate analysis: CO exposure duration >6 hours, a Glasgow Coma Scale (GCS) score <9, seizures, systolic blood pressure <90 mmHg, elevated creatine phosphokinase concentration and leukocytosis. There was no significant correlation with age, sex, voluntary exposure, headache, transient loss of consciousness, GCS between 14 and 9, arterial lactate and carboxyhemoglobin concentration. The multivariate analysis confirmed as independent prognostic factors GCS <9 (OR 7.15; CI 95%: 1.04-48.8) and leukocytosis (OR 3.31; CI 95%: 1.02-10.71). Conclusions Our study identified several potential predictive risk factors for DNS. Treatment algorithms based on an appropriate risk-stratification of patients in the Emergency Department might reduce DNS incidence; however, more studies are needed. Adequate follow-up after hospital discharge, aimed at correct recognition of DNS, is also important. PMID:21414211

Idaho National Laboratory Quarterly Performance Analysis

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

Mitchell, Lisbeth

2014-11-01

This report is published quarterly by the Idaho National Laboratory (INL) Quality and Performance Management Organization. The Department of Energy (DOE) Occurrence Reporting and Processing System (ORPS), as prescribed in DOE Order 232.2, “Occurrence Reporting and Processing of Operations Information,” requires a quarterly analysis of events, both reportable and not reportable, for the previous 12 months. This report is the analysis of 60 reportable events (23 from the 4th Qtr FY14 and 37 from the prior three reporting quarters) as well as 58 other issue reports (including not reportable events and Significant Category A and B conditions) identified at INLmore » from July 2013 through October 2014. Battelle Energy Alliance (BEA) operates the INL under contract DE AC07 051D14517.« less

Revised ground-water monitoring compliance plan for the 300 area process trenches

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

Schalla, R.; Aaberg, R.L.; Bates, D.J.

1988-09-01

This document contains ground-water monitoring plans for process-water disposal trenches located on the Hanford Site. These trenches, designated the 300 Area Process Trenches, have been used since 1973 for disposal of water that contains small quantities of both chemicals and radionuclides. The ground-water monitoring plans contained herein represent revision and expansion of an effort initiated in June 1985. At that time, a facility-specific monitoring program was implemented at the 300 Area Process Trenches as part of a regulatory compliance effort for hazardous chemicals being conducted on the Hanford Site. This monitoring program was based on the ground-water monitoring requirements formore » interim-status facilities, which are those facilities that do not yet have final permits, but are authorized to continue interim operations while engaged in the permitting process. The applicable monitoring requirements are described in the Resource Conservation and Recovery Act (RCRA), 40 CFR 265.90 of the federal regulations, and in WAC 173-303-400 of Washington State's regulations (Washington State Department of Ecology 1986). The program implemented for the process trenches was designed to be an alternate program, which is required instead of the standard detection program when a facility is known or suspected to have contaminated the ground water in the uppermost aquifer. The plans for the program, contained in a document prepared by the US Department of Energy (USDOE) in 1985, called for monthly sampling of 14 of the 37 existing monitoring wells at the 300 Area plus the installation and sampling of 2 new wells. 27 refs., 25 figs., 15 tabs.« less

75 FR 48412 - Proposed Information Collection (Six-Month Post-Exit Focus Interview of Former VHA Employees...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-10

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-New (VA Form 10-0487)] Proposed Information Collection (Six-Month Post-Exit Focus Interview of Former VHA Employees) Activities; Under OMB Review AGENCY...).'' SUPPLEMENTARY INFORMATION: Title: Six-Month Post-Exit Focus Interview of Former VHA Employees, VA Form 10-0487...

Defense.gov Special Report: African-American History Month 2014

Science.gov Websites

Department of Defense Submit Search African-American History Month: Civil Rights in America - February 2014 Proclamation African-American Firsts in U.S. Naval History DEOMI 2014 African American/Black History Month Poster African-American History at National Museum of the U.S. Air Force African-Americans and the U.S

Effects of auditing patient safety in hospital care: design of a mixed-method evaluation

PubMed Central

2013-01-01

Background Auditing of patient safety aims at early detection of risks of adverse events and is intended to encourage the continuous improvement of patient safety. The auditing should be an independent, objective assurance and consulting system. Auditing helps an organisation accomplish its objectives by bringing a systematic, disciplined approach to evaluating and improving the effectiveness of risk management, control, and governance. Audits are broadly conducted in hospitals, but little is known about their effects on the behaviour of healthcare professionals and patient safety outcomes. This study was initiated to evaluate the effects of patient safety auditing in hospital care and to explore the processes and mechanisms underlying these effects. Methods and design Our study aims to evaluate an audit system to monitor and improve patient safety in a hospital setting. We are using a mixed-method evaluation with a before-and-after study design in eight departments of one university hospital in the period October 2011–July 2014. We measure several outcomes 3 months before the audit and 15 months after the audit. The primary outcomes are adverse events and complications. The secondary outcomes are experiences of patients, the standardised mortality ratio, prolonged hospital stay, patient safety culture, and team climate. We use medical record reviews, questionnaires, hospital administrative data, and observations to assess the outcomes. A process evaluation will be used to find out which components of internal auditing determine the effects. Discussion We report a study protocol of an effect and process evaluation to determine whether auditing improves patient safety in hospital care. Because auditing is a complex intervention targeted on several levels, we are using a combination of methods to collect qualitative and quantitative data about patient safety at the patient, professional, and department levels. This study is relevant for hospitals that want to early detect unsafe care and improve patient safety continuously. Trial registration Netherlands Trial Register (NTR): NTR3343 PMID:23800253

Effects of auditing patient safety in hospital care: design of a mixed-method evaluation.

PubMed

Hanskamp-Sebregts, Mirelle; Zegers, Marieke; Boeijen, Wilma; Westert, Gert P; van Gurp, Petra J; Wollersheim, Hub

2013-06-22

Auditing of patient safety aims at early detection of risks of adverse events and is intended to encourage the continuous improvement of patient safety. The auditing should be an independent, objective assurance and consulting system. Auditing helps an organisation accomplish its objectives by bringing a systematic, disciplined approach to evaluating and improving the effectiveness of risk management, control, and governance. Audits are broadly conducted in hospitals, but little is known about their effects on the behaviour of healthcare professionals and patient safety outcomes. This study was initiated to evaluate the effects of patient safety auditing in hospital care and to explore the processes and mechanisms underlying these effects. Our study aims to evaluate an audit system to monitor and improve patient safety in a hospital setting. We are using a mixed-method evaluation with a before-and-after study design in eight departments of one university hospital in the period October 2011-July 2014. We measure several outcomes 3 months before the audit and 15 months after the audit. The primary outcomes are adverse events and complications. The secondary outcomes are experiences of patients, the standardised mortality ratio, prolonged hospital stay, patient safety culture, and team climate. We use medical record reviews, questionnaires, hospital administrative data, and observations to assess the outcomes. A process evaluation will be used to find out which components of internal auditing determine the effects. We report a study protocol of an effect and process evaluation to determine whether auditing improves patient safety in hospital care. Because auditing is a complex intervention targeted on several levels, we are using a combination of methods to collect qualitative and quantitative data about patient safety at the patient, professional, and department levels. This study is relevant for hospitals that want to early detect unsafe care and improve patient safety continuously. Netherlands Trial Register (NTR): NTR3343.

Education Department Auditor Doesn't See Loan Abuses Retiring with Him

ERIC Educational Resources Information Center

Basken, Paul

2008-01-01

As he begins retirement this month after 40 years of federal service, the Education Department's departing inspector general, John P. Higgins Jr., sees one area that stands out for its susceptibility to costly waste and abuse. That area, Higgins said in an interview as he finished packing up his office, is student lending. Unless Congress greatly…

Teacher Perspectives about Lesson Study in Secondary School Departments: A Collaborative Vehicle for Professional Learning and Practice Development

ERIC Educational Resources Information Center

Cajkler, Wasyl; Wood, Phil; Norton, Julie; Pedder, David; Xu, Haiyan

2015-01-01

Two departments in a secondary school in England participated in "lesson study" projects over a five-month period to explore its usefulness as a vehicle for professional development. Through a cycle of two research lessons, conducted separately in each department, teachers identified challenges that inhibited the learning of their…

75 FR 14478 - Executive Order 11423, as Amended; Notice of Receipt of Application To Amend the Presidential...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-25

... DEPARTMENT OF STATE [Public Notice 6930] Executive Order 11423, as Amended; Notice of Receipt of....-Mexico Border AGENCY: Department of State. ACTION: Notice. SUMMARY: The Department of State hereby gives... the produce consumed in the United States during winter months crosses at Mariposa. In 2008, $12.85...

3 CFR 13623 - Executive Order 13623 of August 10, 2012. Preventing and Responding to Violence Against Women and...

Code of Federal Regulations, 2013 CFR

2013-01-01

... section 7061 of House conference report 112-331 accompanying the Department of State, Foreign Operations... consist of representatives from: (i) the Department of the Treasury; (ii) the Department of Defense; (iii.... (c) Within 18 months of the date of this order, the Working Group shall complete a progress report...

Emergency department blood alcohol level associates with injury factors and six-month outcome after uncomplicated mild traumatic brain injury.

PubMed

Yue, John K; Ngwenya, Laura B; Upadhyayula, Pavan S; Deng, Hansen; Winkler, Ethan A; Burke, John F; Lee, Young M; Robinson, Caitlin K; Ferguson, Adam R; Lingsma, Hester F; Cnossen, Maryse C; Pirracchio, Romain; Korley, Frederick K; Vassar, Mary J; Yuh, Esther L; Mukherjee, Pratik; Gordon, Wayne A; Valadka, Alex B; Okonkwo, David O; Manley, Geoffrey T

2017-11-01

The relationship between blood alcohol level (BAL) and mild traumatic brain injury (mTBI) remains in need of improved characterization. Adult patients suffering mTBI without intracranial pathology on computed tomography (CT) from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with emergency department (ED) Glasgow Coma Scale (GCS) 13-15 and recorded blood alcohol level (BAL) were extracted. BAL≥80-mg/dl was set as proxy for excessive use. Multivariable regression was performed for patients with six-month Glasgow Outcome Scale-Extended (GOSE; functional recovery) and Wechsler Adult Intelligence Scale Processing Speed Index Composite Score (WAIS-PSI; nonverbal processing speed), using BAL≥80-mg/dl and <80-mg/dl cohorts, adjusting for demographic/injury factors. Overall, 107 patients were aged 42.7±16.8-years, 67.3%-male, and 80.4%-Caucasian; 65.4% had BAL=0-mg/dl, 4.6% BAL<80-mg/dl, and 30.0% BAL≥80-mg/dl (range 100-440-mg/dl). BAL differed across loss of consciousness (LOC; none: median 0-mg/dl [interquartile range (IQR) 0-0], <30-min: 0-mg/dl [0-43], ≥30-min: 224-mg/dl [50-269], unknown: 108-mg/dl [0-232]; p=0.002). GCS<15 associated with higher BAL (19-mg/dl [0-204] vs. 0-mg/dl [0-20]; p=0.013). On univariate analysis, BAL≥80-mg/dl associated with less-than-full functional recovery (GOSE≤7; 38.1% vs. 11.5%; p=0.025) and lower WAIS-PSI (92.4±12.7, 30th-percentile vs. 105.1±11.7, 63rd-percentile; p<0.001). On multivariable regression BAL≥80-mg/dl demonstrated an odds ratio of 8.05 (95% CI [1.35-47.92]; p=0.022) for GOSE≤7 and an adjusted mean decrease of 8.88-points (95% CI [0.67-17.09]; p=0.035) on WAIS-PSI. Day-of-injury BAL>80-mg/dl after uncomplicated mTBI was associated with decreased GCS score and prolongation of reported LOC. BAL may be a biomarker for impaired return to baseline function and decreased nonverbal processing speed at six-months postinjury. Future confirmatory studies are needed. Published by Elsevier Ltd.

The impact of an emergency fee increase on the composition of patients visiting emergency departments.

PubMed

Jung, Hyemin; Do, Young Kyung; Kim, Yoon; Ro, Junsoo

2014-11-01

This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits. We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions. The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes. A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.

Packaging Patients and Handing Them Over: Communication Context and Persuasion in the Emergency Department.

PubMed

Nugus, Peter; McCarthy, Sally; Holdgate, Anna; Braithwaite, Jeffrey; Schoenmakers, Anne; Wagner, Cordula

2017-02-01

Communication is commonly understood by health professional researchers to consist of relatively isolated exchanges of information. The social and organizational context is given limited credit. This article examines the significance of the environmental complexity of the emergency department (ED) in influencing communication strategies and makes the case for adopting a richer understanding of organizational communication. This study draws on approximately 12 months (1,600 hours) of ethnographic observations, yielding approximately 4,500 interactions across 260 clinicians and staff in the EDs of 2 metropolitan public teaching hospitals in Sydney, Australia. The study identifies 5 communication competencies of increasing complexity that emergency clinicians need to accomplish. Furthermore, it identifies several factors-hierarchy, formally imposed organizational boundaries and roles, power, and education-that contribute to the collective function of ensuring smooth patient transfer through and out of the ED. These factors are expressed by and shape external communication with clinicians from other hospital departments. This study shows that handoff of patients from the ED to other hospital departments is a complex communication process that involves more than a series of "checklistable" information exchanges. Clinicians must learn to use both negotiation and persuasion to achieve objectives. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Expect the unexpected: a role for behavioral economics in understanding the impact of cost-sharing on emergency department utilization.

PubMed

Tzeel, Albert; Brown, Jack

2010-07-01

AS EMPLOYERS AND PAYERS ADDRESS INCREASING HEALTHCARE COSTS, THEY RESORT TO THE TENETS OF CLASSICAL ECONOMICS: if one increases the price for a service (defined as an individual's cost-sharing), then that individual's demand for services should decrease. This, however, may not necessarily be true, and raises the question of whether increased cost-sharing for emergency department services will lead to decreased utilization of those services as would be expected in classical economics. To assess the effect of emergency department cost-sharing on patient utilization of emergency department services. In 2002, we retrospectively reviewed 2001 claims and identified 797 members who have had at least 2 nonemergent visits to the emergency department. This cohort was comprised of members with high emergency department utilization patterns who also had potentially differing emergency department copayment changes from one health insurance plan year to the next. Participants had to be covered by Humana for a minimum of 12 consecutive months. Of the original cohort, 415 remained covered by Humana after the end of the first year, 322 remained covered after the second year, and 194 after the end of the third year. After completions of three 12-month blocks of time with appropriate claims run out, we assessed changes in the cohort's emergency department encounters from the previous year to the current year relative to emergency department copayment changes, using matched pairs t-test. Surprisingly, in the first 12 months, reductions in emergency department copayments resulted in decreases in patient utilization (-58.3% change, P <.007), and increases in emergency department copayment resulted in an increased utilization (1096.0% change, P <.001). This unexpected trend continued in the second and third periods. Overall, in our cohort, increases in emergency department copayments were significantly associated with increased emergency department encounters by different individuals in each of the 3 study periods. In contrast, in the 2 groups with no increases in emergency department copayments, utilization of these services decreased or remained flat. When assessing the need for emergency department services, many factors besides cost play a role in choosing to obtain emergency department care, including individual assessments of the probability of a given illness and the financial or temporal implications for the care sought in terms of "gains" or "losses" relative to a reference point. Behavioral economics can therefore play a role in understanding why healthcare consumers behave as they do. The implications of behavioral economics need to be factored in when considering a healthcare benefit design.

7 CFR 1209.251 - Payment of assessments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE MUSHROOM PROMOTION, RESEARCH...) Each first handler responsible for collecting assessments on domestic mushrooms shall collect the... of the month following the month in which the mushrooms were marketed to or through the first handler...

7 CFR 1209.251 - Payment of assessments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE MUSHROOM PROMOTION, RESEARCH...) Each first handler responsible for collecting assessments on domestic mushrooms shall collect the... of the month following the month in which the mushrooms were marketed to or through the first handler...

7 CFR 1209.251 - Payment of assessments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE MUSHROOM PROMOTION, RESEARCH...) Each first handler responsible for collecting assessments on domestic mushrooms shall collect the... of the month following the month in which the mushrooms were marketed to or through the first handler...

7 CFR 1209.251 - Payment of assessments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE MUSHROOM PROMOTION, RESEARCH...) Each first handler responsible for collecting assessments on domestic mushrooms shall collect the... of the month following the month in which the mushrooms were marketed to or through the first handler...

7 CFR 1209.251 - Payment of assessments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE MUSHROOM PROMOTION, RESEARCH...) Each first handler responsible for collecting assessments on domestic mushrooms shall collect the... of the month following the month in which the mushrooms were marketed to or through the first handler...

7 CFR 1001.10 - Producer-handler.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE NORTHEAST MARKETING AREA Order Regulating... farm and a distributing plant from which there is monthly route disposition in the marketing area...

7 CFR 1005.10 - Producer-handler.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE APPALACHIAN MARKETING AREA Order Regulating... farm and a distributing plant from which there is monthly route disposition in the marketing area; (b...

7 CFR 1006.10 - Producer-handler.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE FLORIDA MARKETING AREA Order Regulating... farm and a distributing plant from which there is monthly route disposition in the marketing area; (b...

7 CFR 1007.10 - Producer-handler.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE SOUTHEAST MARKETING AREA Order Regulating... farm and a distributing plant from which there is monthly route disposition in the marketing area; (b...

7 CFR 28.959 - Limitation of testing services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE COMMODITY STANDARDS AND STANDARD CONTAINER... be submitted by individuals during any one fiscal year or any one calendar month, and may direct that...

12 CFR Appendix I to Part 27 - Monthly Home Loan Activity Format

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Monthly Home Loan Activity Format I Appendix I to Part 27 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY FAIR HOUSING HOME LOAN DATA SYSTEM Pt. 27, App. I Appendix I to Part 27—Monthly Home Loan Activity Format EC22SE91...

12 CFR Appendix I to Part 27 - Monthly Home Loan Activity Format

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Monthly Home Loan Activity Format I Appendix I to Part 27 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY FAIR HOUSING HOME LOAN DATA SYSTEM Pt. 27, App. I Appendix I to Part 27—Monthly Home Loan Activity Format EC22SE91...

12 CFR Appendix I to Part 27 - Monthly Home Loan Activity Format

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Monthly Home Loan Activity Format I Appendix I to Part 27 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY FAIR HOUSING HOME LOAN DATA SYSTEM Pt. 27, App. I Appendix I to Part 27—Monthly Home Loan Activity Format EC22SE91...

12 CFR Appendix I to Part 27 - Monthly Home Loan Activity Format

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Monthly Home Loan Activity Format I Appendix I to Part 27 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY FAIR HOUSING HOME LOAN DATA SYSTEM Pt. 27, App. I Appendix I to Part 27—Monthly Home Loan Activity Format EC22SE91...

12 CFR Appendix I to Part 27 - Monthly Home Loan Activity Format

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Monthly Home Loan Activity Format I Appendix I to Part 27 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY FAIR HOUSING HOME LOAN DATA SYSTEM Pt. 27, App. I Appendix I to Part 27—Monthly Home Loan Activity Format EC22SE91...

Buen Comienzo, Buen Futuro: El Bebe de Tres Meses (Healthy Start, Grow Smart: Your Three-Month-Old).

ERIC Educational Resources Information Center

Department of Agriculture, Washington, DC.

Distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, this Spanish-language pamphlet provides parents with information and advice about their infants in the third month of life. The pamphlet provides information on communicating with the infant through body language, preparing for the 4-month checkup,…

Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury

PubMed Central

Haarbauer-Krupa, Juliet; Taylor, Christopher A.; Yue, John K.; Winkler, Ethan A.; Pirracchio, Romain; Cooper, Shelly R.; Burke, John F.; Stein, Murray B.

2017-01-01

Abstract Post-traumatic stress disorder (PTSD) is a condition associated with traumatic brain injury (TBI). While the importance of PTSD and TBI among military personnel is widely recognized, there is less awareness of PTSD associated with civilian TBI. We examined the incidence and factors associated with PTSD 6 months post-injury in a civilian emergency department population using measures from the National Institute of Neurological Disorders and Stroke TBI Common Data Elements Outcome Battery. Participants with mild TBI (mTBI) from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with complete 6-month outcome batteries (n = 280) were analyzed. Screening for PTSD symptoms was conducted using the PTSD Checklist-Civilian Version. Descriptive measures are summarized and predictors for PTSD were examined using logistic regression. Incidence of screening positive for PTSD was 26.8% at 6 months following mTBI. Screening positive for PTSD was significantly associated with concurrent functional disability, post-concussive and psychiatric symptomatology, decreased satisfaction with life, and decreased performance in visual processing and mental flexibility. Multi-variable regression showed injury mechanism of assault (odds ratio [OR] 3.59; 95% confidence interval [CI] 1.69–7.63; p = 0.001) and prior psychiatric history (OR 2.56; 95% CI 1.42–4.61; p = 0.002) remained significant predictors of screening positive for PTSD, while education (per year OR 0.88; 95% CI 0.79–0.98; p = 0.021) was associated with decreased odds of PTSD. Standardized data collection and review of pre-injury education, psychiatric history, and injury mechanism during initial hospital presentation can aid in identifying patients with mTBI at risk for developing PTSD symptoms who may benefit from closer follow-up after initial injury care. PMID:26936513

Application of time series analysis in modelling and forecasting emergency department visits in a medical centre in Southern Taiwan

PubMed Central

Juang, Wang-Chuan; Huang, Sin-Jhih; Huang, Fong-Dee; Cheng, Pei-Wen; Wann, Shue-Ren

2017-01-01

Objective Emergency department (ED) overcrowding is acknowledged as an increasingly important issue worldwide. Hospital managers are increasingly paying attention to ED crowding in order to provide higher quality medical services to patients. One of the crucial elements for a good management strategy is demand forecasting. Our study sought to construct an adequate model and to forecast monthly ED visits. Methods We retrospectively gathered monthly ED visits from January 2009 to December 2016 to carry out a time series autoregressive integrated moving average (ARIMA) analysis. Initial development of the model was based on past ED visits from 2009 to 2016. A best-fit model was further employed to forecast the monthly data of ED visits for the next year (2016). Finally, we evaluated the predicted accuracy of the identified model with the mean absolute percentage error (MAPE). The software packages SAS/ETS V.9.4 and Office Excel 2016 were used for all statistical analyses. Results A series of statistical tests showed that six models, including ARIMA (0, 0, 1), ARIMA (1, 0, 0), ARIMA (1, 0, 1), ARIMA (2, 0, 1), ARIMA (3, 0, 1) and ARIMA (5, 0, 1), were candidate models. The model that gave the minimum Akaike information criterion and Schwartz Bayesian criterion and followed the assumptions of residual independence was selected as the adequate model. Finally, a suitable ARIMA (0, 0, 1) structure, yielding a MAPE of 8.91%, was identified and obtained as Visitt=7111.161+(at+0.37462 at−1). Conclusion The ARIMA (0, 0, 1) model can be considered adequate for predicting future ED visits, and its forecast results can be used to aid decision-making processes. PMID:29196487

Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury.

PubMed

Haarbauer-Krupa, Juliet; Taylor, Christopher A; Yue, John K; Winkler, Ethan A; Pirracchio, Romain; Cooper, Shelly R; Burke, John F; Stein, Murray B; Manley, Geoffrey T

2017-01-01

Post-traumatic stress disorder (PTSD) is a condition associated with traumatic brain injury (TBI). While the importance of PTSD and TBI among military personnel is widely recognized, there is less awareness of PTSD associated with civilian TBI. We examined the incidence and factors associated with PTSD 6 months post-injury in a civilian emergency department population using measures from the National Institute of Neurological Disorders and Stroke TBI Common Data Elements Outcome Battery. Participants with mild TBI (mTBI) from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with complete 6-month outcome batteries (n = 280) were analyzed. Screening for PTSD symptoms was conducted using the PTSD Checklist-Civilian Version. Descriptive measures are summarized and predictors for PTSD were examined using logistic regression. Incidence of screening positive for PTSD was 26.8% at 6 months following mTBI. Screening positive for PTSD was significantly associated with concurrent functional disability, post-concussive and psychiatric symptomatology, decreased satisfaction with life, and decreased performance in visual processing and mental flexibility. Multi-variable regression showed injury mechanism of assault (odds ratio [OR] 3.59; 95% confidence interval [CI] 1.69-7.63; p = 0.001) and prior psychiatric history (OR 2.56; 95% CI 1.42-4.61; p = 0.002) remained significant predictors of screening positive for PTSD, while education (per year OR 0.88; 95% CI 0.79-0.98; p = 0.021) was associated with decreased odds of PTSD. Standardized data collection and review of pre-injury education, psychiatric history, and injury mechanism during initial hospital presentation can aid in identifying patients with mTBI at risk for developing PTSD symptoms who may benefit from closer follow-up after initial injury care.

[Clinical patterns and treatment of pyoderma gangrenosum in a French department].

PubMed

Anuset, D; Reguiai, Z; Perceau, G; Colomb, M; Durlach, A; Bernard, P

2016-02-01

Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis for which accurate epidemiological data are limited and therapy remains a challenge. The primary study aim was to examine all cases of PG observed in our regional department over a 15-year period in order to describe the relevant characteristics and outcome under therapy. The medical records of all patients with PG from 1997 to 2012 in the Marne department of France were studied retrospectively. Clinical and histological characteristics, comorbidities, therapeutic modalities and outcome were analysed. Forty-two patients were included (30 women, 12 men). A classical, ulcerative form was found in 39 cases and PG was multifocal in 28 cases. The number of lesions did not differ according to age or the presence of comorbidities. The most frequent first-line treatments were doxycycline (23 cases) and oral corticosteroids (15 cases), regardless of age, number of lesions or existence of comorbidities. Complete remission of PG was obtained in 38 cases (median time to remission: 3 months), with relapse occurring in 17 patients (median time to relapse: 12 months after treatment withdrawal). After a median follow-up of 46 months, 8 patients had died (median time to death: 26 months after treatment initiation). This is the first large French series of patients presenting PG and enabling determination of the annual incidence within the Marne department at around 4.6 cases/1000,000 inhabitants. Our study illustrates the value of first-line treatment with tetracycline, which merits confirmation by further prospective, controlled studies. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Using Lean to Rapidly and Sustainably Transform a Behavioral Health Crisis Program: Impact on Throughput and Safety.

PubMed

Balfour, Margaret E; Tanner, Kathleen; Jurica, Paul J; Llewellyn, Dawn; Williamson, Robert G; Carson, Chris A

2017-06-01

Lean has been increasingly applied in health care to reduce waste and improve quality, particularly in fast-paced and high-acuity clinical settings such as emergency departments. In addition, Lean's focus on engagement of frontline staff in problem solving can be a catalyst for organizational change. In this study, ConnectionsAZ demonstrates how they applied Lean principles to rapidly and sustainably transform clinical operations in a behavioral health crisis facility. A multidisciplinary team of management and frontline staff defined values-based outcome measures, mapped the current and ideal processes, and developed new processes to achieve the ideal. Phase I was implemented within three months of assuming management of the facility and involved a redesign of flow, space utilization, and clinical protocols. Phase II was implemented three months later and improved the provider staffing model. Organizational changes such as the development of shift leads and daily huddles were implemented to sustain change and create an environment supportive of future improvements. Post-Phase I, there were significant decreases (pre vs. post and one-year post) in median door-to-door dwell time (343 min vs. 118 and 99), calls to security for behavioral emergencies (13.5 per month vs. 4.3 and 4.8), and staff injuries (3.3 per month vs. 1.2 and 1.2). Post-Phase II, there were decreases in median door-to-doctor time (8.2 hours vs. 1.6 and 1.4) and hours on diversion (90% vs. 17% and 34%). Lean methods can positively affect safety and throughput and are complementary to patient-centered clinical goals in a behavioral health setting. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Paediatric emergency department-based carbon monoxide detector intervention: a randomised trial

PubMed Central

McKenzie, Lara B; Roberts, Kristin J; Kaercher, Roxanne M; Collins, Christy L; Comstock, R Dawn; Fernandez, Soledad; Abdel-Rasoul, Mahmoud; Casavant, Marcel J; Mihalov, Leslie

2017-01-01

Background Although non-fire-related carbon monoxide (CO) poisoning is almost entirely preventable, over 400 people die and 20 000 people are injured each year in the USA from unintentional CO poisoning. Thus, there is a critical need for evidence-based interventions for preventing CO poisoning and increasing the proper use and installation of CO detectors. Methods A randomised, controlled trial (Project CODE, a Carbon Monoxide Detector Education intervention) with 2-week and 6-month follow-up home observations was conducted in 299 parents of children aged ≤18 years recruited in the emergency department of a level 1 paediatric trauma centre. The intervention group received an educational tool, a spiral-bound, laminated booklet that resembled a CO detector containing theory-based safety messages based on the precaution adoption process model, a plug-in CO detector and 9 V battery. The control group received a one page flyer on CO poisoning prevention. Results Although the difference was not statistically significant, mean CO knowledge score increased at a greater rate for the intervention group than the control group. Intervention group parents were more likely to exhibit ‘safe’ CO detector use than control group parents at the 2-week follow-up (RR: 2.75; 95% CI 2.06 to 3.69) and 6-month follow-up (RR: 2.78; 95% CI 2.06 to 3.76), after adjusting for self-reported CO detector use behaviour at enrolment and annual per capita income. Conclusions An emergency department-delivered intervention containing a theory-based educational tool paired with a CO detector can be an effective method for increasing knowledge about CO poisoning, for prevention and for appropriate use of a CO detector. Trial registration number NCT00959478. PMID:28007971

Advancing Quality Improvement in Public Health Departments Through a Statewide Training Program.

PubMed

Davis, Mary V; Cornett, Amanda; Mahanna, Elizabeth; See, Claire; Randolph, Greg

2016-01-01

To examine the effectiveness of an ongoing statewide public health quality improvement training program (PH QI 101) among 4 cohorts of training participants. We conducted a mixed-method evaluation of the PH QI 101 training program that included measures of participants' satisfaction, learning, behavior change, and participants' translation and spread to their organizations what was learned. Data analysis included descriptive quantitative statistics and qualitative reviews. The Mann-Whitney U test was used to examine changes in participants' confidence to conduct a QI project from pre- to posttraining and 6 months posttraining. Two hundred two staff members from 37 North Carolina local health departments. An 8-month experiential learning process in which participants learn to use QI methods by applying them to a specific project. More than 90% of participants reported satisfaction with the program. Median scores on perceived self-confidence to conduct a QI project significantly increased for all training waves. At least 85% of participants reported spreading QI tools to coworkers posttraining. Two-thirds of participants in 3 waves reported that the QI project conducted during the training was at the sustaining results stage. Most participants in 3 of the training waves reported initiating new QI projects at their health department following training. Facilitators to implementation included interest and support from managers and leaders. Lack of interest and competing priorities among other staff were key barriers to implementation. This program successfully trained 4 waves of public health professionals in QI tools and methods. Leader training and involvement was a key addition to the adapted model. This statewide approach may serve as a model to other states as they seek to achieve national accreditation standards.

Carbon Monoxide Alarm and Smoke Alarm Use Among Parents Recruited From a Pediatric Emergency Department.

PubMed

Roberts, Kristin J; Fowler, Erica; Comstock, R Dawn; Fernandez, Soledad; Abdel-Rasoul, Mahmoud; Mihalov, Leslie; Casavant, Marcel J; McKenzie, Lara B

2018-02-01

Although the proper installation and maintenance of carbon monoxide (CO) and smoke alarms can protect individuals from residential CO-related and fire-related injuries, these devices are underutilized. We describe characteristics associated with self-reported CO and smoke alarm use of parents recruited from a pediatric emergency department to improve CO alarm use. Parents of children ≤ 18 years (N = 299) reported socio-demographic characteristics and CO and smoke alarm ownership and practices. We assigned participants to a behavioral profile and a Precaution Adoption Process Model stage based on their self-reported CO and smoke alarm use. Most participants (71%) did not have CO alarms in their homes, but reported owning at least one working smoke alarm (98%). Participants who reported "perfect" CO alarm behavior (defined as having a working CO alarm, one near a sleeping area, with batteries replaced every 6 months; 9%) were more likely to earn a higher income, own their home, and have lived at their current residence for at least 2 years. Participants who reported "perfect" smoke alarm behavior (defined as having a working smoke alarm on every level, with batteries replaced every 6 months; 49%) were more likely to rent their home, receive federal assistance, and have lived at their current residence for at least 2 years. Interventions to increase correct CO alarm use are necessary.

Pattern and determinants of breast feeding and contraceptive practices among mothers within six months postpartum.

PubMed

Kunwar, Shipra; Faridi, Mohammad M A; Singh, Shivani; Zahra, Fatima; Alizaidi, Zeashan

2010-08-01

The present study aims to determine the patterns of breast feeding, return of menstruation, and contraceptive practices in the first six months postpartum in women visiting the outpatient department at a teaching hospital in Lucknow, Northern India. Mothers of infants between six to eight months of age visiting the outpatient department of Era's Lucknow Medical College were interviewed regarding breast feeding practices, return of menstruation, sexual activity, and contraceptive practices within the first six months postpartum using a structured questionnaire. Of all women interviewed only 75.8% practiced exclusive breast feeding with the mean duration of exclusive breast feeding (EBF) being 3.5 months with only 41% practicing EBF for six months, 28% were sexually active within six weeks postpartum, 64.5% women had a return of menstruation within six months. Contraception was practiced by only 54.4% women with a barrier method such as a condom, being the most common. Better education was the only factor significantly affecting EBF (p < 0.004) and use of contraception (p < 0.027). There were a total of 10 pregnancies within six months postpartum. In conclusion, optimal breast feeding practices are poor in this part of the country and lactational amenorrhoea cannot be effectively and reliably used as a method of contraception. Therefore, optimal breast feeding practices, timely introduction of contraception and institutional delivery need to be encouraged.

Adaptive Planning: Understanding Organizational Workload to Capability/ Capacity through Modeling and Simulation

NASA Technical Reports Server (NTRS)

Hase, Chris

2010-01-01

In August 2003, the Secretary of Defense (SECDEF) established the Adaptive Planning (AP) initiative [1] with an objective of reducing the time necessary to develop and revise Combatant Commander (COCOM) contingency plans and increase SECDEF plan visibility. In addition to reducing the traditional plan development timeline from twenty-four months to less than twelve months (with a goal of six months)[2], AP increased plan visibility to Department of Defense (DoD) leadership through In-Progress Reviews (IPRs). The IPR process, as well as the increased number of campaign and contingency plans COCOMs had to develop, increased the workload while the number of planners remained fixed. Several efforts from collaborative planning tools to streamlined processes were initiated to compensate for the increased workload enabling COCOMS to better meet shorter planning timelines. This paper examines the Joint Strategic Capabilities Plan (JSCP) directed contingency planning and staffing requirements assigned to a combatant commander staff through the lens of modeling and simulation. The dynamics of developing a COCOM plan are captured with an ExtendSim [3] simulation. The resulting analysis provides a quantifiable means by which to measure a combatant commander staffs workload associated with development and staffing JSCP [4] directed contingency plans with COCOM capability/capacity. Modeling and simulation bring significant opportunities in measuring the sensitivity of key variables in the assessment of workload to capability/capacity analysis. Gaining an understanding of the relationship between plan complexity, number of plans, planning processes, and number of planners with time required for plan development provides valuable information to DoD leadership. Through modeling and simulation AP leadership can gain greater insight in making key decisions on knowing where to best allocate scarce resources in an effort to meet DoD planning objectives.

The Effect of Availability of Manpower on Trauma Resuscitation Times in a Tertiary Academic Hospital

PubMed Central

Quek, Nathaniel Xin Ern; Koh, Zhi Xiong; Nadkarni, Nivedita; Singaram, Kanageswari; Ho, Andrew Fu Wah; Ong, Marcus Eng Hock

2016-01-01

Background For trauma patients, delays to assessment, resuscitation, and definitive care affect outcomes. We studied the effects of resuscitation area occupancy and trauma team size on trauma team resuscitation speed in an observational study at a tertiary academic institution in Singapore. Methods From January 2014 to January 2015, resuscitation videos of trauma team activated patients with an Injury Severity Score of 9 or more were extracted for review within 14 days by independent reviewers. Exclusion criteria were patients dead on arrival, inter-hospital transfers, and up-triaged patients. Data captured included manpower availability (trauma team size and resuscitation area occupancy), assessment (airway, breathing, circulation, logroll), interventions (vascular access, imaging), and process-of-care time intervals (time to assessment/intervention/adjuncts, time to imaging, and total time in the emergency department). Clinical data were obtained by chart review and from the trauma registry. Results Videos of 70 patients were reviewed over a 13-month period. The median time spent in the emergency department was 154.9 minutes (IQR 130.7–207.5) and the median resuscitation team size was 7, with larger team sizes correlating with faster process-of-care time intervals: time to airway assessment (p = 0.08) and time to disposition (p = 0.04). The mean resuscitation area occupancy rate (RAOR) was 1.89±2.49, and the RAOR was positively correlated with time spent in the emergency department (p = 0.009). Conclusion Our results suggest that adequate staffing for trauma teams and resuscitation room occupancy are correlated with faster trauma resuscitation and reduced time spent in the emergency department. PMID:27136299

7 CFR 981.81 - Assessment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... four months of the succeeding crop year. No later than the fifth month the amount not expended from... its marketing promotion expenses of the succeeding crop year, and any unexpended portion of those...

Integrated hospital emergency care improves efficiency.

PubMed

Boyle, A A; Robinson, S M; Whitwell, D; Myers, S; Bennett, T J H; Hall, N; Haydock, S; Fritz, Z; Atkinson, P

2008-02-01

There is uncertainty about the most efficient model of emergency care. An attempt has been made to improve the process of emergency care in one hospital by developing an integrated model. The medical admissions unit was relocated into the existing emergency department and came under the 4-hour target. Medical case records were redesigned to provide a common assessment document for all patients presenting as an emergency. Medical, surgical and paediatric short-stay wards were opened next to the emergency department. A clinical decision unit replaced the more traditional observation unit. The process of patient assessment was streamlined so that a patient requiring admission was fully clerked by the first attending doctor to a level suitable for registrar or consultant review. Patients were allocated directly to specialty on arrival. The effectiveness of this approach was measured with routine data over the same 3-month periods in 2005 and 2006. There was a 16.3% decrease in emergency medical admissions and a 3.9% decrease in emergency surgical admissions. The median length of stay for emergency medical patients was reduced from 7 to 5 days. The efficiency of the elective surgical services was also improved. Performance against the 4-hour target declined but was still acceptable. The number of bed days for admitted surgical and medical cases rose slightly. There was an increase in the number of medical outliers on surgical wards, a reduction in the number of incident forms and formal complaints and a reduction in income for the hospital. Integrated emergency care has the ability to use spare capacity within emergency care. It offers significant advantages beyond the emergency department. However, improved efficiency in processing emergency patients placed the hospital at a financial disadvantage.

Indiana intelligent transportation systems commercial vehicle operations business plan

DOT National Transportation Integrated Search

1997-12-31

This business plan was developed by the Motor Carrier Services (MCS) division of the Indiana Department of Revenue. It is the result of a nine month study of the various state departments and agencies that directly and indirectly support the intersta...

76 FR 12342 - Notice of Proposed Information Collection Requests

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-07

... savings account. The application collects the necessary bank account information that allows the U.S... automatic debiting of all monthly payments may provide bank account information that allows them to... DEPARTMENT OF EDUCATION Notice of Proposed Information Collection Requests AGENCY: Department of...

Load Balancing at Emergency Departments using ‘Crowdinforming’

PubMed Central

Friesen, Marcia R; Strome, Trevor; Mukhi, Shamir; McLoed, Robert

2011-01-01

Background: Emergency Department (ED) overcrowding is an important healthcare issue facing increasing public and regulatory scrutiny in Canada and around the world. Many approaches to alleviate excessive waiting times and lengths of stay have been studied. In theory, optimal ED patient flow may be assisted via balancing patient loads between EDs (in essence spreading patients more evenly throughout this system). This investigation utilizes simulation to explore “Crowdinforming” as a basis for a process control strategy aimed to balance patient loads between six EDs within a mid-sized Canadian city. Methods: Anonymous patient visit data comprising 120,000 ED patient visits over six months to six ED facilities were obtained from the region’s Emergency Department Information System (EDIS) to (1) determine trends in ED visits and interactions between parameters; (2) to develop a process control strategy integrating crowdinforming; and, (3) apply and evaluate the model in a simulated environment to explore the potential impact on patient self-redirection and load balancing between EDs. Results: As in reality, the data available and subsequent model demonstrated that there are many factors that impact ED patient flow. Initial results suggest that for this particular data set used, ED arrival rates were the most useful metric for ED ‘busyness’ in a process control strategy, and that Emergency Department performance may benefit from load balancing efforts. Conclusions: The simulation supports the use of crowdinforming as a potential tool when used in a process control strategy to balance the patient loads between EDs. The work also revealed that the value of several parameters intuitively expected to be meaningful metrics of ED ‘busyness’ was not evident, highlighting the importance of finding parameters meaningful within one’s particular data set. The information provided in the crowdinforming model is already available in a local context at some ED sites. The extension to a wider dissemination of information via an Internet web service accessible by smart phones is readily achievable and not a technological obstacle. Similarly, the system could be extended to help direct patients by including future estimates or predictions in the crowdinformed data. The contribution of the simulation is to allow for effective policy evaluation to better inform the public of ED ‘busyness’ as part of their decision making process in attending an emergency department. In effect, this is a means of providing additional decision support insights garnered from a simulation, prior to a real world implementation. PMID:23569610

A study of the effect of legal settlement on post-concussion symptoms.

PubMed Central

Fee, C R; Rutherford, W H

1988-01-01

Forty-four consecutive patients with concussion for whom a medico-legal report had been written were followed up for 3-4 years after their accidents. Three cases were still pending at the end of the study. Fifty-seven per cent complained of symptoms when the medico-legal reports were written (mean interval from accident 12.9 months), 39% had symptoms at the time of settlement (mean interval 22.1 months) and 34% had symptoms one year later. When these results were compared with a general series from the same department some years earlier, it was found that the symptoms at the time of writing the reports were not significantly different from symptoms at 6 weeks in the earlier series, but the symptoms one year after settlement were almost two-and-a-half times greater than the symptoms at 12 months in the general series. No evidence could be found to suggest any organic basis for the higher symptom rate in the litigation series. It is suggested that the litigation process itself is a factor in the persistence of symptoms and this effect continues after legal settlement has been reached. Early settlement of the cases might significantly reduce morbidity. PMID:3408521

Buen Comienzo, Buen Futuro: El Bebe de Dos Meses (Healthy Start, Grow Smart: Your Two-Month-Old).

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

Distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, this Spanish-language pamphlet provides parents with information and advice about their infants in the second month of life. The pamphlet outlines typical infant behavior at 2 months of age, the need for regular visits to a physician, health insurance,…

Buen Comienzo, Buen Futuro: El Bebe de Un Mes (Healthy Start, Grow Smart: Your One-Month-Old).

ERIC Educational Resources Information Center

Department of Agriculture, Washington, DC.

This pamphlet, distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, is designed to provide parents with information and advice about their infants in the first month of life. The pamphlet provides information on ways the mother can take care of herself, the one-month checkup, early brain development, infant…

Selected weight management interventions for military populations in the United States: a narrative report.

PubMed

Murray, Jessica; Aboul-Enein, Basil H; Bernstein, Joshua; Kruk, Joanna

2017-06-01

Overweight and obesity continues to be a significant public health burden in the US and particularly among military personnel. Although the US Department of Defense mandates standardized physical activity requirements for military members, incidence and prevalence of overweight and obesity among military personnel continue to increase. Each military department controls their own interventional strategies for physical fitness and weight control. However, unique challenges such as geographic transients, lack of central standardization and empirical efficacy data across military departments, and chronic stress associated with military service adversely affect program outcomes. This brief narrative report explores overweight and obesity interventions among military populations from 2006 to 2016 and includes programmatic reviews of eight overweight and obesity interventions: The Prevention of Obesity in Military Community; Health Eating, Activity, and Lifestyle Training Headquarters (H.E.A.L.T.H); ArmyMOVE!; L.I.F.E.; Look AHEAD; Nutrition-focused Wellness Coaching; Go for Green; and LE3AN. A majority of these interventions did not report significant weight loss 6 months post intervention, and did not mention a theoretical foundation within the interventions. Further research to examine the importance of theory-based programming is warranted to improve process and outcome objectives.

Creating an outpatient center of excellence in CT.

PubMed

Itri, Jason N; Bakow, Eric; Woods, Jordan

2014-12-01

CT examinations represent a substantial portion of the workload for many radiology departments, and optimizing service delivery is a critical function to ensure customer satisfaction. This article describes how the Six Sigma methodology was used in the radiology department at a large academic hospital to improve the patient experience and increase CT capacity while reducing waste and improving staff satisfaction. The 5 distinct phases of Six Sigma are reviewed as they apply to our CT Center of Excellence project: define, measure, analyze, improve, and control. Process metrics used in this project include the percentage of outpatient CT exams started within 5 minutes of the scheduled appointment time, and the number of studies with protocols selected >48 hours before the CT exam is performed. Outcome metrics include monthly department expense per scan and CT Press Ganey "standard test and treatment" mean scores. An approach to developing interventions is described based on identifying critical sources of variation, ranking these by creating risk prioritization numbers, performing root cause analysis, and utilizing the failure mode and effects analysis tool to prioritize possible solutions. Finally, the key features of action plans and a control plan are reviewed. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

[Experience of liaison psychiatry in Morocco: transversal study over 24 months].

PubMed

Barrimi, M; Elghazouani, F; Aarab, C; Tliji, A; Rharrabti, S; Lahlou, F; Rammouz, I; Aalouane, R

2014-10-01

Liaison psychiatry is a discipline caring for psychiatric disorders in patients of general hospitals. It involves clinical, educational, and research aspects. The liaison psychiatry supports patients hospitalized for full-time in medical and surgical departments, patients admitted in day-hospital and patients treated in the emergency department. In this transversal study, we assessed the liaison psychiatry impact that is still in development stage in Morocco. This study lasted 24 months, and was conducted at the University Hospital in Fez, Morocco. The goal of this work was to evaluate the prevalence of psychiatric disorders managed by liaison psychiatry, identify those requiring medical and surgical departments of such psychiatric support, and classify the motivations involved in their needs. This transversal study was initiated in January 2010 and has lasted 24 months. The study recruited 180 patients requiring psychiatric consultation from different medical and surgical departments at the University Hospital in Fes, Morocco. The psychiatric assessment was based on a psychiatric interview using the MINI. The data were collected by a certified psychiatrist using a questionnaire containing 24 items. After initial psychiatric assessment, the follow-up was proposed to the patient in the psychiatric department. During this study, 22 medical and surgical departments of our University Hospital had requested a psychiatric assessment for their patients. Most demands were respectively emitted by the Department of Dermatology (16%) and Nephrology (11%). The most common motivations for psychiatric consultations were respectively psychomotor agitation (17%) and an evaluation of suicide attempts (17%). Depressive and psychotic disorders were the most diagnosed disorders with 47% and 11% respectively. The psychiatric support was based on pharmacological treatment in 60% of cases. Finally, the outcome was favourable in 80% of followed cases. Hospitalized patients in different medical and surgical departments of the University Hospital of Fez have demonstrated a high prevalence of psychiatric disorders. This constitutes a very strong motivation to setup a department of liaison psychiatry. This would allow a better psychiatric support and follow-up of patients. Copyright © 2013 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

7 CFR 1430.602 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the Department. Hundredweight or cwt. means 100 pounds. Hurricane-affected county means a county included in the geographic area covered by a natural disaster declaration related to Hurricane Katrina... program benefits. Base month means the base month for the particular 2005 hurricane assigned in § 1430.604...

7 CFR 1430.602 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the Department. Hundredweight or cwt. means 100 pounds. Hurricane-affected county means a county included in the geographic area covered by a natural disaster declaration related to Hurricane Katrina... program benefits. Base month means the base month for the particular 2005 hurricane assigned in § 1430.604...

7 CFR 1430.602 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the Department. Hundredweight or cwt. means 100 pounds. Hurricane-affected county means a county included in the geographic area covered by a natural disaster declaration related to Hurricane Katrina... program benefits. Base month means the base month for the particular 2005 hurricane assigned in § 1430.604...

7 CFR 1430.602 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the Department. Hundredweight or cwt. means 100 pounds. Hurricane-affected county means a county included in the geographic area covered by a natural disaster declaration related to Hurricane Katrina... program benefits. Base month means the base month for the particular 2005 hurricane assigned in § 1430.604...

45 CFR 233.28 - Monthly reporting.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 2 2013-10-01 2012-10-01 true Monthly reporting. 233.28 Section 233.28 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COVERAGE AND CONDITIONS OF...

45 CFR 233.28 - Monthly reporting.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Monthly reporting. 233.28 Section 233.28 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COVERAGE AND CONDITIONS OF...

38 CFR 21.5071 - Months of entitlement allowed.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Months of entitlement allowed. 21.5071 Section 21.5071 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational Assistance Under...

38 CFR 21.5071 - Months of entitlement allowed.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Months of entitlement allowed. 21.5071 Section 21.5071 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational Assistance Under...

38 CFR 21.5071 - Months of entitlement allowed.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Months of entitlement allowed. 21.5071 Section 21.5071 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational Assistance Under...

38 CFR 21.5071 - Months of entitlement allowed.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Months of entitlement allowed. 21.5071 Section 21.5071 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational Assistance Under...

38 CFR 21.5071 - Months of entitlement allowed.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Months of entitlement allowed. 21.5071 Section 21.5071 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational Assistance Under...

7 CFR 1280.220 - Collections.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE LAMB PROMOTION, RESEARCH, AND INFORMATION ORDER Lamb Promotion, Research, and Information Order Assessments § 1280.220 Collections. (a) Each... remit assessments to the Board by the 15th day of the month following the month in which the lambs were...

25 CFR 141.47 - Monthly billing statement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Monthly billing statement. 141.47 Section 141.47 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES BUSINESS PRACTICES ON THE... closing date of the billing cycle. (g) The unpaid balance at that time. ...

14 CFR 234.6 - Baggage-handling statistics.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Baggage-handling statistics. 234.6 Section 234.6 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION... statistics. Each reporting carrier shall report monthly to the Department on a domestic system basis...

14 CFR 234.6 - Baggage-handling statistics.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Baggage-handling statistics. 234.6 Section 234.6 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION... statistics. Each reporting carrier shall report monthly to the Department on a domestic system basis...

Managing length of stay using patient flow--part 1.

PubMed

Cesta, Toni

2013-02-01

This month we have discussed the fundamentals of patient flow and its related theories. We reviewed the concepts of demand and capacity management as they apply to the hospital setting. Patient flow requires daily diligence and attention. It should not be something focused on only on busy days, but should be managed each and every day. By taking a proactive approach to patient flow, the number of days your hospital will be bottlenecked can be reduced. Patient flow needs to be part of the daily activities of every case management department and should be factored in as a core role and function in a contemporary case management department. Patient flow needs to be addressed at the patient, departmental, and hospital level. In next month's issue we will continue our discussion on patient flow with a detailed review of specific examples that any case management department can use. We will also review all the departments and disciplines that contribute to patient flow and their role in it.

Evolution of proteolytic and physico-chemical characteristics of Norwegian dry-cured ham during its processing.

PubMed

Petrova, Inna; Tolstorebrov, Ignat; Mora, Leticia; Toldrá, Fidel; Eikevik, Trygve Magne

2016-11-01

Proteolytic activity and physico-chemical characteristics were studied for Norwegian dry-cured ham at four different times of processing: raw hams, post-salted hams (3 months of processing), hams selected in the middle of the production (12 months of processing) and hams at the end of the processing (24 months). Cathepsin H activity decreased until negligible values after 3 months of processing, whereas cathepsins B and B+L were inactive at 12 months. AAP was the most active aminopeptidase whereas RAP and MAP were active just during the first 12 months of processing. Proteolysis index reached a value of 4.56±1.03 % with non-significant differences between 12 and 24 months of ripening. Peptide identification by LC-MS/MS was done and two peptides (GVEEPPKGHKGNKK and QAISNNKDQGSY) showing a linear response with the time of processing were found. Unfreezable water content and glass transition temperature were investigated using differential scanning calorimetry (DSC) technique with non-significant differences in the temperature of glass transition for 12 and 24 months of processing. Copyright © 2016 Elsevier Ltd. All rights reserved.

The relationship between processing style, trauma memory processes, and the development of posttraumatic stress symptoms in children and adolescents.

PubMed

McKinnon, Anna; Brewer, Neil; Cameron, Kate; Nixon, Reginald D V

2017-12-01

Data-driven processing, peri-event fear, and trauma memory characteristics are hypothesised to play a core role in the development of Posttraumatic Stress Disorder. We assessed the relationships between these characteristics and Posttraumatic Stress (PTS) symptoms in a sample of youth. Study 1 (N = 36, 7-16 years), involved a sample of children who had undergone a stressful orthopaedic procedure. One week later they answered a series of probed recall questions about the trauma (assessed for accuracy by comparison to a video) and reported on their PTS symptoms. They also rated confidence in their probed recall answers to assess meta-cognitive monitoring of their memory for the trauma. In Study 2, a sample of injured children (N = 57, 7-16 years) were assessed within 1-month of a visit to an Emergency Department, and then at 3-month follow-up. They answered probed recall questions, made confidence ratings, and completed measures of data-driven processing, peri-event fear, PTS and associated psychopathology. Memories were verified using witness accounts. Studies 1 and 2 did not find an association between PTS symptoms and trauma memory accuracy or confidence. In Studies 1 and 2 data-driven processing predicted PTS symptoms. The studies had modest samples sizes and there were ceiling effects for some accuracy and confidence items. Data-driven processing at the time of a trauma was associated with PTS symptoms after accounting for fear at the time of the trauma. Accuracy of recall for trauma memories was not significantly related to PTS symptoms. No decisive conclusion could be drawn regarding the relation between confidence in trauma memories and PTS symptoms. Copyright © 2017 Elsevier Ltd. All rights reserved.

Community-dwelling seniors who present to the emergency department with a fall do not receive Guideline care and their fall risk profile worsens significantly: a 6-month prospective study.

PubMed

Salter, A E; Khan, K M; Donaldson, M G; Davis, J C; Buchanan, J; Abu-Laban, R B; Cook, W L; Lord, S R; McKay, H A

2006-01-01

Fall risk is a major contributor to fracture risk; implementing fall reduction programmes remains a challenge for health professionals and policy-makers. We aimed to (1) ascertain whether the care received by 54 older adults after an emergency department (ED) fall presentation met internationally recommended 'Guideline Care', and (2) prospectively evaluate this cohort's 6-month change in fall risk profile. Participants were men and women aged 70 years or older who were discharged back into the community after presenting to an urban university tertiary-care hospital emergency department with a fall-related complaint. American Geriatric Society (AGS) guideline care was documented by post-presentation emergency department chart examination, daily patient diary of falls submitted monthly, patient interview and physician reconciliation where needed. Both at study entry and at a 6-month followup, we measured participants physiological characteristics by Lord's Physiological Profile Assessment (PPA), functional status, balance confidence, depression, physical activity and other factors. We found that only 2 of 54 (3.7%) of the fallers who presented to the ED received care consistent with AGS Guidelines. Baseline physiological fall risk scores classified the study population at a 1.7 SD higher risk than a 65-year-old comparison group, and during the 6-month followup period the mean fall-risk score increased significantly (i.e. greater risk of falls) (1.7+/-1.6 versus 2.2+/-1.6, p=0.000; 29.5% greater risk of falls). Also, functional ability [100 (15) versus 95 (25), p=0.002], balance confidence [82.5 (44.4) versus 71.3 (58.7), p=0.000] and depression [0 (2) versus 0 (3), p=0.000] all worsened over 6 months. Within 6 months of the index ED visit, five participants had suffered six fall-related fractures. We conclude that this group of community-dwelling fallers, who presented for ED care with a clinical profile suggesting a high risk of further falls and fracture, did not receive Guideline care and worsened in their fall risk profile by 29.5%. This gap in care, at least in one centre, suggests further investigation into alternative approaches to delivering Guideline standard health service.

Year 2000 Computing Crisis: Significant Risks Remain to Department of Education's Student Financial Aid Systems. Testimony before the Subcommittee on Oversight and Investigations, Committee on Education and the Workforce, House of Representatives.

ERIC Educational Resources Information Center

Willemssen, Joel C.

This testimony discusses the risks faced by the U.S. Department of Education due to the year 2000 (Y2K) computing crisis, focusing on student financial aid systems, the actions the Department has taken in recent months to address these risks, and the key issues the Department must deal with if its computer systems are to be ready for the century…

Expect the Unexpected: A Role for Behavioral Economics in Understanding the Impact of Cost-Sharing on Emergency Department Utilization

PubMed Central

Tzeel, Albert; Brown, Jack

2010-01-01

Background As employers and payers address increasing healthcare costs, they resort to the tenets of classical economics: if one increases the price for a service (defined as an individual's cost-sharing), then that individual's demand for services should decrease. This, however, may not necessarily be true, and raises the question of whether increased cost-sharing for emergency department services will lead to decreased utilization of those services as would be expected in classical economics. Objective To assess the effect of emergency department cost-sharing on patient utilization of emergency department services. Method In 2002, we retrospectively reviewed 2001 claims and identified 797 members who have had at least 2 nonemergent visits to the emergency department. This cohort was comprised of members with high emergency department utilization patterns who also had potentially differing emergency department copayment changes from one health insurance plan year to the next. Participants had to be covered by Humana for a minimum of 12 consecutive months. Of the original cohort, 415 remained covered by Humana after the end of the first year, 322 remained covered after the second year, and 194 after the end of the third year. After completions of three 12-month blocks of time with appropriate claims run out, we assessed changes in the cohort's emergency department encounters from the previous year to the current year relative to emergency department copayment changes, using matched pairs t-test. Results Surprisingly, in the first 12 months, reductions in emergency department copayments resulted in decreases in patient utilization (−58.3% change, P <.007), and increases in emergency department copayment resulted in an increased utilization (1096.0% change, P <.001). This unexpected trend continued in the second and third periods. Overall, in our cohort, increases in emergency department copayments were significantly associated with increased emergency department encounters by different individuals in each of the 3 study periods. In contrast, in the 2 groups with no increases in emergency department copayments, utilization of these services decreased or remained flat. Conclusion When assessing the need for emergency department services, many factors besides cost play a role in choosing to obtain emergency department care, including individual assessments of the probability of a given illness and the financial or temporal implications for the care sought in terms of “gains” or “losses” relative to a reference point. Behavioral economics can therefore play a role in understanding why healthcare consumers behave as they do. The implications of behavioral economics need to be factored in when considering a healthcare benefit design. PMID:25126317

Prevalence, types, and geographical distribution of Listeria monocytogenes from a survey of retail Queso Fresco and associated cheese processing plants and dairy farms in Sonora, Mexico.

PubMed

Moreno-Enriquez, R I; Garcia-Galaz, A; Acedo-Felix, E; Gonzalez-Rios, I H; Call, J E; Luchansky, J B; Diaz-Cinco, M E

2007-11-01

In the first part of this study, samples were collected from farms, cheese processing plants (CPPs), and retail markets located in various geographical areas of Sonora, Mexico, over a 12-month period during the summer of 2004 and winter of 2005. Four (all Queso Fresco [QF] from retail markets) of 349 total samples tested positive for Listeria monocytogenes (Lm). Of these four positive samples, three were collected in the northern region and one in the southern region of Sonora. Additionally, two were collected during the winter months, and two were collected during the summer months. For the second part of the study, a total of 39 samples from a farm, a CPP, and retail markets were collected and processed according to a combination of the Norma Oficial Mexicana NOM-143-SSA1-1995.10 method (NOM) and the U.S. Food and Drug Administration (FDA) Bacteriological Analytical Manual method, and 27 samples from these same locations were collected and processed according to the U.S. Department of Agriculture Food Safety and Inspection Service method (USDA-FSIS). The NOM-FDA method recovered the pathogen from 6 (15%) of 39 samples (one cheese and five product contact surfaces), while the USDA-FSIS method recovered the pathogen from 5 (18.5%) of 27 samples (all product contact surfaces). In addition, the 40 isolates recovered from the 15 total samples that tested positive for Lm grouped into five distinct pulsotypes that were ca. 60% related, as determined by pulsed-field gel electrophoresis analysis. The results of this study confirmed a 3.4% prevalence of Lm in QF collected from retail markets located in Sonora and no appreciable difference in the effectiveness of either the NOM-FDA or USDA-FSIS method to recover the pathogen from cheese or environmental samples.

14 CFR 61.39 - Prerequisites for practical tests.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Prerequisites for practical tests. 61.39 Section 61.39 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION...) Pass the required knowledge test within the 24-calendar-month period preceding the month the applicant...

14 CFR 61.39 - Prerequisites for practical tests.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Prerequisites for practical tests. 61.39 Section 61.39 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION...) Pass the required knowledge test within the 24-calendar-month period preceding the month the applicant...

24 CFR 904.109 - Monthly operating expense.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Monthly operating expense. 904.109 Section 904.109 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR PUBLIC AND INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN...

A review and update of the Virginia Department of Transportation's cash flow forecasting model : interim report.

DOT National Transportation Integrated Search

1995-01-01

The Virginia Department of Transportation uses a cash flow forecasting model to predict operations expenditures by month. Components of this general forecasting model estimate line items in the VDOT budget. The cash flow model was developed in the ea...

Predictors of Long-Term Mortality in Oldest Old Patients (90+) Hospitalized to Medical Wards via the Emergency Department: The SAFES Cohort.

PubMed

de Boissieu, P; Mahmoudi, R; Hentzien, M; Toquet, S; Novella, J-L; Blanchard, F; Jolly, D; Dramé, M

2015-06-01

To identify risk factors for long-term mortality in patients aged 90 years and over who are admitted to hospital through the emergency department. Prospective cohort study (SAFES cohort; Sujet Agé Fragile - Évaluation Suivi). 8 university teaching hospitals and one regional, non-academic hospital in France. Among 1306 patients in the SAFES cohort, 291 patients aged 90 or over were included. At inclusion, we recorded socio-demographic data (age, sex, level of education, living alone or in an institution, number of children, presence of helper/caregiver), and data from geriatric evaluation (dependence status, risk of depression, dementia, delirium, nutritional status, walking disorders, risk of falls, comorbidities, risk of pressure sores). Vital status at 36 months was obtained from the treating physician, the general practitioner, administrative registers, or during follow-up consultations. Among 291 patients included, 190 (65.3%) had died at 36 months. Risk factors for mortality at 36 months identified by multivariate analysis were risk of malnutrition (HR 1.6, 95%CI 1.1-2.3, p=0.004) and delirium (HR 1.6, 95%CI 1.1-2.3, p=0.01). Risk of malnutrition and presence of delirium are risk factors for mortality at 36 months in subjects aged 90 years and over hospitalized through the emergency department.

Outcomes of Embedded Care Management in a Family Medicine Residency Patient-Centered Medical Home.

PubMed

Newman, Robert J; Bikowski, Richard; Nakayama, Kristy; Cunningham, Tina; Acker, Pam; Bradshaw, Dana

2017-01-01

Much attention is devoted nationally to preventing hospital readmissions and emergency department (ED) use, given the high cost of this care. There is a growing body of evidence from the Patient Centered Primary Care Collaborative that a patient-centered medical home (PCMH) model successfully lowers these costs. Our study evaluates a specific intervention in a family medicine residency PCMH to decrease readmissions and ED utilization using an embedded care manager. The Department of Family and Community Medicine at Eastern Virginia Medical School in Norfolk, VA, hired an RN care manager in May of 2013 with a well-defined job description focused on decreasing hospital readmissions and ED usage. Our primary outcomes for the study were number of monthly hospital admissions and readmissions over 23 months and monthly ED visits over 20 months. Readmission rates averaged 22.2% per month in the first year of the intervention and 18.3% in the second year, a statistically significant 3.9% decrease. ED visits averaged 176 per month in the first year and 146 per month in the second year, a statistically significant 17% reduction. Our study adds to the evidence that a PCMH model of care with an embedded RN care manager can favorably lower readmission rates and ED utilization in a family medicine residency practice. Developing a viable business model to support this important work remains a challenge.

Cost-effectiveness of a nurse practitioner-family physician model of care in a nursing home: controlled before and after study.

PubMed

Lacny, Sarah; Zarrabi, Mahmood; Martin-Misener, Ruth; Donald, Faith; Sketris, Ingrid; Murphy, Andrea L; DiCenso, Alba; Marshall, Deborah A

2016-09-01

To examine the cost-effectiveness of a nurse practitioner-family physician model of care compared with family physician-only care in a Canadian nursing home. As demand for long-term care increases, alternative care models including nurse practitioners are being explored. Cost-effectiveness analysis using a controlled before-after design. The study included an 18-month 'before' period (2005-2006) and a 21-month 'after' time period (2007-2009). Data were abstracted from charts from 2008-2010. We calculated incremental cost-effectiveness ratios comparing the intervention (nurse practitioner-family physician model; n = 45) to internal (n = 65), external (n = 70) and combined internal/external family physician-only control groups, measured as the change in healthcare costs divided by the change in emergency department transfers/person-month. We assessed joint uncertainty around costs and effects using non-parametric bootstrapping and cost-effectiveness acceptability curves. Point estimates of the incremental cost-effectiveness ratio demonstrated the nurse practitioner-family physician model dominated the internal and combined control groups (i.e. was associated with smaller increases in costs and emergency department transfers/person-month). Compared with the external control, the intervention resulted in a smaller increase in costs and larger increase in emergency department transfers. Using a willingness-to-pay threshold of $1000 CAD/emergency department transfer, the probability the intervention was cost-effective compared with the internal, external and combined control groups was 26%, 21% and 25%. Due to uncertainty around the distribution of costs and effects, we were unable to make a definitive conclusion regarding the cost-effectiveness of the nurse practitioner-family physician model; however, these results suggest benefits that could be confirmed in a larger study. © 2016 John Wiley & Sons Ltd.

Revisit, Subsequent Hospitalization, Recurrent Fall, and Death Within 6 Months After a Fall Among Elderly Emergency Department Patients.

PubMed

Sri-On, Jiraporn; Tirrell, Gregory P; Bean, Jonathan F; Lipsitz, Lewis A; Liu, Shan W

2017-10-01

We seek to describe the risk during 6 months and specific risk factors for recurrent falls, emergency department (ED) revisits, subsequent hospitalizations, and death within 6 months after a fall-related ED presentation. This was a secondary analysis of a retrospective cohort of elderly fall patients who presented to the ED from one urban teaching hospital. We included patients aged 65 years and older who had an ED fall visit in 2012. We examined the frequency and risk factors of adverse events (composite of recurrent falls, ED revisits, subsequent hospitalization, and death, selected a priori) at 6 months. Our study included 350 older adults. Adverse events steadily increased, from 7.7% at 7 days, 21.4% at 30 days, and 50.3% at 6 months. Within 6 months, 22.6% of patients had at least one recurrent fall, 42.6% revisited the ED, 31.1% had subsequent hospitalizations, and 2.6% died. In multivariable logistic regression analysis, psychological or sedative drug use predicted recurrent falls, ED revisits, subsequent hospitalizations, and adverse events. More than half of fall patients had an adverse event within 6 months of presenting to the ED after a fall. The risk during 6 months of these adverse events increased with psychological or sedative drug use. Larger future studies should confirm this association and investigate methods to minimize recurrent falls through management of such medications. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Nurses' intention to resign and avoidance of emergency department violence: A moderated mediation model.

PubMed

Li, Yu-Fang; Chao, Minston; Shih, Chih-Ting

2017-10-10

Studies that examined the negative impact of violence in emergency departments on nurses' leave and avoidance behavior are well-documented. However, few studies provided an integrated model of how and when violence influences their leave and avoidance behavior. The study adopted Affective Events Theory to propose and examine a model of violent events, negative emotions, and (leave and avoidance) behaviors on nurses in emergency departments and further analyzed whether the model is salient to nurses' occupational burnout, nursing experience, and nursing rank. The sample included 123 emergency department nurses at a teaching hospital in northern, Taiwan. All participants had experienced violent incidents within the preceding 6 months. Moderated mediation analysis suggested that nurses experienced one of two emotional processes following violent incidents: "violence-negative feelings toward work-intention to resign" or "violence-negative emotion and physical symptoms-avoidance tendencies." Moreover, nurses with high burnout levels expressed weaker intention to resign after violent incidents, while nurses with more experience and higher rank were less likely to avoid violence after violent incidents. Emergency nurses do not simply elect to escape but may engage in avoidance behavior. This study revealed that how violent incidents affect nurses' resignation or avoidance behaviors depends on how they feel. Occupational burnout and nurses' attributes affected their behavior. Copyright © 2017 Elsevier Ltd. All rights reserved.

25 CFR 39.221 - What is a full school month?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false What is a full school month? 39.221 Section 39.221 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION THE INDIAN SCHOOL EQUALIZATION PROGRAM Administrative Procedures, Student Counts, and Verifications Residential Programs § 39.221 What is...

78 FR 40551 - Agency Information Collection (Monthly Certification of Flight Training) Activity Under OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-05

... Certification of Flight Training) Activity Under OMB Review AGENCY: Veterans Benefits Administration, Department...-0162.'' SUPPLEMENTARY INFORMATION: Title: Monthly Certification of Flight Training, VA Form 22-6553c... or pursuing approved vocational flight training. VA Form 22-6553c serves as a report of flight...

15 CFR 280.320 - Maintenance of the certificate of recordal.

Code of Federal Regulations, 2010 CFR

2010-01-01

... six months following the expiration of the certificate of recordal. (e) After the six-month period... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Maintenance of the certificate of... Trade NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE ACCREDITATION AND...

15 CFR 280.320 - Maintenance of the certificate of recordal.

Code of Federal Regulations, 2011 CFR

2011-01-01

... six months following the expiration of the certificate of recordal. (e) After the six-month period... 15 Commerce and Foreign Trade 1 2011-01-01 2011-01-01 false Maintenance of the certificate of... Trade NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE ACCREDITATION AND...

26 CFR 1.42-8 - Election of appropriate percentage month.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Section 1.42-8 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY INCOME TAX INCOME TAXES Credits Against Tax § 1.42-8 Election of appropriate percentage month. (a) Election under section... previously placed in service under section 42(e). (5) Amount allocated. The housing credit dollar amount...

U.S. Department of Defense Official Website

Science.gov Websites

Us PRESIDENTIAL PROCLAMATION As we celebrate National African American History Month, we recognize * Radiologist Started as Tuskegee Airman * Hospital Celebrates Black History Month * Tuskegee Airman Visits Leave Strong Legacy . Chief makes history, home at 433rd AW . King Honored at Pentagon Breakfast Photo

38 CFR 21.5138 - Computation of benefit payments and monthly rates.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Computation of benefit payments and monthly rates. 21.5138 Section 21.5138 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational...

38 CFR 21.5138 - Computation of benefit payments and monthly rates.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Computation of benefit payments and monthly rates. 21.5138 Section 21.5138 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational...

38 CFR 21.5138 - Computation of benefit payments and monthly rates.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Computation of benefit payments and monthly rates. 21.5138 Section 21.5138 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational...

38 CFR 21.5138 - Computation of benefit payments and monthly rates.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Computation of benefit payments and monthly rates. 21.5138 Section 21.5138 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational...

7 CFR 1001.13 - Producer milk.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE NORTHEAST MARKETING AREA Order Regulating... is picked up from the producer's farm in a tank truck under the control of the operator of a pool... month shall be considered as having been received by the handler during the month in which it is picked...

7 CFR 1001.13 - Producer milk.

Code of Federal Regulations, 2010 CFR

2010-01-01

... and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE NORTHEAST MARKETING AREA Order Regulating... is picked up from the producer's farm in a tank truck under the control of the operator of a pool... month shall be considered as having been received by the handler during the month in which it is picked...

Healthy Start, Grow Smart: Your Five-Month-Old.

ERIC Educational Resources Information Center

Department of Agriculture, Washington, DC.

Distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, this pamphlet provides parents with information and advice about their infants in the fifth month of life. Following a brief description of developmental characteristics at this age, the pamphlet offers information on topics including infant medicines,…

Effect of Pediatric Behavioral Health Screening and Colocated Services on Ambulatory and Inpatient Utilization.

PubMed

Hacker, Karen A; Penfold, Robert B; Arsenault, Lisa N; Zhang, Fang; Soumerai, Stephen B; Wissow, Lawrence S

2015-11-01

The study sought to determine the impact of a pediatric behavioral health screening and colocation model on utilization of behavioral health care. In 2003, Cambridge Health Alliance, a Massachusetts public health system, introduced behavioral health screening and colocation of social workers sequentially within its pediatric practices. An interrupted time-series study was conducted to determine the impact on behavioral health care utilization in the 30 months after model implementation compared with the 18 months prior. Specifically, the change in trends of ambulatory, emergency, and inpatient behavioral health utilization was examined. Utilization data for 11,223 children ages ≥4 years 9 months to <18 years 3 months seen from 2003 to 2008 contributed to the study. In the 30 months after implementation of pediatric behavioral health screening and colocation, there was a 20.4% cumulative increase in specialty behavioral health visit rates (trend of .013% per month, p=.049) and a 67.7% cumulative increase in behavioral health primary care visit rates (trend of .019% per month, p<.001) compared with the expected rates predicted by the 18-month preintervention trend. In addition, behavioral health emergency department visit rates increased 245% compared with the expected rate (trend .01% per month, p=.002). After the implementation of a behavioral health screening and colocation model, more children received behavioral health treatment. Contrary to expectations, behavioral health emergency department visits also increased. Further study is needed to determine whether this is an effect of how care was organized for children newly engaged in behavioral health care or a reflection of secular trends in behavioral health utilization or both.

45 CFR 4.2 - Other process directed to the Department or Secretary.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Other process directed to the Department or Secretary. 4.2 Section 4.2 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION SERVICE OF PROCESS § 4.2 Other process directed to the Department or Secretary. Subpoenas and other...

Alabama Education News. Volume 31, Number 4

ERIC Educational Resources Information Center

Sibley, Michael O., Ed.

2008-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

Alabama Education News. Volume 32, Number 2

ERIC Educational Resources Information Center

Sibley, Michael O., Ed.

2008-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

76 FR 53487 - Agency Information Collection Activities: Proposed Collection, Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-26

... paperwork requirements in the regulations under the Chief Financial Officers Act of 1990 (CFO). DATES... appropriately paid. Companies submit financial information monthly to ONRR on Form ONRR-2014, Report of Sales... Inspector General, or its agent (agent), audits the Department's financial statements. The Department's goal...

Alabama Education News. Volume 27, Number 9

ERIC Educational Resources Information Center

White, Rebecca Leigh, Ed.

2004-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

Alabama Education News. Volume 30, Number 7

ERIC Educational Resources Information Center

Sibley, Michael O., Ed.

2007-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

10 CFR 451.5 - Where and when to apply.

Code of Federal Regulations, 2012 CFR

2012-01-01

... DEPARTMENT OF ENERGY ENERGY CONSERVATION RENEWABLE ENERGY PRODUCTION INCENTIVES § 451.5 Where and when to... renewable energy facility is requested to provide notification at least 6 months in advance of when a... be submitted to the Renewable Energy Production Incentive Program, U.S. Department of Energy, Golden...

10 CFR 451.5 - Where and when to apply.

Code of Federal Regulations, 2011 CFR

2011-01-01

... DEPARTMENT OF ENERGY ENERGY CONSERVATION RENEWABLE ENERGY PRODUCTION INCENTIVES § 451.5 Where and when to... renewable energy facility is requested to provide notification at least 6 months in advance of when a... be submitted to the Renewable Energy Production Incentive Program, U.S. Department of Energy, Golden...

10 CFR 451.5 - Where and when to apply.

Code of Federal Regulations, 2013 CFR

2013-01-01

... DEPARTMENT OF ENERGY ENERGY CONSERVATION RENEWABLE ENERGY PRODUCTION INCENTIVES § 451.5 Where and when to... renewable energy facility is requested to provide notification at least 6 months in advance of when a... be submitted to the Renewable Energy Production Incentive Program, U.S. Department of Energy, Golden...

10 CFR 451.5 - Where and when to apply.

Code of Federal Regulations, 2010 CFR

2010-01-01

... DEPARTMENT OF ENERGY ENERGY CONSERVATION RENEWABLE ENERGY PRODUCTION INCENTIVES § 451.5 Where and when to... renewable energy facility is requested to provide notification at least 6 months in advance of when a... be submitted to the Renewable Energy Production Incentive Program, U.S. Department of Energy, Golden...

10 CFR 451.5 - Where and when to apply.

Code of Federal Regulations, 2014 CFR

2014-01-01

... DEPARTMENT OF ENERGY ENERGY CONSERVATION RENEWABLE ENERGY PRODUCTION INCENTIVES § 451.5 Where and when to... renewable energy facility is requested to provide notification at least 6 months in advance of when a... be submitted to the Renewable Energy Production Incentive Program, U.S. Department of Energy, Golden...

Alabama Education News. Volume 34, Number 2

ERIC Educational Resources Information Center

Sibley, Michael O., Ed.

2010-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

Alabama Education News. Volume 28, Number 9

ERIC Educational Resources Information Center

White, Rebecca Leigh, Ed.

2005-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

Alabama Education News. Volume 30, Number 5

ERIC Educational Resources Information Center

Sibley, Michael O., Ed.

2007-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

77 FR 9216 - Native American Career and Technical Education Program; Proposed Waivers and Extension of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-16

... DEPARTMENT OF EDUCATION Native American Career and Technical Education Program; Proposed Waivers... Education, Department of Education. ACTION: Notice. SUMMARY: For 60-month projects funded in fiscal year (FY) 2007 under the Native American Career and Technical Education Program (NACTEP), the Secretary proposes...

32 CFR 718.1 - General provisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MISSING PERSONS ACT § 718.1 General provisions. (a) Under the provisions of the Missing Persons Act, as amended, a finding of... presumptive death are never made when the “missing” status has not continued for at least 12 months. Whenever...

32 CFR 718.1 - General provisions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MISSING PERSONS ACT § 718.1 General provisions. (a) Under the provisions of the Missing Persons Act, as amended, a finding of... presumptive death are never made when the “missing” status has not continued for at least 12 months. Whenever...

Alabama Education News. Volume 27, Number 8

ERIC Educational Resources Information Center

White, Rebecca Leigh, Ed.

2004-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama," as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

Alabama Education News. Volume 28, Number 1

ERIC Educational Resources Information Center

White, Rebecca Leigh, Ed.

2004-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama," as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

Alabama Education News. Volume 30, Number 2

ERIC Educational Resources Information Center

Sibley, Michael O., Ed.

2006-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

Alabama Education News. Volume 29, Number 7

ERIC Educational Resources Information Center

White, Rebecca Leigh, Ed.

2006-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

Alabama Education News. Volume 33, Number 4

ERIC Educational Resources Information Center

Sibley, Michael O., Ed.

2010-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

75 FR 18873 - Notice of Proposed Information Collection: Youthbuild Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-13

.... The Youthbuild grant life cycle is approximately 30 months with approximately 86 currently active... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5377-N-01] Notice of Proposed... be sent to: Robert Duncan, Department of Housing Urban and Development, 451 7th Street, SW., Room...

Alabama Education News. Volume 31, Number 2

ERIC Educational Resources Information Center

Sibley, Michael O., Ed.

2007-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

Alabama Education News. Volume 34, Number 4

ERIC Educational Resources Information Center

Sibley, Michael O., Ed.

2011-01-01

"Alabama Education News" is published monthly except for June, July, and December by the Alabama Department of Education. This publication, authorized by Section 16-2-4 of the "Code of Alabama", as recompiled in 1975, is a public service of the Alabama Department of Education designed to inform citizens and educators about…

A Step Toward High Reliability: Implementation of a Daily Safety Brief in a Children's Hospital.

PubMed

Saysana, Michele; McCaskey, Marjorie; Cox, Elaine; Thompson, Rachel; Tuttle, Lora K; Haut, Paul R

2017-09-01

Health care is a high-risk industry. To improve communication about daily events and begin the journey toward a high reliability organization, the Riley Hospital for Children at Indiana University Health implemented a daily safety brief. Various departments in our children's hospital were asked to participate in a daily safety brief, reporting daily events and unexpected outcomes within their scope of responsibility. Participants were surveyed before and after implementation of the safety brief about communication and awareness of events in the hospital. The length of the brief and percentage of departments reporting unexpected outcomes were measured. The analysis of the presurvey and the postsurvey showed a statistically significant improvement in the questions related to the awareness of daily events as well as communication and relationships between departments. The monthly mean length of time for the brief was 15 minutes or less. Unexpected outcomes were reported by 50% of the departments for 8 months. A daily safety brief can be successfully implemented in a children's hospital. Communication between departments and awareness of daily events were improved. Implementation of a daily safety brief is a step toward becoming a high reliability organization.

Chair Talk: Resources to Maximize Administrative Efforts

NASA Astrophysics Data System (ADS)

MacDonald, H.; Chan, M. A.; Bierly, E. W.; Manduca, C. A.; Ormand, C. J.

2009-12-01

Earth science department chairs are generally scientists who have little/no formal administrative training. The common rotation of faculty members in three-six year cycles distributes the heavy leadership responsibilities but involves little preparation beforehand to deal with budgets, fundraising, personnel issues, confrontations, and crises. The amount of information exchange and support upon exit and handoff to the next chair is variable. Resources for chairs include workshops, meetings (ranging from annual meetings of geoscience chairs to monthly meetings of small groups of chairs from various disciplines on a campus), discussions, and online resources. These resources, some of which we designed in the past several years, provide information and support for chairs, help them share best practices, and reduce time spent “reinventing the wheel”. Most of these resources involve groups of chairs in our discipline who meet together. The AGU Board of Heads and Chairs of Earth and Space Science Departments offers annual one-day workshops at the Fall AGU meeting. The specific topics vary from year to year; they have included goals and roles of heads and chairs, fundraising and Advisory Boards, student recruitment, interdisciplinarity, dual-career couples, and undergraduate research. The workshop provides ample opportunities for open discussion. Annual one-two day meetings of groups of geoscience department chairs (e.g., research universities in a particular region) provide an opportunity for chairs to share specific data about their departments (e.g., salaries, graduate student stipends, information about facilities) and discuss strategies. At the College of William and Mary, a small group of chairs meets monthly throughout the year; each session includes time for open discussion as well as a more structured discussion on a particular topic (e.g., merit review, development and fundraising, mentoring early career faculty and the tenure process, leadership styles, dealing with difficult situations, working with alumni). Through the Association for Women Geoscientists, we have offered annual one-hour lunch discussions at AGU and GSA meetings on issues facing women chairs and deans. Focusing on a different topic each year, these discussions include sharing good solutions, problem solving on various case scenarios, and so forth. In addition, the Building Strong Geoscience Departments program has offered workshops on different aspects of building strong geoscience departments, distributed reports, and made a variety of materials that would be useful to geoscience chairs available on their website. These programs and resources should continue and build to provide more continuity within departments and to increase a broader experience base of faculty. One of the greatest resources for chairs is to have personal connections with other chairs (via these programs), who can be called upon for advice, ideas, or general support. The sense of collective community could act in a powerful way to inspire and encourage more innovations and creative solutions to promote stronger departments.

[The two-year post graduate training program for nurses: implementation status and personal perspectives].

PubMed

Yin, Yu-Chun

2013-06-01

The Taiwan Joint Commission on Hospital Accreditation (TJCHA) authorized the Teaching Quality Improvement Program for Teaching Hospitals as a way for the Department of Health to plan and implement improvements. The program assists medical and paramedical professionals to establish a postgraduate clinical training system. The two-year postgraduate training program for nurses is one of the program's regular activities, divided into three phases that include location-based curriculum training (3 months), core curriculum training (9 months), and professional courses training (12 months). This paper describes the origin, current implementation status, and efficacy / key problems of this two-year post graduate training program, Information regarding the opinions of new nurses, preceptors, and nursing managers on the three aspects is drawn from the author's relevant professional experience, interactions with nurses, and a review of the literature. Findings include: (1) nursing departments should operate in accordance with TJCHA guidelines; (2) department training should be adequate to promote the ability and willingness of nurses to train a new generation of clinical preceptors; and (3) participant opinions on project execution progress and difficulties. Findings may be referenced to better achieve Teaching Quality Improvement Program for Teaching Hospital objectives.

Trampoline-related injury in children.

PubMed

Shankar, Amitabh; Williams, Kim; Ryan, Mary

2006-09-01

To quantify and describe trampoline-related injuries in children attending an urban pediatric emergency department. Retrospective cohort study of consecutive patients attending a children's emergency department with trampoline-related injuries over a 3-month period (May-July 2005). One hundred and sixty-eight children were treated for trampoline-related injuries during the period reviewed. Sixty-three percent were girls. Their age ranged between 4 months and 16 years (mean, 10.4 years [SD, 3 years and 10 months]). Lower limb injuries (51%) were more common overall. The most common injuries were to the ankle (31%), followed by foot (9.2%), and neck (8.4%). Sprain or soft tissue injuries (68%) were the most common type of injury, followed by fracture (12.2%). The most common mechanism of injury was inversion of the ankle on a trampoline (18.4%). Trampoline-related injuries represented 2.5% of morbidity from accidental trauma in children presenting to emergency department in our study. The rate and severity of injury has become a significant public health concern. It appears that current preventative strategies are inadequate in making children's carers aware of the potential risks of trampoline use, particularly when used recreationally.

Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial.

PubMed

Self, Wesley H; Semler, Matthew W; Wanderer, Jonathan P; Ehrenfeld, Jesse M; Byrne, Daniel W; Wang, Li; Atchison, Leanne; Felbinger, Matthew; Jones, Ian D; Russ, Stephan; Shaw, Andrew D; Bernard, Gordon R; Rice, Todd W

2017-04-13

Prior studies in critically ill patients suggest the supra-physiologic chloride concentration of 0.9% ("normal") saline may be associated with higher risk of renal failure and death compared to physiologically balanced crystalloids. However, the comparative effects of 0.9% saline and balanced fluids are largely unexamined among patients outside the intensive care unit, who represent the vast majority of patients treated with intravenous fluids. This study, entitled Saline Against Lactated Ringer's or Plasma-Lyte in the Emergency Department (SALT-ED), is a pragmatic, cluster, multiple-crossover trial at a single institution evaluating clinical outcomes of adults treated with 0.9% saline versus balanced crystalloids for intravenous fluid resuscitation in the emergency department. All adults treated in the study emergency department receiving at least 500 mL of isotonic crystalloid solution during usual clinical care and subsequently hospitalized outside the intensive care unit are included. Treatment allocation of 0.9% saline versus balanced crystalloids is assigned by calendar month, with study patients treated during the same month assigned to the same fluid type. The first month (January 2016) was randomly assigned to balanced crystalloids, with each subsequent month alternating between 0.9% saline and balanced crystalloids. For balanced crystalloid treatment, clinicians can choose either Lactated Ringer's or Plasma-Lyte A©. The study period is set at 16 months, which will result in an anticipated estimated sample size of 15,000 patients. The primary outcome is hospital-free days to day 28, defined as the number of days alive and out of the hospital from the index emergency department visit until 28 days later. Major secondary outcomes include proportion of patients who develop acute kidney injury by creatinine measurements; major adverse kidney events by hospital discharge or day 30 (MAKE30), which is a composite outcome of death, new renal replacement therapy, and persistent creatinine elevation >200% of baseline; and in-hospital mortality. This ongoing pragmatic trial will provide the most comprehensive evaluation to date of clinical outcomes associated with 0.9% saline compared to physiologically balanced fluids in patients outside the intensive care unit. ClinicalTrials.gov, NCT02614040 . Registered on 18 November 2015.

CQI: using the Hoshin planning system to design an orientation process.

PubMed

Platt, D; Laird, C

1995-01-01

The Hoshin planning system, developed in Japan after World War II, includes management tools intended specifically for planning new processes. There are seven tools, which can be used individually or in any combination: affinity diagrams, interrelationship digraphs, systematic diagrams, matrix diagrams, process decision program charts, arrow diagrams and prioritization matrices. The radiology department at Carson-Tahoe Hospital formed a CQI team to improve the training of front office clerks. The team quickly discovered that a new orientation program was needed and decided to use Hoshin tools to create one. Using the tools, the team identified and prioritized all relevant factors, described specific tasks needed to complete the planning process and how long each would take, anticipated problems, and assigned areas of responsibility to members of the team. Each time the team grew weary or discouraged, the clarity and organization afforded by the tools helped them feel productive and in control of the process. The team was amazed at the creative ideas they generated through this 3-month-long process. Not only did they develop and implement a new orientation program, they also cultivated a stronger sense of pride and confidence in their work and each other.

The developmental emergence of unconscious fear processing from eyes during infancy.

PubMed

Jessen, Sarah; Grossmann, Tobias

2016-02-01

From early in life, emotion detection plays an important role during social interactions. Recently, 7-month-old infants have been shown to process facial signs of fear in others without conscious perception and solely on the basis of their eyes. However, it is not known whether unconscious fear processing from eyes is present before 7months of age or only emerges at around 7months. To investigate this question, we measured 5-month-old infants' event-related potentials (ERPs) in response to subliminally presented fearful and non-fearful eyes and compared these with 7-month-old infants' ERP responses from a previous study. Our ERP results revealed that only 7-month-olds, but not 5-month-olds, distinguished between fearful and non-fearful eyes. Specifically, 7-month-olds' processing of fearful eyes was reflected in early visual processes over occipital cortex and later attentional processes over frontal cortex. This suggests that, in line with prior work on the conscious detection of fearful faces, the brain processes associated with the unconscious processing of fearful eyes develop between 5 and 7months of age. More generally, these findings support the notion that emotion perception and the underlying brain processes undergo critical change during the first year of life. Therefore, the current data provide further evidence for viewing infancy as a formative period in human socioemotional functioning. Copyright © 2015 Elsevier Inc. All rights reserved.

A Pharmacy Blueprint for Electronic Medical Record Implementation Success

PubMed Central

Bach, David S.; Risko, Kenneth R.; Farber, Margo S.; Polk, Gregory J.

2015-01-01

Objective: Implementation of an integrated, electronic medical record (EMR) has been promoted as a means of improving patient safety and quality. While there are a few reports of such processes that incorporate computerized prescriber order entry, pharmacy verification, an electronic medication administration record (eMAR), point-of-care barcode scanning, and clinical decision support, there are no published reports on how a pharmacy department can best participate in implementing such a process across a multihospital health care system. Method: This article relates the experience of the design, build, deployment, and maintenance of an integrated EMR solution from the pharmacy perspective. It describes a 9-month planning and build phase and the subsequent rollout at 8 hospitals over the following 13 months. Results: Key components to success are identified, as well as a set of guiding principles that proved invaluable in decision making and dispute resolution. Labor/personnel requirements for the various stages of the process are discussed, as are issues involving medication workflow analysis, drug database considerations, the development of clinical order sets, and incorporation of bar-code scanning of medications. Recommended implementation and maintenance strategies are presented, and the impact of EMR implementation on the pharmacy practice model and revenue analysis are examined. Conclusion: Adherence to the principles and practices outlined in this article can assist pharmacy administrators and clinicians during all medication-related phases of the development, implementation, and maintenance of an EMR solution. Furthermore, review and incorporation of some or all of practices presented may help ease the process and ensure its success. PMID:26405340

Increased identification of the primary care provider as the main source of asthma care among urban minority children.

PubMed

Iqbal, Sabah F; Jiggetts, Jennifer; Silverbrook, Cheryl; Shelef, Deborah Q; McCarter, Robert; Teach, Stephen J

2016-11-01

Urban, minority, and disadvantaged youth with asthma frequently use emergency departments (EDs) for episodic asthma care instead of their primary care providers (PCPs). We sought to increase the rate of guardians' identification of the PCP as the source of asthma care for their children through integrated electronic health records and care coordination. In this prospective cohort study, we implemented an electronic communication process between an asthma specialty clinic and PCPs coupled with short-term care coordination in sample of youth aged 2-12 years with asthma and surveyed their guardians at baseline and 3 and 6 months after the intervention. Guardians of 50 children (median age 5.8 years, 64% male, 98% African American, 94% public insurance) were enrolled. Compared to baseline, at 3 and 6 months after the intervention, significantly more guardians reported that the PCP was their child's primary asthma health care provider [70% at baseline, 85% at 3 months, 83% at 6 months (time averaged adjusted OR 77.4, 95% CI 3.0, 2027.1]. Further, significantly more guardians reported that they took their child to the PCP when the child experienced problems with his/her asthma [16% at baseline, 35% at 3 months, 41% at 6 months (time averaged adjusted odds ratio (OR) 10.6, 95% CI 2.7, 41.7]. Care in a subspecialty asthma clinic augmented by electronic communication with PCPs and short term care coordination was associated with significantly improved identification of PCPs as the primary source of asthma care in a cohort of urban minority youth.

Implementing iRound: A Computer-Based Auditing Tool.

PubMed

Brady, Darcie

Many hospitals use rounding or auditing as a tool to help identify gaps and needs in quality and process performance. Some hospitals are also using rounding to help improve patient experience. It is known that purposeful rounding helps improve Hospital Consumer Assessment of Healthcare Providers and Systems scores by helping manage patient expectations, provide service recovery, and recognize quality caregivers. Rounding works when a standard method is used across the facility, where data are comparable and trustworthy. This facility had a pen-and-paper process in place that made data reporting difficult, created a silo culture between departments, and most audits and rounds were completed differently on each unit. It was recognized that this facility needed to standardize the rounding and auditing process. The tool created by the Advisory Board called iRound was chosen as the tool this facility would use for patient experience rounds as well as process and quality rounding. The success of the iRound tool in this facility depended on several factors that started many months before implementation to current everyday usage.

Two-Step Process for ED UTI Screening in Febrile Young Children: Reducing Catheterization Rates.

PubMed

Lavelle, Jane M; Blackstone, Mercedes M; Funari, Mary Kate; Roper, Christine; Lopez, Patricia; Schast, Aileen; Taylor, April M; Voorhis, Catherine B; Henien, Mira; Shaw, Kathy N

2016-07-01

Urinary tract infection (UTI) screening in febrile young children can be painful and time consuming. We implemented a screening protocol for UTI in a high-volume pediatric emergency department (ED) to reduce urethral catheterization, limiting catheterization to children with positive screens from urine bag specimens. This quality-improvement initiative was implemented using 3 Plan-Do-Study-Act cycles, beginning with a small test of the proposed change in 1 ED area. To ensure appropriate patients received timely screening, care teams discussed patient risk factors and created patient-specific, appropriate procedures. The intervention was extended to the entire ED after providing education. Finally, visual cues were added into the electronic health record, and nursing scripts were developed to enlist family participation. A time-series design was used to study the impact of the 6-month intervention by using a p-chart to determine special cause variation. The primary outcome measure for the study was defined as the catheterization rate in febrile children ages 6 to 24 months. The ED reduced catheterization rates among febrile young children from 63% to <30% over a 6-month period with sustained results. More than 350 patients were spared catheterization without prolonging ED length of stay. Additionally, there was no change in the revisit rate or missed UTIs among those followed within the hospital's network. A 2-step less-invasive process for screening febrile young children for UTI can be instituted in a high-volume ED without increasing length of stay or missing cases of UTI. Copyright © 2016 by the American Academy of Pediatrics.

Impact of process improvements on measures of emergency department efficiency.

PubMed

Leung, Alexander K; Whatley, Shawn D; Gao, Dechang; Duic, Marko

2017-03-01

To study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures. This was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage. Within the ED, parallel processes unfolded, and there was no restriction on when registration occurred or which health care provider a patient saw first. Flexible nursing ratios allowed nursing staff to redeploy and move to areas of highest demand. Last, demand-based physician scheduling was implemented. The main outcome was length of stay (LOS). Secondary outcomes included time to physician initial assessment (PIA), left-without-being-seen (LWBS) rates, and left-against-medical-advice (LAMA) rates. Segmented regression of interrupted time series analysis was performed to quantify the impact of the intervention, and whether it was sustained. Patients totalling 251,899 attended the ED during the study period. Daily patient volumes increased 17.3% during the post-intervention period. Post-intervention, mean LOS decreased by 0.64 hours (p<0.005). LOS for non-admitted Canadian Triage and Acuity Scale 2 (-0.58 hours, p<0.005), 3 (-0.75 hours, p<0.005), and 4 (-0.32 hours, p<0.005) patients also decreased. There were reductions in PIA (43.81 minutes, p<0.005), LWBS (35.2%, p<0.005), and LAMA (61.9%, p<0.005). A combination of process improvements in the ED was associated with clinically significant reductions in LOS, PIA, LWBS, and LAMA for non-resuscitative patients.

Redefining the business process of Department of Food Security and Agriculture in Government of Surabaya City

NASA Astrophysics Data System (ADS)

Cahyono, H.; Wessiani, N. A.

2018-04-01

Government of Indonesia has been launched the bureaucratic reform program since 2010. One of the action is conducted restructuring organization in all city governments. Department of Food Security and Agriculture in Government of Surabaya City is the result of merger from two Department, namely Bureau of Food Security and Department of Agriculture. This merger makes Department of Food Security and Agriculture to redefine their business process. The new business process is needed to be defined in order to align the new structure with the long term strategic planning of Surabaya City Government. This research aims to redefine the business process of Department of Food Security and Agriculture in Government of Surabaya City. The CIMOSA model is adopted for identifying the activities in the business process. The new business process is important for the department to allocate their resource, mainly the human resource and as the main input for the department to build their standard operating procedure.

Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes.

PubMed

Blackwell, Rebecca Wright Née; Lowton, Karen; Robert, Glenn; Grudzen, Corita; Grocott, Patricia

2017-03-01

Increasing use of emergency departments among older patients with palliative needs has led to the development of several service-level interventions intended to improve care quality. There is little evidence of patient and family involvement in developmental processes, and little is known about the experiences of - and preferences for - palliative care delivery in this setting. Participatory action research seeking to enable collaborative working between patients and staff should enhance the impact of local quality improvement work but has not been widely implemented in such a complex setting. To critique the feasibility of this methodology as a quality improvement intervention in complex healthcare settings, laying a foundation for future work. an Emergency Department in a large teaching hospital in the United Kingdom. Experience-based Co-design incorporating: 150h of nonparticipant observation; semi-structured interviews with 15 staff members about their experiences of palliative care delivery; 5 focus groups with 64 staff members to explore challenges in delivering palliative care; 10 filmed semi-structured interviews with palliative care patients or their family members; a co-design event involving staff, patients and family members. the study successfully identified quality improvement priorities leading to changes in Emergency Department-palliative care processes. Further outputs were the creation of a patient-family-staff experience training DVD to encourage reflective discussion and the identification and application of generic design principles for improving palliative care in the Emergency Department. There were benefits and challenges associated with using Experience-based Co-design in this setting. Benefits included the flexibility of the approach, the high levels of engagement and responsiveness of patients, families and staff, and the impact of using filmed narrative interviews to enhance the 'voice' of seldom heard patients and families. Challenges included high levels of staff turnover during the 19 month project, significant time constraints in the Emergency Department and the ability of older patients and their families to fully participate in the co-design process. Experience-based Co-design is a useful approach for encouraging collaborative working between vulnerable patients, family and staff in complex healthcare environments. The flexibility of the approach allows the specific needs of participants to be accounted for, enabling fuller engagement with those who typically may not be invited to contribute to quality improvement work. Recommendations for future studies in this and similar settings include testing the 'accelerated' form of the approach and experimenting with alternative ways of increasing involvement of patients/families in the co-design phase. Copyright © 2017 Elsevier Ltd. All rights reserved.

42 CFR 406.32 - Monthly premiums.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Monthly premiums. 406.32 Section 406.32 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM... at least the previous one year period to a worker who has 30 or more QCs; (3) Had been married to a...

75 FR 63202 - Notice of Lodging of Consent Decree

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-14

... Department of Environmental Quality permit within a 42-month time period and permanently shut down kilns 1-4 within six months of commencing operation of Kiln 6. Under Option 2, CPC will continue to operate Kilns 1... perform injunctive relief. The proposed decree sets forth two compliance options for [[Page 63203

Healthy Start, Grow Smart: Your Eight-Month-Old.

ERIC Educational Resources Information Center

Department of Agriculture, Washington, DC.

Distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, this pamphlet provides parents with information and advice about their infants in the eighth month of life. Following a brief description of developmental characteristics at this age, the pamphlet offers advice on a variety of topics, including: ways to…

46 CFR 64.81 - 30-month inspection of an MPT.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 2 2010-10-01 2010-10-01 false 30-month inspection of an MPT. 64.81 Section 64.81 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE ENGINEERING MARINE PORTABLE TANKS... external examination for— (i) Corrosion; (ii) Cracking of base material; and (iii) Weld defects; and (2) A...

76 FR 56505 - Agency Information Collection (Suspension of Monthly Check) Activity Under OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-13

... (Suspension of Monthly Check) Activity Under OMB Review AGENCY: Veterans Benefits Administration, Department... 1995 (44 U.S.C. 3501-3521), this notice announces that the Veterans Benefits Administration (VBA... Vermont Avenue, NW., Washington, DC 20420, (202) 461-7485, fax (202) 461-0966 or e-mail [email protected

Healthy Start, Grow Smart: Your Seven-Month-Old.

ERIC Educational Resources Information Center

Department of Agriculture, Washington, DC.

Distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, this pamphlet provides parents with information and advice about their infants in the seventh month of life. Following a brief description of developmental characteristics at this age, the pamphlet offers advice on a variety of topics, including: your…

45 CFR 233.29 - How monthly reports are treated and what notices are required.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 2 2013-10-01 2012-10-01 true How monthly reports are treated and what notices are required. 233.29 Section 233.29 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH...

45 CFR 233.29 - How monthly reports are treated and what notices are required.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false How monthly reports are treated and what notices are required. 233.29 Section 233.29 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH...

7 CFR 774.18 - Interest rate, terms and security requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS EMERGENCY LOAN FOR SEED PRODUCERS PROGRAM § 774.18 Interest rate... percent for 36 months or until the date of settlement of, completion of, or final distribution of assets... bankruptcy claim or 36 months from the date of the note. (2) However, any principal remaining thereafter will...

7 CFR 774.18 - Interest rate, terms and security requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS EMERGENCY LOAN FOR SEED PRODUCERS PROGRAM § 774.18 Interest rate... percent for 36 months or until the date of settlement of, completion of, or final distribution of assets... bankruptcy claim or 36 months from the date of the note. (2) However, any principal remaining thereafter will...

7 CFR 774.18 - Interest rate, terms and security requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS EMERGENCY LOAN FOR SEED PRODUCERS PROGRAM § 774.18 Interest rate... percent for 36 months or until the date of settlement of, completion of, or final distribution of assets... bankruptcy claim or 36 months from the date of the note. (2) However, any principal remaining thereafter will...

7 CFR 774.18 - Interest rate, terms and security requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS EMERGENCY LOAN FOR SEED PRODUCERS PROGRAM § 774.18 Interest rate... percent for 36 months or until the date of settlement of, completion of, or final distribution of assets... bankruptcy claim or 36 months from the date of the note. (2) However, any principal remaining thereafter will...

Healthy Start, Grow Smart, Your Ten-Month-Old.

ERIC Educational Resources Information Center

Department of Agriculture, Washington, DC.

Distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, this pamphlet provides parents with information and advice about their infants in the tenth month of life. Following a brief description of developmental characteristics at this age, the pamphlet offers advice on a variety of topics, including: guarding…

75 FR 56056 - Proposed Information Collection; Comment Request; Manufacturers' Shipments, Inventories, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-15

... and are valuable tools for analysis of business cycle conditions. Major data users include: Members of..., Treasury Department, and the business community. The monthly M3 Survey data reflect primarily the month-to.... Form Number: MA-3001. Type of Review: Regular submission. Affected Public: Businesses or other for...

29 CFR 778.113 - Salaried employees-general.

Code of Federal Regulations, 2010 CFR

2010-07-01

... dividing the monthly salary by the number of working days in the month and then by the number of hours of... Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL... number of hours which the salary is intended to compensate. If an employee is hired at a salary of $182...

NREL to Host Range of Activities for Energy Awareness Month

Science.gov Websites

Host Range of Activities for Energy Awareness Month Events devoted to energy savings Golden, Colo., Sept. 20, 2000 - Visitors will get an inside look at advanced energy technologies and learn tips for cutting utility bills when the U.S. Department of Energy's National Renewable Energy

38 CFR 21.3131 - Rates-educational assistance allowance-38 U.S.C. chapter 35.

Code of Federal Regulations, 2010 CFR

2010-07-01

... DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Survivors' and Dependents... June 30, 2004, and before October 1, 2004: Type of course Monthly rate Institutional: Full time $788.00... September 30, 2004, and before October 1, 2005: Type of course Monthly rate Institutional: Full time $803.00...

Success with voice recognition.

PubMed

Sferrella, Sheila M

2003-01-01

You need a compelling reason to implement voice recognition technology. At my institution, the compelling reason was a turnaround time for Radiology results of more than two days. Only 41 percent of our reports were transcribed and signed within 24 hours. In November 1998, a team from Lehigh Valley Hospital went to RSNA and reviewed every voice system on the market. The evaluation was done with the radiologist workflow in mind, and we came back from the meeting with the vendor selection completed. The next steps included developing a business plan, approval of funds, reference calls to more than 15 sites and contract negotiation, all of which took about six months. The department of Radiology at Lehigh Valley Hospital and Health Network (LVHHN) is a multi-site center that performs over 360,000 procedures annually. The department handles all modalities of radiology: general diagnosis, neuroradiology, ultrasound, CT Scan, MRI, interventional radiology, arthography, myelography, bone densitometry, nuclear medicine, PET imaging, vascular lab and other advanced procedures. The department consists of 200 FTEs and a medical staff of more than 40 radiologists. The budget is in the $10.3 million range. There are three hospital sites and four outpatient imaging center sites where services are provided. At Lehigh Valley Hospital, radiologists are not dedicated to one subspecialty, so implementing a voice system by modality was not an option. Because transcription was so far behind, we needed to eliminate that part of the process. As a result, we decided to deploy the system all at once and with the radiologists as editors. The planning and testing phase took about four months, and the implementation took two weeks. We deployed over 40 workstations and trained close to 50 physicians. The radiologists brought in an extra radiologist from our group for the two weeks of training. That allowed us to train without taking a radiologist out of the department. We trained three to six radiologists a day. I projected a savings of 5.0 FTEs over two years. The actual savings were 8.0 FTEs within three weeks for the first phase and an additional 4.3 FTEs within two weeks of the second phase. The transcription staff was retained to perform other types of transcription and not displaced. The goal was to reduce Medical Records' outsourcing expenses by $670,000 over three years. The actual savings are in excess of $900,000. The proposed payback period was 17 months, and the actual was less than 12 months. For two years prior to implementing the voice system, the turnaround time at Lehigh Valley was 41 percent within 24 hours. One week after implementation, the turnaround time was 78 percent within 24 hours. Today it ranges between 85 percent and 92 percent. Overall, the radiologists at Lehigh Valley Hospital did an excellent job with the cultural change to voice recognition. It has made a major impact on our ability to get reports to physicians in a timely manner so they can make treatment decisions.

3 CFR 8703 - Proclamation 8703 of September 1, 2011. National Ovarian Cancer Awareness Month, 2011

Code of Federal Regulations, 2012 CFR

2012-01-01

... the Federal Government, from the National Institutes of Health to the Department of Defense, have... women to learn about risk factors, including family history, and to discuss possible symptoms, including... Disease Control and Prevention and the Department of Health and Human Services have started a campaign to...

Computing Services Planning, Downsizing, and Organization at the University of Alberta.

ERIC Educational Resources Information Center

Beltrametti, Monica

1993-01-01

In a six-month period, the University of Alberta (Canada) campus computing services department formulated a strategic plan, and downsized and reorganized to meet financial constraints and respond to changing technology, especially distributed computing. The new department is organized to react more effectively to trends in technology and user…

Snakes. A Conservation Education Program of the Department of Fish and Wildlife Resources.

ERIC Educational Resources Information Center

Hubbard, Kelly; Theiss, Nancy S.

The Kentucky Department of Fish and Wildlife Resources is charged with the responsibility to preserve, protect, and perpetuate the fish and wildlife in Kentucky. Involved in this broad program are a number of services, including the Wildlife Conservation Education Program. During the months of September through April, Conservation Club leaders…

Validation of the clinical dehydration scale for children with acute gastroenteritis.

PubMed

Goldman, Ran D; Friedman, Jeremy N; Parkin, Patricia C

2008-09-01

We previously created a clinical dehydration scale. Our objective was to validate the clinical dehydration scale with a new cohort of patients with acute gastroenteritis who were assessed in a tertiary emergency department in a developed country. A prospective observational study was performed in an emergency department at a large pediatric tertiary center in Canada. Children 1 month to 5 years of age with symptoms of acute gastroenteritis who were assessed in the emergency department were enrolled consecutively during a 4-month period. The main outcome measures were length of stay, proportion of children receiving intravenous fluid rehydration, and proportions of children with abnormal serum pH values or bicarbonate levels. A total of 205 children were enrolled, with a mean age of 22.4 +/- 14.9 months; 103 (50%) were male. The distribution of severity categories was as follows: no dehydration (score of 0), n = 117 (57%); some dehydration (score of 1-4), n = 83 (41%); moderate/severe dehydration (score of 5-8), n = 5 (2%). The 3 dehydration categories were significantly different with respect to the validation hypotheses (length of stay, mean +/- SD: none, 245 +/- 181 minutes; some, 397 +/- 302 minutes; moderate/severe, 501 +/- 389 minutes; treatment with intravenous fluids: none, n =17, 15%; some, n = 41, 49%; moderate/severe, n = 4, 80%; number of vomiting episodes in the 7 days before the emergency department visit: none, 8.4 +/- 7.7 episodes; some, 13 +/- 10.7 episodes; moderate/severe, 30.2 +/- 14.8 episodes). The clinical dehydration scale and the 3 severity categories were valid for a prospectively enrolled cohort of patients who were assessed in our tertiary emergency department. The scoring system was valuable in predicting a longer length of stay and the need for intravenous fluid rehydration for children with symptoms of acute gastroenteritis.

45 CFR 4.3 - Process against Department officials in their individual capacities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ADMINISTRATION SERVICE OF PROCESS § 4.3 Process against Department officials in their individual capacities... with the requirements for service of process on individuals who are not governmental officials. The... 45 Public Welfare 1 2010-10-01 2010-10-01 false Process against Department officials in their...

Emergency department attendance by patients with cancer in the last month of life: a systematic review and meta-analysis.

PubMed

Henson, Lesley; Gao, Wei; Higginson, Irene; Smith, Melinda; Davies, Joanna; Ellis-Smith, Clare; Daveson, Barbara

2015-02-26

Emergency department visits towards the end of life by people with cancer are increasing over time. This increase has occurred despite evidence of an association with poor patient outcomes, the majority of patients preferring home-based care, and significant overcrowding and capacity concerns for many emergency departments. We aimed to explore factors associated with emergency department attendance by cancer patients in the last month of life. We searched Medline, Embase, CINAHL, PsychINFO, and the Cochrane Library from inception to February, 2014, for studies investigating emergency department attendances by adult cancer patients (≥18 years) towards the end of life. No time or language limitations were applied. We performed meta-analysis of factors using a random-effects model, with results expressed as odds ratios (OR) for emergency department attendance. Sensitivity analysis explored heterogeneity. 30 studies were identified, reporting three demographic, five clinical, and 13 environmental factors; they included data from five countries and 1 181 842 patients. An increased likelihood of emergency department attendance was found for men versus women (OR 1·24, 95% CI 1·19-1·29), black versus white race (1·45, 1·40-1·50), patients with lung cancer versus other cancers (1·17, 1·10-1·23), and those of lowest versus highest socioeconomic status (1·15, 1·10-1·19). Patients receiving palliative care were less likely than those not receiving palliative care to attend the emergency department in the last month of life (OR 0·43, 95% CI 0·36-0·51). We have identified demographic (men, black race), clinical (lung cancer), and environmental (low socioeconomic status, no palliative care) factors associated with an increased risk of emergency department attendance. These findings could be used to develop screening interventions and assist policy makers in directing limited resources. Future studies should also investigate previously neglected areas of research, including psychosocial factors, and the emergency care preferences of patients and caregivers. LH is a PhD clinical training fellow and funded through project BuildCARE which is supported by Cicely Saunders International and The Atlantic Philanthropies, and led by King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, UK. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Maintenance of exclusive breastfeeding after three months postpartum: An experience in a health department of a Valencian Community].

PubMed

Vila-Candel, Rafael; Soriano-Vidal, Francisco J; Murillo-Llorente, Mayte; Pérez-Bermejo, Marcelino; Castro-Sánchez, Enrique

2018-02-14

To investigate the prevalence of EBF at 3-months postpartum, and the early factors for discontinuation. Observational, retrospective study. Health department of La Ribera, Valencia, Spain. Newborns between December 2012 to January 2017. Pregnant women were interviewed at postpartum and at 3 months regarding variables associated with breastfeeding initiation and continuation, matched with socio-demographic and obstetric-neonatal information. Prevalence of breastfeeding at discharge and exclusive breastfeeding at 3 months. Reasons for interrupt exclusive breastfeeding. Chi-square determination between qualitative variables. One thousand three hundred and thirty-eighth women were recruited. EBF at discharge was 68.2% (913) and at 3 months 46.7% (625). EBF duration was 68.7±32.7 days (95% CI: 66.9-71.2). We found statistically significant differences between the type of breastfeeding and the variables, year of study, country of origin and parity (P<0.001, P=0.005 and P=0.05 respectively). Hypogalactia (21.8%) and lower than recommended increase in newborn weight gain (14.9%) were most frequent factors for discontinuation. The prevalence of EBF at 3 months is low compared to other similar studies, although we see an upward trend. Belief in hypogalactia influenced the maintenance of exclusive breastfeeding. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Introducing quality improvement methods into local public health departments: structured evaluation of a statewide pilot project.

PubMed

Riley, William; Parsons, Helen; McCoy, Kim; Burns, Debra; Anderson, Donna; Lee, Suhna; Sainfort, François

2009-10-01

To test the feasibility and assess the preliminary impact of a unique statewide quality improvement (QI) training program designed for public health departments. One hundred and ninety-five public health employees/managers from 38 local health departments throughout Minnesota were selected to participate in a newly developed QI training program and 65 of those engaged in and completed eight expert-supported QI projects over a period of 10 months from June 2007 through March 2008. As part of the Minnesota Quality Improvement Initiative, a structured distance education QI training program was designed and deployed in a first large-scale pilot. To evaluate the preliminary impact of the program, a mixed-method evaluation design was used based on four dimensions: learner reaction, knowledge, intention to apply, and preliminary outcomes. Subjective ratings of three dimensions of training quality were collected from participants after each of the scheduled learning sessions. Pre- and post-QI project surveys were administered to collect participant reactions, knowledge, future intention to apply learning, and perceived outcomes. Monthly and final QI project reports were collected to further inform success and preliminary outcomes of the projects. The participants reported (1) high levels of satisfaction with the training sessions, (2) increased perception of the relevance of the QI techniques, (3) increased perceived knowledge of all specific QI methods and techniques, (4) increased confidence in applying QI techniques on future projects, (5) increased intention to apply techniques on future QI projects, and (6) high perceived success of, and satisfaction with, the projects. Finally, preliminary outcomes data show moderate to large improvements in quality and/or efficiency for six out of eight projects. QI methods and techniques can be successfully implemented in local public health agencies on a statewide basis using the collaborative model through distance training and expert facilitation. This unique training can improve both core and support processes and lead to favorable staff reactions, increased knowledge, and improved health outcomes. The program can be further improved and deployed and holds great promise to facilitate the successful dissemination of proven QI methods throughout local public health departments.

Understanding practice: the factors that influence management of mild traumatic brain injury in the emergency department--a qualitative study using the Theoretical Domains Framework.

PubMed

Tavender, Emma J; Bosch, Marije; Gruen, Russell L; Green, Sally E; Knott, Jonathan; Francis, Jill J; Michie, Susan; O'Connor, Denise A

2014-01-13

Mild traumatic brain injury is a frequent cause of presentation to emergency departments. Despite the availability of clinical practice guidelines in this area, there is variation in practice. One of the aims of the Neurotrauma Evidence Translation program is to develop and evaluate a targeted, theory- and evidence-informed intervention to improve the management of mild traumatic brain injury in Australian emergency departments. This study is the first step in the intervention development process and uses the Theoretical Domains Framework to explore the factors perceived to influence the uptake of four key evidence-based recommended practices for managing mild traumatic brain injury. Semi-structured interviews were conducted with emergency staff in the Australian state of Victoria. The interview guide was developed using the Theoretical Domains Framework to explore current practice and to identify the factors perceived to influence practice. Two researchers coded the interview transcripts using thematic content analysis. A total of 42 participants (9 Directors, 20 doctors and 13 nurses) were interviewed over a seven-month period. The results suggested that (i) the prospective assessment of post-traumatic amnesia was influenced by: knowledge; beliefs about consequences; environmental context and resources; skills; social/professional role and identity; and beliefs about capabilities; (ii) the use of guideline-developed criteria or decision rules to inform the appropriate use of a CT scan was influenced by: knowledge; beliefs about consequences; environmental context and resources; memory, attention and decision processes; beliefs about capabilities; social influences; skills and behavioral regulation; (iii) providing verbal and written patient information on discharge was influenced by: beliefs about consequences; environmental context and resources; memory, attention and decision processes; social/professional role and identity; and knowledge; (iv) the practice of providing brief, routine follow-up on discharge was influenced by: environmental context and resources; social/professional role and identity; knowledge; beliefs about consequences; and motivation and goals. Using the Theoretical Domains Framework, factors thought to influence the management of mild traumatic brain injury in the emergency department were identified. These factors present theoretically based targets for a future intervention.

The use of reverse logistics for waste management in a Brazilian grocery retailer.

PubMed

Dias, Karina T S; Braga Junior, Sergio S

2016-01-01

Retail growth is a result of the diversification of departments with the intention to look to consumer's needs and level of demand. Pressed by consumers and by the law, the adoption of environmental preservation practices is becoming stronger among grocery retailers. The objective of this research was to analyse the practices of reverse logistics performed by a retailer and measure the amount of waste generated by each department. To reach the proposed goal, a field research study was conducted to directly observe a grocery retailer in the state of Sao Paulo, Brazil, for a period of 6 months and monitor the amounts of cardboard and plastic discarded by each department. Using the Wuppertal method, the first result observed was that the retailer stopped its monthly production of approximately 20 tonne of biotic and abiotic material, which influence global warming and degradation of the ozone layer. Another result observed with the implementation of reverse logistics, was that the general grocery department mostly used cardboard and plastic. This sector includes products such as food cupboard, drinks, household, health and beauty, and pet articles. The fresh fruit and vegetable department and the meat, chicken and frozen department were increasingly using less plastic and cardboard packaging, increasing the use of returnable and durable packaging and thus promoting sustainability. © The Author(s) 2015.

The role of patient-held alert cards in promoting continuity of care for Heart Failure Patients.

PubMed

McBride, Anne; Burey, Lorraine; Megahed, Margo; Feldman, Carolyne; Deaton, Christi

2014-02-01

Patients with heart failure managed by community heart failure specialist nurses (CHFSNs) may have episodes of (often unrelated) ill-health managed separately in hospital. Inadequate communication and multi-disciplinary working between these different providers can impact on the effectiveness of care. This service improvement project explored the potential of patient-held alert cards to improve communication and continuity of care for heart failure patients moving between CHFSNs and hospital settings. Alert cards were distributed to 119 patients on a community case load for presentation at hospital or emergency department. Follow-up data were obtained from practitioners and patients at 12 months. At 12 months, 38 patients from the CHFSN caseload experienced 61 hospital admissions. CHFSNs were informed of 80% of admissions by practitioners (61%) and family members (38%). They were also informed of 59% of discharges. Notification of admission by hospital staff increased from zero in the previous 12 months, to 19 notifications. CHFSNs were more involved with hospital care, and patients reported increased confidence with the alert cards. The study has shown that alert cards can increase the involvement of CHFSNs in the ongoing care and discharge planning process. They can also empower patients and carers to take an active role in their own care.

Effectiveness of a transitional home care program in reducing acute hospital utilization: a quasi-experimental study.

PubMed

Low, Lian Leng; Vasanwala, Farhad Fakhrudin; Ng, Lee Beng; Chen, Cynthia; Lee, Kheng Hock; Tan, Shu Yun

2015-03-14

Improving healthcare utilization is essential as health systems around the world grapple with the escalating demands for acute hospital resources. Evidence suggests that transitional care programs are effective to improve utilization of healthcare. However, the evidence for transitional care programs that enhance the home medical care model and provide multi-disciplinary patient-centered care is not well established. We evaluated if a transitional home care program operated by the Singapore General Hospital was effective in reducing acute hospital utilization. We performed a quasi-experimental study using a pre-post design to evaluate the effectiveness of a transitional home care program in reducing hospital admissions and emergency department attendances of medically complex patients enrolled into the program in a tertiary hospital in Singapore. Patients received a comprehensive needs assessment performed by the physician and a nurse case manager in the home setting, followed by an individualized care plan that included medical and nursing care, patient education and coordination of care with hospital specialists and community services. Primary study outcomes were emergency department attendances and hospital admissions to all hospitals. These were extracted from hospital administrative data and national health records. Wilcoxon Signed Ranks Test was used for assess differences in pre and post continuous data. Overall, 262 patients were enrolled into the program and 259 were analyzed. Patients had a 51.6% and 52.8% reduction in hospital admissions in the three-month and six-month post enrollment, respectively. Similarly, a 47.1% and 48.2% reduction was observed for emergency department attendances in the three and six months post enrollment, respectively. The average difference in per patient hospital bed days in the pre- and post-enrollment periods were 12.05 days and 20.03 days at the 3-month and 6-month periods, respectively. Patients enrolled in the transitional home care program had significantly lower acute hospital utilization through the reduction of emergency department attendances and hospital admissions. A comprehensive assessment of patients' medical and social needs in the home setting and formulation of an individualized care plan optimized post-discharge care for medically complex patients.

Variation in participation in health care settings associated with race and ethnicity.

PubMed

Bliss, Erika B; Meyers, David S; Phillips, Robert L; Fryer, George E; Dovey, Susan M; Green, Larry A

2004-09-01

To use the ecology model of health care to contrast participation of black, non-Hispanics (blacks); white, non-Hispanics (whites); and Hispanics of any race (Hispanics) in 5 health care settings and determine whether disparities between those individuals exist among places where they receive care. 1996 Medical Expenditure Panel Survey data were used to estimate the number of black, white, and Hispanic people per 1,000 receiving health care in each setting. Physicians' offices, outpatient clinics, hospital emergency departments, hospitals, and people's homes. Number of people per 1,000 per month who had at least one contact in a health care setting. Fewer blacks and Hispanics than whites received care in physicians' offices (154 vs 155 vs 244 per 1,000 per month, respectively) and outpatient clinics (15 vs 12 vs 24 per 1,000 per month, respectively). There were no significant differences in proportions hospitalized or receiving care in emergency departments. Fewer Hispanics than blacks or whites received home health care services (7 vs 14 vs 14 per 1,000 per month, respectively). After controlling for 7 variables, blacks and Hispanics were less likely than whites to receive care in physicians' offices (odds ratio [OR], 0.65, 95% confidence interval [CI], 0.60 to 0.69 for blacks and OR, 0.79, 95% CI, 0.73 to 0.85 for Hispanics), outpatient clinics (OR, 0.73, 95% CI, 0.60 to 0.90 for blacks and OR, 0.71, 95% CI, 0.58 to 0.88 for Hispanics), and hospital emergency departments (OR, 0.80, 95% CI, 0.69 to 0.94 for blacks and OR, 0.80, 95% CI, 0.68 to 0.93 for Hispanics) in a typical month. The groups did not differ in the likelihood of receiving care in the hospital or at home. Fewer blacks and Hispanics than whites received health care in physicians' offices, outpatient clinics, and emergency departments in contrast to hospitals and home care. Research and programs aimed at reducing disparities in receipt of care specifically in the outpatient setting may have an important role in the quest to reduce racial and ethnic disparities in health.

Prophylaxis of Venous Thromboembolism in Geriatric Settings: A Cluster-Randomized Multicomponent Interventional Trial.

PubMed

Rwabihama, Jean Paul; Audureau, Etienne; Laurent, Marie; Rakotoarisoa, Lalaina; Jegou, Marc; Saddedine, Sofiane; Krypciak, Sébastien; Herbaud, Stéphane; Benzengli, Hind; Segaux, Lauriane; Guery, Esther; Ambime, Gabin; Rabus, Marie-Thérèse; Perilliat, Jean-Guy; David, Jean-Philippe; Paillaud, Elena

2018-06-01

To evaluate the efficacy of an intervention on the practice of venous thromboembolism prevention. A multicenter, prospective, controlled, cluster-randomized, multifaceted intervention trial consisting of educational lectures, posters, and pocket cards reminding physicians of the guidelines for thromboprophylaxis use. Twelve geriatric departments with 1861 beds total, of which 202, 803, and 856 in acute care, post-acute care, and long-term care wards, respectively. Patients hospitalized between January 1 and May 31, 2015, in participating departments. The primary endpoint was the overall adequacy of thromboprophylaxis prescription at the patient level, defined as a composite endpoint consisting of indication, regimen, and duration of treatment. Geriatric departments were divided into an intervention group (6 departments) and control group (6 departments). The preintervention period was 1 month to provide baseline practice levels, the intervention period 2 months, and the postintervention period 1 month in acute care and post-acute care wards or 2 months in long-term care wards. Multivariable regression was used to analyze factors associated with the composite outcome. We included 2962 patients (1426 preintervention and 1536 postintervention), with median age 85 [79;90] years. For the overall 18.9% rate of inadequate thromboprophylaxis, 11.1% was attributable to underuse and 7.9% overuse. Intervention effects were more apparent in post-acute and long-term care wards although not significantly [odds ratio 1.44 (95% confidence interval 0.78;2.66), P = .241; and 1.44 (0.68, 3.06), P = .345]. Adequacy rates significantly improved in the postintervention period for the intervention group overall (from 78.9% to 83.4%; P = .027) and in post-acute care (from 75.4% to 86.3%; P = .004) and long-term care (from 87.0% to 91.7%; P = .050) wards, with no significant trend observed in the control group. This study failed to demonstrate improvement in prophylaxis adequacy with our intervention. However, the intervention seemed to improve practices in post-acute and long-term care but not acute care wards. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Risk management of emergency service vehicle crashes in the United States fire service: process, outputs, and recommendations.

PubMed

Bui, David P; Pollack Porter, Keshia; Griffin, Stephanie; French, Dustin D; Jung, Alesia M; Crothers, Stephen; Burgess, Jefferey L

2017-11-17

Emergency service vehicle crashes (ESVCs) are a leading cause of death in the United States fire service. Risk management (RM) is a proactive process for identifying occupational risks and reducing hazards and unwanted events through an iterative process of scoping hazards, risk assessment, and implementing controls. We describe the process, outputs, and lessons learned from the application of a proactive RM process to reduce ESVCs in US fire departments. Three fire departments representative of urban, suburban, and rural geographies, participated in a facilitated RM process delivered through focus groups and stakeholder discussion. Crash reports from department databases were reviewed to characterize the context, circumstances, hazards and risks of ESVCs. Identified risks were ranked using a risk matrix that considered risk likelihood and severity. Department-specific control measures were selected based on group consensus. Interviews, and focus groups were used to assess acceptability and utility of the RM process and perceived facilitators and barriers of implementation. Three to six RM meetings were conducted at each fire department. There were 7.4 crashes per 100 personnel in the urban department and 10.5 per 100 personnel in the suburban department; the rural department experienced zero crashes. All departments identified emergency response, backing, on scene struck by, driver distraction, vehicle/road visibility, and driver training as high or medium concerns. Additional high priority risks varied by department; the urban department prioritized turning and rear ending crashes; the suburban firefighters prioritized inclement weather/road environment and low visibility related crashes; and the rural volunteer fire department prioritized exiting station, vehicle failure, and inclement weather/road environment related incidents. Selected controls included new policies and standard operating procedures to reduce emergency response, cameras to enhance driver visibility while backing, and increased training frequency and enhanced training. The RM process was generally acceptable to department participants and considered useful. All departments reported that the focused and systematic analysis of crashes was particularly helpful. Implementation of controls was a commonly cited challenge. Proactive RM of ESVCs in three US fire departments was positively received and supported the establishment of interventions tailored to each department's needs and priorities.

Digitizing dissertations for an institutional repository: a process and cost analysis.

PubMed

Piorun, Mary; Palmer, Lisa A

2008-07-01

This paper describes the Lamar Soutter Library's process and costs associated with digitizing 300 doctoral dissertations for a newly implemented institutional repository at the University of Massachusetts Medical School. Project tasks included identifying metadata elements, obtaining and tracking permissions, converting the dissertations to an electronic format, and coordinating workflow between library departments. Each dissertation was scanned, reviewed for quality control, enhanced with a table of contents, processed through an optical character recognition function, and added to the institutional repository. Three hundred and twenty dissertations were digitized and added to the repository for a cost of $23,562, or $0.28 per page. Seventy-four percent of the authors who were contacted (n = 282) granted permission to digitize their dissertations. Processing time per title was 170 minutes, for a total processing time of 906 hours. In the first 17 months, full-text dissertations in the collection were downloaded 17,555 times. Locally digitizing dissertations or other scholarly works for inclusion in institutional repositories can be cost effective, especially if small, defined projects are chosen. A successful project serves as an excellent recruitment strategy for the institutional repository and helps libraries build new relationships. Challenges include workflow, cost, policy development, and copyright permissions.

Accuracy of immunization histories provided by adults accompanying preschool children to a pediatric emergency department.

PubMed

Goldstein, K P; Kviz, F J; Daum, R S

1993-11-10

Because some have advocated the use of emergency departments to administer delayed childhood immunizations, we evaluated the accuracy of immunization histories obtained in this setting by comparison with medical records of inner-city health care facilities. Questionnaires were orally administered to adults accompanying children to the emergency department. Individual medical records were reviewed. Pediatric emergency department at Wyler Children's Hospital, University of Chicago and 68 inner-city primary care clinics. Children aged 3 to 65 months registering for medical care. Of the sample, 98% were African American; 75% were Medicaid recipients. Adults' knowledge of immunization histories, immunization cards, and medical records compared with American Academy of Pediatrics/Immunization Practices Advisory Committee recommendations. Of the accompanying adults, 64% stated that their child's general immunization status was "up-to-date"; 65% of these had clinic records confirming that status. Only 8% of specific regimens stated by these adults accurately matched those found in clinic records. Moreover, 45% of adults accompanying children at least 16 months and older provided inaccurate information regarding previous receipt of measles immunization. Information provided by accompanying adults (from recall or from immunization cards) is inadequate to determine accurately which preschoolers in the pediatric emergency department are delayed in immunizations.

Impact of the Illinois Seat Belt Use Law on Accidents, Deaths, and Injuries.

ERIC Educational Resources Information Center

Rock, Steven M.

1992-01-01

The impact of the 1985 Illinois seat belt law is explored using Box-Jenkins Auto-Regressive, Integrated Moving Averages (ARIMA) techniques and monthly accident statistical data from the state department of transportation for January-July 1990. A conservative estimate is that the law provides benefits of $15 million per month in Illinois. (SLD)

Celebrating CTE Month 2008: ACTE Tours McKinley Technical High School

ERIC Educational Resources Information Center

Kidwai, Sabrina

2008-01-01

A delegation of visitors descended on McKinley Technical High School in Washington, D.C., on February 19 for Career and Technical Education (CTE) Month. ACTE staff, several congressional staffers, staff from SkillsUSA, FCCLA and the District of Columbia Department of Career and Technical Education visited the school--a public charter which offers…

28 CFR 79.44 - Proof of working level month exposure to radiation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... radiation. 79.44 Section 79.44 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS UNDER THE RADIATION EXPOSURE COMPENSATION ACT Eligibility Criteria for Claims by Uranium Miners § 79.44 Proof of working level month exposure to radiation. (a) If one or more of the sources in § 79.43(a) contain a...

Buen Comienzo, Buen Futuro: El Bebe de Cinco Meses (Healthy Start, Grow Smart: Your Five-Month Old).

ERIC Educational Resources Information Center

Department of Agriculture, Washington, DC.

Distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, this Spanish-language pamphlet provides parents with information and advice about their infants in the fifth month of life. Following a brief description of developmental characteristics at this age, the pamphlet offers information on topics including…

46 CFR 12.409 - General requirements for lifeboatman-limited endorsements.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., except on a seagoing barge and on a tank barge navigating waters other than rivers and/or canals. (b... following sea service requirements: (i) At least 12 months of sea service in any department of vessels on ocean, coastwise, inland, and Great Lakes routes. (ii) At least 6 months of sea service in any...

Federal Student Loans: Better Oversight Could Improve Defaulted Loan Rehabilitation. Report to Congressional Requesters. GAO-14-256

ERIC Educational Resources Information Center

Emrey-Arras, Melissa

2014-01-01

The Department of Education (Education) relies on collection agencies to assist borrowers in rehabilitating defaulted student loans, which allows borrowers who make nine on-time monthly payments within 10 months to have the default removed from their credit reports. Education works with 22 collection agencies to locate borrowers and explain…

An application of business process method to the clinical efficiency of hospital.

PubMed

Leu, Jun-Der; Huang, Yu-Tsung

2011-06-01

The concept of Total Quality Management (TQM) has come to be applied in healthcare over the last few years. The process management category in the Baldrige Health Care Criteria for Performance Excellence model is designed to evaluate the quality of medical services. However, a systematic approach for implementation support is necessary to achieve excellence in the healthcare business process. The Architecture of Integrated Information Systems (ARIS) is a business process architecture developed by IDS Scheer AG and has been applied in a variety of industrial application. It starts with a business strategy to identify the core and support processes, and encompasses the whole life-cycle range, from business process design to information system deployment, which is compatible with the concept of healthcare performance excellence criteria. In this research, we apply the basic ARIS framework to optimize the clinical processes of an emergency department in a mid-size hospital with 300 clinical beds while considering the characteristics of the healthcare organization. Implementation of the case is described, and 16 months of clinical data are then collected, which are used to study the performance and feasibility of the method. The experience gleaned in this case study can be used a reference for mid-size hospitals with similar business models.

Emergency department presentation and readmission after index psychiatric admission: a data linkage study

PubMed Central

Li, Xue; Srasuebkul, Preeyaporn; Reppermund, Simone

2018-01-01

Objective To use linked administrative datasets to assess factors associated with emergency department (ED) presentation and psychiatric readmission in three distinctive time intervals after the index psychiatric admission. Design A retrospective data-linkage study. Setting Cohort study using four linked government minimum datasets including acute hospital care from July 2005 to June 2012 in New South Wales, Australia. Participants People who were alive and aged ≥18 years on 1 July 2005 and who had their index admission to a psychiatric ward from 1 July 2007 to 30 June 2010. Outcome measures ORs of factors associated with psychiatric admission and ED presentation were calculated for three intervals: 0–1 month, 2–5 months and 6–24 months after index separation. Results Index admission was identified in 35 056 individuals (51% -males) with a median age of 42 years. A total of 12 826 (37%) individuals had at least one ED presentation in the 24 months after index admission. Of those, 3608 (28%) presented within 0–1 month, 6350 (50%) within 2–5 months and 10 294 (80%) within 6–24 months after index admission. A total of 14 153 (40%) individuals had at least one psychiatric readmission in the first 24 months. Of those, 6808 (48%) were admitted within 0–1 month, 6433 (45%) within 2–5 months and 7649 (54%) within 6–24 months after index admission. Principal diagnoses and length of stay at index admission, sociodemographic factors, Charlson Comorbidity Index score, drug and alcohol comorbidity, intellectual disability and other inpatient service use were significantly associated with ED presentations and psychiatric readmissions, and these relationships varied somewhat over the intervals studied. Conclusion Social determinants of service use, drug and alcohol intervention, addressing needs of individuals with intellectual disability and recovery-oriented whole-person approaches at index admission are key areas for investment to improve trajectories after index admission. PMID:29490956

U.S. Department of Education, Office of Inspector General Semiannual Report to Congress, October 1, 1997-March 31, 1998.

ERIC Educational Resources Information Center

Office of Inspector General (ED), Washington, DC.

During the 6-month period ending March 31, 1998, the Office of Inspector General assisted the Department of Education in ensuring that taxpayer-funded federal education programs and operations are implemented efficiency, effectiveness, integrity and accountability. In the executive summary, under "Goal 1: Programs and Operations…

Suspended Education Department Official Had Approved Waiver for Former Employer

ERIC Educational Resources Information Center

Basken, Paul

2007-01-01

Matteo Fontana, the student-aid official in the U.S. Department of Education who was suspended last month in an ethics case, issued a controversial high-stakes legal ruling in 2004 that benefited his former employer, Sallie Mae, on the day before the nation's top student lender completed its transition from a government-founded lender into a…

Fund honors Jule G. Charney

NASA Astrophysics Data System (ADS)

The Department of Meteorology and Physical Oceanography at the Massachusetts Institute of Technology has established a fund in honor of the late Jule G. Charney. Charney died in Boston last month (Eos, July 7). Income from the fund will be awarded to meritorious students for graduate study in the department. The awards will be known as the Jule G. Charney Awards.

Report to the Legislature: Department of Elementary and Secondary Education Strategic Plan. Line Item 7010-0005

ERIC Educational Resources Information Center

Massachusetts Department of Elementary and Secondary Education, 2008

2008-01-01

This paper presents the "Report to the Legislature: Department of Elementary and Secondary Education Strategic Plan". This was a year of transition in public education. After former commissioner David Driscoll retired in August 2007, Deputy Commissioner Jeffrey Nellhaus filled in as acting commissioner for nearly nine months until newly…

Education Department to Push for Major Changes in Accreditation

ERIC Educational Resources Information Center

Basken, Paul

2007-01-01

The U.S. Department of Education, overriding opposition from colleges and accreditors, is pushing ahead with a plan to remake American higher education by requiring that colleges show results if they want to remain eligible for more than $90-billion in federal student aid. At the end of a three-day session last month, representatives of colleges…

Getting People Back to Work

ERIC Educational Resources Information Center

White, Frances L.

2003-01-01

Getting people back to work has become a national concern. The nation's economy lost jobs as of July 2003 for six months in a row, dealing another blow to a slow reviving labor market. According to the Labor Department, 486,000 jobs disappeared from the economy. And, the Employment Development Department in California reported a decline of 21,800…

[Resting-state functional magnetic resonance study of brain function changes after TIPS operation in patients with liver cirrhosis].

PubMed

Liu, C; Wang, H B; Yu, Y Q; Wang, M Q; Zhang, G B; Xu, L Y; Wu, J M

2016-12-20

Objective: To investigate the brain function changes in cirrhosis patients after transjugular intrahepatic portosystemic shunt (TIPS), resting-state functional MRI (rs-fMRI) performed and fractional amplitude of low frequency fluctuation (fALFF) was analyzed. Methods: From January 2014 to February 2016, a total of 96 cirrhotic patients from invasive technology department and infection department in the First Affiliated Hospital of Anhui Medical University were selected , the blood ammonia data of 96 cirrhotic patients with TIPS operation in four groups were collected after 1, 3, 6 and 12 month, and all subjects performed rs-fMRI scans. The rs-fMRI data processed with DPARSF and SPM12 softwares, whole-brain fALFF values were calculated, and One-Way analysis of variance , multiple comparison analysis and correlation analysis were performed. Results: There were brain regions with significant function changes in four groups patients with TIPS operation after 1, 3, 6 and 12 month, including bilateral superior temporal gyrus, right middle temportal gyrus , right hippocampus, right island of inferior frontal gyrus, left fusiform gyrus, left olfactory cortex, left orbital superior frontal gyrus (all P <0.005). Multiple comparison analysis showed that compared with patients in the 1-month follow-up, patients in the 3-month follow-up showed that brain function areas increased in left olfactory cortex, left inferior temporal gyrus, left fusiform gyrus, left orbital middle frontal gyrus, left putamen, left cerebelum, and decreased in left lingual gyrus; patients in the 6-month follow-up showed that brain function areas increased in left middle temportal gyrus, right supramarginal gyrus, right temporal pole, right central operculum, and decreased in left top edge of angular gyrus, left postcentral gyrus; patients in the 12-month follow-up showed that brain function areas increased in right hippocampus, right middle cingulate gyrus, and decreased in right middle temportal gyrus.Compared with patients in the 3-month follow-up, patients in the 6-month follow-up showed that brain function areas increased in left superior temporal gyrus, left middle temporal gyrus, right temporal pole, right island of inferior frontal gyrus, and decreased in left cerebelum, left orbital inferior frontal gyrus; patients in the 12-month follow-up showed that there were no obvious increase and decrease brain function areas.Compared with patients in the 6-month follow-up, patients in the 12-month follow-up showed that there were no obvious increase brain function areas , but brain function areas decreased in bilateral middle temportal gyrus( P <0.001). Brain regions were positively related to blood ammonia in right middle cingulate gyrus, right central operculum, left parahippocampal gyrus, while as brain regions were negatively related to blood ammonia in bilateral medial prefrontal lobe, anterior cingulate and paracingulate gyrus, right top edge of angular gyrus, right middle temportal gyrus, left anterior central gyrus, left posterior central gyrus (all P <0.005). Conclusion: The resting state brain function increased or decreased with course of disease in cirrhosis patients after TIPS operation. The brain activity of limbic system and sensorimotor system all had significant correlation with blood ammonia levels. The blood ammonia level and the function of relative brain regions after 6-month with TIPS operation can be gradually improved.

The Future Role of the Department of Defense in Protecting and Defending America’s Economy in Cyberspace

DTIC Science & Technology

2014-12-12

hold. The retail giant installed a FireEye computer security system that completed a month long testing phase in May 2013. The system was designed ...agencies. Through the Untied States Cyber Command, the Department of Defense has capability that can be used to defend America. This reseach paper looks... reseach paper looks at the roles and responsibilities of the Department of Defense as it relates to Homeland Defense and the protection of credit

Removing mystique of the monitoring report.

PubMed

Durbin, Jack

2008-01-01

This article provides a clearer understanding of how to use the monitoring report, a monthly statement of how the department is performing compared to the budget, to move the department forward. Critical items discussed in relation to the report include revenue, salaries, benefits, supplies, services, utilities, leases and rentals, and depreciation. Data in the report tells a story of what is happening in the department and it guides the reviewer to key areas in resolving discrepancies between what has been budgeted and what is actually occurring.

Applying Lean: Implementation of a Rapid Triage and Treatment System

PubMed Central

Murrell, Karen L.; Offerman, Steven R.; Kauffman, Mark B.

2011-01-01

Objective: Emergency department (ED) crowding creates issues with patient satisfaction, long wait times and leaving the ED without being seen by a doctor (LWBS). Our objective was to evaluate how applying Lean principles to develop a Rapid Triage and Treatment (RTT) system affected ED metrics in our community hospital. Methods: Using Lean principles, we made ED process improvements that led to the RTT system. Using this system, patients undergo a rapid triage with low-acuity patients seen and treated by a physician in the triage area. No changes in staffing, physical space or hospital resources occurred during the study period. We then performed a retrospective, observational study comparing hospital electronic medical record data six months before and six months after implementation of the RTT system. Results: ED census was 30,981 in the six months prior to RTT and 33,926 after. Ambulance arrivals, ED patient acuity and hospital admission rates were unchanged throughout the study periods. Mean ED length of stay was longer in the period before RTT (4.2 hours, 95% confidence interval [CI] = 4.2–4.3; standard deviation [SD] = 3.9) than after (3.6 hours, 95% CI = 3.6–3.7; SD = 3.7). Mean ED arrival to physician start time was 62.2 minutes (95% CI = 61.5–63.0; SD = 58.9) prior to RTT and 41.9 minutes (95% CI = 41.5–42.4; SD = 30.9) after. The LWBS rate for the six months prior to RTT was 4.5% (95% CI = 3.1–5.5) and 1.5% (95% CI = 0.6–1.8) after RTT initiation. Conclusion: Our experience shows that changes in ED processes using Lean thinking and available resources can improve efficiency. In this community hospital ED, use of an RTT system decreased patient wait times and LWBS rates. PMID:21691524

Strategies for improving outcomes in the acute management of ischemic stroke in rural emergency departments: a quality improvement initiative in the Stroke Belt.

PubMed

Jauch, Edward C; Huang, David Y; Gardner, Allison J; Blum, Julie L

2018-01-01

The timely evaluation and initiation of treatment for acute ischemic stroke (AIS) is critical to optimal patient outcomes. However, clinical practice often falls short of guideline-established goals. Hospitals in rural regions of the USA, and notably those in the Stroke Belt, are particularly challenged to meet timing goals since the vast majority of primary stroke centers (PSCs) are concentrated in urban academic institutions. Between May 2015 and May 2017, emergency department (ED) teams from 5 non-PSC hospitals in the Stroke Belt participated in a quality improvement (QI) initiative. The intervention included a baseline practice assessment survey, repeat audit-and-feedback cycles with patient data on AIS treatment timing, personalized Continuing Medical Education/Continuing Education-certified grand rounds sessions at each participating site with expert study faculty, targeted reinforcement of best practices, and follow-up to evaluate the benefits and limitations of the intervention. At the start of the initiative, clinical staff from participating EDs overestimated the proportion of patients with AIS who received alteplase within the guideline-recommended 60-minute door-to-needle window at their facility. At the end of the 6-month intervention period, significantly more patients were treated with alteplase within 60 minutes of ED arrival compared to baseline across the entire sample (1.9% of patients at baseline vs. 5.2% at 6 months; P < 0.01). Similarly, there was a trend toward a decrease in the percentage of patients whose alteplase treatment was initiated more than 60 minutes after their arrival at the ED (67.3% at baseline vs. 22.2% at 6 months). Structured QI interventions that engage ED care teams to reflect on processes related to AIS diagnosis and treatment and deploy repeat audit-and-feedback cycles with real-time patient data have the potential to support an increase in the number of patients who receive alteplase within the guideline-recommended timeframe of 60 minutes from hospital arrival.

Application of time series analysis in modelling and forecasting emergency department visits in a medical centre in Southern Taiwan.

PubMed

Juang, Wang-Chuan; Huang, Sin-Jhih; Huang, Fong-Dee; Cheng, Pei-Wen; Wann, Shue-Ren

2017-12-01

Emergency department (ED) overcrowding is acknowledged as an increasingly important issue worldwide. Hospital managers are increasingly paying attention to ED crowding in order to provide higher quality medical services to patients. One of the crucial elements for a good management strategy is demand forecasting. Our study sought to construct an adequate model and to forecast monthly ED visits. We retrospectively gathered monthly ED visits from January 2009 to December 2016 to carry out a time series autoregressive integrated moving average (ARIMA) analysis. Initial development of the model was based on past ED visits from 2009 to 2016. A best-fit model was further employed to forecast the monthly data of ED visits for the next year (2016). Finally, we evaluated the predicted accuracy of the identified model with the mean absolute percentage error (MAPE). The software packages SAS/ETS V.9.4 and Office Excel 2016 were used for all statistical analyses. A series of statistical tests showed that six models, including ARIMA (0, 0, 1), ARIMA (1, 0, 0), ARIMA (1, 0, 1), ARIMA (2, 0, 1), ARIMA (3, 0, 1) and ARIMA (5, 0, 1), were candidate models. The model that gave the minimum Akaike information criterion and Schwartz Bayesian criterion and followed the assumptions of residual independence was selected as the adequate model. Finally, a suitable ARIMA (0, 0, 1) structure, yielding a MAPE of 8.91%, was identified and obtained as Visit t =7111.161+(a t +0.37462 a t -1). The ARIMA (0, 0, 1) model can be considered adequate for predicting future ED visits, and its forecast results can be used to aid decision-making processes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Paediatric emergency department-based carbon monoxide detector intervention: a randomised trial.

PubMed

McKenzie, Lara B; Roberts, Kristin J; Kaercher, Roxanne M; Collins, Christy L; Comstock, R Dawn; Fernandez, Soledad; Abdel-Rasoul, Mahmoud; Casavant, Marcel J; Mihalov, Leslie

2017-10-01

Although non-fire-related carbon monoxide (CO) poisoning is almost entirely preventable, over 400 people die and 20 000 people are injured each year in the USA from unintentional CO poisoning. Thus, there is a critical need for evidence-based interventions for preventing CO poisoning and increasing the proper use and installation of CO detectors. A randomised, controlled trial (Project CODE, a Carbon Monoxide Detector Education intervention) with 2-week and 6-month follow-up home observations was conducted in 299 parents of children aged ≤18 years recruited in the emergency department of a level 1 paediatric trauma centre. The intervention group received an educational tool, a spiral-bound, laminated booklet that resembled a CO detector containing theory-based safety messages based on the precaution adoption process model, a plug-in CO detector and 9 V battery. The control group received a one page flyer on CO poisoning prevention. Although the difference was not statistically significant, mean CO knowledge score increased at a greater rate for the intervention group than the control group. Intervention group parents were more likely to exhibit 'safe' CO detector use than control group parents at the 2-week follow-up (RR: 2.75; 95% CI 2.06 to 3.69) and 6-month follow-up (RR: 2.78; 95% CI 2.06 to 3.76), after adjusting for self-reported CO detector use behaviour at enrolment and annual per capita income. An emergency department-delivered intervention containing a theory-based educational tool paired with a CO detector can be an effective method for increasing knowledge about CO poisoning, for prevention and for appropriate use of a CO detector. NCT00959478. 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/.

The Monthly Cycle of Hypoglycemia: An Observational Claims-based Study of Emergency Room Visits, Hospital Admissions, and Costs in a Commercially Insured Population.

PubMed

Basu, Sanjay; Berkowitz, Seth A; Seligman, Hilary

2017-07-01

Multipayer initiatives have sought to address social determinants of health, such as food insecurity, by linking primary care patients to social services. It remains unclear whether such social determinants contribute to avoidable short-term health care costs. We sought to quantify costs and mitigating factors for the increased risk of hypoglycemia at the end of each month among low-income Americans, a phenomenon related to exhaustion of food budgets. We used claims data on 595,770 commercially insured American adults aged 19 through 64 years old from 2004 through 2015 to estimate the risks and costs of emergency room visits and inpatient hospitalizations for hypoglycemia during the last week of each month versus prior weeks. Although persons with household incomes greater than the national median did not experience a monthly cycle of hypoglycemia, those with incomes less than the national median had an odds ratio of 1.07 (95% confidence interval, 1.02-1.12; P=0.005) for emergency room visits or inpatient hospitalizations for hypoglycemia during the last week of each month, compared with earlier weeks. The risk of end-of-the-month hypoglycemia was mitigated to statistical insignificance during a period of increased federal nutrition program benefits from 2009 through 2013. Eliminating the monthly cycle of hypoglycemia among commercially insured nonelderly adults would be expected to avert $54.1 million per year (95% confidence interval, $0.8-$204.0) in emergency department and inpatient hospitalization costs. Addressing the end-of-the-month increase in hypoglycemia risk among lower-income populations may avert substantial costs from emergency department visits and inpatient hospitalizations.

Improving timeliness for acute asthma care for paediatric ED patients using a nurse driven intervention: an interrupted time series analysis.

PubMed

Brown, Kathleen; Iqbal, Sabah; Sun, Su-Lin; Fritzeen, Jennifer; Chamberlain, James; Mullan, Paul C

2016-01-01

Asthma is the most common chronic paediatric disease treated in the emergency department (ED). Rapid corticosteroid administration is associated with improved outcomes, but our busy ED setting has made it challenging to achieve this goal. Our primary aim was to decrease the time to corticosteroid administration in a large, academic paediatric ED. We conducted an interrupted time series analysis for moderate to severe asthma exacerbations of one to 18 year old patients. A multidisciplinary team designed the intervention of a bedside nurse initiated administration of oral dexamethasone, to replace the prior system of a physician initiated order for oral prednisone. Our baseline and intervention periods were 12 month intervals. Our primary process measure was the time to corticosteroid administration. Other process measures included ED length of stay, admission rate, and rate of emesis. The balance measures included rate of return visits to the ED or clinic within five days, as well as the proportion of discharged patients who were admitted within five days. No special cause variation occurred in the baseline period. The mean time to corticosteroid administration decreased significantly, from 98 minutes in the baseline period to 59 minutes in the intervention period (p < 0.01), and showed special cause variation improvement within two months after the intervention using statistical process control methodology. We sustained the improvement and demonstrated a stable process. The intervention period had a significantly lower admission rate (p<0.01) and emesis rate (p<0.01), with no unforeseen harm to patients found with any of our balance measures. In summary, the introduction of a nurse initiated, standardized protocol for corticosteroid therapy for asthma exacerbations in a paediatric ED was associated with decreased time to corticosteroid administration, admission rates, and post-corticosteroid emesis.

Quality improvement for patients with hip fracture: experience from a multi-site audit.

PubMed

Freeman, C; Todd, C; Camilleri-Ferrante, C; Laxton, C; Murrell, P; Palmer, C R; Parker, M; Payne, B; Rushton, N

2002-09-01

The first East Anglian audit of hip fracture was conducted in eight hospitals during 1992. There were significant differences between hospitals in 90-day mortality, development of pressure sores, median lengths of hospital stay, and in most other process measures. Only about half the survivors recovered their pre-fracture physical function. A marked decrease in physical function (for 31%) was associated with postoperative complications. A re-audit was conducted in 1997 as part of a process of continuing quality improvement. This was an interview and record based prospective audit of process and outcome of care with 3 month follow up. Seven hospitals with trauma orthopaedic departments took part in both audits. Results from the 1992 audit and indicator standards for re-audit were circulated to all orthopaedic consultants, care of the elderly consultants, and lead audit facilitators at each hospital. Processes likely to reduce postoperative complications and improve patient outcomes at 90 days. As this was a multi-site audit, the project group had no direct power to bring about changes within individual NHS hospital trusts. Significant increases were seen in pharmaceutical thromboembolic prophylaxis (from 45% to 81%) and early mobilisation (from 56% to 70%) between 1992 and 1997. There were reduced levels of pneumonia, wound infection, pressure sores, and fatal pulmonary embolism, but no change was recorded in 3 month functional outcomes or mortality. While some hospitals had made improvements in care by 1997, others were failing to maintain their level of good practice. This highlights the need for continuous quality improvement by repeating the audit cycle in order to reach and then improve standards. Rehabilitation and long term support to improve functional outcomes are key areas for future audit and research.

[Establishment of a trauma surgical department at the Diospi Suyana missionary hospital in Curahuasi, Peru].

PubMed

Boeker, T

2017-10-01

The confusingly structured and in many areas corrupt health system in Peru even today provides only a fragmentary and insufficient medical treatment especially for the indigenous population (mainly Quechua Indians). Since October 2007 the Diospi Suyana missionary hospital in Curahuasi (State of Apurímac) has provided an affordable medical treatment at a high level mainly for these indigenous people of Peru; however, so far the hospital could only insufficiently meet the traumatological needs of the region. The establishment of a surgical trauma department aims to meet those needs but is also encumbered by special problems and challenges. Some patients, for example only present at the hospital after the fractures have already incorrectly healed, sometimes many weeks or even months after the trauma either due to a long journey through the country to different hospitals where treatment was not possible or they could not pay for the treatment and sometimes because of inadequate prior treatment, for example by traditional healers. Cultural and infrastructural particularities of the country must be included in the process of choosing the right method of treatment.

Enhanced ABC costing for hospitals: directed expense costing.

PubMed

Ryan, J

1997-10-01

Space limitations do not allow a complete discussion of all the topics and many of the obvious questions that the preceding brief introduction to directed expense costing probably raised in the reader's mind. These include how errors in accounting practices like posting expenses to the wrong period are handled; and how the system automatically adjusts costs for expenses benefiting several periods but posted to the acquisition month. As was mentioned above, underlying this overtly simple costing method are a number of sophisticated and sometimes complex processes that are hidden from the normal user and designed to automatically protect the integrity and accuracy of the costing process. From a user's viewpoint, the system is straightforward, understandable, and easy to use and audit. From a software development perspective, it is not quite that effortless. By using a system that is understood by all users at all levels, these users can now communicate with each other in a new and effective way. This new communication channel only occurs after each user is satisfied as to the overall costing quality achieved by the process. However, not all managers or physicians are always happy that the institution is using this "understandable" cost accounting system. During one of the weekly meetings of a hospital's administrative council, complaints from several powerful department heads concerning the impact that the use of cost data was having on them were brought up for discussion. In defending the continued use of the system, one vice president stated to the group that cost accounting does not get any easier than this, or any less expensive, or any more accurate. The directed expense process works and works very well. Our department heads and physicians will have to come to grips with the accountably it provides us to assess their value to the hospital.

Predicting suicide with the SAD PERSONS scale.

PubMed

Katz, Cara; Randall, Jason R; Sareen, Jitender; Chateau, Dan; Walld, Randy; Leslie, William D; Wang, JianLi; Bolton, James M

2017-09-01

Suicide is a major public health issue, and a priority requirement is accurately identifying high-risk individuals. The SAD PERSONS suicide risk assessment scale is widely implemented in clinical settings despite limited supporting evidence. This article aims to determine the ability of the SAD PERSONS scale (SPS) to predict future suicide in the emergency department. Five thousand four hundred sixty-two consecutive adults were seen by psychiatry consultation teams in two tertiary emergency departments with linkage to population-based administrative data to determine suicide deaths within 6 months, 1, and 5 years. Seventy-seven (1.4%) individuals died by suicide during the study period. When predicting suicide at 12 months, medium- and high-risk scores on SPS had a sensitivity of 49% and a specificity of 60%; the positive and negative predictive values were 0.9 and 99%, respectively. Half of the suicides at both 6- and 12-month intervals were classified as low risk by SPS at index visit. The area under the curve at 12 months for the Modified SPS was 0.59 (95% confidence interval [CI] range 0.51-0.67). High-risk scores (compared to low risk) were significantly associated with death by suicide over the 5-year study period using the SPS (hazard ratio 2.49; 95% CI 1.34-4.61) and modified version (hazard ratio 2.29; 95% CI 1.24-2.29). Although widely used in educational and clinical settings, these findings do not support the use of the SPS and Modified SPS to predict suicide in adults seen by psychiatric services in the emergency department. © 2017 Wiley Periodicals, Inc.

Frontal Fibrosing Alopecia and Vitiligo: Coexistence or True Association?

PubMed

Katoulis, Alexandros C; Diamanti, Konstantina; Sgouros, Dimitrios; Liakou, Aikaterini I; Alevizou, Antigoni; Bozi, Evangelia; Damaskou, Vasileia; Panayiotides, Ioannis; Rigopoulos, Dimitrios

2017-01-01

Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia characterized by a progressive band-like recession of the frontotemporal hairline and frequent loss of the eyebrows. It predominantly affects postmenopausal women. Coexistence of FFA and vitiligo is rarely reported in the literature. We retrospectively studied 20 cases diagnosed with FFA in a 14-month period in our Department. Among them, there were 2 cases, a 72-year-old woman and a 48-year-old man, who developed FFA on preexisting vitiligo of the forehead. Anatomical colocalization of the two dermatoses supports the notion that a causal link may exist and their association may not be coincidental. We suggest that interrelated immunologic events and pathologic processes may underlie both these skin conditions.

Wireless data communication alternatives for small public safety agencies: how one community cost-effectively solved its expanding field data requirements

NASA Astrophysics Data System (ADS)

Canning, Ryan M.; Lefebvre, Eric

2005-06-01

A growing number of Public Safety agencies have begun leveraging wireless data communication technology to improve tactical response capabilities as well as overall productivity. For years police departments subscribed to CDPD (Cellular Digital Packet Data) services to provide officers with basic dispatch data and criminal database access. Now as cellular carriers have deactivated CDPD and shifted to 2.5G and 3G data services such as 1xRTT, GPRS and EDGE, police departments are scrambling to fill the void. Not surprisingly, the extraordinary investments cellular carriers made to upgrade their infrastructures have been transferred to the customer, with monthly fees running as high as $80 a month per user. It's no wonder public safety agencies have been reluctant to adopt these services. Lost in the fray are those smaller police departments which account for nearly 90% of the nation's total. This group has increasingly sought out alternative data communication solutions that are not predicated on budget-busting monthly access fees. One such example is the Marco Island Police Department (MIPD) in Southwestern Florida that received a Federal grant to augment its existing voice communications with data. After evaluating several different technologies and vendors, MIPD chose a 900 MHz ad hoc mesh network solution based on its ability to provide reliable, high-speed and secure IP-based data communications over extensive distances. This paper will discuss technical details of Marco Island's mobile mesh network implementation; including: coverage area with 900 MHz spread spectrum radios, strategic repeater tower placement, interference, throughput performance, and the necessity for application-persistence software.

OK, Let's Teach Graduate Students Differently. But How?

ERIC Educational Resources Information Center

Cassuto, Leonard

2012-01-01

What should graduate teaching look like when it aims to prepare students for a range of careers? That's a welcome question, but it is not an easy one. The author takes up the problem in two parts, this month from the individual faculty member's perspective, and next month on the curricular level (that is, from the point of view of departments and…

Buen Comienzo, Buen Futuro: El Bebe de Ocho Meses. (Healthy Start, Grow Smart: Your Eight-Month-Old).

ERIC Educational Resources Information Center

Department of Agriculture, Washington, DC.

Distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, this Spanish-language pamphlet provides parents with information and advice about their infants in the eighth month of life. Following a brief description of developmental characteristics at this age, the pamphlet offers advice on a variety of topics,…

U.S. Department of Defense Official Website

Science.gov Websites

, Uzbekistan, Gospel choir sing a song during the base observance of Black History Month, Feb. 13, 2005. U.S presentation orchestrated by 256th Brigade Combat Team soldiers, not only to celebrate Black History Month, but America, but also the military, during a Black History program held Feb. 28 at Naval Base San Diego. Story

Buen Comienzo, Buen Futuro: El Bebe de Siete Meses (Healthy Start, Grow Smart: Your Seven-Month-Old).

ERIC Educational Resources Information Center

Department of Agriculture, Washington, DC.

Distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, this Spanish-language pamphlet provides parents with information and advice about their infants in the seventh month of life. Following a brief description of developmental characteristics at this age, the pamphlet offers advice on a variety of topics,…

The Time Is Now: Wisconsin's Journey towards Improving Early Intervention Services

ERIC Educational Resources Information Center

Dicker, Marcy

2011-01-01

In 1990 Katie was diagnosed with a profound hearing loss at 26 months of age. Her communication skills were delayed and a hearing loss had been suspected earlier. Several months later, Katie received hearing aids. Her mother was also referred to the county's Birth to 3 Program. In Wisconsin, Birth to 3 Programs were based out of the Department of…

Buen Comienzo, Buen Futuro: El Bebe de Diez Meses (Healthy Start, Grow Smart: Your Ten-Month-Old).

ERIC Educational Resources Information Center

Landry, Susan, H.; Ramey, Craig T.

Distributed by the U.S. Departments of Agriculture, Education, and Health and Human Services, this Spanish-language pamphlet provides parents with information and advice about their infants in the tenth month of life. Following a brief description of developmental characteristics at this age, the pamphlet offers advice on a variety of topics,…

45 CFR 233.37 - How monthly reports are treated and what notices are required (AFDC).

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 2 2013-10-01 2012-10-01 true How monthly reports are treated and what notices are required (AFDC). 233.37 Section 233.37 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COVERAGE AND...

The effect of less-lethal weapons on injuries in police use-of-force events.

PubMed

MacDonald, John M; Kaminski, Robert J; Smith, Michael R

2009-12-01

We investigated the effect of the use of less-lethal weapons, conductive energy devices (CEDs), and oleoresin capsicum (OC) spray on the prevalence and incidence of injuries to police officers and civilians in encounters involving the use of force. We analyzed data from 12 police departments that documented injuries to officers and civilians in 24,380 cases. We examined monthly injury rates for 2 police departments before and after their adoption of CEDs. Odds of injury to civilians and officers were significantly lower when police used CED weapons, after control for differences in case attributes and departmental policies restricting use of these weapons. Monthly incidence of injury in 2 police departments declined significantly, by 25% to 62%, after adoption of CED devices. Injuries sustained during police use-of-force events affect thousands of police officers and civilians in the United States each year. Incidence of these injuries can be reduced dramatically when law enforcement agencies responsibly employ less-lethal weapons in lieu of physical force.

Capturing every patron interaction: the move from paper statistics to an electronic system to track the whole library.

PubMed

Vardell, Emily; Loper, Kimberly; Vaidhyanathan, Vedana

2012-01-01

Reference departments track patron interactions to illustrate the type and number of services provided as well as to tailor librarians' time and expertise to the interest and needs of their patrons. Until 2010 the Reference, Education, and Community Engagement Department at the Calder Memorial Library tracked statistics using a complicated system of paper tic sheets and two Excel™ spreadsheets. After considering different electronic systems, the department decided to employ an electronic form created with SurveyMonkey™ to track patron interactions. After the system had been in place for three months, the authors administered a satisfaction and use survey to collect faculty and staff feedback on the new system. Seven months later the authors undertook usability testing to collect further evaluative data on the electronic form. The patron interaction form continues to be used to collect statistics, provide data for annual reviews, and recognize the contributions of all faculty and staff at the library.

U.S. Department of Education, Office of Inspector General Semiannual Report to Congress (April 1-September 30, 2002).

ERIC Educational Resources Information Center

Office of Inspector General (ED), Washington, DC.

The Office of Inspector General (OIG) works to assist the Department of Education in ensuring the integrity of its operations and improving its programs. During the 6 months this report covers, OIG issued 60 audit and inspection reports and memoranda, and closed 104 investigations. More specifically, OIG investigated purchase-card abuse and…

U.S. Department of Education, Office of Inspector General Semiannual Report to Congress, October 1, 1995-March 31, 1996.

ERIC Educational Resources Information Center

Office of Inspector General (ED), Washington, DC.

This document contains a semiannual report on the activities of the Department of Education's Office of Inspector General (OIG) for the 6-month period ending March 31, 1996. It highlights the Office's significant accomplishments and activities, including: (1) a series of audit reports to aid reauthorization of the Rehabilitation Act; (2)…

77 FR 44472 - Safety Zone; Port Valdez, Alaska Maritime Highway System Ferry Terminal

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-30

... Game, which does not afford time for public feedback on a safety zone that will be in effect only when... month of July, the Alaska Department of Fish and Game has announced fishing openers in the Port of... an Alaska Department of Fish and Game fish opener that includes the 200-yard radius surrounding the...

The Delaware Department of Correction Life Skills Program. Program Focus.

ERIC Educational Resources Information Center

Finn, Peter

Since 1993, the Delaware Department of Correction has offered a Life Skills Program in its four state prisons. Each year, as many as 300 inmates (of the 5,000 housed inmates) enroll in the program, and nearly 85 percent of them graduate. The 4-month program has three major components: academics, violence reduction, and applied life skills. The…

Semi-Annual Report to Congress: April 1, 1984-September 30, 1984. No. 9. (Submitted Pursuant to Public Law 95-452).

ERIC Educational Resources Information Center

Office of Inspector General (ED), Washington, DC.

This ninth semiannual report issued by the United States Department of Education's Office of Inspector General (OIG) summarizes the activities and accomplishments of that office during a 6-month period ending September 30, 1984. A condensation of audits of Department of Education aid programs presents statistics on OIG activities and the…

Views of Students in the Department of Recreation and Sport Management on Distance Education

ERIC Educational Resources Information Center

Herguner, Gulten

2012-01-01

This study aims to investigate viewpoints of students in recreation and sport management department on distance education, and the effects of sex, having computers and internet access at home, family's monthly income, district of the family, and students' level of class on these viewpoints. Survey method was used to carry out the study. The sample…

An Analysis of a Subject Department in an English Secondary School Using the Collaborative Practice Analytical Framework

ERIC Educational Resources Information Center

James, Christopher; Goodhew, Carolyn

2011-01-01

This article reports the outcomes of research into the nature of and influences on collective working in an English secondary school. A design and technology department was studied over a 13-month period. Data collection was by interviews, observations and document scrutiny. The findings were analysed using collaborative practice (CP) analytical…

Yoichiro Nambu

NASA Astrophysics Data System (ADS)

Clavelli, Louis

Of the physicists born in the twentieth century one of the greatest passed away this month, Yoichiro Nambu. He was a legend in the Physics Department at the University of Chicago since his arrival in 1954 in the last days of Enrico Fermi. The department noted in announcing the sad event that Nambu was known not only for his brilliance in physics but also for his deep humanity...

Some Precipitation Studies over Andhra Pradesh and the Bay of Bengal using TRMM and SSMI data

NASA Astrophysics Data System (ADS)

Rao, S. Ramalingeswara; Krishna, K. Muni; Kumar, Bhanu

2007-07-01

One of the most difficult issues in modeling the global atmosphere and climate by General Circulation Models is the simulation and initialization of precipitation processes and at the same time rainfall is most important meteorological parameter that effects India's economy. An attempt is made in the present study to evaluate diurnal variation of rain rates over the Bay of Bengal (BoB) for the months June through December during 1999-2002. TMI rainfall product of Wentz and Spencer and SSMI data sets were used in this study. Mean hourly rain rates were calculated over the BoB (10°-15° N and 85°-95°E) and discussed; this study highlights that maximum rain rates are observed in the afternoons during summer monsoon seasons. Secondly mean monthly annual cycle of rainfall is prepared using 3B42RT merged rain product and compared with mean monthly India Meteorological Department (IMD) data for the study period over Andhra Pradesh (A.P). Time series of daily variations of 3B42RT precipitation and observed real time rainfall data over A.P. for the study period is validated and the relationship between them is statistically significant at 1% level. Similarly mean monthly data prepared from the daily analysis and compared with the IMD mean monthly rainfall maps. The comparison suggests that even with only available real time data from 3B42RT and rain gauge, it is possible to construct usable large-scale rainfall maps on regular latitude-longitude grids. This analysis, which uses a high resolution and more local rain gauge data, is able to produce realistic details of Indian summer monsoon rainfall over the study period.

Clinical and analytical characteristics and short-term evolution of enteroviral meningitis in young infants presenting with fever without source.

PubMed

Gomez, Borja; Mintegi, Santiago; Rubio, Mari Cruz; Garcia, Diego; Garcia, Silvia; Benito, Javier

2012-06-01

The objective of this study was to describe the characteristics of the enteroviral meningitis diagnosed in a pediatric emergency department among infants younger than 3 months with fever without source and its short-term evolution. This was a retrospective, cross-sectional, 6-year descriptive study including all infants younger than 3 months who presented with fever without source and who were diagnosed with enteroviral meningitis. A lumbar puncture was practiced at their first emergency visit in 398 (29.5%) of 1348 infants, and 65 (4.8%) were diagnosed with enteroviral meningitis, 33 of them (50.7%) between May and July. Among these 65 infants, 61 were classified as well-appearing; parents referred irritability in 16 (25.3%) of them (without statistical significance when compared with infants without meningitis). Forty-one (63.0%) had no altered infectious parameters (white blood cell [WBC] count between 5000 and 15,000/μL, absolute neutrophil count less than 10,000/μL, and C-reactive protein less than 20 g/L), and 39 (60%) had no pleocytosis. All of the 65 infants recovered well, and none of them developed short-term complications. The symptoms in infants younger than 3 months with enteroviral meningitis were similar to those in infants with a self-limited febrile process without intracranial infection. C-reactive protein and WBC count were not good enteroviral meningitis predictors. Cerebrospinal fluid WBC count was normal in many of these infants, so performing a viral test is recommended for febrile infants younger than 3 months in which a lumbar puncture is practiced during warm months. The short-term evolution was benign.

[Changes in weight and diabetes compensation (HbA(1c)) in patients with diabetes mellitus type 2 after adding exenatide (Byetta) to the current treatment in 28 diabetology departments in the Czech Republic - BIBY-I study (observations lasting 3 to 12 months)].

PubMed

Perusicová, J; Haladová, I; Pit'hová, P; Acsová, D; Belobrádková, J; Belzová, A; Berková, K; Dolezalová, B; Dvoráková, H; Hejnicová, K; Hudcová, M; Kallmünzerová, D; Krejsová, Z; Markofová, G; Müllerová, H; Owen, K; Pelikánová, M; Raclavská, L; Racická, E; Skarpová, O; Váchová, A; Veselá, A; Vyoralos, J; Broz, J; Edelsberger, T; Honka, M; Hrdina, T; Chmura, P; Tosovský, J

2013-03-01

BIBY STUDY OBJECTIVE: To obtain experience with exenatide treatment (Byetta) in patients with diabetes mellitus type 2 in a common clinical practice ofdiabetology departments. TYPE OF OBSERVATION: Observational study conducted by a randomly selected group of outpatient medical practitioners from 28 diabetology departments in the Czech Republic. OBSERVED AND ASSESSED POPULATION: 465 patients underwent at least three months of Byetta treatment; 347 persons (74.6% ofthe research population) stayed forthe extended observation of 6-12 months. Apart from the basic identification data (year of birth, sex, age when diabetes mellitus manifested, height, maximum patient weight before diabetes and when diabetes mellitus manifested), the following information was recorded in three-month intervals: weight, waistline, glycated haemoglobin (HbA(1c)), and diabetes mellitus treatment The population included 50.3% women and 49.7% men, and the average age at the time of diabetes manifestation was 48 (20-73 years). The period between the diabetes manifestation and the start of exenatide treatment was 8.3 years on average. The average maximum BMI value before the detection of diabetes was 39.05 (+/- 6.73); at the time of the diabetes manifestation 37.88 (+/- 6.40); and at the start of Byetta treatment 39.01 (+/- 6.22). The BMI after three, six, and 12 months of treatment was as follows: 37.86 (+/- 6.12), 37.18 (+/- 6.0), and 36.60 (+/- 6.21); it decreased by > or = 0.5 in 83.3% patients who were under observation for 12 months. HbA(1c) value decreased in the first three months from 7.39% (+/- 1.57) to 6.41% (+/- 1.34), p < 0.0001. In the period of three-six months, the value decreased to 6.22% (+/- 1.34), and after 12 months, HbA(1c) was at 6.04 (+/- 1.20). An improvement in HbA(1c) value of 0.5-2.0% occurred after the first year in 49% of our research population. The waistline was measured on a regular basis in only 267 patients (58.9%). The average initial value of 120.7 cm was reduced within three months of the treatment to 118.3 cm, and within six and 12 months to 117.3 and 112.6 cm respectively. Adding Byetta to the currently applied treatment of obese patients with diabetes mellitus type 2 led, in 66.8% of the population, to a statistically significant reduction in HbA(1c) levels in the first three-six months of the treatment; after 12 months of treatment, 25% of the population was still showing an improvement in HbA(1c) of > 2.0%. Of observed patients, 74.4% significantly reduced their BMI (by > 0.5) during the first three months; 39.6% of patients reduced their BMI in the period of three-six months.

The Doe Water Cycle Pilot Study.

NASA Astrophysics Data System (ADS)

Miller, N. L.; King, A. W.; Miller, M. A.; Springer, E. P.; Wesely, M. L.; Bashford, K. E.; Conrad, M. E.; Costigan, K.; Foster, P. N.; Gibbs, H. K.; Jin, J.; Klazura, J.; Lesht, B. M.; Machavaram, M. V.; Pan, F.; Song, J.; Troyan, D.; Washington-Allen, R. A.

2005-03-01

A Department of Energy (DOE) multilaboratory Water Cycle Pilot Study (WCPS) investigated components of the local water budget at the Walnut River watershed in Kansas to study the relative importance of various processes and to determine the feasibility of observational water budget closure. An extensive database of local meteorological time series and land surface characteristics was compiled. Numerical simulations of water budget components were generated and, to the extent possible, validated for three nested domains within the Southern Great Plains-the Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Cloud Atmospheric Radiation Testbed (CART), the Walnut River watershed (WRW), and the Whitewater watershed (WW), in Kansas.A 2-month intensive observation period (IOP) was conducted to gather extensive observations relevant to specific details of the water budget, including finescale precipitation, streamflow, and soil moisture measurements that were not made routinely by other programs. Event and seasonal water isotope (d18O, dD) sampling in rainwater, streams, soils, lakes, and wells provided a means of tracing sources and sinks within and external to the WW, WRW, and the ARM CART domains. The WCPS measured changes in the leaf area index for several vegetation types, deep groundwater variations at two wells, and meteorological variables at a number of sites in the WRW. Additional activities of the WCPS include code development toward a regional climate model that includes water isotope processes, soil moisture transect measurements, and water-level measurements in groundwater wells.

Something of Value

ERIC Educational Resources Information Center

Manpower, 1972

1972-01-01

Through relaxed civil service requirements, the Defense Department placed Neighborhood Youth Corps trainees in military installations, with permanent jobs to follow 9 months of training and work experience. (BH)

Controlling Chronic Diseases Through Evidence-Based Decision Making: A Group-Randomized Trial.

PubMed

Brownson, Ross C; Allen, Peg; Jacob, Rebekah R; deRuyter, Anna; Lakshman, Meenakshi; Reis, Rodrigo S; Yan, Yan

2017-11-30

Although practitioners in state health departments are ideally positioned to implement evidence-based interventions, few studies have examined how to build their capacity to do so. The objective of this study was to explore how to increase the use of evidence-based decision-making processes at both the individual and organization levels. We conducted a 2-arm, group-randomized trial with baseline data collection and follow-up at 18 to 24 months. Twelve state health departments were paired and randomly assigned to intervention or control condition. In the 6 intervention states, a multiday training on evidence-based decision making was conducted from March 2014 through March 2015 along with a set of supplemental capacity-building activities. Individual-level outcomes were evidence-based decision making skills of public health practitioners; organization-level outcomes were access to research evidence and participatory decision making. Mixed analysis of covariance models was used to evaluate the intervention effect by accounting for the cluster randomized trial design. Analysis was performed from March through May 2017. Participation 18 to 24 months after initial training was 73.5%. In mixed models adjusted for participant and state characteristics, the intervention group improved significantly in the overall skill gap (P = .01) and in 6 skill areas. Among the 4 organizational variables, only access to evidence and skilled staff showed an intervention effect (P = .04). Tailored and active strategies are needed to build capacity at the individual and organization levels for evidence-based decision making. Our study suggests several dissemination interventions for consideration by leaders seeking to improve public health practice.

Investigation of Central Pain Processing in Post-Operative Shoulder Pain and Disability

PubMed Central

Valencia, Carolina; Fillingim, Roger B.; Bishop, Mark; Wu, Samuel S.; Wright, Thomas W.; Moser, Michael; Farmer, Kevin; George, Steven Z.

2014-01-01

Measures of central pain processing like conditioned pain modulation (CPM), and suprathreshold heat pain response (SHPR) have been described to assess different components of central pain modulatory mechanisms. Central pain processing potentially play a role in the development of postsurgical pain, however, the role of CPM and SHPR in explaining postoperative clinical pain and disability is still unclear. Seventy eight patients with clinical shoulder pain were included in this study. Patients were examined before shoulder surgery, at 3 months, and 6 months after surgery. The primary outcome measures were pain intensity and upper extremity disability. Analyses revealed that the change score (baseline – 3 months) of 5th pain rating of SHPR accounted for a significant amount of variance in 6 month postsurgical clinical pain intensity and disability after age, sex, preoperative pain intensity, and relevant psychological factors were considered. The present study suggests that baseline measures of central pain processing were not predictive of 6 month postoperative pain outcome. Instead, the 3 month change in SHPR might be a relevant factor in the transition to elevated 6-month postoperative pain and disability outcomes. In patients with shoulder pain, the 3 month change in a measure of central pain processing might be a relevant factor in the transition to elevated 6-month postoperative pain and disability scores. PMID:24042347

Marshall Space Flight Center Propulsion Systems Department (PSD) KM Initiative

NASA Technical Reports Server (NTRS)

Caraccioli, Paul; Varnadoe, Tom; McCarter, Mike

2006-01-01

NASA Marshall Space Flight Center s Propulsion Systems Department (PSD) is four months into a fifteen month Knowledge Management (KM) initiative to support enhanced engineering decision making and analyses, faster resolution of anomalies (near-term) and effective, efficient knowledge infused engineering processes, reduced knowledge attrition, and reduced anomaly occurrences (long-term). The near-term objective of this initiative is developing a KM Pilot project, within the context of a 3-5 year KM strategy, to introduce and evaluate the use of KM within PSD. An internal NASA/MSFC PSD KM team was established early in project formulation to maintain a practitioner, user-centric focus throughout the conceptual development, planning and deployment of KM technologies and capabilities with in the PSD. The PSD internal team is supported by the University of Alabama's Aging Infrastructure Systems Center Of Excellence (AISCE), Intergraph Corporation, and The Knowledge Institute. The principle product of the initial four month effort has been strategic planning of PSD KM implementation by first determining the "as is" state of KM capabilities and developing, planning and documenting the roadmap to achieve the desired "to be" state. Activities undertaken to support the planning phase have included data gathering; cultural surveys, group work-sessions, interviews, documentation review, and independent research. Assessments and analyses have been performed including industry benchmarking, related local and Agency initiatives, specific tools and techniques used and strategies for leveraging existing resources, people and technology to achieve common KM goals. Key findings captured in the PSD KM Strategic Plan include the system vision, purpose, stakeholders, prioritized strategic objectives mapped to the top ten practitioner needs and analysis of current resource usage. Opportunities identified from research, analyses, cultural/KM surveys and practitioner interviews include: executive and senior management sponsorship, KM awareness, promotion and training, cultural change management, process improvement, leveraging existing resources and new innovative technologies to align with other NASA KM initiatives (convergence: the big picture). To enable results based incremental implementation and future growth of the KM initiative, key performance measures have been identified including stakeholder value, system utility, learning and growth (knowledge capture, sharing, reduced anomaly recurrence), cultural change, process improvement and return-on-investment. The next steps for the initial implementation spiral (focused on SSME Turbomachinery) have been identified, largely based on the organization and compilation of summary level engineering process models, data capture matrices, functional models and conceptual-level systems architecture. Key elements include detailed KM requirements definition, KM technology architecture assessment, evaluation and selection, deployable KM Pilot design, development, implementation and evaluation, and justifying full implementation (estimated Return-on-Investment). Features identified for the notional system architecture include the knowledge presentation layer (and its components), knowledge network layer (and its components), knowledge storage layer (and its components), User Interface and capabilities. This paper provides a snapshot of the progress to date, the near term planning for deploying the KM pilot project and a forward look at results based growth of KM capabilities with-in the MSFC PSD.

Marshall Space Flight Center Propulsion Systems Department (PSD) Knowledge Management (KM) Initiative

NASA Technical Reports Server (NTRS)

Caraccioli, Paul; Varnedoe, Tom; Smith, Randy; McCarter, Mike; Wilson, Barry; Porter, Richard

2006-01-01

NASA Marshall Space Flight Center's Propulsion Systems Department (PSD) is four months into a fifteen month Knowledge Management (KM) initiative to support enhanced engineering decision making and analyses, faster resolution of anomalies (near-term) and effective, efficient knowledge infused engineering processes, reduced knowledge attrition, and reduced anomaly occurrences (long-term). The near-term objective of this initiative is developing a KM Pilot project, within the context of a 3-5 year KM strategy, to introduce and evaluate the use of KM within PSD. An internal NASA/MSFC PSD KM team was established early in project formulation to maintain a practitioner, user-centric focus throughout the conceptual development, planning and deployment of KM technologies and capabilities within the PSD. The PSD internal team is supported by the University of Alabama's Aging Infrastructure Systems Center of Excellence (AISCE), lntergraph Corporation, and The Knowledge Institute. The principle product of the initial four month effort has been strategic planning of PSD KNI implementation by first determining the "as is" state of KM capabilities and developing, planning and documenting the roadmap to achieve the desired "to be" state. Activities undertaken to suppoth e planning phase have included data gathering; cultural surveys, group work-sessions, interviews, documentation review, and independent research. Assessments and analyses have beon pedormed including industry benchmarking, related local and Agency initiatives, specific tools and techniques used and strategies for leveraging existing resources, people and technology to achieve common KM goals. Key findings captured in the PSD KM Strategic Plan include the system vision, purpose, stakeholders, prioritized strategic objectives mapped to the top ten practitioner needs and analysis of current resource usage. Opportunities identified from research, analyses, cultural1KM surveys and practitioner interviews include: executive and senior management sponsorship, KM awareness, promotion and training, cultural change management, process improvement, leveraging existing resources and new innovative technologies to align with other NASA KM initiatives (convergence: the big picture). To enable results based incremental implementation and future growth of the KM initiative, key performance measures have been identified including stakeholder value, system utility, learning and growth (knowledge capture, sharing, reduced anomaly recurrence), cultural change, process improvement and return-on-investment. The next steps for the initial implementation spiral (focused on SSME Turbomachinery) have been identified, largely based on the organization and compilation of summary level engineering process models, data capture matrices, functional models and conceptual-level svstems architecture. Key elements include detailed KM requirements definition, KM technology architecture assessment, - evaluation and selection, deployable KM Pilot design, development, implementation and evaluation, and justifying full implementation (estimated Return-on-Investment). Features identified for the notional system architecture include the knowledge presentation layer (and its components), knowledge network layer (and its components), knowledge storage layer (and its components), User Interface and capabilities. This paper provides a snapshot of the progress to date, the near term planning for deploying the KM pilot project and a forward look at results based growth of KM capabilities with-in the MSFC PSD.

Monthly variation of United States pediatric headache emergency department visits.

PubMed

Kedia, Sita; Ginde, Adit A; Grubenhoff, Joseph A; Kempe, Allison; Hershey, Andrew D; Powers, Scott W

2014-05-01

The objective of this article is to determine the monthly variation of emergency department (ED) visits for pediatric headache. We hypothesized youth have increased headache-related ED visits in the months associated with school attendance. Using a United States representative sample of ED visits in the National Hospital Ambulatory Medical Care Survey from 1997 to 2009, we estimated number of visits associated with ICD-9 codes related to headache, migraine, status migrainosus, or tension-type headache in 5- to 18-year-olds. Age-stratified multivariate models are presented for month of visit (July as reference). There was a national estimate of 250,000 ED visits annually related to headache (2.1% of total visits) in 5- to 18-year-olds. In 5- to 11-year-olds, the adjusted rate of headache-related visits was lower in April (OR 0.42, 95% CI 0.20, 0.88). In 12- to 18-year-olds, there were higher rates in January (OR 1.92, 95% CI 1.16, 3.14) and September (OR 1.64, 95% CI 1.06, 2.55). In adolescents we found higher ED utilization in January and September, the same months associated with school return from vacation for a majority of children nationally. No significant reduction in the summer suggests that school itself is not the issue, but rather changes in daily lifestyle and transitions.

Evaluation of a curriculum for intimate partner violence screening in a pediatric emergency department.

PubMed

Knapp, Jane F; Dowd, M Denise; Kennedy, Christopher S; Stallbaumer-Rouyer, Jennifer; Henderson, Deborah P

2006-01-01

We sought to describe the assessment of course participant changes in attitudes, self-efficacy, and behaviors after completion of the Its Time to Ask training curriculum for screening for intimate partner violence (IPV) in a pediatric emergency department (PED). A 22-item Likert scale questionnaire was administered at baseline (before training), after training, and at 6-month follow-up to PED employee participants in a 2-hour IPV education program. Mean participant responses were compared between baseline/posttraining and baseline/6-month follow-up. Participants also completed a course-satisfaction survey. A total of 79 PED staff completed the baseline questionnaire before the training. Eighty-seven participants completed the posttraining questionnaire, and 48 completed the 6-month follow-up questionnaire. Participants had consistent, positive changes in attitudes after training that persisted at the 6-month follow-up for 5 items on the questionnaire. Attitudes that did not change showed baseline means already in disagreement with questionnaire statements. Participants reported significant, positive changes for all 7 self-efficacy statements at 1 or both of the posttraining evaluations. The only changes in behavior were observed at 6 months. The majority of participants were satisfied with the training and would recommend it to colleagues. Significant, self-reported changes in attitudes, self-efficacy, and behaviors/clinical practice regarding screening for IPV in a PED can be achieved through participation in a brief training curriculum.

[Definition and stabilization of processes I. Management processes and support in a Urology Department].

PubMed

Pascual, Carlos; Luján, Marcos; Mora, José Ramón; Chiva, Vicente; Gamarra, Manuela

2015-01-01

The implantation of total quality management models in clinical departments can better adapt to the 2009 ISO 9004 model. An essential part of implantation of these models is the establishment of processes and their stabilization. There are four types of processes: key, management, support and operative (clinical). Management processes have four parts: process stabilization form, process procedures form, medical activities cost estimation form and, process flow chart. In this paper we will detail the creation of an essential process in a surgical department, such as the process of management of the surgery waiting list.

The Federal Conference on Intelligent Processing Equipment

NASA Technical Reports Server (NTRS)

1992-01-01

Research and development projects involving intelligent processing equipment within the following U.S. agencies are addressed: Department of Agriculture, Department of Commerce, Department of Energy, Department of Defense, Environmental Protection Agency, Federal Emergency Management Agency, NASA, National Institutes of Health, and the National Science Foundation.

Home-based radiology transcription and a productivity pay plan.

PubMed

Kerr, K

1997-01-01

Shands Hospital in Gainesville, Fla., decided to evaluate the way it provided transcription services in its radiology department. It identified four goals: increased productivity, decreased operating expense, finding much needed space in the radiology department and increasing employee morale. The department performs 165,000 procedures annually, with 66 radiologists, 29 faculty, and 37 residents and fellows on staff. Six FTEs comprised the transcription pool in the radiology department, with transcription their only duty. Transcriptionists were paid an hourly rate based on their years of service, not their productivity. Evaluation and measurement studies were undertaken by the hospital's management systems engineering department. The transcriptionists' hours were then changed to provide coverage during the periods of heaviest dictation. The productivity level of the transcription staff was also measured and various methods of measurement reviewed. The goal was a pure incentive pay plan that would reward employees for every increase in productivity. The incentive pay plan was phased in over a three-month period. Transcriptionists were paid for work performed, with no base pay beyond minimum wage. The move to home-based transcription was planned. The necessary equipment was identified and various issues specific to working at home were addressed. Approximately six months later, the transcriptionists were set up to work at home. The astounding results achieved are presented: 28% increase in productivity, operational cost savings exceeding $25,000 and a space savings of 238 square feet.

Using a balanced scorecard to improve the performance of an emergency department.

PubMed

Huang, Shu-Hsin; Chen, Ping-Ling; Yang, Ming-Chin; Chang, Wen-Yin; Lee, Haw-Jenn

2004-01-01

The performance of the emergency department significantly improved after implementing the balanced scorecard including hours of continuing education attended by the staff, staff job satisfaction, the rate of incomplete laboratory tests within 30 minutes, the average monthly inappropriate return rate, and hospital profit. The results can assist administrators plan for the future. Although this was a pilot program for implementing a balanced scorecard in an emergency department, the indicators used in this study may also be reasonable for a hospital that has limited resources.

ANTIBODY FORMATION IN WORKERS OF ROENTGEN DEPARTMENTS VACCINATED WITH LIVE TULAREMIA VACCINE (in Russian)

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

Marder, B.B.

1961-01-01

Workers of roentgenological departments, physicians, roentgen technicians and auxiliary personnel (a totul of 15 persons) were immunized by the pericutaneous method with live tularemia vaccine. For comparison, subject to immunization were 5 medical workers not working in roentgenological departments. In all the persons immunized blood was taken 1, 2, 3 months and one year after the vaccination for studies of the agglutination titers of sera. The lowest antibody titer was seen in roentgen technicians, whereas the highest---in auxiliary personnel and the controls. (auth)

Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial.

PubMed

Fortney, John C; Pyne, Jeffrey M; Kimbrell, Timothy A; Hudson, Teresa J; Robinson, Dean E; Schneider, Ronald; Moore, William M; Custer, Paul J; Grubbs, Kathleen M; Schnurr, Paula P

2015-01-01

Posttraumatic stress disorder (PTSD) is prevalent, persistent, and disabling. Although psychotherapy and pharmacotherapy have proven efficacious in randomized clinical trials, geographic barriers impede rural veterans from engaging in these evidence-based treatments. To test a telemedicine-based collaborative care model designed to improve engagement in evidence-based treatment of PTSD. The Telemedicine Outreach for PTSD (TOP) study used a pragmatic randomized effectiveness trial design with intention-to-treat analyses. Outpatients were recruited from 11 Department of Veterans Affairs (VA) community-based outpatient clinics serving predominantly rural veterans. Inclusion required meeting diagnostic criteria for current PTSD according to the Clinician-Administered PTSD Scale. Exclusion criteria included receiving PTSD treatment at a VA medical center or a current diagnosis of schizophrenia, bipolar disorder, or substance dependence. Two hundred sixty-five veterans were enrolled from November 23, 2009, through September 28, 2011, randomized to usual care (UC) or the TOP intervention, and followed up for 12 months. Off-site PTSD care teams located at VA medical centers supported on-site community-based outpatient clinic providers. Off-site PTSD care teams included telephone nurse care managers, telephone pharmacists, telepsychologists, and telepsychiatrists. Nurses conducted care management activities. Pharmacists reviewed medication histories. Psychologists delivered cognitive processing therapy via interactive video. Psychiatrists supervised the team and conducted interactive video psychiatric consultations. The primary outcome was PTSD severity as measured by the Posttraumatic Diagnostic Scale. Process-of-care outcomes included medication prescribing and regimen adherence and initiation of and adherence to cognitive processing therapy. During the 12-month follow-up period, 73 of the 133 patients randomized to TOP (54.9%) received cognitive processing therapy compared with 16 of 132 randomized to UC (12.1%) (odds ratio, 18.08 [95% CI, 7.96-41.06]; P < .001). Patients in the TOP arm had significantly larger decreases in Posttraumatic Diagnostic Scale scores (from 35.0 to 29.1) compared with those in the UC arm (from 33.5 to 32.1) at 6 months (β = -3.81; P = .002). Patients in the TOP arm also had significantly larger decreases in Posttraumatic Diagnostic Scale scores (from 35.0 to 30.1) compared with those in the UC arm (from 33.5 to 31.7) at 12 months (β = -2.49; P=.04). There were no significant group differences in the number of PTSD medications prescribed and adherence to medication regimens were not significant. Attendance at 8 or more sessions of cognitive processing therapy significantly predicted improvement in Posttraumatic Diagnostic Scale scores (β = -3.86 [95% CI, -7.19 to -0.54]; P = .02) and fully mediated the intervention effect at 12 months. Telemedicine-based collaborative care can successfully engage rural veterans in evidence-based psychotherapy to improve PTSD outcomes. clinicaltrials.gov Identifier: NCT00821678.

Description and Yield of Current Quality and Safety Review in Selected US Academic Emergency Departments.

PubMed

Griffey, Richard Thomas; Schneider, Ryan M; Sharp, Brian R; Pothof, Jeffrey J; Hodkins, Sheridan; Capp, Roberta; Wiler, Jennifer L; Sreshta, Neil; Sather, John E; Sampson, Christopher S; Powell, Jonathan T; Groner, Kathryn Y; Adler, Lee M

2017-06-29

Quality and safety review for performance improvement is important for systems of care and is required for US academic emergency departments (EDs). Assessment of the impact of patient safety initiatives in the context of increasing burdens of quality measurement compels standardized, meaningful, high-yield approaches for performance review. Limited data describe how quality and safety reviews are currently conducted and how well they perform in detecting patient harm and areas for improvement. We hypothesized that decades-old approaches used in many academic EDs are inefficient and low yield for identifying patient harm. We conducted a prospective observational study to evaluate the efficiency and yield of current quality review processes at five academic EDs for a 12-month period. Sites provided descriptions of their current practice and collected summary data on the number and severity of events identified in their reviews and the referral sources that led to their capture. Categories of common referral sources were established at the beginning of the study. Sites used the Institute for Healthcare Improvement's definition in defining an adverse event and a modified National Coordinating Council for Medication Error Reporting and Prevention (MERP) Index for grading severity of events. Participating sites had similar processes for quality review, including a two-level review process, monthly reviews and conferences, similar screening criteria, and a grading system for evaluating cases. In 60 months of data collection, we reviewed a total of 4735 cases and identified 381 events. This included 287 near-misses, errors/events (MERP A-I) and 94 adverse events (AEs) (MERP E-I). The overall AE rate (event rate with harm) was 1.99 (95% confidence interval = 1.62%-2.43%), ranging from 1.24% to 3.47% across sites. The overall rate of quality concerns (events without harm) was 6.06% (5.42%-6.78%), ranging from 2.96% to 10.95% across sites. Seventy-two-hour returns were the most frequent referral source used, accounting for 47% of the cases reviewed but with a yield of only 0.81% in identifying harm. Other referral sources similarly had very low yields. External referrals were the highest yield referral source, with 14.34% (10.64%-19.03%) identifying AEs. As a percentage of the 94 AEs identified, external referrals also accounted for 41.49% of cases. With an overall adverse event rate of 1.99%, commonly used referral sources seem to be low yield and inefficient for detecting patient harm. Approximately 6% of the cases identified by these criteria yielded a near miss or quality concern. New approaches to quality and safety review in the ED are needed to optimize their yield and efficiency for identifying harm and areas for improvement.

46 CFR 11.454 - Service requirements for mate of Great Lakes and inland steam or motor vessels of not more than...

Code of Federal Regulations, 2011 CFR

2011-10-01

... gross tons is six months of service in the deck department of steam or motor, sail, or auxiliary sail... United States (excluding the Great Lakes). (b) In order to obtain an endorsement for sail or auxiliary sail vessels, the applicant must submit evidence of three months of service on sail or auxiliary sail...

46 CFR 11.428 - Service requirements for master of near coastal steam or motor vessels of not more than 100 gross...

Code of Federal Regulations, 2011 CFR

2011-10-01

... total service in the deck department of steam or motor, sail, or auxiliary sail vessels on ocean or near... service. (b) In order to obtain an endorsement for sail or auxiliary sail vessels, the applicant must submit evidence of 12 months of service on sail or auxiliary sail vessels. The required 12 months of...

46 CFR 11.454 - Service requirements for mate of Great Lakes and inland steam or motor vessels of not more than...

Code of Federal Regulations, 2010 CFR

2010-10-01

... gross tons is six months of service in the deck department of steam or motor, sail, or auxiliary sail... United States (excluding the Great Lakes). (b) In order to obtain an endorsement for sail or auxiliary sail vessels, the applicant must submit evidence of three months of service on sail or auxiliary sail...

46 CFR 11.428 - Service requirements for master of near coastal steam or motor vessels of not more than 100 gross...

Code of Federal Regulations, 2010 CFR

2010-10-01

... total service in the deck department of steam or motor, sail, or auxiliary sail vessels on ocean or near... service. (b) In order to obtain an endorsement for sail or auxiliary sail vessels, the applicant must submit evidence of 12 months of service on sail or auxiliary sail vessels. The required 12 months of...

Short and long-term mortality of patients presenting with bleeding events to the Emergency Department.

PubMed

Conti, Alberto; Renzi, Noemi; Molesti, Daniele; Bianchi, Simone; Bogazzi, Irene; Bongini, Giada; Pepe, Giuseppe; Frosini, Fabiana; Bertini, Alessio; Santini, Massimo

2017-12-01

Death of patients presenting with bleeding events to the Emergency Department still represent a major problem. We sought to analyze clinical characteristics associated with worse outcomes including short- and long-term death, beyond antithombotic treatment strategy. Patients presenting with any bleeding events during 2016-2017years were enrolled. Clinical parameters, site of bleeding, major bleeding, ongoing anti-thrombotic treatment strategy and death were collected. Hard 5:1 propensity score matching was performed to adjust dead patients in baseline characteristics. Endpoints were one-month and one-year death. Out of 166,000 visits to the Emergency Department, 3.050 patients (1.8%) were enrolled and eventually 429 were analyzed after propensity. Overall, anticoagulants or antiplatelets were given to 234(54%). Major bleeding account for 111(26%) patients, without differences between those taking anticoagulants or antiplatelets versus others. Death at one-month and one-year was 26(6%) and 72(17%), respectively. Independent predictors of one-month death were major bleeding (Odds Ratio, OR 26, p<0.001), female gender (OR 7, p<0.001) and white blood cells (OR 1.2, p=0.01); of one-year were major bleeding (OR 7, p<0.001), age (OR 1.1, p<0.001) and female gender (OR 2.3, p=0.043). Of note, death rate of gastrointestinal and intracranial bleeding where higher than others (p<0.001). Overall mortality was approximately 40% on one-month; 60% in older patients and 80% in female gender with CHA 2 D 2 VASC-score≥2. Receiver operator characteristics analysis showed larger areas for major bleeding and age (0.75 and 0.72, respectively) over others; p<0.05 on C-statistic. In patients with bleeding events, death rate was driven by major bleeding on short-term and older age on long-term. Among dead patients mortality was approximately 40% on one-month; 60% in older patients, and 80% in female gender. Copyright © 2017 Elsevier Inc. All rights reserved.

Cost of a roller skating rink to the local accident and emergency department.

PubMed Central

Nayeem, N; Shires, S E; Porter, J E

1990-01-01

A 14 month retrospective study was undertaken to determine the cost implications of the opening of a roller skating rink to the local hospital accident and emergency department (A and E). A total of 398 patients attended following injury at the roller skating rink, of whom 384 were included in the study. The estimated cost of their injuries was determined by the hospital accounts department. The average cost per patient attending the A and E department following roller skating injury was about 100 pounds. The total cost to the A and E department of all injuries sustained at the rink over this period was 38,412 pounds. The cost implications of opening a roller skating rink for the A and E department are considerable. If proposals for self-budgeting are applied, A and E departments will have to seek additional funding if such leisure facilities are opened in their vicinity. PMID:2097020

46 CFR 11.414 - Service requirements for mate of ocean steam or motor vessels of not more than 1600 gross tons.

Code of Federal Regulations, 2010 CFR

2010-10-01

... in the deck department of ocean or near coastal steam or motor, sail, or auxiliary sail vessels...) Three years total service in the deck department on ocean or near coastal steam or motor, sail, or auxiliary sail vessels of over 200 gross tons. Six months of the required service must have been as able...

46 CFR 11.414 - Service requirements for mate of ocean steam or motor vessels of not more than 1600 gross tons.

Code of Federal Regulations, 2011 CFR

2011-10-01

... in the deck department of ocean or near coastal steam or motor, sail, or auxiliary sail vessels...) Three years total service in the deck department on ocean or near coastal steam or motor, sail, or auxiliary sail vessels of over 200 gross tons. Six months of the required service must have been as able...

A randomized controlled evaluation of specialist nurse education following accident and emergency department attendance for acute asthma.

PubMed

Levy, M L; Robb, M; Allen, J; Doherty, C; Bland, J M; Winter, R J

2000-09-01

We investigated whether hospital-based specialist asthma nurses improved recognition and self-treatment of asthma episodes by patients followed up after attending accident and emergency departments (A&E) for asthma exacerbations. We carried out a randomized prospective controlled trial of adult asthma self-management, following a hospital outpatient nurse consultation in two outer-London District General Hospitals (secondary care centres). The study included 211 adults, over 18 years old (mean age 40 years) who attended for asthma in two accident and emergency departments over 13 months. One hundred and eight evaluable patients were randomized into the control group who continued with their usual medical treatment and were not offered any intervention during the study period. One hundred and three evaluable patients were randomized into the intervention group. They were offered three 6-weekly outpatient appointments with one of two specialist asthma nurses for a structured asthma consultation, after attendance at the accident and emergency department. Following assessment of their asthma treatment and control, the nurses advised patients, through the use of self-management-plans, how to recognize and manage uncontrolled asthma and when to seek medical assistance. Medication and inhaler device type were altered if necessary The primary outcome was patient reported self-management of asthma exacerbations for 6 months. Secondary outcomes were assessed at baseline, 3 months and 6 months. These included home peak flow and symptom diaries, structured telephone questionnaires and audit of general practitioner records to determine utilization of services (6 months before and after A&E). Data were analysed on an intention to treat basis by multiple and logistic regression. The intervention group increased their use of inhaled topical steroids in 31/61 (51%) vs. 15/70 (21%) attacks in controls (OR 3.91 CI 1.8-8.4, P<0.001) and their use of rescue medication in 54/61 (89%) severe attacks vs. 53/70 (76%) controls (OR 2.88 CI 1.1-7.9, P<0.05). Intervention patients had significantly higher (mean 20.1 l min(-1); CI 0.4-39.7; P<0.05) and less variable PEF and significantly lower and less variable symptom scores 6 months after entry. Thirty-four percent of intervention patients vs. 42% controls had severe attacks (61 and 70 respectively, OR 0.96 CI 0.7-1.4) during the 6 months. Intervention patients had fewer days off work than controls in the first 3 months (NS) but similar days off during the 6-month period. Intervention patients had fewer episodes away from work in the first (0.34 vs. 0.54, P = 0.08) and the second 3 months (0.25 vs. 0.30, NS) than the controls. Over 80% of the patients records were audited by their general practitioners; the active group had less routine consultations with the doctor (P = 0.03) and practice nurse (P = 0.03), less consultations for uncontrolled episodes (P = 0.06) and less hospital visits (NS) than the controls. Hospital-based specialist nurses reduced asthma morbidity by improving patient self-management behaviour in acute attacks leading to reduced symptoms, improved lung function, less time off work and fewer consultations with health professionals.

Changes in monthly unemployment rates may predict changes in the number of psychiatric presentations to emergency services in South Australia.

PubMed

Bidargaddi, Niranjan; Bastiampillai, Tarun; Schrader, Geoffrey; Adams, Robert; Piantadosi, Cynthia; Strobel, Jörg; Tucker, Graeme; Allison, Stephen

2015-07-24

To determine the extent to which variations in monthly Mental Health Emergency Department (MHED) presentations in South Australian Public Hospitals are associated with the Australian Bureau of Statistics (ABS) monthly unemployment rates. Times series modelling of relationships between monthly MHED presentations to South Australian Public Hospitals derived from the Integrated South Australian Activity Collection (ISAAC) data base and the ABS monthly unemployment rates in South Australia between January 2004-June 2011. Time series modelling using monthly unemployment rates from ABS as a predictor variable explains 69% of the variation in monthly MHED presentations across public hospitals in South Australia. Thirty-two percent of the variation in current month's male MHED presentations can be predicted by using the 2 months' prior male unemployment rate. Over 63% of the variation in monthly female MHED presentations can be predicted by either male or female prior monthly unemployment rates. The findings of this study highlight that even with the relatively favourable economic conditions, small shifts in monthly unemployment rates can predict variations in monthly MHED presentations, particularly for women. Monthly ABS unemployment rates may be a useful metric for predicting demand for emergency mental health services.

Offsetting the Effects of Medical Expenses on Older Adults' Household Food Budgets: An Analysis of the Standard Medical Expense Deduction.

PubMed

Adams, Grace Bagwell; Lee, Jung Sun; Bhargava, Vibha; Super, David A

2017-04-01

The Supplemental Nutrition Assistance Program (SNAP) provides critical nutrition assistance to over 40 million Americans each month. Low-income older adults (60 and older) and disabled participants experience additional budgetary constraints because of high out-of-pocket medical expenses. In recent years, some states have adopted a "Standard Medical Expense Deduction" (SMED) for senior and disabled beneficiaries, making it easier to report medical expenses in the SNAP application process. We conduct a descriptive national analysis that shows increases in benefit levels and reporting of medical expenses for states that have implemented SMED. We then present descriptive findings from Medicare claims data among a sample of low-income older adults in need of food assistance in Georgia. Average medical expenses among this sample approach $200 per month, whereas those for persons diagnosed with multiple chronic conditions exceed $300 per month. Policy implications of this analysis include the need for more states to consider adoption of SMED or alternative estimating approaches, leading to increases in benefit levels for the neediest beneficiaries and decreases in administrative burden among state agencies. We present two possible policy approaches states might take to receive approval for these changes from U.S. Department of Agriculture. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The resident scholar program: a research training opportunity for internal medicine house staff.

PubMed

Byrnes, Abigail B; McCormack, Francis X; Diers, Tiffiny; Jazieh, Abdul-Rahman

2007-01-01

Housestaff research training is a challenging task that is complicated by the lack of a structured process and dedicated time. The Resident Scholar Program (RSP) at the University of Cincinnati, Department of Internal Medicine was created to overcome these challenges. Interested internal medicine house staff are required to submit an application to the residency research director including a project description signed by a faculty mentor. If the project is approved, a 4-month elective rotation is scheduled for the following year. Residents spend the first month on a consult service in the subspecialty area of their research and the remaining 3 months performing their research project. The RSP was launched in July 2003. The percentage of residents participating in research more than tripled. The subspecialty areas represented by RSP research were more diverse than those represented in prior years. Most participants participated in clinical research projects (84%), with 63% of projects being prospective in design. The RSP residents were twice as likely to obtain subspecialty fellowship positions compared to non-RSP residents (89% vs 46%, respectively). The RSP enables house staff to participate in research opportunities in their areas of interest. Development of a more systematic assessment method to study the impact of the program is underway, but the high participation rate reflects resident interest in such a program, particularly for residents with aspirations in pursuing fellowship training.

Foodborne Germs and Illnesses

MedlinePlus

... Health Professionals Health Departments Food Safety Education Month Social Media Messages CDC and Food Safety CDC and the Food Safety Modernization Act Communication Resources Videos Infographics 5 Steps to Clean Your ...

24 CFR 572.120 - Affordability standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND... affordability. (1) The monthly expenditure for principal, interest, taxes, and insurance by an eligible family...

Repositioning an Academic Department to Stimulate Growth

ERIC Educational Resources Information Center

Elrod, Cassandra C.; Daughton, William J.; Murray, Susan L.; Fisher, Caroline M.; Flachsbart, Barry B.

2011-01-01

The complexity of the market in higher education, and the lack of literature regarding marketing, particularly branding, at the academic department level, presented an opportunity to establish a systematic process for evaluating an academic department's brand meaning. A process for evaluating a brand's meaning for an academic department is…

A closer look at the relationships between panic attacks, emergency department visits and non-cardiac chest pain.

PubMed

Foldes-Busque, Guillaume; Denis, Isabelle; Poitras, Julien; Fleet, Richard P; Archambault, Patrick; Dionne, Clermont E

2017-01-01

This study examined the prevalence of emergency department visits prompted by panic attacks in patients with non-cardiac chest pain. A validated structured telephone interview was used to assess panic attacks and their association with the emergency department consultation in 1327 emergency department patients with non-cardiac chest pain. Patients reported at least one panic attack in the past 6 months in 34.5 per cent (95% confidence interval: 32.0%-37.1%) of cases, and 77.1 per cent (95% confidence interval: 73.0%-80.7%) of patients who reported panic attacks had visited the emergency department with non-cardiac chest pain following a panic attack. These results indicate that panic attacks may explain a significant proportion of emergency department visits for non-cardiac chest pain.

Efficacy of a proactive health and safety risk management system in the fire service.

PubMed

Poplin, Gerald S; Griffin, Stephanie; Pollack Porter, Keshia; Mallett, Joshua; Hu, Chengcheng; Day-Nash, Virginia; Burgess, Jefferey L

2018-04-16

This study evaluated the efficacy of a fire department proactive risk management program aimed at reducing firefighter injuries and their associated costs. Injury data were collected for the intervention fire department and a contemporary control department. Workers' compensation claim frequency and costs were analyzed for the intervention fire department only. Total, exercise, patient transport, and fireground operations injury rates were calculated for both fire departments. There was a post-intervention average annual reduction in injuries (13%), workers' compensation injury claims (30%) and claims costs (21%). Median monthly injury rates comparing the post-intervention to the pre-intervention period did not show statistically significant changes in either the intervention or control fire department. Reduced workers' compensation claims and costs were observed following the risk management intervention, but changes in injury rates were not statistically significant.

Pinon Pine power project nears start-up

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

Tatar, G.A.; Gonzalez, M.; Mathur, G.K.

1997-12-31

The IGCC facility being built by Sierra Pacific Power Company (SPPCo) at their Tracy Station in Nevada is one of three IGCC facilities being cost-shared by the US Department of Energy (DOE) under their Clean Coal Technology Program. The specific technology to be demonstrated in SPPCo`s Round Four Project, known as the Pinon Pine IGCC Project, includes the KRW air blown pressurized fluidized bed gasification process with hot gas cleanup coupled with a combined cycle facility based on a new GE 6FA gas turbine. Construction of the 100 MW IGCC facility began in February 1995 and the first firing ofmore » the gas turbine occurred as scheduled on August 15, 1996 with natural gas. Mechanical completion of the gasifier and other outstanding work is due in January 1997. Following the startup of the plant, the project will enter a 42 month operating and testing period during which low sulfur western and high sulfur eastern or midwestern coals will be processed.« less

Design and implementation of a near-miss reporting system at a large, academic pediatric anesthesia department.

PubMed

Guffey, Patrick; Szolnoki, Judit; Caldwell, James; Polaner, David

2011-07-01

Current incident reporting systems encourage retrospective reporting of morbidity and mortality and have low participation rates. A near miss is an event that did not cause patient harm, but had the potential to. By tracking and analyzing near misses, systems improvements can be targeted appropriately, and future errors may be prevented. An electronic, web based, secure, anonymous reporting system for anesthesiologists was designed and instituted at The Children's Hospital, Denver. This portal was compared to an existing hospital incident reporting system. A total of 150 incidents were reported in the first 3 months of operation, compared to four entered in the same time period 1 year ago. An anesthesia-specific anonymous near-miss reporting system, which eases and facilitates data entry and can prospectively identify processes and practices that place patients at risk, was implemented at a large, academic, freestanding children's hospital. This resulted in a dramatic increase in reported events and provided data to target and drive quality and process improvement. © 2011 Blackwell Publishing Ltd.

Introducing practice-based learning and improvement ACGME core competencies into a family medicine residency curriculum.

PubMed

Coleman, Mary Thoesen; Nasraty, Soraya; Ostapchuk, Michael; Wheeler, Stephen; Looney, Stephen; Rhodes, Sandra

2003-05-01

The Accreditation Council for Graduate Medical Education (ACGME) recommends integrating improvement activities into residency training. A curricular change was designed at the Department of Family and Community Medicine, University of Louisville, to address selected ACGME competencies by incorporating practice-based improvement activities into the routine clinical work of family medicine residents. Teams of residents, faculty, and office staff completed clinical improvement projects at three ambulatory care training sites. Residents were given academic credit for participation in team meetings. After 6 months, residents presented results to faculty, medical students, other residents, and staff from all three training sites. Residents, staff, and faculty were recognized for their participation. Resident teams demonstrated ACGME competencies in practice-based improvement: Chart audits indicated improvement in clinical projects; quality improvement tools demonstrated analysis of root causes and understanding of the process; plan-do-study-act cycle worksheets demonstrated the change process. Improvement activities that affect patient care and demonstrate selected ACGME competencies can be successfully incorporated into the daily work of family medicine residents.

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

Marrocco, M.

The Ohio Power Company`s Tidd Pressurized Fluidized Bed Combined Cycle (PFBC) program continues to be the only operating PFBC demonstration program in the nation. The 70 MWe Tidd Demonstration Plant is a Round 1 Clean Coal Technology Project constructed to demonstrate the viability of PFBC combined cycle technology. The plant is now in Rs fourth year of operation. The technology has clearly demonstrated Rs ability to achieve sulfur capture of greater than 95%. The calcium to sulfur molar ratios have been demonstrated to exceed original projections. Unit availability has steadily increased and has been demonstrated to be competitive with othermore » technologies. The operating experience of the first forty-four months of testing has moved the PFBC process from a {open_quotes}promising technology{close_quotes} to available, proven option for efficient, environmentally acceptable base load generation. Funding for the $210 million program is provided by Ohio Power Company, The U.S. Department of Energy, The Ohio Coal Development Office, and the PFBC process vendors - Asea Brown Boveri Carbon (ABBC) and Babcock and Wilcox (B&W).« less

Fostering creativity: how the Duke Graduate Medical Education Quasi-Endowment encourages innovation in GME.

PubMed

Andolsek, Kathryn M; Murphy, Gwendolyn; Nagler, Alisa; Moore, Peggy R; Schlueter, Joanne; Weinerth, John L; Cuffe, Michael S; Dzau, Victor J

2013-02-01

The Duke Medicine Graduate Medical Education Quasi-Endowment, established in 2006, provides infrastructure support and encourages educational innovation. The authors describe Duke's experience with the "grassroots innovation" part of the fund, the Duke Innovation Fund, and discuss the Innovation Fund's processes for application, review, and implementation, and also outcomes, impact, and intended and unintended consequences.In the five years of the Innovation Fund described (2007-2011), 105 projects have been submitted, and 78 have been funded. Thirty-seven projects have been completed. Approved funding ranged from $2,363 to $348,750, with an average award of $66,391. This represents 42% of funding originally requested. Funding could be requested for a period of 6 months to 3 years. The average duration of projects was 27 months, with a range from 6 months to 36 months. Eighty percent of projects were completed on time. Two projects were closed because of lack of progress and failure to adhere to reporting requirements. Thirty-nine are ongoing.Program directors report great success in meeting project outcomes and concrete impacts on resident and faculty attitudes and performance. Ninety-two percent report that their projects would have never been accomplished without this funding. Projects have resulted in at least 68 posters, abstracts, and peer-reviewed presentations. At least 12 peer-reviewed manuscripts were published.There has been tremendous diversity of projects; all 13 clinical departments have been represented. Interdepartmental and intradepartmental program cooperation has increased. This modest seed money has resulted in demonstrable sustainable impacts on teaching and learning, and increased morale and scholarly recognition.

Development of a Performance Improvement Program: A Workplace-Based Educational Intervention on Magnetic Resonance Imaging in Spinal Trauma.

PubMed

Kraus, Michael David; Mueller, Marguerite; Schmitz, Bernd; Cunningham, Michael; Gebhard, Florian

2016-01-01

Performance improvement (PI) programs are an educational tool used to analyze clinical performance of clinicians. The effect of this tool has not been fully explored in orthopedic and trauma surgery. A needs assessment was conducted in connection with a worldwide webinar on magnetic resonance imaging in spinal injuries to identify the clinical need for an educational intervention. A 3-step PI process was defined and implemented over a 6-month period in 1 hospital department. Opportunities for improvement were identified by applying a 10-item quality checklist to 26 cases. A focused educational intervention was delivered to address the identified gaps, and a set of 22 posteducation cases was compared. The department of radiology and the department of trauma surgery of a level I university hospital participated in this study. A total of 26 cases collected before the educational intervention showed several areas for potential improvement. Important information was not provided by the surgeons in their communication with the radiologist. The educational intervention outlined the data and suggested actions. Comparing the information transfer of the preintervention and postintervention data, there was a significant improvement following the intervention (p = 0.0013). Our PI program was able to demonstrate a significant influence on the behavior and the attitude of surgeons and radiologists. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A stratified response system for the emergency management of the severely injured.

PubMed

Lloyd, D A; Patterson, M; Robson, J; Phillips, B

2001-01-01

A decade ago, there were justifiable criticisms of the delivery of emergency care for injured patients in accident and emergency departments in the UK. To address this, a trauma management system was developed in 1991 at Alder Hey Hospital, Liverpool. This includes a trauma team, communication system, management guidelines and quality assurance. On admission to the accident and emergency department, injured patients are triaged to one of three levels of injury severity, and a multidisciplinary team lead by a paediatric surgeon or senior accident and emergency department physician is activated. The level of injury severity determines the composition of the trauma team. A care pathway based on ATLS/APLS principles has been developed. The response process as well patient management are documented and reviewed at a monthly audit meeting. Currently, more than 80% of eligible patients are managed using the trauma system, with an over-triage rate of about 25%. Regular modifications to the trauma system since its inception in 1991 have resulted in an efficient and effective management structure. Stratification of the trauma response has minimised unnecessary use of the multidisciplinary trauma team and ensures that mobilisation and use of hospital staff and resources are tailored to the needs of the injured patient. Although developed in a specialist children's hospital, the system could be adapted for any acute hospital.

Development and Evaluation of an Educational Initiative to Improve Hospital Personnel Preparedness to Care for Children with Autism Spectrum Disorder.

PubMed

Lucarelli, Jennifer; Welchons, Leah; Sideridis, Georgios; Sullivan, Nancy R; Chan, Eugenia; Weissman, Laura

2018-06-01

To evaluate the effectiveness of a multimodal educational curriculum on increasing hospital personnel's awareness of successful strategies and comfort in caring for children with autism spectrum disorder (ASD). We developed a 3-part training for front-line staff (i.e., front desk, clinical assistants, and phlebotomists) in 8 outpatient hospital departments frequented by patients with ASD. Following a needs assessment, participants completed an online educational module and then attended an in-person seminar tailored to each department. To evaluate training effectiveness, we administered pre-, immediate post-, and 1 month post-training surveys assessing personnel attitudes, comfort, perceived knowledge, and behaviors around caring for patients with ASD. We trained 168 staff members from 8 departments. On the needs assessment, participants (N = 129) reported a mean 2.5 behavioral incidents involving patients with ASD over the previous 3 months; 92% believed that the training would be helpful for their work. Across pre-, immediate- and 1-month post-training surveys, scores improved on all questions related to personnel attitudes about the importance of ASD-friendly care, comfort interacting with patients with ASD, perceived knowledge about ASD, and self-reported frequency of behaviors intended to help children with ASD adjust to the hospital setting (p < 0.05). There was no difference in baseline scores or change in scores between clinical and nonclinical personnel. On a program evaluation (N = 57), 81% rated the training as "very good" or "excellent," and 87% reported that they would be able to apply training material immediately to their role. This training initiative led to improvement in attitudes, comfort level, perceived knowledge, and self-reported behaviors of hospital personnel working with patients with ASD, which was maintained over 1 month.

[Determination of prognostic value of the OESIL risk score at 6 months in a Colombian cohort with syncope evaluated in the emergency department; first Latin American experience].

PubMed

Díaz-Tribaldos, Diana Carolina; Mora, Guillermo; Olaya, Alejandro; Marín, Jorge; Sierra Matamoros, Fabio

2017-07-14

To establish the prognostic value, with sensitivity, specificity, positive predictive value, and negative predictive value for the OESIL syncope risk score to predict the presentation of severe outcomes (death, invasive interventions, and readmission) after 6 months of observation in adults who consulted the emergency department due to syncope. Observational, prospective, and multicentre study with enrolment of subjects older than 18 years, who consulted in the emergency department due to syncope. A record was mad of the demographic and clinical information of all patients. The OESIL risk score was calculated, and severe patient outcomes were followed up during a 6 month period using telephone contact. A total of 161 patients met the inclusion criteria and were followed up for 6 months. A score above or equal to 2 in the risk score, classified as high risk, was present in 72% of the patients. The characteristics of the risk score to predict the combined outcome of mortality, invasive interventions, and readmission for a score above or equal to 2 were 75.7, 30.5, 43.1, and 64.4% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively. A score above or equal to 2 in the OESIL risk score applied in Colombian population was of limited use to predict the studied severe outcomes. This score will be unable to discriminate between patients that benefit of early admission and further clinical studies. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

EEG epileptiform abnormalities at admission to a rehabilitation department predict the risk of seizures in disorders of consciousness following a coma.

PubMed

Bagnato, Sergio; Boccagni, Cristina; Sant'Angelo, Antonino; Prestandrea, Caterina; Virgilio, Vittorio; Galardi, Giuseppe

2016-03-01

Seizures affect about a quarter of patients with disorders of consciousness (DOC) after a coma. We investigated whether the presence of epileptiform abnormalities (EAs) in the electroencephalogram (EEG) of patients with DOC may predict the occurrence of seizures. Moreover, we evaluated whether EAs have a prognostic role in these patients. This was a retrospective single-center cohort study of patients hospitalized between January 2005 and December 2014 in a rehabilitation department (mean time from acute brain injury: 46.1 days). We analyzed 30-minute EEGs at admittance for 112 patients with unresponsive wakefulness syndrome (UWS) or in a minimally conscious state (MCS), then compared occurrence of seizures over the following three months across patients with absent, unilateral, and bilateral EAs (generalized or bilateral independent). Outcomes at three months were assessed in the same groups using the Coma Recovery Scale Revised. Epileptiform abnormalities were observed in 38 patients (33.9%). Of these, 25 were unilateral, and 13 were bilateral. Seizures occurred in 84.6% of patients with bilateral EAs, which was significantly higher than in patients without EAs (10.8%, p<0.001) or with unilateral EAs (24%, p=0.001). The presence of EAs was not related to etiology or different DOC and did not significantly affect outcomes at three months. Patients with EAs at admission to a rehabilitation department have an increased risk of seizures. Specifically, most patients with bilateral EAs had seizures within the following 3 months. Evaluation of EAs in EEGs of patients with DOC may give valuable information in the management of antiepileptic drug treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

Digitizing Dissertations for an Institutional Repository: A Process and Cost Analysis*

PubMed Central

Piorun, Mary; Palmer, Lisa A.

2008-01-01

Objective: This paper describes the Lamar Soutter Library's process and costs associated with digitizing 300 doctoral dissertations for a newly implemented institutional repository at the University of Massachusetts Medical School. Methodology: Project tasks included identifying metadata elements, obtaining and tracking permissions, converting the dissertations to an electronic format, and coordinating workflow between library departments. Each dissertation was scanned, reviewed for quality control, enhanced with a table of contents, processed through an optical character recognition function, and added to the institutional repository. Results: Three hundred and twenty dissertations were digitized and added to the repository for a cost of $23,562, or $0.28 per page. Seventy-four percent of the authors who were contacted (n = 282) granted permission to digitize their dissertations. Processing time per title was 170 minutes, for a total processing time of 906 hours. In the first 17 months, full-text dissertations in the collection were downloaded 17,555 times. Conclusion: Locally digitizing dissertations or other scholarly works for inclusion in institutional repositories can be cost effective, especially if small, defined projects are chosen. A successful project serves as an excellent recruitment strategy for the institutional repository and helps libraries build new relationships. Challenges include workflow, cost, policy development, and copyright permissions. PMID:18654648

Immunisation coverage annual report, 2011.

PubMed

Hull, Brynley P; Dey, Aditi; Menzies, Rob I; Brotherton, Julia M; McIntyre, Peter B

2013-12-31

This, the 5th annual immunisation coverage report, documents trends during 2011 for a range of standard measures derived from Australian Childhood Immunisation Register data, and National Human Papillomavirus (HPV) Vaccination Program Register data. The proportion of children 'fully vaccinated' at 12, 24 and 60 months of age was 91.4%, 92.2% and 89.5% respectively. Although pneumococcal vaccine had similar coverage at 12 months to other vaccines, coverage was lower for rotavirus at 12 months (83.8%) and varicella at 24 months (83.9%). By late 2011, the percentage of children who received the 1st dose of DTPa vaccine dose at less than 8 weeks of age was greater than 50% in 3 jurisdictions, the Australian Capital Territory, Victoria, and Queensland and at 70% for New South Wales and Tasmania. Although coverage at 12 months of age was lower among Indigenous children than non-Indigenous children in all jurisdictions, the extent of the difference varied. Overall, coverage at 24 months of age exceeded that at 12 months of age nationally. At 60 months of age, there was dramatic variation between individual jurisdictions, ranging from coverage 8% lower in Indigenous children in South Australia to 6% higher in the Northern Territory. As previously documented, vaccines recommended for Indigenous children only (hepatitis A and pneumococcal polysaccharide vaccine) had suboptimal coverage at 60% and 68%, respectively. On-time receipt (before 49 months of age) of vaccines by Indigenous children at the 60-month milestone age improved between 2010 (18%) and 2011 (19%) but the disparity in on-time vaccination between Indigenous and non-Indigenous children increased at all 3 age milestones. The percentage of vaccine objectors in 2011 (1.7%) has increased from 2007 when it was 1.1%. Coverage data for the 3rd dose of HPV from the national HPV register in the school catch up program was 71% but was substantially lower for the catch-up program for women outside school (39%-67%), although this was an improvement from 2010. This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General's Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca.

Sialolithiasis removal under general anesthesia: A descriptive retrospective study in the maxillofacial surgery department in Lille University Hospital.

PubMed

Ruiz, R; Brygo, A; Nicot, R; Ferri, J

2018-04-01

Since the beginning of the use of sialendoscopy and extracorporeal lithotripsy, recommendations have changed. The purpose of this retrospective study was to evaluate the efficiency of our treatment protocol, without a lithotripter, under general anaesthesia in the Stomatology and Maxillofacial Surgery Department of Lille University Hospital. The secondary goals were to evaluate patient tolerance and satisfaction. All patients treated with sialendoscopy alone, sialendoscopy with a combined surgical approach or a transoral approach (TOA) (sialolithotomy) between January 2013 and December 2015 were included. Efficiency was judged by the number and size of the extracted calculi compared to those found on the preoperative CTS, the symptoms mentioned during the one month postoperative examination and the recurrence within 6 months (telephone follow-up). Success was attained when the calculus was completely eliminated and the patient was symptom free after one month and without recurrence through six months. On the other hand, failure was attained when the calculus could not be completely removed, there was remaining debris, the patient was still symptomatic after one month or if there was a recurrence before six months. The sialendoscopy success rate was 78.57% for the submandibular gland and 92.3% for the parotid gland. We had a 100% success rate with the combined approach for the parotid gland, we had a 96.7% success rate with TOA and we had a 100% success rate with TOA assisted with sialendoscopy. Our results conform with the literature and prompt us to suggest a protocol without a lithotripter. Copyright © 2017. Published by Elsevier Masson SAS.

Maternal behavior predicts infant neurophysiological and behavioral attention processes in the first year.

PubMed

Swingler, Margaret M; Perry, Nicole B; Calkins, Susan D; Bell, Martha Ann

2017-01-01

We apply a biopsychosocial conceptualization to attention development in the 1st year and examine the role of neurophysiological and social processes on the development of early attention processes. We tested whether maternal behavior measured during 2 mother-child interaction tasks when infants (N = 388) were 5 months predicted infant medial frontal (F3/F4) EEG power and observed attention behavior during an attention task at 10 months. After controlling for infant attention behavior and EEG power in the same task measured at an earlier 5-month time point, results indicated a significant direct and positive association from 5-month maternal positive affect to infant attention behavior at 10 months. However, maternal positive affect was not related to medial frontal EEG power. In contrast, 5-month maternal intrusive behavior was associated with infants' task-related EEG power change at the left frontal location, F3, at 10 months of age. The test of indirect effects from 5-month maternal intrusiveness to 10-month infant attention behavior via infants' EEG power change at F3 was significant. These findings suggest that the development of neural networks serving attention processes may be 1 mechanism through which early maternal behavior is related to infant attention development in the 1st year and that intrusive maternal behavior may have a particularly disruptive effect on this process. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Event-Related Potentials Discriminate Familiar and Unusual Goal Outcomes in 5-Month-Olds and Adults

ERIC Educational Resources Information Center

Michel, Christine; Kaduk, Katharina; Ní Choisdealbha, Áine; Reid, Vincent M.

2017-01-01

Previous event-related potential (ERP) work has indicated that the neural processing of action sequences develops with age. Although adults and 9-month-olds use a semantic processing system, perceiving actions activates attentional processes in 7-month-olds. However, presenting a sequence of action context, action execution and action conclusion…

[Economic impact of consultation-liaison psychiatry in a French University Hospital Centre].

PubMed

Yrondi, A; Petiot, D; Arbus, C; Schmitt, L

2016-02-01

In times of fiscal restraint for health structures, apart from the clinical input, it seems important to discuss the economic impact of liaison psychiatry. There are only a few studies on the economic added value provided by a liaison psychiatry team. In addition to this, only a few psychiatric pathologies are coded as they should be, hence we make the assumption of an additional development provided by a specialised team. Over a short period of 4months, in three departments of the Toulouse University Hospital Centre, the added value to the general pricing system of liaison psychiatry was studied. The population was represented by all the consecutive requests for consultations from patients over 18years old, men and women, hospitalised at that time. These three departments frequently request consultations with the psychiatry liaison team. They set a diagnostic, and if this is associated with a higher Homogeneous Group of Patients (HGP), it provides added value. Fifty-two patients benefited from a psychiatric consultation over 4months. The results highlight a development of € 8630.43 for the traumatology department, € 3325.03 for the internal medicine department, and € 513.61 for the haematology department over the study period. The overall development over this period was € 12,469.07. To our knowledge, this approach is one of the first in France to highlight an economic impact of the intervention of liaison psychiatry in the claiming departments. Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Exclusive breastfeeding for six months: the WHO six months recommendation in the Asia Pacific Region.

PubMed

Binns, Colin W; Lee, Mi Kyung

2014-01-01

In 2001 the World Health Assembly adopted the infant feeding strategy which included the recommendation for exclusive breastfeeding until 6 months of age with continued breastfeeding while complementary foods are introduced. This recommendation has been endorsed by many national authorities, professional organisations and most countries in the Asia Pacific Region. Reviews by WHO, the US Surgeon General, Agency for Healthcare Research and Quality, US Department of Health and Human Services and others have documented the many benefits of breastfeeding. The introduction of solid foods before six months of age is associated with increased rates of infection, reduced breastmilk production, disruption to the microbiome and possibly obesity. If solids are introduced at around six months (by 26 weeks) there is no evidence of increases in allergic diseases.

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

Code of Federal Regulations, 2014 CFR

2014-07-01

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

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

Behavioral Approach to Appropriate Antimicrobial Prescribing in Hospitals: The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) Participatory Intervention Study.

PubMed

Sikkens, Jonne J; van Agtmael, Michiel A; Peters, Edgar J G; Lettinga, Kamilla D; van der Kuip, Martijn; Vandenbroucke-Grauls, Christina M J E; Wagner, Cordula; Kramer, Mark H H

2017-08-01

Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs. To examine whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is effective in improving appropriateness of antimicrobial prescribing in hospitals. The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) study was a prospective, stepped-wedge, participatory intervention study performed from October 1, 2011, through December 31, 2015. Outcomes were measured during a baseline period of 16 months and an intervention period of 12 months. The study was performed at 7 clinical departments (2 medical, 3 surgical, and 2 pediatric) in a tertiary care medical center and a general teaching hospital in the Netherlands. Physicians prescribing systemic antimicrobial drugs for any indication for patients admitted to the participating departments during the study period were included in the study. We offered prescribers a free choice of how to improve their antimicrobial prescribing. Prescribers were stimulated to choose interventions with higher potential for success based on a root cause analysis of inappropriate prescribing. Appropriateness of antimicrobial prescriptions was determined using a validated approach based on guideline adherence and motivated guideline deviation and measured with repeated point prevalence surveys (6 per year). Appropriateness judgment was masked for the study period. Antimicrobial consumption was extracted from pharmacy records and measured as days of therapy per admission. We used linear and logistic mixed-model regression analysis to model outcomes over time. A total of 1121 patient cases with 700 antimicrobial prescriptions were assessed during the baseline period and 882 patient cases with 531 antimicrobial prescriptions during the intervention period. The mean antimicrobial appropriateness increased from 64.1% at intervention start to 77.4% at 12-month follow-up (+13.3%; relative risk, 1.17; 95% CI, 1.04-1.27), without a change in slope. No decrease in antimicrobial consumption was found. Use of a behavioral approach preserving prescriber autonomy resulted in an increase in antimicrobial appropriateness sustained for at least 12 months. The approach is inexpensive and could be easily transferable to various health care environments.

Behavioral Approach to Appropriate Antimicrobial Prescribing in Hospitals

PubMed Central

van Agtmael, Michiel A.; Peters, Edgar J. G.; Lettinga, Kamilla D.; van der Kuip, Martijn; Vandenbroucke-Grauls, Christina M. J. E.; Wagner, Cordula; Kramer, Mark H. H.

2017-01-01

Importance Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs. Objective To examine whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is effective in improving appropriateness of antimicrobial prescribing in hospitals. Design, Setting, and Participants The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) study was a prospective, stepped-wedge, participatory intervention study performed from October 1, 2011, through December 31, 2015. Outcomes were measured during a baseline period of 16 months and an intervention period of 12 months. The study was performed at 7 clinical departments (2 medical, 3 surgical, and 2 pediatric) in a tertiary care medical center and a general teaching hospital in the Netherlands. Physicians prescribing systemic antimicrobial drugs for any indication for patients admitted to the participating departments during the study period were included in the study. Interventions We offered prescribers a free choice of how to improve their antimicrobial prescribing. Prescribers were stimulated to choose interventions with higher potential for success based on a root cause analysis of inappropriate prescribing. Main Outcomes and Measures Appropriateness of antimicrobial prescriptions was determined using a validated approach based on guideline adherence and motivated guideline deviation and measured with repeated point prevalence surveys (6 per year). Appropriateness judgment was masked for the study period. Antimicrobial consumption was extracted from pharmacy records and measured as days of therapy per admission. We used linear and logistic mixed-model regression analysis to model outcomes over time. Results A total of 1121 patient cases with 700 antimicrobial prescriptions were assessed during the baseline period and 882 patient cases with 531 antimicrobial prescriptions during the intervention period. The mean antimicrobial appropriateness increased from 64.1% at intervention start to 77.4% at 12-month follow-up (+13.3%; relative risk, 1.17; 95% CI, 1.04-1.27), without a change in slope. No decrease in antimicrobial consumption was found. Conclusions and Relevance Use of a behavioral approach preserving prescriber autonomy resulted in an increase in antimicrobial appropriateness sustained for at least 12 months. The approach is inexpensive and could be easily transferable to various health care environments. PMID:28459929

14 CFR 291.60 - Public disclosure of data.

Code of Federal Regulations, 2014 CFR

2014-01-01

... PROCEEDINGS) ECONOMIC REGULATIONS CARGO OPERATIONS IN INTERSTATE AIR TRANSPORTATION Public Disclosure of Data... following the Department's determination that the database is complete, but no earlier than six months after...

14 CFR 291.60 - Public disclosure of data.

Code of Federal Regulations, 2013 CFR

2013-01-01

... PROCEEDINGS) ECONOMIC REGULATIONS CARGO OPERATIONS IN INTERSTATE AIR TRANSPORTATION Public Disclosure of Data... following the Department's determination that the database is complete, but no earlier than six months after...

14 CFR 291.60 - Public disclosure of data.

Code of Federal Regulations, 2012 CFR

2012-01-01

... PROCEEDINGS) ECONOMIC REGULATIONS CARGO OPERATIONS IN INTERSTATE AIR TRANSPORTATION Public Disclosure of Data... following the Department's determination that the database is complete, but no earlier than six months after...

14 CFR 291.60 - Public disclosure of data.

Code of Federal Regulations, 2011 CFR

2011-01-01

... PROCEEDINGS) ECONOMIC REGULATIONS CARGO OPERATIONS IN INTERSTATE AIR TRANSPORTATION Public Disclosure of Data... following the Department's determination that the database is complete, but no earlier than six months after...

7 CFR 996.17 - Quota year.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE MINIMUM QUALITY AND HANDLING... peanuts produced in Mexico and the 12-month period beginning April 1 and ending March 31 of the following...

7 CFR 996.17 - Quota year.

Code of Federal Regulations, 2010 CFR

2010-01-01

... and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE MINIMUM QUALITY AND HANDLING... peanuts produced in Mexico and the 12-month period beginning April 1 and ending March 31 of the following...

Puerto Rico Experimental Model Dental Auxiliary Training Program. The Comprehensive Report, October 22, 1976-February 24, 1980.

ERIC Educational Resources Information Center

Puerto Rico Univ., San Juan. School of Dentistry.

The Dental Auxiliary Department of the University of Puerto Rico designed a career option dental auxiliary training program which is a step ladder program with three exit points over a period of two academic years. The first option is a six-month track to train a traditional chairside dental auxiliary. The second option is a nine-month track to…

Recent regulatory experience of low-Btu coal gasification. Volume III. Supporting case studies

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

Ackerman, E.; Hart, D.; Lethi, M.

The MITRE Corporation conducted a five-month study for the Office of Resource Applications in the Department of Energy on the regulatory requirements of low-Btu coal gasification. During this study, MITRE interviewed representatives of five current low-Btu coal gasification projects and regulatory agencies in five states. From these interviews, MITRE has sought the experience of current low-Btu coal gasification users in order to recommend actions to improve the regulatory process. This report is the third of three volumes. It contains the results of interviews conducted for each of the case studies. Volume 1 of the report contains the analysis of themore » case studies and recommendations to potential industrial users of low-Btu coal gasification. Volume 2 contains recommendations to regulatory agencies.« less

Emergency department-based brief intervention to reduce risky driving and hazardous/harmful drinking in young adults: a randomized controlled trial.

PubMed

Sommers, Marilyn S; Lyons, Michael S; Fargo, Jamison D; Sommers, Benjamin D; McDonald, Catherine C; Shope, Jean T; Fleming, Michael F

2013-10-01

Risky driving and hazardous drinking are associated with significant human and economic costs. Brief interventions for more than one risky behavior have the potential to reduce health-compromising behaviors in populations with multiple risk-taking behaviors such as young adults. Emergency department (ED) visits provide a window of opportunity for interventions meant to reduce both risky driving and hazardous drinking. We determined the efficacy of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol addressing risky driving and hazardous drinking. We used a randomized controlled trial design with follow-ups through 12 months. ED patients aged 18 to 44 who screened positive for both behaviors (n = 476) were randomized to brief intervention (BIG), contact control (CCG), or no-contact control (NCG) groups. The BIG (n = 150) received a 20-minute assessment and two 20-minute interventions. The CCG (n = 162) received a 20-minute assessment at baseline and no intervention. The NCG (n = 164) were asked for contact information at baseline and had no assessment or intervention. Outcomes at 3, 6, 9, and 12 months were self-reported driving behaviors and alcohol consumption. Outcomes were significantly lower in BIG compared with CCG through 6 or 9 months, but not at 12 months: Safety belt use at 3 months (adjusted odds ratio [AOR], 0.22; 95% confidence interval [CI], 0.08 to 0.65); 6 months (AOR, 0.13; 95% CI, 0.04 to 0.42); and 9 months (AOR, 0.18; 95% CI, 0.06 to 0.56); binge drinking at 3 months (adjusted rate ratio [ARR] 0.84; 95% CI, 0.74 to 0.97) and 6 months (ARR, 0.81; 95% CI, 0.67 to 0.97); and ≥5 standard drinks/d at 3 months (AOR, 0.43; 95% CI, 0.20 to 0.91) and 6 months (AOR, 0.41; 95% CI, 0.17 to 0.98). No substantial differences were observed between BIG and NCG at 12 months. Our findings indicate that SBIRT reduced risky driving and hazardous drinking in young adults, but its effects did not persist after 9 months. Future research should explore methods for extending the intervention effect. Copyright © 2013 by the Research Society on Alcoholism.

Department of Education's College Construction Loan Programs. Hearing before a Subcommittee of the Committee on Government Operations. House of Representatives, Ninety-Eighth Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U. S., Washington, DC. House Committee on Government Operations.

This document records the hearing of a Subcommittee of the House on its 3-month investigation of the College Housing Loan Program and the Academic Facilities Loan Program, which are administered by the Department of Education. These programs have awarded about $5 billion in loans to finance the construction of dormitories, dining halls, student…

A floppy baby.

PubMed

Hebert, Katherine; Haritos, Demetris; Kannikeswaran, Nirupama

2015-06-01

Pompe disease is a rare inherited disorder of glycogen metabolism. We present a case of a 9-month-old infant who presented to the emergency department with generalized hypotonia and respiratory distress and was found to have Pompe disease. In this article, we will review the differential diagnosis of hypotonia in the infant, presentations of hypotonia that are relevant to the emergency department physician, as well as the diagnosis, management, and prognosis of Pompe disease.

Youth Alcohol Use and Dating Abuse Victimization and Perpetration: A Test of the Relationships at the Daily Level in a Sample of Pediatric Emergency Department Patients Who Use Alcohol

ERIC Educational Resources Information Center

Rothman, Emily F.; Stuart, Gregory L.; Winter, Michael; Wang, Na; Bowen, Deborah J.; Bernstein, Judith; Vinci, Robert

2012-01-01

Objective: This study retrospectively examined the daily-level associations between youth alcohol use and dating abuse (DA) victimization and perpetration for a 6-month period. Method: Timeline Followback (TLFB) interview data were collected from 397 urban emergency department patients, ages 17 to 21 years. Patients were eligible if they reported…

75 FR 77624 - Intent To Grant an Exclusive License for U.S. Army Owned Inventions to Polymer Processing Institute

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-13

... DEPARTMENT OF DEFENSE Department of the Army Intent To Grant an Exclusive License for U.S. Army Owned Inventions to Polymer Processing Institute AGENCY: Department of the Army, DoD. ACTION: Notice... contemplates granting an exclusive license to Polymer Processing Institute, a not-for-profit corporation having...

Phonological Processes in the Speech of Jordanian Arabic Children with Cleft Lip and/or Palate

ERIC Educational Resources Information Center

Al-Tamimi, Feda Y.; Owais, Arwa I.; Khabour, Omar F.; Khamaiseh, Zaidan A.

2011-01-01

The controlled and free speech of 15 Jordanian male and female children with cleft lip and/or palate was analyzed to account for the different phonological processes exhibited. Study participants were divided into three main age groups, 4 years 2 months to 4 years 7 months, 5 years 3 months to 5 years 6 months, and 6 years 4 months to 6 years 6…

Inactivation mechanisms of pathogenic bacteria in several matrixes during the composting process in a composting toilet.

PubMed

Sossou, S K; Hijikata, N; Sou, M; Tezuka, R; Maiga, A H; Funamizu, N

2014-01-01

This study aimed to compare the inactivation rate and the mechanisms of pathogenic bacteria in three matrixes (sawdust, rice husk and charcoal) during the composting process. The inactivation rate was evaluated with Escherichia coli strain and the damaged parts and/or functions were evaluated with three different media. Normalized inactivation rate constant in three media and from three matrixes had no significant difference in each process (pure, 1 month and 2 months). The value in rice husk was relatively increased during 2 months but there was no significant difference. The inactivation rate constants of Tryptic Soy Agar (TSA) and Compact Dry E. coli/Coliform in pure sawdust and rice husk were relatively lower than that of Desoxycholate Agar, but increased in 2 months. This indicated that damaging part was changed from outer membrane to enzymes and metabolisms during the 2-month composting process. In the case of charcoal, only the TSA value in apure matrix was relatively lower than that of others, but it increased in 2 months. This indicated that damaging part was changed from outer membrane and enzyme to metabolisms during the composting process. Composting matrix and composting process did not significantly affect inactivation rate of pathogenic bacteria during the process but affected the damaging part of the bacteria.

Enhanced interdisciplinary care improves self-care ability and decreases emergency department visits for older Taiwanese patients over 2 years after hip-fracture surgery: A randomised controlled trial.

PubMed

Shyu, Yea-Ing L; Liang, Jersey; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Chou, Shih-Wei; Chen, Ching-Yen; Yang, Ching-Tzu

2016-04-01

Little evidence is available on the longer-term effects (beyond 12 months) of intervention models consisting of hip fracture-specific care in conjunction with management of malnutrition, depression, and falls. To compare the relative effects of an interdisciplinary care, and a comprehensive care programme with those of usual care for elderly patients with a hip fracture on self-care ability, health care use, and mortality. Randomised experimental trial. A 3000-bed medical centre in northern Taiwan. Patients with hip fracture aged 60 years or older (N=299). Patients were randomly assigned to three groups: comprehensive care (n=99), interdisciplinary care (n=101), and usual care (control) (n=99). Usual care entailed only one or two in-hospital rehabilitation sessions. Interdisciplinary care included not only hospital rehabilitation, but also geriatric consultation, discharge planning, and 4-month in-home rehabilitation. Building upon interdisciplinary care, comprehensive care extended in-home rehabilitation to 12 months and added management of malnutrition and depressive symptoms, and fall prevention. Patients' self-care ability was measured by activities of daily living and instrumental activities of daily living using the Chinese Barthel Index and Chinese version Instrumental Activities of Daily Living scale, respectively. Outcomes were assessed before discharge, and 1, 3, 6, 12, 18, 24 months following hip fracture. Hierarchical linear models were used to analyse health outcomes and health care utilisation, including emergency department visit and hospital re-admission. The comprehensive care group had better performance trajectories for both measures of activities of daily living and fewer emergency department visits than the usual care group, but no difference in hospital readmissions. The interdisciplinary care and usual care groups did not differ in trajectories of self-care ability and service utilisation. The three groups did not differ in mortality during the 2-year follow-up. Comprehensive care, with enhanced rehabilitation, management of malnutrition and depressive symptoms, and fall prevention, improved self-care ability and decreased emergency department visits for elders up to 2 years after hip-fracture surgery, above and beyond the effects of usual care and interdisciplinary care. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Effect of Less-Lethal Weapons on Injuries in Police Use-of-Force Events

PubMed Central

Kaminski, Robert J.; Smith, Michael R.

2009-01-01

Objectives. We investigated the effect of the use of less-lethal weapons, conductive energy devices (CEDs), and oleoresin capsicum (OC) spray on the prevalence and incidence of injuries to police officers and civilians in encounters involving the use of force. Methods. We analyzed data from 12 police departments that documented injuries to officers and civilians in 24 380 cases. We examined monthly injury rates for 2 police departments before and after their adoption of CEDs. Results. Odds of injury to civilians and officers were significantly lower when police used CED weapons, after control for differences in case attributes and departmental policies restricting use of these weapons. Monthly incidence of injury in 2 police departments declined significantly, by 25% to 62%, after adoption of CED devices. Conclusions. Injuries sustained during police use-of-force events affect thousands of police officers and civilians in the United States each year. Incidence of these injuries can be reduced dramatically when law enforcement agencies responsibly employ less-lethal weapons in lieu of physical force. PMID:19846686

Natural gas monthly, August 1993

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

Not Available

1993-08-25

The Natural Gas Monthly (NGM) is prepared in the Data Operations Branch of the Reserves and Natural Gas Division, Office of Oil and Gas, Energy Information Administration (EIA), US Department of Energy (DOE). The NGM highhghts activities, events, and analyses of interest to public and private sector organizations associated with the natural gas industry. Volume and price data are presented each month for natural gas production, distribution, consumption, and interstate pipeline activities. Producer-related activities and underground storage data are also reported. From time to time, the NGM features articles designed to assist readers in using and interpreting natural gas information.

How EIA Estimates Natural Gas Production

EIA Publications

2004-01-01

The Energy Information Administration (EIA) publishes estimates monthly and annually of the production of natural gas in the United States. The estimates are based on data EIA collects from gas producing states and data collected by the U. S. Minerals Management Service (MMS) in the Department of Interior. The states and MMS collect this information from producers of natural gas for various reasons, most often for revenue purposes. Because the information is not sufficiently complete or timely for inclusion in EIA's Natural Gas Monthly (NGM), EIA has developed estimation methodologies to generate monthly production estimates that are described in this document.

Delirium in the Emergency Department and Its Extension into Hospitalization (DELINEATE) Study: Effect on 6-month Function and Cognition.

PubMed

Han, Jin H; Vasilevskis, Eduard E; Chandrasekhar, Rameela; Liu, Xulei; Schnelle, John F; Dittus, Robert S; Ely, E Wesley

2017-06-01

The natural course and clinical significance of delirium in the emergency department (ED) is unclear. We sought to (1) describe the extent to which delirium in the ED persists into hospitalization (ED delirium duration) and (2) determine how ED delirium duration is associated with 6-month functional status and cognition. Prospective cohort study. Tertiary care, academic medical center. ED patients ≥65 years old who were admitted to the hospital. The modified Brief Confusion Assessment Method was used to ascertain delirium in the ED and hospital. Premorbid and 6-month function were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire which ranged from 0 (completely dependent) to 28 (completely dependent). Premorbid and 6-month cognition were determined using the short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) which ranged from 1 to 5 (severe dementia). Multiple linear regression was performed to determine if ED delirium duration was associated with 6-month function and cognition adjusted for baseline OARS ADL and IQCODE, and other confounders. A total of 228 older ED patients were enrolled. Of the 105 patients who were delirious in the ED, 81 (77.1%) patients' delirium persisted into hospitalization. For every ED delirium duration day, the 6-month OARS ADL decreased by 0.63 points (95% CI: -1.01 to -0.24), indicating poorer function. For every ED delirium duration day, the 6-month IQCODE increased 0.06 points (95% CI: 0.01-0.10) indicating poorer cognition. Delirium in the ED is not a transient event and frequently persists into hospitalization. Longer ED delirium duration is associated with an incremental worsening of 6-month functional and cognitive outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Emergency Department Pain Management in Adult Patients With Traumatic Injuries Before and After Implementation of a Nurse-Initiated Pain Treatment Protocol Utilizing Fentanyl for Severe Pain.

PubMed

Ridderikhof, Milan L; Schyns, Frederick J; Schep, Niels W; Lirk, Philipp; Hollmann, Markus W; Goslings, J Carel

2017-04-01

Pain management in the emergency department (ED) remains suboptimal. Nursing staff protocols could improve this, but studies show divergent results. Our aim was to evaluate a nurse-initiated pain-management protocol in adult patients with traumatic injuries in the short and in the long term, utilizing fentanyl for severe pain. In this pre-post implementation study, ED patients were included during three periods. The protocol allowed nurses to administer acetaminophen, non-steroidal anti-inflammatory drugs, or fentanyl autonomously, based on Numeric Rating Scale pain scores. Primary outcome was frequency of analgesic administration at 6 and 18 months after implementation. Secondary outcomes were pain awareness, occurrence of adverse events, and pain treatment after discharge. Five hundred and twelve patients before implementation were compared with 507 and 468 patients at 6 and 18 months after implementation, respectively. Analgesic administration increased significantly at 18 months (from 29% to 36%; p = 0.016), not at 6 months (33%; p = 0.19) after implementation. Pain awareness increased from 30% to 51% (p = 0.00) at 6 months and to 56% (p = 0.00) at 18 months, due to a significant increase in pain assessment: 3% to 30% (p = 0.00) and 32% (p = 0.00), respectively. Post-discharge pain treatment increased significantly at 18 months compared to baseline (from 25% to 33%; p = 0.016) and to 6 months (from 24% to 33%; p = 0.004). No adverse events were recorded. Implementation of a nurse-initiated pain-management protocol only increases analgesic administration in adult patients with traumatic injuries in the long term. Auditing might have promoted adherence. Pain awareness increases significantly in the short and the long term. Copyright © 2016 Elsevier Inc. All rights reserved.

Promoting Gender Equity in Academic Departments: a Study of Department Heads in Top-Ranked Chemistry Departments

NASA Astrophysics Data System (ADS)

Stockard, Jean; Greene, Jessica; Lewis, Priscilla; Richmond, Geraldine

Although the proportion of doctoral degrees in chemistry that have gone to women has increased markedly over the past few decades, the representation of women among higher education faculty has not increased at the same rate. This paper reports the results of a systematic effort to change this pattern by increasing the commitment of department heads in leading departments to the hiring and support of women faculty. Results indicate that participants in a carefully planned intervention changed their attitudes regarding reasons underlying women's underrepresentation and barriers to their progress in the field from pre- to postworkshop. Participants also reported commitment to change immediately after the event and engaging in a number of specific change efforts in the following months. While the quality of these change efforts was not related to changes in attitudes, those with fewer women in their department were more likely to report more fully on change efforts.

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

Recording of community violence by medical and police services

PubMed Central

Sutherland, I; Sivarajasingam, V; Shepherd, J

2002-01-01

Objectives: To determine the extent to which community violence that results in injury treated in emergency departments appears in official police records and to identify age/gender groups at particular risk of under-recording by the police. Methods: Non-confidential data for patients with assault related injury treated in the emergency departments of two hospitals in one South Wales city (Swansea) during a six month period were compared with data relating to all recorded crimes in the category "Violence against the person" in the police area where the hospitals were located. Results: Over the six month period a total of 1513 assaults were recorded by Swansea emergency departments and the police (1019, 67.3% injured males and 494, 32.7% injured females). The majority of these assaults (993, 65.6%) were recorded exclusively by emergency departments; 357 (23.6%) were recorded only by the police and 163 (10.8%) were recorded by both emergency departments and the police. Equal proportions of males (67.3%) and females (67.5%) injured in assaults were recorded by both emergency departments and the police, but men were more likely to have their assault recorded exclusively in emergency departments (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.7 to 2.7) while women were more likely to have their assault recorded exclusively by the police (OR 2.5, 95% CI 2.0 to 3.2). There were no significant relationships between exclusive emergency department recording and increasing age (OR 1.0, 95% CI 0.9 to 1.2), exclusive police recording and increasing age (OR 1.1, 95% CI 1.0 to 1.2), or between age and dual recording (OR 0.9, 95% CI 0.8 to 1.0). Conclusions: Most assaults leading to emergency department treatment, particularly in which males were injured, were not recorded by the police. Assaults on the youngest group (0–10, particularly boys) were those least likely to be recorded by police and females over age 45, the most likely. Emergency department derived assault data provide unique perspectives of community violence and police detection. PMID:12226126

49 CFR 214.523 - Hi-rail vehicles.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF TRANSPORTATION RAILROAD WORKPLACE SAFETY On-Track Roadway Maintenance Machines and Hi-Rail... safety at least annually and with no more than 14 months between inspections. Tram, wheel wear, and gage...

49 CFR 214.523 - Hi-rail vehicles.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF TRANSPORTATION RAILROAD WORKPLACE SAFETY On-Track Roadway Maintenance Machines and Hi-Rail... safety at least annually and with no more than 14 months between inspections. Tram, wheel wear, and gage...

49 CFR 214.523 - Hi-rail vehicles.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF TRANSPORTATION RAILROAD WORKPLACE SAFETY On-Track Roadway Maintenance Machines and Hi-Rail... safety at least annually and with no more than 14 months between inspections. Tram, wheel wear, and gage...

49 CFR 214.523 - Hi-rail vehicles.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF TRANSPORTATION RAILROAD WORKPLACE SAFETY On-Track Roadway Maintenance Machines and Hi-Rail... safety at least annually and with no more than 14 months between inspections. Tram, wheel wear, and gage...