9 CFR 156.8 - Refusal of service; denial or withdrawal of service.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Refusal of service; denial or withdrawal of service. 156.8 Section 156.8 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE § 156.8 Refusal of...

9 CFR 156.8 - Refusal of service; denial or withdrawal of service.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Refusal of service; denial or withdrawal of service. 156.8 Section 156.8 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE § 156.8 Refusal of...

9 CFR 156.8 - Refusal of service; denial or withdrawal of service.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Refusal of service; denial or withdrawal of service. 156.8 Section 156.8 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE § 156.8 Refusal of...

9 CFR 156.8 - Refusal of service; denial or withdrawal of service.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Refusal of service; denial or withdrawal of service. 156.8 Section 156.8 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE § 156.8 Refusal of...

Design criteria for Reedy Creek Demonstration Project

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

Felicione, F.S.; Logan, J.A.

1980-11-01

This document defines the basic criteria for the 100-ton/day pilot plant which will use the Andco-Torrax pyrolysis process at Walt Disney World in Orlando, Florida, to produce hot water. The waste will simulate transuranic wastes which are stored at INEL. The Andco-Torrax process is designed to convert mixed municipal refuse into energy and is called slagging pyrolysis solid waste conversion. (DLC)

Critical Materials Needs

DTIC Science & Technology

1975-05-01

Waste-to-energy systems Recycling of materials from refuse Desulfurization of flue gases from electric power plants Sattelle Specialists...High-Temperature Gas -Turbine Engines for Automotive Applications Initiation of Task II and Task III (Task II: Description of Technologies and...3 - • Mining and Minerals Processing • Ocean Engineering • Transportation • Waste Treatment and Environmental Control The technologies

Combustion Power Unit--400: CPU-400.

ERIC Educational Resources Information Center

Combustion Power Co., Palo Alto, CA.

Aerospace technology may have led to a unique basic unit for processing solid wastes and controlling pollution. The Combustion Power Unit--400 (CPU-400) is designed as a turboelectric generator plant that will use municipal solid wastes as fuel. The baseline configuration is a modular unit that is designed to utilize 400 tons of refuse per day…

The impact of municipal refuse utilization on energy and our environment

NASA Technical Reports Server (NTRS)

1978-01-01

The incinerator/boiler configuration is stressed as the most reliable method of waste utilization. It is also pointed out that the high cost of refuse disposal and the ever increasing cost of energy, have made this method attractive. A plan is outlined for operating a waste utilization plant. Community participation is encouraged in investigating the feasibility of refuse to energy facilities in their area.

Response of crownvetch planted on anthracite breaker refuse

Treesearch

Miroslaw M. Czapowskyj; John P. Mikulecky; Edward A. Sowa

1968-01-01

Lime applications were essential to establishment of crownvetch (Coronilla vuria L.) on coal breaker refuse in the Pennsylvania Anthracite Region, and mulch treatments were highly beneficial. Fertilizer applications had only slight effect on either establishment or growth.

Integrated gasification and plasma cleaning for waste treatment: A life cycle perspective

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

Evangelisti, Sara; Tagliaferri, Carla; Advanced Plasma Power

2015-09-15

Highlights: • A life cycle assessment of an advanced two-stage process is undertaken. • A comparison of the impacts of the process when fed with 7 feedstock is presented. • Sensitivity analysis on the system is performed. • The treatment of RDF shows the lowest impact in terms of both GWP and AP. • The plasma shows a small contribution to the overall impact of the plant. - Abstract: In the past, almost all residual municipal waste in the UK was landfilled without treatment. Recent European waste management directives have promoted the uptake of more sustainable treatment technologies, especially formore » biodegradable waste. Local authorities have started considering other options for dealing with residual waste. In this study, a life cycle assessment of a future 20 MWe plant using an advanced two-stage gasification and plasma technology is undertaken. This plant can thermally treat waste feedstocks with different composition and heating value to produce electricity, steam and a vitrified product. The objective of the study is to analyse the environmental impacts of the process when fed with seven different feedstocks (including municipal solid waste, solid refuse fuel, reuse-derived fuel, wood biomass and commercial & industrial waste) and identify the process steps which contribute more to the environmental burden. A scenario analysis on key processes, such as oxygen production technology, metal recovery and the appropriate choice for the secondary market aggregate material, is performed. The influence of accounting for the biogenic carbon content in the waste from the calculations of the global warming potential is also shown. Results show that the treatment of the refuse-derived fuel has the lowest impact in terms of both global warming potential and acidification potential because of its high heating value. For all the other impact categories analysed, the two-stage gasification and plasma process shows a negative impact for all the waste streams considered, mainly due to the avoided burdens associated with the production of electricity from the plant. The plasma convertor, key characteristic of the thermal process investigated, although utilising electricity shows a relatively small contribution to the overall environmental impact of the plant. The results do not significantly vary in the scenario analysis. Accounting for biogenic carbon enhanced the performance of biomass and refuse-derived fuel in terms of global warming potential. The main analysis of this study has been performed from a waste management perspective, using 1 ton of waste as functional unit. A comparison of the results when 1 kWhe of electricity produced is used as functional unit shows similar trends for the environmental impact categories considered.« less

Refuse dumps from leaf-cutting ant nests reduce the intensity of above-ground competition among neighboring plants in a Patagonian steppe

NASA Astrophysics Data System (ADS)

Farji-Brener, Alejandro G.; Lescano, María Natalia

2017-11-01

In arid environments, the high availability of sunlight due to the scarcity of trees suggests that plant competition take place mainly belowground for water and nutrients. However, the occurrence of soil disturbances that increase nutrient availability and thereby promote plant growth may enhance shoot competition between neighboring plants. We conducted a greenhouse experiment to evaluate the influence of the enriched soil patches generated by the leaf-cutting ant, Acromyrmex lobicornis, on the performance of the alien forb Carduus thoermeri (Asteraceae) under different intraspecific competition scenarios. Our results showed that substrate type and competition scenario affected mainly aboveground plant growth. As expected, plants growing without neighbors and in nutrient-rich ant refuse dumps showed more aboveground biomass than plants growing with neighbors and in nutrient-poor steppe soils. However, aboveground competition was more intense in nutrient-poor substrates: plants under shoot and full competition growing in the nutrient-rich ant refuse dumps showed higher biomass than those growing on steppe soils. Belowground biomass was similar among focal plants growing under different substrate type. Our results support the traditional view that increments in resource availability reduce competition intensity. Moreover, the fact that seedlings in this sunny habitat mainly compete aboveground illustrates how limiting factors may be scale-dependent and change in importance as plants grow.

Perceived Quality of Informed Refusal Process: A Cross-Sectional Study from Iranian Patients' Perspectives.

PubMed

Farzandipour, Mehrdad; Sheikhtaheri, Abbas; Sadeqi Jabali, Monireh

2015-12-01

Patients have the right to refuse their treatment; however, this refusal should be informed. We evaluated the quality of the informed refusal process in Iranian hospitals from patients' viewpoints. To this end, we developed a questionnaire that covered four key aspects of the informed refusal process including; information disclosure, voluntariness, comprehension, and provider-patient relationship. A total of 284 patients who refused their treatment from 12 teaching hospitals in the Isfahan Province, Iran, were recruited and surveyed to produce a convenience sample. Patients' perceptions about the informed refusal process were scored and the mean scores of the four components were calculated. The findings showed that the practice of information disclosure (9.6 ± 6.4 out of 22 points) was perceived to be moderate, however, comprehension (2.3 ± 1.4 out of 4 points), voluntariness (8.7 ± 1.5 out of 12 points) and provider-patient relationship (10.2 ± 5.2 out of 16 points) were perceived to be relatively good. We found that patients, who refused their care before any treatment had commenced, reported a lower quality of information disclosure and voluntariness. Patients informed by nurses and those who had not had a previous related admission, reported lower scores for comprehension and relationship. In conclusion, the process of obtaining informed refusal was relatively satisfactory except for levels of information disclosure. To improve current practices, Iranian patients need to be better informed about; different treatment options, consequences of treatment refusal, costs of not continuing treatment and follow-ups after refusal. Developing more informative refusal forms is needed. © 2014 John Wiley & Sons Ltd.

Size-resolved trace metal characterization of aerosols emitted by four important source types in Switzerland

NASA Astrophysics Data System (ADS)

Buerki, Peter R.; Gaelli, Brigitte C.; Nyffeler, Urs P.

In central Switzerland five types of emission sources are mainly responsible for airborne trace metals: traffic, industrial plants burning heavy oil, resuspension of soil particles, residential heatings and refuse incineration plants. The particulate emissions of each of these source types except refuse incineration were sampled using Berner impactors and the mass and elemental size distributions of Cd, Cu, Mn, Pb, Zn, As and Na determined. Cd, Na and Zn are not characteristic for any of these source types. As and Cu, occurring in the fine particle fractions are characteristic for heavy oil combustion, Mn for soil dust and sometimes for heavy and fuel oil combustion and Pb for traffic aerosols. The mass size distributions of aerosols originating from erosion and abrasion processes show a maximum mass fraction in the coarse particle range larger than about 1 μm aerodynamic equivalent diameters (A.E.D.). Aerosols originating from combustion processes show a second maximum mass fraction in the fine particle range below about 0.5μm A.E.D. Scanning electron microscopy combined with an EDS analyzer was used for the morphological characterization of emission and ambient aerosols.

7 CFR 322.19 - Inspection; refusal of entry.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 5 2010-01-01 2010-01-01 false Inspection; refusal of entry. 322.19 Section 322.19 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation of...

7 CFR 322.34 - Inspection; refusal of entry.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 5 2010-01-01 2010-01-01 false Inspection; refusal of entry. 322.34 Section 322.34 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation and...

7 CFR 322.34 - Inspection; refusal of entry.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 5 2014-01-01 2014-01-01 false Inspection; refusal of entry. 322.34 Section 322.34 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation and...

7 CFR 322.19 - Inspection; refusal of entry.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 5 2011-01-01 2011-01-01 false Inspection; refusal of entry. 322.19 Section 322.19 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation of...

7 CFR 322.19 - Inspection; refusal of entry.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 5 2013-01-01 2013-01-01 false Inspection; refusal of entry. 322.19 Section 322.19 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation of...

7 CFR 322.19 - Inspection; refusal of entry.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 5 2012-01-01 2012-01-01 false Inspection; refusal of entry. 322.19 Section 322.19 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation of...

7 CFR 322.19 - Inspection; refusal of entry.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 5 2014-01-01 2014-01-01 false Inspection; refusal of entry. 322.19 Section 322.19 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation of...

7 CFR 322.34 - Inspection; refusal of entry.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 5 2013-01-01 2013-01-01 false Inspection; refusal of entry. 322.34 Section 322.34 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation and...

7 CFR 322.34 - Inspection; refusal of entry.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 5 2011-01-01 2011-01-01 false Inspection; refusal of entry. 322.34 Section 322.34 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation and...

7 CFR 322.34 - Inspection; refusal of entry.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 5 2012-01-01 2012-01-01 false Inspection; refusal of entry. 322.34 Section 322.34 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE BEES, BEEKEEPING BYPRODUCTS, AND BEEKEEPING EQUIPMENT Importation and...

ENVIRONMENTAL EFFECTS OF UTILIZING SOLID WASTE AS A SUPPLEMENTARY POWER PLANT FUEL

EPA Science Inventory

The results of 3 years of research on the utilization of shredded and magnetically separated municipal refuse to supplement high-sulfur coal as fuel in a stroker-fired boiler are presented. During the first half of the research, a refuse handling and furnace feed system consistin...

9 CFR 156.8 - Refusal of service; denial or withdrawal of service.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Refusal of service; denial or withdrawal of service. 156.8 Section 156.8 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE VOLUNTARY INSPECTION AND CERTIFICATION SERVICE VOLUNTARY INSPECTION AND...

ACOG Committee Opinion No. 306. Informed refusal.

PubMed

2004-12-01

Informed refusal is a fundamental component of the informed consent process. Informed consent laws have evolved to the "materiality or patient viewpoint" standard. A physician must disclose to the patient the risks, benefits, and alternatives that a reasonable person in the patient's position would want to know to make an informed decision. Throughout this process, the patient's autonomy, level of health literacy, and cultural background should be respected. The subsequent election by the patient to forgo an intervention that has been recommended by the physician constitutes informed refusal. Documentation of the informed refusal process is essential. It should include a notation that the need for the intervention, as well as risks, benefits, and alternatives to the intervention, and possible consequences of refusal, have been explained. The patient's reason for refusal also should be documented.

Production, quality and quality assurance of Refuse Derived Fuels (RDFs).

PubMed

Sarc, R; Lorber, K E

2013-09-01

This contribution describes characterization, classification, production, application and quality assurance of Refuse Derived Fuels (RDFs) that are increasingly used in a wide range of co-incineration plants. It is shown in this paper, that the fuel-parameter, i.e. net calorific value [MJ/kg(OS)], particle size d(90) or d(95) [mm], impurities [w%], chlorine content [w%], sulfur content [w%], fluorine content [w%], ash content [w%], moisture [w%] and heavy metals content [mg/kg(DM)], can be preferentially used for the classification of different types of RDF applied for co-incineration and substitution of fossil-fuel in different industial sectors. Describing the external production of RDF by processing and confectioning of wastes as well as internal processing of waste at the incineration plant, a case study is reported on the application of RDF made out of different household waste fractions in a 120,000t/yr Waste to Energy (WtE) circulating fluidized bed (CFB) incinerator. For that purpose, delivered wastes, as well as incinerator feedstock material (i.e. after internal waste processing) are extensively investigated. Starting with elaboration of sampling plan in accordance with the relevant guidelines and standards, waste from different suppliers was sampled. Moreover, manual sorting analyses and chemical analyses were carried out. Finally, results of investigations are presented and discussed in the paper. Copyright © 2013 Elsevier Ltd. All rights reserved.

36 CFR 6.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ashes, but not including metal or plastic. Solid waste means garbage, refuse, sludge from a waste treatment plant, water supply treatment plant, or air pollution control facility and other discarded...

36 CFR 6.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... ashes, but not including metal or plastic. Solid waste means garbage, refuse, sludge from a waste treatment plant, water supply treatment plant, or air pollution control facility and other discarded...

7 CFR 57.132 - Access to plants.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 3 2011-01-01 2011-01-01 false Access to plants. 57.132 Section 57.132 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Access to plants. Access shall not be refused to any representative of the Secretary to any plant, place...

7 CFR 57.132 - Access to plants.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 3 2014-01-01 2014-01-01 false Access to plants. 57.132 Section 57.132 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Access to plants. Access shall not be refused to any representative of the Secretary to any plant, place...

7 CFR 57.132 - Access to plants.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 3 2012-01-01 2012-01-01 false Access to plants. 57.132 Section 57.132 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... Access to plants. Access shall not be refused to any representative of the Secretary to any plant, place...

The effects of ant nests on soil fertility and plant performance: a meta-analysis.

PubMed

Farji-Brener, Alejandro G; Werenkraut, Victoria

2017-07-01

Ants are recognized as one of the major sources of soil disturbance world-wide. However, this view is largely based on isolated studies and qualitative reviews. Here, for the first time, we quantitatively determined whether ant nests affect soil fertility and plant performance, and identified the possible sources of variation of these effects. Using Bayesian mixed-models meta-analysis, we tested the hypotheses that ant effects on soil fertility and plant performance depend on the substrate sampled, ant feeding type, latitude, habitat and the plant response variable measured. Ant nests showed higher nutrient and cation content than adjacent non-nest soil samples, but similar pH. Nutrient content was higher in ant refuse materials than in nest soils. The fertilizer effect of ant nests was also higher in dry habitats than in grasslands or savannas. Cation content was higher in nests of plant-feeding ants than in nests of omnivorous species, and lower in nests from agro-ecosystems than in nests from any other habitat. Plants showed higher green/root biomass and fitness on ant nests soils than in adjacent, non-nest sites; but plant density and diversity were unaffected by the presence of ant nests. Root growth was particularly higher in refuse materials than in ant nest soils, in leaf-cutting ant nests and in deserts habitats. Our results confirm the major role of ant nests in influencing soil fertility and vegetation patterns and provide information about the factors that mediate these effects. First, ant nests improve soil fertility mainly through the accumulation of refuse materials. Thus, different refuse dump locations (external or in underground nest chambers) could benefit different vegetation life-forms. Second, ant nests could increase plant diversity at larger spatial scales only if the identity of favoured plants changes along environmental gradients (i.e. enhancing β-diversity). Third, ant species that feed on plants play a relevant role fertilizing soils, which may balance their known influence as primary consumers. Fourth, the effects of ant nests as fertility islands are larger in arid lands, possibly because fertility is intrinsically lower in these habitats. Overall, this study provide novel and quantitative evidence confirming that ant nests are key soil modifiers, emphasizing their role as ecological engineers. © 2017 The Authors. Journal of Animal Ecology © 2017 British Ecological Society.

Lime helps establish crownvetch on coal-breaker refuse

Treesearch

Miroslaw M. Czapowskyj; Edward A. Sowa

1976-01-01

A study was begun in 1965 to determine the effect of lime fertilizer, and mulch on the establishment and growth of crownvetch crowns planted on anthracite coal-breaker refuse. After 7 years the lime application had by far the strongest effect. Both 2.5 and 5.0 tons per acre increased survival and ground cover manyfold, and both treatments were equally beneficial from...

9 CFR 590.132 - Access to plants.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Access to plants. 590.132 Section 590... Service § 590.132 Access to plants. Access shall not be refused to any representative of the Secretary to any plant, place of business, or transport vehicle subject to inspection under the provisions of this...

9 CFR 590.132 - Access to plants.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Access to plants. 590.132 Section 590... Service § 590.132 Access to plants. Access shall not be refused to any representative of the Secretary to any plant, place of business, or transport vehicle subject to inspection under the provisions of this...

9 CFR 590.132 - Access to plants.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Access to plants. 590.132 Section 590... Service § 590.132 Access to plants. Access shall not be refused to any representative of the Secretary to any plant, place of business, or transport vehicle subject to inspection under the provisions of this...

9 CFR 590.132 - Access to plants.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Access to plants. 590.132 Section 590... Service § 590.132 Access to plants. Access shall not be refused to any representative of the Secretary to any plant, place of business, or transport vehicle subject to inspection under the provisions of this...

Management Impact Assessment of Refuse-Derived Fuel Implementation at Wright-Patterson Air Force Base.

DTIC Science & Technology

1982-03-19

high first and annually recurring costs of flue gas desulfurization . If our future coal systems have the technical flexibility to use these fuels...Democracy Lane Program Element: 64708F Fairfax, Virginia 22030 JON: 20545017 I. CONTROLLING OFFICE NAME AND ADDRESS 12. REPORT DATE Air Force Engineering...plants that supply both heating and process energy to large military installations, the majority of which are natural gas - and/or oil-fired. The goal is

Microbial community structure of leaf-cutter ant fungus gardens and refuse dumps.

PubMed

Scott, Jarrod J; Budsberg, Kevin J; Suen, Garret; Wixon, Devin L; Balser, Teri C; Currie, Cameron R

2010-03-29

Leaf-cutter ants use fresh plant material to grow a mutualistic fungus that serves as the ants' primary food source. Within fungus gardens, various plant compounds are metabolized and transformed into nutrients suitable for ant consumption. This symbiotic association produces a large amount of refuse consisting primarily of partly degraded plant material. A leaf-cutter ant colony is thus divided into two spatially and chemically distinct environments that together represent a plant biomass degradation gradient. Little is known about the microbial community structure in gardens and dumps or variation between lab and field colonies. Using microbial membrane lipid analysis and a variety of community metrics, we assessed and compared the microbiota of fungus gardens and refuse dumps from both laboratory-maintained and field-collected colonies. We found that gardens contained a diverse and consistent community of microbes, dominated by Gram-negative bacteria, particularly gamma-Proteobacteria and Bacteroidetes. These findings were consistent across lab and field gardens, as well as host ant taxa. In contrast, dumps were enriched for Gram-positive and anaerobic bacteria. Broad-scale clustering analyses revealed that community relatedness between samples reflected system component (gardens/dumps) rather than colony source (lab/field). At finer scales samples clustered according to colony source. Here we report the first comparative analysis of the microbiota from leaf-cutter ant colonies. Our work reveals the presence of two distinct communities: one in the fungus garden and the other in the refuse dump. Though we find some effect of colony source on community structure, our data indicate the presence of consistently associated microbes within gardens and dumps. Substrate composition and system component appear to be the most important factor in structuring the microbial communities. These results thus suggest that resident communities are shaped by the plant degradation gradient created by ant behavior, specifically their fungiculture and waste management.

7 CFR 330.211 - Labeling of plant pests for movement under permits.

Code of Federal Regulations, 2011 CFR

2011-01-01

... moved by mail may be refused entry unless the containers thereof bear such labels. Cargo shipments of... AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FEDERAL PLANT PEST REGULATIONS; GENERAL... or through the United States from places outside thereof by mail or cargo. (1) When a permit...

7 CFR 330.211 - Labeling of plant pests for movement under permits.

Code of Federal Regulations, 2014 CFR

2014-01-01

... moved by mail may be refused entry unless the containers thereof bear such labels. Cargo shipments of... AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FEDERAL PLANT PEST REGULATIONS; GENERAL... or through the United States from places outside thereof by mail or cargo. (1) When a permit...

7 CFR 330.211 - Labeling of plant pests for movement under permits.

Code of Federal Regulations, 2010 CFR

2010-01-01

... moved by mail may be refused entry unless the containers thereof bear such labels. Cargo shipments of... AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FEDERAL PLANT PEST REGULATIONS; GENERAL... or through the United States from places outside thereof by mail or cargo. (1) When a permit...

7 CFR 330.211 - Labeling of plant pests for movement under permits.

Code of Federal Regulations, 2013 CFR

2013-01-01

... moved by mail may be refused entry unless the containers thereof bear such labels. Cargo shipments of... AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FEDERAL PLANT PEST REGULATIONS; GENERAL... or through the United States from places outside thereof by mail or cargo. (1) When a permit...

7 CFR 330.211 - Labeling of plant pests for movement under permits.

Code of Federal Regulations, 2012 CFR

2012-01-01

... moved by mail may be refused entry unless the containers thereof bear such labels. Cargo shipments of... AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FEDERAL PLANT PEST REGULATIONS; GENERAL... or through the United States from places outside thereof by mail or cargo. (1) When a permit...

Management of MSW in Spain and recovery of packaging steel scrap.

PubMed

Tayibi, Hanan; Peña, Carmen; López, Félix A; López-Delgado, Aurora

2007-01-01

Packaging steel is more advantageously recovered and recycled than other packaging material due to its magnetic properties. The steel used for packaging is of high quality, and post-consumer waste therefore produces high-grade ferrous scrap. Recycling is thus an important issue for reducing raw material consumption, including iron ore, coal and energy. Household refuse management consists of collection/disposal, transport, and processing and treatment - incineration and composting being the most widely used methods in Spain. Total Spanish MSW production exceeds 21 million tons per year, of which 28.1% and 6.2% are treated in compost and incineration plants, respectively. This paper presents a comprehensive study of incineration and compost plants in Spain, including a review of the different processes and technologies employed and the characteristics and quality of the recovered ferrous scrap. Of the total amount of packaging steel scrap recovered from MSW, 38% comes from compost plants and 14% from incineration plants. Ferrous scrap from incineration plants presents a high degree of chemical alteration as a consequence of the thermal process to which the MSW is subjected, particularly the conditions in which the slag is cooled, and accordingly its quality diminishes. Fragmentation and magnetic separation processes produce an enhancement of the scrap quality. Ferrous scrap from compost plants has a high tin content, which negatively affects its recycling. Cleaning and detinning processes are required prior to recycling.

Outsourcing in the public refuse collection sector: exploiting old certainties or exploring new possibilities?

PubMed

Gustafsson, Ove; Saksvik, Per Øystein

2005-01-01

An outsourcing process in a medium-size city, by Norwegian standards, provided the background for our study. In 1996, the city council decided to contract out the refuse collection in half of its total area (the western part of the city), and to let the public refuse collection enterprise continue to collect in the other half of the area. The public enterprise also participated in the competitive tender, without success, however. The bid submitted by the public refuse collection enterprise was used as the basis for a benchmarking process performed by the chief administrative officer of the city in May 1999. The process resulted in the requirement that the public enterprise downsize its number of refuse collectors by 27 per cent. The city thus acquired a more cost-effective refuse collection system both in the western part, now run by a private company, and in the rest of the city, where the collection remained the responsibility of the public enterprise, in its newly pared-down and reorganized version. Detectable changes in the refuse collectors' health status in the three-year period immediately following the outsourcing constitute our main focus in this study. We found that the downsizing and reorganization of the public enterprise had a negative impact on the refuse collectors' health status. One year after the downsizing, six of the 27 refuse collectors remaining in the public enterprise had been diagnosed with heart problems or musculoskeletal pains that were sufficiently serious to form the basis of their individual approaches to secure a disability pension, which all six were in the process of acquiring. The registered sick leave among the refuse collectors showed a dramatic increase during the same period. We found clear indications that the refuse collectors remaining in the employment of the public enterprise had no alternatives in the labour market. Although not the focus of this study, we found that the totality of costs and benefits, not only for the enterprise in question, but also for local and national authorities, needs to be considered in any realistic assessment of the impact of public sector outsourcing of activities.

Assessment and analysis of aged refuse as ammonium-removal media for the treatment of landfill leachate.

PubMed

He, Yan; Li, Dan; Zhao, Youcai; Huang, Minsheng; Zhou, Gongming

2017-11-01

This is the first attempt to explore the sustainability of aged refuse as ammonium-removal media. Batch experiments combined with the aged-refuse-based reactor were performed to examine how the adsorption and desorption processes are involved in the ammonia removal via aged refuse media in this research. The results showed that the adsorption of ammonium by aged refuse occurred instantly and the adsorbed ammonium was stable and less exchangeable. The adsorption data fit the Freundlich isotherms well and the n value of 0.1-0.5 indicated that the adsorption of ammonium occurred easily. The maximum adsorbed ammonium occupied less than 10% of the cation exchange capacity in aged-refuse-based reactors owing to the high solid/liquid ratios (50:1-120:1). The synergistic transformations of ammonium within the aged-refuse-based reactor indicated that the cation exchange sites only provide temporary storage of ammonium, and the subsequent nitrification process can be considered the predominant restoration pathway of ammonium adsorption capacity of the reactor. It seems reasonable to assume that there is no expiry for the aged-refuse-based reactor in terms of ammonium removal owing to its bioregeneration via nitrification.

Clinical practice guidelines of the French Association for Supportive Care in Cancer and the French Society for Psycho-oncology: refusal of treatment by adults afflicted with cancer.

PubMed

Faivre, J C; Adam, V; Block, V; Metzger, M; Salleron, J; Dauchy, S

2017-11-01

The study's purpose was to develop practical guidelines for assessment and management of refusal of treatment by adults afflicted with cancer. The French Association for Supportive Care in Cancer and the French Society for Psycho-oncology gathered a task force that applied a consensus methodology to draft guidelines studied predisposing situations, the diagnosis, regulatory aspects, and the management of refusal of treatment by adults afflicted with cancer. We propose five guidelines: (1) be aware of the conditions/profiles of patients most often associated with refusal of treatment so as to adequately underpin the care and support measures; (2) understand the complexity of the process of refusal and knowing how to accurately identify the type and the modalities of the refused treatments; (3) apply a way to systematically analyze refusal, thereby promoting progression from a situation of disaccord toward a consensual decision; (4) devise procedures, according to the legal context, to address refusal of treatment that safeguards the stakeholders in situations of sustained disaccord; and (5) know the indications for ethical collective decision-making. The quality of the relationship between patients and health professionals, and the communication between them are essential components involved in reaching a point of consent or refusal of treatment. A process of systematic analysis of refusal is recommended as the only way to ensure that all of the physiological, psychological, and contextual elements that are potentially involved are taken into account.

[The refusal of nursing care by the families].

PubMed

Curchod, Claude; Fisher, Marion

2016-10-01

Caregiving is complex. While it is not easy to admit that the process can be refused by the patient, it is no easier when it is refused by the patient's family. Accepting this fact is however an essential stage in the relational and care processes. The family must therefore be supported by professionals in order to be able to make an enlightened choice. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Objective scoring of animal handling and stunning practices at slaughter plants.

PubMed

Grandin, T

1998-01-01

To develop objective methods for monitoring animal welfare at slaughter plants to ensure compliance with the Humane Methods of Slaughter Act. Survey of existing procedures. 24 federally inspected slaughter plants. 6 variables evaluated at each plant were stunning efficacy, insensibility of animals hanging on the bleeding rail, vocalization, electric prod use, number of animals slipping, and number of animals falling. Of 11 beef plants, only 4 were able to render 95% of cattle insensible with a single shot from a captive-bolt stunner. Personnel at 7 of 11 plants placed the stunning wand correctly on 99% or more of pigs and sheep. At 4 beef plants, percentage of cattle prodded with an electric prod ranged from 5% at a plant at which handlers only prodded cattle that refused to move to 90% at another plant. Use of electric prods at 6 pork plants scored for prod use ranged from 15 to almost 100% of pigs. Percentage of cattle that vocalized during stunning and handling ranged from 1.1% at a plant at which electric prods were only used on cattle that refused to move to 32% at another plant at which electric prods were used on 90% of cattle and a restraint device was inappropriately used to apply excessive pressure. To obtain the most accurate assessment of animal welfare at slaughter plants, it is important to score all of the aforementioned variables.

From in situ coal to the final coal product: A case study of the Danville Coal Member (Indiana)

USGS Publications Warehouse

Mastalerz, Maria; Padgett, P.L.

1999-01-01

A surface coal mine operation and preparation plant in southwestern Indiana was sampled to examine variations in coal quality and coal petrography parameters for the Danville Coal Member of the Dugger Formation (Pennsylvanian-Desmoinesian, Westphalian D). Representative samples from in situ coal, preparation plant feeds, and a final coal product were collected in order to compare coal quality, coal petrography, trace element concentrations, and ash chemistry of the coal to those of the product. Coal quality parameters of the in situ samples and various feeds, coarse refuse, and final product were variable. The quality of the final coal product was best predicted by the coal quality of the clean coal feed (from the middle portions of the seam). Some trace element contents, especially lead and arsenic, varied between the coal feeds and the product. Lead contents increased in the feeds and product compared to the channel sample of the raw coal, possibly due to contamination in the handling process.A surface coal mine operation and preparation plant in southwestern Indiana was sampled to examine variations in coal quality and coal petrography parameters for the Danville Coal Member of the Dugger Formation (Pennsylvanian-Desmoinesian, Westphalian D). Representative samples from in situ coal, preparation plant feeds, and a final coal product were collected in order to compare coal quality, coal petrography, trace element concentrations, and ash chemistry of the coal to those of the product. Coal quality parameters of the in situ samples and various feeds, coarse refuse, and final product were variable. The quality of the final coal product was best predicted by the coal quality of the clean coal feed (from the middle portions of the seam). Some trace element contents, especially lead and arsenic, varied between the coal feeds and the product. Lead contents increased in the feeds and product compared to the channel sample of the raw coal, possibly due to contamination in the handling process.

Studies find more alternatives to soil cover

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

Not Available

1984-02-01

Researchers from Southern Illinois University at Carbondale have experimented with planting forage grasses on acid coal refuse after deeply incorporating sewage sludge and limestone. Studies were conducted at Peabody Coal Co.'s Will Scarlet Mine, two miles north of Stonefort, IL. Digested liquid sewage sludge was hauled from the Chicago Sanitation District and deposited one meter deep into holding basins adjacent to the study site. The material was then dried in these basins for two years. In 1979, a specially modified cable trencher opened trenches 8 cm wide to depths of 30 cm and 60 cm for various treatments. Researchers depositedmore » the dried sludge using a silage wagon and spread the limestone by hand. Eleven different treatments of sludge and limestone were deposited at the two different incorporation depths. In March 1981 three grasses--reed canary grass, red top, and tall fescue--were seeded in a randomized complete block design within each of the eleven treatments. The deep incorporation of sewage sludge and/or limestone improved the physical and chemical properties of the coal refuse sufficiently to establish and maintain good stands of these forage grasses. Also, in spite of the high concentration of heavy metals in coal refuse amended with sewage sludge, the plant uptake was less than the maximum suggested level for feed. Analysis showed that the sewage sludge increased the organic matter of the coal refuse and decreased the bulk density. Water retention was higher in the sewage sludge amended treatments, but there were no differences in the availability of water. The pH of coal refuse increased from 2.5 to 5.0 at higher rates of sludge or limestone.« less

Treatment for School Refusal among Children and Adolescents: A Systematic Review and Meta-Analysis

ERIC Educational Resources Information Center

Maynard, Brandy R.; Heyne, David; Brendel, Kristen Esposito; Bulanda, Jeffery J.; Thompson, Aaron M.; Pigott, Terri D.

2018-01-01

Objective: School refusal is a psychosocial problem associated with adverse short- and long-term consequences for children and adolescents. The authors conducted a systematic review and meta-analysis to examine the effects of psychosocial treatments for children and adolescents with school refusal. Method: A comprehensive search process was used…

Plant growth promoting rhizobacteria and endophytes accelerate phytoremediation of metalliferous soils.

PubMed

Ma, Y; Prasad, M N V; Rajkumar, M; Freitas, H

2011-01-01

Technogenic activities (industrial-plastic, textiles, microelectronics, wood preservatives; mining-mine refuse, tailings, smelting; agrochemicals-chemical fertilizers, farm yard manure, pesticides; aerosols-pyrometallurgical and automobile exhausts; biosolids-sewage sludge, domestic waste; fly ash-coal combustion products) are the primary sources of heavy metal contamination and pollution in the environment in addition to geogenic sources. During the last two decades, bioremediation has emerged as a potential tool to clean up the metal-contaminated/polluted environment. Exclusively derived processes by plants alone (phytoremediation) are time-consuming. Further, high levels of pollutants pose toxicity to the remediating plants. This situation could be ameliorated and accelerated by exploring the partnership of plant-microbe, which would improve the plant growth by facilitating the sequestration of toxic heavy metals. Plants can bioconcentrate (phytoextraction) as well as bioimmobilize or inactivate (phytostabilization) toxic heavy metals through in situ rhizospheric processes. The mobility and bioavailability of heavy metal in the soil, particularly at the rhizosphere where root uptake or exclusion takes place, are critical factors that affect phytoextraction and phytostabilization. Developing new methods for either enhancing (phytoextraction) or reducing the bioavailability of metal contaminants in the rhizosphere (phytostabilization) as well as improving plant establishment, growth, and health could significantly speed up the process of bioremediation techniques. In this review, we have highlighted the role of plant growth promoting rhizo- and/or endophytic bacteria in accelerating phytoremediation derived benefits in extensive tables and elaborate schematic sketches. Copyright © 2010 Elsevier Inc. All rights reserved.

40 CFR 62.14840 - What definitions must I know?

Code of Federal Regulations, 2013 CFR

2013-07-01

... primary chamber. Solid waste means any garbage, refuse, sludge from a waste treatment plant, water supply treatment plant, or air pollution control facility and other discarded material, including solid, liquid... vegetative agricultural materials such as nut and grain hulls and chaff (e.g., almond, walnut, peanut, rice...

40 CFR 62.14840 - What definitions must I know?

Code of Federal Regulations, 2012 CFR

2012-07-01

... primary chamber. Solid waste means any garbage, refuse, sludge from a waste treatment plant, water supply treatment plant, or air pollution control facility and other discarded material, including solid, liquid... vegetative agricultural materials such as nut and grain hulls and chaff (e.g., almond, walnut, peanut, rice...

40 CFR 62.14840 - What definitions must I know?

Code of Federal Regulations, 2014 CFR

2014-07-01

... primary chamber. Solid waste means any garbage, refuse, sludge from a waste treatment plant, water supply treatment plant, or air pollution control facility and other discarded material, including solid, liquid... vegetative agricultural materials such as nut and grain hulls and chaff (e.g., almond, walnut, peanut, rice...

Grid-connected integrated community energy system. Phase II, Stage 2, final report. Preliminary design pyrolysis facility. [Andco-Torrax system

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

Not Available

The University of Minnesota is studying and planning a grid connected integrated community energy system to include disposal of wastes from health centers and utilizing the heat generated. The University of Minnesota has purchased the so called Southeast Generating Station from the Northern States Power Company. This plant contains two coal-fired boilers that will be retrofitted to burn low-sulfur Montana coal. Building modifications and additions will be made to support the components of the Andco-Torrax system and integrate the system with the rest of the plant. The Andco-Torrax system is a new high-temperature refuse-conversion process known technically as slagging pyrolysis.more » Although the pyrolysis of solid waste is a relatively new innovation, pyrolysis processes have been used for years by industry. This report covers the preliminary design and operation of the system. (MCW)« less

Waste-to-methanol: Process and economics assessment.

PubMed

Iaquaniello, Gaetano; Centi, Gabriele; Salladini, Annarita; Palo, Emma; Perathoner, Siglinda; Spadaccini, Luca

2017-11-01

The waste-to-methanol (WtM) process and related economics are assessed to evidence that WtM is a valuable solution both from economic, strategic and environmental perspectives. Bio-methanol from Refuse-derived-fuels (RdF) has an estimated cost of production of about 110€/t for a new WtM 300t/d plant. With respect to waste-to-energy (WtE) approach, this solution allows various advantages. In considering the average market cost of methanol and the premium as biofuel, the WtM approach results in a ROI (Return of Investment) of about 29%, e.g. a payback time of about 4years. In a hybrid scheme of integration with an existing methanol plant from natural gas, the cost of production becomes a profit even without considering the cap for bio-methanol production. The WtM process allows to produce methanol with about 40% and 30-35% reduction in greenhouse gas emissions with respect to methanol production from fossil fuels and bio-resources, respectively. Copyright © 2017 Elsevier Ltd. All rights reserved.

Separation of harmful impurities from refuse derived fuels (RDF) by a fluidized bed.

PubMed

Krüger, B; Mrotzek, A; Wirtz, S

2014-02-01

In firing systems of cement production plants and coal-fired power plants, regular fossil fuels are increasingly substituted by alternative fuels. Rising energy prices and ambitious CO2-reduction goals promote the use of alternative fuels as a significant contribution to efficient energy recovery. One possibility to protect energy resources are refuse-derived fuels (RDF), which are produced during the treatment of municipal solid, commercial and industrial waste. The waste fractions suitable for RDF have a high calorific value and are often not suitable for material recycling. With current treatment processes, RDF still contains components which impede the utilization in firing systems or limit the degree of substitution. The content of these undesired components may amount to 4 wt%. These, in most cases incombustible particles which consist of mineral, ceramic and metallic materials can cause damages in the conveying systems (e. g. rotary feeder) or result in contaminations of the products (e. g. cement, chalk). Up-to-date separation processes (sieve machine, magnet separator or air classifier) have individual weaknesses that could hamper a secure separation of these particles. This article describes a new technology for the separation of impurities from refuse derived fuels based on a rotating fluidized bed. In this concept a rotating motion of the particle bed is obtained by the tangential injection of the fluidization gas in a static geometry. The RDF-particles experience a centrifugal force which fluidized the bed radially. The technical principle allows tearing up of particle clusters to single particles. Radially inwards the vertical velocity is much lower thus particles of every description can fall down there. For the subsequent separation of the particles by form and density an additionally cone shaped plate was installed in the centre. Impurities have a higher density and a compact form compared to combustible particles and can be separated with a high efficiency. The new technology was experimentally investigated and proven using model-RDF, actual-RDF and impurities of different densities. In addition, numerical simulations were also done. The fluidization chamber was operated in batch mode. The article describes experiences and difficulties in using rotating fluidized bed systems. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Some aspects of the management of house-hold refuse].

PubMed

Festy, B

1991-01-01

Each day the average Frenchman produces near 1 kg of HHR, mainly paper and cardboard, vegetal and animal putrescible residues, glass, plastics, metals, ashes,... giving four important linked fractions of recyclable, biodegradable, combustible and inert matters. Production and precollection of HHR are of direct concern for the user, mainly in the collective housing; but the rubbish chute acts as a brake to the selective collection of HHR, which is one aspect of the valorization process of HHR, growing up in France. Three other treatments are used: combustion in plants with or without energy recovery, biological degradation of HHR as a compost used in agriculture, and dumping on or in the ground. All of them have advantages and disadvantages and then they must be used in complement of each other. The treatment units have some pollution effects on the environment and must be watched. Treatment refuses and solid, liquid or gaseous pollutants must be managed as much as HHR themselves. Three examples of collection-treatment-elimination french units are briefly described in Dunkerque (a mean town with selective collection), Bourgneuf-en-Mauges (a rural country with biological treatment and dumping) and Paris (a big town with a new incineration plan). Then the state of the management of HHR in France in 1989 is described with special attention to collection (99.4% of the population), recovery of glass (25%) and paper-cardboard (42%) and authorized treatment (94%) as dumping (43%), incineration (40.5%) and biological (7.5%). Accent is made about the importance of prevention (decrease of refuse production, way of consumption and life style, education of the masses) and of a good management of the HHR and of their treatment refuses and pollutants to limit environmental degradation.

1. GENERAL VIEW FROM BONY PILE LOOKING SOUTH. WASH HOUSE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. GENERAL VIEW FROM BONY PILE LOOKING SOUTH. WASH HOUSE IN LEFT BACKGROUND. TIPPLE AND CLEANING PLANT TO RIGHT. IN CENTER IS A TANK USED FOR TREATING MINE REFUSE AND ACID RUNOFF. - Eureka No. 40, Tipple & Cleaning Plant, East of State Route 56, north of Little Paint Creek, Scalp Level, Cambria County, PA

Sewage sludge drying process integration with a waste-to-energy power plant.

PubMed

Bianchini, A; Bonfiglioli, L; Pellegrini, M; Saccani, C

2015-08-01

Dewatered sewage sludge from Waste Water Treatment Plants (WWTPs) is encountering increasing problems associated with its disposal. Several solutions have been proposed in the last years regarding energy and materials recovery from sewage sludge. Current technological solutions have relevant limits as dewatered sewage sludge is characterized by a high water content (70-75% by weight), even if mechanically treated. A Refuse Derived Fuel (RDF) with good thermal characteristics in terms of Lower Heating Value (LHV) can be obtained if dewatered sludge is further processed, for example by a thermal drying stage. Sewage sludge thermal drying is not sustainable if the power is fed by primary energy sources, but can be appealing if waste heat, recovered from other processes, is used. A suitable integration can be realized between a WWTP and a waste-to-energy (WTE) power plant through the recovery of WTE waste heat as energy source for sewage sludge drying. In this paper, the properties of sewage sludge from three different WWTPs are studied. On the basis of the results obtained, a facility for the integration of sewage sludge drying within a WTE power plant is developed. Furthermore, energy and mass balances are set up in order to evaluate the benefits brought by the described integration. Copyright © 2015 Elsevier Ltd. All rights reserved.

Parental Refusal of Vitamin K and Neonatal Preventive Services: A Need for Surveillance.

PubMed

Marcewicz, Lauren H; Clayton, Joshua; Maenner, Matthew; Odom, Erika; Okoroh, Ekwutosi; Christensen, Deborah; Goodman, Alyson; Warren, Michael D; Traylor, Julie; Miller, Angela; Jones, Timothy; Dunn, John; Schaffner, William; Grant, Althea

2017-05-01

Objectives Vitamin K deficiency bleeding (VKDB) in infants is a coagulopathy preventable with a single dose of injectable vitamin K at birth. The Tennessee Department of Health (TDH) and Centers for Disease Control and Prevention (CDC) investigated vitamin K refusal among parents in 2013 after learning of four cases of VKDB associated with prophylaxis refusal. Methods Chart reviews were conducted at Nashville-area hospitals for 2011-2013 and Tennessee birthing centers for 2013 to identify parents who had refused injectable vitamin K for their infants. Contact information was obtained for parents, and they were surveyed regarding their reasons for refusing. Results At hospitals, 3.0% of infants did not receive injectable vitamin K due to parental refusal in 2013, a frequency higher than in 2011 and 2012. This percentage was much higher at birthing centers, where 31% of infants did not receive injectable vitamin K. The most common responses for refusal were a belief that the injection was unnecessary (53%) and a desire for a natural birthing process (36%). Refusal of other preventive services was common, with 66% of families refusing vitamin K, newborn eye care with erythromycin, and the neonatal dose of hepatitis B vaccine. Conclusions for Practice Refusal of injectable vitamin K was more common among families choosing to give birth at birthing centers than at hospitals, and was related to refusal of other preventive services in our study. Surveillance of vitamin K refusal rates could assist in further understanding this occurrence and tailoring effective strategies for mitigation.

Refuse derived soluble bio-organics enhancing tomato plant growth and productivity.

PubMed

Sortino, Orazio; Dipasquale, Mauro; Montoneri, Enzo; Tomasso, Lorenzo; Perrone, Daniele G; Vindrola, Daniela; Negre, Michele; Piccone, Giuseppe

2012-10-01

Municipal bio-refuse (CVD), containing kitchen wastes, home gardening residues and public park trimmings, was treated with alkali to yield a soluble bio-organic fraction (SBO) and an insoluble residue. These materials were characterized using elemental analysis, potentiometric titration, and 13C NMR spectroscopy, and then applied as organic fertilizers to soil for tomato greenhouse cultivation. Their performance was compared with a commercial product obtained from animal residues. Plant growth, fruit yield and quality, and soil and leaf chemical composition were the selected performance indicators. The SBO exhibited the best performance by enhancing leaf chlorophyll content, improving plant growth and fruit ripening rate and yield. No product performance-chemical composition relationship could be assessed. Solubility could be one reason for the superior performance of SBO as a tomato growth promoter. The enhancement of leaf chlorophyll content is discussed to identify a possible link with the SBO photosensitizing properties that have been demonstrated in other work, and thus with photosynthetic performance. Copyright © 2012 Elsevier Ltd. All rights reserved.

Parental Refusal of Vitamin K and Neonatal Preventive Services: A Need for Surveillance

PubMed Central

Marcewicz, Lauren H.; Clayton, Joshua; Maenner, Matthew; Odom, Erika; Okoroh, Ekwutosi; Christensen, Deborah; Goodman, Alyson; Warren, Michael D.; Traylor, Julie; Miller, Angela; Jones, Timothy; Dunn, John; Schaffner, William; Grant, Althea

2017-01-01

Objectives Vitamin K deficiency bleeding (VKDB) in infants is a coagulopathy preventable with a single dose of injectable vitamin K at birth. The Tennessee Department of Health (TDH) and Centers for Disease Control and Prevention (CDC) investigated vitamin K refusal among parents in 2013 after learning of four cases of VKDB associated with prophylaxis refusal. Methods Chart reviews were conducted at Nashville-area hospitals for 2011–2013 and Tennessee birthing centers for 2013 to identify parents who had refused injectable vitamin K for their infants. Contact information was obtained for parents, and they were surveyed regarding their reasons for refusing. Results At hospitals, 3.0% of infants did not receive injectable vitamin K due to parental refusal in 2013, a frequency higher than in 2011 and 2012. This percentage was much higher at birthing centers, where 31% of infants did not receive injectable vitamin K. The most common responses for refusal were a belief that the injection was unnecessary (53%) and a desire for a natural birthing process (36%). Refusal of other preventive services was common, with 66% of families refusing vitamin K, newborn eye care with erythromycin, and the neonatal dose of hepatitis B vaccine. Conclusions for Practice Refusal of injectable vitamin K was more common among families choosing to give birth at birthing centers than at hospitals, and was related to refusal of other preventive services in our study. Surveillance of vitamin K refusal rates could assist in further understanding this occurrence and tailoring effective strategies for mitigation. PMID:28054156

49 CFR 40.191 - What is a refusal to take a DOT drug test, and what are the consequences?

Code of Federal Regulations, 2011 CFR

2011-10-01

..., you have refused to take a drug test if you: (1) Fail to appear for any test (except a pre-employment... the testing site before the testing process commences (see § 40.63 (c)) for a pre-employment test is... pre-employment test is not deemed to have refused to test; (4) In the case of a directly observed or...

49 CFR 40.191 - What is a refusal to take a DOT drug test, and what are the consequences?

Code of Federal Regulations, 2013 CFR

2013-10-01

..., you have refused to take a drug test if you: (1) Fail to appear for any test (except a pre-employment... the testing site before the testing process commences (see § 40.63 (c)) for a pre-employment test is... pre-employment test is not deemed to have refused to test; (4) In the case of a directly observed or...

49 CFR 40.191 - What is a refusal to take a DOT drug test, and what are the consequences?

Code of Federal Regulations, 2012 CFR

2012-10-01

..., you have refused to take a drug test if you: (1) Fail to appear for any test (except a pre-employment... the testing site before the testing process commences (see § 40.63 (c)) for a pre-employment test is... pre-employment test is not deemed to have refused to test; (4) In the case of a directly observed or...

Effective pine bark composting with the Dome Aeration Technology

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

Trois, Cristina; Polster, Andreas

2007-07-01

In South Africa garden refuse is primarily disposed of in domestic landfills. Due to the large quantities generated, any form of treatment would be beneficial for volume reduction, waste stabilization and resource recovery. Dome Aeration Technology (DAT) is an advanced process for aerobic biological degradation of garden refuse and general waste [Paar, S., Brummack, J., Gemende, B., 1999a. Advantages of dome aeration in mechanical-biological waste treatment. In: Proceedings of the 7th International Waste Management and Landfill Symposium, Cagliari, 4-8 October 1999; Paar, S., Brummack, J., Gemende, B., 1999b. Mechanical-biological waste stabilization by the dome aeration method. Environment Protection Engineering 25more » (3/99). Mollekopf, N., Brummack, J., Paar, S., Vorster, K., 2002. Use of the Dome Aeration Technology for biochemical stabilization of waste prior to landfilling. In: Proceedings of the Wastecon 2002, Waste Congress and Exhibition, Durban, South Africa.]. It is a non-reactor open windrow composting process, with the main advantage being that the input material needs no periodic turning. A rotting time of only 3-4 months indicates the high efficiency. Additionally, the low capital/operational costs, low energy inputs and limited plant requirements provide potential for use in aerobic refuse stabilization. The innovation in the DAT process is the passive aeration achieved by thermally driven advection through open windrows caused by temperature differences between the degrading material and the outside environment. This paper investigates the application of Dome Aeration Technology to pine bark composting as part of an integrated waste management strategy. A full-scale field experiment was performed at the Bisasar Road Landfill Site in Durban to assess the influence of climate, waste composition and operational conditions on the process. A test windrow was constructed and measurements of temperature and airflow through the material were taken. The process monitoring revealed that prevailing climatic conditions in a subtropical location do not affect the high efficiency of this technology. However, the composition of the input material can be detrimental for production of high quality compost because of a lack of nitrate.« less

Recruitment of black and Latina women to a randomized controlled trial.

PubMed

Martin, Anika; Negron, Rennie; Balbierz, Amy; Bickell, Nina; Howell, Elizabeth A

2013-08-01

Minority women are often not adequately represented in randomized controlled trials, limiting the generalizability of research trial results. We implemented a recruitment strategy for a postpartum depression prevention trial that utilized patient feedback to identify and understand the recruitment barriers of black and Latina postpartum women. Feedback on patients' reasons for trial refusal informed adaptations to the recruitment process. We calculated weekly recruitment rates and analyzed qualitative and quantitative data from patient refusals. Of the 668 women who were approached and completed the consent process, 540 enrolled in the trial and 128 declined participation. Over 52-weeks of recruitment, refusal rates decreased from 40% to 19%. A taxonomy of eight reasons for refusal derived from patient responses identified barriers to recruitment and generated targeted revisions to the recruitment message. A recruitment strategy designed to incorporate and respond to patient feedback improved recruitment of Black and Latina women to a clinical trial.

76 FR 77502 - Intent To Prepare a Draft Environmental Impact Statement Regarding the Wolfpen Knob Development...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-13

... the Clean Water Act, may have related to discharges of dredge and fill material into Waters of the... deep mine, a preparation plant, a refuse disposal site, a water impoundment, and a new rail line. The... water impoundment would provide water for the operation of the preparation plant and dust control at the...

Material flow-based economic assessment of landfill mining processes.

PubMed

Kieckhäfer, Karsten; Breitenstein, Anna; Spengler, Thomas S

2017-02-01

This paper provides an economic assessment of alternative processes for landfill mining compared to landfill aftercare with the goal of assisting landfill operators with the decision to choose between the two alternatives. A material flow-based assessment approach is developed and applied to a landfill in Germany. In addition to landfill aftercare, six alternative landfill mining processes are considered. These range from simple approaches where most of the material is incinerated or landfilled again to sophisticated technology combinations that allow for recovering highly differentiated products such as metals, plastics, glass, recycling sand, and gravel. For the alternatives, the net present value of all relevant cash flows associated with plant installation and operation, supply, recycling, and disposal of material flows, recovery of land and landfill airspace, as well as landfill closure and aftercare is computed with an extensive sensitivity analyses. The economic performance of landfill mining processes is found to be significantly influenced by the prices of thermal treatment (waste incineration as well as refuse-derived fuels incineration plant) and recovered land or airspace. The results indicate that the simple process alternatives have the highest economic potential, which contradicts the aim of recovering most of the resources. Copyright © 2016 Elsevier Ltd. All rights reserved.

Medication Refusal: Resident Rights, Administration Dilemma.

PubMed

Haskins, Danielle R; Wick, Jeannette Y

2017-12-01

Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.

A review of technologies and performances of thermal treatment systems for energy recovery from waste.

PubMed

Lombardi, Lidia; Carnevale, Ennio; Corti, Andrea

2015-03-01

The aim of this work is to identify the current level of energy recovery through waste thermal treatment. The state of the art in energy recovery from waste was investigated, highlighting the differences for different types of thermal treatment, considering combustion/incineration, gasification and pyrolysis. Also different types of wastes - Municipal Solid Waste (MSW), Refuse Derived Fuel (RDF) or Solid Refuse Fuels (SRF) and some typologies of Industrial Waste (IW) (sludge, plastic scraps, etc.) - were included in the analysis. The investigation was carried out mainly reviewing papers, published in scientific journals and conferences, but also considering technical reports, to gather more information. In particular the goal of this review work was to synthesize studies in order to compare the values of energy conversion efficiencies measured or calculated for different types of thermal processes and different types of waste. It emerged that the dominant type of thermal treatment is incineration associated to energy recovery in a steam cycle. When waste gasification is applied, the produced syngas is generally combusted in a boiler to generate steam for energy recovery in a steam cycle. For both the possibilities--incineration or gasification--co-generation is the mean to improve energy recovery, especially for small scale plants. In the case of only electricity production, the achievable values are strongly dependent on the plant size: for large plant size, where advanced technical solutions can be applied and sustained from an economic point of view, net electric efficiency may reach values up to 30-31%. In small-medium plants, net electric efficiency is constrained by scale effect and remains at values around 20-24%. Other types of technical solutions--gasification with syngas use in internally fired devices, pyrolysis and plasma gasification--are less common or studied at pilot or demonstrative scale and, in any case, offer at present similar or lower levels of energy efficiency. Copyright © 2014 Elsevier Ltd. All rights reserved.

Knowledge-based fault diagnosis system for refuse collection vehicle

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

Tan, CheeFai; Juffrizal, K.; Khalil, S. N.

The refuse collection vehicle is manufactured by local vehicle body manufacturer. Currently; the company supplied six model of the waste compactor truck to the local authority as well as waste management company. The company is facing difficulty to acquire the knowledge from the expert when the expert is absence. To solve the problem, the knowledge from the expert can be stored in the expert system. The expert system is able to provide necessary support to the company when the expert is not available. The implementation of the process and tool is able to be standardize and more accurate. The knowledgemore » that input to the expert system is based on design guidelines and experience from the expert. This project highlighted another application on knowledge-based system (KBS) approached in trouble shooting of the refuse collection vehicle production process. The main aim of the research is to develop a novel expert fault diagnosis system framework for the refuse collection vehicle.« less

Reconceptualizing Efficacy in Substance Use Prevention Research: Refusal Response Efficacy and Drug Resistance Self-Efficacy in Adolescent Substance Use

PubMed Central

Choi, Hye Jeong; Krieger, Janice L.; Hecht, Michael L.

2014-01-01

The purpose of this study is to utilize the Extended Parallel Process Model (EPPM) to expand the construct of efficacy in the adolescent substance use context. Using survey data collected from 2,129 seventh-grade students in 39 rural schools, we examined the construct of drug refusal efficacy and demonstrated relationships among response efficacy (RE), self-efficacy (SE), and adolescent drug use. Consistent with the hypotheses, confirmatory factor analyses of a 12-item scale yielded a three-factor solution: refusal RE, alcohol-resistance self-efficacy (ASE), and marijuana-resistance self-efficacy (MSE). Refusal RE and ASE/MSE were negatively related to alcohol use and marijuana use, whereas MSE was positively associated with alcohol use. These data demonstrate that efficacy is a broader construct than typically considered in drug prevention. Prevention programs should reinforce both refusal RE and substance-specific resistance SE. PMID:23330857

Need for improvements in physical pretreatment of source-separated household food waste.

PubMed

Bernstad, A; Malmquist, L; Truedsson, C; la Cour Jansen, J

2013-03-01

The aim of the present study was to investigate the efficiency in physical pretreatment processes of source-separated solid organic household waste. The investigation of seventeen Swedish full-scale pretreatment facilities, currently receiving separately collected food waste from household for subsequent anaerobic digestion, shows that problems with the quality of produced biomass and high maintenance costs are common. Four full-scale physical pretreatment plants, three using screwpress technology and one using dispergation technology, were compared in relation to resource efficiency, losses of nitrogen and potential methane production from biodegradable matter as well as the ratio of unwanted materials in produced biomass intended for wet anaerobic digestion. Refuse generated in the processes represent 13-39% of TS in incoming wet waste. The methane yield from these fractions corresponds to 14-36Nm(3)/ton separately collected solid organic household waste. Also, 13-32% of N-tot in incoming food waste is found in refuse. Losses of both biodegradable material and nutrients were larger in the three facilities using screwpress technology compared to the facility using dispersion technology.(1) Thus, there are large potentials for increase of both the methane yield and nutrient recovery from separately collected solid organic household waste through increased efficiency in facilities for physical pretreatment. Improved pretreatment processes could thereby increase the overall environmental benefits from anaerobic digestion as a treatment alternative for solid organic household waste. Copyright © 2012 Elsevier Ltd. All rights reserved.

Occupational factors and pancreatic cancer.

PubMed Central

Norell, S; Ahlbom, A; Olin, R; Erwald, R; Jacobson, G; Lindberg-Navier, I; Wiechel, K L

1986-01-01

The relation between occupational factors and pancreatic cancer has been studied by two different approaches: a population based case-control study with two series of controls and a retrospective cohort study based on register data. With both approaches, some support was found for an association with occupational exposure to petroleum products. Associations were also indicated with exposure to paint thinner (case-control study) and work in painting and in paint and varnish factories (cohort study), for exposure to detergents, floor cleaning agents, or polish (case-control study) and with floor polishing or window cleaning (cohort study), and for exposure to refuse (case-control study) and work in refuse disposal plants (cohort study). PMID:3790458

A novel aerobic sulfate reduction process in landfill mineralized refuse.

PubMed

Liu, Weijia; Long, Yuyang; Fang, Yuan; Ying, Luyao; Shen, Dongsheng

2018-05-08

It is thought that mineralized refuse could be excavated from almost-full landfill sites to provide space for the increasing burden of municipal solid waste. When excavating, however, the H 2 S emissions from the mineralized waste need to be considered carefully. In an attempt to understand how H 2 S emissions might change during this excavation process, we carried out a series of tests, including exposing anaerobic mineralized refuse to oxygen, isolating and determining possible functional bacteria, and characterizing the electron donors and/or acceptors. The results showed that H 2 S would be released when landfill mineralized refuse was exposed to oxygen (O 2 ), and could reach concentrations of 6 mg m -3 , which was 3 times the concentrations of H 2 S released from anaerobic mineralized refuse. Sulfur-metabolized microorganisms accounted for only 0.5% of the microbial functional bacteria (MFB) derived from the mineralized refuse when exposed to O 2 for 60 days, and SRB were not present. The MFB maintained H 2 S production by aerobic sulfate reduction using SO 4 2- and S 2 O 3 2- as electron acceptors, and sulfate-reducing rates of 16% and 55%, respectively, were achieved. Lactate and S 2 O 3 2- were the preferred electron donor and acceptor, respectively. By enhancing the carbon source and electron transfer, MFB may undergo strong aerobic sulfate reduction even at low abundances of sulfur-metabolized microorganisms. Copyright © 2018 Elsevier B.V. All rights reserved.

Women's, midwives' and obstetricians' experiences of a structured process to document refusal of recommended maternity care.

PubMed

Jenkinson, Bec; Kruske, Sue; Stapleton, Helen; Beckmann, Michael; Reynolds, Maree; Kildea, Sue

2016-12-01

Ethical and professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy; the right to refuse care is well established. However, the existing literature is largely silent on the appropriate clinical responses when pregnant women refuse recommended care, and accounts of disrespectful interactions and conflict are numerous. Policies and processes to support women and maternity care providers are rare and unstudied. To document the perspectives of women, midwives and obstetricians following the introduction of a structured process (Maternity Care Plan; MCP) to document refusal of recommended maternity care in a large tertiary maternity unit. A qualitative, interpretive study involved thematic analysis of in-depth semi-structured interviews with women (n=9), midwives (n=12) and obstetricians (n=9). Four major themes were identified including: 'Reassuring and supporting clinicians'; 'Keeping the door open'; 'Varied awareness, criteria and use of the MCP process' and 'No guarantees'. Clinicians felt protected and reassured by the structured documentation and communication process and valued keeping women engaged in hospital care. This, in turn, protected women's access to maternity care. However, the process could not guarantee favourable responses from other clinicians subsequently involved in the woman's care. Ongoing discussions of risk, perceived by women and some midwives to be pressure to consent to recommended care, were still evident. These limitations may have been attributable to the absence of agreed criteria for initiating the MCP process and fragmented care. Varying awareness and use of the process also diminished women's access to it. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

75 FR 76085 - Endangered and Threatened Wildlife and Plants; Designation of Critical Habitat for the Polar Bear...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-07

... and post cards, citizen petitions, e-mail or web messages, and public hearing testimony. We received... humans,'' should include some reference to polar bear use of human refuse dumps and attraction to camps...

37 CFR 1.127 - Petition from refusal to admit amendment.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 37 Patents, Trademarks, and Copyrights 1 2014-07-01 2014-07-01 false Petition from refusal to admit amendment. 1.127 Section 1.127 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE GENERAL RULES OF PRACTICE IN PATENT CASES National Processing...

37 CFR 1.127 - Petition from refusal to admit amendment.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 37 Patents, Trademarks, and Copyrights 1 2011-07-01 2011-07-01 false Petition from refusal to admit amendment. 1.127 Section 1.127 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE GENERAL RULES OF PRACTICE IN PATENT CASES National Processing...

[Refusal of treatments by an adult cancer patient].

PubMed

Dauchy, Sarah; Faivre, Jean-Christophe; Block, Véronique; Metzger, Maude; Salleron, Julia; Charles, Cécile; Adam, Virginie

2018-03-01

Refusal of treatment questions the treatment's adequacy as well as the quality of the care relationship. A rigorous analysis of these situations is necessary in order to respect the patient's fundamental right to decide for him/herself while preventing a potential loss of chance. This paper proposes practical guidelines for assessment and management of the refusal of treatment by adult cancer patients. The French Association for Supportive Care in Cancer and the French Society for Psycho-Oncology formed a task force that applied a consensus methodology to draft guidelines. We propose five guidelines: (1) be informed of the conditions most often associated with refusal of treatment so as to reinforce adequate support measures; (2) understand the complexity of the process of refusal and accurately identify what is precisely refused; (3) apply an approach of systematic analysis to refusal, to try and increase the possibilities of finding an agreement while reinforcing the respect of the patient's position; (4) establish a legal procedure to address refusal of treatment that safeguards the stakeholders when no accord can be found; and (5) know the indications for ethical collective decision-making. A systematic assessment procedure of treatment refusal is necessary in order to ensure that all the physical, psychological and contextual aspects of it are taken into account, and to provide patients with the best treatment possible. The setting of good care relationship, the improvement of communication skills training and of comprehensive multidisciplinary care are all crucial elements in the prevention of these situations. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Informed, advance refusals of treatment by people with severe mental illness in a randomised controlled trial of joint crisis plans: demand, content and correlates.

PubMed

Henderson, Claire; Farrelly, Simone; Flach, Clare; Borschmann, Rohan; Birchwood, Max; Thornicroft, Graham; Waheed, Waquas; Szmukler, George

2017-11-24

In the UK, crisis planning for mental health care should acknowledge the right to make an informed advance treatment refusal under the Mental Capacity Act 2005. Our aims were to estimate the demand for such treatment refusals within a sample of service users who had had a recent hospital admission for psychosis or bipolar disorder, and to examine the relationship between refusals, and service user characteristics. To identify refusals we conducted content analysis of Joint Crisis Plans, which are plans formulated by service users and their clinical team with involvement from an external facilitator, and routine care plans in sub-samples from a multi-centre randomised controlled trial of Joint Crisis Plans (plus routine mental health care) versus routine care alone (CRIMSON) in England. Factors hypothesised to be associated with refusals were identified using the trial data collected through baseline interviews of service users and clinicians and collection of routine clinical data. Ninety-nine of 221 (45%) of the Joint Crisis Plans contained a treatment refusal compared to 10 of 424 (2.4%) baseline routine care plans. No Joint Crisis Plans recorded disagreement with refusals on the part of clinicians. Among those with completed Joint Crisis Plans, adjusted analyses indicated a significant association between treatment refusals and perceived coercion at baseline (odds ratio = 1.21, 95% CI 1.02-1.43), but not with baseline working alliance or a past history of involuntary admission. We demonstrated significant demand for written treatment refusals in line with the Mental Capacity Act 2005, which had not previously been elicited by the process of treatment planning. Future treatment/crisis plans should incorporate the opportunity for service users to record a treatment refusal during the drafting of such plans. ISRCTN11501328 Registered 13th March 2008.

Contamination of water due to major industries and open refuse dumping in the steel city of Orissa--a case study.

PubMed

Mishra, P C; Behera, P C; Patel, R K

2005-04-01

Contamination of ground water is common in the areas surrounded by industrial refuse dumping sites and the probability of contamination is more where dumping is done in low lying areas and the rate of percolation through the soil is high. In order to assess the ground water pollution by leachate around the refuse dumping site, eighteen wells were selected for study. Few wells are nearer to the dumps, few are far away and others are in between. Also an attempt has been made to evaluate the effect of industrial effluents on the ground and surface water due to Integrated Rourkela Steel Plant and other major industries. From the analytical data of physico-chemical parameters, it is indicated that the river water is contaminated mainly due to the industrial and municipal effluents and the ground water of some of the analyzed areas is contaminated due to municipal and industrial solid waste dumping.

Chemical mass balance source apportionment of TSP in a lignite-burning area of Western Macedonia, Greece

NASA Astrophysics Data System (ADS)

Samara, Constantini

Total suspended particle mass concentrations (TSP) were determined in the Kozani-Ptolemais-Florina basin (western Macedonia, Greece), an area with intensive lignite burning for power generation. The study was conducted over a 1-year period (November 2000-November 2001) at 10 receptor sites located at variable distances from the power plants. Ambient TSP samples were analyzed for 27 major, minor and trace elements. Particulate emissions were also collected from a variety of sources including fly ash, lignite dust, automobile traffic, domestic heating, and open-air burning of agricultural biomass and refuse, and analyzed for the same chemical components. Ambient and source chemical profiles were used for source identification and apportionment of TSP by employing a chemical mass balance (CMB) receptor model. Diesel burning in vehicular traffic and in the power plants for generator start up was found to be the major contributor to ambient TSP levels at all 10 sites. Other sources with significant contributions were domestic coal burning, vegetative burning (wood combustion and agricultural burns) and refuse open-air burning. Fly ash escaping the electrostatic precipitators of the power plants was a minor contributor to ambient TSP.

Sampling, characterisation and processing of solid recovered fuel production from municipal solid waste: An Italian plant case study.

PubMed

Ranieri, Ezio; Ionescu, Gabriela; Fedele, Arcangela; Palmieri, Eleonora; Ranieri, Ada Cristina; Campanaro, Vincenzo

2017-08-01

This article presents the classification of solid recovered fuel from the Massafra municipal solid waste treatment plant in Southern Italy in compliancy with the EN 15359 standard. In order to ensure the reproducibility of this study, the characterisation methods of waste input and output flow, the mechanical biological treatment line scheme and its main parameters for each stage of the processing chain are presented in details, together with the research results in terms of mass balance and derived fuel properties. Under this study, only 31% of refused municipal solid waste input stream from mechanical biological line was recovered as solid recovered fuel with a net heating value (NC=HV) average of 15.77 MJ kg -1 ; chlorine content average of 0.06% on a dry basis; median of mercury <0.0064 mg MJ -1 and 80th percentile <0.0068 mg MJ -1 . The solid recovered fuel produced meets the European Union standard requirements and can be classified with the class code: Net heating value (3); chlorine (1); mercury (1).

Parental psychological symptoms and familial risk factors of children and adolescents who exhibit school refusal.

PubMed

Bahali, K; Tahiroglu, A Y; Avci, A; Seydaoglu, G

2011-12-01

To assess the levels of psychological symptoms in the parents of children with school refusal and determine the familial risk factors in its development. This study was performed on 55 pairs of parents who had children exhibiting school refusal and were compared with a control group. A socio-demographic data form, the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Symptom Checklist-90 revised were applied to these parents. Parents of the school refusal group had higher anxiety and depression scores than the controls. Among the risk factors for school refusal, physical punishment by the parents, a history of organic disease in the parents or children, and a history of psychiatric disorders in the parents or other relatives were found to be significant. Depending on genetic and environmental factors, parents with psychiatric disorders appeared to be associated with development of psychiatric disorders in their children. Moreover, psychiatric disorders in parents negatively affected the treatment of their children and adolescents who exhibited school refusal. It is therefore vital to treat psychiatric disorders of parents with the children having psychiatric disorders, and thus increase parent participation in their children's therapeutic process.

EFFECT OF LAND DISPOSAL APPLICATIONS OF MUNICIPAL ENVIRONMENTAL WASTES ON CROP YIELDS AND HEAVY METAL UPTAKE

EPA Science Inventory

This report provides the cumulative data acquired from 1969 through 1975 from field and greenhouse investigations pertaining to the effects on selected soils and plants from municipal compost and sewage sludge applications. Multiple applications of composted municipal refuse resu...

The Sources of Air Pollution and Their Control.

ERIC Educational Resources Information Center

National Air Pollution Control Administration (DHEW), Arlington, VA.

The problems of air pollution and its control are discussed. Major consideration is given the sources of pollution - motor vehicles, industry, power plants, space heating, and refuse disposal. Annual emission levels of five principle pollutants - carbon monoxide, sulfur dioxide, nitrogen oxides, hydrocarbons, and particulate matter - are listed…

Consent and refusal in dementia research: conceptual and practical considerations.

PubMed

Cohen-Mansfield, J

2003-01-01

This article discusses types of consent refusals, rates of refusal, factors that affect consent, and methods to increase rates of consent in elderly research participants and in those with dementia in particular. Refusals can be categorized according to several types: complete refusal, refusal that is time-contingent, partial refusal, and contingent agreement. Rates of consent vary greatly across studies of persons with dementia. This variation can also be affected by different methodologies of calculating rates, in addition to differences in content of studies, populations, and procedures. To warrant consent, a study must first be scientifically sound, with a high likelihood of advancing knowledge, and must provide maximal protection to participants. Consent rates are affected by the following factors: levels of anticipated risks and benefits of the study, relationships among the different caregivers involved in the care of the potential subject, the ability of the researcher to properly identify and locate the person who needs to provide consent, characteristics and attitudes of the person providing consent, and the method of obtaining consent, including timing, location, method of presentation, and type of consent requested. An understanding of these issues can assist the researcher in tailoring research procedures so as to maximize rates of consent. It also raises ethical issues that warrant further discussion concerning the process of obtaining consent from and for persons with dementia.

7 CFR 319.8-8 - Lint, linters, and waste.

Code of Federal Regulations, 2011 CFR

2011-01-01

... before release, or (b) to an approved mill or plant for utilization. (2) Entry of lint, linters, and..., of vacuum fumigation as a condition of entry and the substitution of approved utilization therefor... reasonable time to observe the methods of handling the material, the disposal of refuse, residues, waste, and...

Advancing our Understanding of the Etiologies and Mutational Landscapes of Basal-Like, Luminal A, and Luminal B Breast Cancers

DTIC Science & Technology

2015-11-30

consents and conducting telephone interviews. A total of 1082 cases and controls have been enrolled in the study. Case enrollment is on target and...Subject Refusal 148 78 226 Subject Refusal CSS Opt Out 21 NA 21 TOTAL IN PROCESS FOR INTERVIEW 551 34 585 TOTAL ENROLLED 958 124 1082

Decision-making capacity should not be decisive in emergencies.

PubMed

Hubbeling, Dieneke

2014-05-01

Examples of patients with anorexia nervosa, depression or borderline personality disorder who have decision-making capacity as currently operationalized, but refuse treatment, are discussed. It appears counterintuitive to respect their treatment refusal because their wish seems to be fuelled by their illness and the consequences of their refusal of treatment are severe. Some proposed solutions have focused on broadening the criteria for decision-making capacity, either in general or for specific patient groups, but these adjustments might discriminate against particular groups of patients and render the process less transparent. Other solutions focus on preferences expressed when patients are not ill, but this information is often not available. The reason for such difficulties with assessing decision-making capacity is that the underlying psychological processes of normal decision-making are not well known and one cannot differentiate between unwise decisions caused by an illness or other factors. The proposed alternative, set out in this paper, is to allow compulsory treatment of patients with decision-making capacity in cases of an emergency, if the refusal is potentially life threatening, but only for a time-limited period. The argument is also made for investigating hindsight agreement, in particular after compulsory measures.

[Voluntary stopping eating and drinking (VSED) : A position paper of the Austrian Palliative Society].

PubMed

Feichtner, Angelika; Weixler, Dietmar; Birklbauer, Alois

2018-05-01

In some cases terminally ill patients fear of prolonged dying and suffering can manifest itself in the voluntary refusal of food and fluids, aiming to accelerate the dying process. This represents a considerable area of conflict, because of the ethical responsibility to not aid a person's death but also to respect a patients autonomy.There is a clear separation between an assisted suicide and following a patient's wishes. Not to accept the voluntary refusal of FVNF would have to be considered as forced treatment of patients while they are capable of self-determination.Several symptoms associated with or caused by voluntary refusal of food and fluids do require palliative care. It is important to be aware, that caring for dying patients refusing food and fluids and accepting their choice is not synonymous with assisted suicide. Rather is it part of medical and nursing care for patients during their dying-process.An interprofessional working group of the Austrian Palliative Society (OPG) intends to shed light on the legal, ethical, medical and nursing related aspects concerning this subject of growing public and professional interest.

Initial growth of leguminous trees and shrubs in a cut gold mined area in Minas Gerais State, Brazil

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

Dias, L.E.; Campello, E.F.C.; Ribeiro, E.S. Jr.

In an opencast gold mining in Minas Gerais State, Brazil, leguminous trees and shrubs were used to revegetate an acid cut mined area. the substrate was high in pyrite content (3%) and received 50 cm of covered material in two layers: (1) insulating layer of 20 cm where clay or a mining refuse (MR) was used to prevent the pyrite oxidation, and (2) an upper layer with 30 cm formed by topsoil or topsoil + urban compost (3:1 v/v). After the application of the cover materials, planting holes were manually made spaced by 1 x 1 m. Each hole receivedmore » limestone (100 g), rock phosphate (150 g), potassium chloride (45 g) and cattle manure (2 L). Fifteen leguminous species were planted an each plot (15 x 8 m), spaced by 1.0 x 1.0 m (one specie per row). Sixteen months after the planting the plants were evaluated and the results showed an effect of substrate on the plants survival, height, and diameter. The use of clay as insulating layer was better than mining refuse and the plants did not respond to the addition of urban compost to the topsoil. Among the evaluated species, Thephrosia sinapau, Erytrina verna, Dipterix alata and Stryphnodenadrum guyanensis showed a mortality rate of 100% after 16 months while Sesbania marginata, Acacaia holosericea, Mimosa pellita, Acacia crassicarpa, Acacia mangium and Acacia angustissima exhibited more adaptation capacity to the acid substrate. Analyses from the substrate showed higher exchangeable acidity (Al{sup 3+}) for the plots receiving MR as insulating layer. This study has applications for the acid mine drainage from coal mines of Brazil.« less

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

NONE

Circulating fluidized-bed (CFB) boilers have ben used for years in Scandinavia to burn refuse-derived fuel (RDF). Now, Foster Wheeler Power Systems, Inc., (Clinton, N.J.) is bringing the technology to the US. Touted as the world`s largest waste-to-energy plant to use CFB technology, the Robbins (III.) Resource Recovery Facility will have the capacity to process 1,600 tons/d of municipal solid waste (MSW) when it begins operation in early 1997. The facility will have two materials-separation and RDF-processing trains, each with dual trommel screens, magnetic and eddy current separators, and shredders. About 25% of the incoming MSW will be sorted and removedmore » for recycling, while 75% of it will be turned into fuel, with a heat value of roughly 6,170 btu/lb. Once burned in the twin CFB boilers the resulting steam will be routed through a single turbine generator to produce 50,000 mW of electric power.« less

49 CFR 40.261 - What is a refusal to take an alcohol test, and what are the consequences?

Code of Federal Regulations, 2013 CFR

2013-10-01

... test (except a pre-employment test) within a reasonable time, as determined by the employer, consistent...)) for a pre-employment test is not deemed to have refused to test; (3) Fail to provide an adequate... the testing site before the testing process commences (see § 40.243(a)) for a pre-employment test is...

49 CFR 40.261 - What is a refusal to take an alcohol test, and what are the consequences?

Code of Federal Regulations, 2011 CFR

2011-10-01

... test (except a pre-employment test) within a reasonable time, as determined by the employer, consistent...)) for a pre-employment test is not deemed to have refused to test; (3) Fail to provide an adequate... the testing site before the testing process commences (see § 40.243(a)) for a pre-employment test is...

7 CFR 52.26 - When appeal inspection may be refused.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURAL MARKETING ACT OF 1946 PROCESSED FRUITS AND VEGETABLES, PROCESSED PRODUCTS THEREOF, AND CERTAIN OTHER PROCESSED FOOD PRODUCTS 1 Regulations Governing Inspection and Certification Appeal Inspection...

"My children and I will no longer suffer from malaria": a qualitative study of the acceptance and rejection of indoor residual spraying to prevent malaria in Tanzania.

PubMed

Kaufman, Michelle R; Rweyemamu, Datius; Koenker, Hannah; Macha, Jacob

2012-07-02

The objective of this study was to identify attitudes and misconceptions related to acceptance or refusal of indoor residual spraying (IRS) in Tanzania for both the general population and among certain groups (e.g., farmers, fishermen, community leaders, and women). This study was a series of qualitative, semi-structured, in-depth interviews and focus group discussions conducted from October 2010 to March 2011 on Mainland Tanzania and Zanzibar. Three groups of participants were targeted: acceptors of IRS (those who have already had their homes sprayed), refusers (those whose communities have been sprayed, but refused to have their individual home sprayed), and those whose houses were about to be sprayed as part of IRS scale-up. Interviews were also conducted with farmers, fishermen, women, community leaders and members of non-government organizations responsible for community mobilization around IRS. Results showed refusers are a very small percentage of the population. They tend to be more knowledgeable people such as teachers, drivers, extension workers, and other civil servants who do not simply follow the orders of the local government or the sprayers, but are skeptical about the process until they see true results. Refusal took three forms: 1) refusing partially until thorough explanation is provided; 2) accepting spray to be done in a few rooms only; and 3) refusing outright. In most of the refusal interviews, refusers justified why their houses were not sprayed, often without admitting that they had refused. Reasons for refusal included initial ignorance about the reasons for IRS, uncertainty about its effectiveness, increased prevalence of other insects, potential physical side effects, odour, rumours about the chemical affecting fertility, embarrassment about moving poor quality possessions out of the house, and belief that the spray was politically motivated. To increase IRS acceptance, participants recommended more emphasis on providing thorough public education, ensuring the sprayers themselves are more knowledgeable about IRS, and asking that community leaders encourage participation by their constituents rather than threatening punishment for noncompliance. While there are several rumours and misconceptions concerning IRS in Tanzania, acceptance is very high and continues to increase as positive results become apparent.

Evaluation of gasification and novel thermal processes for the treatment of municipal solid waste

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

Niessen, W.R.; Marks, C.H.; Sommerlad, R.E.

1996-08-01

This report identifies seven developers whose gasification technologies can be used to treat the organic constituents of municipal solid waste: Energy Products of Idaho; TPS Termiska Processor AB; Proler International Corporation; Thermoselect Inc.; Battelle; Pedco Incorporated; and ThermoChem, Incorporated. Their processes recover heat directly, produce a fuel product, or produce a feedstock for chemical processes. The technologies are on the brink of commercial availability. This report evaluates, for each technology, several kinds of issues. Technical considerations were material balance, energy balance, plant thermal efficiency, and effect of feedstock contaminants. Environmental considerations were the regulatory context, and such things as composition,more » mass rate, and treatability of pollutants. Business issues were related to likelihood of commercialization. Finally, cost and economic issues such as capital and operating costs, and the refuse-derived fuel preparation and energy c onversion costs, were considered. The final section of the report reviews and summarizes the information gathered during the study.« less

Sensitive Topics, Missing Data, and Refusal in Social Network Studies: An Ethical Examination.

PubMed

Ellison, Erin Rose; Langhout, Regina Day

2017-12-01

We describe our ethics-driven process of addressing missing data within a social network study about accountability for racism, classism, sexism, heterosexism, cis-sexism, ableism, and other forms of oppression among social justice union organizers. During data collection, some would-be participants did not return emails and others explicitly refused to engage in the research. All refusals came from women of color. We faced an ethical dilemma: Should we continue to seek participation from those who had not yet responded, with the hopes of recruiting more women of color from within the network so their perspectives would not be tokenized? Or, should we stop asking those who had been contacted multiple times, which would compromise the social network data and analysis? We delineate ways in which current discussions of the ethics of social network studies fell short, given our framework and our community psychology (CP) values. We outline literature that was helpful in thinking through this challenge; we looked outside of CP to the decolonization literature on refusal. Lessons learned include listening for the possible meanings of refusals and considering the level of engagement and the labor required of participants when designing research studies. © Society for Community Research and Action 2017.

Co-digestion of concentrated black water and kitchen refuse in an accumulation system within the DESAR (decentralized sanitation and reuse) concept.

PubMed

Kujawa-Roeleveld, K; Elmitwalli, T; Gaillard, A; van Leeuwen, M; Zeeman, G

2003-01-01

Co-digestion of concentrated black water and kitchen refuse within the DESAR concept was the objective of this pilot research. The digestion took place in two, non-mixed accumulation reactors (AC1 and AC2) inoculated with digested primary sludge from a WWTP at a temperature of 20 degrees C for a period of around 150 days. Reactor AC1 was fed with a mixture of faeces, urine and kitchen refuse in the equivalent amount that one individual generates per day. The AC2 was fed with a mixture of faeces and kitchen refuse in the equivalent amount that two individuals produce per day. Some contribution of urine to AC2 was not to be avoided. Detailed characterisation of waste(water) was performed. The performance of the stratified reactor was followed by monitoring the reactor content for several reactors' heights as well as being based on the biogas production. In general the system exposed good process stability. The methanisation of 34 and 61% was obtained for AC1 and AC2 respectively. The biogas yield was 26.5 and 50.8 L/p/d for the respective reactors. Proper choice of inoculum as well as good buffering capacity did not lead to accumulation of VFA and an inhibitive effect due to relatively high ammonium concentration. The chosen process is a promising technology showing good process stability especially for high strength influent.

Performance of mechanical biological treatment of residual municipal waste in Poland

NASA Astrophysics Data System (ADS)

den Boer, Emilia; Jędrczak, Andrzej

2017-11-01

The number and capacity of mechanical-biological treatment (MBT) plants in Europe increased significantly in the past two decades as a response to the legal obligation to limit the landfilling of biodegradable waste in landfills and to increase recycling and energy recovery from waste. The aim of these plants is to prepare residual municipal waste for recovery and disposal operations, including especially separation and stabilization of the easily biodegradable fraction (the biofraction). The final products of MBP technology are recyclables, stabilate, high calorific fraction which is used for the production of refuse derived fuel (RDF) and the remaining residual fraction. The shares of the output fractions, especially of the recyclables and RDF determine the overall efficiency of MBT technology in diverting waste from landfills. In this paper results of an assessment of one exemplary MBT plant are provided. The analysis was performed within a comparative study in which 20 selected MBT plants in Poland were subject to a detailed analysis, focusing, both at the design parameters as well as operational ones. The selected plant showed relatively higher overall materials recovery efficiency. With the view to circular economy targets, increased automation of the mechanical waste treatment will be required to support achieving high level diversion from landfills. The study reviled that stabilisation of biofraction should be improved by a better control of process conditions, especially moisture content.

Should a doctor stop rendering medical services? Principles of conduct towards patients attempting to commit suicide. Part 1 -- the Polish perspective.

PubMed

Zajdel, Justyna; Zajdel, Radoslaw; Krakowiak, Anna

2013-01-01

According to the general idea a doctor can start the medical management process in an adult and not legally incapacitated patient after the patient has given consent to initiate such a process. The patient's refusal makes rendering medical services impossible, irrespective of their scope and kind. It should be emphasized that such a refusal is respected if it is expressed fully, clearly and consciously. Cases in which such a refusal is expressed by an intoxicated suicidal patient, remaining under the influence of narcotics, drugs or medicaments which characterize with a similar activity should be particularly analysed. Although such a person is able to verbally declare his objection, his ability to process the information given by the doctor before initiating medical procedures is limited, or even non-existant. The refusal therefore cannot be regarded as reliable, which results in rendering medical services to the patient. An analysis was made of Acts of Law and the opinions of the judiciar by comparing and excluding contradictory and incoherent elements. Despite the lack of clear regulations of a patient rejecting procedures aimed at saving the patient's life, or the prevention of serious health impairment or sustaining injury, it should be assumed that the objection expressed by the patient who does not demonstrate the ability to process the information provided by the doctor is not reliable, and the doctor is therefore still obliged to render medical services. External factors, such as consumption of alcohol, narcotics and drugs, which characterize with a similar activity impair perception and make the taking of a conscious decision impossible. Not providing medical help and introducing direct compulsion would mean neglecting provision of due diligence in the process of treatment and, as a consequence, placing the patient's health at risk, and suffering from negative implications for the patient's life and/or health in the future. Current provisions should directly regulate the negligence of respecting a refusal expressed 'unconsciously' by a patient who remains under the influence of alcohol, narcotics, drugs or medicaments which characterize with a similar activity. Moreover, apart from legal provisions, the law providers should consider introducing a direct compulsion in patients who are unable to make a conscious decision in the treatment process.

Refuse Derived Fuel (RDF) production and gasification in a pilot plant integrated with an Otto cycle ICE through Aspen plus™ modelling: Thermodynamic and economic viability.

PubMed

Násner, Albany Milena Lozano; Lora, Electo Eduardo Silva; Palacio, José Carlos Escobar; Rocha, Mateus Henrique; Restrepo, Julian Camilo; Venturini, Osvaldo José; Ratner, Albert

2017-11-01

This work deals with the development of a Refuse Derived Fuel (RDF) gasification pilot plant using air as a gasification agent. A downdraft fixed bed reactor is integrated with an Otto cycle Internal Combustion Engine (ICE). Modelling was carried out using the Aspen Plus™ software to predict the ideal operational conditions for maximum efficiency. Thermodynamics package used in the simulation comprised the Non-Random Two-Liquid (NRTL) model and the Hayden-O'Connell (HOC) equation of state. As expected, the results indicated that the Equivalence Ratio (ER) has a direct influence over the gasification temperature and the composition of the Raw Produced Gas (RPG), and effects of ER over the Lower Heating Value (LHV) and Cold Gasification Efficiency (CGE) of the RPG are also discussed. A maximum CGE efficiency of 57-60% was reached for ER values between 0.25 and 0.3, also an average reactor temperature values in the range of 680-700°C, with a peak LHV of 5.8MJ/Nm 3 . RPG was burned in an ICE, reaching an electrical power of 50kW el . The economic assessment of the pilot plant implementation was also performed, showing the project is feasible, with power above 120kW el with an initial investment of approximately US$ 300,000. Copyright © 2017 Elsevier Ltd. All rights reserved.

A novel silica alumina-based backfill material composed of coal refuse and fly ash.

PubMed

Yao, Yuan; Sun, Henghu

2012-04-30

In this paper, a systematic study was conducted to investigate a novel silica alumina-based backfill material composed of coal refuse and fly ash. The coal refuse and fly ash had different properties under various thermal activation temperatures (20 °C, 150 °C, 350 °C, 550 °C, 750 °C and 950 °C). It is known that a thermal activation temperature ranging from 20 °C to 950 °C significantly increases the flowability and pozzolanic properties of the coal refuse; however, the flowability of fly ash decreases when the activation temperature is higher than 550 °C because of a severe agglomeration phenomenon on its surface. An optimal design for this backfill material was determined to include an activated portion composed of 5% coal refuse at 750 °C and 15% fly ash at 20 °C. This combination yields the best performance with excellent flowability, a high compressive strength and a low bleeding rate. The microanalysis results corresponded well with the performance tests at different activation conditions. In the coal refuse, kaolinite peaks began to decrease because of their transformation into metakaolin at 550 °C. Chlorite peaks disappeared at 750 °C. Muscovite peaks decreased at 750 °C and disappeared at 950 °C. During this process, muscovite 2M(1) gradually dehydroxylated to muscovite HT. Furthermore, this paper examined the environmental acceptance and economic feasibility of this technology and found that this silica alumina-based backfill material composed of coal refuse and fly ash not only meets EPA requirements but also has several advantages in industry feasibility when compared with hydraulic backfill, rock backfill and paste backfill. Published by Elsevier B.V.

“The One Who Chases You Away Does Not Tell You Go”: Silent Refusals and Complex Power Relations in Research Consent Processes in Coastal Kenya

PubMed Central

Kamuya, Dorcas M.; Theobald, Sally J.; Marsh, Vicki; Parker, Michael; Geissler, Wenzel P.; Molyneux, Sassy C.

2015-01-01

Consent processes have attracted significant research attention over the last decade, including in the global south. Although relevant studies suggest consent is a complex negotiated process involving multiple actors, most guidelines assume consent is a one-off encounter with a clear ‘yes’ or ‘no’ decision. In this paper we explore the concept of ‘silent refusals’, a situation where it is not clear whether potential participants want to join studies or those in studies want to withdraw from research, as they were not actively saying no. We draw on participant observation, in-depth interviews and group discussions conducted with a range of stakeholders in two large community based studies conducted by the KEMRI Wellcome Trust programme in coastal Kenya. We identified three broad inter-related rationales for silent refusals: 1) a strategy to avoid conflicts and safeguard relations within households, - for young women in particular—to appear to conform to the wishes of elders; 2) an approach to maintain friendly, appreciative and reciprocal relationships with fieldworkers, and the broader research programme; and 3) an effort to retain study benefits, either for individuals, whole households or wider communities. That refusals and underlying rationales were silent posed multiple dilemmas for fieldworkers, who are increasingly recognised to play a key interface role between researchers and communities in many settings. Silent refusals reflect and reinforce complex power relations embedded in decisions about research participation, with important implications for consent processes and broader research ethics practice. Fieldworkers need support to reflect upon and respond to the ethically charged environment they work in. PMID:25978465

Informed consent for genetic research.

PubMed

Hamvas, Aaron; Madden, Katherine K; Nogee, Lawrence M; Trusgnich, Michelle A; Wegner, Daniel J; Heins, Hillary B; Cole, F Sessions

2004-06-01

Rapid technological advances in genetic research and public concern about genetic discrimination have led to anticipatory safeguards in the informed consent process in the absence of legal examples of proven discrimination. Despite federal and state regulations to restrict access to personal health information, including genetic information, institutional review boards have required the addition of language to informed consent documents that warns about the risks of discrimination with participation in genetic research. To determine the reasons that families refused consent for their infant's participation in a study evaluating a genetic cause of respiratory distress syndrome. Survey conducted between February 1, 2002, and March 31, 2003. Academic, tertiary free-standing children's hospital. A convenience sample of 465 families were approached for consent. The 135 families who refused consent were surveyed. Reasons for refusal. Of the nonconsenting families, 79% spontaneously and specifically identified institutionally required language in our consent form concerning the risk of denial of access to health insurance and employment as the primary reason for refusal; 97% indicated that their fears resulted directly from language in our consent form. Only 20% of families who refused consent cited inadequate time to consider the study. The institutionally required description of risk of genetic discrimination due solely to participation in genetic research was the primary reason for refusal to consent in this cohort. Information about federally and institutionally mandated protections for confidentiality of participants in genetic research should be included in the informed consent document to balance the description of hypothetical risks and more accurately inform subjects.

Observations of parent-child co-shoppers in supermarkets: children's involvement in food selections, parental yielding, and refusal strategies.

PubMed

O'Dougherty, Maureen; Story, Mary; Stang, Jamie

2006-01-01

The study aimed to collect descriptive information on the decision-making processes of adult shoppers around food purchases when young children are present. Anthropological field observations were conducted on adult-child grocery shoppers. Eleven supermarkets in the Minneapolis-St. Paul metropolitan region. A convenience sample (n = 142) of adult-child shoppers at 8 budget and 3 deluxe supermarkets located in diverse urban and suburban areas. Observations registered adult-child interactions over food selections, including parental yielding or refusal strategies and child engagement in shopping. Means and frequencies were calculated for food items considered. In 67 (50.4%) of the total 133 observations, a child initiated a request. Half (55.2%) of the requests were for sweets or snacks. Nearly half (47.8%) of adults yielded to the child's request. Brands and marketing techniques appeared to be a factor in 28.6% of selections. The most frequent adult refusals either provided an explanation or ignored the request. Adults yield to children's requests for sweets and snacks nearly as often as they refuse them. However, effective refusal strategies are used by many adults. Opportunities exist in the grocery store for adults to reinforce young children's interest in food and nutrition.

Consent to treatment by minors attending accident and emergency departments: guidelines.

PubMed Central

Williams, L; Harris, A; Thompson, M; Brayshaw, A

1997-01-01

The absolute right to refuse medical treatment, even if the reasons are irrational, is confined to competent adults. Children under 16 years can give legal consent to treatment in the absence of consent from those with parental responsibility. Children under 18 years do not, however, have an absolute right to consent, or refuse to consent, to treatment. The views of children assume increasing importance with age and maturity. Accident and emergency medical and nursing staff may face difficult decisions when children, or those with parental responsibility, refuse to consent to medical treatment. This paper presents guidelines designed to guide the decision making process in immediately or potentially life threatening conditions and in non-life-threatening conditions. Images Figure 1 Figure 2 p289-a PMID:9315927

Pollution concentrations in runoff water from refuse piles

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

Guin, J.A.

1977-03-01

In the processes of removal, refinement and disposal of raw materials, large quantities of waste products become exposed to weathering forces. Subsequent percolation, flushing, and oxidation results in the pollution of waterways, low-lying farmlands and underground aquifers with acidity, alkalinity, hardness, heavy metals, and undesirable organic materials such as tannin and lignin. The need for methodology for estimating the chemical nature and quantity of these leachates becomes more compelling as the extraction of natural materials accelerates. In this work a mass transfer model is formulated which describes the leaching of such pollutants from refuse piles. The model is applied tomore » an actual refuse pile under natural precipitation and weathering conditions and found to adequately represent the pollutant concentrations in the rainfall runoff.« less

A review of technologies and performances of thermal treatment systems for energy recovery from waste

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

Lombardi, Lidia, E-mail: lidia.lombardi@unicusano.it; Carnevale, Ennio; Corti, Andrea

2015-03-15

Highlights: • The topic of energy recovery from waste by thermal treatment is reviewed. • Combustion, gasification and pyrolysis were considered. • Data about energy recovery performances were collected and compared. • Main limitations to high values of energy performances were illustrated. • Diffusion of energy recovery from waste in EU, USA and other countries was discussed. - Abstract: The aim of this work is to identify the current level of energy recovery through waste thermal treatment. The state of the art in energy recovery from waste was investigated, highlighting the differences for different types of thermal treatment, considering combustion/incineration,more » gasification and pyrolysis. Also different types of wastes – Municipal Solid Waste (MSW), Refuse Derived Fuel (RDF) or Solid Refuse Fuels (SRF) and some typologies of Industrial Waste (IW) (sludge, plastic scraps, etc.) – were included in the analysis. The investigation was carried out mainly reviewing papers, published in scientific journals and conferences, but also considering technical reports, to gather more information. In particular the goal of this review work was to synthesize studies in order to compare the values of energy conversion efficiencies measured or calculated for different types of thermal processes and different types of waste. It emerged that the dominant type of thermal treatment is incineration associated to energy recovery in a steam cycle. When waste gasification is applied, the produced syngas is generally combusted in a boiler to generate steam for energy recovery in a steam cycle. For both the possibilities – incineration or gasification – cogeneration is the mean to improve energy recovery, especially for small scale plants. In the case of only electricity production, the achievable values are strongly dependent on the plant size: for large plant size, where advanced technical solutions can be applied and sustained from an economic point of view, net electric efficiency may reach values up to 30–31%. In small-medium plants, net electric efficiency is constrained by scale effect and remains at values around 20–24%. Other types of technical solutions – gasification with syngas use in internally fired devices, pyrolysis and plasma gasification – are less common or studied at pilot or demonstrative scale and, in any case, offer at present similar or lower levels of energy efficiency.« less

An investigation on the fuel savings potential of hybrid hydraulic refuse collection vehicles.

PubMed

Bender, Frank A; Bosse, Thomas; Sawodny, Oliver

2014-09-01

Refuse trucks play an important role in the waste collection process. Due to their typical driving cycle, these vehicles are characterized by large fuel consumption, which strongly affects the overall waste disposal costs. Hybrid hydraulic refuse vehicles offer an interesting alternative to conventional diesel trucks, because they are able to recuperate, store and reuse braking energy. However, the expected fuel savings can vary strongly depending on the driving cycle and the operational mode. Therefore, in order to assess the possible fuel savings, a typical driving cycle was measured in a conventional vehicle run by the waste authority of the City of Stuttgart, and a dynamical model of the considered vehicle was built up. Based on the measured driving cycle and the vehicle model including the hybrid powertrain components, simulations for both the conventional and the hybrid vehicle were performed. Fuel consumption results that indicate savings of about 20% are presented and analyzed in order to evaluate the benefit of hybrid hydraulic vehicles used for refuse collection. Copyright © 2014 Elsevier Ltd. All rights reserved.

Performance and bacterial compositions of aged refuse reactors treating mature landfill leachate.

PubMed

Xie, Bing; Xiong, Shunzi; Liang, Shaobo; Hu, Chong; Zhang, Xiaojun; Lu, Jun

2012-01-01

Aged landfill leachates become more refractory over time and difficulty to treat. Recently, aged refuse bioreactors show great promise in treating leachates. In this study, aged refuse bioreactors were constructed to simulate landfill leachate degradation process. The characteristics of leachate were: CODcr, ∼2200 mg/L; BOD5, ∼280 mg/L; total nitrogen, ∼2030 mg/L; and ammonia, ∼1900 mg/L. Results showed that bioreactor could remove leachate pollutants effectively at hydraulic loading of 20 L/m3 d. The removal rate reduced when hydraulic loading doubled or temperature lowered. Effluent recirculation could alleviate the temperature effect. Combining aged refuse and slag biofilters could treat leachate more efficiently. Pyrosequencing analysis indicated that bacteria from Pseudomonas, Lysobacter, Bacillus and δ-proteobacter, Flexibacteraceae were more abundant in the samples. The Shannon index decreased at lower temperature, while evenness and equitability increased with recirculation. We suggest that filter medium and temperature may be the main factors for shaping bacterial community structure. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Informed Consent to Treatment in Psychiatry

PubMed Central

Neilson, Grainne; Chaimowitz, Gary

2015-01-01

Summary Patients have a right to be informed and actively involved in their health care. Fundamental to a person’s dignity and autonomy is the right to make decisions about their psychiatric treatment, including their right to refuse unwanted treatments, providing that the refusal is a capable one. It is important that psychiatrists have an awareness of the ethical underpinnings of consent and the legislated requirements related to consent, including precedent cases. Consent may change over time and for different conditions and circumstances. Consent must be an ongoing process.

Caregivers who refuse preventive care for their children: the relationship between immunization and topical fluoride refusal.

PubMed

Chi, Donald L

2014-07-01

The aim of this study was to examine caregivers' refusal of preventive medical and dental care for children. Prevalence rates of topical fluoride refusal based on dental records and caregiver self-reports were estimated for children treated in 3 dental clinics in Washington State. A 60-item survey was administered to 1024 caregivers to evaluate the association between immunization and topical fluoride refusal. Modified Poisson regression models were used to estimate prevalence rate ratios (PRRs). The prevalence of topical fluoride refusal was 4.9% according to dental records and 12.7% according to caregiver self-reports. The rate of immunization refusal was 27.4%. In the regression models, immunization refusal was significantly associated with topical fluoride refusal (dental record PRR = 1.61; 95% confidence interval [CI] = 1.32, 1.96; P < .001; caregiver self-report PRR = 6.20; 95% CI = 3.21, 11.98; P < .001). Caregivers younger than 35 years were significantly more likely than older caregivers to refuse both immunizations and topical fluoride (P < .05). Caregiver refusal of immunizations is associated with topical fluoride refusal. Future research should identify the behavioral and social factors related to caregiver refusal of preventive care with the goal of developing multidisciplinary strategies to help caregivers make optimal preventive care decisions for children.

Refusing to Treat Sexual Dysfunction in Sex Offenders.

PubMed

Douglas, Thomas

2017-01-01

This article examines one kind of conscientious refusal: the refusal of healthcare professionals to treat sexual dysfunction in individuals with a history of sexual offending. According to what I call the orthodoxy, such refusal is invariably impermissible, whereas at least one other kind of conscientious refusal-refusal to offer abortion services-is not. I seek to put pressure on the orthodoxy by (1) motivating the view that either both kinds of conscientious refusal are permissible or neither is, and (2) critiquing two attempts to buttress it.

Effect of intermediate soil cover on municipal solid waste decomposition.

PubMed

Márquez-Benavides, L; Watson-Craik, I

2003-01-01

A complex series of chemical and microbiological reactions is initiated with the burial of refuse in a sanitary landfill. At the end of each labour day, the municipal solid wastes (MSW) are covered with native soil (or an alternative material). To investigate interaction between the intermediate cover and the MSW, five sets of columns were set up, one packed with refuse only, and four with a soil-refuse mixture (a clay loam, an organic-rich peaty soil, a well limed sandy soil and a chalky soil). The anaerobic degradation over 6 months was followed in terms of leachate volatile fatty acids, chemical oxygen demand, pH and ammoniacal-N performance. Results suggest that the organic-rich peaty soil may accelerate the end of the acidogenic phase. Clay appeared not to have a significant effect on the anaerobic degradation process.

A narrative review of studies of refusal of psychotropic medication in acute inpatient psychiatric care.

PubMed

Owiti, J A; Bowers, L

2011-09-01

This paper offers a narrative review of the 22 studies of medication refusal in acute psychiatry. Because of varied definitions of medication refusal, diverse methodologies and few rigorous studies, it has not been possible to draw firm conclusions on the average rate of refusal of psychotropic medications in acute psychiatry. However, it is clear that medication refusal is common and leads to poor outcomes characterized by higher rates of seclusion, restraint, threats of, and actual, assaults and longer hospitalizations. There are no statistically significant differences between refusers and acceptors in gender, marital status and preadmission living arrangements. Although no firm conclusions on the influence of ethnicity, status at admission and diagnosis on refusal, the refusers are more likely to have higher number of previous hospitalizations and history of prior refusal. The review indicates that staff factors such as the use of temporary staff, lack of confidence in ward staff and ineffective ward structure are associated with higher rates of medication refusal. Comprehensive knowledge of why, and how, patients refuse medication is lacking. Research on medication refusal is still fragmented, of variable methodological quality and lacks an integrating model. © 2011 Blackwell Publishing.

Refusal of medical treatment in the pediatric emergency service: analysis of reasons and aspects.

PubMed

Gündüz, Ramiz Coşkun; Halil, Halit; Gürsoy, Cüneyt; Çifci, Atilla; Özgün, Seher; Kodaman, Tuğba; Sönmez, Mehtap

2014-01-01

Refusal of treatment for acutely ill children is still an important problem in the emergency service. When families refuse medical treatment for their acutely ill children, healthcare professionals may attempt to provide information and negotiate with the family concerning treatment refusal and its possible adverse outcomes, and request consent for refusal of medical treatment. There is insufficient data about refusal of treatment in our country. The purpose of this study was to analyze the causes of treatment refusal in the pediatric emergency service. We collected data recorded on informed consent forms. During a 2-year-study period, 215 patients refused treatment recommended by acute health care professionals. The majorty of patients were in the 0-2 year age group. Hospitalization was the type of treatment most commonly refused; restrictions regarding family members staying with their children during hospitalization and admission to another hospital were the major reasons for refusal of treatment. Clarifying the reasons for treatment refusal may help us to overcome deficiencies, improve conditions, resolve problems and build confidence between healthcare providers and service users, increasing users' satisfaction in the future.

School refusal by patients with gender identity disorder.

PubMed

Terada, Seishi; Matsumoto, Yosuke; Sato, Toshiki; Okabe, Nobuyuki; Kishimoto, Yuki; Uchitomi, Yosuke

2012-01-01

The accumulating evidence suggests that school refusal behavior is associated with severe negative outcomes. However, previous research has not addressed school refusal by patients with gender identity disorder (GID). In this study, we tried to clarify the prevalence of school refusal among GID patients and the relationship of school refusal to demographic characteristics. A total of 579 consecutive Japanese GID patients at the outpatient GID Clinic of Okayama University Hospital between April 1997 and October 2005 were evaluated. The prevalence of school refusal was 29.2% of the total sample. School refusal was more frequent among GID patients with divorced parents than those with intact families. Multiple logistic regression analysis showed that younger age at consultation and divorce of parents were significantly associated with school refusal among the male-to-female GID patients. The rate of school refusal among GID patients is high, and school refusal is closely related with a low level of education and current unemployment. We should pay more attention to GID patients of school age to prevent their school refusal, which results in low educational achievement. Copyright © 2012 Elsevier Inc. All rights reserved.

Caregivers Who Refuse Preventive Care for Their Children: The Relationship Between Immunization and Topical Fluoride Refusal

PubMed Central

2014-01-01

Objectives. The aim of this study was to examine caregivers’ refusal of preventive medical and dental care for children. Methods. Prevalence rates of topical fluoride refusal based on dental records and caregiver self-reports were estimated for children treated in 3 dental clinics in Washington State. A 60-item survey was administered to 1024 caregivers to evaluate the association between immunization and topical fluoride refusal. Modified Poisson regression models were used to estimate prevalence rate ratios (PRRs). Results. The prevalence of topical fluoride refusal was 4.9% according to dental records and 12.7% according to caregiver self-reports. The rate of immunization refusal was 27.4%. In the regression models, immunization refusal was significantly associated with topical fluoride refusal (dental record PRR = 1.61; 95% confidence interval [CI] = 1.32, 1.96; P < .001; caregiver self-report PRR = 6.20; 95% CI = 3.21, 11.98; P < .001). Caregivers younger than 35 years were significantly more likely than older caregivers to refuse both immunizations and topical fluoride (P < .05). Conclusions. Caregiver refusal of immunizations is associated with topical fluoride refusal. Future research should identify the behavioral and social factors related to caregiver refusal of preventive care with the goal of developing multidisciplinary strategies to help caregivers make optimal preventive care decisions for children. PMID:24832428

Impact of physical pre-treatment of source-sorted organic fraction of municipal solid waste on greenhouse-gas emissions and the economy in a Swedish anaerobic digestion system.

PubMed

Carlsson, My; Holmström, David; Bohn, Irene; Bisaillon, Mattias; Morgan-Sagastume, Fernando; Lagerkvist, Anders

2015-04-01

Several methods for physical pre-treatments of source sorted organic fraction of municipal solid waste (SSOFMSW) before for anaerobic digestion (AD) are available, with the common feature that they generate a homogeneous slurry for AD and a dry refuse fraction for incineration. The selection of efficient methods relies on improved understanding of how the pre-treatment impacts on the separation and on the slurry's AD. The aim of this study was to evaluate the impact of the performance of physical pre-treatment of SSOFMSW on greenhouse-gas (GHG) emissions and on the economy of an AD system including a biogas plant with supplementary systems for heat and power production in Sweden. Based on the performance of selected Swedish facilities, as well as chemical analyses and BMP tests of slurry and refuse, the computer-based evaluation tool ORWARE was improved as to accurately describe mass flows through the physical pre-treatment and anaerobic degradation. The environmental and economic performance of the evaluated system was influenced by the TS concentration in the slurry, as well as the distribution of incoming solids between slurry and refuse. The focus to improve the efficiency of these systems should primarily be directed towards minimising the water addition in the pre-treatment provided that this slurry can still be efficiently digested. Second, the amount of refuse should be minimised, while keeping a good quality of the slurry. Electricity use/generation has high impact on GHG emissions and the results of the study are sensitive to assumptions of marginal electricity and of electricity use in the pre-treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.

Ways to say no: refusal skill strategies among urban adolescents.

PubMed

Nichols, Tracy R; Graber, Julia A; Brooks-Gunn, Jeanne; Botvin, Gilbert J

2006-01-01

To examine associations among adolescents' generated verbal strategies (ie, Simple No, Declarative Statements, Excuse, Alternatives) and underlying nonverbal assertiveness in 2 refusal situations: smoking and shoplifting. Sixth-grade urban minority students (N = 454) participated in videotaped role-play assessments of peer refusal skills. Differences were found by situation with students demonstrating greater use of Simple No in the smoking refusal and Alternatives in the shoplifting refusal. Nonverbal assertiveness was similar across situations and was associated with Declarative Statements, but only in the smoking refusal. Prevention programs should tailor refusal skills practice to cover multiple situations.

Process to convert biomass and refuse derived fuel to ethers and/or alcohols

DOEpatents

Diebold, James P.; Scahill, John W.; Chum, Helena L.; Evans, Robert J.; Rejai, Bahman; Bain, Richard L.; Overend, Ralph P.

1996-01-01

A process for conversion of a feedstock selected from the group consisting of biomass and refuse derived fuel (RDF) to provide reformulated gasoline components comprising a substantial amount of materials selected from the group consisting of ethers, alcohols, or mixtures thereof, comprising: drying said feedstock; subjecting said dried feedstock to fast pyrolysis using a vortex reactor or other means; catalytically cracking vapors resulting from said pyrolysis using a zeolite catalyst; condensing any aromatic byproduct fraction; catalytically alkylating any benzene present in said vapors after condensation; catalytically oligomerizing any remaining ethylene and propylene to higher olefins; isomerizing said olefins to reactive iso-olefins; and catalytically reacting said iso-olefins with an alcohol to form ethers or with water to form alcohols.

Administrative Destruction of Certain Drugs Refused Admission to the United States. Final rule.

PubMed

2015-09-15

The Food and Drug Administration (FDA or Agency) is implementing its authority to destroy a drug valued at $2,500 or less (or such higher amount as the Secretary of the Treasury may set by regulation) that has been refused admission into the United States under the Federal Food, Drug, and Cosmetic Act (the FD&C Act), by issuing a rule that provides to the owner or consignee notice and an opportunity to appear and introduce testimony to the Agency prior to destruction. This regulation is authorized by amendments made to the FD&C Act by the Food and Drug Administration Safety and Innovation Act (FDASIA). Implementation of this authority will allow FDA to better protect the public health by providing an administrative process for the destruction of certain refused drugs, thus increasing the integrity of the drug supply chain.

30 CFR 77.215-4 - Refuse piles; abandonment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles; abandonment. 77.215-4 Section 77... MINES Surface Installations § 77.215-4 Refuse piles; abandonment. When a refuse pile is to be abandoned... refuse pile shall be abandoned in accordance with a plan submitted by the operator and approved by the...

Factors Associated with School Refusal in Adolescents: Some Preliminary Results.

ERIC Educational Resources Information Center

Ficula, Teresa V.; And Others

School refusal, as differentiated from both school phobia and truancy, is a term used to denote emotionally-based avoidance of school. To identify factors associated with school refusal, 41 junior high and high school students (including special education school refusers, special education non-refusers, and a comparison group from a regular…

Systematic Evaluation and Uncertainty Analysis of the Refuse-Derived Fuel Process in Taiwan.

PubMed

Chang, Ying-Hsi; Chang, Ni-Bin; Chen, W C

1998-06-01

In the last few years, Taiwan has set a bold agenda in solid waste recycling and incineration programs. Not only were the recycling activities and incineration projects promoted by government agencies, but the related laws and regulations were continuously promulgated by the Legislative Yen. The solid waste presorting process that is to be considered prior to the existing incineration facilities has received wide attention. This paper illustrates a thorough evaluation for the first refuse-derived fuel pilot process from both quantitative and qualitative aspects. The process is to be installed and integrated with a large-scale municipal incinerator. This pilot process, developed by an engineering firm in Tainan County, consists of standard unit operations of shredding, magnetic separation, trommel screening, and air classification. A series of sampling and analyses were initialized in order to characterize its potentials in the solid waste management system. The probabilistic modeling for various types o f waste pro perties derived in this analysis may provide a basic understanding of system reliability.

The right not to be treated or to refuse treatment.

PubMed

Deutsch, E

1989-01-01

The corollary to the right to refuse treatment is the requirement that, in general, informed consent be obtained before treatment. The Declaration of Lisbon recognises this: "The patient has the right to accept or to refuse treatment after receiving adequate information." The information to be given to the patient is of three kinds, but a special problem in relation to the doctrine of informed refusal places a special duty on the doctor to inform the patient about the possible consequences of refusing treatment. Related topics, such as refusal in part, refusal by a parent or guardian, the novus actus interveniens, the living will, and contributory negligence are touched upon.

The Refusal of Palliative Radiation in Metastatic Non-Small Cell Lung Cancer and Its Prognostic Implications.

PubMed

Stavas, Mark J; Arneson, Kyle O; Ning, Matthew S; Attia, Albert A; Phillips, Sharon E; Perkins, Stephanie M; Shinohara, Eric T

2015-06-01

Patients with metastatic non-small cell lung cancer (NSCLC) have limited survival. Population studies have evaluated the impact of radiation refusal in the curative setting; however, no data exist concerning the prognostic impact of radiation refusal in the palliative care setting. To investigate the patterns of radiation refusal in newly diagnosed patients with metastatic NSCLC. Patients with Stage IV NSCLC diagnosed between 1988 and 2010 were identified in the Surveillance, Epidemiology, and End Results database. Univariate and multivariate analyses were used to identify predictors for refusal of radiation and the impact of radiation and refusal on survival in the palliative setting. A total of 285,641 patients were initially included in the analysis. Palliative radiation was recommended in 42% and refused by 3.1% of patients. Refusal rates remained consistent across included years of study. On multivariate analysis, older, nonblack/nonwhite, unmarried females were more likely to refuse radiation (P < 0.001 in all cases). Median survival for patients refusing radiation was three months vs. five months for those receiving radiation and two months for those whom radiation was not recommended. Patients with metastatic NSCLC who refuse recommended palliative radiation have a poor survival. Radiation refusal or the recommendation against treatment can serve as a trigger for integrating palliative care services sooner and contributes greatly to prognostic awareness. Further investigation into this survival difference and the factors behind refusal are warranted. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The effects of the fungus-growing ant, Trachymyrmex jamaicensis, on soil fertility and seed germination in a subtropical dry forest

Treesearch

J.A. Torres; M. Santiago; M. Salgado

1999-01-01

The fungus-growing ant, Trachymyrmex jamaicensis, is common in the Guanica dry forest of Puerto Rico and uses the pulp of fleshy fruits of many plant species as the primary substrate on which its fungal symbiont is cultivated. The ants discard the seeds and often intact fruits in refuse piles located on the soil surface near the nest entrance. Nest construction...

Steam gasification of tyre waste, poplar, and refuse-derived fuel: a comparative analysis.

PubMed

Galvagno, S; Casciaro, G; Casu, S; Martino, M; Mingazzini, C; Russo, A; Portofino, S

2009-02-01

In the field of waste management, thermal disposal is a treatment option able to recover resources from "end of life" products. Pyrolysis and gasification are emerging thermal treatments that work under less drastic conditions in comparison with classic direct combustion, providing for reduced gaseous emissions of heavy metals. Moreover, they allow better recovery efficiency since the process by-products can be used as fuels (gas, oils), for both conventional (classic engines and heaters) and high efficiency apparatus (gas turbines and fuel cells), or alternatively as chemical sources or as raw materials for other processes. This paper presents a comparative study of a steam gasification process applied to three different waste types (refuse-derived fuel, poplar wood and scrap tyres), with the aim of comparing the corresponding yields and product compositions and exploring the most valuable uses of the by-products.

Adsorption of phenolic compound by aged-refuse.

PubMed

Xiaoli, Chai; Youcai, Zhao

2006-09-01

The adsorption of phenol, 2-chlorophenol, 4-chlorophenol and 2,4-dichlorophenol by aged-refuse has been studied. Adsorption isotherms have been determined for phenol, 2-chlorophenol, 4-chlorophenol and 2,4-dichlorophenol and the data fits well to the Freundlich equation. The chlorinated phenols are absorbed more strongly than the phenol and the adsorption capacity has an oblivious relationship with the numbers and the position of chlorine subsistent. The experiment data suggests that both the partition function and the chemical adsorption involve in the adsorption process. Pseudo-first-order and pseudo-second-order model were applied to investigate the kinetics of the adsorption and the results show that it fit the pseudo-second-order model. More than one step involves in the adsorption process and the overall rate of the adsorption process appears to be controlled by the chemical reaction. The thermodynamic analysis indicates that the adsorption is spontaneous and endothermic.

Refusal of postoperative radiotherapy and its association with survival in head and neck cancer.

PubMed

Schwam, Zachary G; Husain, Zain; Judson, Benjamin L

2015-11-01

Administering postoperative radiotherapy (PORT) is associated with improved survival and slower disease progression in select head and neck cancer patients. Predictive factors for PORT refusal have not been described in this population. Retrospective analysis of 6127 head and neck cancer patients who received or refused PORT in the National Cancer Database (2003-2006) was performed. Statistical analysis included Chi-square, multivariable logistic regression, Kaplan-Meier, and Cox proportional hazards analysis. In total, 247 patients (4.0%) refused PORT. Three-year overall survival was 62.8% versus 53.4% for those who received and refused PORT, respectively. PORT refusers were more likely to have negative nodes than those who underwent PORT (37.4% versus 20.1%, p<.001). In multivariate analysis, predictive factors for refusing PORT included living far from the treatment facility (OR 1.92), having negative nodes (OR 2.14), and Charlson score of ⩾ 2 (OR 2.14) (all p ⩽.001). PORT refusal was associated with increased mortality (hazard ratio 1.20, p=.044). A significant proportion of head and neck cancer patients refused PORT; this was associated with compromised overall survival. Predictive factors for PORT refusal included socioeconomic, demographic, and pathologic variables. Elucidating root causes of refusal may lead to interventions that improve long-term outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Delay and refusal of human papillomavirus vaccine for girls, national immunization survey-teen, 2010.

PubMed

Dorell, Christina; Yankey, David; Jeyarajah, Jenny; Stokley, Shannon; Fisher, Allison; Markowitz, Lauri; Smith, Philip J

2014-03-01

Human papillomavirus (HPV) vaccine coverage among girls is low. We used data reported by parents of 4103 girls, 13 to 17 years old, to assess associations with, and reasons for, delaying or refusing HPV vaccination. Sixty-nine percent of parents neither delayed nor refused vaccination, 11% delayed only, 17% refused only, and 3% both delayed and refused. Eighty-three percent of girls who delayed only, 19% who refused only, and 46% who both delayed and refused went on to initiate the vaccine series or intended to initiate it within the next 12 months. A significantly higher proportion of parents of girls who were non-Hispanic white, lived in households with higher incomes, and had mothers with higher education levels, delayed and/or refused vaccination. The most common reasons for nonvaccination were concerns about lasting health problems from the vaccine, wondering about the vaccine's effectiveness, and believing the vaccine is not needed.

Degradability of Chlorinated Solvents in Landfill Environment

NASA Astrophysics Data System (ADS)

Wang, J. Y.; Litman, M.

2002-12-01

The use of landfills as an in situ remediation system represents a cost-effective alternative for groundwater remediation in the source area. This research was conducted to investigate the intrinsic bioattenuation capacity of the landfill ecosystem for chlorinated aliphatic hydrocarbons (CAHs). This research, using excavated refuse samples, studied how the reductive dechlorination of CAHs is linked to the decomposition of solid waste in landfills. Most research effort in groundwater remediation has focused on the contaminant plumes beneath and downgradient from landfills, while the source area remediation has received increasing attention. Bioreactor landfill and leachate recirculation projects have been planned and implemented by the USEPA and some states. However, the use of bioreactor landfill has primarily been considered only to expedite refuse decomposition. This research provides an understanding of the biological fate of CAHs in landfills, an understanding that can lead to the bioreactor landfill system designed to promote the degradation of pollutants right at the source. The research was conducted in two complementary systems: simulated landfill bioreactors and batch degradation experiment in serum bottles. Refuse samples were excavated from a municipal solid waste landfill located in Wayland, Massachusetts, USA. Bioreactors were designed and operated to facilitate refuse decomposition under landfilling conditions. For each reactor, leachate was collected and recirculated back to the reactor and gas was collected into a gas bag and the methane production rate was monitored. Target CAHs, tetrachloroethene (PCE) and trichloroethene (TCE), were added to selected reactors and maintained at about 20 uM each in leachate. The design is to study the effect of long-term exposure of refuse microorganisms to CAHs on the degradation potential of these chemicals in landfills. Changes of biochemical conditions in bioreactors, including leachate pH, leachate COD, and methane production, were monitored throughout the refuse decomposition process. At two different stages of refuse decomposition, active refuse decomposition representing young landfills and maturation phase representing aged landfills, anaerobic microbial cultures were derived from selected bioreactors and tested in serum bottles for their abilities to biodegrade target CAHs. Complementary to the bioreactor experiment, the serum bottle experiment was designed to investigate specific conditions that potentially control or limit the reductive dechlorination of CAHs in landfills. The conditions tested include 1) inhibited refuse methanogenesis, 2) enhanced methanogenic refuse decomposition, 3) presence of other organic carbons commonly found in landfills such as cellulose, lactate, ethanol, and acetate and 4) presence of yeast extract and humic acids which are commonly found in aged landfills. This research investigated the degradability, the degradation rate, and the extent of dechlorination of CAHs in a landfill ecosystem as the refuse decomposition progresses. The results can lead to a broader application of the intrinsic bioattenuation capacity of landfills. An in situ remedial strategy directly tackling the contaminant source can minimize the risk of future impact and achieve a significant saving in remediation cost. The information of contaminant fate in landfills can also help regulatory agencies formulate risk-based guidelines for post-closure monitoring programs and potential re-development projects.

Environmental impact of emissions from incineration plants in comparison to typical heating systems

NASA Astrophysics Data System (ADS)

Wielgosiński, Grzegorz; Namiecińska, Olga; Czerwińska, Justyna

2018-01-01

In recent years, five modern municipal waste incineration plants have been built in Poland. Next ones are being constructed and at the same time building of several others is being considered. Despite positive experience with the operation of the existing installations, each project of building a new incinerator raises a lot of emotions and social protests. The main argument against construction of an incineration plant is the emission of pollutants. The work compares emissions from municipal waste incineration plants with those from typical heating plants: in the first part, for comparison large heating plants equipped with pulverized coal-fired boilers (OP-140), stoker-fired boilers (three OR-32 boilers) or gas blocks with heat output of about 100 MW have been selected, while the second part compares WR-10 and WR-25 stoker-fired boilers most popular in our heating industry with thermal treatment systems for municipal waste or refuse-derived-fuel (RDF) with similar heat output. Both absolute emission and impact - immission of pollutants in vicinity of the plant were analyzed.

Process to convert biomass and refuse derived fuel to ethers and/or alcohols

DOEpatents

Diebold, J.P.; Scahill, J.W.; Chum, H.L.; Evans, R.J.; Rejai, B.; Bain, R.L.; Overend, R.P.

1996-04-02

A process is described for conversion of a feedstock selected from the group consisting of biomass and refuse derived fuel (RDF) to provide reformulated gasoline components comprising a substantial amount of materials selected from the group consisting of ethers, alcohols, or mixtures thereof, comprising: drying said feedstock; subjecting said dried feedstock to fast pyrolysis using a vortex reactor or other means; catalytically cracking vapors resulting from said pyrolysis using a zeolite catalyst; condensing any aromatic byproduct fraction; catalytically alkylating any benzene present in said vapors after condensation; catalytically oligomerizing any remaining ethylene and propylene to higher olefins; isomerizing said olefins to reactive iso-olefins; and catalytically reacting said iso-olefins with an alcohol to form ethers or with water to form alcohols. 35 figs.

Prostate Cancer Patients' Refusal of Cancer-Directed Surgery: A Statewide Analysis

PubMed Central

Islam, K. M.

2015-01-01

Introduction. Prostate cancer is the most common cancer among men in USA. The surgical outcomes of prostate cancer remain inconsistent. Barriers such as socioeconomic factors may play a role in patients' decision of refusing recommended cancer-directed surgery. Methods. The Nebraska Cancer Registry data was used to calculate the proportion of prostate cancer patients recommended the cancer-directed surgery and the surgery refusal rate. Multivariate logistic regression was applied to analyze the socioeconomic indicators that were related to the refusal of surgery. Results. From 1995 to 2012, 14,876 prostate cancer patients were recommended to undergo the cancer-directed surgery in Nebraska, and 576 of them refused the surgery. The overall refusal rate of surgery was 3.9% over the 18 years. Patients with early-stage prostate cancer were more likely to refuse the surgery. Patients who were Black, single, or covered by Medicaid/Medicare had increased odds of refusing the surgery. Conclusion. Socioeconomic factors were related to the refusal of recommended surgical treatment for prostate cancer. Such barriers should be addressed to improve the utilization of surgical treatment and patients' well-being. PMID:25973276

Risk taking and refusal assertiveness in a longitudinal model of alcohol use among inner-city adolescents.

PubMed

Epstein, J A; Griffin, K W; Botvin, G J

2001-09-01

Risk taking and refusal assertiveness have been shown to be important determinants of adolescent alcohol use. However, it remains unclear whether youth predisposed to risk taking would be less likely to assertively refuse. This study examined the relationships among risk taking, refusal assertiveness, and alcohol use in a sample of inner-city minority students (N = 1,459), using a cross-lagged longitudinal structural equation model. Data collectors administered the questionnaire to students following a standardized protocol during a 40-min class period. Based on the tested model, risk taking was more stable over time than refusal assertiveness. Furthermore, high risk takers reported less frequent subsequent refusal assertiveness, and less frequent refusal assertiveness predicted greater drinking. A predisposition toward risk taking appears to be an enduring characteristic that is associated with low refusal assertiveness and increased alcohol use. These findings suggest that alcohol prevention programs that emphasize refusal skills training may be less effective for high risk takers. But programs that focus on enhancing competence or reducing normative expectations for peer alcohol use might be more effective for high risk-taking youth.

Recovery of glass from the inert fraction refused by MBT plants in a pilot plant.

PubMed

Dias, Nilmara; Garrinhas, Inés; Maximo, Angela; Belo, Nuno; Roque, Paulo; Carvalho, M Teresa

2015-12-01

Selective collection is a common practice in many countries. However, even in some of those countries there are recyclable materials, like packaging glass, erroneously deposited in the Mixed Municipal Solid Waste (MMSW). In the present paper, a solution is proposed to recover glass from the inert reject of Mechanical and Biological Treatment (MBT) plants treating MMSW aiming at its recycling. The inert reject of MBT (MBTr) plants is characterized by its small particle size and high heterogeneity. The study was made with three real samples of diverse characteristics superimposed mainly by the different upstream MBT. One of the samples (VN) had a high content in organics (approximately 50%) and a particle size smaller than 16 mm. The other two were coarser and exhibited similar particle size distribution but one (RE) was rich in glass (almost 70%) while the other (SD) contained about 40% in glass. A flowsheet was developed integrating drying, to eliminate moisture related with organic matter contamination; magnetic separation, to separate remaining small ferrous particles; vacuum suction, to eliminate light materials; screening, to eliminate the finer fraction that has a insignificant content in glass, and to classify the >6mm fraction in 6-16 mm and >16 mm fractions to be processed separately; separation by particle shape, in the RecGlass equipment specifically designed to eliminate stones; and optical sorting, to eliminate opaque materials. A pilot plant was built and the tests were conducted with the three samples separately. With all samples, it was possible to attain approximately 99% content in glass in the glass products, but the recovery of glass was related with the feed particle size. The finer the feed was, the lower the percentage of glass recovered in the glass product. The results show that each one of the separation processes was needed for product enrichment. The organic matter recovered in the glass product was high, ranging from 0.76% to 1.13%, showing that drying was not sufficient in the tests but that it is a key process for the success of the operation. Copyright © 2015 Elsevier Ltd. All rights reserved.

49 CFR 219.213 - Unlawful refusals; consequences.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Unlawful refusals; consequences. 219.213 Section 219.213 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD... § 219.213 Unlawful refusals; consequences. (a) Disqualification. An employee who refuses to cooperate in...

Children of divorce: the differential diagnosis of contact refusal.

PubMed

Freeman, Bradley W

2011-07-01

Contact refusal is a common phenomenon that can occur during the course of, or after, divorce, which affects the relationship between a child and the parent. This article defines the concept of contact refusal and discusses the importance of its recognition. The concept is further narrowed to focus on the child as the one refusing contact, not the parent, which can happen as well. Various types of contact refusals are illustrated in the article through clinical vignettes, and an approach to categorizing the various types of contact refusal is presented. Copyright © 2011 Elsevier Inc. All rights reserved.

Pilot Plant Program for the AED Advanced Coal Cleaning System. Phase II. Interim final report

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

Not Available

1980-08-01

Advanced Energy Dynamics, Inc. (AED), has developed a proprietary coal cleaning process which employs a combination of ionization and electrostatic separation to remove both sulfur and ash from dry pulverized coal. The Ohio Department of Energy sponsored the first part of a program to evaluate, develop, and demonstrate the process in a continuous-flow pilot plant. Various coals used by Ohio electric utilities were characterized and classified, and sulfur reduction, ash reduction and Btu recovery were measured. Sulfur removal in various coals ranged from 33 to 68% (on a Btu basis). Ash removal ranged from 17 to 59% (on a Btumore » basis). Ash removal of particles greater than 53 microns ranged from 46 to 88%. Btu recovery ranged from 90 to 97%. These results, especially the large percentage removal of ash particles greater than 53 microns, suggest that the AED system can contribute materially to improved boiler performance and availability. The study indicated the following potential areas for commercial utilization of the AED process: installation between the pulverizer and boiler of conventional coal-fired power utilities; reclamation of fine coal refuse; dry coal cleaning to supplement, and, if necessary, to take the place of conventional coal cleaning; upgrading coal used in: (1) coal-oil mixtures, (2) gasification and liquefaction processes designed to handle pulverized coal; and (3) blast furnaces for making steel, as a fuel supplement to the coke. Partial cleaning of coking coal blends during preheating may also prove economically attractive. Numerous other industrial processes which use pulverized coal such as the production of activated carbon and direct reduction of iron ore may also benefit from the use of AED coal cleaning.« less

[Refusal of care in the intensive care: how makes decision?].

PubMed

Borel, M; Veber, B; Villette-Baron, K; Hariri, S; Dureuil, B; Hervé, C

2009-11-01

Decision-making bringing to an admission or not in intensive care is complex. The aim of this study is to analyze with an ethical point of view the making decision process leading to the refusal and its consequences. It is proposed a setting in prospect through the principles of beneficence, non-maleficience, respect for autonomy, justice, and the Leonetti law. Prospective study in surgical reanimation at the University Hospital of Rouen over 9 months (November 2007-September 2008). Systematic collection for each non-admitted patient of the general characters, the methods of decision making, immediate becoming and within 48 h Constitution of two groups: patients for whom an admission in intensive care could be an unreasonable situation of obstinacy, and patients for whom an admission in reanimation would not be about unreasonable if it occurred. One hundred and fifty situations were analyzed. The potentially unreasonable character of an admission does not involve necessarily a refusal of care in intensive care. The question of the lack of place and equity in the access to the care is real but relative according to the typology of the patients. The research of the respect of the autonomy of the patient is difficult but could be facilitated. The Leonetti law does not appear to be able to be a framework with the situation of refusal of care in intensive care. It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable.

40 CFR 49.129 - Rule for limiting emissions of sulfur dioxide.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., incinerator, marine vessel, mobile sources, motor vehicle, nonroad engine, nonroad vehicle, open burning, process source, reference method, refuse, residual fuel oil, solid fuel, stack, standard conditions...

40 CFR 49.129 - Rule for limiting emissions of sulfur dioxide.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., incinerator, marine vessel, mobile sources, motor vehicle, nonroad engine, nonroad vehicle, open burning, process source, reference method, refuse, residual fuel oil, solid fuel, stack, standard conditions...

Bioaerosol exposure during refuse collection: results of field studies in the real-life situation.

PubMed

Neumann, H D; Balfanz, J; Becker, G; Lohmeyer, M; Mathys, W; Raulf-Heimsoth, M

2002-07-03

To determine the bioaerosol exposure of refuse collectors, field measurements were performed under real working conditions within the framework of a research project. Influencing variables such as different types of refuse, community structure, collection interval and season were taken into account. Overall, 1612 samples were taken in towns of Westfalia, Germany. With workplace levels on a scale of 10(3) to less than 10(4) CFU/m3 for the loader, the results show a surprisingly low total fungi concentration in comparison with earlier studies. Total bacteria concentrations, in contrast, were largely on a scale of 10(4) CFU/m3, with 10(5) CFU/m3 being registered sporadically, especially in apartment-block districts. Endotoxin levels were high especially in the summer months, occasionally reaching values of more than 50 EU/m3, whereas they were normally below 10 EU/m3 in autumn and winter. Inside the cab, the exposure level for the entire spectrum was at least one power of ten lower. The factors believed to account primarily for the low total fungi concentration were workplace hygiene, the prevailing 1-week collection interval, and the low in-process exposure time resulting from the effective deployment of automatic lifting devices. In contrast, the type of refuse was not found to have a significant influence.

Refusal of Medical and Surgical Interventions by Older Persons with Advanced Chronic Disease

PubMed Central

Van Ness, Peter H.; O’Leary, John R.; Fried, Terri R.

2007-01-01

BACKGROUND Patients with advanced chronic disease are frequently offered medical and surgical interventions with potentially large trade-offs between benefits and burdens. Little is known about the frequency or outcomes of treatment refusal among these patients. OBJECTIVE To assess the frequency of, reasons for, factors associated with, and outcomes of treatment refusal among older persons with advanced chronic disease. DESIGN Observational cohort study. PARTICIPANTS Two hundred twenty-six community-dwelling persons with advanced cancer, chronic obstructive pulmonary disease, or congestive heart failure, interviewed at least every 4 months for up to 2 years. MEASUREMENTS Participants were asked if they had refused any treatments recommended by their physicians, and why. RESULTS Thirty-six of 226 patients (16%) reported refusing 1 or more medical or surgical treatments recommended by their physician. The most frequently refused interventions were cardiac catheterization and surgery. The most common reason for refusal was fear of side effects (41%). Treatment refusal was more frequent among patients who wanted prognostic information (10% vs 2%, p = .02) or estimated their own longevity at 2 years or less (18% vs 5%, p = .02). There was an increased risk of mortality among refusers compared with non-refusers (HR 1.98, 95% CI 1.02–3.86). CONCLUSIONS Refusal of medical and surgical interventions other than medications is common among persons with advanced chronic disease, and is associated with a greater desire for, and understanding of, prognostic information. PMID:17483977

The cost of refusing treatment and equality of outcome.

PubMed Central

Savulescu, J

1998-01-01

Patients have a right to refuse medical treatment. But what should happen after a patient has refused recommended treatment? In many cases, patients receive alternative forms of treatment. These forms of care may be less cost-effective. Does respect for autonomy extend to providing these alternatives? How for does justice constrain autonomy? I begin by providing three arguments that such alternatives should not be offered to those who refuse treatment. I argue that the best argument which refusers can appeal to is based on the egalitarian principle of equality of outcome. However, this principle does not ultimately support a right to less cost-effective alternatives. I focus on Jehovah's Witnesses refusing blood and requesting alternative treatments. However, the point applies to many patients who refuse cost-effective medical care. PMID:9752624

Refusal of treatment in obstetrics - A maternal-fetal conflict.

PubMed

Ohel, Iris; Iris, Ohel; Levy, Amalia; Amalia, Levy; Mazor, Moshe; Moshe, Mazor; Wiznitzer, Arnon; Arnon, Wiznitzer; Sheiner, Eyal; Eyal, Sheiner

2009-07-01

Clinical studies about the necessity of standard obstetric interventions raise questions, making refusal by pregnant women of treatment a legitimate choice. The present study was aimed at characterising patients refusing medical treatment during pregnancy and delivery, and to examine whether refusal of treatment in obstetrics is associated with adverse perinatal outcome. A population-based study, comparing patients who refused (1898) and did not refuse (164,064) medical intervention during pregnancy and delivery, was conducted. Deliveries occurred between the years 1988 and 2002 in a tertiary medical centre. Patients refusing medical intervention tended to be older (30.5 +/- 5.0 vs. 28.4 +/- 5.9, p < 0.001) and of higher parity (above parity 5: 52.5% vs. 32.4%; parity 1: 10.2% vs. 20.0%; p < 0.001) than the controls. Parturients refusing medical treatment experienced significantly higher rates of adverse perinatal outcome including low Apgar scores (less than 7, in 1 and 5 min: 12.4% vs. 4.4%, p < 0.001 and 1.9% vs. 0.6%, p < 0.001, respectively). Moreover, higher rates of perinatal mortality in general and intra-partum death, in particular, were documented among women refusing medical treatment (3.3% vs. 1.5%, p < 0.001; 0.8% vs. 0.1%, p < 0.001). When using a multiple logistic regression model of risk factors for perinatal mortality, refuse of treatment was an independent risk factor for perinatal mortality (OR = 1.5; 95% CI = 1.1-2.0; p = 0.010). Patients refusing a medically indicated intervention have higher rates of pregnancy- and labour- related complications. Refusal of treatment is an independent risk factor for perinatal mortality.

Central Nervous System Disease, Education, and Race Impact Radiation Refusal in Pediatric Cancer Patients.

PubMed

Patel, Chirayu G; Stavas, Mark; Perkins, Stephanie; Shinohara, Eric T

2017-07-01

To investigate the determinants of radiation therapy refusal in pediatric cancer, we used the Surveillance, Epidemiology, and End Results registry to identify 24,421 patients who met the eligibility criteria, diagnosed between 1974 and 2012. Patients had any stage of cancer, were aged 0 to 19, and received radiation therapy or refused radiation therapy when it was recommended. One hundred twenty-eight patients (0.52%) refused radiation therapy when it was recommended. Thirty-two percent of patients who refused radiation therapy ultimately died from their cancer, at a median of 7 months after diagnosis (95% confidence interval, 3-11 mo), as compared with 29.0% of patients who did not refuse radiation therapy died from their cancer, at a median of 17 months after diagnosis (95% confidence interval, 17-18 mo). On multivariable analysis, central nervous system (CNS) site, education, and race were associated with radiation refusal. The odds ratio for radiation refusal for patients with CNS disease was 1.62 (P=0.009) as compared with patients without CNS disease. For patients living in a county with ≥10% residents having less than ninth grade education, the odds ratio for radiation refusal was 1.71 (P=0.008) as compared with patients living in a county with <10% residents having less than ninth grade education. Asian, Pacific Islander, Alaska Native, and American Indian races had an odds ratio of 2.12 (P=0.002) for radiation refusal as compared with black or white race. Although the radiation refusal rate in the pediatric cancer population is low, we show that CNS site, education level, and race are associated with a significant difference in radiation refusal.

Refusal of curative radiation therapy and surgery among patients with cancer.

PubMed

Aizer, Ayal A; Chen, Ming-Hui; Parekh, Arti; Choueiri, Toni K; Hoffman, Karen E; Kim, Simon P; Martin, Neil E; Hu, Jim C; Trinh, Quoc-Dien; Nguyen, Paul L

2014-07-15

Surgery and radiation therapy represent the only curative options for many patients with solid malignancies. However, despite the recommendations of their physicians, some patients refuse these therapies. This study characterized factors associated with refusal of surgical or radiation therapy as well as the impact of refusal of recommended therapy on patients with localized malignancies. We used the Surveillance, Epidemiology, and End Results program to identify a population-based sample of 925,127 patients who had diagnoses of 1 of 8 common malignancies for which surgery and/or radiation are believed to confer a survival benefit between 1995 and 2008. Refusal of oncologic therapy, as documented in the SEER database, was the primary outcome measure. Multivariable logistic regression was used to investigate factors associated with refusal. The impact of refusal of therapy on cancer-specific mortality was assessed with Fine and Gray's competing risks regression. In total, 2441 of 692,938 patients (0.4%) refused surgery, and 2113 of 232,189 patients (0.9%) refused radiation, despite the recommendations of their physicians. On multivariable analysis, advancing age, decreasing annual income, nonwhite race, and unmarried status were associated with refusal of surgery, whereas advancing age, decreasing annual income, Asian American race, and unmarried status were associated with refusal of radiation (P<.001 in all cases). Refusal of surgery and radiation were associated with increased estimates of cancer-specific mortality for all malignancies evaluated (hazard ratio [HR], 2.80, 95% confidence interval [CI], 2.59-3.03; P<.001 and HR 1.97 [95% CI, 1.78-2.18]; P<.001, respectively). Nonwhite, less affluent, and unmarried patients are more likely to refuse curative surgical and/or radiation-based oncologic therapy, raising concern that socioeconomic factors may drive some patients to forego potentially life-saving care. Copyright © 2014 Elsevier Inc. All rights reserved.

Refusal of Curative Radiation Therapy and Surgery Among Patients With Cancer

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

Aizer, Ayal A., E-mail: aaaizer@partners.org; Chen, Ming-Hui; Parekh, Arti

Purpose: Surgery and radiation therapy represent the only curative options for many patients with solid malignancies. However, despite the recommendations of their physicians, some patients refuse these therapies. This study characterized factors associated with refusal of surgical or radiation therapy as well as the impact of refusal of recommended therapy on patients with localized malignancies. Methods and Materials: We used the Surveillance, Epidemiology, and End Results program to identify a population-based sample of 925,127 patients who had diagnoses of 1 of 8 common malignancies for which surgery and/or radiation are believed to confer a survival benefit between 1995 and 2008.more » Refusal of oncologic therapy, as documented in the SEER database, was the primary outcome measure. Multivariable logistic regression was used to investigate factors associated with refusal. The impact of refusal of therapy on cancer-specific mortality was assessed with Fine and Gray's competing risks regression. Results: In total, 2441 of 692,938 patients (0.4%) refused surgery, and 2113 of 232,189 patients (0.9%) refused radiation, despite the recommendations of their physicians. On multivariable analysis, advancing age, decreasing annual income, nonwhite race, and unmarried status were associated with refusal of surgery, whereas advancing age, decreasing annual income, Asian American race, and unmarried status were associated with refusal of radiation (P<.001 in all cases). Refusal of surgery and radiation were associated with increased estimates of cancer-specific mortality for all malignancies evaluated (hazard ratio [HR], 2.80, 95% confidence interval [CI], 2.59-3.03; P<.001 and HR 1.97 [95% CI, 1.78-2.18]; P<.001, respectively). Conclusions: Nonwhite, less affluent, and unmarried patients are more likely to refuse curative surgical and/or radiation-based oncologic therapy, raising concern that socioeconomic factors may drive some patients to forego potentially life-saving care.« less

The Secret Drama at the Patient's Bedside-Refusal of Treatment Because of the Practitioner's Ethnic Identity: The Medical Staff 's Point of View.

PubMed

Popper-Giveon, Ariela; Keshet, Yael

2018-04-01

Patients' refusal of treatment based on the practitioner's ethnic identity reveals a clash of values: neutrality in medicine versus patient-centered care. Taking the Israeli-Palestinian conflict into account, this article aims at examining Israeli health care professionals' points of view concerning patients' refusal of treatment because of a practitioner's ethnic identity. Fifty in-depth interviews were conducted with 10 managers and 40 health care professionals, Jewish and Arab, employed at 11 public hospitals. Most refusal incidents recorded are unidirectional: Jewish patients refusing to be treated by Arab practitioners. Refusals are usually directed toward nurses and junior medical staff members, especially if recognizable as religious Muslims. Refusals are often initiated by the patients' relatives and occur more frequently during periods of escalation in the conflict. The structural competency approach can be applied to increase awareness of the role of social determinants in shaping patients' ethnic-based treatment refusals and to improve the handling of such incidents.

Immunofluorescence Approach to the Study of the Ecology of Thermoplasma acidophilum In Coal Refuse Material

PubMed Central

Bohlool, B. B.; Brock, T. D.

1974-01-01

Specific immunofluorescence staining was applied to the study of the localization, distribution, and growth of Thermoplasma acidophilum in its natural habitat, the coal refuse pile. Different antigenic groups of T. acidophilum could be isolated from the same refuse pile, and the same antigenic groups were isolated from piles from different geographical areas. No correlation could be established between the antigenic groups and the pH or temperature of the habitats. Brightly fluorescing cells of T. acidophilum were detected on microscope slides buried in contact with the coal refuse material or immersed in the water in the stream draining a refuse pile. T. acidophilum grew when inoculated into either coal refuse material and/or an aqueous extract of coal refuse when incubated at its optimal temperature of 55 C, but not when incubated at room temperature or 37 C. The coal refuse pile appears to be a primary habitat for T. acidophilum. PMID:4602306

Sea, soil, sky - Testing solar's limits

NASA Astrophysics Data System (ADS)

Hopkinson, J.

1981-12-01

The potentials and actualities of large scale biomass, ocean thermal, and satellite solar power systems are discussed. Biomass is an energy already on-line in installations ranging from home-sized wood-burning stoves to utility sized generators fueled by sawdust and forest residue. Uses of wheat straw, fast-growing trees such as eucalyptus and alder, and euphorbia as biofuels are examined, noting restrictions imposed by land use limitations and the necessity for genetic engineering for more suitable plants. Pyrolysis and thermochemical gasification of biomass to form gaseous, solid, and liquid fuels are explored, and mention is made of utility refuse and sewage incineration for power generation. OTEC, satellite solar power systems, and tidal generator plants are considered as promising for further investigation and perhaps useful in limited applications, while solar pond power plants require extremely large areas to be effective.

A plea for uniform European definitions for organ donor potential and family refusal rates.

PubMed

Jansen, Nichon E; Haase-Kromwijk, Bernadette J J M; van Leiden, Hendrik A; Weimar, Willem; Hoitsma, Andries J

2009-11-01

Conversion of potential organ donors to actual donors is negatively influenced by family refusals. Refusal rates differ strongly among countries. Is it possible to compare refusal rates in order to be able to learn from countries with the best practices? We searched in the literature for reviews of donor potential and refusal rates for organ donation in intensive care units. We found 14 articles pertinent to this study. There is an enormous diversity among the performed studies. The definitions of potential organ donors and family refusal differed substantially. We tried to re-calculate the refusal rates. This method failed because of the influence caused by the registered will on donation in the Donor Register. We therefore calculated the total refusal rate. This strategy was also less satisfactory considering possible influence of the legal consent system on the approach of family. Because of lack of uniform definitions, we can conclude that the refusal rates for organ donation can not be used for a sound comparison among countries. To be able to learn from well-performing countries, it is necessary to establish uniform definitions regarding organ donation and registration of all intensive care deaths.

Influenza vaccine refusal in Israeli young adults.

PubMed

Balicer, Ran D; Grotto, Itamar; Huerta, Michael; Levian, Yardena; Davidovitch, Nadav

2007-10-01

The purpose of this study was to identify correlates of noncompliance with influenza immunization among young adults and to determine the reasons leading to immunization refusal. Self-administered questionnaires were distributed in 10 military bases during two consecutive annual Israel Defense Force influenza vaccination campaigns. Multivariate logistic regression was performed to identify independent correlates. Of 2,000 questionnaires distributed over two seasons, 942 were completed and returned. Of those, 401 respondents were not vaccinated either because of medical contraindication or for administrative reasons. The remaining 541 respondents who reported either receiving the vaccine or refusing to receive it were analyzed. Risk groups for vaccine refusal included older age (17.9% vs. 3.5% refusal rate) and officer rank (25.9% vs. 13.8% refusal rate). The main reasons for vaccine refusal differed significantly between officers and nonofficers (chi2 = 7.587, p = 0.023). Officers refused mainly (60%) because of fear of possible vaccine adverse effects, whereas nonofficers refused mainly (44.2%) because of disbelief in the vaccine's efficacy in preventing illness. Officers serve as a negative role model in this case, and efforts directed toward dissemination of evidence-based information regarding vaccine-related adverse effects should be introduced to increase vaccination rates in this group.

mHealth intervention to improve medication management in chronically ill patients: analysis of the recruitment process.

PubMed

Anglada-Martínez, Helena; Rovira-Illamola, Marina; Martin-Conde, Maite; Sotoca-Momblona, Jose Miguel; Codina-Jané, Carles

2016-05-01

Mobile phones have been rapidly adopted by the general population and are now a promising technology with considerable potential in health care. However, refusal rates of 24%-75% have been reported in telemedicine studies. We aimed to report the challenges faced when recruiting patients to use Android and iOS smartphone applications aimed at improving medication management and communication between patients and healthcare professionals. The patients invited to participate had heart failure and/or hypertension and/or dyslipidemia. After reaching the number of participants required for inclusion, the recruitment process was analyzed, and the study team determined the reasons for refusal. Of the 448 potential participants who were invited to participate, 210 responded. Of these, 37.1% did not use a smartphone, 2.9% owned a mobile phone that was neither iOS nor Android, and 28.6% were smartphone users who refused to participate. In this case, the most common motive was that patients considered their routine healthcare sufficient and had no trouble remembering to take their medicines (81.7%). The final study sample comprised 48 patients. The mean age of the patients enrolled was significantly lower than that of participants who were not included (59.9 ± 10.6 vs. 66.8 ± 11.4 years, respectively; p=0.00). We found age to be an important barrier to smartphone use in healthcare. Among smartphone users, good adherence and sufficient routine healthcare were the most common reasons for refusal to participate. Thus, this type of intervention could enhance participation for poor adherers or caregivers. Implementing educational initiatives could play a key role in improving patient perceptions of technology.

Outcomes of nighttime refusal of admission to the intensive care unit: The role of the intensivist in triage.

PubMed

Hinds, Nicholas; Borah, Amit; Yoo, Erika J

2017-06-01

To compare outcomes of patients refused medical intensive care unit (MICU) admission overnight to those refused during the day and to examine the impact of the intensivist in triage. Retrospective, observational study of patients refused MICU admission at an urban university hospital. Of 294 patients, 186 (63.3%) were refused admission overnight compared to 108 (36.7%) refused during the day. Severity-of-illness by the Mortality Probability Model was similar between the two groups (P=.20). Daytime triage refusals were more likely to be staffed by an intensivist (P=.01). After risk-adjustment, daytime refusals had a lower odds of subsequent ICU admission (OR 0.46, 95% CI 0.22-0.95, P=.04) than patients triaged at night. There was no evidence for interaction between time of triage and intensivist staffing of the patient (P=.99). Patients refused MICU admission overnight are more likely to be later admitted to an ICU than patients refused during the day. However, the mechanism for this observation does not appear to depend on the intensivist's direct evaluation of the patient. Further investigation into the clinician-specific effects of ICU triage and identification of potentially modifiable hospital triage practices will help to improve both ICU utilization and patient safety. Copyright © 2017 Elsevier Inc. All rights reserved.

Physicians' evaluations of patients' decisions to refuse oncological treatment

PubMed Central

van Kleffens, T; van Leeuwen, E

2005-01-01

Objective: To gain insight into the standards of rationality that physicians use when evaluating patients' treatment refusals. Design of the study: Qualitative design with indepth interviews. Participants: The study sample included 30 patients with cancer and 16 physicians (oncologists and general practitioners). All patients had refused a recommended oncological treatment. Results: Patients base their treatment refusals mainly on personal values and/or experience. Physicians mainly emphasise the medical perspective when evaluating patients' treatment refusals. From a medical perspective, a patient's treatment refusal based on personal values and experience is generally evaluated as irrational and difficult to accept, especially when it concerns a curative treatment. Physicians have a different attitude towards non-curative treatments and have less difficulty accepting a patient's refusal of these treatments. Thus, an important factor in the physician's evaluation of a treatment refusal is whether the treatment refused is curative or non-curative. Conclusion: Physicians mainly use goal oriented and patients mainly value oriented rationality, but in the case of non-curative treatment refusal, physicians give more emphasis to value oriented rationality. A consensus between the value oriented approaches of patient and physician may then emerge, leading to the patient's decision being understood and accepted by the physician. The physician's acceptance is crucial to his or her attitude towards the patient. It contributes to the patient's feeling free to decide, and being understood and respected, and thus to a better physician–patient relationship. PMID:15738431

Refusal of Vitamin K by Parents of Newborns: A Survey of the Better Outcomes Through Research for Newborns Network

PubMed Central

Loyal, Jaspreet; Taylor, James A.; Phillipi, Carrie A.; Goyal, Neera K.; Dhepyasuwan, Niramol; Shapiro, Eugene D.; Colson, Eve

2018-01-01

Objective To survey newborn clinicians in the United States regarding the frequency of intramuscular (IM) vitamin K refusal by a parent, reasons for refusal, and approaches of clinicians to refusals. Methods An electronic survey was administered to the clinician site representative (nursery director or designee knowledgeable about site-specific nursery policies) at all newborn nurseries in the Better Outcomes through Research for Newborns (BORN) network of newborn nurseries. Results Of 92 BORN sites, 85 (92%) respondents completed the survey. Frequency of IM vitamin K refusal during the past 5 years was reported as increased by 52% of respondents, unchanged by 42%, and 6% did not know. Reported frequencies of refusal of IM vitamin K was weekly (9%), a few times a month (31%), once a month (13%), once every 3 to 4 months (20%), once or twice a year (26%), or never (1%). The overall distribution of the reported frequencies of refusal differed among regions in the United States (higher in the West and the South; P < .05). Reported reasons for refusal by parents included perceptions of parents that the injection was unnecessary, lack of knowledge about vitamin K deficiency bleeding, and concern about preservatives. Approaches to refusal included attempts to educate parents, enlisting support from community clinicians, a state mandate, and prescription of oral vitamin K. Conclusions Respondents from a national sample of newborn nursery clinicians reported an increase in refusal of IM vitamin K in the past 5 years with regional variation. Approaches to refusals need further investigation to determine effectiveness. PMID:28277269

When "no" might not quite mean "no"; the importance of informed and meaningful non-consent: results from a survey of individuals refusing participation in a health-related research project.

PubMed

Williams, Brian; Irvine, Linda; McGinnis, Alison R; McMurdo, Marion E T; Crombie, Iain K

2007-04-26

Low participation rates can lead to sampling bias, delays in completion and increased costs. Strategies to improve participation rates should address reasons for non-participation. However, most empirical research has focused on participants' motives rather than the reasons why non-participants refuse to take part. In this study we investigated the reasons why older people choose not to participate in a research project. Follow-up study of people living in Tayside, Scotland who had opted-out of a cross-sectional survey on activities in retirement. Eight hundred and eighty seven people aged 65-84 years were invited to take part in a home-based cross-sectional survey. Of these, 471 refused to take part. Permission was obtained to follow-up 417 of the refusers. Demographic characteristics of people who refused to take part and the reasons they gave for not taking part were collected. 54% of those invited to take part in the original cross-sectional survey refused to do so. However, 61% of these individuals went on to participate in the follow-up study and provided reasons for their original refusal. For the vast majority of people initial non-participation did not reflect an objection to participating in research in principle but frequently stemmed from barriers or misunderstandings about the nature or process of the project itself. Only 28% indicated that they were "not interested in research". The meaningfulness of expressions of non-consent may therefore be called into question. Hierarchical log-linear modelling showed that refusal was independently influenced by age, gender and social class. However, this response pattern was different for the follow-up study in which reasons for non-participation in the first survey were sought. This difference in pattern and response rates supports the likely importance of recruitment issues that are research and context specific. An expression of non-consent does not necessarily mean that a fully informed evaluation of the pros and cons of participation and non-participation has taken place. The meaningfulness of expressions of non-consent may therefore be a cause for concern and should be subject to further research. Many reasons for non-participation may be specific to a particular research topic or population. Information sheets should reflect this by going beyond standardised guidelines for their design and instead proactively seek out and address areas of concern or potential misunderstanding. The use of established behavioural theory in their design could also be considered.

30 CFR 77.215-1 - Refuse piles; identification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles; identification. 77.215-1 Section... COAL MINES Surface Installations § 77.215-1 Refuse piles; identification. A permanent identification marker, at least six feet high and showing the refuse pile identification number as assigned by the...

76 FR 29796 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Refuse...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-23

... for OMB Review; Comment Request; Refuse Piles and Impounding Structures, Recordkeeping and Reporting... Administration (MSHA) sponsored information collection request (ICR) titled, ``Refuse Piles and Impounding... to submit annual reports and certification on refuse piles and impoundments to the agency and to keep...

21 CFR 316.14 - Refusal to provide written recommendations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Refusal to provide written recommendations. 316.14... (CONTINUED) DRUGS FOR HUMAN USE ORPHAN DRUGS Written Recommendations for Investigations of Orphan Drugs § 316.14 Refusal to provide written recommendations. (a) FDA may refuse to provide written recommendations...

37 CFR 1.295 - Review of decision finally refusing to publish a statutory invention registration.

Code of Federal Regulations, 2010 CFR

2010-07-01

... refusing to publish a statutory invention registration. 1.295 Section 1.295 Patents, Trademarks, and... decision finally refusing to publish a statutory invention registration. (a) Any requester who is dissatisfied with the final refusal to publish a statutory invention registration for reasons other than...

22 CFR 42.81 - Procedure in refusing individual visas.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Procedure in refusing individual visas. 42.81 Section 42.81 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE... Procedure in refusing individual visas. (a) Issuance or refusal mandatory. When a visa application has been...

22 CFR 42.81 - Procedure in refusing individual visas.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Procedure in refusing individual visas. 42.81 Section 42.81 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE... Procedure in refusing individual visas. (a) Issuance or refusal mandatory. When a visa application has been...

22 CFR 41.121 - Refusal of individual visas.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Refusal of individual visas. 41.121 Section 41.121 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Refusals and Revocations § 41.121 Refusal of individual visas. (a...

22 CFR 41.121 - Refusal of individual visas.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Refusal of individual visas. 41.121 Section 41.121 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Refusals and Revocations § 41.121 Refusal of individual visas. (a...

22 CFR 42.81 - Procedure in refusing individual visas.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Procedure in refusing individual visas. 42.81 Section 42.81 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE... Procedure in refusing individual visas. (a) Issuance or refusal mandatory. When a visa application has been...

22 CFR 42.81 - Procedure in refusing individual visas.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Procedure in refusing individual visas. 42.81 Section 42.81 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE... Procedure in refusing individual visas. (a) Issuance or refusal mandatory. When a visa application has been...

22 CFR 42.81 - Procedure in refusing individual visas.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Procedure in refusing individual visas. 42.81 Section 42.81 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE... Procedure in refusing individual visas. (a) Issuance or refusal mandatory. When a visa application has been...

22 CFR 41.121 - Refusal of individual visas.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Refusal of individual visas. 41.121 Section 41.121 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Refusals and Revocations § 41.121 Refusal of individual visas. (a...

22 CFR 41.121 - Refusal of individual visas.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Refusal of individual visas. 41.121 Section 41.121 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Refusals and Revocations § 41.121 Refusal of individual visas. (a...

22 CFR 41.121 - Refusal of individual visas.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Refusal of individual visas. 41.121 Section 41.121 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Refusals and Revocations § 41.121 Refusal of individual visas. (a...

9 CFR 439.50 - Refusal of accreditation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ACCREDITATION OF NON-FEDERAL CHEMISTRY LABORATORIES § 439.50 Refusal of accreditation. Upon a determination by the Administrator, a laboratory will be refused accreditation for the following reasons: (a) A laboratory will be refused accreditation for failure to meet the requirements of § 439.5 or § 439.10 of this...

42 CFR 493.567 - Refusal to cooperate with validation inspection.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Refusal to cooperate with validation inspection... § 493.567 Refusal to cooperate with validation inspection. (a) Laboratory with a certificate of accreditation. (1) A laboratory with a certificate of accreditation that refuses to cooperate with a validation...

42 CFR 493.567 - Refusal to cooperate with validation inspection.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Refusal to cooperate with validation inspection... § 493.567 Refusal to cooperate with validation inspection. (a) Laboratory with a certificate of accreditation. (1) A laboratory with a certificate of accreditation that refuses to cooperate with a validation...

42 CFR 493.567 - Refusal to cooperate with validation inspection.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Refusal to cooperate with validation inspection... § 493.567 Refusal to cooperate with validation inspection. (a) Laboratory with a certificate of accreditation. (1) A laboratory with a certificate of accreditation that refuses to cooperate with a validation...

42 CFR 493.567 - Refusal to cooperate with validation inspection.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Refusal to cooperate with validation inspection... § 493.567 Refusal to cooperate with validation inspection. (a) Laboratory with a certificate of accreditation. (1) A laboratory with a certificate of accreditation that refuses to cooperate with a validation...

42 CFR 493.567 - Refusal to cooperate with validation inspection.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Refusal to cooperate with validation inspection... § 493.567 Refusal to cooperate with validation inspection. (a) Laboratory with a certificate of accreditation. (1) A laboratory with a certificate of accreditation that refuses to cooperate with a validation...

78 FR 5516 - Self-Regulatory Organizations; The Depository Trust Company; Notice of Filing Advance Notice To...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-25

... modify its Rules as they relate to the Issuing/Paying Agent's (``IPA's'') refusal to pay process. DTC is proposing not to process a reversal of a transaction initiated by an IPA when issuances of Money Market... morning for MMIs maturing that day. The automatic process electronically sweeps all maturing positions of...

Method of extracting coal from a coal refuse pile

DOEpatents

Yavorsky, Paul M.

1991-01-01

A method of extracting coal from a coal refuse pile comprises soaking the coal refuse pile with an aqueous alkali solution and distributing an oxygen-containing gas throughout the coal refuse pile for a time period sufficient to effect oxidation of coal contained in the coal refuse pile. The method further comprises leaching the coal refuse pile with an aqueous alkali solution to solubilize and extract the oxidized coal as alkali salts of humic acids and collecting the resulting solution containing the alkali salts of humic acids. Calcium hydroxide may be added to the solution of alkali salts of humic acid to form precipitated humates useable as a low-ash, low-sulfur solid fuel.

Parental Refusal of Childhood Vaccines and Medical Neglect Laws.

PubMed

Parasidis, Efthimios; Opel, Douglas J

2017-01-01

To examine the relation of vaccine refusal and medical neglect under child welfare laws. We used the Westlaw legal database to search court opinions from 1905 to 2016 and identified cases in which vaccine refusal was the sole or a primary reason in a neglect proceeding. We also delineated if religious or philosophical exemptions from required school immunizations were available at the time of adjudication. Our search yielded 9 cases from 5 states. Most courts (7 of 9) considered vaccine refusal to constitute neglect. In the 4 cases decided in jurisdictions that permitted religious exemptions, courts either found that vaccine refusal did not constitute neglect or considered it neglect only in the absence of a sincere religious objection to vaccination. Some states have a legal precedent for considering parental vaccine refusal as medical neglect, but this is based on a small number of cases. Each state should clarify whether, under its laws, vaccine refusal constitutes medical neglect.

The Space Station integrated refuse management system

NASA Technical Reports Server (NTRS)

1988-01-01

The University of Central Florida's design of an Integrated Refuse Management System for the proposed International Space Station is addressed. Four integratable subsystems capable of handling an estimated Orbiter shortfall of nearly 40,000 lbs of refuse produced annually are discussed. The subsystems investigated were: (1) collection and transfer; (2) recycle and reuse; (3) advanced disposal; and (4) propulsion assist in disposal. Emphasis is placed on the recycling or reuse of those materials ultimately providing a source of Space Station refuse. Special consideration is given to various disposal methods capable of completely removing refuse from close proximity of the Space Station. There is evidence that pyrolysis is the optimal solution for disposal of refuse through employment of a Rocket Jettison Vehicle. Additionally, design considerations and specifications of the Refuse Management System are discussed. Optimal and alternate design solutions for each of the four subsystems are summarized. Finally, the system configuration is described and reviewed.

Parental Vaccine Acceptance: A Logistic Regression Model Using Previsit Decisions.

PubMed

Lee, Sara; Riley-Behringer, Maureen; Rose, Jeanmarie C; Meropol, Sharon B; Lazebnik, Rina

2017-07-01

This study explores how parents' intentions regarding vaccination prior to their children's visit were associated with actual vaccine acceptance. A convenience sample of parents accompanying 6-week-old to 17-year-old children completed a written survey at 2 pediatric practices. Using hierarchical logistic regression, for hospital-based participants (n = 216), vaccine refusal history ( P < .01) and vaccine decision made before the visit ( P < .05) explained 87% of vaccine refusals. In community-based participants (n = 100), vaccine refusal history ( P < .01) explained 81% of refusals. Over 1 in 5 parents changed their minds about vaccination during the visit. Thirty parents who were previous vaccine refusers accepted current vaccines, and 37 who had intended not to vaccinate choose vaccination. Twenty-nine parents without a refusal history declined vaccines, and 32 who did not intend to refuse before the visit declined vaccination. Future research should identify key factors to nudge parent decision making in favor of vaccination.

30 CFR 77.215-2 - Refuse piles; reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles; reporting requirements. 77.215-2... COAL MINES Surface Installations § 77.215-2 Refuse piles; reporting requirements. (a) The proposed location of a new refuse pile shall be reported to and acknowledged in writing by the District Manager...

30 CFR 77.214 - Refuse piles; general.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Refuse piles; general. 77.214 Section 77.214... Installations § 77.214 Refuse piles; general. (a) Refuse piles constructed on or after July 1, 1971, shall be..., tipples, or other surface installations and such piles shall not be located over abandoned openings or...

38 CFR 17.100 - Refusal of treatment by unnecessarily breaking appointments.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Refusal of treatment by... VETERANS AFFAIRS MEDICAL Breaking Appointments § 17.100 Refusal of treatment by unnecessarily breaking... informed that breaking an additional appointment will be deemed to be a refusal to accept VA treatment. If...

Alternative Fuels Data Center: Renewable Natural Gas From Landfill Powers

Science.gov Websites

Refuse Vehicles Renewable Natural Gas From Landfill Powers Refuse Vehicles to someone by E-mail Share Alternative Fuels Data Center: Renewable Natural Gas From Landfill Powers Refuse Vehicles on Facebook Tweet about Alternative Fuels Data Center: Renewable Natural Gas From Landfill Powers Refuse

22 CFR 40.6 - Basis for refusal.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Basis for refusal. 40.6 Section 40.6 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH NONIMMIGRANTS AND IMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED General Provisions § 40.6 Basis for refusal. A visa can be refused...

25 CFR 135.23 - Refusal of water delivery.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Refusal of water delivery. 135.23 Section 135.23 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES CONSTRUCTION ASSESSMENTS, CROW... District § 135.23 Refusal of water delivery. The right is reserved to refuse the delivery of water to any...

25 CFR 135.6 - Refusal of water delivery.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Refusal of water delivery. 135.6 Section 135.6 Indians... INDIAN IRRIGATION PROJECT Charges Assessed Against Irrigation District Lands § 135.6 Refusal of water delivery. The right is reserved to the United States to refuse the delivery of water to each of the said...

9 CFR 98.9 - Embryos refused entry.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Embryos refused entry. 98.9 Section 98... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.9 Embryos refused entry. Any embryo refused entry into the...

9 CFR 98.9 - Embryos refused entry.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Embryos refused entry. 98.9 Section 98... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.9 Embryos refused entry. Any embryo refused entry into the...

9 CFR 98.9 - Embryos refused entry.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Embryos refused entry. 98.9 Section 98... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.9 Embryos refused entry. Any embryo refused entry into the...

9 CFR 98.9 - Embryos refused entry.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Embryos refused entry. 98.9 Section 98... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.9 Embryos refused entry. Any embryo refused entry into the...

9 CFR 98.9 - Embryos refused entry.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Embryos refused entry. 98.9 Section 98... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.9 Embryos refused entry. Any embryo refused entry into the...

25 CFR 135.6 - Refusal of water delivery.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Refusal of water delivery. 135.6 Section 135.6 Indians... INDIAN IRRIGATION PROJECT Charges Assessed Against Irrigation District Lands § 135.6 Refusal of water delivery. The right is reserved to the United States to refuse the delivery of water to each of the said...

25 CFR 135.23 - Refusal of water delivery.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Refusal of water delivery. 135.23 Section 135.23 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES CONSTRUCTION ASSESSMENTS, CROW... District § 135.23 Refusal of water delivery. The right is reserved to refuse the delivery of water to any...

21 CFR 211.50 - Sewage and refuse.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Sewage and refuse. 211.50 Section 211.50 Food and... CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Buildings and Facilities § 211.50 Sewage and refuse. Sewage, trash, and other refuse in and from the building and immediate premises shall be...

25 CFR 135.6 - Refusal of water delivery.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Refusal of water delivery. 135.6 Section 135.6 Indians... INDIAN IRRIGATION PROJECT Charges Assessed Against Irrigation District Lands § 135.6 Refusal of water delivery. The right is reserved to the United States to refuse the delivery of water to each of the said...

25 CFR 135.23 - Refusal of water delivery.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Refusal of water delivery. 135.23 Section 135.23 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES CONSTRUCTION ASSESSMENTS, CROW... District § 135.23 Refusal of water delivery. The right is reserved to refuse the delivery of water to any...

25 CFR 135.6 - Refusal of water delivery.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true Refusal of water delivery. 135.6 Section 135.6 Indians... INDIAN IRRIGATION PROJECT Charges Assessed Against Irrigation District Lands § 135.6 Refusal of water delivery. The right is reserved to the United States to refuse the delivery of water to each of the said...

25 CFR 135.23 - Refusal of water delivery.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true Refusal of water delivery. 135.23 Section 135.23 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES CONSTRUCTION ASSESSMENTS, CROW... District § 135.23 Refusal of water delivery. The right is reserved to refuse the delivery of water to any...

Intensive (Daily) Behavior Therapy for School Refusal: A Multiple Baseline Case Series

ERIC Educational Resources Information Center

Tolin, David F.; Whiting, Sara; Maltby, Nicholas; Diefenbach, Gretchen J.; Lothstein, Mary Anne; Hardcastle, Surrey; Catalano, Amy; Gray, Krista

2009-01-01

The following multiple baseline case series examines school refusal behavior in 4 male adolescents. School refusal symptom presentation was ascertained utilizing a functional analysis from the School Refusal Assessment Scale (Kearney, 2002). For the majority of cases, treatment was conducted within a 15-session intensive format over a 3-week…

Refusal Skill Ability: An Examination of Adolescent Perceptions of Effectiveness

ERIC Educational Resources Information Center

Nichols, Tracy R.; Birnel, Sara; Graber, Julia A.; Brooks-Gunn, Jeanne; Botvin, Gilbert J.

2010-01-01

This pilot study examined whether refusal assertion as defined by a proven drug prevention program was associated with adolescent perceptions of effectiveness by comparing two sets of coded responses to adolescent videotaped refusal role-plays (N = 63). The original set of codes was defined by programmatic standards of refusal assertion and the…

Social Skills, Competence, and Drug Refusal Efficacy as Predictors of Adolescent Alcohol Use.

ERIC Educational Resources Information Center

Scheier, Lawrence M.; Botvin, Gilbert J.; Diaz, Tracy; Griffin, Kenneth W.

1999-01-01

Examines the extent to which assertiveness and related social skills, personal competence, and refusal efficacy predict alcohol involvement in adolescents. Males were at higher risk for poor refusal skills and reported higher alcohol involvement. Youth characterized by poor social skill development reported lower refusal efficacy, lower grades,…

Miami-Dade County Hydraulic Hybrid Refuse Truck Testing | Transportation

Science.gov Websites

Research | NREL Miami-Dade County Hydraulic Hybrid Refuse Truck Evaluation Miami-Dade County Hydraulic Hybrid Refuse Truck Evaluation Photo of garbage truck with view of lake and city in background. As hydraulic hybrid refuse vehicles, with 29 more on order. Photo courtesy of Parker Hannifin NREL is

Alternative Fuels Data Center: Hydraulic Hybrid Pressed into Service in

Science.gov Websites

Refuse Collection Hydraulic Hybrid Pressed into Service in Refuse Collection to someone by E -mail Share Alternative Fuels Data Center: Hydraulic Hybrid Pressed into Service in Refuse Collection on Facebook Tweet about Alternative Fuels Data Center: Hydraulic Hybrid Pressed into Service in Refuse

Persian Speakers' Use of Refusal Strategies across Politeness Systems

ERIC Educational Resources Information Center

Salmani Nodoushan, Mohammad Ali

2016-01-01

This study aimed at investigating the preferred refusal strategies in Persian. 3047 refusals collected by 108 field workers as well as 376 refusals collected through face to face interviews were analyzed and classified according to the descriptions proposed by Liao (1994) and Liao and Bresnahan (1996). The frequencies of the resulting direct and…

Recycling of aged refuse from a closed landfill.

PubMed

Zhao, Youcai; Song, Liyan; Huang, Renhua; Song, Lijie; Li, Xiong

2007-04-01

In this study, refuse excavated from a typical refuse landfill in Shanghai after 8-10 years of placement was characterized in terms of particle size, total nitrogen, total phosphorus, and biodegradable matter. The refuse contained a large and diverse population of micro-organisms with a high capacity for decomposing refractory organic matter present in some wastewaters, including leachate. It was found that the aged refuse was quite stable after about a decade of decomposition in the warm, humid climate of southern China. The fine fractions resembled and had the properties of black soil, a medium that is suitable for green construction, organic fertilizer, or as bioreactor media for biological treatment of organic wastewaters. Excavation of the aged refuse would make about 50% of the space available for fresh refuse. The plastics, glass, textiles, and cans can be readily mechanically separated and recycled after cleaning. It is estimated that at least 200 millions tonnes of such aged refuse are available in China alone, and at least 10 times that much is buried worldwide. Hence, the evaluation of mined landfill waste and consideration of its potential uses is of great significance.

Conifers growing on anthracite mine soils respond to fertilization

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

Davidson, W.H.; Sowa, E.A.

1982-12-01

Anthracite mine soils will support vegetation. To confirm this one needs only to look at the sizeable number of acres revegetated since passage of the 1963 Pennsylvania Anthracite Strip Mine and Conservation Act. In spite of the large number of acres revegetated, many planted trees, particularly conifers, grow poorly on anthracite mine soils. It is not uncommon for trees of a single species to differ widely in growth, not only from one mine soil to another but even on the same one. Studies were conducted on anthracite mine soils and breaker refuse to examine the growth response of some plantedmore » conifers to 1) slow-release fertilizer and 2) granular fertilizer. Annual height growth was used to measure response. Japanese larch (Larix leptolepis) growing on mine soil responded to slow-release fertilizer in the first year. Red (Pinus resinosa), white (P. strobus), and Austrian (P. nigra) pines did not respond until the second year after treatment. The response lasted for 3 years. This fertilizer did not affect growth of white spruce (Picea glauca) on mine soil, but it had a significant effect for the full, 4 year term of the study on Austrian pine growing on coal breaker refuse. Red and Scotch (P. sylvestris) pines on breaker refuse did not respond to granular fertilizer until the third year and the response was short-lived. Even though significant growth responses were obtained with these treatments, the height differences were relatively small.« less

What happens after a request for euthanasia is refused? Qualitative interviews with patients, relatives and physicians.

PubMed

Pasman, H Roeline W; Willems, Dick L; Onwuteaka-Philipsen, Bregje D

2013-09-01

Obtaining in-depth information from both patient and physician perspectives about what happens after a request for euthanasia or physician-assisted suicide (EAS) is refused. In-depth interviews with nine patients whose EAS request was refused and seven physicians of these patients, and with three relatives of patients who had died after a request was refused and four physicians of these patients. Interviews were conducted at least 6 months after the refusal. A wish to die remained in all patients after refusal, although it sometimes diminished. In most cases patient and physician stopped discussing this wish, and none of the physicians had discussed plans for the future with the patient or evaluated the patient's situation after their refusal. Physicians were aware of patients' continued wish to die. Patients who are refused EAS may subsequently be silent about a wish to die without abandoning it. Open communication about wishes to die is important, even outside the context of EAS, because if people feel unable to talk about them, their quality of life may be further diminished. Follow up appointments after refusal could give patients the opportunity to discuss their feelings and physicians to support them. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children.

PubMed

Hubbard, Kristie L; Anderson, Sarah E; Curtin, Carol; Must, Aviva; Bandini, Linda G

2014-12-01

Parents of children with autism spectrum disorder (ASD) frequently report child food refusal based on characteristics of food. Our study sought to determine whether parent report of food refusal based on the characteristics of food was greater in children with ASD than in typically developing children, associated with a greater percentage of foods refused of those offered, and associated with fruit and vegetable intake. A modified food frequency questionnaire was used to determine overall food refusal as well as fruit and vegetable intake. Parent-reported food refusal related to characteristics of food (eg, texture/consistency, temperature, brand, color, shape, taste/smell, foods mixed together, or foods touching other foods) was compared between 53 children with ASD and 58 typically developing children aged 3 to 11 years in the Children's Activity and Meal Patterns Study (2007-2008). Children with ASD were significantly more likely to refuse foods based on texture/consistency (77.4% vs 36.2%), taste/smell (49.1% vs 5.2%), mixtures (45.3% vs 25.9%), brand (15.1% vs 1.7%), and shape (11.3% vs 1.7%). No differences between groups were found for food refusal based on temperature, foods touching other foods, or color. Irrespective of ASD status, the percentage of foods refused of those offered was associated with parent reports of food refusal based on all characteristics examined, except temperature. Food refusal based on color was inversely associated with vegetable consumption in both groups. Routine screening for food refusal among children with ASD is warranted to prevent dietary inadequacies that may be associated with selective eating habits. Future research is needed to develop effective and practical feeding approaches for children with ASD. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

30 CFR 817.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 3 2013-07-01 2013-07-01 false Coal mine waste: Refuse piles. 817.83 Section... ACTIVITIES § 817.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 817.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 816.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 3 2014-07-01 2014-07-01 false Coal mine waste: Refuse piles. 816.83 Section... ACTIVITIES § 816.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 816.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 817.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 3 2014-07-01 2014-07-01 false Coal mine waste: Refuse piles. 817.83 Section... ACTIVITIES § 817.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 817.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 816.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 3 2013-07-01 2013-07-01 false Coal mine waste: Refuse piles. 816.83 Section... ACTIVITIES § 816.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 816.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 817.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 3 2012-07-01 2012-07-01 false Coal mine waste: Refuse piles. 817.83 Section... ACTIVITIES § 817.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 817.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 816.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Coal mine waste: Refuse piles. 816.83 Section... ACTIVITIES § 816.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 816.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 816.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Coal mine waste: Refuse piles. 816.83 Section... ACTIVITIES § 816.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 816.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 816.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 3 2012-07-01 2012-07-01 false Coal mine waste: Refuse piles. 816.83 Section... ACTIVITIES § 816.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 816.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 817.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Coal mine waste: Refuse piles. 817.83 Section... ACTIVITIES § 817.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 817.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

30 CFR 817.83 - Coal mine waste: Refuse piles.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Coal mine waste: Refuse piles. 817.83 Section... ACTIVITIES § 817.83 Coal mine waste: Refuse piles. Refuse piles shall meet the requirements of § 817.81, the... removed from the disposal area prior to placement of coal mine waste. Topsoil shall be removed, segregated...

School Refusal Behavior Associated with Separation Anxiety Disorder: A Cognitive-Behavioral Approach to Treatment

ERIC Educational Resources Information Center

Doobay, Alissa F.

2008-01-01

School refusal behavior can lead to disruptions in both educational attainment and social development. One of the common causes of school refusal behavior is separation anxiety disorder (SAD). Research suggests that children with SAD and school refusal behavior show an increased rate of psychiatric consultation and a decreased likelihood of…

Alternative Fuels Data Center: Virginia Cleans up With Natural Gas Refuse

Science.gov Websites

Trucks Virginia Cleans up With Natural Gas Refuse Trucks to someone by E-mail Share Alternative Fuels Data Center: Virginia Cleans up With Natural Gas Refuse Trucks on Facebook Tweet about Alternative Fuels Data Center: Virginia Cleans up With Natural Gas Refuse Trucks on Twitter Bookmark Alternative

Academic Self-Attributions for Success and Failure in Mathematics and School Refusal

ERIC Educational Resources Information Center

Gonzálvez, Carolina; Sanmartín, Ricardo; Vicent, María; Inglés, Cándido J.; Aparicio-Flores, M. Pilar; García-Fernández, José M.

2018-01-01

The aim of this research is twofold: to analyze the mean differences scores in mathematic self-attributions based on school refusal and to verify its predictive capability on high scores in school refusal. The Sydney Attribution Scale and the School Refusal Assessment Scale-Revised were administered to 1078 Spanish students (50.8% boys) aged…

Multifuel industrial steam generation

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

Mesko, J.E.

An inefficient, unreliable steam generation and distribution system at the Red River Army Depot (Texarkana, Tex.), a major industrial facility of the federal government, was replaced with a modern, multifuel-burning steam plant. In the new plant, steam is generated by three high-pressure field-erected boilers burning 100 percent coal, 100 percent refuse, or any combination of the two, while maintaining particulate emissions, SO{sub 2} concentration, and NO{sub x} and chlorine levels at or better than clean air standards. The plant, which has been in operation since 1986, is now part of the Army's Energy/Environment Showcase for demonstrating innovative technology to publicmore » and private operators. When the project began, the Red River depot faced several operational problems. Existing No. 2 oil- and gas- fired boilers in three separate boiler plants were inefficient, unreliable, and difficult to maintain. Extra boilers often had to be leased to provide for needed capacity. In addition, the facility had large quantities of waste to dispose of.« less

A comparison of refuse attenuation in laboratory and field scale lysimeters.

PubMed

Youcai, Zhao; Luochun, Wang; Renhua, Hua; Dimin, Xu; Guowei, Gu

2002-01-01

For this study, small and middle scale laboratory lysimeters, and a large scale field lysimeter in situ in Shanghai Refuse Landfill, with refuse weights of 187,600 and 10,800,000 kg, respectively, were created. These lysimeters are compared in terms of leachate quality (pH, concentrations of COD, BOD and NH3-N), refuse composition (biodegradable matter and volatile solid) and surface settlement for a monitoring period of 0-300 days. The objectives of this study were to explore both the similarities and disparities between laboratory and field scale lysimeters, and to compare degradation behaviors of refuse at the intensive reaction phase in the different scale lysimeters. Quantitative relationships of leachate quality and refuse composition with placement time show that degradation behaviors of refuse seem to depend heavily on the scales of the lysimeters and the parameters of concern, especially in the starting period of 0-6 months. However, some similarities exist between laboratory and field lysimeters after 4-6 months of placement because COD and BOD concentrations in leachate in the field lysimeter decrease regularly in a parallel pattern with those in the laboratory lysimeters. NH3-N, volatile solid (VS) and biodegradable matter (BDM) also gradually decrease in parallel in this intensive reaction phase for all scale lysimeters as refuse ages. Though the concrete data are different among the different scale lysimeters, it may be considered that laboratory lysimeters with sufficient scale are basically applicable for a rough simulation of a real landfill, especially for illustrating the degradation pattern and mechanism. Settlement of refuse surface is roughly proportional to the initial refuse height.

9 CFR 93.806 - Animals refused entry.

Code of Federal Regulations, 2014 CFR

2014-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.806 Animals refused entry. Any elephant, hippopotamus, rhinoceros, or tapir refused entry into the...

9 CFR 93.806 - Animals refused entry.

Code of Federal Regulations, 2011 CFR

2011-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.806 Animals refused entry. Any elephant, hippopotamus, rhinoceros, or tapir refused entry into the...

9 CFR 93.806 - Animals refused entry.

Code of Federal Regulations, 2010 CFR

2010-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.806 Animals refused entry. Any elephant, hippopotamus, rhinoceros, or tapir refused entry into the...

9 CFR 93.806 - Animals refused entry.

Code of Federal Regulations, 2013 CFR

2013-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.806 Animals refused entry. Any elephant, hippopotamus, rhinoceros, or tapir refused entry into the...

9 CFR 93.806 - Animals refused entry.

Code of Federal Regulations, 2012 CFR

2012-01-01

... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Elephants, Hippopotami, Rhinoceroses, and Tapirs § 93.806 Animals refused entry. Any elephant, hippopotamus, rhinoceros, or tapir refused entry into the...

20 CFR 229.81 - Refusal to accept vocational rehabilitation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... disabled employee refuses, without good reason, to accept vocational rehabilitation services available... in which the child refuses, without good reason, to accept such vocational rehabilitation services...

20 CFR 401.70 - Appeals of refusals to correct records or refusals to allow access to records.

Code of Federal Regulations, 2010 CFR

2010-04-01

... explaining the decision on your appeal. The time limit for making our decision after we receive your appeal... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Appeals of refusals to correct records or refusals to allow access to records. 401.70 Section 401.70 Employees' Benefits SOCIAL SECURITY...

The Legal Ethical Backbone of Conscientious Refusal.

PubMed

Munthe, Christian; Nielsen, Morten Ebbe Juul

2017-01-01

This article analyzes the idea of a legal right to conscientious refusal for healthcare professionals from a basic legal ethical standpoint, using refusal to perform tasks related to legal abortion (in cases of voluntary employment) as a case in point. The idea of a legal right to conscientious refusal is distinguished from ideas regarding moral rights or reasons related to conscientious refusal, and none of the latter are found to support the notion of a legal right. Reasons for allowing some sort of room for conscientious refusal for healthcare professionals based on the importance of cultural identity and the fostering of a critical atmosphere might provide some support, if no countervailing factors apply. One such factor is that a legal right to healthcare professionals' conscientious refusal must comply with basic legal ethical tenets regarding the rule of law and equal treatment, and this requirement is found to create serious problems for those wishing to defend the idea under consideration. We conclude that the notion of a legal right to conscientious refusal for any profession is either fundamentally incompatible with elementary legal ethical requirements, or implausible because it undermines the functioning of a related professional sector (healthcare) or even of society as a whole.

Estimates and determinants of HPV non-vaccination and vaccine refusal in girls 12 to 14 y of age in Canada: Results from the Childhood National Immunization Coverage Survey, 2013

PubMed Central

Gilbert, Nicolas L.; Gilmour, Heather; Dubé, Ève; Wilson, Sarah E.; Laroche, Julie

2016-01-01

ABSTRACT Since the introduction of HPV vaccination programs in Canada in 2007, coverage has been below public health goals in many provinces and territories. This analysis investigated the determinants of HPV non-vaccination and vaccine refusal. Data from the Childhood National Immunization Coverage Survey (CNICS) 2013 were used to estimate the prevalence of HPV non-vaccination and parental vaccine refusal in girls aged 12–14 years, for Canada and the provinces and territories. Multivariate logistic regression was used to examine factors associated with non-vaccination and vaccine refusal, after adjusting for potential confounders. An estimated 27.7% of 12–14 y old girls had not been vaccinated against HPV, and 14.4% of parents reported refusing the vaccine. The magnitude of non-vaccination and vaccine refusal varied by province or territory and also by responding parent's country of birth. In addition, higher education was associated with a higher risk of refusal of the HPV vaccine. Rates of HPV non-vaccination and of refusal of the HPV vaccine differ and are influenced by different variables. These findings warrant further investigation. PMID:26942572

Heroin refusal self-efficacy and preference for medication-assisted treatment after inpatient detoxification.

PubMed

Kenney, Shannon R; Bailey, Genie L; Anderson, Bradley J; Stein, Michael D

2017-10-01

An individual's self-efficacy to refuse using heroin in high-risk situations is believed to minimize the likelihood for relapse. However, among individuals completing inpatient heroin detoxification, perceived refusal self-efficacy may also reduce one's perceived need for medication-assisted treatment (MAT), an effective and recommended treatment for opioid use disorder. In the current study, we examined the relationship between heroin refusal self-efficacy and preference for MAT following inpatient detoxification. Participants (N=397) were interviewed at the start of brief inpatient opioid detoxification. Multiple logistic regression was used to estimate the adjusted association of background characteristics, depressed mood, and perceived heroin refusal self-efficacy with preference for MAT. Controlling for other covariates, depressed mood and lower perceived refusal self-efficacy were associated with a significantly greater likelihood of expressing preference for MAT (versus no MAT). Perceived ability to refuse heroin after leaving detox is inversely associated with a heroin user's desire for MAT. An effective continuum of care model may benefit from greater attention to patient's perceived refusal self-efficacy during detoxification which may impact preference for MAT and long-term recovery. Copyright © 2017. Published by Elsevier Ltd.

37 CFR 102.6 - Time limits and expedited processing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... requests. Refusal to reasonably modify the scope of a request or arrange an alternate time frame may affect... imminent threat to the life or physical safety of an individual; (ii) The loss of substantial due process... the Government's integrity that affect public confidence; or (iv) An urgency to inform the public...

Disposable containers as larval habitats for Aedes aegypti in a city with regular refuse collection: a study in Marília, São Paulo State, Brazil.

PubMed

Mazine, C A; Macoris, M L; Andrighetti, M T; Yasumaro, S; Silva, M E; Nelson, M J; Winch, P J

1996-09-01

In Marília, Brazil, refuse is collected at least every other day, yet non-useful, non-returnable containers such as cans, plastic bottles and tires account for almost half of the container habitats found positive for the Aedes aegypti mosquito. A study was therefore conducted to investigate why these containers exist despite regular refuse collection and a high level of awareness of dengue prevention, and how the control program could most effectively respond. Differing community perceptions as to what constitutes refuse were found to lead people to store a variety of containers in their yard. Other dimensions of the problem include the presence of informal refuse collectors in search of saleable materials, and dumping of refuse in vacant lots and along roads. An intervention based on these data will involve the informal refuse collectors in implementation of a community-based recycling project.

Do you feel powerless when a patient refuses medication?

PubMed

Carey, N; Jones, S L; O'Toole, A W

1990-10-01

1. Because a client legally has the right to refuse medication, the nurse can only recommend, advise, suggest, or urge the patient to comply. Consequently, it is important to understand the nurse's response to patient refusal of medication. 2. Overall, nurses were more apt to identify with indirect indicators than they were to identify words that address the concept directly (control and powerlessness). 3. The most common hazard identified in a medication refusal event was the potential for injury, and the individuals most at risk were the nurse giving the medication and other personnel on the unit. 4. The most prominent nursing response to medication refusal was counseling. Nearly all the nurse subjects believed that the medication refusal event negatively influenced nursing care, the patient/nurse interaction, and patient teaching.

Primary care pediatricians' perceptions of vaccine refusal in europe.

PubMed

Grossman, Zachi; van Esso, Diego; Del Torso, Stefano; Hadjipanayis, Adamos; Drabik, Anna; Gerber, Andreas; Miron, Dan

2011-03-01

An electronic survey assessing primary care pediatricians' estimations and practices regarding parents' vaccination refusal was sent to 395 members of the European Academy of Pediatrics Research in Ambulatory Setting network, with a response rate of 87%. Of respondents who vaccinate in the clinic, 93% estimated the total vaccine refusal rate as <1%. Of all respondents, 69% prefer a shared decision-making approach to handle refusing parents.

25 CFR 171.420 - Can I dispose of sewage, trash, or other refuse on a BIA irrigation project?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Can I dispose of sewage, trash, or other refuse on a BIA... AND WATER IRRIGATION OPERATION AND MAINTENANCE Irrigation Facilities § 171.420 Can I dispose of sewage, trash, or other refuse on a BIA irrigation project? No. Sewage, trash, or other refuse are considered...

PATIENT REFUSAL OF THROMBOLYTIC THERAPY FOR SUSPECTED ACUTE ISCHEMIC STROKE

PubMed Central

FS, Vahidy; MH, Rahbar; AP, Lal; JC, Grotta; SI, Savitz

2012-01-01

Objective To determine factors associated with patients refusing IV t-PA for suspected acute ischemic stroke (AIS), and to compare the outcomes of patients who refused t-PA (RT) with those treated with t-PA. Methods Patients who were treated with and refused t-PA at our stroke center were identified retrospectively. Demographics, clinical presentation, and outcome measures were collected and compared. Clinical outcome was defined as excellent (mRS: 0–1), good (mRS: 0–2), and poor (mRS: 3–6). Results Over 7.5 years, thirty (4.2%) patients refused t-PA. There were no demographic differences between the treated and RT groups. The rate of RT decreased over time (OR 0.63, 95% CI 0.50 – 0.79). Factors associated with refusal included a later symptom onset to emergency department presentation time (OR 1.02, 95% CI 1.01 – 1.03), lower NIHSS (OR 1.11, 95% CI 1.03 – 1.18), a higher proportion of stroke mimics (OR 17.61, 95% CI 6.20 – 50.02) and shorter hospital stay (OR 1.32, 95% CI 1.09 – 1.61). Among patients who were subsequently diagnosed with ischemic stroke, only length of stay was significantly shorter for refusal patients (OR 1.37, 95% CI 1.06 – 1.78). After controlling for mild strokes and stroke mimics, clinical outcome was not different between the groups (OR 1.61, 95% CI 0.69 – 3.73). Conclusion The incidence of patients refusing t-PA has decreased over time, yet it may be a cause for t-PA under-utilization. Patients with milder symptoms were more likely to refuse t-PA. Refusal patients presented later to the hospital and had shorter hospital stays. One out six refusal patients (16.6%) had a stroke mimic. PMID:23227830

37 CFR 211.7 - Reconsideration procedure for refusals to register.

Code of Federal Regulations, 2010 CFR

2010-07-01

... CONGRESS COPYRIGHT OFFICE AND PROCEDURES MASK WORK PROTECTION § 211.7 Reconsideration procedure for... refusals to register copyright claims are applicable to requests to reconsider refusals to register mask...

Refusal bias in HIV prevalence estimates from nationally representative seroprevalence surveys.

PubMed

Reniers, Georges; Eaton, Jeffrey

2009-03-13

To assess the relationship between prior knowledge of one's HIV status and the likelihood to refuse HIV testing in populations-based surveys and explore its potential for producing bias in HIV prevalence estimates. Using longitudinal survey data from Malawi, we estimate the relationship between prior knowledge of HIV-positive status and subsequent refusal of an HIV test. We use that parameter to develop a heuristic model of refusal bias that is applied to six Demographic and Health Surveys, in which refusal by HIV status is not observed. The model only adjusts for refusal bias conditional on a completed interview. Ecologically, HIV prevalence, prior testing rates and refusal for HIV testing are highly correlated. Malawian data further suggest that amongst individuals who know their status, HIV-positive individuals are 4.62 (95% confidence interval, 2.60-8.21) times more likely to refuse testing than HIV-negative ones. On the basis of that parameter and other inputs from the Demographic and Health Surveys, our model predicts downward bias in national HIV prevalence estimates ranging from 1.5% (95% confidence interval, 0.7-2.9) for Senegal to 13.3% (95% confidence interval, 7.2-19.6) for Malawi. In absolute terms, bias in HIV prevalence estimates is negligible for Senegal but 1.6 (95% confidence interval, 0.8-2.3) percentage points for Malawi. Downward bias is more severe in urban populations. Because refusal rates are higher in men, seroprevalence surveys also tend to overestimate the female-to-male ratio of infections. Prior knowledge of HIV status informs decisions to participate in seroprevalence surveys. Informed refusals may produce bias in estimates of HIV prevalence and the sex ratio of infections.

Predictors of intensive care unit refusal in French intensive care units: a multiple-center study.

PubMed

Garrouste-Orgeas, Maité; Montuclard, Luc; Timsit, Jean-François; Reignier, Jean; Desmettre, Thibault; Karoubi, Philippe; Moreau, Delphine; Montesino, Laurent; Duguet, Alexandre; Boussat, Sandrine; Ede, Christophe; Monseau, Yannick; Paule, Thierry; Misset, Benoit; Carlet, Jean

2005-04-01

To identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. Observational, prospective, multiple-center study. Four university hospitals and seven primary-care hospitals in France. None. Age, underlying diseases (McCabe score and Knaus class), dependency, hospital mortality, and ICU characteristics were recorded. The crude ICU refusal rate was 23.8% (137/574), with variations from 7.1% to 63.1%. The reasons for refusal were too well to benefit (76/137, 55.4%), too sick to benefit (51/137, 37.2%), unit too busy (9/137, 6.5%), and refusal by the family (1/137). In logistic regression analyses, two patient-related factors were associated with ICU refusal: dependency (odds ratio [OR], 14.20; 95% confidence interval [CI], 5.27-38.25; p < .0001) and metastatic cancer (OR, 5.82; 95% CI, 2.22-15.28). Other risk factors were organizational, namely, full unit (OR, 3.16; 95% CI, 1.88-5.31), center (OR, 3.81; 95% CI, 2.27-6.39), phone admission (OR, 0.23; 95% CI, 0.14-0.40), and daytime admission (OR, 0.52; 95% CI, 0.32-0.84). The Standardized Mortality Ratio was 1.41 (95% CI, 1.19-1.69) for immediately admitted patients, 1.75 (95% CI, 1.60-1.84) for refused patients, and 1.03 (95% CI, 0.28-1.75) for later-admitted patients. ICU refusal rates varied greatly across ICUs and were dependent on both patient and organizational factors. Efforts to define ethically optimal ICU admission policies might lead to greater homogeneity in refusal rates, although case-mix variations would be expected to leave an irreducible amount of variation across ICUs.

Parents who refuse or delay HPV vaccine: Differences in vaccination behavior, beliefs, and clinical communication preferences

PubMed Central

Gilkey, Melissa B.; Calo, William A.; Marciniak, Macary W.

2017-01-01

ABSTRACT Background: We sought to estimate the national prevalence of HPV vaccine refusal and delay in a nationally-representative sample of parents of adolescents. We also compared parents who refused versus delayed HPV vaccine in terms of their vaccination beliefs and clinical communication preferences. Methods: In 2014 to 2015, we conducted an online survey of 1,484 US parents who reported on an 11- to 17-year-old child in their household. We used weighted multinomial logistic regression to assess correlates of HPV vaccine refusal and delay. Results: Overall, 28% of parents reported that they had ever “refused or decided not to get” HPV vaccine for their child, and an additional 8% of parents reported that they had “delayed or put off getting” HPV vaccine. Compared to no refusal/delay, refusal was associated with lower confidence in adolescent vaccination (relative risk ratio [RRR] = 0.66, 95% confidence interval [CI], 0.48–0.91), lower perceived HPV vaccine effectiveness (RRR = 0.68, 95% CI, 0.50–0.91), and higher perceived harms (RRR = 3.49, 95% CI, 2.65–4.60). In contrast, delay was associated with needing more information (RRR = 1.76, 95% CI, 1.08–2.85). Most parents rated physicians and information sheets as helpful for making decisions about HPV vaccination, although parents who reported refusal endorsed these resources less often. Conclusions: Our findings suggest that HPV vaccine refusal is common among parents of adolescents and may have increased relative to previous estimates. Because the vaccination beliefs and communication preferences of parents who refuse appear to differ from those who delay, targeted communication strategies may be needed to effectively address HPV vaccine hesitancy. PMID:27763818

Refuse derived fuel (RDF) plasma torch gasification as a feasible route to produce low environmental impact syngas for the cement industry.

PubMed

López-Sabirón, Ana M; Fleiger, Kristina; Schäfer, Stefan; Antoñanzas, Javier; Irazustabarrena, Ane; Aranda-Usón, Alfonso; Ferreira, Germán A

2015-08-01

Plasma torch gasification (PTG) is currently researched as a technology for solid waste recovery. However, scientific studies based on evaluating its environmental implications considering the life cycle assessment (LCA) methodology are lacking. Therefore, this work is focused on comparing the environmental effect of the emissions of syngas combustion produced by refuse derived fuel (RDF) and PTG as alternative fuels, with that related to fossil fuel combustion in the cement industry. To obtain real data, a semi-industrial scale pilot plant was used to perform experimental trials on RDF-PTG.The results highlight that PTG for waste to energy recovery in the cement industry is environmentally feasible considering its current state of development. A reduction in every impact category was found when a total or partial substitution of alternative fuel for conventional fuel in the calciner firing (60 % of total thermal energy input) was performed. Furthermore, the results revealed that electrical energy consumption in PTG is also an important parameter from the LCA approach. © The Author(s) 2015.

49 CFR 219.505 - Refusals.

Code of Federal Regulations, 2013 CFR

2013-10-01

... TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Pre-Employment Tests § 219.505 Refusals. An applicant who has refused to submit to pre-employment testing under this section may not be employed in covered service...

49 CFR 219.505 - Refusals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Pre-Employment Tests § 219.505 Refusals. An applicant who has refused to submit to pre-employment testing under this section may not be employed in covered service...

49 CFR 219.505 - Refusals.

Code of Federal Regulations, 2012 CFR

2012-10-01

... TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Pre-Employment Tests § 219.505 Refusals. An applicant who has refused to submit to pre-employment testing under this section may not be employed in covered service...

49 CFR 219.505 - Refusals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Pre-Employment Tests § 219.505 Refusals. An applicant who has refused to submit to pre-employment testing under this section may not be employed in covered service...

49 CFR 219.505 - Refusals.

Code of Federal Regulations, 2014 CFR

2014-10-01

... TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Pre-Employment Tests § 219.505 Refusals. An applicant who has refused to submit to pre-employment testing under this section may not be employed in covered service...

Denial of service to same-sex and interracial couples: Evidence from a national survey experiment.

PubMed

Powell, Brian; Schnabel, Landon; Apgar, Lauren

2017-12-01

Legislatures and courts are debating whether businesses can deny services to same-sex couples for religious reasons. Yet, little is known about public views on this issue. In a national survey experiment, Americans ( n = 2035) responded to an experimental vignette describing a gay or interracial couple refused service. Vignettes varied the reason for refusal (religion/nonreligious) and by business type (individual/corporation). Results confirm greater support of service refusal by the self-employed than by corporations and to gay couples than to interracial couples. However, religious reasons for refusal to gay couples elicit no more support than do nonreligious reasons. In the first national study to experimentally analyze views on service refusal to sexual minorities, we demonstrate that views vary by several factors but not by whether the refusal was for religious reasons.

The space station integrated refuse management system

NASA Technical Reports Server (NTRS)

Anderson, Loren A.

1988-01-01

The design and development of an Integrated Refuse Management System for the proposed International Space Station was performed. The primary goal was to make use of any existing potential energy or material properties that refuse may possess. The secondary goal was based on the complete removal or disposal of those products that could not, in any way, benefit astronauts' needs aboard the Space Station. The design of a continuous living and experimental habitat in space has spawned the need for a highly efficient and effective refuse management system capable of managing nearly forty-thousand pounds of refuse annually. To satisfy this need, the following four integrable systems were researched and developed: collection and transfer; recycle and reuse; advance disposal; and propulsion assist in disposal. The design of a Space Station subsystem capable of collecting and transporting refuse from its generation site to its disposal and/or recycling site was accomplished. Several methods of recycling or reusing refuse in the space environment were researched. The optimal solution was determined to be the method of pyrolysis. The objective of removing refuse from the Space Station environment, subsequent to recycling, was fulfilled with the design of a jettison vehicle. A number of jettison vehicle launch scenarios were analyzed. Selection of a proper disposal site and the development of a system to propel the vehicle to that site were completed. Reentry into the earth atmosphere for the purpose of refuse incineration was determined to be the most attractive solution.

Contact refusal by children following acrimonious separation: therapeutic approaches with children and parents.

PubMed

Dejong, Margaret; Davies, Hilary

2013-04-01

This paper aims to build on the existing literature, by presenting some thoughts based on clinical experience with nine families of children referred for intractable contact refusal with one parent following marital separation. This particular group of high-conflict divorce cases engenders an inordinate amount of frustration both within the courts and therapeutic agencies. We outline here our assessment process and therapeutic strategies, as well as consideration of the role of the wider professional system and the courts. We conclude that whether or not direct contact with the rejected parent is achieved, useful therapeutic work can be carried out to assist children in moving on with their lives.

Main Reasons for Registration Application Refusal of Generic and Similar Pharmaceutical Drug Products by the Brazilian Health Regulatory Agency (ANVISA).

PubMed

do Carmo, Ana Cerúlia Moraes; Piras, Stefânia Schimaneski; Rocha, Nayrton Flávio Moura; Gratieri, Tais

2017-01-01

Objective . The marketing authorization of generic and similar pharmaceutical drug products involves the analysis of proposing company's administrative aspects as well as drug product technical description and scientific evaluations. This study evaluated the main reasons for registration refusal of generic and similar pharmaceutical drug products in Brazil. The aim is to help future applicants to better organize the proposal. Methods . A retrospective search of drug products registration processes was performed on the Brazilian Government Official Gazette from January 1, 2015, and December 31, 2015. Results . Drug product quality control, drug product stability study, deadline accomplishment, API quality control made by drug manufacturer, active pharmaceutical ingredient (API), and production report were the main reasons for marketing authorization application refusal of generic and similar pharmaceutical drug products in 2015. Conclusion . Disclosure of the reasons behind failed applications is a step forward on regulatory transparency. Sharing of experiences is essential to international regulatory authorities and organizations to improve legislation requirements for the marketing authorization of generic and similar pharmaceutical drug products.

Effect of the raw materials and mixing ratio of composted wastes on the dynamic of organic matter stabilization and nitrogen availability in composts of Sub-Saharan Africa.

PubMed

Kaboré, Théodore Wind-Tinbnoma; Houot, Sabine; Hien, Edmond; Zombré, Prosper; Hien, Victor; Masse, Dominique

2010-02-01

The effect of raw materials and their proportions in initial mixtures on organic matter (OM) stabilization and nitrogen (N) availability during pit composting in Sub-Saharan Africa was assessed using biochemical fractionation and laboratory incubations to characterize composts sampled throughout the composting process. Stabilization of OM occurred more rapidly in mixtures with slaughter-house wastes, it was progressive in mixture with household refuses while tree leaves compost remained unstable. Carbon mineralization from compost samples was positively correlated to water soluble and hemicellulose-like organic fractions. Mixtures containing large proportions of household refuses reached the highest stability and total N but available N remained weak. Slaughter-house wastes in the initial mixtures made possible to reach good OM stabilization and the largest N availability. The nature of initial mixing influenced composting parameters, OM stabilization and N availability. It is suggested mixing household refuses and slaughter-house wastes with tree leaves to reach better amending and fertilizer qualities of composts.

Main Reasons for Registration Application Refusal of Generic and Similar Pharmaceutical Drug Products by the Brazilian Health Regulatory Agency (ANVISA)

PubMed Central

do Carmo, Ana Cerúlia Moraes; Piras, Stefânia Schimaneski; Rocha, Nayrton Flávio Moura

2017-01-01

Objective. The marketing authorization of generic and similar pharmaceutical drug products involves the analysis of proposing company's administrative aspects as well as drug product technical description and scientific evaluations. This study evaluated the main reasons for registration refusal of generic and similar pharmaceutical drug products in Brazil. The aim is to help future applicants to better organize the proposal. Methods. A retrospective search of drug products registration processes was performed on the Brazilian Government Official Gazette from January 1, 2015, and December 31, 2015. Results. Drug product quality control, drug product stability study, deadline accomplishment, API quality control made by drug manufacturer, active pharmaceutical ingredient (API), and production report were the main reasons for marketing authorization application refusal of generic and similar pharmaceutical drug products in 2015. Conclusion. Disclosure of the reasons behind failed applications is a step forward on regulatory transparency. Sharing of experiences is essential to international regulatory authorities and organizations to improve legislation requirements for the marketing authorization of generic and similar pharmaceutical drug products. PMID:28280742

MUNICIPAL WASTE COMBUSTION ASSESSMENT: FOSSIL FUEL CO-FIRING

EPA Science Inventory

The report identifies refuse derived fuel (RDF) processing operations and various RDF types; describes such fossil fuel co-firing techniques as coal fired spreader stokers, pulverized coal wall fired boilers, pulverized coal tangentially fired boilers, and cyclone fired boilers; ...

Legislation and refusal of blood transfusion by a minor Jehovah-Witness in Belgium.

PubMed

Deneyer, M; Matthys, D; Ramet, J; Michel, L; Holsters, D; Vandenplas, Y

2011-01-01

The refusal of blood transfusion by Jehovah's Witnesses in critical situations constitutes an ethical and juridical dilemma. The refusal to receive blood products by Jehovah's Witnesses is based on biblical verses. Recurring arguments to sustain this refusal regard the right to self-determination and the right to freedom of faith. If minors are involved, the problem is rendered even more difficult as the parental authority over young children needs to be taken into account. When adolescents are concerned, the situation if even more ambiguous since adolescents might be considered as mature enough to provide autonomous consent. On the basis of three cases, the most frequent bottlenecks that can come up in paediatric emergency services are highlighted: (1) the refusal of a blood transfusion by the parents of a young child; (2) the refusal by an adolescent and (3) prior refusal based on a "No Blood"-document. Regarding minors, the law on patients' rights in Belgium contains safety mechanisms concerning the preservation of physical integrity. Therefore, a key responsibility has been assigned to the physician. A step-by-step plan and a synoptic diagram are presented.

Co-gasification of solid waste and lignite - a case study for Western Macedonia.

PubMed

Koukouzas, N; Katsiadakis, A; Karlopoulos, E; Kakaras, E

2008-01-01

Co-gasification of solid waste and coal is a very attractive and efficient way of generating power, but also an alternative way, apart from conventional technologies such as incineration and landfill, of treating waste materials. The technology of co-gasification can result in very clean power plants using a wide range of solid fuels but there are considerable economic and environmental challenges. The aim of this study is to present the available existing co-gasification techniques and projects for coal and solid wastes and to investigate the techno-economic feasibility, concerning the installation and operation of a 30MW(e) co-gasification power plant based on integrated gasification combined cycle (IGCC) technology, using lignite and refuse derived fuel (RDF), in the region of Western Macedonia prefecture (WMP), Greece. The gasification block was based on the British Gas-Lurgi (BGL) gasifier, while the gas clean-up block was based on cold gas purification. The competitive advantages of co-gasification systems can be defined both by the fuel feedstock and production flexibility but also by their environmentally sound operation. It also offers the benefit of commercial application of the process by-products, gasification slag and elemental sulphur. Co-gasification of coal and waste can be performed through parallel or direct gasification. Direct gasification constitutes a viable choice for installations with capacities of more than 350MW(e). Parallel gasification, without extensive treatment of produced gas, is recommended for gasifiers of small to medium size installed in regions where coal-fired power plants operate. The preliminary cost estimation indicated that the establishment of an IGCC RDF/lignite plant in the region of WMP is not profitable, due to high specific capital investment and in spite of the lower fuel supply cost. The technology of co-gasification is not mature enough and therefore high capital requirements are needed in order to set up a direct co-gasification plant. The cost of electricity estimated was not competitive, compared to the prices dominating the Greek electricity market and thus further economic evaluation is required. The project would be acceptable if modular construction of the unit was first adopted near operating power plants, based on parallel co-gasification, and gradually incorporating the remaining process steps (gas purification, power generation) with the aim of eventually establishing a true direct co-gasification plant.

A Longitudinal Investigation into L2 Learners' Cognitive Processes during Study Abroad

ERIC Educational Resources Information Center

Ren, Wei

2014-01-01

The present study longitudinally investigates the cognitive processes of advanced L2 learners engaged in a multimedia task that elicited status-equal and status-unequal refusals in English during their study abroad. Data were collected three times by retrospective verbal report from 20 Chinese learners who were studying abroad over the course of…

Perceptions of Refusals to Invitations: Exploring the Minds of Foreign Language Learners

ERIC Educational Resources Information Center

Felix-Brasdefer, J. Cesar

2008-01-01

Descriptions of speech act realisations of native and non-native speakers abound in the cross-cultural and interlanguage pragmatics literature. Yet, what is lacking is an analysis of the cognitive processes involved in the production of speech acts. This study examines the cognitive processes and perceptions of learners of Spanish when refusing…

An in vivo assay performed using multiple biomarkers related to testosterone synthesis and conversion for assessing the androgenic potency of refuse leachate.

PubMed

Gong, Yufeng; Tian, Hua; Dong, Yifei; Zhang, Xiaona; Wang, Wei; Ru, Shaoguo

2017-01-01

Refuse leachate is likely an important source of androgens. However, common in vitro bioassays underestimate the potential androgenic activity of leachate, owing to non-receptor-mediated mechanisms that modify the balance of sex hormones and promote the accumulation of endogenous androgens. This study aimed to develop an in vivo assay by using multiple biomarkers related to testosterone synthesis and conversion for assessing the potential androgenic activity of refuse leachate sampled from a municipal solid waste treatment plant in Qingdao, China. The results indicated that exposure to leachate increased the levels of testosterone and luteinizing hormone, but decreased those of 17β-estradiol in both male and female goldfish (Carassius auratus), suggesting a potential androgenic activity. Further, Leydig cell hyperplasia and decreased gonadal P450 aromatase mRNA levels were observed; these alterations might promote the biosynthesis of testosterone and hinder the conversion of testosterone to 17β-estradiol, which in turn enhance testosterone accumulation. Exposure to leachate also resulted in reproductive impairments, including decreased gonadosomatic index and plasma vitellogenin levels of female goldfish, as well as decreased testicular enzyme activities in male goldfish. The integrated use of biochemical, molecular, and histological markers not only improved our understanding of the androgenic effects of leachate but also verified the reliability and validity of the results. Therefore, the in vivo bioassay described in this study might allow the investigation of the androgenic effects of other complex contaminant mixtures in the future. Copyright © 2016 Elsevier Inc. All rights reserved.

Implied consent refusal impact

DOT National Transportation Integrated Search

1991-09-01

This report examines the extent to which persons suspected of DWI refuse to take a chemical test as required by law, describes implied consent laws in 50 States, analyzes the relation of law features to refusal rate, and analyzes the characteristics ...

Patient Experience Of Provider Refusal Of Medicaid Coverage And Its Implications.

PubMed

Bhandari, Neeraj; Shi, Yunfeng; Jung, Kyoungrae

2016-01-01

Previous studies show that many physicians do not accept new patients with Medicaid coverage, but no study has examined Medicaid enrollees' actual experience of provider refusal of their coverage and its implications. Using the 2012 National Health Interview Survey, we estimate provider refusal of health insurance coverage reported by 23,992 adults with continuous coverage for the past 12 months. We find that among Medicaid enrollees, 6.73% reported their coverage being refused by a provider in 2012, a rate higher than that in Medicare and private insurance by 4.07 (p<.01) and 3.68 (p<.001) percentage points, respectively. Refusal of Medicaid coverage is associated with delaying needed care, using emergency room (ER) as a usual source of care, and perceiving current coverage as worse than last year. In view of the Affordable Care Act's (ACA) Medicaid expansion, future studies should continue monitoring enrollees' experience of coverage refusal.

Anaerobic Nitrogen Fixers on Mars

NASA Astrophysics Data System (ADS)

Lewis, B. G.

2000-07-01

The conversion of atmospheric nitrogen gas to the protein of living systems is an amazing process of nature. The first step in the process is biological nitrogen fixation, the transformation of N2 to NH3. The phenomenon is crucial for feeding the billions of our species on Earth. On Mars, the same process may allow us to discover how life can adapt to a hostile environment, and render it habitable. Hostile environments also exist on Earth. For example, nothing grows in coal refuse piles due to the oxidation of pyrite and marcasite to sulfuric acid. Yet, when the acidity is neutralized, alfalfa and soybean plants develop root nodules typical of symbiotic nitrogen fixation with Rhizobium species possibly living in the pyritic material. When split open, these nodules exhibited the pinkish color of leghemoglobin, a protein in the nodule protecting the active nitrogen-fixing enzyme nitrogenase against the toxic effects of oxygen. Although we have not yet obtained direct evidence of nitrogenase activity in these nodules (reduction of acetylene to ethylene, for example), these findings suggested the possibility that nitrogen fixation was taking place in this hostile, non-soil material. This immediately raises the possibility that freeliving anaerobic bacteria which fix atmospheric nitrogen on Earth, could do the same on Mars.

Copper leaching of MSWI bottom ash co-disposed with refuse: effect of short-term accelerated weathering.

PubMed

Su, Lianghu; Guo, Guangzhai; Shi, Xinlong; Zuo, Minyu; Niu, Dongjie; Zhao, Aihua; Zhao, Youcai

2013-06-01

Co-disposal of refuse with municipal solid waste incinerator (MSWI) bottom ash (IBA) either multi-layered as landfill cover or mixed with refuse could pose additional risk to the environment because of enhanced leaching of heavy metals, especially Cu. This study applied short-term accelerated weathering to IBA, and monitored the mineralogical and chemical properties of IBA during the weathering process. Cu extractability of the weathered IBA was then evaluated using standard leaching protocols (i.e. SPLP and TCLP) and co-disposal leaching procedure. The results showed that weathering had little or no beneficial effect on Cu leaching in SPLP and TCLP, which can be explained by the adsorption and complexation of Cu with DOM. However, the Cu leaching of weathered IBA was reduced significantly when situated in fresh simulated landfill leachate. This was attributed to weakening Cu complexation with fulvic acid or hydrophilic fractions and/or intensifying Cu absorption to neoformed hydr(oxide) minerals in weathered IBA. The amount of total leaching Cu and Cu in free or labile complex fraction (the fraction with the highest mobility and bio-toxicity) of the 408-h weathered IBA were remarkably decreased by 86.3% and 97.6% in the 15-day co-disposal leaching test. Accelerated weathering of IBA may be an effective pretreatment method to decrease Cu leaching prior to its co-disposal with refuse. Copyright © 2013 Elsevier Ltd. All rights reserved.

Impact of canine-assisted ambulation on hospitalized chronic heart failure patients' ambulation outcomes and satisfaction: a pilot study.

PubMed

Abate, Samantha V; Zucconi, Michele; Boxer, Bruce Alan

2011-01-01

Chronic heart failure (HF) is a prevalent and costly disease process. Early ambulation has been shown to have a positive impact on patient outcomes and length of stay. Animal-assisted therapy is a novel modality that has shown to be a safe and effective adjunct to a number of traditional treatment plans. This study sought to synergistically combine ambulation and animal-assisted therapy by using canine-assisted ambulation (CAA) to improve the ambulation outcomes of HF patients. Sixty-nine hospitalized patients with a primary diagnosis of HF were approached to ambulate with a restorative aide. After recording their initial response, they were given the opportunity to participate in CAA (walking with a therapy dog). Initial ambulation refusal rate was compared with a historical population of 537 HF patients. Distance ambulated was recorded using a pedometer and compared with a randomly selected, 64-patient sample from the historical HF patient population, stratified by day of hospital stay. Patient satisfaction was assessed through a 5-item Likert scale survey. The 537-patient historical HF population had an ambulation refusal rate of 28%. When offered the chance to participate in CAA, only 7.2% of the study population refused ambulation (P = .0002). Of the 69-patient study sample, 13 initially refused ambulation then agreed when offered CAA (P = .0009). Distance ambulated increased from 120.2 steps in a randomly selected, stratified historical sample to 235.07 in the CAA study sample (P < .0001). Patients unanimously agreed that they enjoyed CAA and would like to participate in CAA again. Canine-assisted ambulation is a safe and effective adjunct to an early ambulation program for HF patients. Canine-assisted ambulation may decrease hospital length of stay and thereby decrease the costs of HF care. Additional research involving CAA's application to other disease processes in various settings is warranted.

A quality of life quandary: a framework for navigating parental refusal of treatment for co-morbidities in infants with underlying medical conditions.

PubMed

Kunz, Sarah N; McAdams, Ryan M; Diekema, Douglas S; Opel, Douglas J

2015-01-01

Parental refusal of a recommended treatment is not an uncommon scenario in the neonatal intensive care unit. These refusals may be based upon the parents' perceptions of their child's projected quality of life. The inherent subjectivity of quality of life assessments, however, can exacerbate disagreement between parents and healthcare providers. We present a case of parental refusal of surgical intervention for necrotizing enterocolitis in an infant with Bartter syndrome and develop an ethical framework in which to consider the appropriateness of parental refusal based upon an infant's projected quality of life. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

Teaching refusal skills to sexually active adolescents.

PubMed

Warzak, W J; Page, T J

1990-06-01

Refusal skills training was extended to sexually active handicapped female adolescents who lacked an effective refusal strategy. Role-plays for assessment and training were developed using the who, what, when and where of situations which resulted in unwanted intercourse. Refusal skills were trained following the format of rationale, modeling, rehearsal, feedback, and reinforcement. Baseline rates of most target behaviors were quite low. High frequencies of target behaviors were observed as each behavior became the focus of training. Generalization across staff and time was also observed. The skillfulness and effectiveness of the subjects' refusal skills were judged to be improved as a function of training. One-year follow-up showed decreased sexual activity for each girl.

Health and environmental effects of refuse derived fuel (RDF) production and RDF/coal co-firing technologies

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

O'Toole, J.J.; Wessels, T.E.; Lynch, J.F.

1981-10-01

Six facilities, representing the scope of different co-firing techniques with their associated RDF production systems were reviewed in detail for combustion equipment, firing modes, emission control systems, residue handling/disposal, and effluent wastewater treatment. These facilities encompass all currently operational or soon to be operational co-firing plants and associated RDF production systems. Occupational health and safety risks for these plants were evaluated on the basis of fatal and nonfatal accidents and disease arising from the respective fuel cycles, coal and RDF. Occupational risks include exposure to pathogenic organisms in the workplace. Unusual events that are life threatening in the RDF processingmore » industry (e.g., explosions) are also discussed and remedial and safety measures reviewed. 80 refs., 4 figs., 30 tabs.« less

Parental Delay or Refusal of Vaccine Doses, Childhood Vaccination Coverage at 24 Months of Age, and the Health Belief Model

PubMed Central

Smith, Philip J.; Humiston, Sharon G.; Marcuse, Edgar K.; Zhao, Zhen; Dorell, Christina G.; Howes, Cynthia; Hibbs, Beth

2011-01-01

Objective We evaluated the association between parents' beliefs about vaccines, their decision to delay or refuse vaccines for their children, and vaccination coverage of children at aged 24 months. Methods We used data from 11,206 parents of children aged 24–35 months at the time of the 2009 National Immunization Survey interview and determined their vaccination status at aged 24 months. Data included parents' reports of delay and/or refusal of vaccine doses, psychosocial factors suggested by the Health Belief Model, and provider-reported up-to-date vaccination status. Results In 2009, approximately 60.2% of parents with children aged 24–35 months neither delayed nor refused vaccines, 25.8% only delayed, 8.2% only refused, and 5.8% both delayed and refused vaccines. Compared with parents who neither delayed nor refused vaccines, parents who delayed and refused vaccines were significantly less likely to believe that vaccines are necessary to protect the health of children (70.1% vs. 96.2%), that their child might get a disease if they aren't vaccinated (71.0% vs. 90.0%), and that vaccines are safe (50.4% vs. 84.9%). Children of parents who delayed and refused also had significantly lower vaccination coverage for nine of the 10 recommended childhood vaccines including diphtheria-tetanus-acellular pertussis (65.3% vs. 85.2%), polio (76.9% vs. 93.8%), and measles-mumps-rubella (68.4% vs. 92.5%). After adjusting for sociodemographic differences, we found that parents who were less likely to agree that vaccines are necessary to protect the health of children, to believe that their child might get a disease if they aren't vaccinated, or to believe that vaccines are safe had significantly lower coverage for all 10 childhood vaccines. Conclusions Parents who delayed and refused vaccine doses were more likely to have vaccine safety concerns and perceive fewer benefits associated with vaccines. Guidelines published by the American Academy of Pediatrics may assist providers in responding to parents who may delay or refuse vaccines. PMID:21812176

Refusal of Recommended Chemotherapy for Ovarian Cancer: Risk Factors and Outcomes; a National Cancer Data Base Study.

PubMed

Wallace, Sumer K; Lin, Jeff F; Cliby, William A; Leiserowitz, Gary S; Tergas, Ana I; Bristow, Robert E

2016-05-01

To identify risk factors associated with refusal of recommended chemotherapy and its impact on patients with epithelial ovarian cancer (EOC). We identified patients in the National Cancer Data Base diagnosed with EOC from January 1998 to December 2011. Patients who refused chemotherapy were identified and compared with those who received recommended, multiagent chemotherapy. Univariate and multivariable analyses were performed using chi-square test with Bonferroni correction, binary logistic regression, log-rank test, and Cox proportional hazards modeling. The threshold for statistical significance was set at a P value of less than 0.05. From a cohort of 147,713 eligible patients, 2,707 refused chemotherapy. These patients were compared with 92,212 patients who received recommended multiagent chemotherapy. Older age, more medical comorbidities, not having insurance, and later year of diagnosis were directly and significantly associated with chemotherapy refusal when analyzed using multivariable logistic regression. In addition, lower-than-expected facility adherence to NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Ovarian Cancer, treatment at low-volume center, lower grade, and higher stage were all significantly and independently associated with chemotherapy refusal. Median overall survival of patients who received multiagent chemotherapy was significantly longer than that of those who refused chemotherapy (43 vs 4.8 months; P<.0005). After controlling for known patient, facility, and disease prognostic factors, chemotherapy refusal is significantly associated with increased risk of death. Refusal of recommended chemotherapy carries significant risk of early death from ovarian cancer. Our data demonstrate that the decision to refuse chemotherapy is multifactorial and, in addition to unalterable factors (eg, stage/grade, age), involves factors that can be changed, including facility type and payor. Efforts at addressing these discrepancies in care can improve compliance with chemotherapy recommendations in the NCCN Guidelines for Ovarian Cancer and outcomes. Copyright © 2016 by the National Comprehensive Cancer Network.

Legal briefing: conscience clauses and conscientious refusal.

PubMed

Pope, Thaddeus Mason

2010-01-01

This issue's "Legal Briefing" column covers legal developments pertaining to conscience clauses and conscientious refusal. Not only has this topic been the subject of recent articles in this journal, but it has also been the subject of numerous public and professional discussions. Over the past several months, conscientious refusal disputes have had an unusually high profile not only in courthouses, but also in legislative and regulatory halls across the United States. Healthcare providers' own moral beliefs have been obstructing and are expected to increasingly obstruct patients' access to medical services. For example, some providers, on ethical or moral grounds, have denied: (1) sterilization procedures to pregnant patients, (2) pain medications in end-of-life situations, and (3) information about emergency contraception to rape victims. On the other hand, many healthcare providers have been forced to provide medical treatment that is inconsistent with their moral beliefs. There are two fundamental types of conscientious objection laws. First, there are laws that permit healthcare workers to refuse providing - on ethical, moral, or religious grounds healthcare services that they might otherwise have a legal or employer-mandated obligation to provide. Second, there are laws directed at forcing healthcare workers to provide services to which they might have ethical, moral, or religious objections. Both types of laws are rarely comprehensive, but instead target: (1) certain types of healthcare providers, (2) specific categories of healthcare services, (3) specific patient circumstances, and (4) certain conditions under which a right or obligation is triggered. For the sake of clarity, I have grouped recent legal developments concerning conscientious refusal into eight categories: 1. Abortion: right to refuse 2. Abortion: duty to provide 3. Contraception: right to refuse 4. Contraception: duty to provide 5. Sterilization: right to refuse 6. Fertility, HIV, vaccines, counseling 7. End-of-life measures: right to refuse 8. Comprehensive laws: right to refuse.

National Metal Casting Research Institute final report. Volume 1, Sand reclamation

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

Vondra, L.F.; Burningham, J.S.

1995-08-01

A mobile thermal foundry sand reclamation unit was designed and constructed. This unit consisted of thermal and mechanical sand reclamation equipment installed on the bed of a 50 foot low-boy trailer. It was transported to a number of Midwest foundries for on-site demonstration of the sand reclamation process. This allowed participating foundries to have their own refuse sand (10-100 tons) processed and then reused in production for evaluation. The purpose for building the unit was to demonstrate to foundries through ``hands on`` experience that refuse sands can be reclaimed and successfully reused particularly in regard to product quality. Most ofmore » the participating foundries indicated a high level of satisfaction with the reclaimed sand. Laboratory testing of samples of the used sand, before and after processing by the demonstration unit, verified the usability of the reclaimed sand. One of the foundries participating was a brass foundry, the sand from this foundry contained lead and is classified as a hazardous material. After reclamation the sand was no longer hazardous and could also be reused in the foundry.« less

Pragmatic Transfer in Thai EFL Refusals

ERIC Educational Resources Information Center

Wannaruk, Anchalee

2008-01-01

Communication breakdowns can occur during cross-cultural communication due to different perceptions and interpretations of appropriateness and politeness. This study investigates similarities and differences between refusals in American English and Thai and incidences of pragmatic transfer by Thai EFL learners when making refusals. The…

Breath Test Refusals and Their Effect on DWI Prosecution

DOT National Transportation Integrated Search

2012-07-01

This report describes the design and results of a project aimed at estimating the rate that drivers : refuse to submit to a legally-requested breath alcohol concentration test, and the effect of such : refusals on the prosecution of DWI cases. The st...

16 CFR 1210.18 - Refusal of importation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Refusal of importation. 1210.18 Section 1210.18 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS SAFETY STANDARD FOR CIGARETTE LIGHTERS Certification Requirements § 1210.18 Refusal of importation. (a...

Belief About Mandatory School Vaccinations and Vaccination Refusal Among Ohio Appalachian Parents: Do Demographic and Religious Factors, General Health, and Political Affiliation Play a Role?

PubMed

Krok-Schoen, Jessica L; Bernardo, Brittany M; Weier, Rory C; Peng, Juan; Katz, Mira L; Reiter, Paul L; Richardson, Morgan S; Pennell, Michael L; Tatum, Cathy M; Paskett, Electra D

2017-11-14

To examine how demographic, general health, religious, and political characteristics influenced beliefs about mandatory school vaccinations and history of vaccination refusal for children among Ohio Appalachian parents. In 2013 and 2014, baseline data were obtained from parents (n = 337) of girls aged 9-17 from 12 counties in rural Ohio Appalachia enrolled in the Community Awareness, Resources and Education (CARE II) Project. Multivariate logistic regression models were used to identify correlates of parental beliefs about mandatory school vaccinations and history of refusing a doctor-recommended vaccine for their child(ren). About 47% of parents agreed that parents should have the right to refuse mandatory school vaccinations for their child(ren). Participants who reported their political affiliation as Republican (OR = 2.45, 95% CI: 1.28-4.66) or Independent (OR = 3.31, 95% CI: 1.70-6.44) were more likely to agree that parents should have the right to refuse school-mandated vaccinations than parents who reported their political affiliation as Democrat. Approximately 39% of parents reported ever refusing a vaccine for their child(ren). Participants who were female (OR = 3.90, 95% CI: 1.04-14.58) and believed that parents should have the right to refuse mandatory school vaccinations (OR = 3.27, 95% CI: 1.90-5.62) were more likely to report ever refusing a vaccine for their child(ren). The study findings provide information to better understand factors related to vaccination refusal among parents in Appalachia Ohio that can be used to design interventions to improve vaccination uptake. © 2017 National Rural Health Association.

Insulin therapy refusal among type II diabetes mellitus patients in Kubang Pasu district, Kedah, Malaysia

PubMed Central

Tan, Wei Leong; Asahar, Siti Fairus; Harun, Noor Liani

2015-01-01

INTRODUCTION Diabetes mellitus is a rising non-communicable disease in Malaysia. Insulin therapy refusal is a challenge for healthcare providers, as it results in delayed insulin initiation. This study was conducted to determine the prevalence of insulin therapy refusal and its associated factors. METHODS This cross-sectional study was conducted at seven public health clinics in Kubang Pasu district of Kedah, Malaysia, from March to October 2012. A newly developed and validated questionnaire was used and participants were selected via systematic random sampling. Only patients diagnosed with type II diabetes mellitus (T2DM) and under the public health clinic care in Kubang Pasu were included in the study. Multiple logistic regression was used to study the association between insulin therapy refusal and its associated factors. RESULTS There were 461 respondents and the response rate was 100%. Among these 461 patients with T2DM, 74.2% refused insulin therapy. The most common reason given for refusal was a lack of confidence in insulin injection (85.4%). Multiple logistic regression revealed that respondents who had secondary education were 55.0% less likely to refuse insulin therapy than those who had primary education or no formal education (adjusted odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25–0.82, p = 0.009). There was also a significant inverse association between glycated haemoglobin (HbA1c) level and insulin therapy refusal (adjusted OR 0.87, 95% CI 0.76–1.00, p = 0.047). CONCLUSION Insulin therapy refusal is common in Kubang Pasu. Educational status and HbA1c level should be taken into consideration when counselling patients on insulin therapy initiation. PMID:25532511

Insulin therapy refusal among type II diabetes mellitus patients in Kubang Pasu district, the state of Kedah, Malaysia.

PubMed

Tan, Wei Leong; Asahar, Siti Fairus; Harun, Noor Liani

2015-04-01

Diabetes mellitus is a rising non-communicable disease in Malaysia. Insulin therapy refusal is a great challenge for healthcare providers, as it results in delayed insulin initiation. This study was conducted to determine the prevalence of insulin therapy refusal and its associated factors. This cross sectional study was conducted at seven public health clinics in Kubang Pasu district, Malaysia, from March to October 2012. A newly developed and validated questionnaire was used and participants were selected via systematic random sampling. Only patients diagnosed with type II diabetes mellitus (T2DM) and under the public health clinic care in Kubang Pasu were included in the study. Multiple logistic regressions were used to study the association between insulin therapy refusal and its associated factors. There were 461 respondents and the response rate was 100%. Among these 461 patients with T2DM, 74.2% refused insulin therapy. The most common reason given for refusal was a lack of confidence in insulin injection (85.4%). Multiple logistic regression revealed that respondents who had secondary education were 55.0% less likely to refuse insulin therapy than those who had primary or no formal education (p = 0.009, adjusted odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.25-0.82). There was also a significant inverse association between glycated haemoglobin (HbA1c) and insulin therapy refusal (p = 0.047, adjusted OR = 0.87, 95% CI = 0.76-1.00). Insulin therapy refusal is common in Kubang Pasu. Education status and HbA1c should be taken into consideration when counselling patients on insulin therapy initiation.

State Right to Refuse Medication Laws and Procedures: Impact on Homicide and Suicide.

PubMed

Edwards, Griffin

2016-09-01

As part of the expansive overhaul of the mental health system that occurred in the latter half of the 20th Century, many states passed laws that allow, under certain conditions, voluntary and involuntarily committed patients to refuse medication. While some predicted the consequences of these laws would be dire, the effect on violent behavior remains untested. The aim is to decipher any differences state right to refuse medication laws may have on violence. Using the homicide rate of every US state between 1972 and 2001 (N = 1,479), and the suicide rate between 1981 and 2001 (N = 1,071). The study compares the difference in homicide/suicide rates before and after a law change to that same difference in a set of control states to estimate the effect of laws aimed at extending the right to refuse medication to both voluntary and involuntarily committed mental health patients. Laws designed to allow voluntarily committed patients to refuse medication are associated with a 0.8 increase in homicides per 100,000 of the state population while laws dictating an involuntarily committed patient's right to request refusal of medication are negative but statistically insignificant using standard t test. Laws designed to allow voluntarily committed patients to refuse medication have no statistically significant effect on suicides while laws dictating an involuntarily committed patient's right to request refusal of medication, specifically when the request is reviewed by independent mental health professionals, are associated with a statistically significant reduction in suicides. Allowing voluntarily committed patients to refuse medication may entice some to enter in-patient facilities, but the brief and optional exposure to medication and their side effects may actually discourage treatment and increase violence.

Long-term monitoring and prediction for settlement and composition of refuse in Shanghai Laogang Municipal Landfill.

PubMed

Jiangying, Liu; Dimin, Xu; Youcai, Zhao; Shaowei, Chen; Guojian, Li; Qi, Zhou

2004-09-01

Parameters about composition of refuse such as mass percentage of biodegradable matter, volatile solid, organic carbon, cellulose, total sugar, and settlement were monitored and analyzed in a large-scale experimental unit. The empirical formulas between composition and refuse age were established in terms of the data obtained from the experimental unit and verified by comparing with the corresponding parameters of refuse in the closed landfill units from 1991 until 1994 in the Shanghai Laogang Municipal Landfill. Furthermore, the long-term prediction for the composition of refuse was made, and it was predicted that the half-life is 7 to 11 years for biodegradable matter, 9 to 12 years for organic carbon or volatile solid, 7 to 16 years for cellulose, and 4 to 6 years for total sugar. In addition, a mathematical model, based on the mechanism of refuse biodegradation in the landfill, was developed to simulate the relationship between the settlement and the refuse age and manifests the secondary settlement potential. The mathematical model was proved not only to be reliable but also should be accurate for predicting the settlement of the landfill. The secondary settlement, which mainly results from the slow and gradual biodegradation of refuse, is linear with respect to the exponent of refuse age. Finally, according to the settlement model and empirical biodegradation formulas, it may be predicted that, 79.4% of biodegradable matter, 92.9% of total sugar, 72.7% of volatile solid and organic carbon, and 73.1% of cellulose will be biodegraded and that 79% of the maximum secondary settlement potential will occur before the Shanghai Laogang Municipal Landfill is in a high stabilization situation, i.e., approximately 21 years after final closure.

Crew appliance concepts. Volume 5, appendix C: Modular space station appliances supporting engineering data

NASA Technical Reports Server (NTRS)

Proctor, B. W.; Reysa, R. P.; Russell, D. J.

1975-01-01

Housekeeping, off-duty, and medical data concerning the appliances considered for the space station are presented. Appliance functions analyzed include: cleanup, collection, processing and storage of refuse; crew entertainment and physical exercise, and the autoclaves and ergometers.

37 CFR 1.17 - Patent application and reexamination processing fees.

Code of Federal Regulations, 2011 CFR

2011-07-01

... decision on petition refusing to accept delayed payment of maintenance fee in an expired patent. § 1.741(b... and record payment of a maintenance fee filed prior to expiration of a patent. § 1.550(c)—for patent... application from issue. § 1.314—to defer issuance of a patent. (i) Processing fee for taking action under one...

15 CFR 760.2 - Prohibitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... refusal to do business under this section for a United States person to provide management, procurement... race, religion, sex, or national origin of any U.S. person. (d) Furnishing information about business... OR BOYCOTTS § 760.2 Prohibitions. (a) Refusals to do business. Prohibition Against Refusals To Do...

47 CFR 73.4005 - Advertising-refusal to sell.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 4 2010-10-01 2010-10-01 false Advertising-refusal to sell. 73.4005 Section 73.4005 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.4005 Advertising—refusal to sell. See 412...

47 CFR 73.4005 - Advertising-refusal to sell.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 4 2011-10-01 2011-10-01 false Advertising-refusal to sell. 73.4005 Section 73.4005 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.4005 Advertising—refusal to sell. See 412...

47 CFR 73.4005 - Advertising-refusal to sell.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 4 2012-10-01 2012-10-01 false Advertising-refusal to sell. 73.4005 Section 73.4005 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.4005 Advertising—refusal to sell. See 412...

47 CFR 73.4005 - Advertising-refusal to sell.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 4 2014-10-01 2014-10-01 false Advertising-refusal to sell. 73.4005 Section 73.4005 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.4005 Advertising—refusal to sell. See 412...

47 CFR 73.4005 - Advertising-refusal to sell.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 4 2013-10-01 2013-10-01 false Advertising-refusal to sell. 73.4005 Section 73.4005 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.4005 Advertising—refusal to sell. See 412...

Understanding the antecedents of Korean high school students' drinking refusal self-efficacy: parental influence, peer influence, and behavior.

PubMed

Jang, Su Ahn; Cho, Namauk; Yoo, Jina

2011-12-29

The current study examined the factors that influence Korean adolescents' drinking refusal self-efficacy, which is known to be associated with alcohol use and drinking intentions. Specifically, this study considered parental monitoring, parent-child communication satisfaction, peer influence, and prior alcohol use as possible antecedents of Korean high school students' drinking refusal self-efficacy. High school students (n = 538) in South Korea responded to the current study. The data revealed that parent-child communication satisfaction facilitated parental monitoring, and these factors indirectly predicted adolescents' drinking behavior through peer influence. We also found that prior drinking, parental monitoring, and peer influence were directly associated with drinking refusal self-efficacy, and the self-efficacy, in turn, was associated with drinking intentions. These results not only suggest that drinking refusal self-efficacy are related to drinking behavior and intentions, but they also provide a theoretical explanation for how parental and peer influences are associated with adolescents' drinking refusal self-efficacy.

Understanding the Antecedents of Korean High School Students’ Drinking Refusal Self-Efficacy: Parental Influence, Peer Influence, and Behavior

PubMed Central

Jang, Su Ahn; Cho, NamAuk; Yoo, Jina

2012-01-01

The current study examined the factors that influence Korean adolescents’ drinking refusal self-efficacy, which is known to be associated with alcohol use and drinking intentions. Specifically, this study considered parental monitoring, parent-child communication satisfaction, peer influence, and prior alcohol use as possible antecedents of Korean high school students’ drinking refusal self-efficacy. High school students (n = 538) in South Korea responded to the current study. The data revealed that parent-child communication satisfaction facilitated parental monitoring, and these factors indirectly predicted adolescents’ drinking behavior through peer influence. We also found that prior drinking, parental monitoring, and peer influence were directly associated with drinking refusal self-efficacy, and the self-efficacy, in turn, was associated with drinking intentions. These results not only suggest that drinking refusal self-efficacy are related to drinking behavior and intentions, but they also provide a theoretical explanation for how parental and peer influences are associated with adolescents’ drinking refusal self-efficacy. PMID:22980099

Conscientious objection to referrals for abortion: pragmatic solution or threat to women’s rights?

PubMed Central

2014-01-01

Background Conscientious objection has spurred impassioned debate in many Western countries. Some Norwegian general practitioners (GPs) refuse to refer for abortion. Little is know about how the GPs carry out their refusals in practice, how they perceive their refusal to fit with their role as professionals, and how refusals impact patients. Empirical data can inform subsequent normative analysis. Methods Qualitative research interviews were conducted with seven GPs, all Christians. Transcripts were analysed using systematic text condensation. Results Informants displayed a marked ambivalence towards their own refusal practices. Five main topics emerged in the interviews: 1) carrying out conscientious objection in practice, 2) justification for conscientious objection, 3) challenges when relating to colleagues, 4) ambivalence and consistency, 5) effects on the doctor-patient relationship. Conclusions Norwegian GP conscientious objectors were given to consider both pros and cons when evaluating their refusal practices. They had settled on a practical compromise, the precise form of which would vary, and which was deemed an acceptable middle way between competing interests. PMID:24571955

The moderating role of risk-taking tendency and refusal assertiveness on social influences in alcohol use among inner-city adolescents.

PubMed

Epstein, Jennifer A; Botvin, Gilbert J

2002-07-01

Many etiological models of adolescent alcohol use concentrate on the main effects of risk and protective factors. This study examined the moderating influence of risk-taking tendency and refusal assertiveness on perceived friends' drinking as associated with alcohol use among inner-city adolescents. Participants (N = 2,400; 54% female) completed questionnaires that included measures of risk-taking tendency, refusal assertiveness, perceived friends' drinking and alcohol use (drinking frequency, drinking amount and drunkenness). Main effects for perceived friends' drinking, risk-taking tendency and refusal assertiveness were found for all three drinking measures, consistent with prior work. Furthermore, significant interactions were found between (1) risk-taking tendency and perceived friends' drinking and (2) refusal assertiveness and perceived friends' drinking. High risk-taking tendency and low refusal assertiveness increased the impact of perceived friends' drinking on alcohol use among inner-city adolescents. This suggests that these factors are important components in preventing alcohol use.

Process evaluation of a national school-based iron supplementation program for adolescent girls in Iran.

PubMed

Kheirouri, Sorayya; Alizadeh, Mohammad

2014-09-16

Iron deficiency anemia remains as one of the most common nutritional problems in Iran, especially in women and girls. A process evaluation study of the national iron supplementation program targeting girls attending high schools was conducted to examine degree of exposure and satisfaction of the targets with the intervention components, and to assess the delivery (quantity), fidelity (quality), and environmental mediators of the intervention. Three assessment tools were developed and used for the process evaluation. A total of 8 schools were selected using a simple randomization method. Data were collected from students (n = 658 of 661 participants), teachers (n = 80), and school principals (n = 7 of 8). For the qualitative measures semi-structured interviews were conducted with the three study groups. Mean continuous compliance was 62.3%. Intolerance to pills and no water supply in classrooms accounted for 47.72% and 36.21% of the refusals, respectively. The refusal rate was significantly correlated (p < 0.001) with the absence of a classroom water supply, and with each student's knowledge of iron deficiency issues (p < 0.05). The odds of refusal in the absence of a classroom water supply were 2.02 (95% CI 1 · 044 to 3 · 900) times greater than for those classrooms with a water supply. Student exposure to the program's goal was satisfactory; however, delivery and fidelity of educational materials and training sessions were inadequate. The findings suggest that the methods of delivery and the fidelity of the program components, education materials and training sessions were insufficient and need to be improved. Additionally, specific attention has to be given to contextual factors to ensure the success of the program.

Effective Intervention for School Refusal Behaviour

ERIC Educational Resources Information Center

Nuttall, Clare; Woods, Kevin

2013-01-01

Evaluation of successful professional intervention for two case studies of female adolescents' school refusal behaviour is presented. Data gathered from the young person, professionals, and parents in each case are synthesised to propose a multi-level, ecologically situated model of intervention for school refusal behaviour. The proposed model…

BEHAVIOR AND ASSIMILATION OF ORGANIC AND INORGANIC PRIOIRTY POLLUTANTS CODISPOSED WITH MUNICIPAL REFUSE - VOLUME II - APPENDICES

EPA Science Inventory

Organic and inorganic priority pollutants codisposed with municipal solid waste (MSW) in ten pilot-scale simulated landfill columns, operated under single pass leaching or leachate recycle, were capable of being attenuated by microbially-mediated landfill stabilization processes....

Breath test refusals and DWI prosecution : traffic tech.

DOT National Transportation Integrated Search

2012-08-01

There are typically about 1.4 million DWI (driving while : impaired) arrests each year in the United States. An officers : request to a driver for a breath (or blood, or urine) test is an : important part of the arrest process. The percentage of d...

ALKALINE NONCYANIDE ZINC PLATING WITH REFUSE OF RECOVERED CHEMICALS

EPA Science Inventory

A metal finishing process can create environmental problems because it uses chemicals that are not only toxic but also resistant to degradation or decomposition. Study was undertaken at a zinc electroplating operation to achieve zero discharge of wastewater and total recycle of r...

Journals and Justice.

ERIC Educational Resources Information Center

Curzer, Howard J.

1996-01-01

Addresses the process of journal deselection from the point of view of justice and argues that when journal cuts are necessary, libraries should first, reduce all departments to core holdings; second, ask departments with expensive journals for permission to implement an efficiency principle; third, if refused permission, implement an equal…

Two stages catalytic pyrolysis of refuse derived fuel: production of biofuel via syncrude.

PubMed

Miskolczi, N; Buyong, F; Angyal, A; Williams, P T; Bartha, L

2010-11-01

Thermo-catalytic pyrolysis of refuse derived fuels with different catalysts had been conducted in a two stages process due to its important potential value as fuel. The first stage was a pure thermal pyrolysis in a horizontal tubular reactor with feed rate of 0.5kg hourly. The second stage was a semi-batch process in the presence of catalysts. Results showed that the tested catalysts significantly have affected the quantity of products. E.g. gas yield could be increased with 350% related to the catalyst free case using ZSM-5, while that of pyrolytic oil was 115% over Y-zeolite. Gases consisted of mainly CO and CO(2) obtained from the tubular reactor, while dominantly hydrocarbons from the second stage. Ni-Mo-catalyst and Co-Mo-catalyst had shown activity in pyrolytic oil upgrading via in-situ hydrogenation-dehydrogenation reactions. Sulphur, nitrogen and chlorine level in pyrolytic oils could be significantly declined by using of catalysts.

[Technology of composting].

PubMed

Jäger, B

1983-09-01

The technology of composting must guarantee the material-chemical, biological and physical-technical reaction conditions essential for the rotting process. In this, the constituents of the input material and the C/N ratio play an important role. Maintaining optimum decomposition conditions is rendered difficult by the fact that the physical-technical reaction parameters partly exclude each other. These are: optimum humidity, adequate air/oxygen supply, large active surface, loose structure with sufficient decomposition volume. The processing of the raw refuse required to maintain the physical-technical reaction parameters can be carried out either by the conventional method of preliminary fragmentizing, sieving and mixing or else in conjunction with separating recycling in adapted systems. The latter procedure obviates some drawbacks which mainly result from the high expenditure required for preliminary fragmentation of the raw refuse. Moreover, presorting affords the possibility of reducing the heavy-metal content of the organic composing fraction and this approaches a solution to the noxa disposal problem which at present stands in the way of being accepted as an ecological waste disposal method.

[Paradoxes in the judicial institution concerning decision-making in pediatric oncology].

PubMed

Sirvent, N

2010-02-01

In paediatric oncology, the medical decision-making process is characterized by the importance of what is at stake: the vital prognosis. Refusal of care, or, more specifically, refusal of a treatment, always appears "at the crossroads of multiple stakes... implicating an entourage [family members], a medical team, and rules of law that sometimes give rise to contradictory interpretations". Paradoxes in the judicial institution are evident on two levels: i) in the values established by the law; where adults are concerned, the law explicitly refuses to consider the biological survival of an individual as the supreme value; it gives priority to respect of the patient's wishes and his or her autonomy; for children, in contrast, the supreme value established by the law is biological survival; the physician must provide the care indispensable to protect the health of a minor at all cost; ii) between legal texts and jurisprudence; while the law authorizes a physician to override the parental authority when he judges a treatment necessary to protect the health of a minor, jurisprudence in pediatric oncology has always declined to define the best therapeutic strategy where a child's chances of survival are concerned. Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.

School Refuser Child Identities

ERIC Educational Resources Information Center

Stroobant, Emma; Jones, Alison

2006-01-01

"School refuser" is an always-already negative child identity. The term is used to categorize children or adolescents who appear to dislike and fear school (or aspects of school) and persistently refuse to attend or attend very unwillingly. Given that school attendance is generally considered a necessary social good, regular and anxious…

43 CFR 8365.1-1 - Sanitation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... or petroleum products or dump refuse or waste other than wash water from any trailer or other vehicle... industrial refuse or waste brought as such from private or municipal property; (5) Pollute or contaminate water supplies or water used for human consumption; or (6) Use a refuse container or disposal facility...

28 CFR 549.65 - Refusal to accept treatment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Refusal to accept treatment. 549.65 Section 549.65 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.65 Refusal to accept treatment. (a) When, as a result of...

16 CFR § 1210.18 - Refusal of importation.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Refusal of importation. § 1210.18 Section § 1210.18 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS SAFETY STANDARD FOR CIGARETTE LIGHTERS Certification Requirements § 1210.18 Refusal of importation. (a...

20 CFR 702.410 - Duties of employees with respect to special examinations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... PROCEDURE Medical Care and Supervision § 702.410 Duties of employees with respect to special examinations... to submit to such examination unless circumstances justified the refusal. (c) Where an employee... of further compensation during such time as the refusal continues. Except that refusal to submit to...

20 CFR 702.410 - Duties of employees with respect to special examinations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PROCEDURE Medical Care and Supervision § 702.410 Duties of employees with respect to special examinations... to submit to such examination unless circumstances justified the refusal. (c) Where an employee... of further compensation during such time as the refusal continues. Except that refusal to submit to...

21 CFR 1316.12 - Refusal to allow inspection with an administrative warrant.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Refusal to allow inspection with an administrative warrant. 1316.12 Section 1316.12 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE ADMINISTRATIVE FUNCTIONS, PRACTICES, AND PROCEDURES Administrative Inspections § 1316.12 Refusal to allow...

Family Influences on Treatment Refusal in School-Linked Mental Health Services

ERIC Educational Resources Information Center

Keeley, Mary L.; Wiens, Brenda A.

2008-01-01

This study analyzed family influences on treatment refusal in school-linked mental health services (SLMHS). Specifically, it assessed whether levels of family cohesion, conflict, and organization were related to whether a family refused to initiate recommended treatment. Children (N = 133) referred for emotional and behavioral problems and their…

Integrated solid waste management in Japan

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

Not Available

The Japanese, through a combination of public policy, private market conditions, a geographic necessity, practice integrated municipal solid waste (MSW) management. The approach of MSW management in Japan is as follows: The basic concept of refuse treatment consists of recycling discharged refuse into usable resources, reusing such resources as much as possible, and then treating or disposing of the usable portion into a sanitary condition. Considering the difficulty of procuring land or seaside areas for such purpose as a refuse disposal site, it will be necessary to minimize the volume of refuse collected for treatment or disposal.

The right to refuse treatment: a model act.

PubMed Central

1983-01-01

Although the right to refuse medical treatment is universally recognized as a fundamental principle of liberty, this right is not always honored. A refusal can be thwarted either because a patient is unable to competently communicate or because providers insist on continuing treatment. To help enhance the patient's right to refuse treatment, many states have enacted so-called "living will" or "natural death" statutes. We believe the time has come to move beyond these current legislative models, and we therefore propose a Model Act that clearly enunciates an individual's right to refuse treatment, does not limit its exercise to the terminally ill or to heroic measures, and provides a mechanism by which individuals can set forth their wishes in advance and designate another person to enforce them. PMID:6869647

Pervasive refusal syndrome. Three German cases provide further illustration.

PubMed

Jans, Thomas; Ball, Juliane; Preiss, Maike; Haberhausen, Michael; Warnke, Andreas; Renner, Tobias J

2011-09-01

Pervasive refusal syndrome (PRS) has been proposed as a new diagnostic entity among child and adolescent psychiatric disorders. It is characterized by a cluster of life-threatening symptoms including refusal of hood intake, decreased or complete lack of mobilization, and lack of communication as well as retreat from normal life activities. Active refusal to accept help as well as neglect of personal care have been core features of PRS in the limited number of cases reported in the last decade. There have, however; been cases with predominantly passive resistance, indicating the possibility that there may be a continuum from active refusal to passive resistance within PRS. Postulating this continuum allows for the integration of "depressive devitalization" -- a refusal syndrome mainly characterized by passive resistance -- into the concept of PRS. Here, three case vignettes of adolescent patients with PRS are presented. The patients' symptomatology can be allocated on this continuum of PRS. PRS and dissociative disorders are compared in greater detail and contrasted within this discussion of differential diagnoses at the poles of such a continuum. PRS is a useful diagnosis for cases involving symptoms of predominating refusal and retreat which cannot satisfactorily be classified by existing diagnostic categories, and which can mostly clearly be separated from dissociative disorder.

Are Patients Ready for Lesbian, Gay and Bisexual Family Physicians - A Croatian Study.

PubMed

Grabovac, Igor; Mustajbegović, Jadranka; Milošević, Milan

2016-06-01

Discrimination and harassment of lesbian, gay and bisexual (LGB) physicians from their colleagues and superiors are known. However there is little knowledge about the patients’ attitudes and discrimination toward physicians. A cross sectional Internet survey was conducted in urban Croatian regions. The participants were asked to answer questions regarding their socio-demographic status, the Attitudes Towards Lesbians and Gay Men Scale (ATLG), and whether they would refuse to see a LGB physician and, if so, why. Of the 1004 participants, 8.8% said they would refuse a male GB physician while 7.9% would refuse a female LB physician, and 7.3% would refuse both. The two most common reasons for discriminating were: “disaccord with political or religious beliefs” and “fear of being sexually harassed”. A logistical regression model showed that male sex, higher ATLG score and higher age were associated with more refusals of male GB physicians. Also higher age, higher ATLG score were associated with more refusals of female LB physicians, while personal contact with LGB people was associated with less refusals of both groups. The observed prevalence of discrimination is significant. The results suggest that discrimination is based on emotional reasons and stereotypical beliefs. Educational efforts should be directed towards changing misconceptions about LGB people.

Factors associated with repeated refusal to participate in longitudinal population-based HIV surveillance in rural South Africa: an observational study, regression analyses

PubMed Central

Giordano, Katie; McGrath, Nuala; Snow, Rachel; Harlow, Siobán; Newell, Marie-Louise

2014-01-01

Background For many estimation purposes, individuals who repeatedly refuse to participate in longitudinal HIV surveillance pose a bigger threat to valid inferences than individuals who participate at least occasionally. We investigate the determinants of repeated refusal to consent to HIV testing in a population-based longitudinal surveillance in rural South Africa. Methods We used data from two years (2005 & 2006) of the annual HIV surveillance conducted by the Africa Centre for Health and Population Studies, linking the HIV surveillance data to demographic and socioeconomic data. The outcome for the analysis was “repeated refusal”. Demographic variables included sex, age, highest educational attainment, and place of residence. We also included a measure of wealth and the variable “ever had sex”. To compare the association of each variable with the outcome, unadjusted odds ratios and standard errors were estimated. Multivariable logistic regression was used to estimate adjusted odds ratios and their standard errors. Data were analyzed using STATA 10.0. Results Of 15,557 eligible individuals, 46% refused to test for HIV in both rounds. Males were significantly more likely than females to repeatedly refuse testing. Holding all other variables constant, individuals in the middle age groups were more likely to repeatedly refuse testing compared with younger and older age groups. The odds of repeated refusal increased with increasing level of education and relative wealth. People living in urban areas were significantly more likely to repeatedly refuse an HIV test than people living in peri-urban or rural areas. Compared to those who had ever had sex, both males and females who had not yet had sex were significantly more likely to refuse to participate. Conclusions The likelihood of repeated refusal to test for HIV in this longitudinal surveillance increases with education, wealth, urbanization, and primary sexual abstinence. Since the factors determining repeated HIV testing refusal are likely associated with HIV status, it is critical that selection effects are controlled for in the analysis of HIV surveillance data. Interventions to increase consent to HIV testing should consider targeting the relatively well educated and wealthy, people in urban areas, and individuals who have not yet sexually debuted. PMID:25621095

Developmentally sensitive cognitive behavioral therapy for adolescent school refusal: rationale and case illustration.

PubMed

Heyne, David; Sauter, Floor M; Ollendick, Thomas H; Van Widenfelt, Brigit M; Westenberg, P Michiel

2014-06-01

School refusal can be difficult to treat and the poorest treatment response is observed among older school refusers. This poor response may be explained, in part, by the impact of developmental transitions and tasks upon the young person, their family, and the treatment process. This paper describes and illustrates the @school program, a cognitive behavioral therapy (CBT) designed to promote developmental sensitivity when planning and delivering treatment for adolescent school refusal. Treatment is modularized and it incorporates progress reviews, fostering a planned yet flexible approach to CBT. The treatment is illustrated in the case of Allison, a 16-year-old female presenting with major depressive disorder and generalized anxiety disorder. A case formulation guided the selection, sequencing, and pacing of modules targeting predisposing, precipitating, perpetuating, and protective factors. Treatment comprised 16 sessions with Allison (interventions addressing depression, anxiety, and school attendance) and 15 concurrent sessions with her mother (strategies to facilitate an adolescent's school attendance), including two sessions with Allison and mother together (family communication and problem solving to reduce parent-adolescent conflict). Two treatment-related consultations were also conducted with Allison's homeroom teacher. Allison's school attendance improved during the course of treatment. By post-treatment, there was a decrease in internalizing behavior, an increase in self-efficacy, and remission of depressive disorder and anxiety disorder. Clinically significant treatment gains were maintained at 2-month follow-up. Factors influencing outcome may include those inherent to the @school program together with less specific factors. Special consideration is given to parents' use of both authoritative and autonomy-granting approaches when helping an adolescent to attend school.

Factors related to treatment refusal in Taiwanese cancer patients.

PubMed

Chiang, Ting-Yu; Wang, Chao-Hui; Lin, Yu-Fen; Chou, Shu-Lan; Wang, Ching-Ting; Juang, Hsiao-Ting; Lin, Yung-Chang; Lin, Mei-Hsiang

2015-01-01

Incidence and mortality rates for cancer have increased dramatically in the recent 30 years in Taiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and life quality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusal of treatment in cancer patients via a cancer case manager system. This study analysed data from a case management system during the period from 2010 to 2012 at a medical center in Northern Taiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model as a framework, we conducted logistic regression analysis to identify independent variables that are significantly associated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied to estimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI). A total of 253 patients (1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusal of treatment in cancer patient included: concerns about adverse effects (p<0.001), poor performance(p<0.001), changes in medical condition (p<0.001), timing of case manager contact (p=.026), the methods by which case manager contact patients (p<0.001) and the frequency that case managers contact patients (≥10times) (p=0.016). Cancer patients who refuse treatment have poor survival. The present study provides evidence of factors that are related to refusal of therapy and might be helpful for further application and improvement of cancer care.

Drink refusal training as part of a combined behavioral intervention: Effectiveness and mechanisms of change

PubMed Central

Witkiewitz, Katie; Donovan, Dennis M.; Hartzler, Bryan

2012-01-01

Objective Many trials have demonstrated the effectiveness of cognitive behavioral interventions for alcohol dependence, yet few studies have examined why particular treatments are effective. This study was designed to evaluate whether drink refusal training was an effective component of a combined behavioral intervention (CBI) and whether change in self-efficacy was a mechanism of change following drink refusal training for individuals with alcohol dependence. Method The current study is a secondary analysis of data from the COMBINE study, a randomized clinical trial that combined pharmacotherapy with behavioral intervention in the treatment of alcohol dependence. The goal of the current study was to examine whether a drink refusal skills training module, administered as part of a 16-week CBI (n=776; 31% female, 23% non-White, average age=44) predicted changes in drinking frequency and self-efficacy during and following the CBI, and whether changes in self-efficacy following drink refusal training predicted changes in drinking frequency up to one year following treatment. Results Participants (n=302) who received drink refusal skills training had significantly fewer drinking days during treatment (d=0.50) and up to one year following treatment (d=0.23). In addition the effect of the drink refusal skills training module on drinking outcomes following treatment was significantly mediated by changes in self-efficacy, even after controlling for changes in drinking outcomes during treatment (proportion mediated = 0.47). Conclusions Drink refusal training is an effective component of CBI and some of the effectiveness may be attributed to changes in client self-efficacy. PMID:22289131

Obstetrician-gynaecologists' opinions about conscientious refusal of a request for abortion: results from a national vignette experiment.

PubMed

Rasinski, Kenneth A; Yoon, John D; Kalad, Youssef G; Curlin, Farr A

2011-12-01

Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee--whether the doctor referred and whether the doctor disclosed their objection to the abortion. 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Physicians indicated their approval for the vignette doctor's decision. Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor-patient relationship.

Emissions During Co-Firing of RDF-5 with Coal in a 22 t/h Steam Bubbling Fluidized Bed Boiler

NASA Astrophysics Data System (ADS)

Wan, Hou-Peng; Chen, Jia-Yuan; Juch, Ching-I.; Chang, Ying-Hsi; Lee, Hom-Ti

The co-firing of biomass and fossil fuel in the same power plant is one of the most important issues when promoting the utilization of renewable energy in the world. Recently, the co-firing of coal together with biomass fuel, such as "densified refuse derived fuel" (d-RDF or RDF-5) or RPF (refuse paper & plastic fuel) from waste, has been considered as an environmentally sound and economical approach to both waste remediation and energy production in the world. Because of itscomplex characteristics when compared to fossil fuel, potential problems, such as combustion system stability, the corrosion of heat transfer tubes, the qualities of the ash, and the emissionof pollutants, are major concerns when co-firing the biomass fuel with fossil fuel in a traditional boiler. In this study, co-firing of coal with RDF-5 was conducted in a 22t/h bubbling fluidized bed (BFB) steam boiler to investigate the feasibility of utilizing RDF-5 as a sustainable fuels in a commercial coal-fired steam BFB boiler. The properties of the fly ash, bottom ash, and the emission of pollutants are analyzed and discussed in this study.

Mechanical-biological treatment: performance and potentials. An LCA of 8 MBT plants including waste characterization.

PubMed

Montejo, Cristina; Tonini, Davide; Márquez, María del Carmen; Astrup, Thomas Fruergaard

2013-10-15

In the endeavour of avoiding presence of biodegradable waste in landfills and increasing recycling, mechanical-biological treatment (MBT) plants have seen a significant increase in number and capacity in the last two decades. The aim of these plants is separating and stabilizing the quickly biodegradable fraction of the waste as well as recovering recyclables from mixed waste streams. In this study the environmental performance of eight MBT-based waste management scenarios in Spain was assessed by means of life cycle assessment. The focus was on the technical and environmental performance of the MBT plants. These widely differed in type of biological treatment and recovery efficiencies. The results indicated that the performance is strongly connected with energy and materials recovery efficiency. The recommendation for upgrading and/or commissioning of future plants is to optimize materials recovery through increased automation of the selection and to prioritize biogas-electricity production from the organic fraction over direct composting. The optimal strategy for refuse derived fuel (RDF) management depends upon the environmental compartment to be prioritized and the type of marginal electricity source in the system. It was estimated that, overall, up to ca. 180-190 kt CO2-eq. y(-1) may be saved by optimizing the MBT plants under assessment. Copyright © 2013 Elsevier Ltd. All rights reserved.

21 CFR 515.21 - Refusal to approve a medicated feed mill license application.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Refusal to approve a medicated feed mill license... SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS MEDICATED FEED MILL LICENSE Administrative Actions on Licenses § 515.21 Refusal to approve a medicated feed mill license application. (a) The...

49 CFR 382.211 - Refusal to submit to a required alcohol or controlled substances test.

Code of Federal Regulations, 2014 CFR

2014-10-01

....211 Refusal to submit to a required alcohol or controlled substances test. No driver shall refuse to submit to a pre-employment controlled substance test required under § 382.301, a post-accident alcohol or... controlled substances test. 382.211 Section 382.211 Transportation Other Regulations Relating to...

49 CFR 382.211 - Refusal to submit to a required alcohol or controlled substances test.

Code of Federal Regulations, 2012 CFR

2012-10-01

....211 Refusal to submit to a required alcohol or controlled substances test. No driver shall refuse to submit to a pre-employment controlled substance test required under § 382.301, a post-accident alcohol or... controlled substances test. 382.211 Section 382.211 Transportation Other Regulations Relating to...

49 CFR 382.211 - Refusal to submit to a required alcohol or controlled substances test.

Code of Federal Regulations, 2010 CFR

2010-10-01

....211 Refusal to submit to a required alcohol or controlled substances test. No driver shall refuse to submit to a post-accident alcohol or controlled substances test required under § 382.303, a random... controlled substances test. 382.211 Section 382.211 Transportation Other Regulations Relating to...

49 CFR 382.211 - Refusal to submit to a required alcohol or controlled substances test.

Code of Federal Regulations, 2011 CFR

2011-10-01

....211 Refusal to submit to a required alcohol or controlled substances test. No driver shall refuse to submit to a post-accident alcohol or controlled substances test required under § 382.303, a random... controlled substances test. 382.211 Section 382.211 Transportation Other Regulations Relating to...

49 CFR 219.209 - Reports of tests and refusals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Reports of tests and refusals. 219.209 Section 219... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Post-Accident Toxicological Testing § 219.209 Reports of tests and refusals. (a)(1) A railroad that has experienced one or more events for...

49 CFR 382.211 - Refusal to submit to a required alcohol or controlled substances test.

Code of Federal Regulations, 2013 CFR

2013-10-01

....211 Refusal to submit to a required alcohol or controlled substances test. No driver shall refuse to submit to a pre-employment controlled substance test required under § 382.301, a post-accident alcohol or... controlled substances test. 382.211 Section 382.211 Transportation Other Regulations Relating to...

Refusals in Chinese: How Do L1 and L2 Differ?

ERIC Educational Resources Information Center

Hong, Wei

2011-01-01

This article reports on an empirical study of refusal strategies in Chinese by native speakers (NS) and nonnative Chinese learners (NNS). Sixty subjects (perceived as "students") were to refuse an invitation by "the professor" to a Chinese New Year's party. The study found that the NS group produced 10 strategies, whereas the…

Using Descriptive Assessment in the Treatment of Bite Acceptance and Food Refusal

ERIC Educational Resources Information Center

Casey, Sean D.; Perrin, Christopher J.; Lesser, Aaron D.; Perrin, Stefanie H.; Casey, Cheryl L.; Reed, Gregory K.

2009-01-01

The feeding behaviors of two children who maintained failure to thrive diagnoses and displayed food refusal are assessed in their homes. Descriptive assessments are used to identify schedules of consequence provided by each child's care providers for bite acceptance and food refusal behaviors. Assessments reveal rich schedules of praise and access…

Obstetric Patients Who Select and Those Who Refuse Medical Students' Participation in Their Care.

ERIC Educational Resources Information Center

Magrane, Diane; And Others

1994-01-01

A survey of 222 obstetrics patients assisted by medical clerkship students from the University of Vermont and 78 who refused student participation found privacy the primary motivation for refusal and a desire to contribute to students' education a primary reason for accepting student participation. Patients frequently erroneously anticipated the…

Forms and Functions of School Refusal Behavior in Youth: An Empirical Analysis of Absenteeism Severity

ERIC Educational Resources Information Center

Kearney, Christopher A.

2007-01-01

Background: School refusal behavior is a particularly nettlesome problem for mental health and education professionals because of its symptom severity and heterogeneity as well as lack of consensus regarding inclusive classification strategies. Alternatively, a functional model of school refusal behavior may provide a particularly useful way of…

24 CFR 3282.354 - Submittal of false information or refusal to submit information.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Submittal of false information or... ENFORCEMENT REGULATIONS Primary Inspection Agencies § 3282.354 Submittal of false information or refusal to submit information. The submittal of false information or the refusal to submit information required...

Acquisition of cup drinking using previously refused foods as positive and negative reinforcement.

PubMed

Kelley, Michael E; Piazza, Cathleen C; Fisher, Wayne W; Oberdorff, Amanda J

2003-01-01

We used previously refused foods as positive and negative reinforcement in the acquisition of cup drinking. Cup drinking increased with positive and negative reinforcement, both alone and in combination (without escape extinction), indicating that treatment of food refusal can establish some foods as appetitive stimuli whereas others remain aversive.

22 CFR 92.9 - Refusals of requests for notarial services.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Refusals of requests for notarial services. 92.9 Section 92.9 Foreign Relations DEPARTMENT OF STATE LEGAL AND RELATED SERVICES NOTARIAL AND RELATED... services should be refused only after the most careful deliberation. [22 FR 10858, Dec. 27, 1957, as...

9 CFR 98.20 - Embryos refused entry.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Embryos refused entry. 98.20 Section... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos From Regions Where Rinderpest or Foot-and-Mouth Disease Exists § 98.20 Embryos refused entry. If any embryos are determined to be ineligible...

9 CFR 98.20 - Embryos refused entry.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Embryos refused entry. 98.20 Section... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos From Regions Where Rinderpest or Foot-and-Mouth Disease Exists § 98.20 Embryos refused entry. If any embryos are determined to be ineligible...

9 CFR 98.20 - Embryos refused entry.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Embryos refused entry. 98.20 Section... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos From Regions Where Rinderpest or Foot-and-Mouth Disease Exists § 98.20 Embryos refused entry. If any embryos are determined to be ineligible...

9 CFR 98.20 - Embryos refused entry.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Embryos refused entry. 98.20 Section... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos From Regions Where Rinderpest or Foot-and-Mouth Disease Exists § 98.20 Embryos refused entry. If any embryos are determined to be ineligible...

9 CFR 98.20 - Embryos refused entry.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Embryos refused entry. 98.20 Section... CERTAIN ANIMAL EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos From Regions Where Rinderpest or Foot-and-Mouth Disease Exists § 98.20 Embryos refused entry. If any embryos are determined to be ineligible...

10 CFR 709.13 - Implications of refusal to take a polygraph examination.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Implications of refusal to take a polygraph examination. 709.13 Section 709.13 Energy DEPARTMENT OF ENERGY COUNTERINTELLIGENCE EVALUATION PROGRAM CI Evaluation Protocols and Protection of National Security § 709.13 Implications of refusal to take a polygraph...

49 CFR 219.209 - Reports of tests and refusals.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Reports of tests and refusals. 219.209 Section 219.209 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Post-Accident Toxicological Testing § 219.209 Reports of tests and refusals. (...

Veterinary opinions on refusing euthanasia: justifications and philosophical frameworks.

PubMed

Yeates, J W; Main, D C J

2011-03-12

To obtain information on euthanasia decisions from practising veterinary surgeons, respondents were asked to estimate how often during their time in practice they had refused to euthanase a dog and how often they had wanted to refuse to euthanase a dog but not done so because of other pressures. For each, respondents were then asked to state their most common reasons for refusing/not refusing in free text. The responses of clinicians were considered in the light of established ethical concepts to produce an evidence-based ethical framework for decision making. In total, 58 practitioners responded. Common reasons given for decisions on whether to refuse euthanasia referred to the patient's interests, such as the possibility of treatment or rehoming, and the fear of other unacceptable outcomes for the dog. Other reasons were based on concern for owners' interests. Some respondents reported being pressured into euthanasia by clients and other veterinary surgeons. This gives insight into the ethical principles that explicitly underlie veterinary surgeons' euthanasia decisions and the resultant framework may be useful for discussing and teaching euthanasia.

Discipline and Due Process.

ERIC Educational Resources Information Center

Collins, Mildred; Dowell, Mary L.

1998-01-01

Increasing numbers of parents do not accept a school's discipline policy and are refusing to permit their children to comply with disciplinary sanctions. According to the California Education Code, educators have the right to expect parents to accept disciplinary decisions made in compliance with required procedures. Parental defiance might worsen…

32 CFR 634.11 - Administrative due process for suspensions and revocations.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., military or civilian police report of apprehension, chemical test results if completed, refusal to consent... preliminary breath tests results, and other pertinent evidence. Immediate suspension should not be based... pre-determined by the final action authority. (6) For civilian personnel, written notice of suspension...

32 CFR 634.11 - Administrative due process for suspensions and revocations.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., military or civilian police report of apprehension, chemical test results if completed, refusal to consent... preliminary breath tests results, and other pertinent evidence. Immediate suspension should not be based... pre-determined by the final action authority. (6) For civilian personnel, written notice of suspension...

32 CFR 634.11 - Administrative due process for suspensions and revocations.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., military or civilian police report of apprehension, chemical test results if completed, refusal to consent... preliminary breath tests results, and other pertinent evidence. Immediate suspension should not be based... pre-determined by the final action authority. (6) For civilian personnel, written notice of suspension...

Grades: Review of Academic Evaluations in Law Schools.

ERIC Educational Resources Information Center

Doniger, Thomas

1980-01-01

Lack of independent review process in professional schools and refusal of courts to review errors not resulting from arbitrariness, caprice, or bad faith leave student and societal interests in accurate grading inadequately protected. (Journal availability: University of the Pacific, 3201 Donner Way, Sacramento, CA 95817.) (MSE)

How to Manage Rejected Scientific Papers? UNAIS as Final Solution.

PubMed

Diana, Alessandro

2012-01-01

Before publication, biomedical papers might undergo a very complex process, from journal selection, authors' motivations for submissions, modifications, and final publication or refusal. UNAIS (Unpublished Articles In Science) is an online repository in which authors can publish previously rejected scientific articles or articles that have never been submitted for publication. At UNAIS, authors can also publish the reasons behind the refusals to publication. UNAIS is more than an e-journal: it is a scientific drop box in which scientists can find indicative and negative results, as well as ideas that can inspire others. UNAIS's goal is also to help students and scientists who want to learn how to write scientific articles. UNAIS' aim is to exchange and promote knowledge. Have a look on www.unais.net.

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

None

The Staunton 1 Reclamation Demonstration Project involves an evaluation of the reclamation process for a deep coal mine refuse system. A typical abandoned midwestern deep coal mine refuse site was selected, final land use was determined, baseline data were collected, engineering plans were developed and implemented, and a post-construction evaluation was begun. The project is a cooperative effort by two state agencies--the Abandoned Mined Land Reclamation Council of Illinois the Illinois Institute for Environmental Quality--and the U.S. Department of Energy through the Land Reclamation Program at Argonne National Laboratory. Current investigations are monitoring groundwater, surface water quality, aquatic ecosystems, revegetation,more » soil characteristics, erosion and runoff, soil microbial and soil fauna populations, wildlife, and economic effects of the reclamation effort. The research is a multidisciplinary approach to the concept of ecosystem response to reclamation.« less

Production of liquid fuels out of plant biomass and refuse: Methods, cost, potential (in MIXED)

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

Woick, B.; Friedrich, R.

1981-09-01

Different ways of producing biomass and its conversion into high grade fuel for vehicles are reviewed with particular reference to physical and geographical factors, pertaining in the Federal Republic of Germany (FRG). Even with the potentially small amount of biomass in the FRG, the fueling of diesel engines with rape oil or modified ethanol, which can be obtained from any cellulosic feedstock, seems to pose the fewest difficulties and promises greatest efficiency. However, the amount of fuel produced from biomass can probably only meet a very small percentage of the total amount required.

Childhood vaccine refusal and hesitancy intentions in Croatia: insights from a population-based study.

PubMed

Repalust, Anja; Šević, Sandra; Rihtar, Stanko; Štulhofer, Aleksandar

2017-10-01

Considering that programmatic data suggest a recent rise in vaccine refusal in Croatia, this study, first of its kind in Southeast Europe, aimed to estimate the prevalence, and sociodemographic, and sociocultural determinants of childhood vaccine refusal and hesitancy (CVRH) intentions among Croatian adults. Multi-stage stratified population-based survey included 1000 individuals aged 18-88 years (M age  = 47.7, SD = 17.8), of whom 51.7% were women. The outcome, a categorical indicator, distinguished among individuals who would approve vaccinating their children (vaccine accepting), those who would approve some but not all vaccines (vaccine hesitant), and those who would refuse vaccination (vaccine refusing). A sizeable minority of participants was characterized by childhood vaccine refusal (10.6%) and hesitancy intentions (19.5%). In a multivariate assessment controlling for parenthood, the odds of vaccine hesitancy were significantly increased by a younger age (AOR = 1.96-3.03, p < .01). Religiosity (AOR = 1.12, p < .05) and the use of alternative medicine (AOR = 2.85, p < .001) increased the odds of vaccine refusal. However, individual characteristics seem to be relatively poor predictors of CVRH intentions in Croatia. Following the social contagion model, future research should move beyond individual-level approach and take into account social interaction and social network effects.

Geophysical investigations of near-surface materials and groundwater quality at abandoned mine land site No. 1087, Pike County, Indiana

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

Spindler, K.M.; Olyphant, G.A.; Harper, D.

Reclamation of Abandoned Mine Land (AML) Site No. 1087 (Midwestern) includes extensive use of coal-combustion byproducts such as fly ash and fixated scrubber sludge (FSS) as fill and cover materials. Prior to reclamation, a deposit of coarse-grained pyritic refuse in the central part of the site was the primary source for acidic mine drainage. The FSS tends to have a low permeability, so it was applied over the refuse to serve as a barrier to vertical recharge and thereby inhibit generation and mobilization of additional acidity. Repeated post-reclamation measurements of soil-water content using a neutron moisture gauge provide evidence thatmore » vertical recharge is, in fact, not occurring through the FSS. However, a previously existing plume of acidic water extends beyond the area of the refuse into adjacent areas of disturbed overburden (spoil). Electrical resistivity profiles using the offset Wenner method were used to delineate the horizontal extent of the refuse and to quantify spatial variability of groundwater chemistry within the refuse and adjacent spoil. Ground penetrating radar (GPR) was used to precisely determine the thickness and extent of the FSS layer and its relation to the refuse and to the surrounding plume of acidic water. Together, these techniques provide a complete three-dimensional representation of the FSS, refuse, spoil, and plume of acidic groundwater.« less

43 CFR 15.4 - Refuse and polluting substances.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Refuse and polluting substances. 15.4 Section 15.4 Public Lands: Interior Office of the Secretary of the Interior KEY LARGO CORAL REEF PRESERVE § 15.4 Refuse and polluting substances. No person shall dump or deposit in or on the waters of this...

43 CFR 15.4 - Refuse and polluting substances.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Refuse and polluting substances. 15.4 Section 15.4 Public Lands: Interior Office of the Secretary of the Interior KEY LARGO CORAL REEF PRESERVE § 15.4 Refuse and polluting substances. No person shall dump or deposit in or on the waters of this...

43 CFR 15.4 - Refuse and polluting substances.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Refuse and polluting substances. 15.4 Section 15.4 Public Lands: Interior Office of the Secretary of the Interior KEY LARGO CORAL REEF PRESERVE § 15.4 Refuse and polluting substances. No person shall dump or deposit in or on the waters of this...

43 CFR 15.4 - Refuse and polluting substances.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Refuse and polluting substances. 15.4 Section 15.4 Public Lands: Interior Office of the Secretary of the Interior KEY LARGO CORAL REEF PRESERVE § 15.4 Refuse and polluting substances. No person shall dump or deposit in or on the waters of this...

43 CFR 15.4 - Refuse and polluting substances.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Refuse and polluting substances. 15.4 Section 15.4 Public Lands: Interior Office of the Secretary of the Interior KEY LARGO CORAL REEF PRESERVE § 15.4 Refuse and polluting substances. No person shall dump or deposit in or on the waters of this...

New Report Compares Performance of Compressed Natural Gas Refuse Haulers to

Science.gov Websites

Diesel-Powered Trucks Report Compares Performance of Compressed Natural Gas Refuse Haulers to Diesel-Powered Trucks For more information contact: e:mail: Public Affairs A new report that compares the performance of compressed natural gas (CNG) refuse haulers in New York City to similar diesel-powered trucks

Using a Preventive Social Work Program for Reducing School Refusal

ERIC Educational Resources Information Center

Elsherbiny, Mohamed Mohamed

2017-01-01

This article describes a study aimed at solving the problem of school refusal by implementing a preventive program and raising the awareness of parents, social workers, and school personnel. The school children involved in this study were reported by their parents and school social workers to refuse to go to school, and according to the children's…

Alternative Fuels Data Center: Fleet Application for Refuse Collection

Science.gov Websites

CNG - Compressed Natural Gas 1 Electric 1 Hybrid - CNG 1 Hybrid - LNG 1 Hydraulic hybrid 9 LNG - Liquified Natural Gas icon for refuse collection vehicle application Autocar ACMD-Xpert Hybrid - CNG Hybrid - Compressed Natural Gas LNG - Liquified Natural Gas icon for refuse collection vehicle application BYD All

21 CFR 514.110 - Reasons for refusing to file applications.

Code of Federal Regulations, 2010 CFR

2010-04-01

... of the applicant and to receive communications on all matters pertaining to the application. (7) The... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Reasons for refusing to file applications. 514.110... Applications § 514.110 Reasons for refusing to file applications. (a) The date of receipt of an application for...

Thinking through Moments of Sexual Refusal in "Looking for Alibrandi" and "The Rage in Placid Lake"

ERIC Educational Resources Information Center

Clarke, Kyra

2016-01-01

This paper explores two scenarios in which young women refuse the sexual advances of young men in the films "Looking for Alibrandi" and "The Rage in Placid Lake." The paper highlights the heteronormative nature of education around refusing sex, which reinstates gendered stereotypes of masculine as active and feminine as…

The case of Ms B: suicide's slippery slope?

PubMed

Keown, J

2002-08-01

In the case of Ms B, the High Court ruled that as Ms B was a competent adult patient, her doctors acted unlawfully in overriding her refusal of life-preserving ventilation. This commentary considers whether this case supports the proposition that in English law the right to refuse treatment extends even to refusals which are clearly suicidal.

7 CFR 91.34 - When an appeal of a laboratory service may be refused.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Appeal of Laboratory Services § 91.34 When an appeal of a laboratory service may be refused. An application for an appeal of a laboratory... 7 Agriculture 3 2010-01-01 2010-01-01 false When an appeal of a laboratory service may be refused...

28 CFR 100.16 - Cost estimate submission.

Code of Federal Regulations, 2013 CFR

2013-07-01

... evaluation of the estimated costs. The FBI reserves the right to request additional cost data from carriers... if, as determined by the FBI, all cost data reasonably available to the carrier are either submitted... explain the estimating process are required by the FBI and the carrier refuses to provide necessary data...

28 CFR 100.16 - Cost estimate submission.

Code of Federal Regulations, 2011 CFR

2011-07-01

... evaluation of the estimated costs. The FBI reserves the right to request additional cost data from carriers... if, as determined by the FBI, all cost data reasonably available to the carrier are either submitted... explain the estimating process are required by the FBI and the carrier refuses to provide necessary data...

28 CFR 100.16 - Cost estimate submission.

Code of Federal Regulations, 2012 CFR

2012-07-01

... evaluation of the estimated costs. The FBI reserves the right to request additional cost data from carriers... if, as determined by the FBI, all cost data reasonably available to the carrier are either submitted... explain the estimating process are required by the FBI and the carrier refuses to provide necessary data...

28 CFR 100.16 - Cost estimate submission.

Code of Federal Regulations, 2014 CFR

2014-07-01

... evaluation of the estimated costs. The FBI reserves the right to request additional cost data from carriers... if, as determined by the FBI, all cost data reasonably available to the carrier are either submitted... explain the estimating process are required by the FBI and the carrier refuses to provide necessary data...

75 FR 9599 - Notice of Public Information Collection Being Reviewed by the Federal Communications Commission...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-03

..., Franchise Application Process. Type of Review: Extension of a currently approved collection. Form Number: N... franchising authorities from unreasonably refusing to award competitive franchises for the provision of cable... 76.41(b) requires a competitive franchise applicant to include the following information in writing...

Is There an Honorary Doctor in the House?

ERIC Educational Resources Information Center

Freiherr, Gregory T.

1979-01-01

The practice of awarding honorary degrees by American colleges and universities is examined. Topics include the background of the practice, schools that refuse to participate, the selection process used by some institutions, possible financial and other reasons for granting honorary degrees, and benefits gained by those honored. (JMD)

Cost/Benefits of Solid Waste Reuse

ERIC Educational Resources Information Center

Schulz, Helmut W.

1975-01-01

Municipalities and industry are being forced to seek alternatives to sanitary landfills and incineration as means of eliminating solid wastes. Based on the Columbia study, the two most cost-effective, environmentally acceptable alternatives are the high temperature, oxygen-fed pyrolysis process and the co-combustion of refuse-derived fuel in…

32 CFR 155.6 - Procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... process may prevent the DOHA from making a clearance decision. If an applicant fails or refuses to: (1... decision and to otherwise comply with the procedures authorized by this part. The applicant may elect on.... If the request is denied, in whole or in part, the decision is final and bars reapplication for a...

Self-reporting and measurement of body mass index in adolescents: refusals and validity, and the possible role of socioeconomic and health-related factors.

PubMed

Chau, Nearkasen; Chau, Kénora; Mayet, Aurélie; Baumann, Michèle; Legleye, Stéphane; Falissard, Bruno

2013-09-08

Body mass index assessment using self-reported height and weight (BMIsr) can encounter refusals and under/over-reporting while for assessment with measured data (BMIm) refusals can be more frequent. This could relate to socioeconomic and health-related factors. We explored these issues by investigating numerous potential factors: gender, age, family structure, father's occupation, income, physical/sports activity, subjective weight perception, school performance, unhealthy behaviours, physical/psychological health, social relationships, living environment, having sustained violence, sexual abuse, and involvement in violence. The sample included 1559 adolescents from middle schools in north-eastern France. They completed a questionnaire including socioeconomic and health-related data, self-reported height/weight, measured height/weight, and weight perception (participation rate 94%). Data were analysed using logistic regression models. BMIsr encountered under-reporting (with change in BMI category, 11.8%), over-reporting (6.0%), and reporting refusals (3.6%). BMIm encountered more numerous refusals (7.9%). Reporting refusal was related to living with a single parent, low school performance, lack of physical/sports activity, sustained violence, poor psychological health, and poor social relationships (gender/age-adjusted odds ratios 1.95 to 2.91). Further to these factors, measurement refusal was related to older age, having divorced/separated parents, a father being a manual worker/inactive, insufficient family income, tobacco/cannabis use, involvement in violence, poor physical health, and poor living environment (1.30 to 3.68). Under-reporting was related to male gender, involvement in violence, poor psychological health, and overweight/obesity (as assessed with BMIm) (1.52 to 11). Over-reporting was related to male gender, younger age, alcohol consumption, and underweight (1.30 to 5.35). Weight perception was linked to reporting refusals and under/over-reporting, but slightly linked to measurement refusal. The contributions of socioeconomic and health-related factors to the associations of weight perception with reporting refusal and under/over-reporting ranged from -82% to 44%. There were substantial discrepancies in the associations between socioeconomic/health-related factors and overweight/obesity assessed with BMIsr and BMIm. BMIsr and BMIm were affected by numerous biases related to vulnerability which were also obesity risk factors. BMIsr encountered under/over-reporting which were related to some socioeconomic and health-related factors, weight perception, and BMIm. BMIm was more affected by refusals than BMIsr due to socioeconomic and health-related factors. Further research is needed.

Refusal of hemodialysis by hospitalized chronic kidney disease patients in Pakistan.

PubMed

Shafi, Salman Tahir; Saleem, Mohammad; Anjum, Roshina; Abdullah, Wajid; Shafi, Tahir

2018-01-01

In Pakistan, patients with chronic kidney disease (CKD) are commonly diagnosed at a late stage. There is little information about the refusal of hemodialysis by hospitalized CKD patients who need hemodialysis (HD) and reasons for acceptance and refusal among these patients. All patients with Stage V CKD who had medical indications to undergo HD and were hospitalized at a tertiary care facility over a six-month period were invited to participate in this study. Patients were surveyed regarding acceptance or refusing of HD and reasons for their decisions. Demographic, socioeconomic, and clinical characteristics of patients were compared between patients who accepted or refused HD. A total of 125 patients were included in the study. The mean age of the patients was 47.9 ±12.1 years. The mean duration of diagnosis of CKD was 2.5 ± 0.6 months. Of all patients, 72 (57.6%) agreed to do HD and 53 (42.4%) refused HD. Patients with arteriovenous fistula in place (27.1 vs. 9.1%, P 0.02) and those in the middle- or higher-income group (64.4% vs. 38.6%, p = 0.03) were more willing to undergo HD. Trust in doctor's advice (86.1%) was the most common reason for acceptance of HD. Frequency of HD per week (52.8%), lifelong and permanent nature of HD (50.9%), advice by family members or friends (37.7%), perception of poor quality of life on HD (35.8%), and fear of HD needles and complications during HD (33.9%) were the most common reasons for refusal. Refusal of HD is common among hospitalized CKD patients with medical indications to undergo HD, especially in lower income group.

[Treatment Refusal in Pediatric Oncology].

PubMed

Špótová, A; Husáková, K; Hrašková, A; Mikesková, M; Puškáčová, J; Hederová, S; Jamárik, M; Rabenseifertová, E; Jalovecká, Z; Kolenová, A; Šubová, Z

2017-01-01

Pediatric oncologists are often faced with situations in which parents or guardians refuse recommended treatment for curable childhood cancer. Deciding how to proceed in such situations is an ethical dilemma. The aim of this article is to consider optimal approaches when parents are strongly against oncological treatment, potentially compromising their childrens rights for health care and to the chance for cure. In this paper, we report two cases of treatment refusal from our department and the impact of such decisions on the children themselves. Case no. 1 describes a child with retinoblastoma whose parents refused standard treatment in order to seek alternative treatment abroad. Case no. 2 describes a patient with a primary lymphoma of bone who received treatment by a court order after parental refusal. When parents refuse a treatment for potentially curable cancer, the medical team often focuses on the certainty of death without treatment. In the background, there is a smaller but still significant risk that - even if the treatment is eventually accepted or compelled - the child will still die from treatment-related complications or refractory disease, possibly with considerable suffering. The reasons for refusing a treatment vary. The entire medical team is tasked with trying to respectfully understand the reasoning behind the parents unwillingness to accept the treatment, in order to address all possible misunderstandings and to propose solutions that could be acceptable for the parents. In some situations however, it is necessary to resolve the dilemma by legal means in order to protect the life of the child.Key words: oncology - ethics - decision making - treatment refusal - legal guardians The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 7. 8. 2017Accepted: 7. 9. 2017.

[Refusal of initiation of dialysis by elderly patients with chronic renal failure].

PubMed

Fujimaki, Hiroshi; Kasuya, Yutaka; Kawaguchi, Sachiko; Hara, Shino; Koga, Shiro; Takahashi, Tadao; Mizuno, Shoichi

2005-07-01

Refusal of dialysis is not uncommon in elderly patients with chronic renal failure. In this study, we retrospectively inspected our dealings with patients who refused our offer to initiate dialysis. In addition, we discussed how to grasp the meaning of this phenomenon. We treated 152 patients with advanced chronic renal failure aged 60 years and over at Tokyo Metropolitan Geriatric Hospital. The patients fulfilling the following two criteria were considered to be refusal cases. The first criterion was that an acceptance of the initiation of dialysis could not be obtained in spite of repeated counseling. The second criterion was that a definite outcome was precipitated by the development of severe uremic symptoms. In every refusal case, clinical characteristics and household members were surveyed. Verbal expressions of the reasons for refusal were retrieved from medical charts. The outcome was also studied. The two criteria were fulfilled in 7 cases. The male/female ratio was 5:2. The age was 78 +/- 7 years (mean +/- standard deviation). All but one cases were ambulatory, and all cases had normal cognitive function. Four cases were married, and the other cases had lost their partners. The number of household members was 3.9 +/- 1.8. We speculated that every case could maintain a good quality of life even after the initiation of dialysis. Representative expressions of the reasons for refusal were "I have already lived fully" and "I would prefer to accept death rather than dialysis". The outcome was urgent initiation of dialysis (five cases) and death (two cases). The time between initial counseling and the outcome was 115 +/- 37 days. Accepting or refusing dialysis therapy is a selection related to life or death. We must make an effort to obtain consent to initiating dialysis if patients are assessed as suitable for dialysis.

Validation of the Vaccination Confidence Scale: A brief measure to identify parents at risk for refusing adolescent vaccines

PubMed Central

Reiter, Paul L.; Magnus, Brooke E.; McRee, Annie-Laurie; Dempsey, Amanda F.; Brewer, Noel T.

2015-01-01

Objective To support efforts to address vaccine hesitancy, we sought to validate a brief measure of vaccination confidence using a large, nationally representative sample of parents. Methods We analyzed weighted data from 9,018 parents who completed the 2010 National Immunization Survey-Teen, an annual, population-based telephone survey. Parents reported on the immunization history of a 13- to 17-year-old child in their households for vaccines including tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal, and human papillomavirus (HPV) vaccines. For each vaccine, separate logistic regression models assessed associations between parents’ mean scores on the 8-item Vaccination Confidence Scale and vaccine refusal, vaccine delay, and vaccination status. We repeated analyses for the scale’s 4-item short form. Results One quarter of parents (24%) reported refusal of any vaccine, with refusal of specific vaccines ranging from 21% for HPV to 2% for Tdap. Using the full 8-item scale, vaccination confidence was negatively associated with measures of vaccine refusal and positively associated with measures of vaccination status. For example, refusal of any vaccine was more common among parents whose scale scores were medium (odds ratio [OR] = 2.08, 95% confidence interval [CI], 1.75–2.47) or low (OR = 4.61, 95% CI, 3.51–6.05) versus high. For the 4-item short form, scores were also consistently associated with vaccine refusal and vaccination status. Vaccination confidence was inconsistently associated with vaccine delay. Conclusions The Vaccination Confidence Scale shows promise as a tool for identifying parents at risk for refusing adolescent vaccines. The scale’s short form appears to offer comparable performance. PMID:26300368

Dialysis patients refusing kidney transplantation: data from the Slovenian Renal Replacement Therapy Registry.

PubMed

Buturović-Ponikvar, Jadranka; Gubenšek, Jakob; Arnol, Miha; Bren, Andrej; Kandus, Aljoša; Ponikvar, Rafael

2011-06-01

Kidney transplantation is considered the best renal replacement therapy (RRT) for patients with end-stage renal disease; nevertheless, some dialysis patients refuse to be transplanted. The aim of our registry-based, cross-sectional study was to compare kidney transplant candidates to dialysis patients refusing transplantation. Data were collected from the Slovenian Renal Replacement Therapy Registry database, as of 31 December 2008. Demographic and some RRT data were compared between the groups. There were 1448 dialysis patients, of whom 1343 were treated by hemodialysis and 105 by peritoneal dialysis (PD); 132 (9%) were on the waiting list for transplantation, 208 (14%) were preparing for enrollment (altogether 340 [23%] dialysis patients were kidney transplant candidates); 200 (13.7%) patients were reported to refuse transplantation, all ≤ 65 years of age; 345 (24%) were not enrolled due to medical contraindications, 482 (33%) due to age, and 82 (6%) due to other or unknown reasons. No significant difference was found in age, gender, or presence of diabetes between kidney transplant candidates vs. patients refusing transplantation (mean age 50.5 ± 13.9 vs. 51.3 ± 9.6 years, males 61% vs. 63%, diabetics 18% vs. 17%). The proportion of patients ≤ 65 years old who were refusing transplantation was 28% (187/661) for hemodialysis and 17% (13/79) for PD patients (P = 0.03). There is a considerable group of dialysis patients in Slovenia refusing kidney transplantation. Compared to the kidney transplant candidates, they are similar in age, gender and prevalence of diabetes. Patients treated by peritoneal dialysis refuse kidney transplantation less often than hemodialysis patients. © 2011 The Authors. Therapeutic Apheresis and Dialysis © 2011 International Society for Apheresis.

How to justify enforcing a Ulysses contract when Ulysses is competent to refuse.

PubMed

Davis, John K

2008-03-01

Sometimes the mentally ill have sufficient mental capacity to refuse treatment competently, and others have a moral duty to respect their refusal. However, those with episodic mental disorders may wish to precommit themselves to treatment, using Ulysses contracts known as "mental health advance directives." How can health care providers justify enforcing such contracts over an agent's current, competent refusal? I argue that providers respect an agent's autonomy not retrospectively--by reference to his or her past wishes-and not merely synchronically--so that the agent gets what he or she wants right now-but diachronically and prospectively, acting so that the agent can shape his or her circumstances as the agent wishes over time, for the agent will experience the consequences of providers' actions over time. Mental health directives accomplish this, so they are a way of respecting the agent's autonomy even when providers override the agent's current competent refusal.

Examining the ethico-legal aspects of the right to refuse treatment in Turkey.

PubMed

Sert, Gurkan; Guven, Tolga

2013-10-01

This paper examines the ethico-legal problems regarding the right to refuse treatment in Turkey's healthcare system. We discuss these problems in the light of a recent case that was directly reported to us. We first summarise the experience of a chronically dependent patient (as recounted by her daughter) and her family during their efforts to refuse treatment and receive palliative care only. This is followed by a summary of the legal framework governing the limits of the right to refuse treatment in Turkey. With the help of this background information on the legal framework, we re-examine the ethico-legal aspects of the case and explain the underlying reasons for the problems the family and the patient experienced. Finally, we conclude that Turkey's legal framework relating to the right to refuse treatment needs to be clarified and amended in accordance with international conventions and fundamental human rights.

Mediators of sexual revictimization risk in adult sexual assault victims.

PubMed

Ullman, Sarah E; Vasquez, Amanda L

2015-01-01

This study examined sexual risk behaviors and sexual refusal assertiveness in relationship to child sexual abuse, emotion dysregulation, and adult sexual revictimization. Path analyses of 1,094 survivors who had sex in the past year were done to examine sexual risk behavior and sexual refusal assertiveness mediational pathways by which child sexual abuse severity and emotion dysregulation may affect revictimization over one year in adult female sexual assault survivors. Exchanging sex for money and sexual refusal assertiveness were significantly associated with emotion dysregulation, whereas exchanging sex for money, and not sexual refusal assertiveness, was only significantly related to child sexual abuse severity. Both exchanging sex for money and sex refusal assertiveness mediated the relationship between emotion dysregulation and adult sexual revictimization. Exchanging sex for money mediated the child sexual abuse severity-revictimization relationship. These findings demonstrate the importance of considering both risky and protective sexual behaviors in research and prevention programming that address sexual revictimization in women.

Mediators of Sexual Revictimization Risk in Adult Sexual Assault Victims

PubMed Central

Ullman, Sarah E.; Vasquez, Amanda L.

2015-01-01

This study examined sexual risk behaviors and sexual refusal assertiveness in relationship to child sexual abuse (CSA), emotion dysregulation, and adult sexual revictimization. Path analyses of 1,094 survivors who had sex in the past year were done to examine sexual risk behavior, and sexual refusal assertiveness mediational pathways by which CSA severity and emotion dysregulation may affect revictimization over one year in adult female sexual assault survivors. Exchanging sex for money and sexual refusal assertiveness were significantly associated with emotion dysregulation, whereas exchanging sex for money, and not sexual refusal assertiveness, was only significantly related to CSA severity. Both exchanging sex for money and sex refusal assertiveness mediated the relationship between emotion dysregulation and adult sexual revictimization. Exchanging sex for money mediated the CSA severity-revictimization relationship. These findings demonstrate the importance of considering both risky and protective sexual behaviors in research and prevention programming that address sexual revictimization in women. PMID:25942287

Refusal skill ability: an examination of adolescent perceptions of effectiveness.

PubMed

Nichols, Tracy R; Birnel, Sara; Graber, Julia A; Brooks-Gunn, Jeanne; Botvin, Gilbert J

2010-06-01

This pilot study examined whether refusal assertion as defined by a proven drug prevention program was associated with adolescent perceptions of effectiveness by comparing two sets of coded responses to adolescent videotaped refusal role-plays (N = 63). The original set of codes was defined by programmatic standards of refusal assertion and the second by a group of high school interns. Consistency with programming criteria was found for interns' ratings of several indicators of verbal and non-verbal assertiveness. However, a strategy previously defined by the program as effective was perceived as ineffective by adolescents while another deemed ineffective and problematic by intervention developers was viewed as effective. Interns endorsed presenting detailed and reasonable arguments as an effective refusal strategy while short, simple statements were deemed ineffective. This study suggests the importance of including adolescent perspectives in the design, delivery, and evaluation of drug prevention strategies.

[Voluntary Refusal of Food and Fluid in palliative care: a mapping literature review].

PubMed

Klein Remane, Ursula; Fringer, André

2013-12-01

Voluntary Refusal of Food and Fluid (VRFF) is one possibility for patients in palliative situations to hasten death and avoid further suffering. By means of a mapping literature review this article describes the medical, nursing, ethical and legal perspective of care for people who wish to hasten death using VRFF. The results show that the wish to die is affected by psychological, social, spiritual and physical factors. VRFF is a little-known, legal and independently viable method to hasten death. Reducing fluid intake to 40 ml daily, the dying process takes one to three weeks. VRFF can be regarded as a natural death, foregoing treatment or as suicide. In contrast to physician assisted suicide or euthanasia, patients dying by VRFF experience a "natural" dying process and the decision is reversible in the first few days. As authority to act lies with the person wishing to die professionals and family caring for the dying are practicing palliative care, as opposed to assisted suicide or euthanasia. Professionals and family involved in the decision-making process are confronted with various ethical problems. Further research concerning VRFF and its implications for practice is necessary.

Parental Grief Following the Brain Death of a Child: Does Consent or Refusal to Organ Donation Affect Their Grief?

ERIC Educational Resources Information Center

Bellali, Thalia; Papadatou, Danai

2006-01-01

The purpose of this study was to investigate the grieving process of parents who were faced with the dilemma of donating organs and tissues of their underage brain dead child, and to explore the impact of their decision on their grief process. A grounded theory methodology was adopted and a semi-structured interview was conducted with 11 bereaved…

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

Kara, Mustafa, E-mail: mustafa.kara@mam.gov.t; Guenay, Esin; Tabak, Yasemin

Municipal solid waste (MSW) is one of the most important environmental problems arising from rapid urbanization and industrialization. The use of alternative fuels in rotary kilns of cement plants is very important for reducing cost, saving fossil fuels and also eliminating waste materials, accumulated during production or after using these materials. Cement industries has an important potential for supplying preferable solutions to the waste management. Energy recovery from waste is also important for the reduction of CO{sub 2} emissions. This paper presents an investigation of the development of refuse derived fuel (RDF) materials from non-recycling wastes and the determination ofmore » its potential use as an alternative fuel in cement production in Istanbul, Turkey. RDF produced from MSW was analyzed and its effects on cement production process were examined. For this purpose, the produced RDF was mixed with the main fuel (LPG) in ratios of 0%, 5%, 10%, 15% and 20%. Then chemical and mineralogical analyses of the produced clinker were carried out. It is believed that successful results of this study will be a good example for municipalities and cement industries in order to achieve both economic and environmental benefits.« less

49 CFR 655.49 - Refusal to submit to a drug or alcohol test.

Code of Federal Regulations, 2013 CFR

2013-10-01

... IN TRANSIT OPERATIONS Types of Testing § 655.49 Refusal to submit to a drug or alcohol test. (a) Each employer shall require a covered employee to submit to a post-accident drug and alcohol test required under... 49 Transportation 7 2013-10-01 2013-10-01 false Refusal to submit to a drug or alcohol test. 655...

49 CFR 655.49 - Refusal to submit to a drug or alcohol test.

Code of Federal Regulations, 2011 CFR

2011-10-01

... IN TRANSIT OPERATIONS Types of Testing § 655.49 Refusal to submit to a drug or alcohol test. (a) Each employer shall require a covered employee to submit to a post-accident drug and alcohol test required under... 49 Transportation 7 2011-10-01 2011-10-01 false Refusal to submit to a drug or alcohol test. 655...

49 CFR 655.49 - Refusal to submit to a drug or alcohol test.

Code of Federal Regulations, 2014 CFR

2014-10-01

... IN TRANSIT OPERATIONS Types of Testing § 655.49 Refusal to submit to a drug or alcohol test. (a) Each employer shall require a covered employee to submit to a post-accident drug and alcohol test required under... 49 Transportation 7 2014-10-01 2014-10-01 false Refusal to submit to a drug or alcohol test. 655...

49 CFR 655.49 - Refusal to submit to a drug or alcohol test.

Code of Federal Regulations, 2012 CFR

2012-10-01

... IN TRANSIT OPERATIONS Types of Testing § 655.49 Refusal to submit to a drug or alcohol test. (a) Each employer shall require a covered employee to submit to a post-accident drug and alcohol test required under... 49 Transportation 7 2012-10-01 2012-10-01 false Refusal to submit to a drug or alcohol test. 655...

49 CFR 655.49 - Refusal to submit to a drug or alcohol test.

Code of Federal Regulations, 2010 CFR

2010-10-01

... IN TRANSIT OPERATIONS Types of Testing § 655.49 Refusal to submit to a drug or alcohol test. (a) Each employer shall require a covered employee to submit to a post-accident drug and alcohol test required under... 49 Transportation 7 2010-10-01 2010-10-01 false Refusal to submit to a drug or alcohol test. 655...

[Refusal of nursing care, the legal perspective].

PubMed

Fisman, Jérôme

2016-10-01

The refusal of nursing care forms part of the freedom offered to anyone wanting to refuse, consciously and knowingly, any form of nursing care such as washing, the taking of medication or hospitalisation. However, limits are fixed by law as well as by case law. Are we totally free in the expression of our will? Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Frequency and predictors of seasonal influenza vaccination and reasons for refusal among patients at a large tertiary referral hospital.

PubMed

Masnick, Max; Leekha, Surbhi

2015-07-01

We assessed frequency and predictors of seasonal influenza vaccination acceptance among inpatients at a large tertiary referral hospital, as well as reasons for vaccination refusal. Over 5 seasons, >60% of patients unvaccinated on admission refused influenza vaccination while hospitalized; "believes not at risk" was the reason most commonly given.

Graduated Exposure and Compliance Training Intervention for Blood Draw Avoidance and Refusal in a Woman with Intellectual Disability and Schizoaffective Disorder

ERIC Educational Resources Information Center

Cromartie, R. Samuel; Flood, William A.; Luiselli, James K.

2014-01-01

This case report concerns a woman with intellectual disability, schizoaffective disorder, and avoidance and refusal of having her blood drawn. She required but refused blood draws to properly monitor the therapeutic dose of a necessary psychotropic medication. During intervention at a community-based habilitation setting and under simulated…

45 CFR 400.77 - Effect of quitting employment or failing or refusing to participate in required services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 2 2011-10-01 2011-10-01 false Effect of quitting employment or failing or... Employment General Requirements § 400.77 Effect of quitting employment or failing or refusing to participate... quit employment or have refused to accept an offer of employment determined to be appropriate by the...

Making Sense of Iconic Symbols: A Study of Preschool Children Conducting a Refuse-Sorting Task

ERIC Educational Resources Information Center

Ljung-Djärf, Agneta; Åberg-Bengtsson, Lisbeth; Ottosson, Torgny; Beach, Dennis

2015-01-01

This article is part of a larger project focusing upon explanatory illustrations that children encounter in pre- and primary school education. The research questions concerned (a) how preschool children make sense of iconic symbols when placing items of refuse on illustrations of refuse bins in a sorting task and (b) what stumbling blocks they…

Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations.

PubMed

Marco, Catherine A; Brenner, Jay M; Kraus, Chadd K; McGrath, Norine A; Derse, Arthur R

2017-11-01

Informed consent is an important component of emergency medical treatment. Most emergency department patients can provide informed consent for treatment upon arrival. Informed consent should also be obtained for emergency medical interventions that may entail significant risk. A related concept to informed consent is informed refusal of treatment. Patients may refuse emergency medical treatment during their evaluation and treatment. This article addresses important considerations for patients who refuse treatment, including case studies and discussion of definitions, epidemiology, assessment of decisional capacity, information delivery, medicolegal considerations, and alternative care plans. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

[Refusal of care by a HIV-positive adolescent: role of the cross-cultural approach].

PubMed

Bouaziz, Nora; Titia Rizzi, Alice

The refusal of treatment is frequent in human immunodeficiency virus-positive adolescents. The clinical history of a teenage girl presenting severe immunodepression secondary to the virus, a depressive disorder and a refusal of treatment, illustrates the benefit of combined paediatric, child psychiatric and cross-cultural care as proposed by the Cochin-Paris Adolescent Centre. Working on the meaning of the refusal was a prerequisite for the construction of a care project forming part of a life project, as the psychopathological work could only begin once somatic care ensuring the patient's protection was in place. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Ground-Water Quality in the Vicinity of Coal-Refuse Areas Reclaimed with Biosolids in Fulton County, Illinois

USGS Publications Warehouse

Morrow, William S.

2007-01-01

The Metropolitan Water Reclamation District of Greater Chicago has applied biosolids, followed by revegetation, to reclaim three coal-refuse areas. Most of the reclamation at the three sites was done from 1989 through 1992, and included the application of lime, clay, and various loads of biosolids up to 1,000 dry tons per acre. Water samples collected from 12 monitoring wells installed in the vicinity of the three reclaimed coal-refuse areas were analyzed to better understand the hydrogeology and water-quality effects. Ground water probably flows along preferential paths in the disturbed coal-refuse areas, and is impeded by undisturbed glacial till. Most of the samples contained elevated concentrations of sulfate, iron, and manganese, constituents associated with ground water in coal-mined areas. Concentrations of aluminum, cadmium, nickel, or zinc were somewhat elevated in samples from four wells, and greatest in water samples with pH less than 5. The smaller nutrient concentrations indicate that the applied biosolids are not identifiably affecting nutrients or metal concentrations in shallow ground water near the refuse piles. The coal refuse likely is the primary influence on the chemical characterization of ground-water in the area.

Attitudes of prehospital emergency care professionals toward refusal of treatment: A regional survey in Turkey.

PubMed

Erbay, Hasan; Alan, Sultan; Kadioglu, Selim

2014-08-01

Prehospital emergency medicine is a specific field of emergency medicine. The basic approach of prehospital emergency medicine is to provide patients with medical intervention at the scene of the incident. This special environment causes health professionals to encounter various problems. One of the most important problems in this field is ethics, in particular questions involving refusal of treatment and the processes associated with it. The objective of this study is to identify emergency health professionals' views regarding refusal of treatment. This study was conducted with 356 health professionals who were on active duty in prehospital emergency health services. The data were collected through a form which included 10 statements. The participants were asked to indicate their level of agreement with the statements given by rating them between 0 and 10. Before conducting the research, permission was received from the local ethics committee. Participants were given written information about the purpose of the study. Participants were assured that their participation was voluntary. The healthcare professionals with fewer years of experience in the profession and female participants adopted an attitude of giving priority to providing care. Young participants, in general, respected patient autonomy. However, paradoxically, when it comes to emergency medical cases, they expressed an opinion closer to paternalism. This study has found that prehospital emergency health professionals generally respect the patient's right to refuse treatment; however, they do not prioritize this right when there is a life-threatening situation or when the person does not have decision-making capacity. In these cases, prehospital emergency health professionals tended to adopt a more paternalistic approach. © The Author(s) 2013.

Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons.

PubMed

Swift, Joshua K; Greenberg, Roger P; Tompkins, Kelley A; Parkin, Susannah R

2017-03-01

The purpose of this meta-analysis was to examine rates of treatment refusal and premature termination for pharmacotherapy alone, psychotherapy alone, pharmacotherapy plus psychotherapy, and psychotherapy plus pill placebo treatments. A systematic review of the literature resulted in 186 comparative trials that included a report of treatment refusal and/or premature termination for at least 2 of the 4 treatment conditions. The data from these studies were pooled using a random-effects analysis. Odds Ratio effect sizes were then calculated to compare the rates between treatment conditions, once across all studies and then again for specific client disorder categories. An average treatment refusal rate of 8.2% was found across studies. Clients who were assigned to pharmacotherapy were 1.76 times more likely to refuse treatment compared with clients who were assigned psychotherapy. Differences in refusal rates for pharmacotherapy and psychotherapy were particularly evident for depressive disorders, panic disorder, and social anxiety disorder. On average, 21.9% of clients prematurely terminated their treatment. Across studies, clients who were assigned to pharmacotherapy were 1.20 times more likely to drop out compared with clients who were assigned to psychotherapy. Pharmacotherapy clients with anorexia/bulimia and depressive disorders dropped out at higher rates compared with psychotherapy clients with these disorders. Treatment refusal and dropout are significant problems in both psychotherapy and pharmacotherapy and providers of these treatments should seek to employ strategies to reduce their occurrence. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Comparing the quality of life in insulin recipient and refusal patients with type 2 diabetes.

PubMed

Khalili, Mitra; Sabouhi, Fakhri; Abazari, Parvaneh; Aminorroaya, Ashraf

2016-01-01

Better control of blood sugar and reduction of diabetes complications through insulin therapy could convince people to choose this method. However, patients might refuse insulin therapy due to its painful injection, limitations in daily activities, and hypoglycemia. Thus, insulin therapy could have both positive and negative effects on patients' quality of life (QOL). Therefore, the aim of this study was to compare the QOL of insulin recipient and insulin refusal patients with type 2 diabetes. This study was a descriptive and comparative research conducted on 126 patients; 63 were insulin recipients and 63 had refused insulin therapy. Participants were under the care of the Endocrine and Metabolism Research Center of Isfahan, Iran. Data were gathered using the Diabetes Quality of Life (DQOL) questionnaire. In this tool, higher scores indicated lower QOL in patients. Data were analyzed using independent t-test, analysis of covariance, Mann-Whitney, Chi-square, and Pearson and Spearman's correlation. There was a significant difference (P < 0.001) between insulin recipient patients (mean = 2.02, SD = 0.31) and insulin refusal patients (mean = 1.74, SD = 0.41) in terms of mean QOL score. In addition, men and participants with higher educational levels reported a better QOL (P < 0.001). Results showed that insulin refusal patients had a better QOL. It seems that QOL is associated with the acceptance or refusal of insulin therapy. Therefore, enhancement of QOL could be related to all aspects of the disease, especially its treatment method and solving the therapeutic problems.

Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital.

PubMed

Salam, Asma Abdus; Afshan, Gauhar

2016-01-01

Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by elderly population. The objective of this study was to determine the frequency of various reasons for refusal of RA in elderly patients undergoing orthopedic surgeries. A prospective study conducted over a period of 1 year, had 549 patients with ages above 60 years who underwent different types of elective orthopedic procedures 182 patients who refused RA were interviewed according to a structured questionnaire designed to assess the reasons of refusal. Most common reason for the refusal of RA was surgeon's choice (38.5%), whereas 20.3% of the patients were unaware about the RA. There was a significant association between female gender and refusing RA due to backache (17.2%) and fear of being awake during the operation (24.1%) respectively. This survey showed that the main reasons among elderly female population were the fear of remaining awake and backache. However, overall it was the surgeon's choice which made patients refuse RA, and the anesthesiologists were the main source of information.

Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital

PubMed Central

Salam, Asma Abdus; Afshan, Gauhar

2016-01-01

Background and Aims: Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by elderly population. The objective of this study was to determine the frequency of various reasons for refusal of RA in elderly patients undergoing orthopedic surgeries. Material and Methods: A prospective study conducted over a period of 1 year, had 549 patients with ages above 60 years who underwent different types of elective orthopedic procedures 182 patients who refused RA were interviewed according to a structured questionnaire designed to assess the reasons of refusal. Results: Most common reason for the refusal of RA was surgeon's choice (38.5%), whereas 20.3% of the patients were unaware about the RA. There was a significant association between female gender and refusing RA due to backache (17.2%) and fear of being awake during the operation (24.1%) respectively. Conclusion: This survey showed that the main reasons among elderly female population were the fear of remaining awake and backache. However, overall it was the surgeon's choice which made patients refuse RA, and the anesthesiologists were the main source of information. PMID:27006550

Clinical ethics protocols in the clinical ethics committees of Madrid.

PubMed

Herreros, Benjamin; Ramnath, Venktesh R; Bishop, Laura; Pintor, Emilio; Martín, María Dolores; Sánchez-González, Miguel A

2014-03-01

Currently, The nature and scope of Clinical Ethics Protocols (CEPs) in Madrid (Spain) are not well understood. The main objective is to describe the features of 'guideline/recommendation' type CEPs that have been or are being developed by existing Clinical Ethics Committees (CECs) in Madrid. Secondary objectives include characterisation of those CECs that have been the most prolific in reference to CEP creation and implementation and identification of any trends in future CEP development. We collected CEPs produced and in process by CECs accredited in the public hospitals in Madrid, Spain, from 1996 to 2008. CECs developed 30 CEPs, with 10 more in process. The most common topic is refusal of treatment (seven CEPs developed; two in process). If CEPs addressing terminal illness, Do-Not-Resuscitate orders and advance directives are placed into a separate 'ethical problems at the end of life' category, this CEP subject emerges as the most common (eight developed; four in process). There is a relationship between the age of the CEC and the development of CEPs (the oldest CECs have developed more CEPs). CECs now seem to be more likely to engage in CEP development. The CECs in Madrid, Spain, have developed a significant number of CEPs (30 in total and 10 in process) and there is a trend towards continued development. The most frequent topics are ethical problems at the end of life and refusal of treatment by the patient.

[Ethical and legal duty of anesthesiologists regarding Jehovah's Witness patient: care protocol].

PubMed

Takaschima, Augusto Key Karazawa; Sakae, Thiago Mamôru; Takaschima, Alexandre Karazawa; Takaschima, Renata Dos Santos Teodoro; de Lima, Breno José Santiago Bezerra; Benedetti, Roberto Henrique

Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist. The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine (FCM), opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested. The FCM resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Ethical and legal duty of anesthesiologists regarding Jehovah's Witness patient: care protocol.

PubMed

Takaschima, Augusto Key Karazawa; Sakae, Thiago Mamôru; Takaschima, Alexandre Karazawa; Takaschima, Renata Dos Santos Teodoro; Lima, Breno José Santiago Bezerra de; Benedetti, Roberto Henrique

Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist. The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine, opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested. The Federal Council of Medicine resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Self-concept and adolescents' refusal of unprotected sex: a test of mediating mechanisms among African American girls.

PubMed

Salazar, Laura F; DiClemente, Ralph J; Wingood, Gina M; Crosby, Richard A; Harrington, Kathy; Davies, Susan; Hook, Edward W; Oh, M Kim

2004-09-01

During adolescence, girls form self-concepts that facilitate the transition to adulthood. This process may entail engaging in risky sexual behaviors resulting in STD infection and pregnancy. This study assessed the relation between self-concept and unwanted, unprotected sex refusal among 335 African American adolescent girls. The second aim was to determine whether attributes of partner communication about sex would act as a mediating mechanism on this hypothesized relationship. These assessments were made within the context of several theoretical models (social cognitive theory and theory of gender and power). Self-concept was composed of self-esteem, ethnic identity, and body image, whereas attributes of partner communication about sex was conceptualized as frequency of communication, fear of condom use negotiation, and self-efficacy of condom use negotiation. Structural equation modeling was used to analyze data. The results showed that self-concept was associated with partner communication attributes about sex, which in turn, was associated with frequency of unprotected sex refusal. The hypothesized mediating role of partner communication was also supported. STD-HIV preventive interventions for this population may be more effective if they target self-concept as opposed to only self-esteem, incorporate an Afrocentric approach, and focus on enhancing several attributes of partner communication about sex.

45 CFR 400.77 - Effect of quitting employment or failing or refusing to participate in required services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Effect of quitting employment or failing or... Employment General Requirements § 400.77 Effect of quitting employment or failing or refusing to participate... employment or fail or refuse to meet the requirements of § 400.75(a). [54 FR 5477, Feb. 3, 1989, as amended...

45 CFR 400.77 - Effect of quitting employment or failing or refusing to participate in required services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 2 2014-10-01 2012-10-01 true Effect of quitting employment or failing or... Employment General Requirements § 400.77 Effect of quitting employment or failing or refusing to participate... employment or fail or refuse to meet the requirements of § 400.75(a). [54 FR 5477, Feb. 3, 1989, as amended...

14 CFR 61.16 - Refusal to submit to an alcohol test or to furnish test results.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Refusal to submit to an alcohol test or to furnish test results. 61.16 Section 61.16 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: PILOTS, FLIGHT INSTRUCTORS, AND GROUND INSTRUCTORS General § 61.16 Refusal to submit to a...

14 CFR 61.16 - Refusal to submit to an alcohol test or to furnish test results.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Refusal to submit to an alcohol test or to furnish test results. 61.16 Section 61.16 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: PILOTS, FLIGHT INSTRUCTORS, AND GROUND INSTRUCTORS General § 61.16 Refusal to submit to a...

14 CFR 61.16 - Refusal to submit to an alcohol test or to furnish test results.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false Refusal to submit to an alcohol test or to furnish test results. 61.16 Section 61.16 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: PILOTS, FLIGHT INSTRUCTORS, AND GROUND INSTRUCTORS General § 61.16 Refusal to submit to a...

14 CFR 61.16 - Refusal to submit to an alcohol test or to furnish test results.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false Refusal to submit to an alcohol test or to furnish test results. 61.16 Section 61.16 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: PILOTS, FLIGHT INSTRUCTORS, AND GROUND INSTRUCTORS General § 61.16 Refusal to submit to a...

14 CFR 61.16 - Refusal to submit to an alcohol test or to furnish test results.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false Refusal to submit to an alcohol test or to furnish test results. 61.16 Section 61.16 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: PILOTS, FLIGHT INSTRUCTORS, AND GROUND INSTRUCTORS General § 61.16 Refusal to submit to a...

Ethnic Identity, Neighborhood Risk, and Adolescent Drug and Sex Attitudes and Refusal Efficacy: The Urban African American Girls' Experience

ERIC Educational Resources Information Center

Corneille, Maya A.; Belgrave, Faye Z.

2007-01-01

This study examined the impact of ethnic identity and neighborhood risk on drug and sex attitudes and refusal efficacy among early adolescent urban African American females (n = 175). The model also predicted a moderating relationship of ethnic identity on neighborhood risk for drug and sex attitudes and refusal efficacy. Data were collected as…

49 CFR 199.103 - Use of persons who fail or refuse a drug test.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SAFETY DRUG AND ALCOHOL TESTING Drug Testing § 199.103 Use of persons who fail or refuse a drug test. (a) An operator may not knowingly use as an employee any person who— (1) Fails a drug test required by... 49 Transportation 3 2013-10-01 2013-10-01 false Use of persons who fail or refuse a drug test. 199...

49 CFR 199.103 - Use of persons who fail or refuse a drug test.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SAFETY DRUG AND ALCOHOL TESTING Drug Testing § 199.103 Use of persons who fail or refuse a drug test. (a) An operator may not knowingly use as an employee any person who— (1) Fails a drug test required by... 49 Transportation 3 2014-10-01 2014-10-01 false Use of persons who fail or refuse a drug test. 199...

49 CFR 199.103 - Use of persons who fail or refuse a drug test.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SAFETY DRUG AND ALCOHOL TESTING Drug Testing § 199.103 Use of persons who fail or refuse a drug test. (a) An operator may not knowingly use as an employee any person who— (1) Fails a drug test required by... 49 Transportation 3 2011-10-01 2011-10-01 false Use of persons who fail or refuse a drug test. 199...

49 CFR 199.103 - Use of persons who fail or refuse a drug test.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SAFETY DRUG AND ALCOHOL TESTING Drug Testing § 199.103 Use of persons who fail or refuse a drug test. (a) An operator may not knowingly use as an employee any person who— (1) Fails a drug test required by... 49 Transportation 3 2012-10-01 2012-10-01 false Use of persons who fail or refuse a drug test. 199...

49 CFR 199.103 - Use of persons who fail or refuse a drug test.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SAFETY DRUG AND ALCOHOL TESTING Drug Testing § 199.103 Use of persons who fail or refuse a drug test. (a) An operator may not knowingly use as an employee any person who— (1) Fails a drug test required by... 49 Transportation 3 2010-10-01 2010-10-01 false Use of persons who fail or refuse a drug test. 199...

Realization of Speech Acts of Refusals and Pragmatic Competence by Turkish EFL Learners

ERIC Educational Resources Information Center

Han, Turgay; Burgucu-Tazegül, Assiye

2016-01-01

The purpose of the present study is to examine a) how lower-intermediate and upper-intermediate level Turkish learners of English-as-a-foreign language (EFL) realize refusals in English, b) the differences between native and non-native speakers of English in the use of refusals, and c) if L2 proficiency affects possible pragmatic transfer or not.…

Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet

PubMed Central

Lammert, Sara M.; Rao, Sowmya R.; Jentes, Emily S.; Fairley, Jessica K.; Erskine, Stefanie; Walker, Allison T.; Hagmann, Stefan H.; Sotir, Mark J.; Ryan, Edward T.

2017-01-01

Background: International travellers are at risk of travel-related, vaccine-preventable diseases. More data are needed on the proportion of travellers who refuse vaccines during a pre-travel health consultation and their reasons for refusing vaccines. Methods: We analyzed data on travellers seen for a pre-travel health consultation from July 2012 through June 2014 in the Global TravEpiNet (GTEN) consortium. Providers were required to indicate one of three reasons for a traveller refusing a recommended vaccine: (1) cost concerns, (2) safety concerns or (3) not concerned with the illness. We calculated refusal rates among travellers eligible for each vaccine based on CDC recommendations current at the time of travel. We used multivariable logistic regression models to examine the effect of individual variables on the likelihood of accepting all recommended vaccines. Results: Of 24 478 travellers, 23 768 (97%) were eligible for at least one vaccine. Travellers were most frequently eligible for typhoid (N = 20 092), hepatitis A (N = 12 990) and influenza vaccines (N = 10 539). Of 23 768 eligible travellers, 6573 (25%) refused one or more recommended vaccine(s). Of those eligible, more than one-third refused the following vaccines: meningococcal: 2232 (44%) of 5029; rabies: 1155 (44%) of 2650; Japanese encephalitis: 761 (41%) of 1846; and influenza: 3527 (33%) of 10 539. The most common reason for declining vaccines was that the traveller was not concerned about the illness. In multivariable analysis, travellers visiting friends and relatives (VFR) in low or medium human development countries were less likely to accept all recommended vaccines, compared with non-VFR travellers (OR = 0.74 (0.59–0.95)). Conclusions: Travellers who sought pre-travel health care refused recommended vaccines at varying rates. A lack of concern about the associated illness was the most commonly cited reason for all refused vaccines. Our data suggest more effective education about disease risk is needed for international travellers, even those who seek pre-travel advice. PMID:27799502

Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet.

PubMed

Lammert, Sara M; Rao, Sowmya R; Jentes, Emily S; Fairley, Jessica K; Erskine, Stefanie; Walker, Allison T; Hagmann, Stefan H; Sotir, Mark J; Ryan, Edward T; LaRocque, Regina C

2016-07-01

International travellers are at risk of travel-related, vaccine-preventable diseases. More data are needed on the proportion of travellers who refuse vaccines during a pre-travel health consultation and their reasons for refusing vaccines. We analyzed data on travellers seen for a pre-travel health consultation from July 2012 through June 2014 in the Global TravEpiNet (GTEN) consortium. Providers were required to indicate one of three reasons for a traveller refusing a recommended vaccine: (1) cost concerns, (2) safety concerns or (3) not concerned with the illness. We calculated refusal rates among travellers eligible for each vaccine based on CDC recommendations current at the time of travel. We used multivariable logistic regression models to examine the effect of individual variables on the likelihood of accepting all recommended vaccines. Of 24 478 travellers, 23 768 (97%) were eligible for at least one vaccine. Travellers were most frequently eligible for typhoid (N = 20 092), hepatitis A (N = 12 990) and influenza vaccines (N = 10 539). Of 23 768 eligible travellers, 6573 (25%) refused one or more recommended vaccine(s). Of those eligible, more than one-third refused the following vaccines: meningococcal: 2232 (44%) of 5029; rabies: 1155 (44%) of 2650; Japanese encephalitis: 761 (41%) of 1846; and influenza: 3527 (33%) of 10 539. The most common reason for declining vaccines was that the traveller was not concerned about the illness. In multivariable analysis, travellers visiting friends and relatives (VFR) in low or medium human development countries were less likely to accept all recommended vaccines, compared with non-VFR travellers (OR = 0.74 (0.59-0.95)). Travellers who sought pre-travel health care refused recommended vaccines at varying rates. A lack of concern about the associated illness was the most commonly cited reason for all refused vaccines. Our data suggest more effective education about disease risk is needed for international travellers, even those who seek pre-travel advice. © International Society of Travel Medicine, 2016. Published by Oxford University Press.

Factors Associated with Participation, Active Refusals and Reasons for Not Taking Part in a Mortality Followback Survey Evaluating End-of-Life Care

PubMed Central

Calanzani, Natalia; Higginson, Irene J; Koffman, Jonathan; Gomes, Barbara

2016-01-01

Background Examination of factors independently associated with participation in mortality followback surveys is rare, even though these surveys are frequently used to evaluate end-of-life care. We aimed to identify factors associated with 1) participation versus non-participation and 2) provision of an active refusal versus a silent refusal; and systematically examine reasons for refusal in a population-based mortality followback survey. Methods Postal survey about the end-of-life care received by 1516 people who died from cancer (aged ≥18), identified through death registrations in London, England (response rate 39.3%). The informant of death (a relative in 95.3% of cases) was contacted 4–10 months after the patient died. We used multivariate logistic regression to identify factors associated with participation/active refusals and content analysis to examine refusal reasons provided by 205 nonparticipants. Findings The odds of partaking were higher for patients aged 90+ (AOR 3.48, 95%CI: 1.52–8.00, ref: 20–49yrs) and female informants (AOR 1.70, 95%CI: 1.33–2.16). Odds were lower for hospital deaths (AOR 0.62, 95%CI: 0.46–0.84, ref: home) and proxies other than spouses/partners (AORs 0.28 to 0.57). Proxies of patients born overseas were less likely to provide an active refusal (AOR 0.49; 95% CI: 0.32–0.77). Refusal reasons were often multidimensional, most commonly study-related (36.0%), proxy-related and grief-related (25.1% each). One limitation of this analysis is the large number of nonparticipants who did not provide reasons for refusal (715/920). Conclusions Our survey better reached proxies of older patients while those dying in hospitals were underrepresented. Proxy characteristics played a role, with higher participation from women and spouses/partners. More information is needed about the care received by underrepresented groups. Study design improvements may guide future questionnaire development and help develop strategies to increase response rates. PMID:26745379

Changes in carbon fractions during composting and maturation of organic wastes

NASA Astrophysics Data System (ADS)

Garcia, Carlos; Hernandez, Teresa; Costa, Francisco

1991-05-01

Seven mixtures from four organic residues—an aerobic sewage sludge, a city refuse, a peat residue, and a grape debris—were composted, and the changes undergone by their different carbon fractions during their composting and maturation were studied. In most cases a decrease in carbon fractions during the composting and maturation processes was observed. The extractable carbon, however, increased during maturation. Organic matter mineralization was greater in the composts with city refuse than in those with sewage sludge. The samples with peat residue showed the lowest decreases in carbon fractions. During maturation, an increase of humiclike fraction was observed, which was reflected by a decrease in the soluble carbon-precipitated carbon ratio at pH 2. Water-soluble carbon was the carbon fraction most easily degradable by microorganisms, and its amount correlated significantly with composting time in all the samples.

Plant Materials are Sustainable Substrates Supporting New Technologies of Plant-Only-Based Culture Media for in vitro Culturing of the Plant Microbiota

PubMed Central

Mourad, Elhussein F; Sarhan, Mohamed S; Daanaa, Hassan-Sibroe A; Abdou, Mennatullah; Morsi, Ahmed T; Abdelfadeel, Mohamed R; Elsawey, Hend; Nemr, Rahma; El-Tahan, Mahmoud; Hamza, Mervat A; Abbas, Mohamed; Youssef, Hanan H; Abdelhadi, Abdelhadi A; Amer, Wafaa M; Fayez, Mohamed; Ruppel, Silke; Hegazi, Nabil A

2018-01-01

In order to improve the culturability and biomass production of rhizobacteria, we previously introduced plant-only-based culture media. We herein attempted to widen the scope of plant materials suitable for the preparation of plant-only-based culture media. We chemically analyzed the refuse of turfgrass, cactus, and clover. They were sufficiently rich to support good in vitro growth by rhizobacteria isolates representing Proteobacteria and Firmicutes. They were also adequate and efficient to produce a cell biomass in liquid batch cultures. These culture media were as sufficient as artificial culture media for the cultivation and recovery of the in situ rhizobacteria of barley (Hordeum murinum L.). Based on culture-dependent (CFU plate counting) and culture-independent analyses (qPCR), mowed turfgrass, in particular, supported the highest culturable population of barley endophytes, representing >16% of the total bacterial number quantified with qPCR. This accurately reflected the endophytic community composition, in terms of diversity indices (S′, H′, and D′) based on PCR-DGGE, and clustered the plant culture media together with the qPCR root populations away from the artificial culture media. Despite the promiscuous nature of the plant materials tested to culture the plant microbiome, our results indicated that plant materials of a homologous nature to the tested host plant, at least at the family level, and/or of the same environment were more likely to be selected. Plant-only-based culture media require further refinements in order to provide selectivity for the in vitro growth of members of the plant microbiome, particularly difficult-to-culture bacteria. This will provide insights into their hidden roles in the environment and support future culturomic studies. PMID:29479006

Plant Materials are Sustainable Substrates Supporting New Technologies of Plant-Only-Based Culture Media for in vitro Culturing of the Plant Microbiota.

PubMed

Mourad, Elhussein F; Sarhan, Mohamed S; Daanaa, Hassan-Sibroe A; Abdou, Mennatullah; Morsi, Ahmed T; Abdelfadeel, Mohamed R; Elsawey, Hend; Nemr, Rahma; El-Tahan, Mahmoud; Hamza, Mervat A; Abbas, Mohamed; Youssef, Hanan H; Abdelhadi, Abdelhadi A; Amer, Wafaa M; Fayez, Mohamed; Ruppel, Silke; Hegazi, Nabil A

2018-03-29

In order to improve the culturability and biomass production of rhizobacteria, we previously introduced plant-only-based culture media. We herein attempted to widen the scope of plant materials suitable for the preparation of plant-only-based culture media. We chemically analyzed the refuse of turfgrass, cactus, and clover. They were sufficiently rich to support good in vitro growth by rhizobacteria isolates representing Proteobacteria and Firmicutes. They were also adequate and efficient to produce a cell biomass in liquid batch cultures. These culture media were as sufficient as artificial culture media for the cultivation and recovery of the in situ rhizobacteria of barley (Hordeum murinum L.). Based on culture-dependent (CFU plate counting) and culture-independent analyses (qPCR), mowed turfgrass, in particular, supported the highest culturable population of barley endophytes, representing >16% of the total bacterial number quantified with qPCR. This accurately reflected the endophytic community composition, in terms of diversity indices (S', H', and D') based on PCR-DGGE, and clustered the plant culture media together with the qPCR root populations away from the artificial culture media. Despite the promiscuous nature of the plant materials tested to culture the plant microbiome, our results indicated that plant materials of a homologous nature to the tested host plant, at least at the family level, and/or of the same environment were more likely to be selected. Plant-only-based culture media require further refinements in order to provide selectivity for the in vitro growth of members of the plant microbiome, particularly difficult-to-culture bacteria. This will provide insights into their hidden roles in the environment and support future culturomic studies.

30 CFR 784.16 - Reclamation plan: Siltation structures, impoundments, and refuse piles.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Resources Conservation Service's Web site athttp://www.info.usda.gov/scripts/lpsiis.dll/TR/TR_210_60.htm... State program approval process engineering design standards that ensure stability comparable to a 1.3 minimum static safety factor in lieu of engineering tests to establish compliance with the minimum static...

30 CFR 780.25 - Reclamation plan: Siltation structures, impoundments, and refuse piles.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Resources Conservation Service's Web site at http://www.info.usda.gov/scripts/lpsiis.dll/TR/TR_210_60.htm... authority may establish through the State program approval process, engineering design standards that ensure stability comparable to a 1.3 minimum static safety factor in lieu of engineering tests to establish...

His Trail of Silence: A Case Study in Reaching a Child Who Refused To Speak.

ERIC Educational Resources Information Center

Van Antwerp, Kathleen

1999-01-01

Discusses selective mutism, a childhood disorder characterized by persistent failure to speak in specific social situations. Details a case study of one boy from kindergarten until treatment was received in 8th grade. Discusses techniques used in the communication process between the boy and his counselor. (Author/JDM)

29 CFR 102.177 - Exclusion from hearings; Refusal of witness to answer questions; Misconduct by attorneys and...

Code of Federal Regulations, 2014 CFR

2014-07-01

... questions; Misconduct by attorneys and party representatives before the Agency; Procedures for processing misconduct allegations. 102.177 Section 102.177 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Misconduct by Attorneys or Party Representatives § 102.177...

29 CFR 102.177 - Exclusion from hearings; Refusal of witness to answer questions; Misconduct by attorneys and...

Code of Federal Regulations, 2011 CFR

2011-07-01

... questions; Misconduct by attorneys and party representatives before the Agency; Procedures for processing misconduct allegations. 102.177 Section 102.177 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Misconduct by Attorneys or Party Representatives § 102.177...

29 CFR 102.177 - Exclusion from hearings; Refusal of witness to answer questions; Misconduct by attorneys and...

Code of Federal Regulations, 2010 CFR

2010-07-01

... questions; Misconduct by attorneys and party representatives before the Agency; Procedures for processing misconduct allegations. 102.177 Section 102.177 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Misconduct by Attorneys or Party Representatives § 102.177...

29 CFR 102.177 - Exclusion from hearings; Refusal of witness to answer questions; Misconduct by attorneys and...

Code of Federal Regulations, 2012 CFR

2012-07-01

... questions; Misconduct by attorneys and party representatives before the Agency; Procedures for processing misconduct allegations. 102.177 Section 102.177 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Misconduct by Attorneys or Party Representatives § 102.177...

29 CFR 102.177 - Exclusion from hearings; Refusal of witness to answer questions; Misconduct by attorneys and...

Code of Federal Regulations, 2013 CFR

2013-07-01

... questions; Misconduct by attorneys and party representatives before the Agency; Procedures for processing misconduct allegations. 102.177 Section 102.177 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD RULES AND REGULATIONS, SERIES 8 Misconduct by Attorneys or Party Representatives § 102.177...

Tales of Refusal, Adoption, and Maintenance: Evidence-Based Substance Abuse Prevention via School-Extension Collaborations

ERIC Educational Resources Information Center

St. Pierre, Tena L.; Kaltreider, D. Lynne

2004-01-01

Despite availability of empirically supported school-based substance abuse prevention programs, adoption and implementation fidelity of such programs appear to be low. A replicated case study was conducted to investigate school adoption and implementation processes of the EXSELS model (Project ALERT delivered by program leaders through Cooperative…

49 CFR 382.107 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... driver: (1) Fail to appear for any test (except a pre-employment test) within a reasonable time, as... testing process commences (see § 40.63(c) of this title) a pre-employment test is not deemed to have... pre-employment test is not deemed to have refused to test; (4) In the case of a directly observed or...

49 CFR 382.107 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (except a pre-employment test) within a reasonable time, as determined by the employer, consistent with...) of this title) a pre-employment test is not deemed to have refused to test; (3) Fail to provide a... testing process commences (see § 40.63(c) of this title) for a pre-employment test is not deemed to have...

49 CFR 382.107 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... (except a pre-employment test) within a reasonable time, as determined by the employer, consistent with...) of this title) a pre-employment test is not deemed to have refused to test; (3) Fail to provide a... testing process commences (see § 40.63(c) of this title) for a pre-employment test is not deemed to have...

49 CFR 382.107 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (except a pre-employment test) within a reasonable time, as determined by the employer, consistent with...) of this title) a pre-employment test is not deemed to have refused to test; (3) Fail to provide a... testing process commences (see § 40.63(c) of this title) for a pre-employment test is not deemed to have...

49 CFR 382.107 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... driver: (1) Fail to appear for any test (except a pre-employment test) within a reasonable time, as... testing process commences (see § 40.63(c) of this title) a pre-employment test is not deemed to have... pre-employment test is not deemed to have refused to test; (4) In the case of a directly observed or...

Parental Refusal to Consent for Evaluation: A Legal Analysis with Implications for School Psychologists

ERIC Educational Resources Information Center

Etscheidt, Susan; Clopton, Kerri; Haselhuhn, Charlotte

2012-01-01

The decision to begin the process for special education eligibility has complexities impacting children, parents, teachers, and schools. The Individuals with Disabilities Education Improvement Act (IDEA) eligibility provisions specify the need to obtain consent prior to evaluation and options when consent cannot be obtained. School psychologists…

Hardened, environmentally disposable composite granules of coal cleaning refuse, coal combustion waste, and other wastes, and method preparing the same

DOEpatents

Burnet, George; Gokhale, Ashok J.

1990-07-10

A hardened, environmentally inert and disposable composite granule of coal cleaning refuse and coal combustion waste, and method for producing the same, wherein the coal combustion waste is first granulated. The coal cleaning refuse is pulverized into fine particles and is then bound, as an outer layer, to the granulated coal combustion waste granules. This combination is then combusted and sintered. After cooling, the combination results in hardened, environmentally inert and disposable composite granules having cores of coal combustion waste, and outer shells of coal cleaning refuse. The composite particles are durable and extremely resistant to environmental and chemical forces.

Hardened, environmentally disposable composite granules of coal cleaning refuse, coal combustion waste, and other wastes, and method preparing the same

DOEpatents

Burnet, G.; Gokhale, A.J.

1990-07-10

A hardened, environmentally inert and disposable composite granule of coal cleaning refuse and coal combustion waste and method for producing the same are disclosed, wherein the coal combustion waste is first granulated. The coal cleaning refuse is pulverized into fine particles and is then bound, as an outer layer, to the granulated coal combustion waste granules. This combination is then combusted and sintered. After cooling, the combination results in hardened, environmentally inert and disposable composite granules having cores of coal combustion waste, and outer shells of coal cleaning refuse. The composite particles are durable and extremely resistant to environmental and chemical forces. 3 figs.

Microbial ecology studies at two coal mine refuse sites in Illinois

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

Miller, R. M.; Cameron, R. E.

An investigation was made of the microflora associated with coal refuse at two abandoned mines in the midwestern United States. Information was gathered for both the edaphic and the biotic composition of the refuse material. Emphasis was placed on heterotrophic and autotrophic components as to numbers, kinds, and physiological groups. The presence of chemolithotrophs was also investigated. The relationship between abiotic and biotic components in regard to distribution of bacteria, fungi, and algae is discussed. Information presented in this report will be utilized in assessing trends and changes in microbial numbers and composition related to manipulations of the edaphic andmore » biotic ecosystem components associated with reclamation of the refuse piles.« less

The Role of Relational Harmony in the Use of Drug-Refusal Strategies of Rural Native Hawaiian Youths

PubMed Central

Bills, Kaycee; Okamoto, Scott K.; Helm, Susana

2016-01-01

This study examined the role of maintaining relational harmony among family members in the use of drug refusal strategies for rural Hawaiian youth. Youth focus groups were conducted to validate refusal strategies used in realistic, hypothetical drug-related problem situations. The findings suggested gender-specific motivations for maintaining relational harmony among family members when faced with drug offers from them. Specifically, boys described instrumental concerns when using refusal strategies (i.e., not wanting to get into trouble), while girls described holistic relational concerns (i.e., not wanting family members to be upset with each other). Implications for prevention and social work practice are discussed. PMID:28133439

Competence to make treatment decisions in anorexia nervosa: thinking processes and values

PubMed Central

Tan, Dr. Jacinta O. A.; Hope, Professor Tony; Stewart, Dr. Anne; Fitzpatrick, Professor Raymond

2005-01-01

This paper explores the ethical and conceptual implications of the findings from an empirical study of decision-making capacity in anorexia nervosa. In the study, ten female patients aged 13 to 21 years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semi-structured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient participants were also tested using the MacCAT-T test of competence. This is a formalised, structured interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief self-administered questionnaires to assess their levels of psychopathology. The issues identified from the interviews are described under two headings: difficulties with thought processing, and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches or current standardised tests of competence. PMID:18066393

Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust

PubMed Central

Umotong, Eno

2016-01-01

Abstract The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability. PMID:27893528

Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust: Audit.

PubMed

Umotong, Eno

2016-12-01

The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability.

A defense of compulsory vaccination.

PubMed

Flanigan, Jessica

2014-03-01

Vaccine refusal harms and risks harming innocent bystanders. People are not entitled to harm innocents or to impose deadly risks on others, so in these cases there is nothing to be said for the right to refuse vaccination. Compulsory vaccination is therefore justified because non-vaccination can rightly be prohibited, just as other kinds of harmful and risky conduct are rightly prohibited. I develop an analogy to random gunfire to illustrate this point. Vaccine refusal, I argue, is morally similar to firing a weapon into the air and endangering innocent bystanders. By re-framing vaccine refusal as harmful and reckless conduct my aim is to shift the focus of the vaccine debate from non-vaccinators' religious and refusal rights to everyone else's rights against being infected with contagious illnesses. Religious freedom and rights of informed consent do not entitle non-vaccinators to harm innocent bystanders, and so coercive vaccination requirements are permissible for the sake of the potential victims of the anti-vaccine movement.

Lime retention in anthracite coal-breaker refuse

Treesearch

Miroslaw M. Czapowskyj; Edward A. Sowa

1973-01-01

Hydrated lime was applied to extremely acid anthracite coal-breaker refuse at rates of 2.5 and 5.0 tons per acre. The lime raised the pH to neutral range, and this range was still in evidence 7 years after treatment. The pH readings decreased with the depth of the refuse profile, and below 9 inches they approximated those of the control plots. The 2.5-tons-of-lime-per-...

Bacteria and Acidic Drainage from Coal Refuse: Inhibition by Sodium Lauryl Sulfate and Sodium Benzoate

PubMed Central

Dugan, Patrick R.; Apel, William A.

1983-01-01

The application of an aqueous solution of sodium lauryl sulfate and sodium benzoate to the surface of high-sulfur coal refuse resulted in the inhibition of iron-and sulfur-oxidizing chemoautotrophic bacteria and in the decrease of acidic drainage from the refuse, suggesting that acid drainage can be abated in the field by inhibiting iron- and sulfur-oxidizing bacteria. PMID:16346347

[The parents' experience of school refusal in adolescence].

PubMed

Bussard, Dewi; Harf, Aurélie; Sibeoni, Jordan; Radjack, Rahmeth; Benoit, Jean Pierre; Moro, Marie Rose

2015-01-01

While today's society places considerable importance on schooling and performances, school absenteeism is currently very high. One of the causes is anxiety-based school refusal. This phenomenon affects the adolescent but also has an impact on their family. Exploring the experience of the parents of teenagers presenting anxiety-based school refusal enables these families to be given better support. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

14 CFR 63.12a - Refusal to submit to an alcohol test or to furnish test results.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false Refusal to submit to an alcohol test or to furnish test results. 63.12a Section 63.12a Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: FLIGHT CREWMEMBERS OTHER THAN PILOTS General § 63.12a Refusal to submit to an alcohol...

14 CFR 63.12a - Refusal to submit to an alcohol test or to furnish test results.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Refusal to submit to an alcohol test or to furnish test results. 63.12a Section 63.12a Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: FLIGHT CREWMEMBERS OTHER THAN PILOTS General § 63.12a Refusal to submit to an alcohol...

14 CFR 63.12a - Refusal to submit to an alcohol test or to furnish test results.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false Refusal to submit to an alcohol test or to furnish test results. 63.12a Section 63.12a Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: FLIGHT CREWMEMBERS OTHER THAN PILOTS General § 63.12a Refusal to submit to an alcohol...

14 CFR 63.12a - Refusal to submit to an alcohol test or to furnish test results.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false Refusal to submit to an alcohol test or to furnish test results. 63.12a Section 63.12a Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: FLIGHT CREWMEMBERS OTHER THAN PILOTS General § 63.12a Refusal to submit to an alcohol...

14 CFR 63.12a - Refusal to submit to an alcohol test or to furnish test results.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Refusal to submit to an alcohol test or to furnish test results. 63.12a Section 63.12a Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: FLIGHT CREWMEMBERS OTHER THAN PILOTS General § 63.12a Refusal to submit to an alcohol...

Refusal Strategies of Iranian University English as a Foreign Language and Non-English Learners in Native Language: A Comparative Study

ERIC Educational Resources Information Center

Sa'd, Seyyed Hatam Tamimi; Qadermazi, Zohre

2014-01-01

This study is an attempt to examine the possible effect that exposure to English has had on the use of refusal strategies in English as a Foreign Language (EFL) learners compared with those of non-English learners when refusing in their native language, Persian. The sample included 12 EFL learners and 12 learners of other academic majors including…

49 CFR 40.191 - What is a refusal to take a DOT drug test, and what are the consequences?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 1 2014-10-01 2014-10-01 false What is a refusal to take a DOT drug test, and... Transportation PROCEDURES FOR TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Problems in Drug Tests § 40.191 What is a refusal to take a DOT drug test, and what are the consequences? (a) As an employee...

49 CFR 40.191 - What is a refusal to take a DOT drug test, and what are the consequences?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false What is a refusal to take a DOT drug test, and... Transportation PROCEDURES FOR TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Problems in Drug Tests § 40.191 What is a refusal to take a DOT drug test, and what are the consequences? (a) As an employee...

[Novel resources utilization technique for rural domestic refuse].

PubMed

Qiu, Cai-Di; He, Ruo; Chen, Song-Mei; Lou, Bin; Shen, Dong-Sheng

2009-03-15

In order to speed up rural domestic refuse resources utilization, intermittent aeration and continuous aeration were applied to treat rural domestic refuse after anaerobic fermentation. Three kinds of refuse were selected on base of fermentative age, i.e. three months, five months and seven months. Results showed that aeration could remove water and organic materials of the refuse effectively. Points of view on aeration, continuous aeration was better than intermittent aeration, and on the other side, water removal rate increased with ventilation and decreased with fermentative age in the condition of intermittent aeration. On organic materials removal point, it was affected by fermentative age significantly, i. e. increase of fermentative age could resulted in decrease in the removal efficiency. In conclusion, intermittent aeration of 0.06 m3/(min x m3) was considered to be feasible for treatment. The water removal efficiency of three months, five months and seven months fermentative age refuse could be up to 49.1%, 45.3% and 44.0%, and organic compound removal efficiency was 41.9%, 24.8% and 13.1%, respectively, after intermittent aeration for 21 d. Moreover, concentrated effect was presented on major nutrient ingredients, such as total nitrogen, phosphorus, and potassium during the aeration, which realized for resources utilization.