33 CFR 126.29 - Supervision and control of dangerous cargo.

Code of Federal Regulations, 2012 CFR

2012-07-01

... dangerous cargo. 126.29 Section 126.29 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) WATERFRONT FACILITIES HANDLING OF DANGEROUS CARGO AT WATERFRONT FACILITIES § 126.29 Supervision and control of dangerous cargo. (a) Authority. The Captain of the Port is authorized to require...

Innovation in supervision and support of community health workers for better newborn survival in southern Tanzania.

PubMed

Mkumbo, Elibariki; Hanson, Claudia; Penfold, Suzanne; Manzi, Fatuma; Schellenberg, Joanna

2014-12-01

Home visits by community health workers may help to improve newborn survival, but sustained high-quality supervision of community volunteers is challenging. To compare facility-led and community-linked supervision approaches of 824 community health volunteers working to improve newborn care in Southern Tanzania. Using a before-after design, we compared 6 months of supervision reports from each approach. During the community-linked approach over 50 times more supervision contacts were recorded than during the facility-only supervision approach (1.04 contacts per volunteer per month vs 0.02), and the volunteer-supervisor ratio reduced from 7.8 to 1.6. Involving community leaders has the potential to improve supervision of community health volunteers. ClinicalTrials.gov Identifier: NCT01022788; http://clinicaltrials.gov/ct2/show/NCT01022788?term=INSIST&rank=1. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

28 CFR 115.213 - Supervision and monitoring.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Supervision and monitoring. 115.213 Section 115.213 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Community Confinement Facilities Prevention Planning § 115.213 Supervision...

28 CFR 115.213 - Supervision and monitoring.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Supervision and monitoring. 115.213 Section 115.213 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Community Confinement Facilities Prevention Planning § 115.213 Supervision...

28 CFR 115.213 - Supervision and monitoring.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Supervision and monitoring. 115.213 Section 115.213 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Standards for Community Confinement Facilities Prevention Planning § 115.213 Supervision...

A review of the safety and efficacy of inhaled methoxyflurane as an analgesic for outpatient procedures.

PubMed

Jephcott, C; Grummet, J; Nguyen, N; Spruyt, O

2018-05-01

Methoxyflurane delivered via a hand-held inhaler is a proven analgesic which has been used in Australasia for emergency relief of trauma associated pain since the 1970s. The agent is self-administered by the patient under the supervision of trained personnel. More than 5 million patients have received inhaled methoxyflurane without significant side effects. Methoxyflurane is also licensed in Australasia for the relief of pain in monitored conscious patients requiring analgesia for minor surgical procedures. Recent clinical studies undertaken in a variety of outpatient settings, including colonoscopy, prostate biopsy, dental procedures, bone marrow biopsy, and the management of burns dressings, indicate that inhaled methoxyflurane has significant analgesic activity, without producing deep sedation or respiratory depression. Return to full psychomotor activity is rapid. Thus, methoxyflurane may be a suitable and well-tolerated alternative to traditional i.v. sedative agents for outpatient medical and surgical procedures. There are direct advantages to the patient in terms of rapid recovery and an early return to normal activities, and significant benefits for outpatient departments in terms of cost saving and rate of throughput. Further randomised controlled trials comparing the efficacy, safety, and cost-effectiveness of inhaled methoxyflurane against traditional i.v. sedative techniques are currently in progress. Copyright © 2018 British Journal of Anaesthesia. All rights reserved.

Supervision of community health workers in Mozambique: a qualitative study of factors influencing motivation and programme implementation.

PubMed

Ndima, Sozinho Daniel; Sidat, Mohsin; Give, Celso; Ormel, Hermen; Kok, Maryse Catelijne; Taegtmeyer, Miriam

2015-09-01

Community health workers (CHWs) in Mozambique (known as Agentes Polivalentes Elementares (APEs)) are key actors in providing health services in rural communities. Supervision of CHWs has been shown to improve their work, although details of how it is implemented are scarce. In Mozambique, APE supervision structures and scope of work are clearly outlined in policy and rely on supervisors at the health facility of reference. The aim of this study was to understand how and which aspects of supervision impact on APE motivation and programme implementation. Qualitative research methodologies were used. Twenty-nine in-depth interviews were conducted to capture experiences and perceptions of purposefully selected participants. These included APEs, health facility supervisors, district APE supervisors and community leaders. Interviews were recorded, translated and transcribed, prior to the development of a thematic framework. Supervision was structured as dictated by policy but in practice was irregular and infrequent, which participants identified as affecting APE's motivation. When it did occur, supervision was felt to focus more on fault-finding than being supportive in nature and did not address all areas of APE's work - factors that APEs identified as demotivating. Supervisors, in turn, felt unsupported and felt this negatively impacted performance. They had a high workload in health facilities, where they had multiple roles, including provision of health services, taking care of administrative issues and supervising APEs in communities. A lack of resources for supervision activities was identified, and supervisors felt caught up in administrative issues around APE allowances that they were unable to solve. Many supervisors were not trained in providing supportive supervision. Community governance and accountability mechanisms were only partially able to fill the gaps left by the supervision provided by the health system. The findings indicate the need for an improved supervision system to enhance support and motivation and ultimately performance of APEs. Our study found disconnections between the APE programme policy and its implementation, with gaps in skills, training and support of supervisors leading to sub-optimal supervision. Improved methods of supervision could be implemented including those that maximize the opportunities during face-to-face meetings and through community-monitoring mechanisms.

7 CFR 1942.129 - Borrower supervision and servicing.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 13 2012-01-01 2012-01-01 false Borrower supervision and servicing. 1942.129 Section 1942.129 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE... Facilities Projects § 1942.129 Borrower supervision and servicing. Loans under this subpart are subject to...

7 CFR 1942.129 - Borrower supervision and servicing.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 13 2014-01-01 2013-01-01 true Borrower supervision and servicing. 1942.129 Section 1942.129 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE... Facilities Projects § 1942.129 Borrower supervision and servicing. Loans under this subpart are subject to...

7 CFR 1942.129 - Borrower supervision and servicing.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 13 2013-01-01 2013-01-01 false Borrower supervision and servicing. 1942.129 Section 1942.129 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE... Facilities Projects § 1942.129 Borrower supervision and servicing. Loans under this subpart are subject to...

7 CFR 1942.129 - Borrower supervision and servicing.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 13 2010-01-01 2009-01-01 true Borrower supervision and servicing. 1942.129 Section 1942.129 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE... Facilities Projects § 1942.129 Borrower supervision and servicing. Loans under this subpart are subject to...

7 CFR 1942.129 - Borrower supervision and servicing.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 13 2011-01-01 2009-01-01 true Borrower supervision and servicing. 1942.129 Section 1942.129 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE... Facilities Projects § 1942.129 Borrower supervision and servicing. Loans under this subpart are subject to...

Rapid analysis of hyperbaric oxygen therapy registry data for reimbursement purposes: Technical communication.

PubMed

Fife, Caroline E; Gelly, Helen; Walker, David; Eckert, Kristen Allison

2016-01-01

To explain how Hyperbaric Oxygen Therapy Registry (HBOTR) data of the US Wound Registry (USWR) helped establish a fair analysis of the physician work of hyperbaric chamber supervision for reimbursement purposes. We queried HBOTR data from January 1, 2013, to December 31, 2013, on patient comorbidities and medications as well as the number of hyperbaric oxygen (HBO₂) therapy treatments supervised per physician per day from all hyperbaric facilities participating in the USWR that had been using the electronic medical record (EHR) for more than six months and had passed data completeness checks. Among 11,240 patients at the 87 facilities included, the mean number of comorbidities and medications was 10 and 12, respectively. The mean number of HBO₂ treatments supervised per physician per day was 3.7 at monoplace facilities and 5.4 at multiplace facilities. Following analysis of these data by the RUC, the reimbursement rate of chamber supervision was decreased to $112.06. Patients undergoing HBO₂ therapy generally suffer from multiple, serious comorbidities and require multiple medications, which increase the risk of HBO₂ and necessitate the presence of a properly trained hyperbaric physician. The lack of engagement by hyperbaric physicians in registry reporting may result in lack of adequate data being available to counter future challenges to reimbursement.

Using drugs in un/safe spaces: Impact of perceived illegality on an underground supervised injecting facility in the United States.

PubMed

Davidson, Peter J; Lopez, Andrea M; Kral, Alex H

2018-03-01

Supervised injection facilities (SIFs) are spaces where people can consume pre-obtained drugs in hygienic circumstances with trained staff in attendance to provide emergency response in the event of an overdose or other medical emergency, and to provide counselling and referral to other social and health services. Over 100 facilities with formal legal sanction exist in ten countries, and extensive research has shown they reduce overdose deaths, increase drug treatment uptake, and reduce social nuisance. No facility with formal legal sanction currently exists in the United States, however one community-based organization has successfully operated an 'underground' facility since September 2014. Twenty three qualitative interviews were conducted with people who used the underground facility, staff, and volunteers to examine the impact of the facility on peoples' lives, including the impact of lack of formal legal sanction on service provision. Participants reported that having a safe space to inject drugs had led to less injections in public spaces, greater ability to practice hygienic injecting practices, and greater protection from fatal overdose. Constructive aspects of being 'underground' included the ability to shape rules and procedures around user need rather than to meet political concerns, and the rapid deployment of the project, based on immediate need. Limitations associated with being underground included restrictions in the size and diversity of the population served by the site, and reduced ability to closely link the service to drug treatment and other health and social services. Unsanctioned supervised injection facilities can provide a rapid and user-driven response to urgent public health needs. This work draws attention to the need to ensure such services remain focused on user-defined need rather than external political concerns in jurisdictions where supervised injection facilities acquire local legal sanction. Copyright © 2017 Elsevier B.V. All rights reserved.

75 FR 40795 - Review of Sourcing Change, Foreign-Trade Subzone 61H, Baxter Healthcare of Puerto Rico...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-14

..., Foreign-Trade Subzone 61H, Baxter Healthcare of Puerto Rico (Inhalation Anesthetics Manufacturing... inhalation anesthetics at Foreign-Trade Subzone 61H, at the facility of Baxter Healthcare of Puerto Rico.../7/1997) at the Baxter Healthcare of Puerto Rico (Baxter) (formerly Ohmeda Caribe Inc./Ohmeda...

Exercise at an onsite facility with or without direct exercise supervision improves health-related physical fitness and exercise participation: An 8-week randomised controlled trial with 15-month follow-up.

PubMed

Hunter, Jayden R; Gordon, Brett A; Lythgo, Noel; Bird, Stephen R; Benson, Amanda C

2018-04-01

Physical activity and exercise participation is limited by a perceived lack of time, poor access to facilities and low motivation. The aim was to assess whether providing an exercise program to be completed at the workplace with or without direct supervision was effective for promoting health-related physical fitness and exercise participation. Fifty university employees aged (Mean ± SD) 42.5 ± 11.1 years were prescribed a moderate- to vigorous-intensity aerobic and resistance exercise program to be completed at an onsite facility for 8 weeks. Participants were randomly allocated to receive direct exercise supervision or not. Cardiorespiratory fitness (V̇O 2max ) and maximal muscular strength were assessed at baseline and 8 weeks. Self-report physical activity was assessed at baseline, 8 weeks and 15 months post-intervention. Attendance or exercise session volume were not different between groups. Cardiorespiratory fitness (Mean ± 95% CI); +1.9 ± 0.7 mL·kg·min -1 ; P < .001), relative knee flexion (+7.4 ± 3.5 Nm·kg -1 %; P < .001) and extension (+7.4 ± 4.6 Nm·kg -1 %; P < .01) strength increased, irrespective of intervention group. Self-reported vigorous-intensity physical activity increased over the intervention (mean ± 95% CI; +450 ± 222 MET·minutes per week; P < .001), but did not remain elevated at 15 months (+192 ± 276 MET·minutes per week). Providing a workplace exercise facility to complete an individually-prescribed 8-week exercise program is sufficient to improve health-related physical fitness in the short-term independent to the level of supervision provided, but does not influence long-term participation. SO WHAT?: Lower cost onsite exercise facility supervision is as effective at improving physical health and fitness as directly supervised exercise, however ongoing support may be required for sustained physical activity behaviour change. © 2017 Australian Health Promotion Association.

The impact of a human resource management intervention on the capacity of supervisors to support and supervise their staff at health facility level.

PubMed

Uduma, Ogenna; Galligan, Marie; Mollel, Henry; Masanja, Honorati; Bradley, Susan; McAuliffe, Eilish

2017-08-30

A systematic and structured approach to the support and supervision of health workers can strengthen the human resource management function at the district and health facility levels and may help address the current crisis in human resources for health in sub-Saharan Africa by improving health workers' motivation and retention. A supportive supervision programme including (a) a workshop, (b) intensive training and (c) action learning sets was designed to improve human resource management in districts and health facilities in Tanzania. We conducted a randomised experimental design to evaluate the impact of the intervention. Data on the same measures were collected pre and post the intervention in order to identify any changes that occurred (between baseline and end of project) in the capacity of supervisors in intervention a + b and intervention a + b + c to support and supervise their staff. These were compared to supervisors in a control group in each of Tanga, Iringa and Tabora regions (n = 9). A quantitative survey of 95 and 108 supervisors and 196 and 187 health workers sampled at baseline and end-line, respectively, also contained open-ended responses which were analysed separately. Supervisors assessed their own competency levels pre- and post-intervention. End-line samples generally scored higher compared to the corresponding baseline in both intervention groups for competence activities. Significant differences between baseline and end-line were observed in the total scores on 'maintaining high levels of performance', 'dealing with performance problems', 'counselling a troubled employee' and 'time management' in intervention a + b. In contrast, for intervention a + b + c, a significant difference in distribution of scores was only found on 'counselling a troubled employee', although the end-line mean scores were higher than their corresponding baseline mean scores in all cases. Similar trends to those in the supervisors' reports are seen in health workers data in terms of more efficient supervision processes, although the increases are not as marked. A number of different indicators were measured to assess the impact of the supportive supervision intervention on the a + b and a + b + c intervention sites. The average frequency of supervision visits and the supervisors' competency levels across the facilities increased in both intervention types. This would suggest that the intervention proved effective in raising awareness of the importance of supervision and this understanding led to action in the form of more supportive supervision.

Distributed architecture and distributed processing mode in urban sewage treatment

NASA Astrophysics Data System (ADS)

Zhou, Ruipeng; Yang, Yuanming

2017-05-01

Decentralized rural sewage treatment facility over the broad area, a larger operation and management difficult, based on the analysis of rural sewage treatment model based on the response to these challenges, we describe the principle, structure and function in networking technology and network communications technology as the core of distributed remote monitoring system, through the application of case analysis to explore remote monitoring system features in a decentralized rural sewage treatment facilities in the daily operation and management. Practice shows that the remote monitoring system to provide technical support for the long-term operation and effective supervision of the facilities, and reduced operating, maintenance and supervision costs for development.

Inhalation of foreign bodies in children: experience of 22 years.

PubMed

Sahin, Atalay; Meteroglu, Fatih; Eren, Sevval; Celik, Yusuf

2013-02-01

Foreign body (FB) inhalation into airways of the respiratory system is a life-threatening condition and can be fatal. The purpose of this survey was to evaluate the types and characteristics of inhaled foreign bodies, the age distribution of children, and the outcome. We outlined a retrospective review of hospital data of patients between 1990 and 2012. FB inhalation occurring in children 0 year to 16 years was considered for inclusion. During the study period, 1,660 patients undergoing bronchoscopy with the diagnosis of FB were included. Deaths on arrival were excluded. Of the patients, 53% were male, and 47% were female (p > 0.05). The mean age was 6.2 years for girls and 4.7 years for boys. In 57% of all cases, the children were younger than 3 years. An FB was found within the respiratory tract of 1,565 patients. The FBs were always extracted by using rigid bronchoscopy. Hospitalization was always required owing to an institutional requirement. The origin of the FBs were within the two main groups of food and objects. Food FBs included seeds, nuts, beans, and fruit parts. FB objects included pins, toy parts, and metal pieces. FB and subsequent treatment revealed that morbidity was present; however, mortality was rare. Most of the inhaled FBs were found in the bronchial tree. Children younger than 3 years are more vulnerable. There seemed to be an association between the aspirated FBs and season, geographic locality, and sociocultural environment. The removal of choice is rigid bronchoscopy under general anesthesia. That most cases of FB in children occurs under the supervision of adults indicates that the incidence and severity of airway FB inhalation can be reduced by parental education and public awareness. Epidemiologic study, level III.

Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work?

PubMed

Steele, Maureen; Silins, Edmund; Flaherty, Ian; Hiley, Sarah; van Breda, Nick; Jauncey, Marianne

2018-01-01

Wheel-filtration of pharmaceutical opioid tablets is a recognised harm reduction strategy, but uptake of the practice among people who inject drugs is low. The study aimed to: (i) examine perceptions of filtration practices; (ii) provide structured education on wheel-filtration; and (iii) assess uptake of the practice. Frequent opioid tablet injectors (n = 30) attending a supervised injecting facility in Sydney, Australia, received hands-on instruction on wheel-filtration based on recommended practice. Pre-education, post-education and follow-up questionnaires were administered. Wheel-filtration was generally regarded as better than cotton-filtration (the typical method) in terms of perceived effects on health, ease of use and overall drug effect. Sixty-eight percent of those who said they would try wheel-filtration after the education had actually done so. Of those who usually used cotton-filtration, over half (60%) had used wheel-filtration two weeks later. Uptake of safer preparation methods for pharmaceutical opioid tablets increases after structured education in wheel-filtration. Findings suggest that SIFs are an effective site for this kind of education. Supervised injecting facility workers are uniquely positioned to provide harm reduction education at the time of injection. [Steele M, Silins E, Flaherty I, Hiley S, van Breda N, Jauncey M. Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work? Drug Alcohol Rev 2018;37:116-120]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

A Survey of Inhalant Use Disorders among Delinquent Youth: Prevalence, Clinical Features, and Latent Structure of DSM-IV Diagnostic Criteria

PubMed Central

Howard, Matthew O; Perron, Brian E

2009-01-01

Background Inhalant use is among the most pernicious and poorly understood forms of adolescent substance use. Many youth in the juvenile justice system have used inhalants, but little is known about inhalant use disorders (IUDs) in antisocial youth populations. The purpose of this study was to examine the prevalence, clinical features, and latent structure of DSM-IV IUDs in a state population of antisocial youth. Methods Cross-sectional survey conducted in 2003. Of 740 youth residing in Missouri State Division of Youth Services' (MDYS) residential treatment facilities at the time the study was conducted, 723 (97.7%) completed interviews. Eighty-seven percent were male, with a mean age of 15.5 (SD = 1.2). Nearly 4 in 10 youth (38.5%; n = 279) reported lifetime inhalant use. Youth ranged from very mildly to severely antisocial. Results Of 279 inhalant users, 52 (18.6%) met DSM-IV inhalant abuse criteria and 79 (28.3%) met inhalant dependence criteria. Five of 10 IUD criteria were met by > 10% of the total sample. Latent class analyses demonstrated a substantial concordance between DSM-IV-defined IUDs and an empirically-derived classification based on responses to DSM-IV IUD diagnostic criteria. Conclusion IUDs and constituent criteria were prevalent among youth in the juvenile justice system. Two groups of problem inhalant users were identified, symptomatic users-DSM-IV inhalant abuse and highly symptomatic users-DSM-IV inhalant dependence, which differed primarily in severity of inhalant-related problems. Inhalant screening, prevention and treatment efforts in juvenile justice settings are rarely delivered, but critically needed. PMID:19267939

Perceptions on evaluative and formative functions of external supervision of Rwandan primary healthcare facilities: A qualitative study.

PubMed

Schriver, Michael; Cubaka, Vincent Kalumire; Itangishaka, Sylvere; Nyirazinyoye, Laetitia; Kallestrup, Per

2018-01-01

External supervision of primary healthcare facilities in low- and middle-income countries often has a managerial main purpose in which the role of support for professional development is unclear. To explore how Rwandan primary healthcare supervisors and providers (supervisees) perceive evaluative and formative functions of external supervision. Qualitative, exploratory study. Focus group discussions: three with supervisors, three with providers, and one mixed (n = 31). Findings were discussed with individual and groups of supervisors and providers. Evaluative activities occupied providers' understanding of supervision, including checking, correcting, marking and performance-based financing. These were presented as sources of motivation, that in self-determination theory indicate introjected regulation. Supervisors preferred to highlight their role in formative supervision, which may mask their own and providers' uncontested accounts that systematic performance evaluations predominated supervisors' work. Providers strongly requested larger focus on formative and supportive functions, voiced as well by most supervisors. Impact of performance evaluation on motivation and professional development is discussed. While external supervisors intended to support providers' professional development, our findings indicate serious problems with this in a context of frequent evaluations and performance marking. Separating the role of supporter and evaluator does not appear as the simple solution. If external supervision is to improve health care services, it is essential that supervisors and health centre managers are competent to support providers in a way that transparently accounts for various performance pressures. This includes delivery of proper formative supervision with useful feedback, maintaining an effective supervisory relationship, as well as ensuring providers are aware of the purpose and content of evaluative and formative supervision functions.

Assessing the quality of data aggregated by antiretroviral treatment clinics in Malawi.

PubMed

Makombe, Simon D; Hochgesang, Mindy; Jahn, Andreas; Tweya, Hannock; Hedt, Bethany; Chuka, Stuart; Yu, Joseph Kwong-Leung; Aberle-Grasse, John; Pasulani, Olesi; Bailey, Christopher; Kamoto, Kelita; Schouten, Erik J; Harries, Anthony D

2008-04-01

As national antiretroviral treatment (ART) programmes scale-up, it is essential that information is complete, timely and accurate for site monitoring and national planning. The accuracy and completeness of reports independently compiled by ART facilities, however, is often not known. This study assessed the quality of quarterly aggregate summary data for April to June 2006 compiled and reported by ART facilities ("site report") as compared to the "gold standard" facility summary data compiled independently by the Ministry of Health supervision team ("supervision report"). Completeness and accuracy of key case registration and outcome variables were compared. Data were considered inaccurate if variables from the site reports were missing or differed by more than 5% from the supervision reports. Additionally, we compared the national summaries obtained from the two data sources. Monitoring and evaluation of Malawi's national ART programme is based on WHO's recommended tools for ART monitoring. It includes one master card for each ART patient and one patient register at each ART facility. Each quarter, sites complete cumulative cohort analyses and teams from the Ministry of Health conduct supervisory visits to all public sector ART sites to ensure the quality of reported data. Most sites had complete case registration and outcome data; however many sites did not report accurate data for several critical data fields, including reason for starting, outcome and regimen. The national summary using the site reports resulted in a 12% undercount in the national total number of persons on first-line treatment. Several facility-level characteristics were associated with data quality. While many sites are able to generate complete data summaries, the accuracy of facility reports is not yet adequate for national monitoring. The Ministry of Health and its partners should continue to identify and support interventions such as supportive supervision to build sites' capacity to maintain and compile quality data to ensure that accurate information is available for site monitoring and national planning.

25 CFR 12.4 - Who supervises the Bureau of Indian Affairs uniformed police, detention, and conservation...

Code of Federal Regulations, 2010 CFR

2010-04-01

... police, detention, and conservation enforcement functions? 12.4 Section 12.4 Indians BUREAU OF INDIAN... Who supervises the Bureau of Indian Affairs uniformed police, detention, and conservation enforcement... uniformed police operations, detention facilities, and conservation enforcement operations at any agency...

Understanding the impact of supervision on reducing medication risks: an interview study in long-term elderly care.

PubMed

Vermeulen, J A; Kleefstra, S M; Zijp, E M; Kool, R B

2017-07-06

In 2009, the Dutch Health Care Inspectorate (IGZ) observed several serious risks to safety involving medication within elderly care facilities. However, by 2011, high risks had been reduced in almost all the organisations we visited. And yet the IGZ analysed too the alarming increase in the number of incidents arising in the self-reported national indicator of medication safety between 2009 and 2010. The aim of this study was to understand the factors that can explain this contradiction between the increase in self-reported medication incidents and the observation of the IGZ in reducing the risks to medication safety through supervision. We interviewed health care professionals of ten care facilities, visited by the IGZ, who were involved in, or responsible for, the improvement of medication safety in their institutions. As outcome measures we used the rate of medication safety risk per facility; the perceptions of the participant with regard to the reports of medication incidents; the level of medication safety of the facility; the measures used to improve medication safety; and the supervision of medication safety. This was a mixed methods study, qualitative in that we used semi-structured interviews, and quantitative, by calculating risks for the different organisations we visited. The findings from both study methods resulted in a comprehensive view and an in-depth understanding of this contradiction. The contradiction between the increase in self-reported medication incidents and the observation of reduced risks was explained by three themes: activities designed to improve medication safety, the reporting of medication incidents, and, lastly, the impact of supervision. The focus of the IGZ on issues of medication safety stimulated most elderly care facilities to reduce medication risks. Also, a change in the culture of reporting incidents caused an increase in the number of reported incidents. Supervision contributed to an improvement in actions geared towards reducing the risks associated with the safety of medication. It also increased a willingness to report such incidents. The more incidents reported are therefore not necessarily a sign of an increase in the risks, but can also be considered as a sign of a safer culture.

Perceptions on evaluative and formative functions of external supervision of Rwandan primary healthcare facilities: A qualitative study

PubMed Central

Schriver, Michael; Cubaka, Vincent Kalumire; Itangishaka, Sylvere; Nyirazinyoye, Laetitia; Kallestrup, Per

2018-01-01

Background External supervision of primary healthcare facilities in low- and middle-income countries often has a managerial main purpose in which the role of support for professional development is unclear. Aim To explore how Rwandan primary healthcare supervisors and providers (supervisees) perceive evaluative and formative functions of external supervision. Design Qualitative, exploratory study. Data Focus group discussions: three with supervisors, three with providers, and one mixed (n = 31). Findings were discussed with individual and groups of supervisors and providers. Results Evaluative activities occupied providers’ understanding of supervision, including checking, correcting, marking and performance-based financing. These were presented as sources of motivation, that in self-determination theory indicate introjected regulation. Supervisors preferred to highlight their role in formative supervision, which may mask their own and providers’ uncontested accounts that systematic performance evaluations predominated supervisors’ work. Providers strongly requested larger focus on formative and supportive functions, voiced as well by most supervisors. Impact of performance evaluation on motivation and professional development is discussed. Conclusion While external supervisors intended to support providers’ professional development, our findings indicate serious problems with this in a context of frequent evaluations and performance marking. Separating the role of supporter and evaluator does not appear as the simple solution. If external supervision is to improve health care services, it is essential that supervisors and health centre managers are competent to support providers in a way that transparently accounts for various performance pressures. This includes delivery of proper formative supervision with useful feedback, maintaining an effective supervisory relationship, as well as ensuring providers are aware of the purpose and content of evaluative and formative supervision functions. PMID:29462144

Inhalation Toxicology Research Institute annual report, October 1, 1994--September 30, 1995

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

Bice, D.E.; Hahn, F.F.; Hoover, M.D.

1995-12-01

The mission of the Inhalation Toxicology Research Institute (ITRI) is to conduct basic and applied research to improve the understanding of the nature and magnitude of the human health impacts of inhaling airborne materials in the home, workplace, and general environment. Institute research programs have a strong basic science orientation with emphasis on the nature and behavior of airborne materials, the fundamental biology of the respiratory tract, the fate of inhaled materials and the mechanisms by which they cause disease, and the means by which data produced in the laboratory can be used to estimate risks to human health. Disordersmore » of the respiratory tract continue to be a major health concern, and inhaled toxicants are thought to contribute substantially to respiratory morbidity. As the largest laboratory dedicated to the study of basic inhalation toxicology, ITRI provides a national resource of specialized facilities, personnel, and educational activities serving the needs of government, academia, and industry. Selected papers are indexed separately for inclusion in the Energy Science and Technology Database.« less

43 CFR 3162.6 - Well and facility identification.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Well and facility identification. 3162.6... for Operating Rights Owners and Operators § 3162.6 Well and facility identification. (a) Every well within a Federal or Indian lease or supervised agreement shall have a well indentification sign. All...

43 CFR 3162.6 - Well and facility identification.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Well and facility identification. 3162.6... for Operating Rights Owners and Operators § 3162.6 Well and facility identification. (a) Every well within a Federal or Indian lease or supervised agreement shall have a well indentification sign. All...

43 CFR 3162.6 - Well and facility identification.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Well and facility identification. 3162.6... for Operating Rights Owners and Operators § 3162.6 Well and facility identification. (a) Every well within a Federal or Indian lease or supervised agreement shall have a well indentification sign. All...

28 CFR 115.313 - Supervision and monitoring.

Code of Federal Regulations, 2014 CFR

2014-07-01

... from internal or external oversight bodies; (5) All components of the facility's physical plant... juvenile facility shall maintain staff ratios of a minimum of 1:8 during resident waking hours and 1:16... fully documented. Only security staff shall be included in these ratios. Any facility that, as of the...

28 CFR 115.313 - Supervision and monitoring.

Code of Federal Regulations, 2012 CFR

2012-07-01

... from internal or external oversight bodies; (5) All components of the facility's physical plant... juvenile facility shall maintain staff ratios of a minimum of 1:8 during resident waking hours and 1:16... fully documented. Only security staff shall be included in these ratios. Any facility that, as of the...

28 CFR 115.313 - Supervision and monitoring.

Code of Federal Regulations, 2013 CFR

2013-07-01

... from internal or external oversight bodies; (5) All components of the facility's physical plant... juvenile facility shall maintain staff ratios of a minimum of 1:8 during resident waking hours and 1:16... fully documented. Only security staff shall be included in these ratios. Any facility that, as of the...

Supervision, monitoring and evaluation of nationwide scale-up of antiretroviral therapy in Malawi.

PubMed Central

Libamba, Edwin; Makombe, Simon; Mhango, Eustice; de Ascurra Teck, Olga; Limbambala, Eddie; Schouten, Erik J.; Harries, Anthony D.

2006-01-01

OBJECTIVE: To describe the supervision, monitoring and evaluation strategies used to assess the delivery of antiretroviral therapy during nationwide scale-up of treatment in Malawi. METHODS: In the first quarter of 2005, the HIV Unit of the Ministry of Health and its partners (the Lighthouse Clinic; Médecins Sans Frontières-Belgium, Thyolo district; and WHO's Country Office) undertook structured supervision and monitoring of all public sector health facilities in Malawi delivering antiretroviral therapy. FINDINGS: Data monitoring showed that by the end of 2004, there were 13,183 patients (5274 (40%) male, 12 527 (95%) adults) who had ever started antiretroviral therapy. Of patients who had ever started, 82% (10 761/13,183) were alive and taking antiretrovirals; 8% (1026/13,183) were dead; 8% (1039/13,183) had been lost to follow up; <1% (106/13,183) had stopped treatment; and 2% (251/13,183) had transferred to another facility. Of those alive and on antiretrovirals, 98% (7098/7258) were ambulatory; 85% (6174/7258) were fit to work; 10% (456/4687) had significant side effects; and, based on pill counts, 96% (6824/7114) had taken their treatment correctly. Mistakes in the registration and monitoring of patients were identified and corrected. Drug stocks were checked, and one potential drug stock-out was averted. As a result of the supervisory visits, by the end of March 2005 recruitment of patients to facilities scheduled to start delivering antiretroviral therapy had increased. CONCLUSION: This report demonstrates the importance of early supervision for sites that are starting to deliver antiretroviral therapy, and it shows the value of combining data collection with supervision. Making regular supervisory and monitoring visits to delivery sites are essential for tracking the national scale-up of delivery of antiretrovirals. PMID:16628306

Farm Animal Models of Organic Dust Exposure and Toxicity: Insights and Implications for Respiratory Health

PubMed Central

McClendon, Chakia J.; Gerald, Carresse L.; Waterman, Jenora T.

2016-01-01

Purpose of review Modern food animal production is a major contributor to the global economy, owing to advanced intensive indoor production facilities aimed at increasing market readiness and profit. Consequences of these advances are accumulation of dusts, gases and microbial products that diminish air quality within production facilities. Chronic inhalation exposure contributes to onset and exacerbation of respiratory symptoms and diseases in animals and workers. This article reviews literature regarding constituents of farm animal production facility dusts; animal responses to production building and organic dust exposure, and the effect of chronic inhalation exposure on pulmonary oxidative stress and inflammation. Recent findings –Porcine models of production facility and organic dust exposures reveal striking similarities to observations of human cells, tissues and clinical data. Oxidative stress plays a key role in mediating respiratory diseases in animals and humans, and enhancement of antioxidant levels through nutritional supplements can improve respiratory health. Summary – Pigs are well adapted to the exposures common to swine production buildings and thus serve as excellent models for facility workers. Insight for understanding mechanisms governing organic dust associated respiratory diseases may come from parallel comparisons between farmers and the animals they raise. PMID:25636160

Ten Commandments for Microcomputer Facility Planners.

ERIC Educational Resources Information Center

Espinosa, Leonard J.

1991-01-01

Presents factors involved in designing a microcomputer facility, including how computers will be used in the instructional program; educational specifications; planning committees; user input; quality of purchases; visual supervision considerations; location; workstation design; turnkey systems; electrical requirements; local area networks;…

A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Ottawa, Canada.

PubMed

Jozaghi, Ehsan; Reid, Andrew A; Andresen, Martin A; Juneau, Alexandre

2014-08-04

Supervised injection facilities (SIFs) are venues where people who inject drugs (PWID) have access to a clean and medically supervised environment in which they can safely inject their own illicit drugs. There is currently only one legal SIF in North America: Insite in Vancouver, British Columbia, Canada. The responses and feedback generated by the evaluations of Insite in Vancouver have been overwhelmingly positive. This study assesses whether the above mentioned facility in the Downtown Eastside of Vancouver needs to be expanded to other locations, more specifically that of Canada's capital city, Ottawa. The current study is aimed at contributing to the existing literature on health policy by conducting cost-benefit and cost-effective analyses for the opening of SIFs in Ottawa, Ontario. In particular, the costs of operating numerous SIFs in Ottawa was compared to the savings incurred; this was done after accounting for the prevention of new HIV and Hepatitis C (HCV) infections. To ensure accuracy, two distinct mathematical models and a sensitivity analysis were employed. The sensitivity analyses conducted with the models reveals the potential for SIFs in Ottawa to be a fiscally responsible harm reduction strategy for the prevention of HCV cases--when considered independently. With a baseline sharing rate of 19%, the cumulative annual cost model supported the establishment of two SIFs and the marginal annual cost model supported the establishment of a single SIF. More often, the prevention of HIV or HCV alone were not sufficient to justify the establishment cost-effectiveness; rather, only when both HIV and HCV are considered does sufficient economic support became apparent. Funded supervised injection facilities in Ottawa appear to be an efficient and effective use of financial resources in the public health domain.

A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Ottawa, Canada

PubMed Central

2014-01-01

Background Supervised injection facilities (SIFs) are venues where people who inject drugs (PWID) have access to a clean and medically supervised environment in which they can safely inject their own illicit drugs. There is currently only one legal SIF in North America: Insite in Vancouver, British Columbia, Canada. The responses and feedback generated by the evaluations of Insite in Vancouver have been overwhelmingly positive. This study assesses whether the above mentioned facility in the Downtown Eastside of Vancouver needs to be expanded to other locations, more specifically that of Canada’s capital city, Ottawa. Methods The current study is aimed at contributing to the existing literature on health policy by conducting cost-benefit and cost-effective analyses for the opening of SIFs in Ottawa, Ontario. In particular, the costs of operating numerous SIFs in Ottawa was compared to the savings incurred; this was done after accounting for the prevention of new HIV and Hepatitis C (HCV) infections. To ensure accuracy, two distinct mathematical models and a sensitivity analysis were employed. Results The sensitivity analyses conducted with the models reveals the potential for SIFs in Ottawa to be a fiscally responsible harm reduction strategy for the prevention of HCV cases – when considered independently. With a baseline sharing rate of 19%, the cumulative annual cost model supported the establishment of two SIFs and the marginal annual cost model supported the establishment of a single SIF. More often, the prevention of HIV or HCV alone were not sufficient to justify the establishment cost-effectiveness; rather, only when both HIV and HCV are considered does sufficient economic support became apparent. Conclusions Funded supervised injection facilities in Ottawa appear to be an efficient and effective use of financial resources in the public health domain. PMID:25091704

Community residential facilities in mental health services: A ten-year comparison in Lombardy.

PubMed

Barbato, Angelo; Civenti, Graziella; D'Avanzo, Barbara

2017-06-01

Residential mental health services grew steadily since 2000 in Italy. A reorganisation of residential facilities was implemented in 2007 in Lombardy, introducing supported housing in addition to staffed facilities. We compare the provision and characteristics of residential facilities in the 2007 and 2016. In 2007 there were 3462 beds (35.9/100,000 population) in 276 facilities. In 2016 beds were 4783 (47.8/100,000) in 520 facilities. The increase were unevenly distributed in the public and private sector, and the overall increase was due to a higher increase in the private sector. 72% of beds were in highly supervised facilities in 2007 and 66% in 2016. The public sector managed more facilities with a rehabilitation goal, while the private sector more for long-term accommodation. Mean numbers of beds were higher in facilities managed by the private sector in both years. The 2007 reorganisation and the stop to opening new facilities in the last years were not enough to correct the imbalance between highly supervised and flexible solutions. A wider and more diverse offer might have triggered off an increased demand, rather than a more rational use. Given the costs of highly staffed facilities, and the risk of reproducing custodial models, close evaluation of the use of residential facilities should inform policies. Copyright © 2017 Elsevier B.V. All rights reserved.

Bioterrorism-related Inhalational Anthrax in an Elderly Woman, Connecticut, 2001

PubMed Central

Mead, Paul; Armstrong, Gregory L.; Painter, John; Kelley, Katherine A.; Hoffmaster, Alex R.; Mayo, Donald; Barden, Diane; Ridzon, Renee; Parashar, Umesh; Teshale, Eyasu Habtu; Williams, Jen; Noviello, Stephanie; Perz, Joseph F.; Mast, Eric E.; Swerdlow, David L.; Hadler, James L.

2003-01-01

On November 20, 2001, inhalational anthrax was confirmed in an elderly woman from rural Connecticut. To determine her exposure source, we conducted an extensive epidemiologic, environmental, and laboratory investigation. Molecular subtyping showed that her isolate was indistinguishable from isolates associated with intentionally contaminated letters. No samples from her home or community yielded Bacillus anthracis, and she received no first-class letters from facilities known to have processed intentionally contaminated letters. Environmental sampling in the regional Connecticut postal facility yielded B. anthracis spores from 4 (31%) of 13 sorting machines. One extensively contaminated machine primarily processes bulk mail. A second machine that does final sorting of bulk mail for her zip code yielded B. anthracis on the column of bins for her carrier route. The evidence suggests she was exposed through a cross-contaminated bulk mail letter. Such cross-contamination of letters and postal facilities has implications for managing the response to future B. anthracis–contaminated mailings. PMID:12781007

Developing a Shared Research Facility.

ERIC Educational Resources Information Center

Goodman, Ira S.; Newcomb, Elizabeth W.

1990-01-01

Planning, creation, and current operation of the Transgenic Mouse Research Facility at the New York University Kaplan Cancer Center are discussed. The university considered need, space, funding, supervision, and marketing and followed a logical and structured management process embodying both scientific and administrative input. (Author/MSE)

Development and validation of the ExPRESS instrument for primary health care providers' evaluation of external supervision.

PubMed

Schriver, Michael; Cubaka, Vincent Kalumire; Vedsted, Peter; Besigye, Innocent; Kallestrup, Per

2018-01-01

External supervision of primary health care facilities to monitor and improve services is common in low-income countries. Currently there are no tools to measure the quality of support in external supervision in these countries. To develop a provider-reported instrument to assess the support delivered through external supervision in Rwanda and other countries. "External supervision: Provider Evaluation of Supervisor Support" (ExPRESS) was developed in 18 steps, primarily in Rwanda. Content validity was optimised using systematic search for related instruments, interviews, translations, and relevance assessments by international supervision experts as well as local experts in Nigeria, Kenya, Uganda and Rwanda. Construct validity and reliability were examined in two separate field tests, the first using exploratory factor analysis and a test-retest design, the second for confirmatory factor analysis. We included 16 items in section A ('The most recent experience with an external supervisor'), and 13 items in section B ('The overall experience with external supervisors'). Item-content validity index was acceptable. In field test I, test-retest had acceptable kappa values and exploratory factor analysis suggested relevant factors in sections A and B used for model hypotheses. In field test II, models were tested by confirmatory factor analysis fitting a 4-factor model for section A, and a 3-factor model for section B. ExPRESS is a promising tool for evaluation of the quality of support of primary health care providers in external supervision of primary health care facilities in resource-constrained settings. ExPRESS may be used as specific feedback to external supervisors to help identify and address gaps in the supervision they provide. Further studies should determine optimal interpretation of scores and the number of respondents needed per supervisor to obtain precise results, as well as test the functionality of section B.

Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda

PubMed Central

Namazzi, Gertrude; Waiswa, Peter; Nakakeeto, Margaret; Nakibuuka, Victoria K.; Namutamba, Sarah; Najjemba, Maria; Namusaabi, Ruth; Tagoola, Abner; Nakate, Grace; Ajeani, Judith; Peterson, Stefan; Byaruhanga, Romano N.

2015-01-01

Background In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. Objective This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. Design This health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. Results Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of health facilities reporting no stock-outs. Conclusion Health system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes. Through a participatory process with wide engagement, training, and improvements to support supervision and logistics, health workers were able to change behaviours and practices for maternal and newborn care. Local solutions are needed to ensure sustainability of medical commodities. PMID:25843496

Inputs to quality: supervision, management, and community involvement in health facilities in Egypt in 2004.

PubMed

Cherlin, Emily J; Allam, Adel A; Linnander, Erika L; Wong, Rex; El-Toukhy, Essam; Sipsma, Heather; Krumholz, Harlan M; Curry, Leslie A; Bradley, Elizabeth H

2011-10-20

As low- and middle-income countries experience economic development, ensuring quality of health care delivery is a central component of health reform. Nevertheless, health reforms in low- and middle-income countries have focused more on access to services rather than the quality of these services, and reporting on quality has been limited. In the present study, we sought to examine the prevalence and regional variation in key management practices in Egyptian health facilities within three domains: supervision of the facility from the Ministry of Health and Population (MOHP), managerial processes, and patient and community involvement in care. We conducted a cross-sectional analysis of data from 559 facilities surveyed with the Egyptian Service Provision Assessment (ESPA) survey in 2004, the most recent such survey in Egypt. We registered on the Measure Demographic and Health Survey (DHS) website http://legacy.measuredhs.com/login.cfm to gain access to the survey data. From the ESPA sampled 559 MOHP facilities, we excluded a total of 79 facilities because they did not offer facility-based 24-hour care or have at least one physician working in the facility, resulting in a final sample of 480 facilities. The final sample included 76 general service hospitals, 307 rural health units, and 97 maternal and child health and urban health units (MCH/urban units). We used standard frequency analyses to describe facility characteristics and tested the statistical significance of regional differences using chi-square statistics. Nearly all facilities reported having external supervision within the 6 months preceding the interview. In contrast, key facility-level managerial processes, such as having routine and documented management meetings and applying quality assurance approaches, were uncommon. Involvement of communities and patients was also reported in a minority of facilities. Hospitals and health units located in Urban Egypt compared with more rural parts of Egypt were significantly more likely to have management committees that met at least monthly, to keep official records of the meetings, and to have an approach for reviewing quality assurance activities. Although the data precede the recent reform efforts of the MOHP, they provide a baseline against which future progress can be measured. Targeted efforts to improve facility-level management are critical to supporting quality improvement initiatives directed at improving the quality of health care throughout the country.

17 CFR 37.1501 - Chief compliance officer.

Code of Federal Regulations, 2014 CFR

2014-04-01

... facility's self-regulatory program that is requested by the board of directors or the regulatory oversight... compliance office review, look-back, internal or external audit finding, self-reported error, or validated...) Supervising the swap execution facility's self-regulatory program with respect to trade practice surveillance...

77 FR 780 - Procurement List Proposed Additions

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-06

... will perform management, supervision, cooking, food preparation, and baking in the two facilities. At no time will the contractor be responsible for the management and operational control of the dining facilities. These Government personnel are expected to be the food service personnel assigned to military...

Safety evaluation of laninamivir octanoate hydrate through analysis of adverse events reported during early post-marketing phase vigilance.

PubMed

Nakano, Takashi; Okumura, Akihisa; Tanabe, Takuya; Niwa, Shimpei; Fukushima, Masato; Yonemochi, Rie; Eda, Hisano; Tsutsumi, Hiroyuki

2013-06-01

Abnormal behavior and delirium are common in children with influenza. While abnormal behavior and delirium are considered to be associated with influenza encephalopathy, an increased risk of such neuropsychiatric symptoms in patients receiving neuraminidase inhibitor treatment is suspected. Laninamivir octanoate hydrate, recently approved in Japan, is a long-acting neuraminidase inhibitor. It is important to establish a safety profile for laninamivir early, based on post-marketing experiences. Spontaneous safety reports collected in the early post-marketing phase vigilance were analyzed. Adverse events of interest such as abnormal behavior/delirium, dizziness/vertigo, respiratory disorders, shock/syncope, and any other serious events were intensively reviewed by the Safety Evaluation Committee. Abnormal behavior/delirium was a frequently reported event. Almost all the reported cases were considered to be due to influenza and not laninamivir. There were 32 cases of abnormal behavior/delirium that could lead to dangerous accidents, and these were observed more frequently in males and teenagers. Syncope probably related to the act of inhalation per se of laninamivir was reported during this survey. This safety review revealed that the safety profile of laninamivir for abnormal behavior/delirium and syncope was similar to that of other neuraminidase inhibitors. As stated in the labeling, teenage patients inhaling laninamivir should remain under constant parental supervision for at least 2 days and should be closely monitored for behavioral changes to prevent serious accidents associated with abnormal behavior/delirium. Furthermore, to avoid syncope because of inhalation, patients should be instructed to inhale in a relaxed sitting position.

[Design of a supervision model for administration of the Child Development Evaluation Test at primary care facilities in Mexico].

PubMed

Villasís-Keever, Miguel Ángel; Rizzoli-Córdoba, Antonio; Delgado-Ginebra, Ismael; Mares-Serratos, Blanca Berenice; Martell-Valdez, Liliana; Sánchez-Velázquez, Olivia; Reyes-Morales, Hortensia; O'Shea-Cuevas, Gabriel; Aceves-Villagrán, Daniel; Carrasco-Mendoza, Joaquín; Antillón-Ocampo, Fátima Adriana; Villagrán-Muñoz, Víctor Manuel; Halley-Castillo, Elizabeth; Baqueiro-Hernández, César Iván; Pizarro-Castellanos, Mariel; Martain-Pérez, Itzamara Jacqueline; Palma-Tavera, Josuha Alexander; Vargas-López, Guillermo; Muñoz-Hernández, Onofre

The Child Development Evaluation (CDE) test designed and validated in Mexico has been used as a screening tool for developmental problems in primary care facilities across Mexico. Heterogeneous results were found among those states where these were applied, despite using the same standardized training model for application. The objective was to evaluate a supervision model for quality of application of the CDE test at primary care facilities. A study was carried out in primary care facilities from three Mexican states to evaluate concordance of the results between supervisor and primary care personnel who administered the test using two different methods: direct observation (shadow study) or reapplication of the CDE test (consistency study). There were 380 shadow studies applied to 51 psychologists. General concordance of the shadow study was 86.1% according to the supervisor: green 94.5%, yellow 73.2% and red 80.0%. There were 302 re-test evaluations with a concordance of 88.1% (n=266): green 96.8%, yellow 71.7% and red 81.8%. There were no differences between CDE test subgroups by age. Both shadow and re-test study were adequate for the evaluation of the quality of the administration of the CDE Test and may be useful as a model of supervision in primary care facilities. The decision of which test to use relies on the availability of supervisors. Copyright © 2015 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

Constant supervision of bathing in French public swimming pools: an unrealistic regulatory requirement?

PubMed

Vignac, Élie; Lebihain, Pascal; Soulé, Bastien

2017-09-01

In France, to prevent drowning accidents in public swimming pools (PSPs), bathing must be constantly supervised by qualified staff. However, fatal drowning regularly occurs in supervised aquatic facilities. A review of the literature shows that human supervision is a complex task. The aim of this research is to fully assess the periods during which supervision is not carried out, or carried out in an inadequate manner. The observations made in 108 French PSPs show that supervision is not carried out 18% of the time and that it is carried out inadequately 33% of the time. The medical literature shows that, in order to expect to survive without after-effects, an immersed victim requires intervention within a time limit of not more than three minutes; however, we noted, over a total observation time of 54 hours, 147 periods (29.8%) during which the supervision system was degraded for three minutes or more. This quantification research on the periods of degraded supervision is complemented by an identification of the causes leading to these degradations, from which we can draw interesting areas for improvement, particularly from an organizational point of view, in order to improve safety management in French PSPs.

First regulatory inspections measuring adherence to Good Pharmacy Practices in the public sector in Uganda: a cross-sectional comparison of performance between supervised and unsupervised facilities.

PubMed

Trap, Birna; Kikule, Kate; Vialle-Valentin, Catherine; Musoke, Richard; Lajul, Grace Otto; Hoppenworth, Kim; Konradsen, Dorthe

2016-01-01

Since its inception, the Uganda National Drug Authority (NDA) has regularly inspected private sector pharmacies to monitor adherence to Good Pharmacy Practices (GPP). This study reports findings from the first public facility inspections following an intervention (SPARS: Supervision, Performance Assessment, and Recognition Strategy) to build GPP and medicines management capacity in the public sector. The study includes 455 public facilities: 417 facilities were inspected after at least four SPARS visits by trained managerial district staff (SPARS group), 38 before any exposure to SPARS. NDA inspectors measured 10 critical, 20 major, and 37 minor GPP indicators in every facility and only accredited facilities that passed all 10 critical and failed no more than 7 major indicators. Lack of compliance for a given indicator was defined as less than 75 % facilities passing that indicator. We assessed factors associated with certification using logistic regression analysis and compared number of failed indicators between the SPARS and comparative groups using two sample t-tests with equal or unequal variance. 57.4 % of inspected facilities obtained GPP certification: 57.1 % in the SPARS and 60.5 % in the comparative group (Adj. OR = 0.91, 95 % CI 0.45-1.85, p = 0.802). Overall, facilities failed an average of 10 indicators. SPARS facilities performed better than comparative facilities (9 (SD 6.1) vs. 13 (SD 7.7) failed indicators respectively; p = 0.017), and SPARS supported facilities scored better on indicators covered by SPARS. For all indicators but one minor, performance in the SPARS group was equal to or significantly better than in unsupervised facilities. Within the SPARS (intervention) group, certified facilities had < 75 % compliance on 7 indicators (all minor), and uncertified facilities on 19 (4 critical, 2 major, and 13 minor) indicators. Half of the Ugandan population obtains medicines from the public sector. Yet, we found only 3/5 of inspected public health facilities meet GPP standards. SPARS facilities tended to perform better than unsupervised facilities, substantiating the value of supporting supervision interventions in GPP areas that need strengthening. None compliant indicators can be improved through practices and behavioral changes; some require infrastructure investments. We conclude that regular NDA inspections of public sector pharmacies in conjunction with interventions to improve GPP adherence can revolutionize patient care in Uganda.

Radon exposure at a radioactive waste storage facility.

PubMed

Manocchi, F H; Campos, M P; Dellamano, J C; Silva, G M

2014-06-01

The Waste Management Department of Nuclear and Energy Research Institute (IPEN) is responsible for the safety management of the waste generated at all internal research centers and that of other waste producers such as industry, medical facilities, and universities in Brazil. These waste materials, after treatment, are placed in an interim storage facility. Among them are (226)Ra needles used in radiotherapy, siliceous cake arising from conversion processes, and several other classes of waste from the nuclear fuel cycle, which contain Ra-226 producing (222)Rn gas daughter.In order to estimate the effective dose for workers due to radon inhalation, the radon concentration at the storage facility has been assessed within this study. Radon measurements have been carried out through the passive method with solid-state nuclear track detectors (CR-39) over a period of nine months, changing detectors every month in order to determine the long-term average levels of indoor radon concentrations. The radon concentration results, covering the period from June 2012 to March 2013, varied from 0.55 ± 0.05 to 5.19 ± 0.45 kBq m(-3). The effective dose due to (222)Rn inhalation was further assessed following ICRP Publication 65.

27 CFR 19.279 - Office facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Office facilities. 19.279... OF THE TREASURY LIQUORS DISTILLED SPIRITS PLANTS Construction, Equipment and Security § 19.279 Office... plant to supervise operations, the proprietor shall provide an office at the distilled spirits plant for...

Low levels of exposure to libby amphibole asbestos and localized pleural thickening.

PubMed

Christensen, Krista Yorita; Bateson, Thomas F; Kopylev, Leonid

2013-11-01

To explore the relationship between low levels of exposure to Libby amphibole asbestos (LAA) and pleural abnormalities, specifically localized pleural thickening (LPT). Three studies presenting the risks associated with quantitative LAA exposure estimates were reviewed, paying particular attention to lower exposure ranges. Studies reviewed were conducted among workers exposed to LAA at mining and milling operations in Libby, Montana, at a vermiculite processing facility in Marysville, Ohio, and community residents exposed to LAA from a vermiculite processing facility in Minneapolis, Minnesota. Pleural abnormalities were evaluated using radiographs. Despite differences in study populations and design, each study found that cumulative inhalation LAA exposure was associated with increased risk of LPT even at low levels of exposure. Inhalation exposure to LAA is associated with increased risk of LPT even at the lowest levels of exposure in each study.

Derivation of an occupational exposure limit for an inhalation analgesic methoxyflurane (Penthrox(®)).

PubMed

Frangos, John; Mikkonen, Antti; Down, Christin

2016-10-01

Methoxyflurane (MOF) a haloether, is an inhalation analgesic agent for emergency relief of pain by self administration in conscious patients with trauma and associated pain. It is administered under supervision of personnel trained in its use. As a consequence of supervised use, intermittent occupational exposure can occur. An occupational exposure limit has not been established for methoxyflurane. Human clinical and toxicity data have been reviewed and used to derive an occupational exposure limit (referred to as a maximum exposure level, MEL) according to modern principles. The data set for methoxyflurane is complex given its historical use as anaesthetic. Distinguishing clinical investigations of adverse health effects following high and prolonged exposure during anaesthesia to assess relatively low and intermittent exposure during occupational exposure requires an evidence based approach to the toxicity assessment and determination of a critical effect and point of departure. The principal target organs are the kidney and the central nervous system and there have been rare reports of hepatotoxicity, too. Methoxyflurane is not genotoxic based on in vitro bacterial mutation and in vivo micronucleus tests and it is not classifiable (IARC) as a carcinogenic hazard to humans. The critical effect chosen for development of a MEL is kidney toxicity. The point of departure (POD) was derived from the concentration response relationship for kidney toxicity using the benchmark dose method. A MEL of 15 ppm (expressed as an 8 h time weighted average (TWA)) was derived. The derived MEL is at least 50 times higher than the mean observed TWA (0.23 ppm) for ambulance workers and medical staff involved in supervising use of Penthrox. In typical treatment environments (ambulances and treatment rooms) that meet ventilation requirements the derived MEL is at least 10 times higher than the modelled TWA (1.5 ppm or less) and the estimated short term peak concentrations are within the MEL. The odour threshold for MOF of 0.13-0.19 ppm indicates that the odour is detectable well below the MEL. Given the above considerations the proposed MEL is health protective. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

The relationship between primary healthcare providers and their external supervisors in Rwanda.

PubMed

Schriver, Michael; Cubaka, Vincent K; Nyirazinyoye, Laetitia; Itangishaka, Sylvere; Kallestrup, Per

2017-11-01

External supervision of Rwandan primary healthcare facilities unfolds as an interaction between supervisors and healthcare providers. Their relationship has not been thoroughly studied in Rwanda, and rarely in Africa. To explore perceived characteristics and effects of the relationship between providers in public primary healthcare facilities and their external supervisors in Rwanda. We conducted three focus group discussions with primary healthcare providers (n = 16), three with external supervisors (n = 15) and one mixed (n = 5). Focus groups were facilitated under low-moderator involvement. Findings were extracted thematically and discussed with participating and non-participating providers and supervisors. While external supervision is intended as a source of motivation and professional development in addition to its managerial purpose, it appeared linked to excessive evaluation anxiety among Rwandan primary healthcare providers. Supervisors related this mainly to inescapable evaluations within performance-based financing, whereas providers additionally related it to communication problems. External supervision appeared driven by systematic performance evaluations, which may prompt a strongly asymmetric supervisory power relation and challenge intentions to explore providers' experienced work problems. There is a risk that this may harm provider motivation, calling for careful attention to factors that influence the supervisory relationship. It is a dilemma that providers most in need of supervision to improve performance may be most unlikely to benefit from it. This study reveals a need for provider-oriented supportive supervision including constructive attention on providers who have performance difficulties, effective relationship building and communication, objective and diligent evaluation and two-way feedback channels.

Handling of Diskus dry powder inhaler in Chinese chronic obstructive pulmonary disease patients.

PubMed

Li, Huaidong; Chen, Yuanyuan; Zhang, Zhaorui; Dong, Xiaoxuan; Zhang, Guogang; Zhang, Hui

2014-06-01

The incorrect handling of Diskus inhalers in Chinese patients with chronic obstructive pulmonary disease (COPD) is not well documented. The present study was conducted to evaluate in detail the handling errors related to the Diskus device, and to elucidate the importance of educating COPD patients on the proper use of the device. A total of 384 COPD patients from a pulmonary clinic in China over a period of 5 years were included in the study. The compliance of COPD patients to the 13 discrete steps of Diskus usage were scored and analyzed by three measures: (1) On day 0, patients were given only a package insert on Diskus, and the handling error rate was assessed. Then the patients were given instruction on the 13-step Diskus procedure until they could demonstrate the proper technique. (2) On days 1, 2, and 3, the observation group was continuously educated on a 13-step procedure, and the percentage of patients who scored 100% for each step was recorded. The control group had no such training. (3) On days 10, 20, and 30, the percentage of all subjects correctly performing the Diskus 13-step inhalation procedure was assessed. Incorrect handling techniques on Diskus usage were widely distributed among Chinese COPD patients. Step 8 ("Inhale forcefully from the beginning, slowly, deeply, and uniformly during the inspiratory phase until the lungs are full") was the most commonly mishandled step (93.8%). The total score and individual step scores of the patients from the observation group were significantly improved during 3-day continuous education. There was also a significantly higher percentage of correctly performed steps in the observation group than in the control group upon assessment on day 10 (96.24% vs. 85.63%, respectively; p<0.01), day 20 (97.31% vs. 86.09%, respectively; p<0.01), and day 30 (98.19% vs. 87.39%, respectively; p<0.01). Handling errors of the Diskus 13-step inhalation procedure were commonly observed in Chinese COPD patients. Continuous educational interventions and regular supervision by health-care providers are therefore crucial for the optimum use of the Diskus inhaler.

Summary of Ambient Air Monitoring in Southeast Chicago - Oct. 28, 2013

EPA Pesticide Factsheets

The monitoring station at George Washington High School reports pollutants including fine particulate matter, inhalable particulate matter, lead, and toxic metals. Data suggests sources including Beemsterboer and KCBX petcoke (petroleum coke) facilities.

Kratom exposures reported to Texas poison centers.

PubMed

Forrester, Mathias B

2013-01-01

Kratom use is a growing problem in the United States. Kratom exposures reported to Texas poison centers between January 1998 and September 2013 were identified. No kratom exposures were reported from 1998 to 2008 and 14 exposures were reported from 2009 to September 2013. Eleven patients were male, and 11 patients were in their 20s. The kratom was ingested in 12 patients, inhaled in 1, and both ingested and inhaled in 1. Twelve patients were managed at a healthcare facility and the remaining 2 were managed at home.

WORKER INHALATION DOSE COEFFICIENTS FOR RADIONUCLIDES NOT PREVIOUSLY IDENTIFIED IN ICRP PUBLICATION 68

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

McLaughlin, David A; Schwahn, Scott O

2011-01-01

While inhalation dose coefficients are provided for about 800 radionuclides in International Commission on Radiological Protection (ICRP) Publication 68, many radionuclides of practical dosimetric interest for facilities such as high-energy proton accelerators are not specifically addressed, nor are organ-specific dose coefficients tabulated. The ICRP Publication 68 methodology is used, along with updated radiological decay data and metabolic data, to identify committed equivalent dose coefficients [hT(50)] and committed effective dose coefficients [e(50)] for radionuclides produced at the Oak Ridge National Laboratory s Spallation Neutron Source.

District health managers' perceptions of supervision in Malawi and Tanzania.

PubMed

Bradley, Susan; Kamwendo, Francis; Masanja, Honorati; de Pinho, Helen; Waxman, Rachel; Boostrom, Camille; McAuliffe, Eilish

2013-09-05

Mid-level cadres are being used to address human resource shortages in many African contexts, but insufficient and ineffective human resource management is compromising their performance. Supervision plays a key role in performance and motivation, but is frequently characterised by periodic inspection and control, rather than support and feedback to improve performance. This paper explores the perceptions of district health management teams in Tanzania and Malawi on their role as supervisors and on the challenges to effective supervision at the district level. This qualitative study took place as part of a broader project, "Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers". Semi-structured interviews were conducted with 20 district health management team personnel in Malawi and 37 council health team members in Tanzania. The interviews covered a range of human resource management issues, including supervision and performance assessment, staff job descriptions and roles, motivation and working conditions. Participants displayed varying attitudes to the nature and purpose of the supervision process. Much of the discourse in Malawi centred on inspection and control, while interviewees in Tanzania were more likely to articulate a paradigm characterised by support and improvement. In both countries, facility level performance metrics dominated. The lack of competency-based indicators or clear standards to assess individual health worker performance were considered problematic. Shortages of staff, at both district and facility level, were described as a major impediment to carrying out regular supervisory visits. Other challenges included conflicting and multiple responsibilities of district health team staff and financial constraints. Supervision is a central component of effective human resource management. Policy level attention is crucial to ensure a systematic, structured process that is based on common understandings of the role and purpose of supervision. This is particularly important in a context where the majority of staff are mid-level cadres for whom regulation and guidelines may not be as formalised or well-developed as for traditional cadres, such as registered nurses and medical doctors. Supervision needs to be adequately resourced and supported in order to improve performance and retention at the district level.

District health managers’ perceptions of supervision in Malawi and Tanzania

PubMed Central

2013-01-01

Background Mid-level cadres are being used to address human resource shortages in many African contexts, but insufficient and ineffective human resource management is compromising their performance. Supervision plays a key role in performance and motivation, but is frequently characterised by periodic inspection and control, rather than support and feedback to improve performance. This paper explores the perceptions of district health management teams in Tanzania and Malawi on their role as supervisors and on the challenges to effective supervision at the district level. Methods This qualitative study took place as part of a broader project, “Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers”. Semi-structured interviews were conducted with 20 district health management team personnel in Malawi and 37 council health team members in Tanzania. The interviews covered a range of human resource management issues, including supervision and performance assessment, staff job descriptions and roles, motivation and working conditions. Results Participants displayed varying attitudes to the nature and purpose of the supervision process. Much of the discourse in Malawi centred on inspection and control, while interviewees in Tanzania were more likely to articulate a paradigm characterised by support and improvement. In both countries, facility level performance metrics dominated. The lack of competency-based indicators or clear standards to assess individual health worker performance were considered problematic. Shortages of staff, at both district and facility level, were described as a major impediment to carrying out regular supervisory visits. Other challenges included conflicting and multiple responsibilities of district health team staff and financial constraints. Conclusion Supervision is a central component of effective human resource management. Policy level attention is crucial to ensure a systematic, structured process that is based on common understandings of the role and purpose of supervision. This is particularly important in a context where the majority of staff are mid-level cadres for whom regulation and guidelines may not be as formalised or well-developed as for traditional cadres, such as registered nurses and medical doctors. Supervision needs to be adequately resourced and supported in order to improve performance and retention at the district level. PMID:24007354

Examining triage patterns of inhalation injury and toxic epidermal necrolysis-Stevens Johnson syndrome.

PubMed

Davis, James S; Pandya, Reeni K; Pizano, Louis R; Namias, Nicholas; Dearwater, Stephen; Schulman, Carl I

2013-01-01

The American Burn Association recommends that patients with toxic epidermal necrolysis-Stevens Johnson syndrome (TEN-SJS) or burn inhalation injuries would benefit from admission or transfer to a burn center (BC). This study examines to what extent those criteria are observed within a regional burn network. Hospital discharge data from 2000 to 2010 was obtained for all hospitals within the South Florida regional burn network. Patients with International Classification of Disease-9th revision discharge diagnoses for TEN-SJS or burn inhalation injury and their triage destination were compared using burn triage referral criteria to determine whether the patients were triaged differently from American Burn Association recommendations. Two hundred ninety-nine TEN-SJS and 131 inhalation injuries were admitted to all South Florida hospitals. Only 25 (8.4%) of TEN-SJS and 27 (21%) of inhalation injuries were admitted to the BC. BC patients had greater length of stay (TEN-SJS 22 vs 10 days; inhalation 13 vs 7) and were more likely to be funded by charity or be self-paid (TEN-SJS 24 vs 9.5%, P = .025; inhalation 44 vs 14%, P < .001), but less likely to hold some form of private or government insurance (TEN-SJS 72 vs 88%, P = .02; inhalation 48 vs 81%, P = .006). TEN-SJS BC patients were more frequently discharged home for self-care (76 vs 50%, P = .006). Non-BC patients were more often discharged to other healthcare facilities (28 vs 0% TEN-SJS, 20 vs 7.4% inhalation). Inappropriate triage may occur in more than 3 out of 4 of the TEN-SJS and inhalation injury patients within our burn network. Unfamiliarity with triage criteria, patient insurance status, and overcoding may play a role. Further studies should fully characterize the problem and implement education or incentives to encourage more appropriate triage.

Elemental properties of copper slag and measured airborne exposures at a copper slag processing facility.

PubMed

Mugford, Christopher; Gibbs, Jenna L; Boylstein, Randy

2017-08-01

In 1974, the National Institute for Occupational Safety and Health recommended a ban on the use of abrasives containing >1% silica, giving rise to abrasive substitutes like copper slag. We present results from a National Institute for Occupational Safety and Health industrial hygiene survey at a copper slag processing facility that consisted of the collection of bulk samples for metals and silica; and full-shift area and personal air samples for dust, metals, and respirable silica. Carcinogens, suspect carcinogens, and other toxic elements were detected in all bulk samples, and area and personal air samples. Area air samples identified several areas with elevated levels of inhalable and respirable dust, and respirable silica: quality control check area (236 mg/m 3 inhalable; 10.3 mg/m 3 respirable; 0.430 mg/m 3 silica), inside the screen house (109 mg/m 3 inhalable; 13.8 mg/m 3 respirable; 0.686 mg/m 3 silica), under the conveyor belt leading to the screen house (19.8 mg/m 3 inhalable), and inside a conveyor access shack (11.4 mg/m 3 inhalable; 1.74 mg/m 3 respirable; 0.067 mg/m 3 silica). Overall, personal dust samples were lower than area dust samples and did not exceed published occupational exposure limits. Silica samples collected from a plant hand and a laborer exceeded the American Conference of Governmental Industrial Hygienist Threshold Limit Value of 0.025 µg/m 3 . All workers involved in copper slag processing (n = 5) approached or exceeded the Occupational Safety and Health Administration permissible exposure limit of 10 µg/m 3 for arsenic (range: 9.12-18.0 µg/m 3 ). Personal total dust levels were moderately correlated with personal arsenic levels (R s = 0.70) and personal respirable dust levels were strongly correlated with respirable silica levels (R s = 0.89). We identified multiple areas with elevated levels of dust, respirable silica, and metals that may have implications for personal exposure at other facilities if preventive measures are not taken. To our knowledge, this is the first attempt to characterize exposures associated with copper slag processing. More in-depth air monitoring and health surveillance is needed to understand occupational exposures and health outcomes in this industry.

Characterization of airborne and bulk particulate from iron and steel manufacturing facilities.

PubMed

Machemer, Steven D

2004-01-15

Characterization of airborne and bulk particulate material from iron and steel manufacturing facilities, commonly referred to as kish, indicated graphite flakes and graphite flakes associated with spherical iron oxide particles were unique particle characteristics useful in identifying particle emissions from iron and steel manufacturing. Characterization of airborne particulate material collected in receptor areas was consistent with multiple atmospheric release events of kish particles from the local iron and steel facilities into neighboring residential areas. Kish particles deposited in nearby residential areas included an abundance of graphite flakes, tens of micrometers to millimeters in size, and spherical iron oxide particles, submicrometer to tens of micrometers in size. Bulk kish from local iron and steel facilities contained an abundance of similar particles. Approximately 60% of blast furnace kish by volume consisted of spherical iron oxide particles in the respirable size range. Basic oxygen furnace kish contained percent levels of strongly alkaline components such as calcium hydroxide. In addition, concentrations of respirable Mn in airborne particulate in residential areas and at local iron and steel facilities were approximately 1.6 and 53 times the inhalation reference concentration of 0.05 microg/m3 for chronic inhalation exposure of Mn, respectively. Thus, airborne release of kish may pose potential respirable particulate, corrosive, or toxic hazards for human health and/or a corrosive hazard for property and the environment.

No Place for Kids: The Case for Reducing Juvenile Incarceration

ERIC Educational Resources Information Center

Mendel, Richard A.

2011-01-01

States confine juvenile offenders in many types of facilities, including group homes, residential treatment centers, boot camps, wilderness programs, or country-run youth facilities (some of them locked, others secured only through staff supervision). But the largest share of committed youth--about 40 percent of the total--are held in locked…

12 CFR 550.160 - What personnel and facilities may I use to perform fiduciary services?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false What personnel and facilities may I use to perform fiduciary services? 550.160 Section 550.160 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY FIDUCIARY POWERS OF SAVINGS ASSOCIATIONS Exercising Fiduciary Powers Fiduciary...

12 CFR 550.160 - What personnel and facilities may I use to perform fiduciary services?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 5 2011-01-01 2011-01-01 false What personnel and facilities may I use to perform fiduciary services? 550.160 Section 550.160 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY FIDUCIARY POWERS OF SAVINGS ASSOCIATIONS Exercising Fiduciary Powers Fiduciary...

12 CFR 560.37 - Real estate for office and related facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Real estate for office and related facilities. 560.37 Section 560.37 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY LENDING AND INVESTMENT Lending and Investment Powers for Federal Savings Associations § 560.37 Real estate...

Library of Congress Mass Book Deacidification Facility. Hearing before the Committee on Rules and Administration, United States Senate, Ninety-Eighth Congress, Second Session, on S. 2418, Providing for the Library of Congress Mass Book Deacidification Facility.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Rules and Administration.

This document presents testimony heard on S. 2418, a bill to authorize the Librarian of Congress to construct the Library of Congress Mass Book Deacidification Facility at Fort Detrick, near Frederick, Maryland, subject to the supervision and construction authority of a federal, civilian, or military agency. The facility would be used to…

SSI recipients in domiciliary care facilities: federally administered optional supplementation, March 1976.

PubMed

Kochhar, S

1977-12-01

Under the supplemental security income program, federally administered payments amounting to $24.7 million were made in March 1976 to 107,000 persons who were residing in domiciliary care facilities and under other supervised living arrangements. These persons were unable to function under totally independent living arrangements but did not require medical or nursing care on a regular basis. Of the total, $9.5 million was represented in Federal SSI payments and $15.2 million came from optional State supplements--with California paying $6.2 million and New York $4.6 million. The average payment to the residents of these facilities was $232 a month. Comparable data for four States show greater caseload growth for persons in domiciliary care facilities and under other supervised living arrangements than for the total SSI population. Nearly two-thirds of the States are adding funds to Federal SSI payments for persons under such care. Data are available, however, only from Social Security Administration program records for those States that have elected Federal administration of their optional programs.

Inhalation of uranium nanoparticles: respiratory tract deposition and translocation to secondary target organs in rats.

PubMed

Petitot, Fabrice; Lestaevel, Philippe; Tourlonias, Elie; Mazzucco, Charline; Jacquinot, Sébastien; Dhieux, Bernadette; Delissen, Olivia; Tournier, Benjamin B; Gensdarmes, François; Beaunier, Patricia; Dublineau, Isabelle

2013-03-13

Uranium nanoparticles (<100 nm) can be released into the atmosphere during industrial stages of the nuclear fuel cycle and during remediation and decommissioning of nuclear facilities. Explosions and fires in nuclear reactors and the use of ammunition containing depleted uranium can also produce such aerosols. The risk of accidental inhalation of uranium nanoparticles by nuclear workers, military personnel or civilian populations must therefore be taken into account. In order to address this issue, the absorption rate of inhaled uranium nanoparticles needs to be characterised experimentally. For this purpose, rats were exposed to an aerosol containing 10⁷ particles of uranium per cm³ (CMD=38 nm) for 1h in a nose-only inhalation exposure system. Uranium concentrations deposited in the respiratory tract, blood, brain, skeleton and kidneys were determined by ICP-MS. Twenty-seven percent of the inhaled mass of uranium nanoparticles was deposited in the respiratory tract. One-fifth of UO₂ nanoparticles were rapidly cleared from lung (T(½)=2.4 h) and translocated to extrathoracic organs. However, the majority of the particles were cleared slowly (T(½)=141.5 d). Future long-term experimental studies concerning uranium nanoparticles should focus on the potential lung toxicity of the large fraction of particles cleared slowly from the respiratory tract after inhalation exposure. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Atmospheric concentrations of polybrominated diphenyl ethers at near-source sites.

PubMed

Cahill, Thomas M; Groskova, Danka; Charles, M Judith; Sanborn, James R; Denison, Michael S; Baker, Lynton

2007-09-15

Concentrations of polybrominated diphenyl ethers (PBDEs) were determined in air samples from near suspected sources, namely an indoors computer laboratory, indoors and outdoors at an electronics recycling facility, and outdoors at an automotive shredding and metal recycling facility. The results showed that (1) PBDE concentrations in the computer laboratorywere higherwith computers on compared with the computers off, (2) indoor concentrations at an electronics recycling facility were as high as 650,000 pg/m3 for decabromodiphenyl ether (PBDE 209), and (3) PBDE 209 concentrations were up to 1900 pg/m3 at the downwind fenceline at an automotive shredding/metal recycling facility. The inhalation exposure estimates for all the sites were typically below 110 pg/kg/day with the exception of the indoor air samples adjacent to the electronics shredding equipment, which gave exposure estimates upward of 40,000 pg/kg/day. Although there were elevated inhalation exposures at the three source sites, the exposure was not expected to cause adverse health effects based on the lowest reference dose (RfD) currently in the Integrated Risk Information System (IRIS), although these RfD values are currently being re-evaluated by the U.S. Environmental Protection Agency. More research is needed on the potential health effects of PBDEs.

Community walking programs for treatment of peripheral artery disease

PubMed Central

Mays, Ryan J.; Rogers, R. Kevin; Hiatt, William R.; Regensteiner, Judith G.

2013-01-01

Background Supervised walking programs offered at medical facilities for patients with peripheral artery disease (PAD) and intermittent claudication (IC), while effective, are often not utilized due to barriers including lack of reimbursement and the need to travel to specialized locations for the training intervention. Walking programs for PAD patients that occur in community settings, such as those outside of supervised settings, may be a viable treatment option, as they are convenient and potentially bypass the need for supervised walking. This review evaluated the various methodologies and outcomes of community walking programs for PAD. Methods A literature review using appropriate search terms was conducted within PubMed/Medline and the Cochrane databases to identify studies in the English language employing community walking programs to treat PAD patients with IC. Search results were reviewed, and relevant articles were identified that form the basis of this review. The primary outcome was peak walking performance on the treadmill. Results Randomized controlled trials (n=10) examining peak walking outcomes in 558 PAD patients demonstrated that supervised exercise programs were more effective than community walking studies that consisted of general recommendations for patients with IC to walk at home. Recent community trials that incorporated more advice and feedback for PAD patients in general resulted in similar outcomes with no differences in peak walking time compared to supervised walking exercise groups. Conclusions Unstructured recommendations for patients with symptomatic PAD to exercise in the community are not efficacious. Community walking programs with more feedback and monitoring offer improvements in walking performance for patients with claudication and may bypass some obstacles associated with facility-based exercise programs. PMID:24103409

The relationship between primary healthcare providers and their external supervisors in Rwanda

PubMed Central

Itangishaka, Sylvere

2017-01-01

Background External supervision of Rwandan primary healthcare facilities unfolds as an interaction between supervisors and healthcare providers. Their relationship has not been thoroughly studied in Rwanda, and rarely in Africa. Aim To explore perceived characteristics and effects of the relationship between providers in public primary healthcare facilities and their external supervisors in Rwanda. Setting We conducted three focus group discussions with primary healthcare providers (n = 16), three with external supervisors (n = 15) and one mixed (n = 5). Methods Focus groups were facilitated under low-moderator involvement. Findings were extracted thematically and discussed with participating and non-participating providers and supervisors. Results While external supervision is intended as a source of motivation and professional development in addition to its managerial purpose, it appeared linked to excessive evaluation anxiety among Rwandan primary healthcare providers. Supervisors related this mainly to inescapable evaluations within performance-based financing, whereas providers additionally related it to communication problems. Conclusion External supervision appeared driven by systematic performance evaluations, which may prompt a strongly asymmetric supervisory power relation and challenge intentions to explore providers’ experienced work problems. There is a risk that this may harm provider motivation, calling for careful attention to factors that influence the supervisory relationship. It is a dilemma that providers most in need of supervision to improve performance may be most unlikely to benefit from it. This study reveals a need for provider-oriented supportive supervision including constructive attention on providers who have performance difficulties, effective relationship building and communication, objective and diligent evaluation and two-way feedback channels. PMID:29113446

Assessment of multiple DWI offender restrictions

DOT National Transportation Integrated Search

1989-12-01

This report discusses nine new approaches for reducing recidivism among multiple DWI offenders: dedicated detention facilities, diversion programs, electronic monitoring, ignition interlock systems, intensive probation supervision, publishing offende...

Embedding systematic quality assessments in supportive supervision at primary healthcare level: application of an electronic Tool to Improve Quality of Healthcare in Tanzania.

PubMed

Mboya, Dominick; Mshana, Christopher; Kessy, Flora; Alba, Sandra; Lengeler, Christian; Renggli, Sabine; Vander Plaetse, Bart; Mohamed, Mohamed A; Schulze, Alexander

2016-10-13

Assessing quality of health services, for example through supportive supervision, is essential for strengthening healthcare delivery. Most systematic health facility assessment mechanisms, however, are not suitable for routine supervision. The objective of this study is to describe a quality assessment methodology using an electronic format that can be embedded in supervision activities and conducted by council health staff. An electronic Tool to Improve Quality of Healthcare (e-TIQH) was developed to assess the quality of primary healthcare provision. The e-TIQH contains six sub-tools, each covering one quality dimension: infrastructure and equipment of the facility, its management and administration, job expectations, clinical skills of the staff, staff motivation and client satisfaction. As part of supportive supervision, council health staff conduct quality assessments in all primary healthcare facilities in a given council, including observation of clinical consultations and exit interviews with clients. Using a hand-held device, assessors enter data and view results in real time through automated data analysis, permitting immediate feedback to health workers. Based on the results, quality gaps and potential measures to address them are jointly discussed and actions plans developed. For illustrative purposes, preliminary findings from e-TIQH application are presented from eight councils of Tanzania for the period 2011-2013, with a quality score <75 % classed as 'unsatisfactory'. Staff motivation (<50 % in all councils) and job expectations (≤50 %) scored lowest of all quality dimensions at baseline. Clinical practice was unsatisfactory in six councils, with more mixed results for availability of infrastructure and equipment, and for administration and management. In contrast, client satisfaction scored surprisingly high. Over time, each council showed a significant overall increase of 3-7 % in mean score, with the most pronounced improvements in staff motivation and job expectations. Given its comprehensiveness, convenient handling and automated statistical reports, e-TIQH enables council health staff to conduct systematic quality assessments. Therefore e-TIQH may not only contribute to objectively identifying quality gaps, but also to more evidence-based supervision. E-TIQH also provides important information for resource planning. Institutional and financial challenges for implementing e-TIQH on a broader scale need to be addressed.

12 CFR 555.300 - Must I inform OTS before I use electronic means or facilities?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 5 2011-01-01 2011-01-01 false Must I inform OTS before I use electronic means or facilities? 555.300 Section 555.300 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY ELECTRONIC OPERATIONS Requirements Applicable to All Savings Associations § 555.300 Must...

12 CFR 550.170 - May my other departments or affiliates use fiduciary personnel and facilities to perform other...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false May my other departments or affiliates use fiduciary personnel and facilities to perform other services? 550.170 Section 550.170 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY FIDUCIARY POWERS OF SAVINGS ASSOCIATIONS...

12 CFR 550.170 - May my other departments or affiliates use fiduciary personnel and facilities to perform other...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 5 2011-01-01 2011-01-01 false May my other departments or affiliates use fiduciary personnel and facilities to perform other services? 550.170 Section 550.170 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY FIDUCIARY POWERS OF SAVINGS ASSOCIATIONS...

Designing Effective Safety Signs, Based on a Study of Recall for Safety Signs.

ERIC Educational Resources Information Center

Berry, Dennis W.

Aside from direct supervision at a recreational facility, safety signs, if designed properly, are the most effective approach to facility safety. This study was conducted to investigate the effectiveness of various sign designs: (l) multiple concepts with text; (2) single concept with text; and (3) single concept with graphics. A discussion of…

Research study on multi-KW-DC distribution system

NASA Technical Reports Server (NTRS)

Berkery, E. A.; Krausz, A.

1975-01-01

A detailed definition of the HVDC test facility and the equipment required to implement the test program are provided. The basic elements of the test facility are illustrated, and consist of: the power source, conventional and digital supervision and control equipment, power distribution harness and simulated loads. The regulated dc power supplies provide steady-state power up to 36 KW at 120 VDC. Power for simulated line faults will be obtained from two banks of 90 ampere-hour lead-acid batteries. The relative merits of conventional and multiplexed power control will be demonstrated by the Supervision and Monitor Unit (SMU) and the Automatically Controlled Electrical Systems (ACES) hardware. The distribution harness is supported by a metal duct which is bonded to all component structures and functions as the system ground plane. The load banks contain passive resistance and reactance loads, solid state power controllers and active pulse width modulated loads. The HVDC test facility is designed to simulate a power distribution system for large aerospace vehicles.

[Implementation of the new drinking water regulation section sign 18: monitoring of drinking water systems in houses--water for public use].

PubMed

Hentschel, W; Voigt, K; Heudorf, U

2006-08-01

The monitoring of drinking water based on the drinking water regulation is one of the central tasks of public health authorities in Germany. With the coming into force of the new drinking water regulation in the year 2003 also water supply plants "from which water is made available for the public, in particular in schools, kindergartens, hospitals, restaurants and other communal facilities" must be supervised for the first time (TrinkwV section sign 18). Thus, for Frankfurt/Main the number of the facilities/objects which are to be supervised rose from approx. 300 to approx. 4,700. Since appropriate expansion of personnel was not possible, innovative solutions were in demand for implementation of these tasks. These are introduced here.

Barriers impacting the utilization of supervision techniques in genetic counseling.

PubMed

Masunga, Abigail; Wusik, Katie; He, Hua; Yager, Geoffrey; Atzinger, Carrie

2014-12-01

Clinical supervision is an essential element in training genetic counselors. Although live supervision has been identified as the most common supervision technique utilized in genetic counseling, there is limited information on factors influencing its use as well as the use of other techniques. The purpose of this study was to identify barriers supervisors face when implementing supervision techniques. All participants (N = 141) reported utilizing co-counseling. This was most used with novice students (96.1%) and intermediate students (93.7%). Other commonly used techniques included live supervision where the supervisor is silent during session (98.6%) which was used most frequently with advanced students (94.0%), and student self-report (64.7%) used most often with advanced students (61.2%). Though no barrier to these commonly used techniques was identified by a majority of participants, the most frequently reported barriers included time and concern about patient's welfare. The remaining supervision techniques (live remote observation, video, and audio recording) were each used by less than 10% of participants. Barriers that significantly influenced use of these techniques included lack of facilities/equipment and concern about patient reactions to technique. Understanding barriers to implementation of supervisory techniques may allow students to be efficiently trained in the future by reducing supervisor burnout and increasing the diversity of techniques used.

The impact of a supportive supervision intervention on health workers in Niassa, Mozambique: a cluster-controlled trial.

PubMed

Madede, Tavares; Sidat, Mohsin; McAuliffe, Eilish; Patricio, Sergio Rogues; Uduma, Ogenna; Galligan, Marie; Bradley, Susan; Cambe, Isabel

2017-09-02

Regular supportive supervision is critical to retaining and motivating staff in resource-constrained settings. Previous studies have shown the particular contribution that supportive supervision can make to improving job satisfaction amongst over-stretched health workers in such settings. The Support, Train and Empower Managers (STEM) study designed and implemented a supportive supervision intervention and measured its' impact on health workers using a controlled trial design with a three-arm pre- and post-study in Niassa Province in Mozambique. Post-intervention interviews with a small sample of health workers were also conducted. The quantitative measurements of job satisfaction, emotional exhaustion and work engagement showed no statistically significant differences between end-line and baseline. The qualitative data collected from health workers post the intervention showed many positive impacts on health workers not captured by this quantitative survey. Health workers perceived an improvement in their performance and attributed this to the supportive supervision they had received from their supervisors following the intervention. Reports of increased motivation were also common. An unexpected, yet important consequence of the intervention, which participants directly attributed to the supervision intervention, was the increase in participation and voice amongst health workers in intervention facilities.

Adherence to Antimicrobial Inhalational Anthrax Prophylaxis among Postal Workers, Washington, D.C., 2001

PubMed Central

Laserson, Kayla; Fry, Alicia M.; Roy, Sharon; Hayslett, James; Grummer-Strawn, Laurence; Kettel-Khan, Laura; Schuchat, Anne

2002-01-01

In October 2001, two envelopes containing Bacillus anthracis spores were processed at the Washington, D.C., Processing and Distribution Center of the U.S. Postal Service; inhalational anthrax developed in four workers at this facility. More than 2,000 workers were advised to complete 60 days of postexposure prophylaxis to prevent inhalational anthrax. Interventions to promote adherence were carried out to support workers, and qualitative information was collected to evaluate our interventions. A quantitative survey was administered to a convenience sample of workers to assess factors influencing adherence. No anthrax infections developed in any workers involved in the interventions or interviews. Of 245 workers, 98 (40%) reported full adherence to prophylaxis, and 45 (18%) had completely discontinued it. Experiencing adverse effects to prophylaxis, anxiety, and being <45 years old were risk factors for discontinuing prophylaxis. Interventions, especially frequent visits by public health staff, proved effective in supporting adherence. PMID:12396929

SMELTING PLANT CADMIUM/ARSENIC EXPOSURE COHORT ANALYSIS

EPA Science Inventory

EPA's proposed IRIS cancer assessment (as well as OSHA, NIOSH and the European Union assessments) classify cadmium as a probable human carcinogen by inhalation exposure, based principally on data from the Globe Manufacturing facility located in the Western U.S. A major confoundi...

"Kicked out into the real world": prostate cancer patients' experiences with transitioning from hospital-based supervised exercise to unsupervised exercise in the community.

PubMed

Schmidt, Mette L K; Østergren, Peter; Cormie, Prue; Ragle, Anne-Mette; Sønksen, Jens; Midtgaard, Julie

2018-06-21

Regular exercise is recommended to mitigate the adverse effects of androgen deprivation therapy in men with prostate cancer. The purpose of this study was to explore the experience of transition to unsupervised, community-based exercise among men who had participated in a hospital-based supervised exercise programme in order to propose components that supported transition to unsupervised exercise. Participants were selected by means of purposive, criteria-based sampling. Men undergoing androgen deprivation therapy who had completed a 12-week hospital-based, supervised, group exercise intervention were invited to participate. The programme involved aerobic and resistance training using machines and included a structured transition to a community-based fitness centre. Data were collected by means of semi-structured focus group interviews and analysed using thematic analysis. Five focus group interviews were conducted with a total of 29 men, of whom 25 reported to have continued to exercise at community-based facilities. Three thematic categories emerged: Development and practice of new skills; Establishing social relationships; and Familiarising with bodily well-being. These were combined into an overarching theme: From learning to doing. Components suggested to support transition were as follows: a structured transition involving supervised exercise sessions at a community-based facility; strategies to facilitate peer support; transferable tools including an individual exercise chart; and access to 'check-ups' by qualified exercise specialists. Hospital-based, supervised exercise provides a safe learning environment. Transferring to community-based exercise can be experienced as a confrontation with the real world and can be eased through securing a structured transition, having transferable tools, sustained peer support and monitoring.

7 CFR 500.22 - Fees and conditions for use of facilities and grounds.

Code of Federal Regulations, 2013 CFR

2013-01-01

... is committed, including time used to set up before and clean up after an event. For after-hours usage of sites or facilities, an additional $40/hour will be added for supervision for each required staff... the planned use or event. (4) A 50 percent non-refundable deposit will be due at the time of a booking...

7 CFR 500.22 - Fees and conditions for use of facilities and grounds.

Code of Federal Regulations, 2014 CFR

2014-01-01

... is committed, including time used to set up before and clean up after an event. For after-hours usage of sites or facilities, an additional $40/hour will be added for supervision for each required staff... the planned use or event. (4) A 50 percent non-refundable deposit will be due at the time of a booking...

7 CFR 500.22 - Fees and conditions for use of facilities and grounds.

Code of Federal Regulations, 2011 CFR

2011-01-01

... is committed, including time used to set up before and clean up after an event. For after-hours usage of sites or facilities, an additional $40/hour will be added for supervision for each required staff... the planned use or event. (4) A 50 percent non-refundable deposit will be due at the time of a booking...

7 CFR 500.22 - Fees and conditions for use of facilities and grounds.

Code of Federal Regulations, 2012 CFR

2012-01-01

... is committed, including time used to set up before and clean up after an event. For after-hours usage of sites or facilities, an additional $40/hour will be added for supervision for each required staff... the planned use or event. (4) A 50 percent non-refundable deposit will be due at the time of a booking...

12 CFR 555.200 - How may I use or participate with others to use electronic means and facilities?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 5 2011-01-01 2011-01-01 false How may I use or participate with others to use electronic means and facilities? 555.200 Section 555.200 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY ELECTRONIC OPERATIONS Authority of Federal Savings Associations To Conduct...

Inhalability for aerosols at ultra-low windspeeds

NASA Astrophysics Data System (ADS)

Sleeth, Darrah K.; Vincent, James H.

2009-02-01

Most previous experimental studies of aerosol inhalability were conducted in wind tunnels for windspeeds greater than 0.5 ms-1. While that body of work was used to establish a convention for the inhalable fraction, results from studies in calm air chambers (for essentially zero windspeed) are being discussed as the basis of a modified criterion. However, information is lacking for windspeeds in the intermediate range, which - it so happens - pertain to most actual workplaces. With this in mind, we have developed a new experimental system to assess inhalability - and, ultimately, personal sampler performance - for aerosols with particle aerodynamic diameter within the range from about 9 to 90 μm for ultra-low windspeed environments from about 0.1 to 0.5 ms1. This new system contains an aerosol test facility, fully described elsewhere, that combines the physical attributes and performance characteristics of moving air wind tunnels and calm air chambers, both of which have featured individually in previous research. It also contains a specially-designed breathing, heated, life-sized mannequin that allows for accurate recovery of test particulate material that has been inhaled. Procedures have been developed that employ test aerosols of well-defined particle size distribution generated mechanically from narrowly-graded powders of fused alumina. Using this new system, we have conducted an extensive set of new experiments to measure the inhalability of a human subject (as represented by the mannequin), aimed at filling the current knowledge gap for conditions that are more realistic than those embodied in most previous research. These data reveal that inhalability throughout the range of interest is significantly different based on windspeed, indicating a rise in aspiration efficiency as windspeed decreases. Breathing flowrate and mode of breathing (i.e. nose versus mouth breathing) did not show significant differences for the inhalability of aerosols. On the whole however, the data obtained here are within the range of inhalability data that exist from the large body of the previous experimental work performed at the higher windspeeds. These latest findings are an important contribution to the ongoing discussion in international standards-setting bodies about the possible adjustment of the quantitative definition of what constitutes the inhalable fraction.

Users' guide to new approaches and sanctions for multiple DWI offenders

DOT National Transportation Integrated Search

1989-12-01

This guide describes nine new approaches for reducing recidivism among multiple DWI offenders: dedicated detention facilities, diversion programs, electronic monitoring, ignition interlock systems, intensive probation supervision, publishing offender...

Manganese in Air: Associations in Residents with Tremor and Motor Function

EPA Science Inventory

Objective: An environmental study examined air manganese (Mn) exposed residents of two towns in Ohio: Marietta (near a ferro-manganese smelter) and East Liverpool (EL)(adjacent to an open-storage ore packaging facility). Air Mn inhalation is associated with neuropsychological/neu...

Nursing home resident smoking policies.

PubMed

Stefanacci, Richard G; Lester, Paula E; Kohen, Izchak

2008-01-01

To identify nursing home standards related to resident smoking through a nation wide survey of directors of nursing. A national survey was distributed online and was completed by 248 directors of nursing. The directors of nurses answered questions concerning resident smoking including the criteria utilized to determine an unsafe resident smoker. For those residents identified as unsafe, the questions asked were specifically related to monitoring, staff involvement, safety precautions and policy. The results of the survey demonstrated a consistent policy practiced among facilities across the United States. The monitoring of nursing home residents is based on a resident's mental acuity, physical restrictions and equipment requirements. Once a resident was identified as a smoker at risk of harm to self or others, staff involvement ranged from distributing cigarettes to direct supervision. In addition, the majority of facilities required residents to wear fire resistant aprons and provided a fire extinguisher in smoking areas. Monitoring policies of nursing home residents who smoke starts with identifying those residents at risk based on an assessment of mental acuity, physical restrictions and equipment requirements. Those that are identified as being at risk smokers have their cigarettes controlled and distributed by nursing staff and are supervised by facility staff when smoking. This policy is implemented through written policy as well as staff education. Despite some discrepancies in the actual implementation of policies to supervise residents who smoke, the policies for assessment for at-risk smokers requiring monitoring is consistent on a national basis.

42 CFR 93.407 - HHS administrative actions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND FACILITIES PUBLIC HEALTH SERVICE POLICIES ON... cooperative agreement. (6) Special review of all requests for PHS funding. (7) Imposition of supervision... PHS funding component, and the debarring official. ...

Comparison of a direct-reading device to gravimetric methods for evaluating organic dust aerosols in an enclosed swine production environment.

PubMed

Taylor, C D; Reynolds, S J

2001-01-01

The production of livestock in enclosed facilities has become an accepted practice, driven by the need for increased efficiency. Exposure to organic dusts, containing various bioactive components, has been identified an important risk factor for the high rate of lung disease found among workers in these environments. Assessment of organic dust exposure requires technical skills and instrumentation not readily available to most agricultural enterprises. Development of a simple, cost-effective method for measuring organic dust levels would be useful in evaluating and controlling exposures in these environments. The objective of this study was to evaluate the usefulness of the direct reading MIE PDM-3 Miniram for estimating organic dust concentrations in enclosed swine production facilities. Responses from the MIE PDM-3 Miniram were compared to gravimetric methods for total and inhalable dust. Total dust determinations were conducted in accordance with the National Institute for Occupational Safety and Health (NIOSH) method 0500. Inhalable particulate mass (IPM) sampling was conducted using SKC brand IOM (Institute of Occupational Medicine) sampling cassettes, which meet the American Conference of Governmental Industrial Hygienists ACGIH criteria for inhalable dust sampling. This study design also allowed for the comparison of traditional total dust method to the IPM method, in collecting organic dusts in an agricultural setting. Fifteen sets of side-by-side samples (Miniram, total dust, and IPM) were collected over a period of six months in a swine confinement building. There were statistically significant differences in the results provided by the three sampling methods. Measurements for inhalable dust exceeded those for total dust in eleven of fifteen samples. The Miniram time-weighted average (TWA) response to the organic dust was always the lower of the three methods. A high degree of correlation was found among all three methods. The Miniram performed well under field conditions of varying temperature and humidity. The Miniram has the potential to predict the inhalable and total dust concentrations, assuming a correction factor for the organic dust being measured is applied.

Characterisation of CS Aerosol used in Mask Test Facilities

DTIC Science & Technology

2010-04-01

ultrafine particles ? Inhalation Toxicology, 1995. 7: p. 111–124. 15. Peters, A., et al., Respiratory effects are associated with the number of... ultrafine particles . American Journal of Respiratory and Critical Care Medicine, 1997. 155: p. 1376–1383. 16. Jamriska, M., L. Morawska, and B.A. Clark

46 CFR 160.151-47 - Requirements for owners or operators of servicing facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

...— (a) Ensure that servicing technicians have received sufficient information and training to follow... direct supervision of a servicing technician who has completed the requirements of either § 160.151-39 (a...

Sea ice type maps from Alaska synthetic aperture radar facility imagery: An assessment

NASA Technical Reports Server (NTRS)

Fetterer, Florence M.; Gineris, Denise; Kwok, Ronald

1994-01-01

Synthetic aperture radar (SAR) imagery received at the Alaskan SAR Facility is routinely and automatically classified on the Geophysical Processor System (GPS) to create ice type maps. We evaluated the wintertime performance of the GPS classification algorithm by comparing ice type percentages from supervised classification with percentages from the algorithm. The root mean square (RMS) difference for multiyear ice is about 6%, while the inconsistency in supervised classification is about 3%. The algorithm separates first-year from multiyear ice well, although it sometimes fails to correctly classify new ice and open water owing to the wide distribution of backscatter for these classes. Our results imply a high degree of accuracy and consistency in the growing archive of multiyear and first-year ice distribution maps. These results have implications for heat and mass balance studies which are furthered by the ability to accurately characterize ice type distributions over a large part of the Arctic.

Modeling of occupational exposure to accidentally released manufactured nanomaterials in a production facility and calculation of internal doses by inhalation

PubMed Central

Vaquero-Moralejo, Celina; Jaén, María; Lopez De Ipiña Peña, Jesús; Neofytou, Panagiotis

2016-01-01

Background Occupational exposure to manufactured nanomaterials (MNMs) and its potential health impacts are of scientific and practical interest, as previous epidemiological studies associate exposure to nanoparticles with health effects, including increased morbidity of the respiratory and the circulatory system. Objectives To estimate the occupational exposure and effective internal doses in a real production facility of TiO2 MNMs during hypothetical scenarios of accidental release. Methods Commercial software for geometry and mesh generation, as well as fluid flow and particle dispersion calculation, were used to estimate occupational exposure to MNMs. The results were introduced to in-house software to calculate internal doses in the human respiratory tract by inhalation. Results Depending on the accidental scenario, different areas of the production facility were affected by the released MNMs, with a higher dose exposure among individuals closer to the particles source. Conclusions Granted that the study of the accidental release of particles can only be performed by chance, this numerical approach provides valuable information regarding occupational exposure and contributes to better protection of personnel. The methodology can be used to identify occupational settings where the exposure to MNMs would be high during accidents, providing insight to health and safety officials. PMID:27670588

Airway foreign bodies: A critical review for a common pediatric emergency

PubMed Central

Salih, Alaaddin M; Alfaki, Musab; Alam-Elhuda, Dafalla M

2016-01-01

BACKGROUND: Airway foreign bodies (AFBs) is an interdisciplinary area between emergency medicine, pediatrics and otolaryngology. It is a life-threatening condition that is not infrequently seen; however, it is poorly covered in medical literature. Accidental aspiration of an element into airways is a widespread clinical scenario among children under 3 years, predominantly males. Moreover, it is the leading cause of infantile deaths and the fourth one among preschool children. DATA RESOURCES: A systemic search was conducted in July 2015 using PubMed/PubMed Central Database of The National Center for Biotechnology Information (NCBI) (http://www.ncbi.nlm.nih.gov/). A total of 1 767 articles were identified and most of them were meta-analyses, systematic reviews, and case series. Those thoroughly discussing assessment and management of AFBs were retrieved. RESULTS: AFBs episodes may be either witnessed or missed. Presence of a witness for the inhalation is diagnostic. The later usually present with persistent active cough. A classical triad of paroxysmal cough, wheezing, and dyspnoea/decreased air entry was reported, though many presentations have inconsistent findings. Hence, diagnosis requires high index of clinical suspicion. Flexible fibro-optic bronchoscopy is the gold standard of diagnosis, whereas inhaled objects are best retrieved by rigid bronchoscopes. CONCLUSIONS: Close supervision of pediatrics is the hallmark of prevention. Caregivers should ensure a safe surrounding milieu, including the toys their offspring play with. Immediate complications result from direct obstruction or injury by the inhaled object. Alternatively, prolonged lodging traps air and induces inflammatory response causing atelectesis and pneumonia, respectively. PMID:27006731

Dosimetric assessment from 212Pb inhalation at a thorium purification plant.

PubMed

Campos, M P; Pecequilo, B R S

2004-01-01

At the Instituto de Pesquisas Energeticas e Nucleares (IPEN), Sao Paulo, Brazil, there is a facility (thorium purification plant) where materials with high thorium concentrations are manipulated. In order to estimate afterwards the lung cancer risk for the workers, the thoron daughter (212Pb) levels were assessed and the committed effective and lung committed equivalent doses for workers in place. A total of 28 air filter samples were measured by total alpha counting through the modified Kusnetz method, to determine the 212Pb concentraion. The committed effective dose and lung committed equivalent dose due to 212Pb inhalation were derived from compartmental analysis following the ICRP 66 lung compartmental model, and ICRP 67 lead metabolic model.

Investigation of Bioterrorism-Related Anthrax, United States, 2001: Epidemiologic Findings

PubMed Central

Raghunathan, Pratima L.; Bell, Beth P.; Brechner, Ross; Bresnitz, Eddy A.; Butler, Jay C.; Cetron, Marty; Cohen, Mitch; Doyle, Timothy; Fischer, Marc; Greene, Carolyn; Griffith, Kevin S.; Guarner, Jeannette; Hadler, James L.; Hayslett, James A.; Meyer, Richard; Petersen, Lyle R.; Phillips, Michael; Pinner, Robert; Popovic, Tanja; Quinn, Conrad P.; Reefhuis, Jennita; Reissman, Dori; Rosenstein, Nancy; Schuchat, Anne; Shieh, Wun-Ju; Siegal, Larry; Swerdlow, David L.; Tenover, Fred C.; Traeger, Marc; Ward, John W.; Weisfuse, Isaac; Wiersma, Steven; Yeskey, Kevin; Zaki, Sherif; Ashford, David A.; Perkins, Bradley A.; Ostroff, Steve; Hughes, James; Fleming, David; Koplan, Jeffrey P.; Gerberding, Julie L.

2002-01-01

In October 2001, the first inhalational anthrax case in the United States since 1976 was identified in a media company worker in Florida. A national investigation was initiated to identify additional cases and determine possible exposures to Bacillus anthracis. Surveillance was enhanced through health-care facilities, laboratories, and other means to identify cases, which were defined as clinically compatible illness with laboratory-confirmed B. anthracis infection. From October 4 to November 20, 2001, 22 cases of anthrax (11 inhalational, 11 cutaneous) were identified; 5 of the inhalational cases were fatal. Twenty (91%) case-patients were either mail handlers or were exposed to worksites where contaminated mail was processed or received. B. anthracis isolates from four powder-containing envelopes, 17 specimens from patients, and 106 environmental samples were indistinguishable by molecular subtyping. Illness and death occurred not only at targeted worksites, but also along the path of mail and in other settings. Continued vigilance for cases is needed among health-care providers and members of the public health and law enforcement communities. PMID:12396909

Abuse of isobutyl nitrite inhalation (Rush) by adolescents.

PubMed

Schwartz, R H; Peary, P

1986-06-01

Isobutyl nitrite is a volatile liquid sold without a prescription as a "room odorizer" but is widely used as an inhalant to produce feelings of euphoria. Of the 173 13-22-year-olds (mean age, 16 years) clients of a long-term drug treatment facility who completed a questionnaire related to drug use, 74 (43%) admitted to having used isobutyl nitrite at least once, 22 (13%) had used the substance ten or more times, and eight (4%) used the substance 50 or more times. Inhalation of this malodorous substance leads almost universally to dizziness and lightheadedness and usually to severe symptoms of vasodilatation such as "pounding of the heart," blurred vision, and a "warm feeling." The feeling was unpleasant to 44 percent of the users in this study, and most also experienced pulsatile headache. In addition, contact dermatitis and irritation of the tracheobronchial tree and eyes occurred in some users. The primary use of this substance as an euphoric agent warrants consideration of banning its sale altogether.

Determination of in vitro lung solubility and intake-to-dose conversion factor for tritiated lanthanum nickel aluminum alloy.

PubMed

Farfán, Eduardo B; Labone, Thomas R; Staack, Gregory C; Cheng, Yung-Sung; Zhou, Yue; Varallo, Thomas P

2012-09-01

A sample of tritiated lanthanum nickel aluminum alloy (LaNi4.25Al0.75 or LANA.75) similar to that used at the Savannah River Site Tritium Facilities was analyzed to estimate the particle size distribution of this metal tritide powder and the rate at which this material dissolves in the human respiratory tract after it is inhaled. This information is used to calculate the committed effective dose received by a worker after inhaling the material. These doses, which were calculated using the same methodology given in the U.S. Department of Energy Tritium Handbook, are presented as inhalation intake-to-dose conversion factors (DCF). The DCF for this metal tritide was determined to be 9.4 × 10 Sv Bq, which is less than the DCF for tritiated water. Therefore, the radiation worker bioassay programs designed for tritiated water are adequate to monitor for intakes of this material.

76 FR 42768 - Electronic Operations

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

... DEPARTMENT OF THE TREASURY Office of Thrift Supervision Electronic Operations AGENCY: Office of... comments concerning the following information collection. Title of Proposal: Electronic Operations. OMB... with others to use, electronic means or facilities to perform any function, or provide any product or...

24 CFR 576.56 - Homeless assistance and participation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... treatment, mental health treatment, counseling, supervision, and other services essential for achieving... Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT COMMUNITY FACILITIES EMERGENCY SHELTER GRANTS PROGRAM: STEWART B. McKINNEY...

The Critical Role of Supervision in Retaining Staff in Obstetric Services: A Three Country Study

PubMed Central

McAuliffe, Eilish; Daly, Michael; Kamwendo, Francis; Masanja, Honorati; Sidat, Mohsin; de Pinho, Helen

2013-01-01

Millennium Development Goal (MDG) 5 commits us to reducing maternal mortality rates by three quarters and MDG 4 commits us to reducing child mortality by two-thirds between 1990 and 2015. In order to reach these goals, greater access to basic emergency obstetric care (EmOC) as well as comprehensive EmOC which includes safe Caesarean section, is needed.. The limited capacity of health systems to meet demand for obstetric services has led several countries to utilize mid-level cadres as a substitute to more extensively trained and more internationally mobile healthcare workers. Although this does provide greater capacity for service delivery, concern about the performance and motivation of these workers is emerging. We propose that poor leadership characterized by inadequate and unstructured supervision underlies much of the dissatisfaction and turnover that has been shown to exist amongst these mid-level healthcare workers and indeed health workers more generally. To investigate this, we conducted a large-scale survey of 1,561 mid-level cadre healthcare workers (health workers trained for shorter periods to perform specific tasks e.g. clinical officers) delivering obstetric care in Malawi, Tanzania, and Mozambique. Participants indicated the primary supervision method used in their facility and we assessed their job satisfaction and intentions to leave their current workplace. In all three countries we found robust evidence indicating that a formal supervision process predicted high levels of job satisfaction and low intentions to leave. We find no evidence that facility level factors modify the link between supervisory methods and key outcomes. We interpret this evidence as strongly supporting the need to strengthen leadership and implement a framework and mechanism for systematic supportive supervision. This will promote better job satisfaction and improve the retention and performance of obstetric care workers, something which has the potential to improve maternal and neonatal outcomes in the countdown to 2015. PMID:23555581

75 FR 56995 - Termination of Review of Sourcing Change, Foreign-Trade Subzone 61H, Baxter Healthcare of Puerto...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-17

... DEPARTMENT OF COMMERCE Foreign-Trade Zones Board [Docket 44-2010] Termination of Review of Sourcing Change, Foreign-Trade Subzone 61H, Baxter Healthcare of Puerto Rico, (Inhalation Anesthetics... chemical ingredients at the manufacturing facility of Baxter Healthcare of Puerto Rico located in Guayama...

Military Government

DTIC Science & Technology

1949-07-01

The water supply may be disrupted or poluted . ( 4) Hospital facilities and medical supplies may be extremely scarce. Dead may be found unburied and...insurance unit may supervise all insurance companies, or an income tax unit may audit internal revenue offices. (2) Other military government units carry

Secondary Vocational Horticulture Programs--An Assessment.

ERIC Educational Resources Information Center

Burnett, Michael F.; Smith, Charles W.

1983-01-01

The objectives of the study were to determine characteristics of secondary horticulture teachers, the structure of horticulture departments, funding sources, nature and scope of facilities, types of supervised occupational experience programs in which horticulture students participated, and curriculum characteristics of vocational horticulture…

7 CFR 1436.2 - Administration.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Administration. 1436.2 Section 1436.2 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF... Administration. (a) The Farm Storage Facility Loan Program will be administered under the general supervision of...

7 CFR 1436.2 - Administration.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 10 2013-01-01 2013-01-01 false Administration. 1436.2 Section 1436.2 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF... Administration. (a) The Farm Storage Facility Loan Program will be administered under the general supervision of...

7 CFR 1436.2 - Administration.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Administration. 1436.2 Section 1436.2 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF... Administration. (a) The Farm Storage Facility Loan Program will be administered under the general supervision of...

42 CFR 483.15 - Quality of life.

Code of Federal Regulations, 2010 CFR

2010-10-01

... supervised social work experience in a health care setting working directly with individuals. (h) Environment. The facility must provide— (1) A safe, clean, comfortable, and homelike environment, allowing the... environment that promotes maintenance or enhancement of each resident's quality of life. (a) Dignity. The...

7 CFR 1436.2 - Administration.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Administration. 1436.2 Section 1436.2 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF... Administration. (a) The Farm Storage Facility Loan Program will be administered under the general supervision of...

Malaria diagnostic capacity in health facilities in Ethiopia

PubMed Central

2014-01-01

Background Accurate early diagnosis and prompt treatment is one of the key strategies to control and prevent malaria in Ethiopia where both Plasmodium falciparum and Plasmodium vivax are sympatric and require different treatment regimens. Microscopy is the standard for malaria diagnosis at the health centres and hospitals whereas rapid diagnostic tests are used at community-level health posts. The current study was designed to assess malaria microscopy capacity of health facilities in Oromia Regional State and Dire Dawa Administrative City, Ethiopia. Methods A descriptive cross-sectional study was conducted from February to April 2011 in 122 health facilities, where health professionals were interviewed using a pre-tested, standardized assessment tool and facilities’ laboratory practices were assessed by direct observation. Results Of the 122 assessed facilities, 104 (85%) were health centres and 18 (15%) were hospitals. Out of 94 health facilities reportedly performing blood films, only 34 (36%) used both thin and thick smears for malaria diagnosis. The quality of stained slides was graded in 66 health facilities as excellent, good and poor quality in 11(17%), 31 (47%) and 24 (36%) respectively. Quality assurance guidelines and malaria microscopy standard operating procedures were found in only 13 (11%) facilities and 12 (10%) had involved in external quality assessment activities, and 32 (26%) had supportive supervision within six months of the survey. Only seven (6%) facilities reported at least one staff’s participation in malaria microscopy refresher training during the previous 12 months. Although most facilities, 96 (79%), had binocular microscopes, only eight (7%) had the necessary reagents and supplies to perform malaria microscopy. Treatment guidelines for malaria were available in only 38 (31%) of the surveyed facilities. Febrile patients with negative malaria laboratory test results were managed with artemether-lumefantrine or chloroquine in 51% (53/104) of assessed health facilities. Conclusions The current study indicated that most of the health facilities had basic infrastructure and equipment to perform malaria laboratory diagnosis but with significant gaps in continuous laboratory supplies and reagents, and lack of training and supportive supervision. Overcoming these gaps will be critical to ensure that malaria laboratory diagnosis is of high-quality for better patient management. PMID:25073561

Barriers to providing quality emergency obstetric care in Addis Ababa, Ethiopia: Healthcare providers' perspectives on training, referrals and supervision, a mixed methods study.

PubMed

Austin, Anne; Gulema, Hanna; Belizan, Maria; Colaci, Daniela S; Kendall, Tamil; Tebeka, Mahlet; Hailemariam, Mengistu; Bekele, Delayehu; Tadesse, Lia; Berhane, Yemane; Langer, Ana

2015-03-29

Increasing women's access to and use of facilities for childbirth is a critical national strategy to improve maternal health outcomes in Ethiopia; however coverage alone is not enough as the quality of emergency obstetric services affects maternal mortality and morbidity. Addis Ababa has a much higher proportion of facility-based births (82%) than the national average (11%), but timely provision of quality emergency obstetric care remains a significant challenge for reducing maternal mortality and improving maternal health. The purpose of this study was to assess barriers to the provision of emergency obstetric care in Addis Ababa from the perspective of healthcare providers by analyzing three factors: implementation of national referral guidelines, staff training, and staff supervision. A mixed methods approach was used to assess barriers to quality emergency obstetric care. Qualitative analyses included twenty-nine, semi-structured, key informant interviews with providers from an urban referral network consisting of a hospital and seven health centers. Quantitative survey data were collected from 111 providers, 80% (111/138) of those providing maternal health services in the same referral network. Respondents identified a lack of transportation and communication infrastructure, overcrowding at the referral hospital, insufficient pre-service and in-service training, and absence of supportive supervision as key barriers to provision of quality emergency obstetric care. Dedicated transportation and communication infrastructure, improvements in pre-service and in-service training, and supportive supervision are needed to maximize the effective use of existing human resources and infrastructure, thus increasing access to and the provision of timely, high quality emergency obstetric care in Addis Ababa, Ethiopia.

Toys in the upper aerodigestive tract: evidence on their risk as emerging from the ESFBI study.

PubMed

Foltran, Francesca; Gregori, Dario; Passàli, Desiderio; Bellussi, Luisa; Caruso, Giuseppe; Passàli, Francesco Maria; Passàli, Giulio Cesare

2011-10-01

Foreign body inhalation/aspiration or ingestion is a relatively common event in young children and, despite many efforts made in several Countries to reach acceptable safety levels for products devoted to children, small toys or toy parts are frequently mentioned among risky foreign bodies. The aim of the present study is to characterize the risk of complications and prolonged hospitalization due to toys inhalation/aspiration or ingestion according to age and gender of patients, FB characteristics and FB location, circumstances of the accident, as emerging from the ESFBI study. A retrospective study in major hospitals of 19 European Countries was realized on children aged 0-14 having inhaled/aspired or ingested a toy, with regard to the characteristics of the child and the FB (shape, volume, consistency), the FB location, the hospitalization's details and the occurrence of complications. In the years 2000-2003 a total of 2094 FB injuries occurred in children aged 0-14 years. Among them 121 (5.8%) were due to toys (mainly parts of toys) and 95 (4.5%) occurred in the lower/upper aero-digestive tract. 58 children needed hospitalization. The first determinant of a damage requiring hospitalization is the rigid consistence of the object. Almost 27% of toys related injuries happened under adults' supervision. Despite the adoption of preventive strategies, including products modification by manufacturers, has resulted in a decrease of children's mortality rate for choking in the last decades, our results seem to testify that preventive strategies imposing a regulation of industrial production, even if fundamental, are not sufficient and need to be integrated with other preventive intervention addressed to improve parents ability to be conscious of FB injuries and attentive toward a proper surveillance of children. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Performance of the first Japanese large-scale facility for radon inhalation experiments with small animals.

PubMed

Ishimori, Yuu; Mitsunobu, Fumihiro; Yamaoka, Kiyonori; Tanaka, Hiroshi; Kataoka, Takahiro; Sakoda, Akihiro

2011-07-01

A radon test facility for small animals was developed in order to increase the statistical validity of differences of the biological response in various radon environments. This paper illustrates the performances of that facility, the first large-scale facility of its kind in Japan. The facility has a capability to conduct approximately 150 mouse-scale tests at the same time. The apparatus for exposing small animals to radon has six animal chamber groups with five independent cages each. Different radon concentrations in each animal chamber group are available. Because the first target of this study is to examine the in vivo behaviour of radon and its effects, the major functions to control radon and to eliminate thoron were examined experimentally. Additionally, radon progeny concentrations and their particle size distributions in the cages were also examined experimentally to be considered in future projects.

42 CFR 410.33 - Independent diagnostic testing facility.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services... supplier of portable x-ray services, a nurse practitioner, or a clinical nurse specialist when he or she... electrophysiologic clinical specialist and permitted to provide the service under State law. (b) Supervising...

42 CFR 410.33 - Independent diagnostic testing facility.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services... supplier of portable x-ray services, a nurse practitioner, or a clinical nurse specialist when he or she... electrophysiologic clinical specialist and permitted to provide the service under State law. (b) Supervising...

42 CFR 410.33 - Independent diagnostic testing facility.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services... supplier of portable x-ray services, a nurse practitioner, or a clinical nurse specialist when he or she... electrophysiologic clinical specialist and permitted to provide the service under State law. (b) Supervising...

42 CFR 485.51 - Definition.

Code of Federal Regulations, 2011 CFR

2011-10-01

...” means a nonresidential facility that— (a) Is established and operated exclusively for the purpose of..., disabled, or sick persons, at a single fixed location, by or under the supervision of a physician except as.... May provide influenza, pneumococcal and Hepatitis B vaccines provided the applicable conditions of...

Clinical Preceptor.

ERIC Educational Resources Information Center

Gardipee, Sheila; Clemens, Glenna

A clinical preceptor is an employed registered nurse in a clinical facility who supervises and evaluates a student's performance independent of a clinical instructor. This manual is intended to assist the clinical preceptor, especially the preceptor dealing with re-entry nursing students. It encompasses a practical approach with actual situations…

Regulatory Supervision of Radiological Protection in the Russian Federation as Applied to Facility Decommissioning and Site Remediation

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

Sneve, M.K.; Shandala, N.K.

2007-07-01

The Russian Federation is carrying out major work to manage the legacy of exploitation of nuclear power and use of radioactive materials. This paper describes work on-going to provide enhanced regulatory supervision of these activities as regards radiological protection. The scope includes worker and public protection in routine operation; emergency preparedness and response; radioactive waste management, including treatment, interim storage and transport as well as final disposal; and long term site restoration. Examples examined include waste from facilities in NW Russia, including remediation of previous shore technical bases (STBs) for submarines, spent fuel and radioactive waste management from ice-breakers, andmore » decommissioning of Radio-Thermal-Generators (RTGs) used in navigational devices. Consideration is given to the identification of regulatory responsibilities among different regulators; development of necessary regulatory instruments; and development of regulatory procedures for safety case reviews and compliance monitoring and international cooperation between different regulators. (authors)« less

Decontamination and decorporation: the clinical experience

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

Poda, G.A.

1979-01-01

Decontamination and decorporation are quite interrelated when dealing with a contaminated person. Some clinical experiences from a transuranium production facility are offered. Skin decontamination is accomplished by washing with detergent and water. Stubborn cases are treated with sodium hypochlorite followed by rinsing, and emery cloth is used on more stubborn nail or finger pad contamination. If inhaled, the usual skin cleansing followed by nasal douche with normal saline decontaminates reachable areas and one of the DTPA salts given via aerosol both decontaminates and decorporates the inner recesses. Saline laxative reduces the time inhaled, and ingested particles remain in the gastro-intestinalmore » tract. Conservatism prevails in general, but most persons found to have inhaled contamination are given a single chelation within the hour of discovery and if subsequently found to have over 10% M.P.P.B. of a soluble actinide are offered further chelation. Single dose chelation has been found to be relatively innocuous and usually sufficient. The longest case of chelation therapy spanned 2-1/4 years and encompassed 123 doses of CaNa-DTPA.« less

33 CFR 106.210 - OCS Facility Security Officer (FSO).

Code of Federal Regulations, 2010 CFR

2010-07-01

..., testing and maintenance of security equipment and systems. (c) Responsibilities. In addition to any other... compliance with this part; (2) Ensure the maintenance of and supervision of the implementation of the FSP... of stores and industrial supplies in compliance with this part; (4) Where applicable, propose...

42 CFR 410.33 - Independent diagnostic testing facility.

Code of Federal Regulations, 2010 CFR

2010-10-01

... supplier of portable x-ray services, a nurse practitioner, or a clinical nurse specialist when he or she... furnished by a clinical psychologist or a qualified independent psychologist as defined in program... electrophysiologic clinical specialist and permitted to provide the service under State law. (b) Supervising...

Influence of provider type (nurse anesthetist or resident physician), staff assignments, and other covariates on daily evaluations of anesthesiologists' quality of supervision.

PubMed

Dexter, Franklin; Ledolter, Johannes; Smith, Thomas C; Griffiths, David; Hindman, Bradley J

2014-09-01

At many U.S. healthcare facilities, supervision of anesthesiology residents and/or Certified Registered Nurse Anesthetists (CRNAs) is a major daily responsibility of anesthesiologists. Our department implemented a daily process by which the supervision provided by each anesthesiologist working in operating rooms was evaluated by the anesthesiology resident(s) and CRNA(s) with whom they worked the previous day. Requests for evaluation were sent daily via e-mail to each resident and CRNA after working in an operating room. Supervision scores were analyzed after 6 months, and aligned with the cases' American Society of Anesthesiologists Relative Value Guide units. (1) Mean monthly evaluation completion rates exceeded 85% (residents P = 0.0001, CRNAs P = 0.0005). (2) Pairwise by anesthesiologist, residents and CRNAs mean supervision scores were correlated (P < 0.0001), but residents assigned greater scores than did CRNAs (P < 0.0001). The pairwise differences between residents and CRNAs were heterogeneous among anesthesiologists (P < 0.0001). (3) Anesthesiologist supervision scores provided by residents were: (a) greater when a resident had more units of work that day with the rated anesthesiologist (P < 0.0001), and (b) less when the anesthesiologist had more units of work that same day with other providers (P < 0.0001). However, the relationships were unimportantly small, Kendall τb = +0.083 ± 0.014 (SE) and τb = -0.057 ± 0.014, respectively. The correlations were even less among the CRNAs, τb = -0.029 ± 0.013 and τb = -0.004 ± 0.012, respectively. (4) There also was unimportantly small association between a resident's or CRNA's mean score for an anesthesiologist and the number of days worked together (τb = -0.069 ± 0.023 and τb = +0.038 ± 0.020, respectively). Although the attributes that residents and CRNA perceive as constituting "supervision" significantly share commonalities, supervision scores should be analyzed separately for residents and CRNAs. Although mean supervision scores differ markedly among anesthesiologists, supervision scores are influenced negligibly by staff assignments (e.g., how busy the anesthesiologist is with other operating rooms).

Surgical resident supervision in the operating room and outcomes of care in Veterans Affairs hospitals.

PubMed

Itani, Kamal M F; DePalma, Ralph G; Schifftner, Tracy; Sanders, Karen M; Chang, Barbara K; Henderson, William G; Khuri, Shukri F

2005-11-01

There has been concern that a reduced level of surgical resident supervision in the operating room (OR) is correlated with worse patient outcomes. Until September 2004, Veterans' Affairs (VA) hospitals entered in the surgical record level 3 supervision on every surgical case when the attending physician was available but not physically present in the OR or the OR suite. In this study, we assessed the impact of level 3 on risk-adjusted morbidity and mortality in the VA system. Surgical cases entered into the National Surgical Quality Improvement Program database between 1998 and 2004, from 99 VA teaching facilities, were included in a logistic regression analysis for each year. Level 3 versus all other levels of supervision were forced into the model, and patient characteristics then were selected stepwise to arrive at a final model. Confidence limits for the odds ratios were calculated by profile likelihood. A total of 610,660 cases were available for analysis. Thirty-day mortality and morbidity rates were reported in 14,441 (2.36%) and 63,079 (10.33%) cases, respectively. Level 3 supervision decreased from 8.72% in 1998 to 2.69% in 2004. In the logistic regression analysis, the odds ratios for mortality for level 3 ranged from .72 to 1.03. Only in the year 2000 were the odds ratio for mortality statistically significant at the .05 level (odds ratio, .72; 95% confidence interval, .594-.858). For morbidity, the odds ratios for level 3 supervision ranged from .66 to 1.01, and all odds ratios except for the year 2004 were statistically significant. Between 1998 and 2004, the level of resident supervision in the OR did not affect clinical outcomes adversely for surgical patients in the VA teaching hospitals.

Disaggregating the Relationship Between Schools and Crime: A Spatial Analysis

ERIC Educational Resources Information Center

Murray, Rebecca K.; Swatt, Marc L.

2013-01-01

Although an extensive literature exists on crime in schools, surprisingly few studies have examined crime within the vicinity of schools. Schools, like other urban facilities, can generate crime by providing youth opportunities to congregate with little supervision, particularly before and after school hours. Some noteworthy studies have…

12 CFR 550.190 - Must fiduciary officers and employees be bonded?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Must fiduciary officers and employees be bonded? 550.190 Section 550.190 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY FIDUCIARY POWERS OF SAVINGS ASSOCIATIONS Exercising Fiduciary Powers Fiduciary Personnel and Facilities...

28 CFR 541.21 - Conditions of disciplinary segregation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... facility and under the supervision and control of the medical staff. (2) Cell occupancy. The number of... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Conditions of disciplinary segregation... inmate housed in a special housing unit in a cell either alone or with other inmates, separated from the...

Music in Australian Schools.

ERIC Educational Resources Information Center

Bartle, Graham

This document is an English-language abstract (approximately 1,500 words) of a survey of music in Australian schools. The survey included all types of schools, and includes facilities and equipment for musical education, and the use made of them. The courses of study, organization of musical activities, finance, supervision, teacher training, and…

12 CFR 550.190 - Must fiduciary officers and employees be bonded?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 5 2011-01-01 2011-01-01 false Must fiduciary officers and employees be bonded? 550.190 Section 550.190 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY FIDUCIARY POWERS OF SAVINGS ASSOCIATIONS Exercising Fiduciary Powers Fiduciary Personnel and Facilities...

Administration of Computer Resources.

ERIC Educational Resources Information Center

Franklin, Gene F.

Computing at Stanford University has, until recently, been performed at one of five facilities. The Stanford hospital operates an IBM 370/135 mainly for administrative use. The university business office has an IBM 370/145 for its administrative needs and support of the medical clinic. Under the supervision of the Stanford Computation Center are…

9 CFR 98.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.2 Definitions. The following terms, when used in this... supervision of such government. Approved embryo transfer unit. A facility approved or licensed by the national...

9 CFR 98.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.2 Definitions. The following terms, when used in this... supervision of such government. Approved embryo transfer unit. A facility approved or licensed by the national...

9 CFR 98.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... EMBRYOS AND ANIMAL SEMEN Ruminant and Swine Embryos from Regions Free of Rinderpest and Foot-and-Mouth Disease; and Embryos of Horses and Asses § 98.2 Definitions. The following terms, when used in this... supervision of such government. Approved embryo transfer unit. A facility approved or licensed by the national...

Improving quality of reproductive health care in Senegal through formative supervision: results from four districts.

PubMed

Suh, Siri; Moreira, Philippe; Ly, Moussa

2007-11-29

In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. This study evaluated changes in service quality and community involvement after two rounds of supervision in 45 health facilities in four districts of Senegal. We used checklists to assess quality in four areas of service delivery: infrastructure, staff and services management, record-keeping, and technical competence. We also measured community involvement in improving service quality using the completion rates of action plans. The most notable improvement across regions was in infection prevention.Management of staff, services, and logistics also consistently improved across the four districts. Record-keeping skills showed variable but lower improvement by region. The completion rates of action plans suggest that communities are engaged in improving service quality in all four districts. Formative supervision can improve the quality of reproductive health services, especially in areas where there is on-site skill building and refresher training. This approach can also mobilize communities to participate in improving service quality.

Improving quality of reproductive health care in Senegal through formative supervision: results from four districts

PubMed Central

Suh, Siri; Moreira, Philippe; Ly, Moussa

2007-01-01

Background In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. Methods This study evaluated changes in service quality and community involvement after two rounds of supervision in 45 health facilities in four districts of Senegal. We used checklists to assess quality in four areas of service delivery: infrastructure, staff and services management, record-keeping, and technical competence. We also measured community involvement in improving service quality using the completion rates of action plans. Results The most notable improvement across regions was in infection prevention. Management of staff, services, and logistics also consistently improved across the four districts. Record-keeping skills showed variable but lower improvement by region. The completion rates of action plans suggest that communities are engaged in improving service quality in all four districts. Conclusion Formative supervision can improve the quality of reproductive health services, especially in areas where there is on-site skill building and refresher training. This approach can also mobilize communities to participate in improving service quality. PMID:18047678

Human health risk assessment of occupational and residential exposures to dechlorane plus in the manufacturing facility area in China and comparison with e-waste recycling site.

PubMed

Wang, De-Gao; Alaee, Mehran; Byer, Jonathan D; Brimble, Samantha; Pacepavicius, Grazina

2013-02-15

A screening level human health risk assessment based on the worst-case scenario was conducted on the occupational and residential exposures to dechlorane plus (DP) in the manufacturing facility region and an electronic-waste (e-waste) recycling site in China, which are two of the most polluted areas of DP in the world. Total estimated exposure doses (EEDs) via dietary intake, dermal contact, and inhalation was approximately 0.01 mg kg(-1) d(-1) for people living in the manufacturing facility region. In comparison, total EEDs (approximate 0.03 μg kg(-1), d(-1)) were 300-fold lower in people living near an e-waste recycling site in China. Chronic oral, dermal, and inhalation reference doses (RfDs) were estimated to be 5.0, 2.0, and 0.01 mg kg(-1)d (-1), respectively. The oral RfD was markedly greater than Mirex (2×10(-4) mg kg(-1) d(-1)) and decabromodiphenyl ether (BDE-209; 7×10(-3) mg kg(-1) d(-1)), which have been or might be replaced by DP as a flame retardant with less toxicity. Monte Carlo simulation was used to generate the probability densities and functions for the hazard index which was calculated from the EEDs and RfDs to assess the human health risk. The hazard index was three orders of magnitude lower than 1, suggesting that occupational and residential exposures were relatively safe in the manufacturing facility region and e-waste recycling site. Copyright © 2012 Elsevier B.V. All rights reserved.

A screening level risk assessment of the indirect impacts from the Columbus Waste to Energy facility in Columbus, Ohio

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

Lorber, M.; Cleverly, D.; Schaum, J.

1996-12-31

Testing for emissions of dioxins from the stack of the Columbus, Ohio Waste to Energy (WTE) municipal solid waste combustion facility in 1992 implied that dioxin emissions could approach 1,000 grams of dioxin toxic equivalents (TEQs) per year. The incinerator has been in operation since the early 1980s. Several varying activities to further evaluate or curtail emissions were conducted by local, state and federal agencies in 1994. Also in that year, US EPA`s Region 5 issued an emergency order under Section 7003 of RCRA requiring the facility to install maximum Achievable Control Technology (MACT). As part of their justification formore » this emergency order, Region 5 used a screening level risk assessment of potential indirect impacts. This paper describes this assessment. The exposure setting is a hypothetical dairy farm where individuals on the farm obtain their beef, milk, and vegetables from home sources. A 70-year exposure scenario is considered, which includes 45 years of facility operation at the pre- and post-MACT emission rates, followed by 25 years of impact due to residual soil concentrations. Soil dermal contact, inhalation, and breast milk exposures were also considered for this assessment. The source term, or dioxin loadings to this setting, were derived from air dispersion modeling of emissions from the Columbus WTE. A key finding of the assessment was that exposures to dioxin in beef and milk dominated the estimated risks, with excess cancer risk form these two pathways estimated at 2.8 {times} 10{sup {minus}4}. A second key finding was that over 90% of a lifetime of impact from these two pathways, and the inhalation and vegetable ingestion pathways, has already occurred due to pre-MACT emissions.« less

A survey of size-fractionated dust levels in the U.S. wood processing industry.

PubMed

Kalliny, Medhat I; Brisolara, Joseph A; Glindmeyer, Henry; Rando, Roy

2008-08-01

A survey of size-fractionated dust exposure was carried out in 10 wood processing plants across the United States as part of a 5-year longitudinal respiratory health study. The facilities included a sawmill, plywood assembly plants, secondary wood milling operations, and factories producing finished wood products such as wood furniture and cabinets. Size-fractionated dust exposures were determined using the RespiCon Personal Particle Sampler. There were 2430 valid sets of respirable, thoracic, and inhalable dust samples collected. Overall, geometric mean (geometric standard deviation) exposure levels were found to be 1.44 (2.67), 0.35 (2.65), and 0.18 (2.54) mg/m, for the inhalable, thoracic, and respirable fractions, respectively. Averaged across all samples, the respirable fraction accounted for 16.7% of the inhalable dust mass, whereas the corresponding figure for thoracic fraction as a percentage of the inhalable fraction was 28.7%. Exposures in the furniture manufacturing plants were significantly higher than those in sawmill and plywood assembly plants, wood milling plants, and cabinet manufacturing plants, whereas the sawmill and plywood assembly plants exhibited significantly lower dust levels than the other industry segments. Among work activities, cleaning with compressed air and sanding processes produced the highest size-fractionated dust exposures, whereas forklift drivers demonstrated the lowest respirable and inhalable dust fractions and shipping processes produced the lowest thoracic dust fraction. Other common work activities such as sawing, milling, and clamping exhibited intermediate exposure levels, but there were significant differences in relative ranking of these across the various industry segments. Processing of hardwood and mixed woods generally were associated with higher exposures than were softwood and plywood, although these results were confounded with industry segment also.

Biokinetics and internal dosimetry of inhaled metal tritide particles

NASA Astrophysics Data System (ADS)

Wang, Yansheng

1998-12-01

Metal tritides (MT), stable chemical compounds of tritium, are widely used in nuclear engineering facilities. MT particles can be released as aerosols. Inhaling MT particles is a potential occupational radiation hazard. Little information is available on their dissolution behavior, biokinetics, and dosimetry. The objectives of present dissertation are to estimate dissolution rates, to develop biokinetic models, to improve internal dosimetric considerations, and to classify MT materials. This study consisted of three phases: In vitro dissolution in a simulated lung fluid, In vivo rat experiments on retention and clearance, and biokinetic modeling and dosimetric evaluation. There was a supporting study on self- absorption of tritium beta in MT particles. MT materials used in this study were titanium (Ti) and zirconium (Zr) tritides. Results shows considerable self-absorption of beta particles and their energy, even for respirable MT particles smaller than 5 μm. The self-absorption factors should be required for counting MT particle samples and for estimating absorbed dose to tissues. In vitro and in vivo dissolution data indicate that Ti and Zr tritides are poorly soluble materials. Ti tritide belongs to the W class or M type while Zr tritide can be classified as Y class or S type. Due to long retention time of the MT particles, tritium betas directly from the particles contribute over 90% of the absorbed dose to lung. The lung dose contributes most of the effective dose to the whole body. Dissolved tritium including tritiated water (HTO) and organically bound tritium (OBT) has less effect on the lung dose and effective dose. Results on the annual limit on intake (ALI) indicate that the current radiation protection guideline based on HTO is not adequate for inhalation exposure to MT particles and needs to be modified. The biokinetic models developed in this study have predictive powers to estimate the consequences of a human inhalation exposure to MT aerosols. The animal excretory patterns found from in vivo rat studies may provide useful information for nuclear engineering facilities to setup bioassay program in workplace. The applications of the results from this research are limited in their scopes.

Inhalation and dermal exposure to eight antineoplastic drugs in an industrial laundry facility.

PubMed

Fransman, Wouter; Huizer, Daan; Tuerk, Jochen; Kromhout, Hans

2007-04-01

The aims of the study were to quantify levels of dermal and inhalation exposure to antineoplastic drugs in an industrial laundry service in the Netherlands and to test the removal efficiency of the washing procedure for removal of antineoplastic drugs. During four workdays dermal and inhalation exposure to eight frequently used antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, 5-fluorouracil, etoposide, cytarabine, gemcitabine and chlorambucil) were measured for all job titles involved in handling unwashed laundry. To test the removal efficiency of the washing procedure, 10 x 10 cm sections were excised before and after the washing procedure. These sections were taken from 15 bed sheets that were collected in hospitals of patients who were treated with one of the selected antineoplastic drugs. During none of the four measurement days, detectable levels of any of the eight antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, 5-fluorouracil, etoposide, cytarabine, gemcitabine, or chlorambucil) were found on workers' skin of hands or in any of the air samples. Only four out of the 15 bed sheets from patients that were treated with antineoplastic drugs appeared to be contaminated with detectable levels of antineoplastic drugs before the washing procedure (range 13.0-3,060 ng/100 cm(2)). After the pre-washing and after the complete washing procedure, no detectable levels of any of the eight antineoplastic drugs were found anymore in the selected bed sheets. The implementation of guidelines for working with antineoplastic drugs seems to be successful in reducing exposure to antineoplastic drugs of workers in this laundry facility to an acceptable, non-detectable level and to remove antineoplastic drug contamination from bed linen.

National Assessment of Data Quality and Associated Systems-Level Factors in Malawi

PubMed Central

O'Hagan, Richael; Marx, Melissa A; Finnegan, Karen E; Naphini, Patrick; Ng'ambi, Kumbukani; Laija, Kingsley; Wilson, Emily; Park, Lois; Wachepa, Sautso; Smith, Joseph; Gombwa, Lewis; Misomali, Amos; Mleme, Tiope; Yosefe, Simeon

2017-01-01

ABSTRACT Background: Routine health data can guide health systems improvements, but poor quality of these data hinders use. To address concerns about data quality in Malawi, the Ministry of Health and National Statistical Office conducted a data quality assessment (DQA) in July 2016 to identify systems-level factors that could be improved. Methods: We used 2-stage stratified random sampling methods to select health centers and hospitals under Ministry of Health auspices, included those managed by faith-based entities, for this DQA. Dispensaries, village clinics, police and military facilities, tertiary-level hospitals, and private facilities were excluded. We reviewed client registers and monthly reports to verify availability, completeness, and accuracy of data in 4 service areas: antenatal care (ANC), family planning, HIV testing and counseling, and acute respiratory infection (ARI). We also conducted interviews with facility and district personnel to assess health management information system (HMIS) functioning and systems-level factors that may be associated with data quality. We compared systems and quality factors by facility characteristics using 2-sample t tests with Welch's approximation, and calculated verification ratios comparing total entries in registers to totals from summarized reports. Results: We selected 16 hospitals (of 113 total in Malawi), 90 health centers (of 466), and 16 district health offices (of 28) in 16 of Malawi's 28 districts. Nearly all registers were available and complete in health centers and district hospitals, but data quality varied across service areas; median verification ratios comparing register and report totals at health centers ranged from 0.78 (interquartile range [IQR]: 0.25, 1.07) for ARI and 0.99 (IQR: 0.82, 1.36) for family planning to 1.00 (IQR: 0.96, 1.00) for HIV testing and counseling and 1.00 (IQR: 0.80, 1.23) for ANC. More than half (60%) of facilities reported receiving a documented supervisory visit for HMIS in the prior 6 months. A recent supervision visit was associated with better availability of data (P=.05), but regular district- or central-level supervision was not. Use of data by the facility to track performance toward targets was associated with both improved availability (P=.04) and completeness of data (P=.02). Half of facilities had a full-time statistical clerk, but their presence did not improve the availability or completeness of data (P=.39 and P=.69, respectively). Conclusion: Findings indicate both strengths and weaknesses in Malawi's HMIS performance, with key weaknesses including infrequent data quality checks and unreliable supervision. Efforts to strengthen HMIS in low- and middle-income countries should be informed by similar assessments. PMID:28963173

Use of a medically supervised injection facility among street youth.

PubMed

Hadland, Scott E; DeBeck, Kora; Kerr, Thomas; Nguyen, Paul; Simo, Annick; Montaner, Julio S; Wood, Evan

2014-11-01

Supervised injecting facilities (SIFs) provide a sanctioned space for injection drug users and are associated with decreased overdose mortality and HIV risk behaviors among adults. Little is known about SIF use among youth. We identified factors associated with use of the Vancouver SIF, the only such facility in North America, among street youth. From September 2005 to May 2012, we collected data from the At-Risk Youth Study, a prospective cohort of street youth in Vancouver, BC, Canada. Eligible youth were aged 14-26 years. Participants reporting injection completed questionnaires at baseline and semiannually. We used generalized estimating equation logistic regression to identify factors associated with SIF use. During the study period, 42.3% of 414 injecting youth reported use of the SIF at least once. Of all SIF-using youth, 51.4% went to the facility at least weekly, and 44.5% used it for at least one-quarter of all injections. SIF-using youth were more likely to live or spend time in the neighborhood surrounding the SIF (adjusted odds ratio [AOR], 3.29; 95% confidence interval [CI], 2.38-4.54), to inject in public (AOR, 2.08; 95% CI, 1.53-2.84), or to engage in daily injection of heroin (AOR, 2.36; 95% CI, 1.72-3.24), cocaine (AOR, 2.44; 95% CI, 1.34-4.45), or crystal methamphetamine (AOR, 1.62; 95% CI, 1.13-2.31). This study, the first to examine SIF use among street youth in North America, demonstrated that the facility attracted high-frequency young drug users most at risk of blood-borne infection and overdose and those who otherwise inject in public spaces. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Children in Detention and Shelter Care: Surveying the System in New Jersey.

ERIC Educational Resources Information Center

Wood, Linda J.; And Others

The report examines the characteristics of children (primarily between the ages of 6 and 17 years) placed in 42 New Jersey detention facilities, juveniles in need of supervision (JINS) shelters, and children's shelters; and provides descriptive information and analysis on the programs, policies, and budgets of these "temporary"…

Syllabus for a Course of Instruction, Preparing the Nurse's Assistant.

ERIC Educational Resources Information Center

New York State Education Dept., Albany. Bureau of Secondary Curriculum Development.

The rapidly increasing need for persons trained to assist the nursing staff of health facilities presents occupational education programs with both an opportunity and a duty. This course syllabus is designed for the instruction of nurse's assistants and is the minimum course content acceptable for State credit. A program of supervised experience…

12 CFR 555.100 - What does this part do?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 5 2011-01-01 2011-01-01 false What does this part do? 555.100 Section 555.100 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY ELECTRONIC OPERATIONS § 555... provide products and services through electronic means and facilities. Subpart B of this part contains...

12 CFR 555.100 - What does this part do?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false What does this part do? 555.100 Section 555.100 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY ELECTRONIC OPERATIONS § 555... provide products and services through electronic means and facilities. Subpart B of this part contains...

Sports Safety. Accident Prevention and Injury Control in Physical Education, Athletics, and Recreation.

ERIC Educational Resources Information Center

Yost, Charles Peter, Ed.

This anthology of articles concerned with injury in sports and safety procedures is divided into three parts. Part One is devoted to general discussions of safety and a guiding philosophy for accident prevention. Part Two develops articles on administration and supervision, including discussions of health examination, legal liability, facilities,…

7 CFR 500.24 - Fee Schedule.

Code of Federal Regulations, 2011 CFR

2011-01-01

... natural or cultural resources or administrative facilities; or take place where members of the public are.... Cinematography: Set Preparation $30$250 plus Supervision Application FeePer Whole Day. Set up; no filming. Filming $1,500 to $3,900 Per Whole Day Sliding scale based on number of people in cast and crew and number...

7 CFR 500.24 - Fee Schedule.

Code of Federal Regulations, 2013 CFR

2013-01-01

... natural or cultural resources or administrative facilities; or take place where members of the public are.... Cinematography: Set Preparation $30 $250 plus Supervision Application FeePer Whole Day. Set up; no filming. Filming $1,500 to $3,900 Per Whole Day Sliding scale based on number of people in cast and crew and number...

7 CFR 500.24 - Fee Schedule.

Code of Federal Regulations, 2014 CFR

2014-01-01

... natural or cultural resources or administrative facilities; or take place where members of the public are.... Cinematography: Set Preparation $30$250 plus Supervision Application FeePer Whole Day. Set up; no filming. Filming $1,500 to $3,900 Per Whole Day Sliding scale based on number of people in cast and crew and number...

7 CFR 500.24 - Fee Schedule.

Code of Federal Regulations, 2012 CFR

2012-01-01

... natural or cultural resources or administrative facilities; or take place where members of the public are.... Cinematography: Set Preparation $30$250 plus Supervision Application FeePer Whole Day. Set up; no filming. Filming $1,500 to $3,900 Per Whole Day Sliding scale based on number of people in cast and crew and number...

33 CFR 127.1319 - Transfer of LHG.

Code of Federal Regulations, 2014 CFR

2014-07-01

... operator of a waterfront facility handling LHG shall notify the COTP of the time and place of each transfer...) The person in charge supervises transfers only to or from one vessel at a time unless authorized by... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Transfer of LHG. 127.1319 Section...

33 CFR 127.1319 - Transfer of LHG.

Code of Federal Regulations, 2012 CFR

2012-07-01

... operator of a waterfront facility handling LHG shall notify the COTP of the time and place of each transfer...) The person in charge supervises transfers only to or from one vessel at a time unless authorized by... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Transfer of LHG. 127.1319 Section...

33 CFR 127.1319 - Transfer of LHG.

Code of Federal Regulations, 2011 CFR

2011-07-01

... operator of a waterfront facility handling LHG shall notify the COTP of the time and place of each transfer...) The person in charge supervises transfers only to or from one vessel at a time unless authorized by... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Transfer of LHG. 127.1319 Section...

33 CFR 127.1319 - Transfer of LHG.

Code of Federal Regulations, 2010 CFR

2010-07-01

... operator of a waterfront facility handling LHG shall notify the COTP of the time and place of each transfer...) The person in charge supervises transfers only to or from one vessel at a time unless authorized by... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Transfer of LHG. 127.1319 Section...

33 CFR 127.1319 - Transfer of LHG.

Code of Federal Regulations, 2013 CFR

2013-07-01

... operator of a waterfront facility handling LHG shall notify the COTP of the time and place of each transfer...) The person in charge supervises transfers only to or from one vessel at a time unless authorized by... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Transfer of LHG. 127.1319 Section...

First Case of Bioterrorism-Related Inhalational Anthrax in the United States, Palm Beach County, Florida, 2001

PubMed Central

Wiersma, Steven T.; Rosenstein, Nancy E.; Malecki, Jean M.; Shepard, Colin W.; Raghunathan, Pratima L.; Pillai, Segaran P.; Popovic, Tanja; Quinn, Conrad P.; Meyer, Richard F.; Zaki, Sharif R.; Kumar, Savita; Bruce, Sherrie M.; Sejvar, James J.; Dull, Peter M.; Tierney, Bruce C.; Jones, Joshua D.; Perkins, Bradley A.

2002-01-01

On October 4, 2001, we confirmed the first bioterrorism-related anthrax case identified in the United States in a resident of Palm Beach County, Florida. Epidemiologic investigation indicated that exposure occurred at the workplace through intentionally contaminated mail. One additional case of inhalational anthrax was identified from the index patient’s workplace. Among 1,076 nasal cultures performed to assess exposure, Bacillus anthracis was isolated from a co-worker later confirmed as being infected, as well as from an asymptomatic mail-handler in the same workplace. Environmental cultures for B. anthracis showed contamination at the workplace and six county postal facilities. Environmental and nasal swab cultures were useful epidemiologic tools that helped direct the investigation towards the infection source and transmission vehicle. We identified 1,114 persons at risk and offered antimicrobial prophylaxis. PMID:12396910

Improved Survival of Patients With Extensive Burns: Trends in Patient Characteristics and Mortality Among Burn Patients in a Tertiary Care Burn Facility, 2004-2013.

PubMed

Strassle, Paula D; Williams, Felicia N; Napravnik, Sonia; van Duin, David; Weber, David J; Charles, Anthony; Cairns, Bruce A; Jones, Samuel W

Classic determinants of burn mortality are age, burn size, and the presence of inhalation injury. Our objective was to describe temporal trends in patient and burn characteristics, inpatient mortality, and the relationship between these characteristics and inpatient mortality over time. All patients aged 18 years or older and admitted with burn injury, including inhalation injury only, between 2004 and 2013 were included. Adjusted Cox proportional hazards regression models were used to estimate the relationship between admit year and inpatient mortality. A total of 5540 patients were admitted between 2004 and 2013. Significant differences in sex, race/ethnicity, burn mechanisms, TBSA, inhalation injury, and inpatient mortality were observed across calendar years. Patients admitted between 2011 and 2013 were more likely to be women, non-Hispanic Caucasian, with smaller burn size, and less likely to have an inhalation injury, in comparison with patients admitted from 2004 to 2010. After controlling for patient demographics, burn mechanisms, and differential lengths of stay, no calendar year trends in inpatient mortality were detected. However, a significant decrease in inpatient mortality was observed among patients with extensive burns (≥75% TBSA) in more recent calendar years. This large, tertiary care referral burn center has maintained low inpatient mortality rates among burn patients over the past 10 years. While observed decreases in mortality during this time are largely due to changes in patient and burn characteristics, survival among patients with extensive burns has improved.

Organizational characteristics influencing nursing home social service directors' qualifications: a national study.

PubMed

Simons, Kelsey V

2006-11-01

This research sought to identify organizational characteristics associated with the amount of professional qualifications among a nationally representative sample of nursing home social service directors. A self-administered survey was sent to directors in 675 facilities randomly sampled from a federal database, excluding facilities with fewer than 120 beds that are not required to staff a full-time social worker. The response rate was 45 percent (N = 299). Univariate results showed that most respondents possessed a social work degree, most lacked licensure, and few were clinically supervised. A multiple regression analysis found that nonprofit, independently owned facilities in rural areas staffed social service directors who were significantly more qualified than directors in for-profit, chain-affiliated facilities in urban and suburban areas. Facilities with fewer psychosocial deficiencies and higher occupancy rates employed social service directors with greater qualifications. The implications of these findings for social work education, practice, policy, and research are discussed.

Effects of increased overnight supervision on resident education, decision-making, and autonomy.

PubMed

Haber, Lawrence A; Lau, Catherine Y; Sharpe, Bradley A; Arora, Vineet M; Farnan, Jeanne M; Ranji, Sumant R

2012-10-01

New supervisory regulations highlight the challenge of balancing housestaff supervision and autonomy. To better understand the impact of increased supervision on residency training, we investigated housestaff perceptions of education, autonomy, and clinical decision-making before and after implementation of an in-hospital, overnight attending physician (nocturnist). We established a nocturnist program in July 2010 at our academic, tertiary care medical center. We administered pre-surveys and post-surveys of internal medicine residents on night float rotation during the 2010-2011 academic year. We surveyed residents before and after experiencing the nocturnist program. Housestaff reported an increase in the clinical value of the night float rotation (3.95 vs 4.27, P = 0.01) and the adequacy of overnight supervision (3.65 vs 4.30, P < 0.0001) without a change in decision-making autonomy (4.35 vs 4.45, P = 0.44). Trainees agreed that nocturnist supervision positively impacted patient outcomes (3.79 vs 4.30, P = 0.002). Housestaff contacted attendings more frequently for transfers from outside facilities (2.00 vs 3.20, P = 0.006), during adverse events (2.51 vs 3.25, P = 0.04), prior to ordering invasive diagnostics (1.75 vs 2.76, P = 0.004), and prior to vasopressor use (1.52 vs 2.40, P = 0.004). Residents' fear of revealing knowledge gaps and desire to make decisions independently did not change. Increased overnight supervision enhanced the clinical value of the night float rotation, increased rates of attending contact during critical clinical decision-making, and improved perception of patient care. These changes occurred without a decrease in housestaff's perceived decision-making autonomy. Copyright © 2012 Society of Hospital Medicine.

Study of the impacts of regulations affecting the acceptance of Integrated Community Energy Systems: public utility, energy facility siting and municipal franchising regulatory programs in Rhode Island. Preliminary background report

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

Feurer, D A; Weaver, C L; Gallagher, K C

1980-01-01

The Rhode Island statutes vest in the Public Utility Commission and the Division of Public Utilities the exclusive power and authority to regulate public utility companies in that state. Both bodies have been established within the Department of Business Regulation but are independent of the Department's director and are not under his jurisdiction. The jurisdiction to regulate utilities is shared by the Commission and the Division. The Commission serves as a quasi-judicial tribunal with jurisdiction, powers, and duties to hold investigations and hearings involving rates, sufficiency and resonableness of facilities, gas, electric, water, and pipeline public utilities. The administrator, whomore » is chief executive officer of the Division, is responsible for exercising the jurisdiction, supervision, powers, and duties not specifically assigned to the Commission. By virtue of his office, the chairman of the Commission serves also as the administrator and he supervises and directs the execution of all laws relating to public utilities and carriers and all regulations and orders of the Commission governing the conduct and charges of public utilities. Public utility regulatory statutes, energy facility siting programs, and municipal franchising authority are examined to identify how they may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES.« less

Examining the potential role of a supervised injection facility in Saskatoon, Saskatchewan, to avert HIV among people who inject drugs

PubMed Central

Jozaghi, Ehsan; Jackson, Asheka

2015-01-01

Background: Research predicting the public health and fiscal impact of Supervised Injection Facilities (SIFs), across different cities in Canada, has reported positive results on the reduction of HIV cases among People Who Inject Drugs (PWID). Most of the existing studies have focused on the outcomes of Insite, located in the Vancouver Downtown Eastside (DTES). Previous attention has not been afforded to other affected areas of Canada. The current study seeks to address this deficiency by assessing the cost-effectiveness of opening a SIF in Saskatoon, Saskatchewan. Methods: We used two different mathematical models commonly used in the literature, including sensitivity analyses, to estimate the number of HIV infections averted due to the establishment of a SIF in the city of Saskatoon, Saskatchewan. Results: Based on cumulative cost-effectiveness results, SIF establishment is cost-effective. The benefit to cost ratio was conservatively estimated to be 1.35 for the first two potential facilities. The study relied on 34% and 14% needle sharing rates for sensitivity analyses. The result for both sensitivity analyses and the base line estimates indicated positive prospects for the establishment of a SIF in Saskatoon. Conclusion: The opening of a SIF in Saskatoon, Saskatchewan is financially prudent in the reduction of tax payers’ expenses and averting HIV infection rates among PWID PMID:26029896

Recreation safety in municipal parks - Bloomington, Indiana and Tsukuba, Japan: a comparison study of risk management

Treesearch

Bruce Hronek

2001-01-01

Cultural differences affects the design and use of playground equipment in parks. Comparative research exploring the differences in playground facilities, parental supervision, and use was conducted on-site in Tsukuba City, Ibaraki Perfecture, Japan and Bloomington, Indiana, USA. The study examines park design, play equipment, sports fields, use patterns, and parental...

Land Use and the Legislatures: The Politics of State Innovation. Land Use Series.

ERIC Educational Resources Information Center

Rosenbaum, Nelson

This study analyzes and predicts the spread of three different types of land use legislation: mandatory local growth management, major facility siting, and critical areas protection. Chapter 2 focuses on innovative statutes that provide a new or expanded role for state agencies in supervising local control of development. The three statutes…

Developing an Effective Intervention for Incarcerated Teen Fathers: The Baby Elmo Program

ERIC Educational Resources Information Center

Brito, Natalie; Barr, Rachel; Rodriguez, Jennifer; Shauffer, Carole

2012-01-01

The absence of a father figure has been linked to very poor developmental outcomes. The Baby Elmo Program, a parenting and structured visitation program, aims to form and maintain bonds between children and their incarcerated teen fathers. The program is taught and supervised by probation staff in juvenile detention facilities. This intervention…

VLTI: First Light for the Second Generation

NASA Astrophysics Data System (ADS)

Woillez, J.; Gonté, F.; Abad, J. A.; Abadie, S.; Abuter, R.; Accardo, M.; Acuña, M.; Alonso, J.; Andolfato, L.; Avila, G.; Barriga, P. J.; Beltran, J.; Berger, J.-P.; Bollados, C.; Bourget, P.; Brast, R.; Bristow, P.; Caniguante, L.; Castillo, R.; Conzelmann, R.; Cortes, A.; Delplancke, F.; Dell Valle, D.; Derie, F.; Diaz, A.; Donoso, R.; Duhoux, Ph.; Dupuy, C.; Elao, C.; Egner, S.; Fuenteseca, E.; Fernandez, R.; Gaytan, D.; Glindemann, A.; Gonzales, J.; Guisard, S.; Hagenauer, P.; Haimerl, A.; Heinz, V.; Henriquez, J. P.; van der Heyden, P.; Hubin, N.; Huerta, R.; Jochum, L.; Kirchbauer, J.-P.; Leiva, A.; Lévêque, S.; Lizon, J.-P.; Luco, F.; Mardones, P.; Mellado, A.; Mérand, A.; Osorio, J.; Ott, J.; Pallanca, L.; Pavez, M.; Pasquini, L.; Percheron, I.; Pirard, J.-F.; Phan, D. T.; Pineda, J. C.; Pino, A.; Poupar, S.; Ramírez, A.; Reinero, C.; Riquelme, M.; Romero, J.; Rivinius, Th.; Rojas, C.; Rozas, F.; Salgado, F.; Schöller, M.; Schuhler, N.; Siclari, W.; Stephan, C.; Tamblay, R.; Tapia, M.; Tristram, K.; Valdes, G.; de Wit, W.-J.; Wright, A.; Zins, G.

2015-12-01

The Very Large Telescope Interferometer (VLTI) stopped operation on 4 March 2015 with the objective of upgrading its infrastructure in preparation for the second generation VLTI instruments GRAVITY and MATISSE. A brief account of the eight bustling months it took our interferometer to metamorphose into its second generation, under the supervision of the VLTI Facility Project, is presented.

Laundry and Drycleaning Supervisor, 18-4. Military Curriculum Materials for Vocational and Technical Education.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. National Center for Research in Vocational Education.

This instructional package for laundry/dry cleaning supervisor training has been adapted from military curriculum materials for use in vocational and technical education programs. The course is designed to train personnel to perform duties in the supervision and operation of a laundry/dry cleaning facility. This instructional package contains both…

9 CFR 381.196 - Eligibility of foreign countries for importation of poultry products into the United States.

Code of Federal Regulations, 2010 CFR

2010-01-01

... inspection in the United States with respect to: (A) Organizational structure and staffing, so as to insure... acceptability of a foreign poultry inspection system for purposes of this section shall be based on an... construction, facilities, and equipment; (D) Direct and continuous official supervision of slaughtering of...

Topical otic drugs in a multi-purpose manufacturing facility: a guide on determination and application of permitted daily exposure (PDE).

PubMed

Wiesner, Lisa; Prause, Maarten; Lovsin Barle, Ester

2018-03-01

Due to newly introduced EU GMP (Good Manufacturing Practice) guideline for Medicinal Products for Human and Veterinary use, product specific permitted daily exposure (PDE) for toxicological evaluation in multi-purpose facilities are required within a documented process for risk assessment. European Medicines Agency (EMA) guidance on setting PDE limits so far focused on systemic administration routes such as intravenous (IV), oral or inhalation. This article provides guidance on setting PDE values for risk management purposes in multi-purpose facilities for active pharmaceutical ingredients (APIs) applied as topical otic drugs to the outer ear canal. The therewith determined PDE otic, is used for the calculation of maximum safe carry-over (MSC) in manufacturing scenarios where a topical otic product is manufactured followed by another topical otic product.

Inhalation analgesia with nitrous oxide versus other analgesic techniques in hysteroscopic polypectomy: a pilot study.

PubMed

Del Valle Rubido, Cristina; Solano Calvo, Juan Antonio; Rodríguez Miguel, Antonio; Delgado Espeja, Juan José; González Hinojosa, Jerónimo; Zapico Goñi, Álvaro

2015-01-01

To show the decrease in pain and better tolerance to inhalation analgesia with a 50% equimolar mixture of nitrogen protoxide and oxygen in hysteroscopic polypectomy compared with paracervical anesthesia and a control group. One hundred six patients scheduled for office hysteroscopy and polypectomy were divided into the following 3 groups: the control group, the nitrous oxide group, and the paracervical infiltration group. Patients were assigned sequentially (Canadian Task Force classification II-1). The study took place in a hysteroscopy outpatient clinic under the supervision of a gynecologist and 2 nurses trained to cooperate in the trial. One hundred six women from Area III of Madrid Community, Spain, who had been diagnosed with endometrial polyps at a gynecology office and were scheduled for office hysteroscopy and polypectomy agreed to participate in the study. Patients in group 1 (control group) received no treatment. Group 2 received inhaled nitrous oxide and group 3 paracervical infiltration with 1% lidocaine. Pain was assessed using the visual analog scale (0-10). Pain perceived by patients was lower in the nitrous Oxide group (mean: 3.55 ± 0.60, median: 3) versus the control group (mean: 5.49 ± 1.88, median: 6, p < .05) and the paracervical infiltration group (mean: 4.22 ± 1.73, median: 5). Tolerance to pain, assessed by the medical staff using qualitative variables, was bad for the control group, very good for the nitrous oxide group, and good for the paracervical infiltration group (p < .05). There were no complications in 82% of the patients in the nitrous oxide group, whereas in the paracervical infiltration group, there were complications in more than 50% of the patients. No severe complications occurred. Nitrous oxide is a safe and effective analgesic technique for polipectomy office hysteroscopy compared with the paracervical infiltration and control groups. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Reporting a sudden death due to accidental gasoline inhalation.

PubMed

Martínez, María Antonia; Ballesteros, Salomé; Alcaraz, Rafael

2012-02-10

The investigation of uncertain fatalities requires accurate determination of the cause of death, with assessment of all factors that may have contributed to it. Gasoline is a complex and highly variable mixture of aliphatic and aromatic hydrocarbons that can lead to cardiac arrhythmias due to sensitization of the myocardium to catecholamines or acts as a simple asphyxiant if the vapors displace sufficient oxygen from the breathing atmosphere. This work describes a sudden occupational fatality involving gasoline. The importance of this petroleum distillate detection and its quantitative toxicological significance is discussed using a validated analytical method. A 51 year-old Caucasian healthy man without significant medical history was supervising the repairs of the telephone lines in a manhole near to a gas station. He died suddenly after inhaling gasoline vapors from an accidental leak. Extensive blistering and peeling of skin were observed on the skin of the face, neck, anterior chest, upper and lower extremities, and back. The internal examination showed a strong odor of gasoline, specially detected in the respiratory tract. The toxicological screening and quantitation of gasoline was performed by means of gas chromatography with flame ionization detector and confirmation was performed using gas chromatography-mass spectrometry. Disposition of gasoline in different tissues was as follows: heart blood, 35.7 mg/L; urine, not detected; vitreous humor, 1.9 mg/L; liver, 194.7 mg/kg; lung, 147.6 mg/kg; and gastric content, 116,6 mg/L (2.7 mg total). Based upon the toxicological data along with the autopsy findings, the cause of death was determined to be gasoline poisoning and the manner of death was accidental. We would like to alert on the importance of testing for gasoline, and in general for volatile hydrocarbons, in work-related sudden deaths involving inhalation of hydrocarbon vapors and/or exhaust fumes. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Occupational exposures in two industrial plants devoted to the production of ammonium phosphate fertilisers.

PubMed

Bolívar, J P; García-Tenorio, R; Mosqueda, F; Gázquez, M J; López-Coto, I; Adame, J A; Vaca, F

2013-03-01

In order to fill a gap in the open literature, occupational exposures and activity concentrations have been assessed in two NORM industrial plants, located in the south-west of Spain, devoted to the production of mono-ammonium phosphate (MAP) and di-ammonium phosphate (DAP) fertilisers. The annual effective doses received by the workers from these plants are clearly below 1 mSv yr(-1) and the contribution due to external radiation is similar to that due to inhalation. The contribution to the maximum effective doses due to inhalation of particulate matter has been estimated to be about 0.12 mSv yr(-1), while the (222)Rn concentrations inside the plants are of no concern. Consequently, no additional actions or radiological protection measures need to be taken to decrease the natural radiation received by the workers in these facilities.

Modeling Tool for Decision Support during Early Days of an Anthrax Event.

PubMed

Rainisch, Gabriel; Meltzer, Martin I; Shadomy, Sean; Bower, William A; Hupert, Nathaniel

2017-01-01

Health officials lack field-implementable tools for forecasting the effects that a large-scale release of Bacillus anthracis spores would have on public health and hospitals. We created a modeling tool (combining inhalational anthrax caseload projections based on initial case reports, effects of variable postexposure prophylaxis campaigns, and healthcare facility surge capacity requirements) to project hospitalizations and casualties from a newly detected inhalation anthrax event, and we examined the consequences of intervention choices. With only 3 days of case counts, the model can predict final attack sizes for simulated Sverdlovsk-like events (1979 USSR) with sufficient accuracy for decision making and confirms the value of early postexposure prophylaxis initiation. According to a baseline scenario, hospital treatment volume peaks 15 days after exposure, deaths peak earlier (day 5), and recovery peaks later (day 23). This tool gives public health, hospital, and emergency planners scenario-specific information for developing quantitative response plans for this threat.

Academic satisfaction among traditional and problem based learning medical students. A comparative study.

PubMed

Albarrak, Ahmed I; Mohammed, Rafiuddin; Abalhassan, Mohammed F; Almutairi, Nasser K

2013-11-01

To evaluate the academic satisfaction and importance among traditional learning (TL) and problem based learning (PBL) medical students, and to further evaluate the areas of concern in the academic education from the student's point of view. A cross sectional study was conducted at the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia from May to June 2012. The survey questionnaires were self-administered and consisted of mainly 6 sections: teaching, learning, supervision, course organization, information technology (IT) facilities, and development of skills. A total of 92 TL (males: 66 [71.7%]; females: 26 [28.3%]), and 108 PBL (males: 84 [77.8%]; females: 24 [22.1%]), with a mean age of 21.3 +/- 1.3 (TL), and 20.7 +/- 1.0 (PBL) were included in the study. The overall satisfaction rate was higher in the PBL students when compared with TL students in: teaching (84.7%/60.3%); learning (81.4%/64.5%); supervision (80%/51.5%); course organization (69.3%/46.9%); IT facilities (74.0%/58.9%); and development of skills (79.1%/53.9%). There was statistical significance difference in academic satisfaction comparing both groups of students (p

2017 LLNL Nuclear Forensics Summer Internship Program

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

Zavarin, Mavrik

The Lawrence Livermore National Laboratory (LLNL) Nuclear Forensics Summer Internship Program (NFSIP) is designed to give graduate students an opportunity to come to LLNL for 8-10 weeks of hands-on research. Students conduct research under the supervision of a staff scientist, attend a weekly lecture series, interact with other students, and present their work in poster format at the end of the program. Students can also meet staff scientists one-on-one, participate in LLNL facility tours (e.g., the National Ignition Facility and Center for Accelerator Mass Spectrometry), and gain a better understanding of the various science programs at LLNL.

Studies of Chlordane Availability and Volatility in Air Force Soils and Facilities

DTIC Science & Technology

2011-03-01

exposure, or inhalation of vapors. Chlordane primarily affects the nervous system and the digestive system causing headaches, irritability, confusion and...Administration (FDA) limits chlordane in fruits and vegetables to  ppb, and  ppb in animal fat and fish (ATSDR 1994). Exposure in the...roots of poplar and willow trees was a potentially useful tool for removing the pesticide from groundwater (Skaates et al. 2005). The potential of fungi

Can formalizing links among community health workers, accredited drug dispensing outlet dispensers, and health facility staff increase their collaboration to improve prompt access to maternal and child care? A qualitative study in Tanzania.

PubMed

Dillip, Angel; Kimatta, Suleiman; Embrey, Martha; Chalker, John C; Valimba, Richard; Malliwah, Mariam; Meena, John; Lieber, Rachel; Johnson, Keith

2017-06-19

In Tanzania, progress toward achieving the 2015 Millennium Development Goals for maternal and newborn health was slow. An intervention brought together community health workers, health facility staff, and accredited drug dispensing outlet (ADDO) dispensers to improve maternal and newborn health through a mechanism of collaboration and referral. This study explored barriers, successes, and promising approaches to increasing timely access to care by linking the three levels of health care provision. The study was conducted in the Kibaha district, where we applied qualitative approaches with in-depth interviews and focus group discussions. In-depth interview participants included retail drug shop dispensers (36), community health workers (45), and health facility staff members (15). We conducted one focus group discussion with district officials and four with mothers of newborns and children under 5 years old. Relationships among the three levels of care improved after the linkage intervention, especially for ADDO dispensers and health facility staff who previously had no formal communication pathway. The study participants perceptions of success included improved knowledge of case management and relationships among the three levels of care, more timely access to care, increased numbers of patients/customers, more meetings between community health workers and health facility staff, and a decrease in child and maternal mortality. Reported challenges included stock-outs of medicines at the health facility, participating ADDO dispensers who left to work in other regions, documentation of referrals, and lack of treatment available at health facilities on the weekend. The primary issue that threatens the sustainability of the intervention is that local council health management team members, who are responsible for facilitating the linkage, had not made any supervision visits and were therefore unaware of how the program was running. The study highlights the benefits of approaches that link different levels of care providers to improve access to maternal and child health care. To strengthen this collaboration further, health campaign platforms should include retail drug dispensers as a type of community health care provider. To increase linkage sustainability, the council health management team needs to develop feasible supervision plans.

Validation of cleaning method for various parts fabricated at a Beryllium facility

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

Davis, Cynthia M.

This study evaluated and documented a cleaning process that is used to clean parts that are fabricated at a beryllium facility at Los Alamos National Laboratory. The purpose of evaluating this cleaning process was to validate and approve it for future use to assure beryllium surface levels are below the Department of Energy’s release limits without the need to sample all parts leaving the facility. Inhaling or coming in contact with beryllium can cause an immune response that can result in an individual becoming sensitized to beryllium, which can then lead to a disease of the lungs called chronic berylliummore » disease, and possibly lung cancer. Thirty aluminum and thirty stainless steel parts were fabricated on a lathe in the beryllium facility, as well as thirty-two beryllium parts, for the purpose of testing a parts cleaning method that involved the use of ultrasonic cleaners. A cleaning method was created, documented, validated, and approved, to reduce beryllium contamination.« less

Solving the "Rural School Problem": New State Aid, Standards, and Supervision of Local Schools, 1900-1933

ERIC Educational Resources Information Center

Steffes, Tracy L.

2008-01-01

In 1918, Minnesota county superintendent Julius Arp argued that the greatest educational problem facing the American people was the Rural School Problem, saying: "There is no defect more glaring today than the inequality that exists between the educational facilities of the urban and rural communities. Rural education in the United States has…

An Ethic of Connectedness: Enacting Moral School Leadership through People and Programs

ERIC Educational Resources Information Center

Frick, J. Edward; Frick, William C.

2010-01-01

As educators, we grapple with a myriad of dilemmas and often have difficulty resolving issues that relate to curriculum and instruction, funding, facilities and supervision, to name a few. Depending on the leader(s), a variety of ethics come in to play when making decisions. The ethic of connectedness refers to community building and welfare as…

Visualizing Abolition: Two Graphic Novels and a Critical Approach to Mass Incarceration for the Composition Classroom

ERIC Educational Resources Information Center

Sutcliffe, Michael

2015-01-01

This article outlines two graphic novels and an accompanying activity designed to unpack complicated intersections between racism, poverty, and (d)evolving criminal-legal policy. Over 2 million adults are held in U.S. prison facilities, and several million more are under custodial supervision, and it has become clearly unsustainable. In the last…

Influential impacts of combined government policies for safe disposal of dead pigs on farmer behavior.

PubMed

Chen, Xiujuan; Qiu, Guangqian; Wu, Linhai; Xu, Guoyan; Wang, Jianhua; Hu, Wuyang

2017-02-01

Improper disposal of dead pigs by pig farmers may have an adverse impact on the ecological environment and food safety. In this paper, disposal of dead pigs by pig farmers in four main pig production provinces in China (Jiangsu, Anhui, Hubei, and Hunan) was empirically investigated. Then, pig farmers' awareness and evaluation of current combined government policies for the safe disposal of dead pigs were analyzed. Furthermore, the influential effects of combined government policies on the disposal of dead pigs by pig farmers were examined using Decision-Making Trial and Evaluation Laboratory (DEMATEL). Results indicated that the issue of disposal of dead pigs by farmers was very complex and was influenced by the combination of subsidy and compensation, facility and technology, and supervision and punishment policies. The findings also indicated that the different types of policies had different effects and interacted with each other. Among these three combinations, supervision and punishment policies were the most influential policies and facility and technology policies were in most urgent need to improve for regulating the current state of the disposal of dead pigs by farmers. These findings have implications for sustainable pig production.

Complete healing of chronic wounds of a lower leg with haemoglobin spray and regeneration of an accompanying severe dermatoliposclerosis with intermittent normobaric oxygen inhalation (INBOI): a case report

PubMed Central

Barnikol, Wolfgang K. R.; Pötzschke, Harald

2011-01-01

A new healing procedure has been developed on the basis of the successful treatment of therapy-resistant hypoxic (and practically anoxic) leg ulcerations located within a heavy dermatoliposclerosis. The procedure involves an initial intra-ulceral application of haemoglobin followed by the intermittent administration of normobaric oxygen via inhalation. Haemoglobin is capable of externally supplying the granulating wound bed with oxygen at low partial pressure in a physiological manner, like a micro lung, so that oxidative stress can be avoided. A long-term daily administration of oxygen from within – including the peri-ulceral skin – is achieved by intermittent normobaric oxygen inhalation (INBOI) regularly throughout the day in the form of 1-hour sessions. Using this combined healing treatment during haemoglobin applications the ulcerations healed within about 1 month, and subsequently with INBOI therapy within further approx. 4 months the peri-ulceral skin regenerated as far as the oxygenation status was concerned: The peri-ulceral transcutaneous oxygen partial pressure (tcPO2) of zero (measured during breathing of normal air) rose to a satisfactory value of approx. 35 mmHg. After 28 months of treatment, the completely hypoxic and degenerated skin on the leg had practically returned to normal with a PO2 of 45 mmHg. Furthermore, the skin dermatoliposclerosis regressed. The skin regeneration was long-lasting, which was probably related to cellular tissue regeneration with an increase in the capillary density, whereby it had to be maintained by regular oxygen inhalation (INBOI maintaining treatment). By unintended intra-individual therapy variations it is evidenced that local hypoxia was the reason for skin degeneration: 3 x 1 h oxygen inhalation were sufficient for the healing treatment; 2 x 1 h sufficed for maintenance, whereas 2 x 0.5 h did not. The new procedure carries practically no risks, is simple, cheap and effective. Whereas the application of haemoglobin requires professional supervision, the oxygen inhalation can be carried out at home following initial guidance and monitoring by a physician. Using this novel method, the therapy-resistant ulceration could be closed within 5 months, during which daily outpatient care was only necessary for 1 month. The successful outcome of the treatment in terms of improvement of oxygen supply can monitored at any time using peri-ulceral tcPO2 measurements, whereby, due to the inhomogeneity of the values, measurements at a minimum of two locations at the wound edge are strongly recommended and more measurements at more skin locations would be preferable. Besides its use in the healing of ulcers, the new procedure is also suitable for the prevention of ulceration development (prophylactic INBOI treatment) in skin rendered susceptible due to the presence of hypoxia. Here, peri-ulceral transcutaneous oxygen partial pressures of below 10 mmHg should be considered as being critical and are an indication for a prophylactic oxygen inhalation treatment. The new procedure may also be suitable even before the peri-ulceral oxygen partial pressure falls below 10 mmHg. Four measures for rehabilitation, conservation, and prevention with regard to a healed chronic wound are proposed. PMID:21468328

Nursing delegation and medication administration in assisted living.

PubMed

Mitty, Ethel; Resnick, Barbara; Allen, Josh; Bakerjian, Debra; Hertz, Judith; Gardner, Wendi; Rapp, Mary Pat; Reinhard, Susan; Young, Heather; Mezey, Mathy

2010-01-01

Assisted living (AL) residences are residential long-term care settings that provide housing, 24-hour oversight, personal care services, health-related services, or a combination of these on an as-needed basis. Most residents require some assistance with activities of daily living and instrumental activities of daily living, such as medication management. A resident plan of care (ie, service agreement) is developed to address the health and psychosocial needs of the resident. The amount and type of care provided, and the individual who provides that care, vary on the basis of state regulations and what services are provided within the facility. Some states require that an RN hold a leadership position to oversee medication management and other aspects of care within the facility. A licensed practical nurse/licensed vocational nurse can supervise the day-to-day direct care within the facility. The majority of direct care in AL settings is provided by direct care workers (DCWs), including certified nursing assistants or unlicensed providers. The scope of practice of a DCW varies by state and the legal structure within that state. In some states, the DCW is exempt from the nurse practice act, and in some states, the DCW may practice within a specific scope such as being a medication aide. In most states, however, the DCW scope of practice is conscribed, in part, by the delegation of responsibilities (such as medication administration) by a supervising RN. The issue of RN delegation has become the subject of ongoing discussion for AL residents, facilities, and regulators and for the nursing profession. The purpose of this article is to review delegation in AL and to provide recommendations for future practice and research in this area.

Impact of an Electronic Monitoring Intervention to Improve Adherence to Inhaled Medication in Patients with Asthma and Chronic Obstructive Pulmonary Disease: Study Protocol for a Randomized Controlled Trial

PubMed Central

Dieterle, Thomas; Dürr, Selina; Arnet, Isabelle; Hersberger, Kurt E; Leuppi, Jörg D

2017-01-01

Background Despite progress in pharmacological and non-pharmacological treatment in recent years, the burden of disease among patients with asthma and chronic obstructive pulmonary disease (COPD) is high and patients are frequently hospitalized due to exacerbations. Reasons for uncontrolled diseases are manifold, but are often associated with poor inhalation technique and non-adherence to the prescribed treatment plan. This causes substantial mortality, morbidity, and costs to the healthcare system. In this respect, the study of causes for non-adherence and the development of measures to increase and maintain treatment adherence in chronic diseases is of major clinical importance. Objective The primary objective of this study is to investigate the impact of using specific, validated electronic devices on adherence to inhaled medication in patients with chronic obstructive lung diseases such as asthma and COPD. Furthermore, it aims to assess the impact of a reminder and close supervision of the course of disease and quality of life. Methods In this ongoing prospective, single-blind, randomized controlled study, adherence to inhaled medication is analyzed over a 6-month period in at least 154 in- and outpatients with asthma or COPD who have experienced at least 1 exacerbation during the last year. Adherence is measured using electronic data capture devices, which save the date and time of each inhalative device actuation and transfer these data daily via a wireless connection to a Web-based database. Patients are randomly assigned to either the intervention or the control group. The clinical intervention consists of an automated and personal reminder. The intervention group receives an audio reminder and support calls in case medication has not been taken as prescribed or if rescue medication is used more frequently than pre-specified in the study protocol. During the study, participants are assessed every 2 months in the form of clinical visits. Results Recruitment started in January 2014. To date, a total of 169 patients have been recruited. Follow-up assessments are still ongoing. The study will be concluded in the first quarter of 2017. Data analysis will take place during 2017. Conclusions Few studies have investigated medication adherence in patients with chronic obstructive lung diseases. With this prospective study design and the use of state-of-the-art devices for measuring adherence, we expect scientifically relevant and clinically meaningful results that will have a substantial and positive impact on the provision of healthcare in chronically ill patients suffering from asthma or COPD. Trial Registration ClinicalTrials.gov: NCT02386722; https://clinicaltrials.gov/ct2/show/NCT02386722 (Archived by WebCite at http://www.webcitation.org/6oJq1fel0) PMID:29061556

Early educator-supervised student rocketry: The galcit rocket research project, 1936-1939. A tribute to Frank J. Malina

NASA Astrophysics Data System (ADS)

James, George S.; Winter, Frank H.

Dr. Frank J. Malina, (1912-1981) is best known to members of the International Astronautical Federation and the International Academy of Astronautics for his deep commitment to, and active involvement in, both organizations; to his associates at UNESCO for his leadership in organizing the UNESCO Division of Scientific Research; to members of the art world for his kinetic paintings and editorship of the journal Leonardo; and to aerospace historians for his co-founding, with Dr. Theodore von Karman (1881-1963), of the Jet Propulsion Laboratory with its World War II development of rocket takeoff assist units for aircraft and, after WWII, America's first production sounding rocket, the WAC Corporal. However, Frank Malina has received little recognition from aerospace educators for his equally pioneering efforts on their behalf. This paper highlights Dr. Malina's efforts not only as an early participant in educator-supported student rocketry but also in helping establishing some of the guiding principles of this field of science motivation. As Dr. Malina noted in 1968, upon becoming one of the founding members of the Supervision of Youth Research Experiments (SYRE) subcommittee of the IAF's Education Committee, the fundamental safety and educational ground rules of: (A) qualified supervision, (B) proper safety facilities, and (C) professionally designed equipment, conceived almost fifty years ago, are equally valid to today's supervised youth rocketry space-related experiment educational programs.

Quality of child healthcare at primary healthcare facilities: a national assessment of the Integrated Management of Childhood Illnesses in Afghanistan.

PubMed

Mansoor, Ghulam Farooq; Chikvaidze, Paata; Varkey, Sherin; Higgins-Steele, Ariel; Safi, Najibullah; Mubasher, Adela; Yusufi, Khaksar; Alawi, Sayed Alisha

2017-02-01

To assess quality of the national Integrated Management of Childhood Illness (IMCI) program services provided for sick children at primary health facilities in Afghanistan. Mixed methods including cross-sectional study. Thirteen (of thirty-four) provinces in Afghanistan. Observation of case management and re-examination of 177 sick children, exit interviews with caretakers and review of equipment/supplies at 44 health facilities. Introduction and scale up of Integrated Management of Childhood Illnesses at primary health care facilities. Care of sick children according to IMCI guidelines, health worker skills and essential health system elements. Thirty-two (71%) of the health workers were trained in IMCI and five (11%) received supervision in clinical case management during the past 6 months. On average, 5.4 out of 10 main assessment tasks were performed during cases observed, the index being higher in children seen by trained providers than untrained (6.3 vs 3.5, 95% CI 5.8-6.8 vs 2.9-4.1). In all, 74% of the 104 children who needed oral antibiotics received prescriptions, while 30% received complete and correct advice and 30% were overprescribed, and more so by untrained providers. Home care counseling was associated with provider training status (41.3% by trained and 24.5% by untrained). Essential oral and pre-referral injectable medicine and equipment/supplies were available in 66%, 23%, and 45% of health facilities, respectively. IMCI training improved assessment, rational use of antibiotics and counseling; further investment in IMCI in Afghanistan, continuing provider capacity building and supportive supervision for improved quality of care and counseling for sick children is needed, especially given high burden treatable childhood illness. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Preliminary Assessment of Relative Toxicity and Mutagenic Potential of 1 Nitroso-3,5-Dinitro-1,3,5-Triazacyclohexane (Mononitroso-RDX)

DTIC Science & Technology

1984-09-01

Inhalation Toxicology, Mehlman, Crammer , and Shapiro, editors, 302-344, Pathotox Publishers, Inc., Park Forest South, Illinois (1977). 8. Shimkin, M. and G...Laboratory Studies. (3) Final Rule , Pesticide Programs; Good Laboratory Practice Standards; 48 Federal Register (FR) 53963-53969, 29 November 1983. (4...Final Rule , Toxic Substances Control; Good Laboratory Practice Standards; 48 Federal Register (FR) 53922-53944, 29 November 1983. b. Facilities were

Simulation of air quality and operational cost to ventilate swine farrowing facilities in Midwest U.S. during winter

PubMed Central

Park, Jae Hong; Peters, Thomas M.; Altmaier, Ralph; Jones, Samuel M.; Gassman, Richard; Anthony, T. Renée

2017-01-01

We have developed a time-dependent simulation model to estimate in-room concentrations of multiple contaminants [ammonia (NH3), carbon dioxide (CO2), carbon monoxide (CO) and dust] as a function of increased ventilation with filtered recirculation for swine farrowing facilities. Energy and mass balance equations were used to simulate the indoor air quality (IAQ) and operational cost for a variety of ventilation conditions over a 3-month winter period for a facility located in the Midwest U.S., using simplified and real-time production parameters, comparing results to field data. A revised model was improved by minimizing the sum of squared errors (SSE) between modeled and measured NH3 and CO2. After optimizing NH3 and CO2, other IAQ results from the simulation were compared to field measurements using linear regression. For NH3, the coefficient of determination (R2) for simulation results and field measurements improved from 0.02 with the original model to 0.37 with the new model. For CO2, the R2 for simulation results and field measurements was 0.49 with the new model. When the makeup air was matched to hallway air CO2 concentrations (1,500 ppm), simulation results showed the smallest SSE. With the new model, the R2 for other contaminants were 0.34 for inhalable dust, 0.36 for respirable dust, and 0.26 for CO. Operation of the air cleaner decreased inhalable dust by 35% and respirable dust concentrations by 33%, while having no effect on NH3, CO2, in agreement with field data, and increasing operational cost by $860 (58%) for the three-month period. PMID:28775911

Technical Note: A proposal of air ventilation system design criteria for a clinical room in a heavy-ion medical facility.

PubMed

Kum, Oyeon

2018-06-01

An optimized air ventilation system design for a treatment room in Heavy-ion Medical Facility is an important issue in the aspects of nuclear safety because the activated air produced in a treatment room can directly affect the medical staff and the general public in the radiation-free area. Optimized design criteria of air ventilation system for a clinical room in 430 MeV/u carbon ion beam medical accelerator facility was performed by using a combination of MCNPX2.7.0 and CINDER'90 codes. Effective dose rate and its accumulated effective dose by inhalation and residual gamma were calculated for a normal treatment scenario (2 min irradiation for one fraction) as a function of decay time. Natural doses around the site were measured before construction and used as reference data. With no air ventilation system, the maximum effective dose rate was about 3 μSv/h (total dose of 90 mSv/y) and minimum 0.2 μSv/h (total dose of 6 mSv/y), which are over the legal limits for medical staff and for the general public. Although inhalation dose contribution was relatively small, it was considered seriously because of its long-lasting effects in the body. The integrated dose per year was 1.8 mSv/y in the radiation-free area with the 20-min rate of air ventilation system. An optimal air ventilation rate of 20 min is proposed for a clinical room, which also agrees with the best mechanical design value. © 2018 American Association of Physicists in Medicine.

Police and public health partnerships: evidence from the evaluation of Vancouver's supervised injection facility.

PubMed

DeBeck, Kora; Wood, Evan; Zhang, Ruth; Tyndall, Mark; Montaner, Julio; Kerr, Thomas

2008-05-07

In various settings, drug market policing strategies have been found to have unintended negative effects on health service use among injection drug users (IDU). This has prompted calls for more effective coordination of policing and public health efforts. In Vancouver, Canada, a supervised injection facility (SIF) was established in 2003. We sought to determine if local police impacted utilization of the SIF. We used generalized estimating equations (GEE) to prospectively identify the prevalence and correlates of being referred by local police to Vancouver's SIF among IDU participating in the Scientific Evaluation of Supervised Injecting (SEOSI) cohort during the period of December 2003 to November 2005. Among 1090 SIF clients enrolled in SEOSI, 182 (16.7%) individuals reported having ever been referred to the SIF by local police. At baseline, 22 (2.0%) participants reported that they first learned of the SIF via police. In multivariate analyses, factors positively associated with being referred to the SIF by local police when injecting in public include: sex work (Adjusted Odds Ratio [AOR] = 1.80, 95%CI 1.28-2.53); daily cocaine injection (AOR = 1.54, 95%CI 1.14-2.08); and unsafe syringe disposal (AOR = 1.46, 95%CI 1.00-2.11). These findings indicate that local police are facilitating use of the SIF by IDU at high risk for various adverse health outcomes. We further found that police may be helping to address public order concerns by referring IDU who are more likely to discard used syringes in public spaces. Our study suggests that the SIF provides an opportunity to coordinate policing and public health efforts and thereby resolve some of the existing tensions between public order and health initiatives.

2016 LLNL Nuclear Forensics Summer Program

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

Zavarin, Mavrik

The Lawrence Livermore National Laboratory (LLNL) Nuclear Forensics Summer Program is designed to give graduate students an opportunity to come to LLNL for 8–10 weeks for a hands-on research experience. Students conduct research under the supervision of a staff scientist, attend a weekly lecture series, interact with other students, and present their work in poster format at the end of the program. Students also have the opportunity to meet staff scientists one-on-one, participate in LLNL facility tours (e.g., the National Ignition Facility and Center for Accelerator Mass Spectrometry), and gain a better understanding of the various science programs at LLNL.

From chaos to calm: one jail system's struggle with suicide prevention.

PubMed

Hayes, L M

1997-01-01

This article profiles the suicide prevention practices at a large metropolitan jail, a facility that experienced nine inmate suicides in a recent 24-month period. The suicide rate in this facility was found to far exceed the rate for jails of comparable size as well as the national rate of jail suicides. The nine suicides are summarized and common features (including the issue of protective custody) of the deaths and systemic jail deficiencies are discussed. The process by which the jail system developed a suicide prevention program based upon the principles of staff training, identification/screening, communication, levels of supervision, housing, and intervention is offered.

Juvenile Offenders' Alcohol and Marijuana Trajectories: Risk and Protective Factor Effects in the Context of Time in a Supervised Facility

ERIC Educational Resources Information Center

Mauricio, Anne M.; Little, Michelle; Chassin, Laurie; Knight, George P.; Piquero, Alex R.; Losoya, Sandra H.; Vargas-Chanes, Delfino

2009-01-01

The current study modeled trajectories of substance use from ages 15 to 20 among 1,095 male serious juvenile offenders (M age = 16.54; 42% African-American, 34% Latino, 20% European-American, and 4% other ethnic/racial backgrounds) and prospectively predicted trajectories from risk and protective factors before and after controlling for time spent…

Final Natural Resource Actions Environmental Assessment

DTIC Science & Technology

2005-06-22

populations through use of insecticides and rodenticides would be accomplished under the supervision of the Base Pest Management Office and coordinated... Insecticide , Fungicide, and Rodenticide Act; DoD Directive 4150.7, DoD Pest Management Program; AFI 32-1053, Pest Management Program; and the North... insecticide and herbicide. Grand Forks AFB constructed a 2,400-square-foot pest management facility in 1996 in accor- dance with the guidelines

Comprehensive Diabetes and Non-Communicable Disease Educator in the Low-Resource Settings.

PubMed

Bhattarai, M D

2016-01-01

The role of self-management education in diabetes and other major non-communicable diseases is clearly evident. To take care of and educate people with diabetes and other major NCD under the supervision of medical professionals and for education of other health care professionals, Comprehensive Diabetes and NCD Educators are needed in the routine service in peripheral health clinics and hospitals. The areas of training of CDNCD educator should match with the cost-effective interventions for diabetes and other major NCD that are feasible and planned for implementation in primary care in the low resource settings. Most of such interventions are part of diabetes education as required for Diabetes Self-Management Education programmes and traditional Diabetes Educator. The addition of use of inhaled steroids and bronchodilator in chronic respiratory disease and identification of presenting features of cancer, also required for many people with diabetes with various such common co-morbidities, will complete the areas of training of traditional Diabetes Educator as that of CDNCD Educator. Staff nurse and health assistants, who are as such already providing routine clinical service to all patients including with diabetes and major NCD in peripheral health clinics and hospitals, are most appropriate for CDNCD Educator training. The training of CDNCD Educator, like that of traditional Diabetes Educator, requires fulfilment of sufficient hours of practical work experience under supervision and achievement of the essential competencies entailing at least 6 month or more of intensive training schedules to be eligible to appear in its final certifying examination.

Field and wind tunnel comparison of four aerosol samplers using agricultural dusts.

PubMed

Reynolds, Stephen J; Nakatsu, Jason; Tillery, Marvin; Keefe, Thomas; Mehaffy, John; Thorne, Peter S; Donham, Kelley; Nonnenmann, Matthew; Golla, Vijay; O'shaughnessy, Patrick

2009-08-01

Occupational lung disease is a significant problem among agricultural workers exposed to organic dusts. Measurements of exposure in agricultural environments in the USA have traditionally been conducted using 37-mm closed-face cassettes (CFCs) and respirable Cyclones. Inhalable aerosol samplers offer significant improvement for dose estimation studies to reduce respiratory disease. The goals of this study were to determine correction factors between the inhalable samplers (IOM and Button) and the CFC and Cyclone for dusts sampled in livestock buildings and to determine whether these factors vary among livestock types. Determination of these correction factors will allow comparison between inhalable measurements and historical measurements. Ten sets of samples were collected in swine, chicken, turkey, and dairy facilities in both Colorado and Iowa. Pairs of each sampling device were attached to the front and back of a rotating mannequin. Laboratory studies using a still-air chamber and a wind tunnel provided information regarding the effect of wind speed on sampler performance. Overall, the IOM had the lowest coefficient of variation (best precision) and was least affected by changes in wind speed. The performance of the Button was negatively impacted in poultry environments where larger (feather) particulates clogged the holes in the initial screen. The CFC/IOM ratios are important for comparisons between newer and older studies. Wind speed and dust type were both important factors affecting ratios. Based on the field studies (Table 6), a ratio of 0.56 is suggested as a conversion factor for the CFC/IOM (average for all environments because of no statistical difference). Suggested conversion factors for the Button/IOM are swine (0.57), chicken (0.80), turkey (0.53), and dairy (0.67). Any attempt to apply a conversion factor between the Cyclone and inhalable samplers is not recommended.

A Cost Analysis of Salbutamol Administration by Metered-Dose Inhalers with Spacers versus Nebulization for Patients with Wheeze in the Pediatric Emergency Department: Evidence from Observational Data in Nova Scotia.

PubMed

Spin, Paul; Sketris, Ingrid; Hill-Taylor, Barbara; Ward, Courtney; Hurley, Katrina F

2017-01-01

Despite evidence demonstrating the advantages of metered-dose inhalers with spacers (MDI-s), nebulization (NEB) remains the primary method of asthma treatment in some pediatric emergency departments (PEDs). There is a perception that delivering salbutamol by MDI-s is more costly than by NEB. This research evaluates the relative costs of MDI-s and NEB using local, hospital-specific, patient-level data. Regression models estimated associations between the salbutamol inhalation method and costs, length of stay (LOS) in the PED and hospital, and the probability of admission. Our population was a random sample of 822 patients presenting with wheeze to the PED in 2008/2009. Control variables included age, sex, triage acuity, time of PED visit, other medications, and vitals. Costs were calculated using the prices and quantities of medical resources used per treatment. Probabilistic sensitivity analysis was used. Treatment with MDI-s versus NEB was associated with an absolute decrease in hospitalization of 4.4% (p<0.05) and a 25-hour (p<0.001) reduction in average inpatient stay, after controlling for triage acuity and patient characteristics. This resulted in savings of $24/patient in the PED and $180/patient overall (p<0.001). Inpatient care accounted for more than 90% of total patient costs. Our results suggest economic gains associated with MDI-s for salbutamol inhalation in PEDs. Sensitivity analyses show that this conclusion is not affected by changes in model parameters that may differ by jurisdiction. Since most facilities already collect the data used for this study, our methods could be adopted for a cross-jurisdictional account of the cost effectiveness of MDI-s.

Supporting employees' work-family needs improves health care quality: Longitudinal evidence from long-term care.

PubMed

Okechukwu, Cassandra A; Kelly, Erin L; Bacic, Janine; DePasquale, Nicole; Hurtado, David; Kossek, Ellen; Sembajwe, Grace

2016-05-01

We analyzed qualitative and quantitative data from U.S.-based employees in 30 long-term care facilities. Analysis of semi-structured interviews from 154 managers informed quantitative analyses. Quantitative data include 1214 employees' scoring of their supervisors and their organizations on family supportiveness (individual scores and aggregated to facility level), and three outcomes: (1), care quality indicators assessed at facility level (n = 30) and collected monthly for six months after employees' data collection; (2), employees' dichotomous survey response on having additional off-site jobs; and (3), proportion of employees with additional jobs at each facility. Thematic analyses revealed that managers operate within the constraints of an industry that simultaneously: (a) employs low-wage employees with multiple work-family challenges, and (b) has firmly institutionalized goals of prioritizing quality of care and minimizing labor costs. Managers universally described providing work-family support and prioritizing care quality as antithetical to each other. Concerns surfaced that family-supportiveness encouraged employees to work additional jobs off-site, compromising care quality. Multivariable linear regression analysis of facility-level data revealed that higher family-supportive supervision was associated with significant decreases in residents' incidence of all pressure ulcers (-2.62%) and other injuries (-9.79%). Higher family-supportive organizational climate was associated with significant decreases in all falls (-17.94%) and falls with injuries (-7.57%). Managers' concerns about additional jobs were not entirely unwarranted: multivariable logistic regression of employee-level data revealed that among employees with children, having family-supportive supervision was associated with significantly higher likelihood of additional off-site jobs (RR 1.46, 95%CI 1.08-1.99), but family-supportive organizational climate was associated with lower likelihood (RR 0.76, 95%CI 0.59-0.99). However, proportion of workers with additional off-site jobs did not significantly predict care quality at facility levels. Although managers perceived providing work-family support and ensuring high care quality as conflicting goals, results suggest that family-supportiveness is associated with better care quality. Copyright © 2016 Elsevier Ltd. All rights reserved.

Supporting employees’ work-family needs improves health care quality: longitudinal evidence from long-term care

PubMed Central

Okechukwu, Cassandra A.; Kelly, Erin L.; Bacic, Janine; DePasquale, Nicole; Hurtado, David; Kossek, Ellen; Sembajwe, Grace

2016-01-01

We analyzed qualitative and quantitative data from U.S.-based employees in 30 long-term care facilities. Analysis of semi-structured interviews from 154 managers informed quantitative analyses. Quantitative data include 1,214 employees’ scoring of their supervisors and their organizations on family supportiveness (individual scores and aggregated to facility level), and three outcomes: (1), care quality indicators assessed at facility level (n=30) and collected monthly for six months after employees’ data collection; (2), employees’ dichotomous survey response on having additional off-site jobs; and (3), proportion of employees with additional jobs at each facility. Thematic analyses revealed that managers operate within the constraints of an industry that simultaneously: (a) employs low-wage employees with multiple work-family challenges, and (b) has firmly institutionalized goals of prioritizing quality of care and minimizing labor costs. Managers universally described providing work-family support and prioritizing care quality as antithetical to each other. Concerns surfaced that family-supportiveness encouraged employees to work additional jobs off-site, compromising care quality. Multivariable linear regression analysis of facility-level data revealed that higher family-supportive supervision was associated with significant decreases in residents’ incidence of all pressure ulcers (−2.62%) and other injuries (−9.79%). Higher family-supportive organizational climate was associated with significant decreases in all falls (−17.94%) and falls with injuries (−7.57%). Managers’ concerns about additional jobs were not entirely unwarranted: multivariable logistic regression of employee-level data revealed that among employees with children, having family-supportive supervision was associated with significantly higher likelihood of additional off-site jobs (RR 1.46, 95%CI 1.08-1.99), but family-supportive organizational climate was associated with lower likelihood (RR 0.76, 95%CI 0.59-0.99). However, proportion of workers with additional off-site jobs did not significantly predict care quality at facility levels. Although managers perceived providing work-family support and ensuring high care quality as conflicting goals, results suggest that family-supportiveness is associated with better care quality. PMID:27082022

Quality Assurance of Rapid Diagnostic Tests for Malaria in Routine Patient Care in Rural Tanzania

PubMed Central

McMorrow, Meredith L.; Masanja, M. Irene; Kahigwa, Elizeus; Abdulla, Salim M. K.; Kachur, S. Patrick

2010-01-01

Histidine-rich protein II (HRP2)-based malaria rapid diagnostic tests (RDTs) have shown high sensitivity and specificity for detecting Plasmodium falciparum malaria in a variety of study settings. However, RDTs are susceptible to heat and humidity and variation in individual performance, which may affect their use in field settings. We evaluated sensitivity and specificity of RDTs during routine use for malaria case management in peripheral health facilities. From December 2007 to October 2008, HRP2-based ParaHIT-f RDTs were introduced in 12 facilities without available microscopy in Rufiji District, Tanzania. Health workers received a single day of instruction on how to perform an RDT and thick blood smear. Job aids, Integrated Management of Childhood Illness guidelines, and national malaria treatment algorithms were reviewed. For quality assurance (QA), thick blood smears for reference microscopy were collected for 2 to 3 days per week from patients receiving RDTs; microscopy was not routinely performed at the health facilities. Slides were stained and read centrally within 72 hours of collection by a reference microscopist. When RDT and blood smear results were discordant, blood smears were read by additional reference microscopists blinded to earlier results. Facilities were supervised monthly by the district laboratory supervisor or a member of the study team. Ten thousand six hundred fifty (10,650) patients were tested with RDTs, and 51.5% (5,488/10,650) had a positive test result. Blood smear results were available for 3,914 patients, of whom 40.1% (1,577/3,914) were positive for P. falciparum malaria. Overall RDT sensitivity was 90.7% (range by facility 85.7–96.5%) and specificity was 73.5% (range 50.0–84.3%). Sensitivity increased with increasing parasite density. Successful implementation of RDTs was achieved in peripheral health facilities with adequate training and supervision. Quality assurance is essential to the adequate performance of any laboratory test. Centralized staining and reading of blood smears provided useful monitoring of RDT performance. However, this level of QA may not be sustainable nationwide. PMID:20065013

A Comparison of "Total Dust" and Inhalable Personal Sampling for Beryllium Exposure

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

Carter, Colleen M.

2012-05-09

In 2009, the American Conference of Governmental Industrial Hygienists (ACGIH) reduced the Beryllium (Be) 8-hr Time Weighted Average Threshold Limit Value (TLV-TWA) from 2.0 μg/m 3 to 0.05 μg/m 3 with an inhalable 'I' designation in accordance with ACGIH's particle size-selective criterion for inhalable mass. Currently, per the Department of Energy (DOE) requirements, the Lawrence Livermore National Laboratory (LLNL) is following the Occupational Health and Safety Administration (OSHA) Permissible Exposure Limit (PEL) of 2.0 μg/m 3 as an 8-hr TWA, which is also the 2005 ACGIH TLV-TWA, and an Action Level (AL) of 0.2 μg/m 3 and sampling is performedmore » using the 37mm (total dust) sampling method. Since DOE is considering adopting the newer 2009 TLV guidelines, the goal of this study was to determine if the current method of sampling using the 37mm (total dust) sampler would produce results that are comparable to what would be measured using the IOM (inhalable) sampler specific to the application of high energy explosive work at LLNL's remote experimental test facility at Site 300. Side-by-side personal sampling using the two samplers was performed over an approximately two-week period during chamber re-entry and cleanup procedures following detonation of an explosive assembly containing Beryllium (Be). The average ratio of personal sampling results for the IOM (inhalable) vs. 37-mm (total dust) sampler was 1.1:1 with a P-value of 0.62, indicating that there was no statistically significant difference in the performance of the two samplers. Therefore, for the type of activity monitored during this study, the 37-mm sampling cassette would be considered a suitable alternative to the IOM sampler for collecting inhalable particulate matter, which is important given the many practical and economic advantages that it presents. However, similar comparison studies would be necessary for this conclusion to be applied to other types of activities, where earlier studies have shown that the IOM sampler tends to collect higher concentrations of Be compared to the 37-mm cassette, which could complicate compliance with what is already an extremely low exposure limit.« less

Setting up and running an advanced light microscopy and imaging facility.

PubMed

Sánchez, Carlos; Muñoz, Ma Ángeles; Villalba, Maite; Labrador, Verónica; Díez-Guerra, F Javier

2011-07-01

During the last twenty years, interest in light microscopy and imaging techniques has grown in various fields, such as molecular and cellular biology, developmental biology, and neurobiology. In addition, the number of scientific articles and journals using these techniques is rapidly increasing. Nowadays, most research institutions require sophisticated microscopy systems to cover their investigation demands. In general, such instruments are too expensive and complex to be purchased and managed by a single laboratory or research group, so they have to be shared with other groups and supervised by specialized personnel. This is the reason why microscopy and imaging facilities are becoming so important at research institutions nowadays. In this unit, we have gathered and presented a number of issues and considerations from our own experience that we hope will be helpful when planning or setting up a new facility.

Enhancing the quality of supportive supervisory behavior in long-term care facilities.

PubMed

McGillis Hall, Linda; McGilton, Katherine S; Krejci, Janet; Pringle, Dorothy; Johnston, Erin; Fairley, Laura; Brown, Maryanne

2005-04-01

The practices of managers and registered nurses (RNs) in long-term care facilities are frequently ineffective in assisting the licensed practical nurses (LPNs) and healthcare aides (HCAs) whom they supervise. Little research exists that examines the area of supportive relationships between nursing staff and supervisors in these settings. The purpose of this study was to gather data that could improve management practices in long-term care residential facilities and enhance the quality of the supervisory relationships between supervisors (nurse managers and RNs) and care providers (HCAs and LPNs) in these settings. The study also identified factors that influence the supervisors' ability to establish supportive relationships with care providers. The challenges and barriers to nurse managers and leaders related to enacting supportive behaviors are discussed as well as their implications for long-term care settings.

Characterization of exposure to silver nanoparticles in a manufacturing facility

NASA Astrophysics Data System (ADS)

Park, Junsu; Kwak, Byoung Kyu; Bae, Eunjoo; Lee, Jeongjin; Kim, Younghun; Choi, Kyunghee; Yi, Jongheop

2009-10-01

An assessment of the extent of exposure to nanomaterials in the workplace will be helpful in improving the occupational safety of workers. It is essential that the exposure data in the workplace are concerned with risk management to evaluate and reduce worker exposure. In a manufacturing facility dealing with nanomaterials, some exposure data for gas-phase reactions are available, but much less information is available regarding liquid-phase reactions. Although the potential for inhaling nanomaterials in a liquid-phase process is less than that for gas-phase, the risks of exposure during wet-chemistry processes are not negligible. In this study, we monitored and analyzed the exposure characteristics of silver nanoparticles during a liquid-phase process in a commercial production facility. Based on the measured exposure data, the source of Ag nanoparticles emitted during the production processes was indentified and a mechanism for the growth of Ag nanoparticle released is proposed. The data reported in this study could be used to establish occupational safety guidelines in the nanotechnology workplace, especially in a liquid-phase production facility.

Quality clinical placements: The perspectives of undergraduate nursing students and their supervising nurses.

PubMed

Ford, Karen; Courtney-Pratt, Helen; Marlow, Annette; Cooper, John; Williams, Danielle; Mason, Ron

2016-02-01

Clinical placement for students of nursing is a central component of tertiary nursing programs but continues to be a complex and multifaceted experience for all stakeholders. This paper presents findings from a longitudinal 3-year study across multiple sites within the Australian context investigating the quality of clinical placements. A study using cross-sectional survey. Acute care, aged care and subacute health care facilities. A total of 1121 Tasmanian undergraduate nursing students and 932 supervising ward nurses. Survey data were collected at completion of practicum from participating undergraduate students and supervising ward nurses across the domains of "welcome and belonging," "competence and confidence: reflections on learning," and "support for learning." In addition, free text comments were sought to further inform understandings of what constitutes quality clinical placements. Overwhelmingly quantitative data demonstrate high-quality clinical placements are provided. Analysis of free text responses indicates further attention to the intersect between the student and the supervising ward nurse is required, including the differing expectations that each holds for the other. While meaningful interpersonal interactions are pivotal for learning, these seemingly concentrated on the relationship between student and their supervisor-the patient/client was not seen to be present. Meaningful learning occurs within an environment that facilitates mutual respect and shared expectations. The role the patient has in student learning was not made obvious in the results and therefore requires further investigation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Shooting gallery operation in the context of establishing a medically supervised injecting center: Sydney, Australia.

PubMed

Kimber, Jo; Dolan, Kate

2007-03-01

Shooting galleries (SGs) are illicit off-street spaces close to drug markets used for drug injection. Supervised injecting facilities (SIFs) are low threshold health services where injecting drug users (IDUs) can inject pre-obtained drugs under supervision. This study describes SG use in Kings Cross, Sydney before and after the opening of the Sydney Medically Supervised Injecting Centre (MSIC), Australia's first SIF. Operational and environmental characteristics of SGs, reasons for SG use, and willingness to use MSIC were also examined. An exploratory survey of SG users (n = 31), interviews with SG users (n = 17), and drug workers (n = 8), and counts of used needles routinely collected from SGs (6 months before and after MSIC) and visits to the MSIC (6 months after MSIC) were triangulated. We found five SGs operated during the study period. Key operational characteristics were 24-h operation, AUS $10 entry fee, 30-min time limit, and dual use for sex work. Key reasons for SG use were to avoid police, a preference not to inject in public, and assistance from SG operators in case of overdose. SG users reported high levels of willingness to use the MSIC. The number of used needles collected from SGs decreased by 69% (41,819 vs. 12,935) in the 6 months after MSIC opened, while MSIC visits increased incrementally. We conclude that injections were transferred from SGs to the MSIC, but SGs continued to accommodate injections and harm reduction outreach should be maintained.

A cost-benefit/cost-effectiveness analysis of an unsanctioned supervised smoking facility in the Downtown Eastside of Vancouver, Canada.

PubMed

Jozaghi, Ehsan

2014-11-13

Smoking crack involves the risk of transmitting diseases such as HIV and hepatitis C (HCV). The current study determines whether the formerly unsanctioned supervised smoking facility (SSF)-operated by the grassroot organization, Vancouver Area Network of Drug Users (VANDU) for the last few years-costs less than the costs incurred for health-care services as a direct consequence of not having such a program in Vancouver, Canada. The data pertaining to the attendance at the SSF was gathered in 2012-2013 by VANDU. By relying on this data, a mathematical model was employed to estimate the number of HCV infections prevented by the former facility in Vancouver's Downtown Eastside (DTES). The DTES SSF's benefit-cost ratio was conservatively estimated at 12.1:1 due to its low operating cost. The study used 70% and 90% initial pipe-sharing rates for sensitivity analysis. At 80% sharing rate, the marginal HCV cases prevented were determined to be 55 cases. Moreover, at 80% sharing rate, the marginal cost-effectiveness ratio ranges from $1,705 to $97,203. The results from both the baseline and sensitivity analysis demonstrated that the establishment of the SSF by VANDU on average had annually saved CAD$1.8 million dollars in taxpayer's money. Funding SSFs in Vancouver is an efficient and effective use of financial resources in the public health domain; therefore, Vancouver Coastal Health should actively participate in their establishment in order to reduce HCV and other blood-borne infections such as HIV within the non-injecting drug users.

The Portapotty Experiment: Neoliberal approaches to the intertwined epidemics of opioid-related overdose and HIV/HCV, and why we need cultural anthropologists in the South Bronx.

PubMed

Wolfson-Stofko, Brett; Curtis, Ric; Fuentes, Faustino; Manchess, Ed; Del Rio-Cumba, Alexis; Bennett, Alex S

2016-12-01

The following report from the field focuses on the authors' collective efforts to operate an ad hoc safer injection facility (SIF) out of portapotties (portable toilets) in an area of the South Bronx that has consistently experienced some of the highest overdose morbidity and mortality rates in New York City over the past decade (New York City Department of Health and Mental Hygiene, 2011, 2015, 2016). Safer injection facilities (also known as supervised injection facilities, drug consumption rooms, etc.) operating outside the US provide a legal, hygienic, and supervised environment for individuals to use drugs in order to minimize the likelihood of fatal overdose and the spread of blood-borne infections while reducing public injection. In the US, the operation of SIFs is federally prohibited by the federal "Crack House" statute though federal, state, and local elected officials can sanction their operation to various degrees (Beletsky, Davis, Anderson, & Burris, 2008). The activists, researchers, undergraduate students and peers from syringe exchange programs who came together to operate the portapotties discovered that they were, in many ways, emblematic of neoliberal solutions to disease prevention: primarily focused on auditing individual risk behaviors and virtually blind to the wider social context that shapes those lives. That social context - the culture of drug injection - was and is out in the open for all of us to see. Going forward, the cultural anthropologist's toolbox will be opened up and used by large groups of undergraduate students to better understand the culture of drug use and how it is changing.

Malawi's contribution to "3 by 5": achievements and challenges.

PubMed

Libamba, Edwin; Makombe, Simon D; Harries, Anthony D; Schouten, Erik J; Yu, Joseph Kwong-Leung; Pasulani, Olesi; Mhango, Eustice; Aberle-Grasse, John; Hochgesang, Mindy; Limbambala, Eddie; Lungu, Douglas

2007-02-01

Many resource-poor countries have started scaling up antiretroviral therapy (ART). While reports from individual clinics point to successful implementation, there is limited information about progress in government institutions at a national level. Malawi started national ART scale-up in 2004 using a structured approach. There is a focus on one generic, fixed-dose combination treatment with stavudine, lamivudine and nevirapine. Treatment is delivered free of charge to eligible patients with HIV and there is a standardized system for recruiting patients, monthly follow-up, registration, monitoring and reporting of cases and outcomes. All treatment sites receive quarterly supervision and evaluation. In January 2004, there were nine public sector facilities delivering ART to an estimated 4 000 patients. By December 2005, there were 60 public sector facilities providing free ART to 37,840 patients using national standardized systems. Analysis of quarterly cohort treatment outcomes at 12 months showed 80% of patients were alive, 10% dead, 9% lost to follow-up and 1% had stopped treatment. Achievements were the result of clear national ART guidelines, implementing partners working together, an intensive training schedule focused on clinical officers and nurses, a structured system of accrediting facilities for ART delivery, quarterly supervision and monitoring, and no stock-outs of antiretroviral drugs. The main challenges are to increase the numbers of children, pregnant women and patients with tuberculosis being started on ART, and to avert high early mortality and losses to follow-up. The capacity of the health sector to cope with escalating case loads and to scale up prevention alongside treatment will determine the future success of ART delivery in Malawi.

Safety analysis of long-term budesonide nasal irrigations in patients with chronic rhinosinusitis post endoscopic sinus surgery.

PubMed

Soudry, Ethan; Wang, Jane; Vaezeafshar, Reza; Katznelson, Laurence; Hwang, Peter H

2016-06-01

Although the safety of topical nasal steroids is well established for nasal spray forms, data regarding the safety of steroid irrigations is limited. We studied the effect of long-term budesonide nasal irrigations (>6 months) on hypothalamic-pituitary-adrenal axis (HPAA) function and intraocular pressure (IOP) in patients post-endoscopic sinus surgery. This was retrospective case series. Adrenal function was assessed by using the high-dose cosyntropin stimulation test. A total of 48 patients were assessed, with a mean duration of budesonide irrigations of 22 months. Stimulated cortisol levels were abnormally low in 11 patients (23%). None reported to have symptoms of adrenal suppression. Three of 4 patients who repeated the study being off budesonide for at least 1 month returned to near normal levels. Logistic regression analysis revealed that concomitant use of both nasal steroid sprays and pulmonary steroid inhalers was significantly associated with HPAA suppression (p = 0.024). Patients with low stimulated cortisol levels were able to continue budesonide irrigations under the supervision of an endocrinologist without frank clinical manifestations of adrenal insufficiency. IOP was within normal limits in all patients. Long-term use of budesonide nasal irrigations is generally safe, but asymptomatic HPAA suppression may occur in selected patients. Concomitant use of both nasal steroid sprays and pulmonary steroid inhalers while using daily budesonide nasal irrigations is associated with an increased risk. Rhinologists should be alerted to the potential risks of long-term use of budesonide nasal irrigations, and monitoring for HPAA suppression may be warranted in patients receiving long-term budesonide irrigation therapy. © 2016 ARS-AAOA, LLC.

Estimating Supplies Program: Evaluation Report

DTIC Science & Technology

2002-12-24

Inhalation, Non-vaccinated1, Incubating, Asymptomatic 352 Anthrax, Inhalation, Non-vaccinated, Prodromal 353 Anthrax, Inhalation, Non-vaccinated, Acute...B-11 PC Code PC Description 354 Anthrax, Inhalation, Vaccinated, Asymptomatic 355 Anthrax, Inhalation, Vaccinated, Prodromal 356...Anthrax, Inhalation, Vaccinated, Acute 357 Plague, Inhalation, Incubating, Asymptomatic 358 Plague, Inhalation, Acute 359 Plague Meningitis 360

Study of robotics systems applications to the space station program

NASA Technical Reports Server (NTRS)

Fox, J. C.

1983-01-01

Applications of robotics systems to potential uses of the Space Station as an assembly facility, and secondarily as a servicing facility, are considered. A typical robotics system mission is described along with the pertinent application guidelines and Space Station environmental assumptions utilized in developing the robotic task scenarios. A functional description of a supervised dual-robot space structure construction system is given, and four key areas of robotic technology are defined, described, and assessed. Alternate technologies for implementing the more routine space technology support subsystems that will be required to support the Space Station robotic systems in assembly and servicing tasks are briefly discussed. The environmental conditions impacting on the robotic configuration design and operation are reviewed.

Installation Restoration Program. Phase 2. Confirmation/Quantification. Stage 1 for Minot Air Force Base, Minot, North Dakota. Volume 3. Appendices G through M

DTIC Science & Technology

1988-10-01

TOTAL DISSOVLED SOLIDS 3523/017 1896 1918 --- 3538/024 2625 2567 --- IV. PETROLEUM HYDROCARBON DUPLICATE ANALYSIS WAS NOT DONE DUE TO INSUFFICIENT...Characterized existing hydrogeologic conditions, prepared hydrologic budgets, delineated productive aquifers, performed safe yield determinations , and...New Jersey to determine suitability for building construction. * Supervised soil borings program at large waste disposal facility in Model City, New

HERALD OF COMMUNICATIONS, 1963, VOL. 23, NO. 3 (275).

DTIC Science & Technology

all possible ways; communication facilities and computer technique help direct the industry ; carrier-telephony equipment of the type KV-12; widening of...facsimile appara tuses for the elimination of flaws in the process ing of telegrams; public supervision over the performance quality of communication workers ...simplified cable finder. Results of the completion for the best suggestion in the field of postal-service mechanization; and the training of postal workers at a polytechnic school.

Identifying and Reducing Remaining Stocks of Rinderpest Virus

PubMed Central

Visser, Dawid; Evans, Brian; Vallat, Bernard

2015-01-01

In 2011, the world was declared free from rinderpest, one of the most feared and devastating infectious diseases of animals. Rinderpest is the second infectious disease, after smallpox, to have been eradicated. However, potentially infectious rinderpest virus material remains widely disseminated among research and diagnostic facilities across the world and poses a risk for disease recurrence should it be released. Member Countries of the World Organisation for Animal Health and the Food and Agricultural Organization of the United Nations are committed to destroying remaining stocks of infectious material or ensuring that it is stored under international supervision in a limited number of approved facilities. To facilitate this commitment and maintain global freedom from rinderpest, World Organisation for Animal Health Member Countries must report annually on rinderpest material held in their countries. The first official surveys, conducted during 2013–2015, revealed that rinderpest material was stored in an unacceptably high number of facilities and countries. PMID:26584400

Development of a scalable mental healthcare plan for a rural district in Ethiopia

PubMed Central

Fekadu, Abebaw; Hanlon, Charlotte; Medhin, Girmay; Alem, Atalay; Selamu, Medhin; Giorgis, Tedla W.; Shibre, Teshome; Teferra, Solomon; Tegegn, Teketel; Breuer, Erica; Patel, Vikram; Tomlinson, Mark; Thornicroft, Graham; Prince, Martin; Lund, Crick

2016-01-01

Background Developing evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority. Aims To outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia. Method A mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation). Results The community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability. Conclusions The MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC. PMID:26447174

Implementation research to improve quality of maternal and newborn health care, Malawi.

PubMed

Brenner, Stephan; Wilhelm, Danielle; Lohmann, Julia; Kambala, Christabel; Chinkhumba, Jobiba; Muula, Adamson S; De Allegri, Manuela

2017-07-01

To evaluate the impact of a performance-based financing scheme on maternal and neonatal health service quality in Malawi. We conducted a non-randomized controlled before and after study to evaluate the effects of district- and facility-level performance incentives for health workers and management teams. We assessed changes in the facilities' essential drug stocks, equipment maintenance and clinical obstetric care processes. Difference-in-difference regression models were used to analyse effects of the scheme on adherence to obstetric care treatment protocols and provision of essential drugs, supplies and equipment. We observed 33 health facilities, 23 intervention facilities and 10 control facilities and 401 pregnant women across four districts. The scheme improved the availability of both functional equipment and essential drug stocks in the intervention facilities. We observed positive effects in respect to drug procurement and clinical care activities at non-intervention facilities, likely in response to improved district management performance. Birth assistants' adherence to clinical protocols improved across all studied facilities as district health managers supervised and coached clinical staff more actively. Despite nation-wide stock-outs and extreme health worker shortages, facilities in the study districts managed to improve maternal and neonatal health service quality by overcoming bottlenecks related to supply procurement, equipment maintenance and clinical performance. To strengthen and reform health management structures, performance-based financing may be a promising approach to sustainable improvements in quality of health care.

Estimation of inhalation flow profile using audio-based methods to assess inhaler medication adherence.

PubMed

Taylor, Terence E; Lacalle Muls, Helena; Costello, Richard W; Reilly, Richard B

2018-01-01

Asthma and chronic obstructive pulmonary disease (COPD) patients are required to inhale forcefully and deeply to receive medication when using a dry powder inhaler (DPI). There is a clinical need to objectively monitor the inhalation flow profile of DPIs in order to remotely monitor patient inhalation technique. Audio-based methods have been previously employed to accurately estimate flow parameters such as the peak inspiratory flow rate of inhalations, however, these methods required multiple calibration inhalation audio recordings. In this study, an audio-based method is presented that accurately estimates inhalation flow profile using only one calibration inhalation audio recording. Twenty healthy participants were asked to perform 15 inhalations through a placebo Ellipta™ DPI at a range of inspiratory flow rates. Inhalation flow signals were recorded using a pneumotachograph spirometer while inhalation audio signals were recorded simultaneously using the Inhaler Compliance Assessment device attached to the inhaler. The acoustic (amplitude) envelope was estimated from each inhalation audio signal. Using only one recording, linear and power law regression models were employed to determine which model best described the relationship between the inhalation acoustic envelope and flow signal. Each model was then employed to estimate the flow signals of the remaining 14 inhalation audio recordings. This process repeated until each of the 15 recordings were employed to calibrate single models while testing on the remaining 14 recordings. It was observed that power law models generated the highest average flow estimation accuracy across all participants (90.89±0.9% for power law models and 76.63±2.38% for linear models). The method also generated sufficient accuracy in estimating inhalation parameters such as peak inspiratory flow rate and inspiratory capacity within the presence of noise. Estimating inhaler inhalation flow profiles using audio based methods may be clinically beneficial for inhaler technique training and the remote monitoring of patient adherence.

Estimation of inhalation flow profile using audio-based methods to assess inhaler medication adherence

PubMed Central

Lacalle Muls, Helena; Costello, Richard W.; Reilly, Richard B.

2018-01-01

Asthma and chronic obstructive pulmonary disease (COPD) patients are required to inhale forcefully and deeply to receive medication when using a dry powder inhaler (DPI). There is a clinical need to objectively monitor the inhalation flow profile of DPIs in order to remotely monitor patient inhalation technique. Audio-based methods have been previously employed to accurately estimate flow parameters such as the peak inspiratory flow rate of inhalations, however, these methods required multiple calibration inhalation audio recordings. In this study, an audio-based method is presented that accurately estimates inhalation flow profile using only one calibration inhalation audio recording. Twenty healthy participants were asked to perform 15 inhalations through a placebo Ellipta™ DPI at a range of inspiratory flow rates. Inhalation flow signals were recorded using a pneumotachograph spirometer while inhalation audio signals were recorded simultaneously using the Inhaler Compliance Assessment device attached to the inhaler. The acoustic (amplitude) envelope was estimated from each inhalation audio signal. Using only one recording, linear and power law regression models were employed to determine which model best described the relationship between the inhalation acoustic envelope and flow signal. Each model was then employed to estimate the flow signals of the remaining 14 inhalation audio recordings. This process repeated until each of the 15 recordings were employed to calibrate single models while testing on the remaining 14 recordings. It was observed that power law models generated the highest average flow estimation accuracy across all participants (90.89±0.9% for power law models and 76.63±2.38% for linear models). The method also generated sufficient accuracy in estimating inhalation parameters such as peak inspiratory flow rate and inspiratory capacity within the presence of noise. Estimating inhaler inhalation flow profiles using audio based methods may be clinically beneficial for inhaler technique training and the remote monitoring of patient adherence. PMID:29346430

The inhalation characteristics of patients when they use different dry powder inhalers.

PubMed

Azouz, Wahida; Chetcuti, Philip; Hosker, Harold S R; Saralaya, Dinesh; Stephenson, John; Chrystyn, Henry

2015-02-01

The characteristics of each inhalation maneuver when patients use dry powder inhalers (DPIs) are important, because they control the quality of the emitted dose. We have measured the inhalation profiles of asthmatic children [CHILD; n=16, mean forced expiratory volume in 1 sec (FEV1) 79% predicted], asthmatic adults (ADULT; n=53, mean predicted FEV1 72%), and chronic obstructive pulmonary disease (COPD; n=29, mean predicted FEV1 42%) patients when they inhaled through an Aerolizer, Diskus, Turbuhaler, and Easyhaler using their "real-life" DPI inhalation technique. These are low-, medium-, medium/high-, and high-resistance DPIs, respectively. The inhalation flow against time was recorded to provide the peak inhalation flow (PIF; in L/min), the maximum pressure change (ΔP; in kPa), acceleration rates (ACCEL; in kPa/sec), time to maximum inhalation, the length of each inhalation (in sec), and the inhalation volume (IV; in liters) of each inhalation maneuver. PIF, ΔP, and ACCEL values were consistent with the order of the inhaler's resistance. For each device, the inhalation characteristics were in the order ADULT>COPD>CHILD for PIF, ΔP, and ACCEL (p<0.001). The results showed a large variability in inhalation characteristics and demonstrate the advantages of ΔP and ACCEL rather than PIFs. Overall inhaled volumes were low, and only one patient achieved an IV >4 L and ΔP >4 kPa. The large variability of these inhalation characteristics and their range highlights that if inhalation profiles were used with compendial in vitro dose emission measurements, then the results would provide useful information about the dose patients inhale during routine use. The inhalation characteristics highlight that adults with asthma have greater inspiratory capacity than patients with COPD, whereas children with asthma have the lowest. The significance of the inhaled volume to empty doses from each device requires investigation.

Lifetime use of illicit drugs and associated factors among Brazilian schoolchildren, National Adolescent School-based Health Survey (PeNSE 2012).

PubMed

Horta, Rogério Lessa; Horta, Bernardo Lessa; da Costa, Andre Wallace Nery; do Prado, Rogério Ruscitto; Oliveira-Campos, Maryane; Malta, Deborah Carvalho

2014-01-01

This study aimed at describing the prevalence of illicit drug use among 9th grade students in the morning period of public and private schools in Brazil, and assessing associated factors. The Brazilian survey PeNSE (National Adolescent School-based Health Survey) 2012 evaluated a representative sample of 9th grade students in the morning period, in Brazil and its five regions. The use of illicit drugs at least once in life was assessed for the most commonly used drugs, such as marijuana, cocaine, crack, solvent-based glue, general ether-based inhalants, ecstasy and oxy. Data were subjected to descriptive analysis, and Pearson's χ² test and logistic regression was used in the multivariate analysis. The use of illicit drugs at least once in life was reported by 7.3% (95%CI 5.3 - 9.4) of the respondents. Logistic regression was used for multivariate analysis and the evidences suggest that illicit drug use is associated to social conditions of greater consumption power, the use of alcohol and tobacco, behaviors related to socialization, such as having friends or sexual activity, and also the perception of loneliness, loose contact between school and parents and experiences of abuse in the family environment. The outcome was inversely associated with close contact with parents and parental supervision. In addition to the association with the processes of socialization and consumption, the influence of family and school is expressed in a particularly protective manner in different records of direct supervision and care.

Inhalation devices: from basic science to practical use, innovative vs generic products.

PubMed

Pirozynski, Michal; Sosnowski, Tomasz R

2016-11-01

Inhalation therapy is a convenient method of treating respiratory diseases. The key factors required for inhalation are the preparation of drug carriers (aerosol particles) allowing reproducible dosing during administration. These technical challenges are accomplished with a variety of inhalation devices (inhalers) and medicinal formulations, which are optimized to be easily converted into inhalable aerosols. Areas covered: This review is focused on the most important, but often overlooked, effects, which are required for the reliable and reproducible inhalable drug administration. The effects of patient-related issues that influence inhalation therapy, such as proper selection of inhalers for specific cases is discussed. We also discuss factors that are the most essential if generic inhalation product should be considered equivalent to the drugs with the clinically confirmed efficacy. Expert opinion: Proper device selection is crucial in clinical results of inhalation therapy. The patients' ability to coordinate inhalation with actuation, generation of optimal flow through the device, use of optimal inspiratory volume, all produces crucial effects on disease control. Also the severity of the disease process effects proper use of inhalers. Interchanging of inhalers can produce potentially conflicting problem regarding efficacy and safety of inhalation therapy.

Skylab

NASA Image and Video Library

1972-01-01

This chart details Skylab's Metabolic Activity experiment (M171), a medical evaluation facility designed to measure astronauts' metabolic changes while on long-term space missions. The experiment obtained information on astronauts' physiological capabilities and limitations and provided data useful in the design of future spacecraft and work programs. Physiological responses to physical activity was deduced by analyzing inhaled and exhaled air, pulse rate, blood pressure, and other selected variables of the crew while they performed controlled amounts of physical work with a bicycle ergometer. The Marshall Space Flight Center had program responsibility for the development of Skylab hardware and experiments.

Skylab

NASA Image and Video Library

1973-01-01

This Skylab-3 onboard photograph shows Astronaut Allen Bean on the ergometer, breathing into the metabolic analyzer. Skylab's Metabolic Activity experiment (M171), a medical evaluation facility, was designed to measure astronauts' metabolic changes while on long-term space missions. The experiment obtained information on astronauts' physiological capabilities and limitations and provided data useful in the design of future spacecraft and work programs. Physiological responses to physical activity was deduced by analyzing inhaled and exhaled air, pulse rate, blood pressure, and other selected variables of the crew while they performed controlled amounts of physical work with a bicycle ergometer.

An analysis of employee exposure to organic dust at large-scale composting facilities

NASA Astrophysics Data System (ADS)

Sykes, P.; Allen, J. A.; Wildsmith, J. D.; Jones, K. P.

2009-02-01

The occupational health implications from exposure to dust, endotoxin and 1-3 β Glucan at commercial composting sites are uncertain. This study aims to establish employee exposure levels to inhalable and respirable dust, endotoxin and 1-3 β Glucan during various operational practices in the composting process. Personal samples were collected and the inhalable and respirable dust fractions were determined by gravimetric analysis. Endotoxin concentrations were determined using a Limulus Amebocyte Lysate assay (LAL). 1-3 β Glucan levels were estimated using a specific blocking agent to establish the contribution that these compounds gave to the original endotoxin assay. Employees' exposure to dust was found to be generally lower than the levels stipulated in the Control of Substances Hazardous to Health Regulations (COSHH) 2002 (as amended), (median inhalable fraction 1.08 mg/m3, min 0.25 mg/m3 max 10.80 mg/m3, median respirable fraction 0.05 mg/m3, min 0.02 mg/m3, max 1.49 mg/m3). Determination of the biological component of the dust showed that employees' exposures to endotoxin were elevated (median 31.5 EU/m3, min 2.00 EU/m3, max 1741.78 EU/m3), particularly when waste was agitated (median 175.0 EU/m3, min 2.03 EU/m3, max 1741.78 EU/m3). Eight out of 32 (25%) of the personal exposure data for endotoxin exceeded the 200 EU/m3 temporary legal limit adopted in the Netherlands and thirteen out of 32 (40.6%) exceeded the suggested 50 EU/m3 guidance level suggested to protect workers from respiratory health effects. A significant correlation was observed between employee inhalable dust exposure and personal endotoxin concentration (r = 0.728, p<0.05) and also personal endotoxin exposure and 1-3 β Glucan concentration (r = 0.817, p<0.05). Further work is needed to explore the possibility of using inhalable dust concentration as a predictor for personal endotoxin exposure. The general dust levels stipulated in the COSHH Regulations 2002 (as amended) are inadequate for managing the potential health risks associated with endotoxin exposure at composting sites. Employee exposure levels and dose-response disease mechanisms are not well understood at this present time. Consequently, in light of this uncertainty, it is recommended that a precautionary approach be adopted in managing the potential health risks associated with inhalation of organic dusts at composting sites.

Shooting Gallery Operation in the Context of Establishing a Medically Supervised Injecting Center: Sydney, Australia

PubMed Central

Dolan, Kate

2007-01-01

Shooting galleries (SGs) are illicit off-street spaces close to drug markets used for drug injection. Supervised injecting facilities (SIFs) are low threshold health services where injecting drug users (IDUs) can inject pre-obtained drugs under supervision. This study describes SG use in Kings Cross, Sydney before and after the opening of the Sydney Medically Supervised Injecting Centre (MSIC), Australia’s first SIF. Operational and environmental characteristics of SGs, reasons for SG use, and willingness to use MSIC were also examined. An exploratory survey of SG users (n = 31), interviews with SG users (n = 17), and drug workers (n = 8), and counts of used needles routinely collected from SGs (6 months before and after MSIC) and visits to the MSIC (6 months after MSIC) were triangulated. We found five SGs operated during the study period. Key operational characteristics were 24-h operation, AUS$10 entry fee, 30-min time limit, and dual use for sex work. Key reasons for SG use were to avoid police, a preference not to inject in public, and assistance from SG operators in case of overdose. SG users reported high levels of willingness to use the MSIC. The number of used needles collected from SGs decreased by 69% (41,819 vs. 12,935) in the 6 months after MSIC opened, while MSIC visits increased incrementally. We conclude that injections were transferred from SGs to the MSIC, but SGs continued to accommodate injections and harm reduction outreach should be maintained. PMID:17273925

Primary Care-Mental Health Integration in the Veterans Affairs Health System: Program Characteristics and Performance.

PubMed

Cornwell, Brittany L; Brockmann, Laurie M; Lasky, Elaine C; Mach, Jennifer; McCarthy, John F

2018-06-01

The Veterans Health Administration (VHA) has achieved substantial national implementation of primary care-mental health integration (PC-MHI) services. However, little is known regarding program characteristics, variation in characteristics across settings, or associations between program fidelity and performance. This study identified core elements of PC-MHI services and evaluated their associations with program characteristics and performance. A principal-components analysis (PCA) of reports from 349 sites identified factors associated with PC-MHI fidelity. Analyses assessed the correlation among factors and between each factor and facility type (medical center or community-based outpatient clinic), primary care population size, and performance indicators (receipt of PC-MHI services, same-day access to mental health and primary care services, and extended duration of services). PCA identified seven factors: core implementation, care management (CM) assessments and supervision, CM supervision receipt, colocated collaborative care (CCC) by prescribing providers, CCC by behavioral health providers, participation in patient aligned care teams (PACTs) for special populations, and treatment of complex mental health conditions. Sites serving larger populations had greater core implementation scores. Medical centers and sites serving larger populations had greater scores for CCC by prescribing providers, CM assessments and supervision, and participation in PACTs. Greater core implementation scores were associated with greater same-day access. Sites with greater scores for CM assessments and supervision had lower scores for treatment of complex conditions. Outpatient clinics and sites serving smaller populations experienced challenges in integrated care implementation. To enhance same-day access, VHA should continue to prioritize PC-MHI implementation. Providing brief, problem-focused care may enhance CM implementation.

A Survey of the Medical Needs of a Group of Small Factories*

PubMed Central

Lee, W. R.

1962-01-01

The present interest in medical services for small factories is matched by the limited objective information which is available on the demand for and needs of such services. As a teaching project, a survey was made of factories with between 30 and 200 employees on an estate in the North West where there was no organized medical service. Unfortunately, time allowed only 22 factories to be visited. The findings, therefore, are regarded as indicative rather than conclusive, but this does not detract from their interest. Factories were visited by two or three postgraduate students who completed a questionnaire designed to standardize their findings. The questionnaire is included as an appendix to this paper. Regarding the demand for medical services, four of the 22 factories were subsidiaries of larger organizations and had part-time medical advice, 14 expressed no interest even if this would have involved no financial commitment, and the remaining four were interested for differing reasons. The needs of the factories in this context were found to be, first, advice and perhaps better supervision of non-mechanical hazards and, secondly, supervision of the first aid arrangements. From the ambulance journey records of the local authority there appeared to be no great demand for local casualty facilities. To meet these needs it is suggested that the functions of the appointed factory doctor might be modified to include wider supervision of non-mechanical hazards and supervision of first aid arrangements. It is also suggested that the National Health Service should form the basis for dealing with those cases requiring more than first aid. PMID:14463582

The Portapotty Experiment: Neoliberal approaches to the intertwined epidemics of opioid-related overdose and HIV/HCV, and why we need cultural anthropologists in the South Bronx

PubMed Central

Wolfson-Stofko, Brett; Curtis, Ric; Fuentes, Faustino; Manchess, Ed; Del Rio-Cumba, Alexis; Bennett, Alex S.

2016-01-01

The following report from the field focuses on the authors’ collective efforts to operate an ad hoc safer injection facility (SIF) out of portapotties (portable toilets) in an area of the South Bronx that has consistently experienced some of the highest overdose morbidity and mortality rates in New York City over the past decade (New York City Department of Health and Mental Hygiene, 2011, 2015, 2016). Safer injection facilities (also known as supervised injection facilities, drug consumption rooms, etc.) operating outside the US provide a legal, hygienic, and supervised environment for individuals to use drugs in order to minimize the likelihood of fatal overdose and the spread of blood-borne infections while reducing public injection. In the US, the operation of SIFs is federally prohibited by the federal “Crack House” statute though federal, state, and local elected officials can sanction their operation to various degrees (Beletsky, Davis, Anderson, & Burris, 2008). The activists, researchers, undergraduate students and peers from syringe exchange programs who came together to operate the portapotties discovered that they were, in many ways, emblematic of neoliberal solutions to disease prevention: primarily focused on auditing individual risk behaviors and virtually blind to the wider social context that shapes those lives. That social context — the culture of drug injection — was and is out in the open for all of us to see. Going forward, the cultural anthropologist’s toolbox will be opened up and used by large groups of undergraduate students to better understand the culture of drug use and how it is changing. PMID:27917016

Effectiveness of Nurse-Driven Inhaler Education on Inhaler Proficiency and Compliance Among Obstructive Lung Disease Patients: A Quasi-Experimental Study.

PubMed

Al-Kalaldeh, Mahmoud; El-Rahman, Mona Abd; El-Ata, Amal

2016-06-01

Background Health education on proper inhaler usage is the most feasible and accessible strategy to increase inhaler effectiveness. Purpose To assess the impact of nurse-driven inhaler education on the compliance and proficiency of using inhalers among inhaler users. Methods This single-center, quasi-experimental study included the implementation of an individualized 60-min educational session on inhalers use. Health education and pretest and posttest outcomes were assessed by the Inhaler Proficiency Schedule and Patient Reported Behaviour tools. Results One hundred and twenty-one participants joined the study. At pretest, participants showed inadequate knowledge of general inhaler use. No previous training had been received by participants and difficulty with use and complications from using the inhalers were reported. At posttest, participants reported improvement in inhaler proficiency scores from 5.72 to 8.60 ( t = 17.99, df = 220, p < 0.001). Likewise, they showed a significant reduction towards the noncompliant behaviors from 15.21 to 11.19 ( t = 16.388, df = 238, p < 0.001). Conclusions Nurse-driven inhaler education yielded positive outcomes in both inhaler proficiency and compliance. The patients' assessment of using inhalers is crucial to determine the patients' educational deficits.

Checklists for the Assessment of Correct Inhalation Therapy.

PubMed

Knipel, V; Schwarz, S; Magnet, F S; Storre, J H; Criée, C P; Windisch, W

2017-02-01

Introduction  For the long-term treatment of obstructive lung diseases inhalation therapy with drugs being delivered directly to the lungs as an aerosol has become the method of choice. However, patient-related mistakes in inhalation techniques are frequent and recognized to be associated with reduced disease control. Since the assessment of patient-mistakes in inhalation has yet not been standardized, the present study was aimed at developing checklists for the assessment of correct inhalation. Methods  Checklists were developed in German by an expert panel of pneumologists and professionally translated into English following back-translation procedures. The checklists comparably assessed three major steps of inhalation: 1) inhalation preparation, 2) inhalation routine, and 3) closure of inhalation. Results  Checklists for eight frequently used inhalers were developed: Aerolizer, Breezhaler, Diskus (Accuhaler), metered-dose inhaler, Handihaler, Novolizer, Respimat, Turbohaler. Each checklist consists of ten items: three for inhalation preparation, six for inhalation routine, and one for closure of inhalation. Discussion  Standardized checklists for frequently used inhalers are available in German and English. These checklists can be used for clinical routines or for clinical trials. All checklists can be downloaded free of charge for non-profit application from the homepage of the German Airway League (Deutsche Atemwegsliga e. V.): www.atemwegsliga.de. © Georg Thieme Verlag KG Stuttgart · New York.

Management and Supervision Procedures for Wastewater Facilities, Wastewater Technology: A Two-Year Post High School Instructional Program. An Instructor's Guide for Use of Instructional Material in Wastewater Technology Training Programs. Volume IV.

ERIC Educational Resources Information Center

Mason, George J.; And Others

This document is one in a series which outlines performance objectives and instructional modules for a course of study in the management of wastewater treatment plants. The modules are arranged in an order appropriate for teaching students with no experience. The modules can also be rearranged and adapted for courses to upgrade personnel moving…

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

Gibbs, P. W.

Secure Transport Management Course (STMC) course provides managers with information related to procedures and equipment used to successfully transport special nuclear material. This workshop outlines these procedures and reinforces the information presented with the aid of numerous practical examples. The course focuses on understanding the regulatory framework for secure transportation of special nuclear materials, identifying the insider and outsider threat(s) to secure transportation, organization of a secure transportation unit, management and supervision of secure transportation units, equipment and facilities required, training and qualification needed.

Models Used by the Military Services to Develop Budgets for Activities Associated with Operational Readiness

DTIC Science & Technology

2012-02-01

Operating Tempo and Training ($19.0 billion) Facilities ($18.1 billion) Maintenance ($11.3 billion) Not Modeled ($26.3 billion) Miscellaneous...Adebayo Adedeji, Daniel Frisk, and Derek Trunkey of CBO’s National Secur supervision of Matthew Goldberg and David Mosher. CBO staff members Elizabeth...rs M ce F ciliti e Op nt M aintng Direct Costs for Unit Operating Tempo and Training ng Indirect Costs for Unit Operating Tempo and Training odel

Fools rush in where angels fear to tread Playing God with Vancouver's Supervised Injection Facility in the political borderland.

PubMed

Small, Dan

2007-01-01

Healthcare does not exist in a social vacuum. Nowhere is this more obvious than in the case of people living with active addiction who are treated as social lepers: feared, despised and socially banished from the wider human family. People with addictions, and their families, fight for survival in the moral borderland between two competing understandings of their condition. According to one understanding, addiction is a concern for the criminal justice system while according to the other it is primarily a population health issue. In one orientation, addicts are troublesome offenders, while in the other they are wounded persons in need of medical attention. These competing values form a cultural web of belief that extends far beyond healthcare to the highest political office of Canadian society. This paper examines the politics of addiction over a 6-year period beginning at the municipal level in Vancouver and culminating with a confrontation between the Prime Minister of Canada and the tiny neighbourhood that provides a home for North America's only Supervised Injection Facility. Not wanting to let the medical facts get in the way of a political stand, Prime Minister Stephen Harper and his Health Minister, Tony Clement, played God this summer by playing politics with the lives of people in the shadows of Canadian society.

Ambivalence about supervised injection facilities among community stakeholders.

PubMed

Strike, Carol; Watson, Tara Marie; Kolla, Gillian; Penn, Rebecca; Bayoumi, Ahmed M

2015-08-21

Community stakeholders express a range of opinions about supervised injection facilities (SIFs). We sought to identify reasons for ambivalence about SIFs amongst community stakeholders in two Canadian cities. We used purposive sampling methods to recruit various stakeholder representatives (n = 141) for key informant interviews or focus group discussions. Data were analyzed using a thematic process. We identified seven reasons for ambivalence about SIFs: lack of personal knowledge of evidence about SIFs; concern that SIF goals are too narrow and the need for a comprehensive response to drug use; uncertainty that the community drug problem is large enough to warrant a SIF(s); the need to know more about the "right" places to locate a SIF(s) to avoid damaging communities or businesses; worry that a SIF(s) will renew problems that existed prior to gentrification; concern that resources for drug use prevention and treatment efforts will be diverted to pay for a SIF(s); and concern that SIF implementation must include evaluation, community consultation, and an explicit commitment to discontinue a SIF(s) in the event of adverse outcomes. Stakeholders desire evidence about potential SIF impacts relevant to local contexts and that addresses perceived potential harms. Stakeholders would also like to see SIFs situated within a comprehensive response to drug use. Future research should determine the relative importance of these concerns and optimal approaches to address them to help guide decision-making about SIFs.

Halogenated flame-retardant concentrations in settled dust, respirable and inhalable particulates and polyurethane foam at gymnastic training facilities and residences.

PubMed

La Guardia, Mark J; Hale, Robert C

2015-06-01

Halogenated flame-retardants (FRs) are used in a wide array of polymer-containing products. Animal studies and structure-activity modeling exercises suggest that FR exposure may result in detrimental toxicological effects. Workers with extended contact with such polymers (e.g., electronic dismantlers, carpet installers and aircraft personnel) have previously been observed to exhibit elevated body burdens of FRs, e.g., polybrominated diphenyl ethers (PBDEs). Recently, elevated PBDE blood levels were also reported in a non-occupational exposure group, gymnasts. These levels were hypothesized to be related to the large volumes of FR-treated polyurethane foam in gymnastics facilities. To further our understanding of workers' potential exposure, we analyzed FR concentrations in indoor dust and size-fractionated air particulates (respirable (<4 μm) and inhalable (>4 μm)) from gymnastic studios. Values were compared to samples from the homes of coaches employed at these facilities. Polyurethane foam blocks (i.e., pit foam) were also analyzed to characterize potential FR sources. FRs examined included those used to flame-retard polyurethane foam: 8 PBDE congeners, two brominated components of Firemaster 550 (2-ethylhexyl 2, 3, 4, 5-tetrabromobenzoate (TBB) and bis(2-ethylhexyl) 3, 4, 5, 6-tetrabromophthalate (TBPH)) and three chlorinated organophosphates (tris(2-chloroethyl) phosphate (TCEP), tris(1-chloro-2-propyl) phosphate (TCPP) and tris(1,3-dichloro-2-propyl) phosphate (TDCPP)). Several additional FRs not used in polyurethane were also evaluated. These have also been detected in indoor dust and air and may also lead to adverse health effects. These include: BDE-183 and its replacement product (1, 2-bis(2, 4, 6-tribromophenoxy) ethane (BTBPE), two congeners of the deca-BDE formulation (BDE-206, -209) and their replacement decabromodiphenyl ethane (DBDPE) and hexabromocyclododecane (α-, β-, γ-HBCD), and tetrabromobisphenol-A (TBBPA)). Pit foam contained multiple FRs at cumulative concentrations of 12,100 to 25,800 μg g(-1), or 1.2% to 2.6% by weight. TBB and TBPH were the most abundant FRs detected, followed by TDCPP and several PBDEs. The mean total FR burden detected at the gyms was 8.6-fold higher (574 μg g(-1)) than that observed in the house dust samples (66.8 μg g(-1)). However, the polyurethane additives TBB and TDCPP were the only FRs that exhibited significantly greater levels (P<0.05) in gym than house dust. Mean levels of five FRs (BDE-99, -100, -153, -209 and TDCPP) were also higher in respirable particulates from the gyms than the homes and four FRs (BDE-47, TBB, TBPH and DBDPE) were higher at the homes than the gyms; these differences were not significant (P>0.05). Several additional FRs were detected in inhalable particulates; mean levels of BDE-66, -206 and TCPP were higher in the homes and BDE-47, -85, -99, -100, -153, -209, TBB, TBPH, and TDCPP were higher at the gyms. But, only the polyurethane additives i.e., BDE-100, TBB and TDCPP were significantly greater (P<0.05) in inhalable particulates from the gyms than at the homes. In conclusion, polyurethane foam collected from gymnastic studios exhibited a variety of FR compositional signatures; likely reflective of changes in FR usage over time and by different manufacturers. FR concentrations and compositional signatures also differed between settled dust, respirable and inhalable particulates between the gyms and homes. Concentrations of FRs used in polyurethane foam were higher in gym air and dust compared to homes, particularly TBB and TDCPP - which were also the primary FRs detected in the pit foam samples. Although these results should be interpreted with caution, as the sample size was small, these findings do suggest that FR concentrations observed in dust and air particulates from the gymnastic studios are further evidence that individuals frequenting these environments are at greater risk for exposure to these polymer additives. Copyright © 2015 Elsevier Ltd. All rights reserved.

An assessment of workplace programmes designed to control inhalation risks using respiratory protective equipment.

PubMed

Bell, Nikki; Vaughan, Nicholas P; Morris, Len; Griffin, Peter

2012-04-01

Few studies have assessed respiratory protective equipment (RPE) failures at the organizational level despite evidence to suggest that compliance with good practice may be low. The aim of this study was to develop an understanding of what current RPE programmes look like across industry and how this compares with good practice. Twenty cross-industry site visits were conducted with companies that had RPE programmes in place. Visits involved management interviews to explore current RPE systems and procedures and the decision making underpinning these. Observations of RPE operatives were included followed by short interviews to discuss the behaviours observed. Post-site assessments jointly undertaken by an RPE scientist and psychologist produced ratings for each site on six critical aspects of RPE programmes (knowledge/awareness, selection, use, training/information, supervision, and storage/cleaning/maintenance). Overall ratings for theoretical competence (i.e. management knowledge of RPE) and practical control (i.e. actual RPE practice on the shop floor) were also given. Qualitative analysis was performed on all interview data. The performance of RPE programmes varied across industry. Fewer than half the companies visited were considered to have an acceptable level of theoretical competence and practical control. Four distinct groups emerged from the 20 sites studied, ranging from Learners (low theoretical competence and practical control--four sites), Developers (acceptable theoretical competence and low practical control--five sites), and Fortuitous (low theoretical competence and acceptable practical control--two sites), to Proficient (acceptable theoretical competence and practical control--nine sites). None of the companies visited were achieving optimal control through the use of RPE. Widespread inadequacies were found with programme implementation, particularly training, supervision, and maintenance. Our taxonomy based on the four groups (Learners, Developers, Fortuitous, and Proficient) provided a useful expert-informed tool for explaining the variation in performance of RPE programmes across industry. Although further research and development are required, this taxonomy offers a useful starting point for the development of practical tools that may assist managers in making the much-needed improvements to all facets of programme implementation, particularly training, supervision, and maintenance.

Practical aspects of inhaler use in the management of chronic obstructive pulmonary disease in the primary care setting.

PubMed

Yawn, Barbara P; Colice, Gene L; Hodder, Rick

2012-01-01

Sustained bronchodilation using inhaled medications in moderate to severe chronic obstructive pulmonary disease (COPD) grades 2 and 3 (Global Initiative for Chronic Obstructive Lung Disease guidelines) has been shown to have clinical benefits on long-term symptom control and quality of life, with possible additional benefits on disease progression and longevity. Aggressive diagnosis and treatment of symptomatic COPD is an integral and pivotal part of COPD management, which usually begins with primary care physicians. The current standard of care involves the use of one or more inhaled bronchodilators, and depending on COPD severity and phenotype, inhaled corticosteroids. There is a wide range of inhaler devices available for delivery of inhaled medications, but suboptimal inhaler use is a common problem that can limit the clinical effectiveness of inhaled therapies in the real-world setting. Patients' comorbidities, other physical or mental limitations, and the level of inhaler technique instruction may limit proper inhaler use. This paper presents information that can overcome barriers to proper inhaler use, including issues in device selection, steps in correct technique for various inhaler devices, and suggestions for assessing and monitoring inhaler techniques. Ensuring proper inhaler technique can maximize drug effectiveness and aid clinical management at all grades of COPD.

Practical aspects of inhaler use in the management of chronic obstructive pulmonary disease in the primary care setting

PubMed Central

Yawn, Barbara P; Colice, Gene L; Hodder, Rick

2012-01-01

Sustained bronchodilation using inhaled medications in moderate to severe chronic obstructive pulmonary disease (COPD) grades 2 and 3 (Global Initiative for Chronic Obstructive Lung Disease guidelines) has been shown to have clinical benefits on long-term symptom control and quality of life, with possible additional benefits on disease progression and longevity. Aggressive diagnosis and treatment of symptomatic COPD is an integral and pivotal part of COPD management, which usually begins with primary care physicians. The current standard of care involves the use of one or more inhaled bronchodilators, and depending on COPD severity and phenotype, inhaled corticosteroids. There is a wide range of inhaler devices available for delivery of inhaled medications, but suboptimal inhaler use is a common problem that can limit the clinical effectiveness of inhaled therapies in the real-world setting. Patients’ comorbidities, other physical or mental limitations, and the level of inhaler technique instruction may limit proper inhaler use. This paper presents information that can overcome barriers to proper inhaler use, including issues in device selection, steps in correct technique for various inhaler devices, and suggestions for assessing and monitoring inhaler techniques. Ensuring proper inhaler technique can maximize drug effectiveness and aid clinical management at all grades of COPD. PMID:22888221

Teaching inhaler use in chronic obstructive pulmonary disease patients.

PubMed

Lareau, Suzanne C; Hodder, Richard

2012-02-01

To review barriers to the successful use of inhalers in patients with chronic obstructive pulmonary disease (COPD), and the role of the nurse practitioner (NP) in facilitating optimum inhaler use. Review of the national and international scientific literature. Pharmacologic treatment of COPD patients comprises mainly inhaled medications. Incorrect use of inhalers is very common in these individuals. Some of the consequences of poor inhaler technique include reduced therapeutic dosing, medication adherence, and disease stability, which can lead to increased morbidity, decreased quality of life, and a high burden on the healthcare system. Knowledgeable evaluation and frequent reassessment of inhaler use coupled with education of patients, caregivers, and healthcare professionals can significantly improve the benefits COPD patients derive from inhaled therapy. Patient education is vital for correct use of inhalers and to ensure the effectiveness of inhaled medications. The NP has a critical role in assessing potential barriers to successful learning by the patient and improving inhaler technique and medication management. The NP can also facilitate success with inhaled medications by providing up-to-date inhaler education for other healthcare team members, who may then act as patient educators. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

Detection of facilities in satellite imagery using semi-supervised image classification and auxiliary contextual observables

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

Harvey, Neal R; Ruggiero, Christy E; Pawley, Norma H

2009-01-01

Detecting complex targets, such as facilities, in commercially available satellite imagery is a difficult problem that human analysts try to solve by applying world knowledge. Often there are known observables that can be extracted by pixel-level feature detectors that can assist in the facility detection process. Individually, each of these observables is not sufficient for an accurate and reliable detection, but in combination, these auxiliary observables may provide sufficient context for detection by a machine learning algorithm. We describe an approach for automatic detection of facilities that uses an automated feature extraction algorithm to extract auxiliary observables, and a semi-supervisedmore » assisted target recognition algorithm to then identify facilities of interest. We illustrate the approach using an example of finding schools in Quickbird image data of Albuquerque, New Mexico. We use Los Alamos National Laboratory's Genie Pro automated feature extraction algorithm to find a set of auxiliary features that should be useful in the search for schools, such as parking lots, large buildings, sports fields and residential areas and then combine these features using Genie Pro's assisted target recognition algorithm to learn a classifier that finds schools in the image data.« less

Inhaled Asthma Medications

MedlinePlus

... metered – dose inhaler (MDI), which uses a chemical propellant to push the medication out of the inhaler. ... powder inhalers (DPIs) deliver medication without using chemical propellants, but they require a strong and fast inhalation. ...

Endotoxin deposits on the inner surfaces of closed-face cassettes during bioaerosol sampling: a field investigation at composting facilities.

PubMed

Duquenne, Philippe; Simon, Xavier; Demange, Valérie; Harper, Martin; Wild, Pascal

2015-05-01

A set of 270 bioaerosol samples was taken from 15 composting facilities using polystyrene closed-face filter cassettes (CFCs). The objective was to measure the quantity of endotoxin deposits on the inner surfaces of the cassettes (sometimes referred to as 'wall deposits'). The results show that endotoxins are deposited on the inner surfaces of the CFCs through sampling and/or handling of samples. The quantity of endotoxins measured on inner surfaces range between 0.05 (the limit of detection of the method) and 3100 endotoxin units per cassette. The deposits can represent a large and variable percentage of the endotoxins sampled. More than a third of the samples presented a percentage of inner surface deposits >40% of the total quantity of endotoxins collected (filter + inner surfaces). Omitting these inner surface deposits in the analytical process lead to measurement errors relative to sampling all particles entering the CFC sampler, corresponding to a developing consensus on matching the inhalable particulate sampling convention. The result would be underestimated exposures and could affect the decision as to whether or not a result is acceptable in comparison to airborne concentration limits defined in terms of the inhalability convention. The results of this study suggest including the endotoxins deposited on the inner surfaces of CFCs during analysis. Further researches are necessary to investigate endotoxin deposits on the inner cassette surfaces in other working sectors. © The Author 2014. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

Empowering family physicians to impart proper inhaler teaching to patients with chronic obstructive pulmonary disease and asthma

PubMed Central

Leung, Janice M; Bhutani, Mohit; Leigh, Richard; Pelletier, Dan; Good, Cathy; Sin, Don D

2015-01-01

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) and asthma depend on inhalers for management, but critical errors committed during inhaler use can limit drug effectiveness. Outpatient education in inhaler technique remains inconsistent due to limited resources and inadequate provider knowledge. OBJECTIVE: To determine whether a simple, two-session inhaler education program can improve physician attitudes toward inhaler teaching in primary care practice. METHODS: An inhaler education program with small-group hands-on device training was instituted for family physicians (FP) in British Columbia and Alberta. Sessions were spaced one to three months apart. All critical errors were corrected in the first session. Questionnaires surveying current inhaler teaching practices and attitudes toward inhaler teaching were distributed to physicians before and after the program. RESULTS: Forty-one (60%) of a total 68 participating FPs completed both before and after program questionnaires. Before the program, only 20 (49%) reported providing some form of inhaler teaching in their practices, and only four (10%) felt fully competent to teach patients inhaler technique. After the program, 40 (98%) rated their inhaler teaching as good to excellent. Thirty-four (83%) reported providing inhaler teaching in their practices, either by themselves or by an allied health care professional they had personally trained. All stated they could teach inhaler technique within 5 min. Observation of FPs during the second session by certified respiratory educators found that none made critical errors and all had excellent technique. CONCLUSION: A physician inhaler education program can improve attitudes toward inhaler teaching and facilitate implementation in clinical practices. PMID:26436910

The Evolution of 21 CFR Parts 210 & 211 for Drug Compounders: AN UNSPOKEN OPPORTUNITY FOR PHARMACISTS.

PubMed

Parks, Kenneth Chase; Bernard, Brian; Cogdill, Christopher Blake

2015-01-01

A high-level assessment of recent U.S. Food and Drug Administration audits of 503A facilities indicates that a regulatory paradigm shift is occurring. Data and rationale further indicates that the agency seems to be taking a proactive approach for how it monitors these facilities. The auditing practices and observations are eerily similar to those which are seen for 503B Outsourcing Facilities, as well as Current Good Manufacturing Practices Drug and Device Manufacture plants. Perhaps the U.S. Food and Drug Administration is attempting to avoid any major medical outbreaks that may stem from under-supervised drug preparation centers. This report presents the rationale that may be behind the U.S. Food and Drug Administration's motive for increased 503A scrutiny. In addition, new market incentives are also highlighted, as it seems that firms, which are able to maintain good graces with the agency, will be uniquely positioned to obtain greater market share. All signs indicate that for 503A facilities, regulatory compliance may be the key to greater market share.

Inhalant Use and Inhalant Use Disorders in the United States

PubMed Central

Howard, Matthew O.; Bowen, Scott E.; Garland, Eric L.; Perron, Brian E.; Vaughn, Michael G.

2011-01-01

More than 22 million Americans age 12 and older have used inhalants, and every year more than 750,000 use inhalants for the first time. Despite the substantial prevalence and serious toxicities of inhalant use, it has been termed “the forgotten epidemic.” Inhalant abuse remains the least-studied form of substance abuse, although research on its epidemiology, neurobiology, treatment, and prevention has accelerated in recent years. This review examines current findings in these areas, identifies gaps in the research and clinical literatures pertaining to inhalant use, and discusses future directions for inhalant-related research and practice efforts. PMID:22003419

[Did the patients with chronic obstructive pulmonary disease in Primary Care center Anton de Borja correctly utilize inhalers?].

PubMed

Represas-Carrera, Francisco Jesús

2015-01-01

To determine the percentage of patients with Pulmonary Obstructive Chronic Disease who doing of incorrect form the inhaler technique. Descriptive transversal study made in the Primary Care Center "Antón de Borja" of Rubi (in Barcelona) during the period between May and December 2013, where it was studied a representative sample of 200 patients. To assess the inhaler technique was performed a personal interview with the patient in which it was requested him to carry out a demonstration of how he was using his inhaler regularly evaluating his inhaler technique by means of the regulations established by Spanish Society of Pneumology and Thoracic Surgery. 43% of the patients carry out inhaler technique incorrectly. The percentage of inadequate use of inhalers of dry powder was 26%, of the pressurized cartridge 38% and the inhaler chamber 10%. 82% of patients ≥ 65 years who have prescribed a pressurized inhaler cartridge do not perform accompanied by an inhaler chamber. A high percentage of patients do not correctly carry out inhaler technique, pointing the rare use made of the inhaler chamber despite its proven efficacy and the high number of patients with pressurized inhaler cartridge. These results reflect the need for the implementation of an educational program in our Primary Care Center to teach patients to use inhaler devices. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Occupational Survey Report, Cardiopulmonary Laboratory, AFSC 4H0X1, OSSN: 2541

DTIC Science & Technology

2004-02-01

patients within facility 97 E0211 Set up humidifiers 97 E0175 Instruct patients in use of incentive spirometers 97 A0031 Obtain sputum samples 97 A0026...D0137 Calibrate pulmonary function testing equipment 100 D0150 Perform routine spirometry tests 100 D0146 Perform lung diffusion tests 100 A0042 Perform...consultations, or procedures 31 D0150 Perform routine spirometry tests 23 35 TABLE A2 REPRESENTATIVE TASKS PERFORMED BY MEMBERS IN THE SUPERVISION AND

KSC-01pp1041

NASA Image and Video Library

2001-05-30

Workers supervise the off-loading of segments of a Lockheed Martin Atlas II rocket at the Skid Strip at Cape Canaveral Air Force Station.; The rocket will be used to launch the Geostationary Operational Environmental Satellite-M (GOES-M), the latest in the current series of advanced geostationary weather satellites in service.; GOES-M is being prepared for launch at the Astrotech Space Operations facility located in the Spaceport Florida Industrial Park in Titusville, Fla. The launch is scheduled for July 15 from Pad 36-A, Cape Canaveral Air Force Station

KSC-05PD-0752

NASA Technical Reports Server (NTRS)

2005-01-01

KENNEDY SPACE CENTER, FLA. In the Orbiter Processing Facility at NASAs Kennedy Space Center, the nose landing gear on Space Shuttle Atlantis is retracted under the supervision of United Space Alliance technicians Terry Williams (left) and Ron Delaney. Compression measurements are being taken of the newly installed nose landing gear thermal barrier seal with the gear in position in its wheel well and the landing gear doors closed. Atlantis is being processed for launch on the second Return to Flight mission, STS-121, which is scheduled to fly in July.

KSC-01pp1040

NASA Image and Video Library

2001-05-30

Workers supervise the off-loading of segments of a Lockheed Martin Atlas II rocket at the Skid Strip at Cape Canaveral Air Force Station.; The rocket will be used to launch the Geostationary Operational Environmental Satellite-M (GOES-M), the latest in the current series of advanced geostationary weather satellites in service.; GOES-M is being prepared for launch at the Astrotech Space Operations facility located in the Spaceport Florida Industrial Park in Titusville, Fla. The launch is scheduled for July 15 from Pad 36-A, Cape Canaveral Air Force Station

Credit WCT. Original 21/4"x21/4" color negative is housed in the ...

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

Credit WCT. Original 2-1/4"x2-1/4" color negative is housed in the JPL Photography Laboratory, Pasadena, California. At one time, Building 4285/E-86 accommodated tensile testing of propellant samples. This view shows a tensile strength tester set up for propellant tests, under the supervision of JPL staff member Milton Clay (JPL negative no. JPL-10291AC, 27 January 1989) - Jet Propulsion Laboratory Edwards Facility, Casting & Curing Building, Edwards Air Force Base, Boron, Kern County, CA

Assessing fullness of asthma patients' aerosol inhalers.

PubMed

Rickenbach, M A; Julious, S A

1994-07-01

The importance of regular medication in order to control asthma symptoms is recognized. However, there is no accurate mechanism for assessing the fullness of aerosol inhalers. The contribution to asthma morbidity of unexpectedly running out of inhaled medication is unknown. A study was undertaken to determine how patients assess inhaler fullness and the accuracy of their assessments, and to evaluate the floatation method of assessing inhaler fullness. An interview survey of 98 patients (51% of those invited to take part), using 289 inhalers, was completed at one general practice in Hampshire. One third of participants said they had difficulty assessing aerosol inhaler fullness and those aged 60 years and over were found to be more inaccurate in assessing fullness than younger participants. Shaking the inhaler to feel the contents move was the commonest method of assessment. When placed in water, an inhaler canister floating on its side with a corner of the canister valve exposed to air indicates that the canister is less than 15% full (sensitivity 90%, specificity 99%). Floating a canister in water provides an objective measurement of aerosol inhaler fullness. Providing the method is recommended by the aerosol inhaler manufacturer, general practitioners should demonstrate the floatation method to patients experiencing difficulty in assessing inhaler fullness.

The chemo and the mona: inhalants, devotion and street youth in Mexico City.

PubMed

Gigengack, Roy

2014-01-01

This paper understands inhalant use--the deliberate inhalation of volatile solvents or glues with intentions of intoxication--as a socially and culturally constituted practice. It describes the inhalant use of young street people in Mexico City from their perspective ("the vicioso or inhalant fiend's point of view"). Even if inhalant use is globally associated with economic inequality and deprivation, there is a marked lack of ethnography. Incomprehension and indignation have blocked our understanding of inhalant use as a form of marginalised drug use. The current explanation models reduce inhalant consumption to universal factors and individual motives; separating the practice from its context, these models tend to overlook gustatory meanings and experiences. The paper is informed by long-term, on-going fieldwork with young street people in Mexico City. Fieldwork was done from 1990 through 2010, in regular periods of fieldwork and shorter visits, often with Mexican colleagues. We created extensive sets of fieldnotes, which were read and re-read. "Normalcy" is a striking feature of inhalant use in Mexico City. Street-wise inhabitants of popular neighbourhoods have knowledge about inhalants and inhalant users, and act accordingly. Subsequently, Mexico City's elaborate street culture of sniffing is discussed, that is, the range of inhalants used, how users classify the substances, and their techniques for sniffing. The paper also distinguishes three patterns of inhalant use, which more or less correlate with age. These patterns indicate embodiments of street culture: the formation within users of gusto, that is, an acquired appetite for inhalants, and of vicio, the inhalant fiends' devotion to inhalants. What emerges from the ethnographic findings is an elaborate street culture of sniffing, a complex configuration of shared perspectives and embodied practices, which are shaped by and shaping social exclusion. These findings are relevant to appreciate and address the inhalant fiends' acquired appetite and habit. Copyright © 2013 Elsevier B.V. All rights reserved.

Development of Safety Assessment Code for Decommissioning of Nuclear Facilities

NASA Astrophysics Data System (ADS)

Shimada, Taro; Ohshima, Soichiro; Sukegawa, Takenori

A safety assessment code, DecDose, for decommissioning of nuclear facilities has been developed, based on the experiences of the decommissioning project of Japan Power Demonstration Reactor (JPDR) at Japan Atomic Energy Research Institute (currently JAEA). DecDose evaluates the annual exposure dose of the public and workers according to the progress of decommissioning, and also evaluates the public dose at accidental situations including fire and explosion. As for the public, both the internal and the external doses are calculated by considering inhalation, ingestion, direct radiation from radioactive aerosols and radioactive depositions, and skyshine radiation from waste containers. For external dose for workers, the dose rate from contaminated components and structures to be dismantled is calculated. Internal dose for workers is calculated by considering dismantling conditions, e.g. cutting speed, cutting length of the components and exhaust velocity. Estimation models for dose rate and staying time were verified by comparison with the actual external dose of workers which were acquired during JPDR decommissioning project. DecDose code is expected to contribute the safety assessment for decommissioning of nuclear facilities.

Salmeterol inhaler using a non-chlorinated propellant, HFA134a: systemic pharmacodynamic activity in healthy volunteers.

PubMed Central

Kirby, S. M.; Smith, J.; Ventresca, G. P.

1995-01-01

BACKGROUND--Metered dose inhalers for the treatment of asthma use chlorofluorocarbons as propellants. These face an international ban due to their effect on the ozone layer. Salmeterol has been reformulated using the non-chlorinated propellant Glaxo inhalation grade HFA134a. METHODS--The safety, tolerability and systemic pharmacodynamic activity of the salmeterol/HFA134a inhaler, the current salmeterol inhaler, and placebo (HFA134a) were compared in 12 healthy volunteers in a double blind, randomised crossover study using a cumulative dosing design. RESULTS--Safety and tolerability were similar and the response was related to the dose over the range used (50-400 micrograms) with both salmeterol inhalers. The salmeterol/HFA134a inhaler showed no differences from the current inhaler for pulse rate, blood pressure, tremor, QTc interval, and plasma glucose levels. The salmeterol/HFA134a inhaler had significantly less effect on plasma potassium levels. CONCLUSIONS--In healthy volunteers the salmeterol/HFA134a inhaler is at least as safe and well tolerated as the current salmeterol inhaler, and has similar systemic pharmacodynamic activity. PMID:7638815

[RADIATION SAFETY DURING REMEDIATION OF THE "SEVRAO" FACILITIES].

PubMed

Shandala, N K; Kiselev, S M; Titov, A V; Simakov, A V; Seregin, V A; Kryuchkov, V P; Bogdanova, L S; Grachev, M I

2015-01-01

Within a framework of national program on elimination of nuclear legacy, State Corporation "Rosatom" is working on rehabilitation at the temporary waste storage facility at Andreeva Bay (Northwest Center for radioactive waste "SEVRAO"--the branch of "RosRAO"), located in the North-West of Russia. In the article there is presented an analysis of the current state of supervision for radiation safety of personnel and population in the context of readiness of the regulator to the implementation of an effective oversight of radiation safety in the process of radiation-hazardous work. Presented in the article results of radiation-hygienic monitoring are an informative indicator of the effectiveness of realized rehabilitation measures and characterize the radiation environment in the surveillance zone as a normal, without the tendency to its deterioration.

A review of basic patient rights in psychiatric care.

PubMed

Cady, Rebecca F

2010-01-01

Although patient rights is a concept that all nurse managers need to be aware of, this concept often becomes confusing when applied to patients undergoing psychiatric treatment. It is important for the nurse manager to understand the basic rights that psychiatric patients are entitled to, to best be able to help staff nurses under his/her supervision to protect these rights. The nurse manager on a psychiatric unit often serves as a reference for staff nurses, and even for physicians, when questions regarding patient rights present themselves. The nurse manager should be certain to discuss these issues with the facility's legal and risk management team to be aware of particulars of the law of the state in which the facility is located, as state laws may differ somewhat in their treatment of psychiatric patients.

[THE PRESENT STATE OF EPIZOOTOLOGICAL MONITORING OF THE NATURAL FOCI OF INFECTIONS IN THE RUSSIAN FEDERATION].

PubMed

Trankvilevsky, D V; Tsarenko, V A; Zhukov, V I

2016-01-01

The facilities of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare play a leading role in epizootological monitoring. The specialists (zoologists and entomologists) of Hygiene and Epidemiology Centers do basic work in the subjects of the Russian Federation. The data obtained in the participation of different ministries and departments are used to analyze the results of monitoring. The latter is one of the important steps in the management of the epidemic, process in natural focal infections. In recent years, there has been an unjustified reduction in the volume of studies in the natural foci. This negatively affects the reliability of estimates and predictions of the epidemic activity of the natural foci of infections. Ensuring the national, security of the Russian Federation, epidemiological surveillance, and control of its natural foci requires staffing and appropriate professional training in the zoological and entomological subdivisions of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare.

Inhalation Therapy in Horses.

PubMed

Cha, Mandy L; Costa, Lais R R

2017-04-01

This article discusses the benefits and limitations of inhalation therapy in horses. Inhalation drug therapy delivers the drug directly to the airways, thereby achieving maximal drug concentrations at the target site. Inhalation therapy has the additional advantage of decreasing systemic side effects. Inhalation therapy in horses is delivered by the use of nebulizers or pressured metered dose inhalers. It also requires the use of a muzzle or nasal mask in horses. Drugs most commonly delivered through inhalation drug therapy in horses include bronchodilators, antiinflammatories, and antimicrobials. Copyright © 2016 Elsevier Inc. All rights reserved.

Inhalers and nebulizers: basic principles and preliminary measurements

NASA Astrophysics Data System (ADS)

Misik, Ondrej; Lizal, Frantisek; Asl, Vahid Farhikhteh; Belka, Miloslav; Jedelsky, Jan; Elcner, Jakub; Jicha, Miroslav

2018-06-01

Inhalers are hand-held devices which are used for administration of therapeutic aerosols via inhalation. Nebulizers are larger devices serving for home and hospital care using inhaled medication. This contribution describes the basic principles of dispersion of aerosol particles used in various types of inhalers and nebulizers, and lists the basic physical mechanisms contributing to the deposition of inhaled particles in the human airways. The second part of this article presents experimental setup, methodology and preliminary results of particle size distributions produced by several selected inhalers and nebulizers.

Public health assessment for C and R Battery Inc. , Richmond, Chesterfield County, Virginia, Region 3. Cerclis No. VAD049957913. Final report

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

Not Available

The C R Battery Company, Inc. property, a former battery recycling facility, is a National Priorities List (NPL) site situated in Chesterfield County, approximately 6 miles southeast of Richmond, Virginia. The contaminants found on the site at concentrations considered to be of concern include antimony, arsenic, cadmium, and lead. Potential exposure pathways include inhalation of contaminated dust, and the ingestion of contaminated groundwater. The site is an indeterminate public health hazard. However, data are not available for all environmental media to which humans may be exposed.

Metabolic Activity - Skylab Experiment M171

NASA Technical Reports Server (NTRS)

1972-01-01

This chart details Skylab's Metabolic Activity experiment (M171), a medical evaluation facility designed to measure astronauts' metabolic changes while on long-term space missions. The experiment obtained information on astronauts' physiological capabilities and limitations and provided data useful in the design of future spacecraft and work programs. Physiological responses to physical activity was deduced by analyzing inhaled and exhaled air, pulse rate, blood pressure, and other selected variables of the crew while they performed controlled amounts of physical work with a bicycle ergometer. The Marshall Space Flight Center had program responsibility for the development of Skylab hardware and experiments.

Skylab-3 Mission Onboard Photograph - Astronaut Bean on Ergometer

NASA Technical Reports Server (NTRS)

1973-01-01

This Skylab-3 onboard photograph shows Astronaut Allen Bean on the ergometer, breathing into the metabolic analyzer. Skylab's Metabolic Activity experiment (M171), a medical evaluation facility, was designed to measure astronauts' metabolic changes while on long-term space missions. The experiment obtained information on astronauts' physiological capabilities and limitations and provided data useful in the design of future spacecraft and work programs. Physiological responses to physical activity was deduced by analyzing inhaled and exhaled air, pulse rate, blood pressure, and other selected variables of the crew while they performed controlled amounts of physical work with a bicycle ergometer.

Practice makes perfect: self-reported adherence a positive marker of inhaler technique maintenance.

PubMed

Azzi, Elizabeth; Srour, Pamela; Armour, Carol; Rand, Cynthia; Bosnic-Anticevich, Sinthia

2017-04-24

Poor inhaler technique and non-adherence to treatment are major problems in the management of asthma. Patients can be taught how to achieve good inhaler technique, however maintenance remains problematic, with 50% of patients unable to demonstrate correct technique. The aim of this study was to determine the clinical, patient-related and/or device-related factors that predict inhaler technique maintenance. Data from a quality-controlled longitudinal community care dataset was utilized. 238 patients using preventer medications where included. Data consisted of patient demographics, clinical data, medication-related factors and patient-reported outcomes. Mixed effects logistic regression was used to identify predictors of inhaler technique maintenance at 1 month. The variables found to be independently associated with inhaler technique maintenance using logistic regression (Χ 2 (3,n = 238) = 33.24, p < 0.000) were inhaler technique at Visit 1 (OR 7.1), device type (metered dose inhaler and dry powder inhalers) (OR 2.2) and self-reported adherent behavior in the prior 7 days (OR 1.3). This research is the first to unequivocally establish a predictive relationship between inhaler technique maintenance and actual patient adherence, reinforcing the notion that inhaler technique maintenance is more than just a physical skill. Inhaler technique maintenance has an underlying behavioral component, which future studies need to investigate. BEHAVIORAL ELEMENT TO CORRECT LONG-TERM INHALER TECHNIQUES: Patients who consciously make an effort to perfect asthma inhaler technique will maintain their skills long-term. Elizabeth Azzi at the University of Sydney, Australia, and co-workers further add evidence that there is a strong behavioral component to patients retaining correct inhaler technique over time. Poor inhaler technique can limit asthma control, affecting quality of life and increasing the chances of severe exacerbations. Azzi's team followed 238 patients to determine the key predictors of inhaler technique maintenance from factors including age, asthma knowledge and perceived future risks. Correct inhaler technique at initial assessment was the strongest predictor of long-term success, but this was strengthened further when patients reported good adherence to their own medication regimen. This suggests that maintaining correct inhaler technique is more than just a physical skill. Careful guidance towards this 'practice makes perfect' approach may improve patients' long-term technique maintenance.

The optimization of iloprost inhalation under moderate flow of oxygen therapy in severe pulmonary arterial hypertension.

PubMed

Nakayama, Kazuhiko; Emoto, Noriaki; Tamada, Naoki; Okano, Mitsumasa; Shinkura, Yuto; Yanaka, Kenichi; Onishi, Hiroyuki; Hiraishi, Mana; Yamada, Shinichiro; Tanaka, Hidekazu; Shinke, Toshiro; Hirata, Ken-Ichi

2018-01-01

Inhaled iloprost efficiently improves pulmonary hemodynamics, exercise capacity, and quality of life in patients with pulmonary arterial hypertension (PAH). However, the process of inhalation is laborious for patients suffering from resting dyspnea. We describe a 75-year-old man with idiopathic PAH and a low gas transfer. Investigations excluded significant parenchymal lung disease and airflow obstruction (presuming FEV1/FVC ration > 70%). The patient struggled to complete iloprost inhalation due to severe dyspnea and hypoxemia. As such, we optimized the methods of oxygen supply from the nasal cannula to the trans-inhalator during the inhalation. We successfully shortened the inhalation duration that effectively reduced the laborious efforts required of patients. We also recorded pulmonary hemodynamics during inhalation of nebulized iloprost. This revealed significant hemodynamic improvement immediately following inhalation but hemodynamics returned to baseline within 2 hours. We hope that this optimization will enable patients with severe PAH to undergo iloprost inhalation.

Effect of novel inhaler technique reminder labels on the retention of inhaler technique skills in asthma: a single-blind randomized controlled trial.

PubMed

Basheti, Iman A; Obeidat, Nathir M; Reddel, Helen K

2017-02-09

Inhaler technique can be corrected with training, but skills drop off quickly without repeated training. The aim of our study was to explore the effect of novel inhaler technique labels on the retention of correct inhaler technique. In this single-blind randomized parallel-group active-controlled study, clinical pharmacists enrolled asthma patients using controller medication by Accuhaler [Diskus] or Turbuhaler. Inhaler technique was assessed using published checklists (score 0-9). Symptom control was assessed by asthma control test. Patients were randomized into active (ACCa; THa) and control (ACCc; THc) groups. All patients received a "Show-and-Tell" inhaler technique counseling service. Active patients also received inhaler labels highlighting their initial errors. Baseline data were available for 95 patients, 68% females, mean age 44.9 (SD 15.2) years. Mean inhaler scores were ACCa:5.3 ± 1.0; THa:4.7 ± 0.9, ACCc:5.5 ± 1.1; THc:4.2 ± 1.0. Asthma was poorly controlled (mean ACT scores ACCa:13.9 ± 4.3; THa:12.1 ± 3.9; ACCc:12.7 ± 3.3; THc:14.3 ± 3.7). After training, all patients had correct technique (score 9/9). After 3 months, there was significantly less decline in inhaler technique scores for active than control groups (mean difference: Accuhaler -1.04 (95% confidence interval -1.92, -0.16, P = 0.022); Turbuhaler -1.61 (-2.63, -0.59, P = 0.003). Symptom control improved significantly, with no significant difference between active and control patients, but active patients used less reliever medication (active 2.19 (SD 1.78) vs. control 3.42 (1.83) puffs/day, P = 0.002). After inhaler training, novel inhaler technique labels improve retention of correct inhaler technique skills with dry powder inhalers. Inhaler technique labels represent a simple, scalable intervention that has the potential to extend the benefit of inhaler training on asthma outcomes. REMINDER LABELS IMPROVE INHALER TECHNIQUE: Personalized labels on asthma inhalers remind patients of correct technique and help improve symptoms over time. Iman Basheti at the Applied Science Private University in Jordan and co-workers trialed the approach of placing patient-specific reminder labels on dry-powder asthma inhalers to improve long-term technique. Poor asthma control is often exacerbated by patients making mistakes when using their inhalers. During the trial, 95 patients received inhaler training before being split into two groups: the control group received no further help, while the other group received individualized labels on their inhalers reminding them of their initial errors. After three months, 67% of patients with reminder labels retained correct technique compared to only 12% of controls. They also required less reliever medication and reported improved symptoms. This represents a simple, cheap way of tackling inhaler technique errors.

Improving Tanzanian childbirth service quality.

PubMed

Jaribu, Jennie; Penfold, Suzanne; Green, Cathy; Manzi, Fatuma; Schellenberg, Joanna

2018-04-16

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

Implementation research to improve quality of maternal and newborn health care, Malawi

PubMed Central

Wilhelm, Danielle; Lohmann, Julia; Kambala, Christabel; Chinkhumba, Jobiba; Muula, Adamson S; De Allegri, Manuela

2017-01-01

Abstract Objective To evaluate the impact of a performance-based financing scheme on maternal and neonatal health service quality in Malawi. Methods We conducted a non-randomized controlled before and after study to evaluate the effects of district- and facility-level performance incentives for health workers and management teams. We assessed changes in the facilities’ essential drug stocks, equipment maintenance and clinical obstetric care processes. Difference-in-difference regression models were used to analyse effects of the scheme on adherence to obstetric care treatment protocols and provision of essential drugs, supplies and equipment. Findings We observed 33 health facilities, 23 intervention facilities and 10 control facilities and 401 pregnant women across four districts. The scheme improved the availability of both functional equipment and essential drug stocks in the intervention facilities. We observed positive effects in respect to drug procurement and clinical care activities at non-intervention facilities, likely in response to improved district management performance. Birth assistants’ adherence to clinical protocols improved across all studied facilities as district health managers supervised and coached clinical staff more actively. Conclusion Despite nation-wide stock-outs and extreme health worker shortages, facilities in the study districts managed to improve maternal and neonatal health service quality by overcoming bottlenecks related to supply procurement, equipment maintenance and clinical performance. To strengthen and reform health management structures, performance-based financing may be a promising approach to sustainable improvements in quality of health care. PMID:28670014

First Dutch Consensus of Pain Quality Indicators for Pain Treatment Facilities.

PubMed

de Meij, Nelleke; van Grotel, Marloes; Patijn, Jacob; van der Weijden, Trudy; van Kleef, Maarten

2016-01-01

There is a general consensus about the need to define and improve the quality of pain treatment facilities. Although guidelines and recommendations to improve the quality of pain practice management have been launched, provision of appropriate pain treatment is inconsistent and the quality of facilities varies widely. The aim of the study was to develop an expert-agreed list of quality indicators applicable to pain treatment facilities. The list was also intended to be used as the basis for a set of criteria for registered status of pain treatment facilities. The University Pain Center Maastricht at the Department of Anesthesiology and Pain Management of the Maastricht University Medical Center conducted a 3-round Delphi study in collaboration with the Board of the Pain Section of the Dutch Society of Anesthesiologists (NVA). Twenty-five quality indicators were selected as relevant to 2 types of pain treatment facilities, pain clinics and pain centers. The final expert-agreed list consisted of 22 quality indicators covering 7 quality domains: supervision, availability of care, staffing level and patient load, quality policy, multidisciplinarity, regionalization, and research and education. This set of quality indicators may facilitate organizational evaluation and improve insight into service quality from the perspectives of patients, pain specialists, and other healthcare professionals. Recommendations for improvements to the current set of quality indicators are made. In 2014 the process of registering pain treatment facilities in the Netherlands started; facilities can register as a pain clinic or pain center. © 2015 World Institute of Pain.

Assessing fullness of asthma patients' aerosol inhalers.

PubMed Central

Rickenbach, M A; Julious, S A

1994-01-01

BACKGROUND. The importance of regular medication in order to control asthma symptoms is recognized. However, there is no accurate mechanism for assessing the fullness of aerosol inhalers. The contribution to asthma morbidity of unexpectedly running out of inhaled medication is unknown. AIM. A study was undertaken to determine how patients assess inhaler fullness and the accuracy of their assessments, and to evaluate the floatation method of assessing inhaler fullness. METHOD. An interview survey of 98 patients (51% of those invited to take part), using 289 inhalers, was completed at one general practice in Hampshire. RESULTS. One third of participants said they had difficulty assessing aerosol inhaler fullness and those aged 60 years and over were found to be more inaccurate in assessing fullness than younger participants. Shaking the inhaler to feel the contents move was the commonest method of assessment. When placed in water, an inhaler canister floating on its side with a corner of the canister valve exposed to air indicates that the canister is less than 15% full (sensitivity 90%, specificity 99%). CONCLUSION. Floating a canister in water provides an objective measurement of aerosol inhaler fullness. Providing the method is recommended by the aerosol inhaler manufacturer, general practitioners should demonstrate the floatation method to patients experiencing difficulty in assessing inhaler fullness. PMID:7619099

New graduate transition to practice: how can the literature inform support strategies?

PubMed

Moores, Alis; Fitzgerald, Cate

2017-07-01

Objective The transition to practice for new graduate health professionals has been identified as challenging, with health services typically adopting a range of support and management strategies to assist safe professional practice. Queensland's state-wide Occupational Therapy Clinical Education Program supporting new graduates within public sector health facilities conducted a narrative literature review to identify evidence-based recommended actions that would assist new graduate occupational therapists' to transition from student to practitioner. Method Searches of Medline, CINAHL and PubMed databases were used to locate articles describing or evaluating occupational therapy new graduate support actions. Results The themes of supervision, support and education emerged from the literature. Additionally, four interactions were identified as factors potentially influencing and being influenced by the processes and outcomes of supervision, support and education actions. The interactions identified were professional reasoning, professional identity, an active approach to learning and reflective practice. Conclusions The interactions emerging from the literature will serve to inform the delivery and focus of supervision, support and education for new graduate occupational therapists as they transition to practice. The results may have application for other health professions. What is known about the topic? The transition to practice for new graduate occupational therapists has been reported as challenging with health services implementing various actions to support and assist this transition. A previous literature review of recommended support strategies could not be found providing an impetus for this enquiry. What does this paper add? This narrative literature review identified three themes of actions supporting the transition of new graduates from student to practitioner. In addition to these themes of supervision, support and education, also emerging from the literature were factors identified as important to facilitating the transition of new graduates to the workplace. These factors, or interactions, are identified in this paper as professional reasoning, professional identity, an active approach to learning, and reflective practice. It is proposed that these interactions have an effect on and can be effected by supervision, support and education actions. The articulation between the interactions and the themes was a notable outcome emerging from this literature review. What are the implications for practitioners? This literature review will assist those planning actions to guide new graduates' transition into practice. It is proposed that the methods of implementing supervision, support and education actions are optimised by the identified interactions.

How to match the optimal currently available inhaler device to an individual child with asthma or recurrent wheeze.

PubMed

van Aalderen, Wim M; Garcia-Marcos, Luis; Gappa, Monika; Lenney, Warren; Pedersen, Søren; Dekhuijzen, Richard; Price, David

2015-01-08

Inhaled medications are the cornerstone of treatment in early childhood wheezing and paediatric asthma. A match between patient and device and a correct inhalation technique are crucial for good asthma control. The aim of this paper is to propose an inhaler strategy that will facilitate an inhaler choice most likely to benefit different groups of children. The main focus will be on pressurised metered dose inhalers and dry powder inhalers. In this paper we will discuss (1) practical difficulties with the devices and with inhaled therapy and (2) the optimal location for deposition of medicines in the lungs, and (3) we will propose a practical and easy way to make the best match between the inhaler device and the individual patient. We hope that this paper will contribute to an increased likelihood of treatment success and improved adherence to therapy.

Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facility.

PubMed

Irwin, Amos; Jozaghi, Ehsan; Weir, Brian W; Allen, Sean T; Lindsay, Andrew; Sherman, Susan G

2017-05-12

In Baltimore, MD, as in many cities throughout the USA, overdose rates are on the rise due to both the increase of prescription opioid abuse and that of fentanyl and other synthetic opioids in the drug market. Supervised injection facilities (SIFs) are a widely implemented public health intervention throughout the world, with 97 existing in 11 countries worldwide. Research has documented the public health, social, and economic benefits of SIFs, yet none exist in the USA. The purpose of this study is to model the health and financial costs and benefits of a hypothetical SIF in Baltimore. We estimate the benefits by utilizing local health data and data on the impact of existing SIFs in models for six outcomes: prevented human immunodeficiency virus transmission, Hepatitis C virus transmission, skin and soft-tissue infection, overdose mortality, and overdose-related medical care and increased medication-assisted treatment for opioid dependence. We predict that for an annual cost of $1.8 million, a single SIF would generate $7.8 million in savings, preventing 3.7 HIV infections, 21 Hepatitis C infections, 374 days in the hospital for skin and soft-tissue infection, 5.9 overdose deaths, 108 overdose-related ambulance calls, 78 emergency room visits, and 27 hospitalizations, while bringing 121 additional people into treatment. We conclude that a SIF would be both extremely cost-effective and a significant public health and economic benefit to Baltimore City.

HIV point of care diagnosis: preventing misdiagnosis experience from a pilot of rapid test algorithm implementation in selected communes in Vietnam.

PubMed

Nguyen, Van Thi Thuy; Best, Susan; Pham, Hong Thang; Troung, Thi Xuan Lien; Hoang, Thi Thanh Ha; Wilson, Kim; Ngo, Thi Hong Hanh; Chien, Xuan; Lai, Kim Anh; Bui, Duc Duong; Kato, Masaya

2017-08-29

In Vietnam, HIV testing services had been available only at provincial and district health facilities, but not at the primary health facilities. Consequently, access to HIV testing services had been limited especially in rural areas. In 2012, Vietnam piloted decentralization and integration of HIV services at commune health stations (CHSs). As a part of this pilot, a three-rapid test algorithm was introduced at CHSs. The objective of this study was to assess the performance of a three-rapid test algorithm and the implementation of quality assurance measures to prevent misdiagnosis, at primary health facilities. The three-rapid test algorithm (Determine HIV-1/2, followed by ACON HIV 1/2 and DoubleCheckGold HIV 1&2 in parallel) was piloted at CHSs from August 2012 to December 2013. Commune health staff were trained to perform HIV testing. Specimens from CHSs were sent to the provincial confirmatory laboratory (PCL) for confirmatory and validation testing. Quality assurance measures were undertaken including training, competency assessment, field technical assistance, supervision and monitoring and external quality assessment (EQA). Data on HIV testing were collected from the testing logbooks at commune and provincial facilities. Descriptive analysis was conducted. Sensitivity and specificity of the rapid testing algorithm were calculated. A total of 1,373 people received HIV testing and counselling (HTC) at CHSs. Eighty people were diagnosed with HIV infection (5.8%). The 755/1244 specimens reported as HIV negative at the CHS were sent to PCL and confirmed as negative, and all 80 specimens reported as HIV positive at CHS were confirmed as positive at the PCL. Forty-nine specimens that were reactive with Determine but negative with ACON and DoubleCheckGold at the CHSs were confirmed negative at the PCL. The results show this rapid test algorithm to be 100% sensitive and 100% specific. Of 21 CHSs that received two rounds of EQA panels, 20 CHSs submitted accurate results. Decentralization of HIV confirmatory testing to CHS is feasible in Vietnam. The results obtained from this pilot provided strong evidence of the feasibility of HIV testing at primary health facilities. Quality assurance measures including training, competency assessment, regular monitoring and supervision and an EQA scheme are essential for prevention of misdiagnosis.

Assessment of the core and support functions of the Integrated Disease Surveillance system in Maharashtra, India

PubMed Central

2013-01-01

Background Monitoring the progress of the Integrated Disease Surveillance (IDS) strategy is an important component to ensure its sustainability in the state of Maharashtra in India. The purpose of the study was to document the baseline performance of the system on its core and support functions and to understand the challenges for its transition from an externally funded “project” to a state owned surveillance “program”. Methods Multi-centre, retrospective cross-sectional evaluation study to assess the structure, core and support surveillance functions using modified WHO generic questionnaires. All 34 districts in the state and randomly identified 46 facilities and 25 labs were included in the study. Results Case definitions were rarely used at the periphery. Limited laboratory capacity at all levels compromised case and outbreak confirmation. Only 53% districts could confirm all priority diseases. Stool sample processing was the weakest at the periphery. Availability of transport media, trained staff, and rapid diagnostic tests were main challenges at the periphery. Data analysis was weak at both district and facility levels. Outbreak thresholds were better understood at facility level (59%) than at the district (18%). None of the outbreak indicator targets were met and submission of final outbreak report was the weakest. Feedback and training was significantly better (p < 0.0001) at district level (65%; 76%) than at facility level (15%; 37%). Supervision was better at the facility level (37%) than at district (18%) and so were coordination, communication and logistic resources. Contractual part time positions, administrative delays in recruitment, and vacancies (30%) were main human resource issues that hampered system performance. Conclusions Significant progress has been made in the core and support surveillance functions in Maharashtra, however some challenges exist. Support functions (laboratory, transport and communication equipment, training, supervision, human and other resources) are particularly weak at the district level. Structural integration and establishing permanent state and district surveillance officer positions will ensure leadership; improve performance; support continuity; and offer sustainability to the program. Institutionalizing the integrated disease surveillance strategy through skills based personnel development and infrastructure strengthening at district levels is the only way to avoid it from ending up isolated! Improving surveillance quality should be the next on agenda for the state. PMID:23764137

Is the 'blue' colour convention for inhaled reliever medications important? A UK-based survey of healthcare professionals and patients with airways disease.

PubMed

Fletcher, Monica; Scullion, Jane; White, John; Thompson, Bronwen; Capstick, Toby

2016-11-03

In many countries, short-acting β 2 -agonist inhalers have traditionally been coloured blue. This inhaled therapy has also conventionally been known as a 'reliever' by patients and healthcare professionals (HCPs), in comparison with 'preventer' medications (inhaled steroids). With the rapidly changing market in inhaled therapy for COPD and asthma and growing numbers of devices, there has been some concern that the erosion of traditional colour conventions is leading to patients (and HCPs) becoming confused about the role of different therapies. In order to assess whether there was concern over the perceived changing colour conventions, the UK Inhaler Group carried out a large online survey of patients and HCPs. The aim was to determine how patients and HCPS identify and describe inhaled drugs, and how this might impact on use of medicines and safety. The results of the survey highlighted the importance of the term 'blue inhaler' for patients with only 11.3% never referring to the colour when referring to their inhaler. For HCPs, 95% felt colour conventions were important when referring to reliever medication. In addition, HCPs appear to refer to inhalers mainly by colour when talking to patients. Our conclusions were that the concept of a 'blue inhaler' remains important to patients and healthcare professionals. These results add to the debate about the need to formalise the colour coding of inhaled therapies, in particular using the colour blue for inhalers for rapid relief of symptoms, as this convention may be an important measure and contributor to patient safety. Our survey should provide impetus for all interested parties to discuss and agree a formal industry-wide approach to colour coding of inhaled therapies for the benefit of patients and carers and HCPs.

Customizing inhaled therapy to meet the needs of COPD patients.

PubMed

Fromer, Leonard; Goodwin, Elizabeth; Walsh, John

2010-03-01

Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airflow limitation resulting from emphysema and chronic bronchitis. Inhaled therapy is the major therapeutic approach for treating COPD. Multiple inhaler medications are available in the United States and are delivered by a variety of different devices: metered-dose inhalers, dry powdered inhalers, and nebulizers. Each inhaler device has unique requirements for use that must be correctly performed by the patient for successful drug delivery. Patients with COPD represent a medically diverse population, with each patient having distinct characteristics, such as lung function, comorbidities, cognitive functions, hand strength, and lifestyle. These characteristics impact the patient's ability to properly use specific inhaler devices and therefore affect adherence to therapy, therapeutic outcomes, and quality of life. It is estimated that between 28% to 68% of patients do not use metered-dose inhalers or dry powder inhalers correctly. Worsening symptoms or increased frequency of exacerbations may not always indicate disease progression but may indicate a patient's inability to use their inhaler device properly. This review discusses the patient- and device-specific factors to be considered when choosing an inhaled therapy, which will be concordant with the patient's medical needs, preferences, and lifestyle. The review also considers how the ideas underlying the patient-centered medical home model can be incorporated into the choice and use of inhaler device for a given patient with COPD to improve treatment outcomes.

How do we know? An assessment of integrated community case management data quality in four districts of Malawi.

PubMed

Yourkavitch, Jennifer; Zalisk, Kirsten; Prosnitz, Debra; Luhanga, Misheck; Nsona, Humphreys

2016-11-01

The World Health Organization contracted annual data quality assessments of Rapid Access Expansion (RAcE) projects to review integrated community case management (iCCM) data quality and the monitoring and evaluation (M&E) system for iCCM, and to suggest ways to improve data quality. The first RAcE data quality assessment was conducted in Malawi in January 2014 and we present findings pertaining to data from the health management information system at the community, facility and other sub-national levels because RAcE grantees rely on that for most of their monitoring data. We randomly selected 10 health facilities (10% of eligible facilities) from the four RAcE project districts, and collected quantitative data with an adapted and comprehensive tool that included an assessment of Malawi's M&E system for iCCM data and a data verification exercise that traced selected indicators through the reporting system. We rated the iCCM M&E system across five function areas based on interviews and observations, and calculated verification ratios for each data reporting level. We also conducted key informant interviews with Health Surveillance Assistants and facility, district and central Ministry of Health staff. Scores show a high-functioning M&E system for iCCM with some deficiencies in data management processes. The system lacks quality controls, including data entry verification, a protocol for addressing errors, and written procedures for data collection, entry, analysis and management. Data availability was generally high except for supervision data. The data verification process identified gaps in completeness and consistency, particularly in Health Surveillance Assistants' record keeping. Staff at all levels would like more training in data management. This data quality assessment illuminates where an otherwise strong M&E system for iCCM fails to ensure some aspects of data quality. Prioritizing data management with documented protocols, additional training and approaches to create efficient supervision practices may improve iCCM data quality. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Quality of Midwife-provided Intrapartum Care in Amhara Regional State, Ethiopia.

PubMed

Yigzaw, Tegbar; Abebe, Fantu; Belay, Lalem; Assaye, Yewulsew; Misganaw, Equlinet; Kidane, Ashebir; Ademie, Desalegn; van Roosmalen, Jos; Stekelenburg, Jelle; Kim, Young-Mi

2017-08-16

Despite much progress recently, Ethiopia remains one of the largest contributors to the global burden of maternal and newborn deaths and stillbirths. Ethiopia's plan to meet the sustainable development goals for maternal and child health includes unprecedented emphasis on improving quality of care. The purpose of this study was to assess the quality of midwifery care during labor, delivery and immediate postpartum period. A cross-sectional study using multiple data collection methods and a 2-stage cluster sampling technique was conducted from January 25 to February 14, 2015 in government health facilities of the Amhara National Regional State of Ethiopia. Direct observation of performance was used to determine competence of midwives in providing care during labor, delivery, and the first 6 h after childbirth. Inventory of drugs, medical equipment, supplies, and infrastructure was conducted to identify availability of resources in health facilities. Structured interview was done to assess availability of resources and performance improvement opportunities. Data analysis involved calculating percentages, means and chi-square tests. A total of 150 midwives and 56 health facilities were included in the study. The performance assessment showed 16.5% of midwives were incompetent, 72.4% were competent, and 11.1% were outstanding in providing routine intrapartum care. Forty five midwives were observed while managing 54 obstetric and newborn complications and 41 (91%) of them were rated competent. Inventory of resources found that the proportion of facilities with more than 75% of the items in each category was 32.6% for drugs, 73.1% for equipment, 65.4% for supplies, 47.9% for infection prevention materials, and 43.6% for records and forms. Opportunities for performance improvement were inadequate, with 31.3% reporting emergency obstetric and newborn care training, and 44.7% quarterly or more frequent supportive supervision. Health centers fared worse in provider competence, physical resources, and quality improvement practices except for supportive supervision visits and in-service training. Although our findings indicate most midwives are competent in giving routine and emergency intrapartum care, the major gaps in the enabling environment and the significant proportion of midwives with unsatisfactory performance suggest that the conditions for providing quality intrapartum care are not optimal.

Inhalant Use, Abuse, and Dependence among Adolescent Patients: Commonly Comorbid Problems.

ERIC Educational Resources Information Center

Sakai, Joseph T.; Hall, Shannon K.; Mikulich-Gilbertson, Susan K.; Crowley, Thomas J.

2004-01-01

Objective: Little is known about adolescents with DSM-IV-defined inhalant abuse and dependence. The aim of this study was to compare comorbidity among (1) adolescents with inhalant use disorders, (2) adolescents who reported using inhalants without inhalant use disorder, and (3) other adolescent patients drawn from an adolescent drug and alcohol…

Effectiveness of Various Methods of Teaching Proper Inhaler Technique.

PubMed

Axtell, Samantha; Haines, Seena; Fairclough, Jamie

2017-04-01

To compare the effectiveness of 4 different instructional interventions in training proper inhaler technique. Randomized, noncrossover trial. Health fair and indigent clinic. Inhaler-naive adult volunteers who spoke and read English. Subjects were assigned to complete the following: (1) read a metered dose inhaler (MDI) package insert pamphlet, (2) watch a Centers for Disease Control and Prevention (CDC) video demonstrating MDI technique, (3) watch a YouTube video demonstrating MDI technique, or (4) receive direct instruction of MDI technique from a pharmacist. Inhaler use competency (completion of all 7 prespecified critical steps). Of the 72 subjects, 21 (29.2%) demonstrated competent inhaler technique. A statistically significant difference between pharmacist direct instruction and the remaining interventions, both combined ( P < .0001) and individually ( P ≤ .03), was evident. No statistically significant difference was detected among the remaining 3 intervention groups. Critical steps most frequently omitted or improperly performed were exhaling before inhalation and holding of breath after inhalation. A 2-minute pharmacist counseling session is more effective than other interventions in successfully educating patients on proper inhaler technique. Pharmacists can play a pivotal role in reducing the implications of improper inhaler use.

A cross-sectional observational study to assess inhaler technique in Saudi hospitalized patients with asthma and chronic obstructive pulmonary disease

PubMed Central

Ammari, Maha Al; Sultana, Khizra; Yunus, Faisal; Ghobain, Mohammed Al; Halwan, Shatha M. Al

2016-01-01

Objectives: To assess the proportion of critical errors committed while demonstrating the inhaler technique in hospitalized patients diagnosed with asthma and chronic obstructive pulmonary disease (COPD). Methods: This cross-sectional observational study was conducted in 47 asthmatic and COPD patients using inhaler devices. The study took place at King Abdulaziz Medical City, Riyadh, Saudi Arabia between September and December 2013. Two pharmacists independently assessed inhaler technique with a validated checklist. Results: Seventy percent of patients made at least one critical error while demonstrating their inhaler technique, and the mean number of critical errors per patient was 1.6. Most patients used metered dose inhaler (MDI), and 73% of MDI users and 92% of dry powder inhaler users committed at least one critical error. Conclusion: Inhaler technique in hospitalized Saudi patients was inadequate. Health care professionals should understand the importance of reassessing and educating patients on a regular basis for inhaler technique, recommend the use of a spacer when needed, and regularly assess and update their own inhaler technique skills. PMID:27146622

Use of Respimat® Soft Mist™ Inhaler in COPD patients

PubMed Central

Anderson, Paula

2006-01-01

Events of the past decade have stimulated development of new drug formulations and delivery devices that have improved the efficiency, ease of use, and environmental impact of inhaled drug therapy. Respimat® Soft Mist™ Inhaler is a novel, multidose, propellant-free, hand-held, liquid inhaler that represents a new category of inhaler devices. The aerosol cloud generated by Respimat contains a higher fraction of fine particles than most pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs), and the aerosol spray exits the inhaler more slowly and for a longer duration than with pMDIs. This translates into higher lung drug deposition and lower oropharyngeal deposition, making it possible to give lower nominal doses of delivered drugs without lowering efficacy. In clinical trials in patients with COPD, bronchodilator drugs delivered from Respimat were equally effective at half of the dose delivered from a pMDI. In one study of inhaler preference, Respimat was preferred over the pMDI by patients with COPD and other obstructive lung diseases. Respimat is a valuable addition to the range of inhaler devices available to the patient with COPD. PMID:18046862

Inhalation Injuries

MedlinePlus

... breathe in toxic substances, such as smoke (from fires), chemicals, particle pollution, and gases. Inhalation injuries can ... of thermal injuries. Over half of deaths from fires are due to inhalation injuries. Symptoms of inhalation ...

Reliability and validity of the anesthesiologist supervision instrument when certified registered nurse anesthetists provide scores.

PubMed

Dexter, Franklin; Masursky, Danielle; Hindman, Bradley J

2015-01-01

At many facilities in the United States, supervision of Certified Registered Nurse Anesthetists (CRNAs) is a major daily responsibility of anesthesiologists. We use the term "supervision" to include clinical oversight functions directed toward assuring the quality of clinical care whenever the anesthesiologist is not the sole anesthesia care provider. In our department, the supervision provided by each anesthesiologist working in operating rooms is evaluated each day by the CRNA(s) and anesthesiology resident(s) with whom they worked the previous day. The evaluations utilize the 9 questions developed by de Oliveira Filho for residents to assess anesthesiologist supervision. Each question is answered on a 4-point Likert scale (1 = never, 2 = rarely, 3 = frequently, and 4 = always). We evaluated the reliability and validity of the instrument when used in daily practice by CRNAs. The data set included all 7273 daily supervision scores and 1088 comments of 77 anesthesiologists provided by 49 CRNAs, as well as the 6246 scores and 681 comments provided by 62 residents, for dates of service between July 1, 2013, and June 30, 2014. Reliability of the instrument was assessed using its internal consistency. Content analysis was used to associate supervision scores (i.e., mean of the 9 answers) and presence of the verbs "see" or "saw" combined with negation in comments (e.g., "I did not see the anesthesiologist during the case(s) together"). Results are reported as the mean ± SE from among the 6 two-month periods. Supervision scores <2 were provided for 7.2% ± 0.4% of assessments and scores <3 were provided for 36.6% ± 1.1% of assessments, by 18.2 ± 0.9 and 34.0 ± 0.6 CRNAs, respectively (i.e., low scores were not attributable to just a few CRNAs or anesthesiologists). These frequencies were greater than for trainees (anesthesiology residents) (both P < 0.0001). No single question among the 9 questions in the supervision instrument explained CRNA supervision scores <2 (or <3) because of substantial (expected) interquestion correlation. Cronbach's alpha equaled 0.895 ± 0.003 among the 6 two-month periods. Among the CRNA evaluations that included a written comment, the Cronbach's alpha was 0.907 ± 0.003. Thus, like for anesthesiology residents, when used by CRNAs, the questions measured a one-dimensional attribute. The presence of a comment containing the action verb "see" or "saw," with the focus theme ("I did not see …"), increased the odds of a CRNA providing a supervision score <2 (odds ratio = 74.2, P = 0.0003) and supervision score <3 (odds ratio = 48.2, P < 0.0001). Limiting consideration to scores with comments, there too was an association between these words and a score <2 (odds ratio = 19.4, P = 0.0003) and a score <3 (odds ratio = 31.5, P < 0.0001). In Iowa, substantial anesthesiologist presence is not required for CRNA billing. More comments containing "see" or "saw" were made by CRNAs rather than residents (n = 75 [97.4%] versus n = 2 [2.6%], respectively, P < 0.0001), indicating face validity of the analysis. If some of the 9 questions were not perceived by the CRNAs as relevant to their interprofessional interactions, Cronbach's alpha would be low, not the 0.907 ± 0.003, above. Similarly, one or more of the individual questions would also not routinely be scored at its upper boundary of 4.0 ("always"). This was not so, being as the score was 4.0 for 24.9% ± 0.3% of the CRNA evaluations, and that score of 4.0 was more common than even the next most common combination of scores (P < 0.0001). The de Oliveira Filho supervision instrument was designed for use by residents. Our results show that the instrument also is reliable and valid when used by CRNAs. This is important given our previous finding that the CRNA:MD ratio had no correlation with the level of supervision provided.

Site specific risk assessment of an energy-from-waste thermal treatment facility in Durham Region, Ontario, Canada. Part A: Human health risk assessment.

PubMed

Ollson, Christopher A; Knopper, Loren D; Whitfield Aslund, Melissa L; Jayasinghe, Ruwan

2014-01-01

The regions of Durham and York in Ontario, Canada have partnered to construct an energy-from-waste thermal treatment facility as part of a long term strategy for the management of their municipal solid waste. This paper presents the results of a comprehensive human health risk assessment for this facility. This assessment was based on extensive sampling of baseline environmental conditions (e.g., collection and analysis of air, soil, water, and biota samples) as well as detailed site specific modeling to predict facility-related emissions of 87 identified contaminants of potential concern. Emissions were estimated for both the approved initial operating design capacity of the facility (140,000 tonnes per year) and for the maximum design capacity (400,000 tonnes per year). For the 140,000 tonnes per year scenario, this assessment indicated that facility-related emissions are unlikely to cause adverse health risks to local residents, farmers, or other receptors (e.g., recreational users). For the 400,000 tonnes per year scenarios, slightly elevated risks were noted with respect to inhalation (hydrogen chloride) and infant consumption of breast milk (dioxins and furans), but only during predicted 'upset conditions' (i.e. facility start-up, shutdown, and loss of air pollution control) that represent unusual and/or transient occurrences. However, current provincial regulations require that additional environmental screening would be mandatory prior to expansion of the facility beyond the initial approved capacity (140,000 tonnes per year). Therefore, the potential risks due to upset conditions for the 400,000 tonnes per year scenario should be more closely investigated if future expansion is pursued. © 2013.

A cross-sectional survey of essential surgical capacity in Somalia

PubMed Central

Elkheir, Natalie; Sharma, Akshay; Cherian, Meena; Saleh, Omar Abdelrahman; Everard, Marthe; Popal, Ghulam Rabani; Ibrahim, Abdi Awad

2014-01-01

Objective To assess life-saving and disability-preventing surgical services (including emergency, trauma, obstetrics, anaesthesia) of health facilities in Somalia and to assist in the planning of strategies for strengthening surgical care systems. Design Cross-sectional survey. Setting Health facilities in all 3 administrative zones of Somalia; northwest Somalia (NWS), known as Somaliland; northeast Somalia (NES), known as Puntland; and south/central Somalia (SCS). Participants 14 health facilities. Measures The WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was employed to capture a health facility's capacity to deliver surgical and anaesthesia services by investigating four categories of data: infrastructure, human resources, interventions available and equipment. Results The 14 facilities surveyed in Somalia represent 10 of the 18 districts throughout the country. The facilities serve an average patient population of 331 250 people, and 12 of the 14 identify as hospitals. While major surgical procedures were provided at many facilities (caesarean section, laparotomy, appendicectomy, etc), only 22% had fully available oxygen access, 50% fully available electricity and less than 30% had any management guidelines for emergency and surgical care. Furthermore, only 36% were able to provide general anaesthesia inhalation due to lack of skills, supplies and equipment. Basic supplies for airway management and the prevention of infection transmission were severely lacking in most facilities. Conclusions According to the results of the WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care survey, there exist significant gaps in the capacity of emergency and essential surgical services in Somalia including inadequacies in essential equipment, service provision and infrastructure. The information provided by the WHO tool can serve as a basis for evidence-based decisions on country-level policy regarding the allocation of resources and provision of emergency and essential surgical services. PMID:24812189

A cross-sectional survey of essential surgical capacity in Somalia.

PubMed

Elkheir, Natalie; Sharma, Akshay; Cherian, Meena; Saleh, Omar Abdelrahman; Everard, Marthe; Popal, Ghulam Rabani; Ibrahim, Abdi Awad

2014-05-07

To assess life-saving and disability-preventing surgical services (including emergency, trauma, obstetrics, anaesthesia) of health facilities in Somalia and to assist in the planning of strategies for strengthening surgical care systems. Cross-sectional survey. Health facilities in all 3 administrative zones of Somalia; northwest Somalia (NWS), known as Somaliland; northeast Somalia (NES), known as Puntland; and south/central Somalia (SCS). 14 health facilities. The WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was employed to capture a health facility's capacity to deliver surgical and anaesthesia services by investigating four categories of data: infrastructure, human resources, interventions available and equipment. The 14 facilities surveyed in Somalia represent 10 of the 18 districts throughout the country. The facilities serve an average patient population of 331 250 people, and 12 of the 14 identify as hospitals. While major surgical procedures were provided at many facilities (caesarean section, laparotomy, appendicectomy, etc), only 22% had fully available oxygen access, 50% fully available electricity and less than 30% had any management guidelines for emergency and surgical care. Furthermore, only 36% were able to provide general anaesthesia inhalation due to lack of skills, supplies and equipment. Basic supplies for airway management and the prevention of infection transmission were severely lacking in most facilities. According to the results of the WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care survey, there exist significant gaps in the capacity of emergency and essential surgical services in Somalia including inadequacies in essential equipment, service provision and infrastructure. The information provided by the WHO tool can serve as a basis for evidence-based decisions on country-level policy regarding the allocation of resources and provision of emergency and essential surgical services.

Density assessment and mapping of microorganisms around a biocomposting plant in Sanandaj, Iran.

PubMed

Rashidi, Sanaz; Shahmoradi, B; Maleki, Afshin; Sharafi, Kiomars; Darvishi, Ebrahim

2017-05-01

Exposure to microorganisms can cause various diseases or exacerbate the excitatory responses, inflammation, dry cough and shortness of breath, reduced lung function, chronic obstructive pulmonary disease, and allergic response or allergic immune. The aim of the present study was to investigate the density of microorganisms around the air of processing facilities of a biocomposting plant. Each experiment was carried out according to ASTM E884-82 (2001) method. The samples were collected from inhaled air in four locations of the plant, which had a high traffic of workers and employees, including screen, conveyor belt, aerated compost pile, and static compost pile. The sampling was repeated five times for each location selected. The wind speed and its direction were measured using an anemometer. Temperature and humidity were also recorded at the time of sampling. The multistage impactor used for sampling was equipped with a solidified medium (agar) and a pump (with a flow rate of 28.3 l/m) for passing air through the media. It was found that the mean density of total bacteria was >1.7 × 10 3  cfu/m 3 in the study area. Moreover, the mean densities of fungi, intestinal bacteria (Klebsiella), and Staphylococcus aureus were 5.9 × 10 3 , 3.3 × 10 3 , and 4.1 × 10 3  cfu/m 3 , respectively. In conclusion, according to the findings, the density of bacteria and fungi per cubic meter of air in the samples collected around the processing facilities of the biocomposting plant in Sanandaj City was higher than the microbial standard for inhaled air.

Lung function measures following simulated wildland firefighter exposures.

PubMed

Ferguson, Matthew D; Semmens, Erin O; Weiler, Emily; Domitrovich, Joe; French, Mary; Migliaccio, Christopher; Palmer, Charles; Dumke, Charles; Ward, Tony

2017-09-01

Across the world, biomass smoke is a major source of air pollution and is linked with a variety of adverse health effects. This is particularly true in the western U.S. where wood smoke from wildland forest fires are a significant source of PM 2.5 . Wildland firefighters are impacted as they experience elevated PM 2.5 concentrations over extended periods of time, often occurring during physical exertion. Various epidemiological studies have investigated wood smoke impacts on human health, including occupational field exposures experienced by wildland firefighters. As there are numerous challenges in carrying out these field studies, having the ability to research the potential health impacts to this occupational cohort in a controlled setting would provide important information that could be translated to the field setting. To this end, we have carried out a simulated wildland firefighter exposure study in a wood smoke inhalation facility. Utilizing a randomized crossover trial design, we exposed 10 participants once to clean filtered-air, 250 µg/m 3 , and 500 µg/m 3 wood stove-generated wood smoke PM 2.5 . Participants exercised on a treadmill at an absolute intensity designed to simulate wildland firefighting for 1.5 hr. In addition to measured PM 2.5 smoke concentrations, mean levels of CO 2 , CO, and % relative humidity were continuously monitored and recorded and were representative of occupational "real-world" exposures. Pulmonary function was measured at three time points: before, immediately after, and 1-hr post-exposure. Although there were some reductions in FVC, FEV 1 , and FVC:FEV 1 measures, results of the spirometry testing did not show significant changes in lung function. The development of this wood smoke inhalational facility provides a platform to further address unique research questions related to wood smoke exposures and associated adverse health effects.

Occupational exposure in the fluorescent lamp recycling sector in France

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

Zimmermann, François, E-mail: francois.zimmermann@inrs.fr; Lecler, Marie-Thérèse; Clerc, Frédéric

Highlights: • Chemical risks were assessed in the five fluorescent lamp recycling facilities. • The main hazardous agents are mercury vapors and dust containing lead and yttrium. • Exposure and pollutant levels were correlated with steps and processes. • All the stages and processes are concerned by worrying levels of pollutants. • We suggest recommendations to reduce chemical risk. - Abstract: The fluorescent lamp recycling sector is growing considerably in Europe due to increasingly strict regulations aimed at inciting the consumption of low energy light bulbs and their end-of-life management. Chemical risks were assessed in fluorescent lamp recycling facilities bymore » field measurement surveys in France, highlighting that occupational exposure and pollutant levels in the working environment were correlated with the main recycling steps and processes. The mean levels of worker exposure are 4.4 mg/m{sup 3}, 15.4 μg/m{sup 3}, 14.0 μg/m{sup 3}, 247.6 μg/m{sup 3}, respectively, for total inhalable dust, mercury, lead and yttrium. The mean levels of airborne pollutants are 3.1 mg/m{sup 3}, 9.0 μg/m{sup 3}, 9.0 μg/m{sup 3}, 219.2 μg/m{sup 3}, respectively, for total inhalable dust, mercury, lead and yttrium. The ranges are very wide. Surface samples from employees’ skin and granulometric analysis were also carried out. The overview shows that all the stages and processes involved in lamp recycling are concerned by the risk of hazardous substances penetrating into the bodies of employees, although exposure of the latter varies depending on the processes and tasks they perform. The conclusion of this study strongly recommends the development of a new generation of processes in parallel with more information sharing and regulatory measures.« less

Fiber inhalability and head deposition in rats and humans. ...

EPA Pesticide Factsheets

Due to their dimensions and long durability, inhaled asbestos fibers clear slowly from lung airways. Retained fibers may injure the epithelium, interact with macrophages, or translocate to the interstitium to result in various respiratory diseases. Therefore, calculations of fiber inhalability, deposition, and retention in respiratory tract regions of both rats and humans are crucial, both to assess the health risk of fiber exposures and to facilitate inferences from rat inhalation studies. Rat inhalation experiments are underway at the EPA and NIEHS. A model of fiber inhalability and initial deposition in the human and rat nasal cavity was developed. Existing models for particles were extended to fibers by replacing particle diameter with an equivalent fiber diameter. Since fiber inhalability into the respiratory tract and deposition in the extra thoracic airways depended mainly on its inertia, equivalent impaction diameters were derived and substituted in expressions for spherical particle diameter to determine fiber inhalability and nasal losses. Fiber impaction diameter depended strongly on its orientation in the air. Highest inhalability was obtained when fibers were aligned perpendicular to the flow streamlines in the inhaled air. However, detailed calculations of fiber transport in slow moving air such as that in the atmosphere and in lung airways showed that fibers stayed primarily aligned (parallel) to the flow. Therefore, for inhalability calculations,

Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique.

PubMed

Basheti, Iman A; Armour, Carol L; Bosnic-Anticevich, Sinthia Z; Reddel, Helen K

2008-07-01

To evaluate the feasibility, acceptability and effectiveness of a brief intervention about inhaler technique, delivered by community pharmacists to asthma patients. Thirty-one pharmacists received brief workshop education (Active: n=16, CONTROL: n=15). Active Group pharmacists were trained to assess and teach dry powder inhaler technique, using patient-centered educational tools including novel Inhaler Technique Labels. Interventions were delivered to patients at four visits over 6 months. At baseline, patients (Active: 53, CONTROL: 44) demonstrated poor inhaler technique (mean+/-S.D. score out of 9, 5.7+/-1.6). At 6 months, improvement in inhaler technique score was significantly greater in Active cf. CONTROL patients (2.8+/-1.6 cf. 0.9+/-1.4, p<0.001), and asthma severity was significantly improved (p=0.015). Qualitative responses from patients and pharmacists indicated a high level of satisfaction with the intervention and educational tools, both for their effectiveness and for their impact on the patient-pharmacist relationship. A simple feasible intervention in community pharmacies, incorporating daily reminders via Inhaler Technique Labels on inhalers, can lead to improvement in inhaler technique and asthma outcomes. Brief training modules and simple educational tools, such as Inhaler Technique Labels, can provide a low-cost and sustainable way of changing patient behavior in asthma, using community pharmacists as educators.

Ease-of-use preference for the ELLIPTA® dry powder inhaler over a commonly used single-dose capsule dry powder inhaler by inhalation device-naïve Japanese volunteers aged 40 years or older.

PubMed

Komase, Yuko; Asako, Akimoto; Kobayashi, Akihiro; Sharma, Raj

2014-01-01

In patients receiving inhaled medication, dissatisfaction with and difficulty in using the inhaler can affect treatment adherence. The incidence of handling errors is typically higher in the elderly than in younger people. The aim of the study was to assess inhaler preference for and handling errors with the ELLIPTA® dry powder inhaler (DPI), (GSK), compared with the established BREEZHALER™, a single-dose capsule DPI (Novartis), in inhalation device-naïve Japanese volunteers aged ≥40 years. In this open-label, nondrug interventional, crossover DPI preference study comparing the ELLIPTA DPI and BREEZHALER, 150 subjects were randomized to handle the ELLIPTA or BREEZHALER DPIs until the point of inhalation, without receiving verbal or demonstrative instruction (first attempt). Subjects then crossed over to the other inhaler. Preference was assessed using a self-completed questionnaire. Inhaler handling was assessed by a trained assessor using a checklist. Subjects did not inhale any medication in the study, so efficacy and safety were not measured. The ELLIPTA DPI was preferred to the BREEZHALER by 89% of subjects (odds ratio [OR] 70.14, 95% confidence interval [CI] 33.69-146.01; P-value not applicable for this inhaler) for ease of use, by 63% of subjects (OR 2.98, CI 1.87-4.77; P<0.0001) for ease of determining the number of doses remaining in the inhaler, by 91% for number of steps required, and by 93% for time needed for handling the inhaler. The BREEZHALER was preferred to the ELLIPTA DPI for comfort of the mouthpiece by 64% of subjects (OR 3.16, CI 1.97-5.06; P<0.0001). The incidence of handling errors (first attempt) was 11% with ELLIPTA and 68% with BREEZHALER; differences in incidence were generally similar when analyzed by age (< or ≥65 years) or sex. These data, obtained in an inhalation device-naïve population, suggest that the ELLIPTA DPI is preferred to an established alternative based on its ease-of-use features and is associated with fewer handling errors.

Methods for Derivation of Inhalation Reference Concentrations and Application of Inhalation Dosimetry

EPA Pesticide Factsheets

EPA's methodology for estimation of inhalation reference concentrations (RfCs) as benchmark estimates of the quantitative dose-response assessment of chronic noncancer toxicity for individual inhaled chemicals.

Toxicity study of dimethylethoxysilane (DMSES), the waterproofing agent for the Orbiter heat protective system

NASA Technical Reports Server (NTRS)

Lam, Chiu-Wing; James, John T.; Dodd, Darol; Stuart, Bruce; Rothenberg, Simon; Kershaw, Mary Ann; Thilagar, A.

1993-01-01

DMES, a volatile liquid, is used by NASA to waterproof the Orbiter thermal protective system. During waterproofing operations at the Oribter Processing Facility at KSC, workers could be exposed to DMES vapor. To assess the toxicity of DMES, acute and subchronic (2-week and 13-week) inhalation studies were conducted with rats. Studies were also conducted to assess the potential of DMES. Inhalation exposure concentrations ranged from 40 ppm to 4000 ppm. No mortality was observed during the studies. Exposures to 2100 ppm produced narcosis and ataxia. Post-exposure recovery from these CNS effects was rapid (less than 1 hr). These effects were concentration-dependent and relatively independent of exposure length. Exposure to 3000 ppm for 2 weeks (5 h/d, 5 d/wk) produced testicular toxicity. The 13-week study yielded similar results. Results from the genotoxicity assays (in vivo/in vitro unscheduled DNA synthesis in rat primary heptaocytes, chromosomal aberrations in rat bone marrow cells; reverse gene mutation in Salmonella typhimurium; and forward mutation in Chinese hamster culture cells) were negative. These studies indicated that DMES is mildly to moderately toxic but not a multagen.

INFLUENCE OF INHALATION INJURY ON ENERGY EXPENDITURE IN SEVERELY BURNED CHILDREN

PubMed Central

Przkora, Rene; Fram, Ricki Y.; Herndon, David N.; Suman, Oscar E.; Mlcak, Ronald P.

2014-01-01

Objective Determine the effect of inhalation injury on burn-induced hypermetabolism in children. Design Prospective study comparing hypermetabolism (i.e., resting energy expenditure and oxygen consumption) in burned children with and without inhalation injury during acute hospitalization. Setting Single pediatric burn center. Patients Eighty-six children (1–18 years) with ≥ 40% total body surface area burns were stratified to two groups: no inhalation injury and inhalation injury. Interventions None. Main Measurements and Results Inhalation injury was diagnosed based on bronchoscopic evaluation. At admission, PaO2:FiO2 ratios (an index of respiratory distress) were significantly higher in patients with no inhalation injury than in patient with inhalation injury. No differences were detected in resting energy expenditure or percent of the predicted basal metabolic rate between groups. Additionally, oxygen consumption did not significantly differ between groups. Conclusions Inhalation injury does not augment the burn-induced hypermetabolic stress response in children, as reflected by resting energy expenditure and oxygen consumption. PMID:24893760

Comparison of peak inspiratory flow rate via the Breezhaler®, Ellipta® and HandiHaler® dry powder inhalers in patients with moderate to very severe COPD: a randomized cross-over trial.

PubMed

Altman, Pablo; Wehbe, Luis; Dederichs, Juergen; Guerin, Tadhg; Ament, Brian; Moronta, Miguel Cardenas; Pino, Andrea Valeria; Goyal, Pankaj

2018-06-14

The chronic and progressive nature of chronic obstructive pulmonary disease (COPD) requires self-administration of inhaled medication. Dry powder inhalers (DPIs) are increasingly being used for inhalation therapy in COPD. Important considerations when selecting DPIs include inhalation effort required and flow rates achieved by patients. Here, we present the comparison of the peak inspiratory flow rate (PIF) values achieved by COPD patients, with moderate to very severe airflow limitation, through the Breezhaler®, the Ellipta® and the HandiHaler® inhalers. The effects of disease severity, age and gender on PIF rate were also evaluated. This randomized, open-label, multicenter, cross-over, Phase IV study recruited patients with moderate to very severe airflow limitation (Global Initiative for Obstructive Lung Disease 2014 strategy), aged ≥40 years and having a smoking history of ≥10 pack years. No active drug or placebo was administered during the study. The inhalation profiles were recorded using inhalers fitted with a pressure tap and transducer at the wall of the mouthpiece. For each patient, the inhalation with the highest PIF value, out of three replicate inhalations per device, was selected for analysis. A paired t-test was performed to compare mean PIFs between each combination of devices. In total, 97 COPD patients were enrolled and completed the study. The highest mean PIF value (L/min ± SE) was observed with the Breezhaler® (108 ± 23), followed by the Ellipta® (78 ± 15) and the HandiHaler® (49 ± 9) inhalers and the lowest mean pressure drop values were recorded with the Breezhaler® inhaler, followed by the Ellipta® inhaler and the HandiHaler® inhaler, in the overall patient population. A similar trend was consistently observed in patients across all subgroups of COPD severity, within all age groups and for both genders. Patients with COPD were able to inhale with the least inspiratory effort and generate the highest mean PIF value through the Breezhaler® inhaler when compared with the Ellipta® and the HandiHaler® inhalers. These results were similar irrespective of patients' COPD severity, age or gender. The trial was registered with ClinicalTrials.gov NCT02596009 on 4 November 2015.

Supraventricular tachycardia after fenoterol inhalation: report of two cases.

PubMed

Hung, Yu-Fa; Yang, Winnie; Chang, Mei-Ling

2003-01-01

Supraventricular tachycardia (SVT) following fenoterol inhalation in metered-dose inhaler (MDI) has never been reported. We report two cases of SVT after fenoterol inhalation in MDI. Case one was a 4-year-old boy who had asthma since early childhood. Paroxysmal supraventricular tachycardia (PSVT) was found after fenoterol inhalation (MDI), which returned to normal sinus rhythm following adenosine injection. The other one was a 9-year-old male who also had asthma since early childhood. He suffered from attacks of PSVT four times after fenoterol inhalation within one year. After verapamil injection and vagal maneuvers, PSVT was converted to normal sinus rhythm. There were no other episodes of SVT after discontinuing usage of fenoterol inhalation for 2 years in the follow-up. We report these two cases to remind pediatricians that cardiac arrhythmias should be evaluated following fenoterol inhalation (MDI).

"...you would probably want to do it. Cause that's what made them popular": Exploring perceptions of inhalant utility among young adolescent nonusers and occasional users.

PubMed

Siegel, Jason T; Alvaro, Eusebio M; Patel, Neil; Crano, William D

2009-01-01

With an eye toward future primary prevention efforts, this study explores perceptions of inhalant utility among young adolescents in the United States. The study makes use of data gathered via nine focus groups conducted in Tucson, Arizona in 2004 (N = 47, mean age = 13.2 years). Three main themes emerged concerning the perceived utility of inhalant use: (1) Inhalant use as a means of mental escape, (2) Inhalant use as a social tool, and (3) Inhalant use as a parental relations tool. Additionally, participants discussed an interaction hypothesis regarding inhalant use and popularity. Implications for future research are suggested and limitations described.

Impact of Family Planning and Business Trainings on Private-Sector Health Care Providers in Nigeria.

PubMed

Ugaz, Jorge; Leegwater, Anthony; Chatterji, Minki; Johnson, Doug; Baruwa, Sikiru; Toriola, Modupe; Kinnan, Cynthia

2017-06-01

Private health care providers are an important source of modern contraceptives in Sub-Saharan Africa, yet they face many challenges that might be addressed through targeted training. This study measures the impact of a package of trainings and supportive supervision activities targeted to private health care providers in Lagos State, Nigeria, on outcomes including range of contraceptive methods offered, providers' knowledge and quality of counseling, recordkeeping practices, access to credit and revenue. A total of 965 health care facilities were randomly assigned to treatment and control groups. Facilities in the treatment group-but not those in the control group-were offered a training package that included a contraceptive technology update and interventions to improve counseling and clinical skills and business practices. Multivariate regression analysis of data collected through facility and mystery client surveys was used to estimate effects. The training program had a positive effect on the range of contraceptive methods offered, with facilities in the treatment group providing more methods than facilities in the control group. The training program also had a positive impact on the quality of counseling services, especially on the range of contraceptive methods discussed by providers, their interpersonal skills and overall knowledge. Facilities in the treatment group were more likely than facilities in the control group to have good recordkeeping practices and to have obtained loans. No effect was found on revenue generation. Targeted training programs can be effective tools to improve the provision of family planning services through private providers.

49 CFR 172.400 - General labeling requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 172.411 1.6 EXPLOSIVES 1.6 172.411 2.1 FLAMMABLE GAS 172.417 2.2 NONFLAMMABLE GAS 172.415 2.3 POISON...)) POISON INHALATION HAZARD 172.429 6.1(other than material poisonous by inhalation) POISON 172.430 6.1 (inhalation hazard, Zone A or B) POISON INHALATION HAZARD 172.429 6.1 (other than inhalation hazard, Zone A or...

49 CFR 172.400 - General labeling requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 172.411 1.6 EXPLOSIVES 1.6 172.411 2.1 FLAMMABLE GAS 172.417 2.2 NONFLAMMABLE GAS 172.415 2.3 POISON...)) POISON INHALATION HAZARD 172.429 6.1(other than material poisonous by inhalation) POISON 172.430 6.1 (inhalation hazard, Zone A or B) POISON INHALATION HAZARD 172.429 6.1 (other than inhalation hazard, Zone A or...

49 CFR 172.400 - General labeling requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 172.411 1.6 EXPLOSIVES 1.6 172.411 2.1 FLAMMABLE GAS 172.417 2.2 NONFLAMMABLE GAS 172.415 2.3 POISON...)) POISON INHALATION HAZARD 172.429 6.1(other than material poisonous by inhalation) POISON 172.430 6.1 (inhalation hazard, Zone A or B) POISON INHALATION HAZARD 172.429 6.1 (other than inhalation hazard, Zone A or...

49 CFR 172.400 - General labeling requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 172.411 1.6 EXPLOSIVES 1.6 172.411 2.1 FLAMMABLE GAS 172.417 2.2 NONFLAMMABLE GAS 172.415 2.3 POISON...)) POISON INHALATION HAZARD 172.429 6.1(other than material poisonous by inhalation) POISON 172.430 6.1 (inhalation hazard, Zone A or B) POISON INHALATION HAZARD 172.429 6.1 (other than inhalation hazard, Zone A or...

49 CFR 172.400 - General labeling requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 172.411 1.6 EXPLOSIVES 1.6 172.411 2.1 FLAMMABLE GAS 172.417 2.2 NONFLAMMABLE GAS 172.415 2.3 POISON...)) POISON INHALATION HAZARD 172.429 6.1(other than material poisonous by inhalation) POISON 172.430 6.1 (inhalation hazard, Zone A or B) POISON INHALATION HAZARD 172.429 6.1 (other than inhalation hazard, Zone A or...

Objective Assessment of Patient Inhaler User Technique Using an Audio-Based Classification Approach.

PubMed

Taylor, Terence E; Zigel, Yaniv; Egan, Clarice; Hughes, Fintan; Costello, Richard W; Reilly, Richard B

2018-02-01

Many patients make critical user technique errors when using pressurised metered dose inhalers (pMDIs) which reduce the clinical efficacy of respiratory medication. Such critical errors include poor actuation coordination (poor timing of medication release during inhalation) and inhaling too fast (peak inspiratory flow rate over 90 L/min). Here, we present a novel audio-based method that objectively assesses patient pMDI user technique. The Inhaler Compliance Assessment device was employed to record inhaler audio signals from 62 respiratory patients as they used a pMDI with an In-Check Flo-Tone device attached to the inhaler mouthpiece. Using a quadratic discriminant analysis approach, the audio-based method generated a total frame-by-frame accuracy of 88.2% in classifying sound events (actuation, inhalation and exhalation). The audio-based method estimated the peak inspiratory flow rate and volume of inhalations with an accuracy of 88.2% and 83.94% respectively. It was detected that 89% of patients made at least one critical user technique error even after tuition from an expert clinical reviewer. This method provides a more clinically accurate assessment of patient inhaler user technique than standard checklist methods.

A Tablet-Based Multimedia Education Tool Improves Provider and Subject Knowledge of Inhaler Use Techniques.

PubMed

Mulhall, Aaron M; Zafar, Muhammad A; Record, Samantha; Channell, Herman; Panos, Ralph J

2017-02-01

Although inhaled medications are effective therapies for COPD, many patients and providers use them incorrectly. We recruited providers who prescribe inhalers or teach inhaler technique and assessed their use of metered-dose inhalers (MDIs), various dry powder inhalers (DPIs), and Respimat using predefined checklists. Then they watched tablet-based multimedia educational videos that demonstrated correct inhaler technique by a clinical pharmacist with teach-back from a patient and were re-evaluated. We also recruited patients with COPD and assessed their use of their prescribed inhalers and then retested them after 3-6 months. Baseline and follow-up respiratory symptoms were measured by the COPD Assessment Test. Fifty-eight providers and 50 subjects participated. For all providers, correct inhaler technique (reported as percentage correct steps) increased after the videos: MDI without a spacer (72% vs 97%) MDI with a spacer (72% vs 96%), formoterol DPI (50% vs 94%), mometasone DPI (43% vs 95%), tiotropium DPI (73% vs 99%), and Respimat (32% vs 93%) (before vs after, P < .001 for all comparisons). Subjects also improved their inhaler use technique after viewing the educational videos: MDI without a spacer (69% vs 92%), MDI with a spacer (73% vs 95%), and tiotropium DPI (83% vs 96%) (before vs after, P < .001 for all comparisons). The beneficial effect of this educational intervention declined slightly for subjects but was durably improved after several months. COPD Assessment Test scores did not demonstrate any change in respiratory symptoms. A tablet-based inhaler education tool improved inhaler technique for both providers and subjects. Although this intervention did show durable efficacy for improving inhaler use by patients, it did not reduce their respiratory symptoms. Copyright © 2017 by Daedalus Enterprises.

Impact of Performance-Based Financing in a Low-Resource Setting: A Decade of Experience in Cambodia.

PubMed

Van de Poel, Ellen; Flores, Gabriela; Ir, Por; O'Donnell, Owen

2016-06-01

This paper exploits the geographic expansion of performance-based financing (PBF) in Cambodia over a decade to estimate its effect on the utilization of maternal and child health services. PBF is estimated to raise the proportion of births occurring in incentivized public health facilities by 7.5 percentage points (25%). A substantial part of this effect arises from switching the location of institutional births from private to public facilities; there is no significant impact on deliveries supervised by a skilled birth attendant, nor is there any significant effect on neonatal mortality, antenatal care and vaccination rates. The impact on births in public facilities is much greater if PBF is accompanied by maternity vouchers that cover user fees, but there is no significant effect among the poorest women. Heterogeneous effects across schemes differing in design suggest that maintaining management authority within a health district while giving explicit service targets to facilities is more effective in raising utilization than contracting management to a non-governmental organization while denying it full autonomy and leaving financial penalties vague. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Management of radioactive material safety programs at medical facilities. Final report

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

Camper, L.W.; Schlueter, J.; Woods, S.

A Task Force, comprising eight US Nuclear Regulatory Commission and two Agreement State program staff members, developed the guidance contained in this report. This report describes a systematic approach for effectively managing radiation safety programs at medical facilities. This is accomplished by defining and emphasizing the roles of an institution`s executive management, radiation safety committee, and radiation safety officer. Various aspects of program management are discussed and guidance is offered on selecting the radiation safety officer, determining adequate resources for the program, using such contractual services as consultants and service companies, conducting audits, and establishing the roles of authorized usersmore » and supervised individuals; NRC`s reporting and notification requirements are discussed, and a general description is given of how NRC`s licensing, inspection and enforcement programs work.« less

Role of the battalion surgeon in the Iraq and Afghanistan War.

PubMed

Moawad, Fouad J; Wilson, Ramey; Kunar, Mathew T; Hartzell, Joshua D

2012-04-01

The battalion surgeon is an invaluable asset to a deploying unit. The primary role of a battalion surgeon is to provide basic primary care medicine and combat resuscitation. Other expectations include health care screening, vaccinations, supervision of medics, and being a medical advisor to the unit's commander. As many physicians who fill this role previously worked at medical treatment facilities or medical centers without prior deployment experience, the objective of this article is to highlight some of the challenges a battalion surgeon may encounter before, during, and following deployment.

Relocation and the characteristics of hospital and hostel regimes.

PubMed

Booth, T; Simons, K; Booth, W

1991-01-01

Drawing on evidence from a research evaluation of a local community care programme, this paper explores whether relocation from a British National Health Service mental handicap hospital into local authority hostels (supervised residential facilities) brought about a qualitative change in the residential environment of movers towards less restrictive management practices and caring routines, more responsive attitudes towards their rights and needs as individuals, and greater control over their own lives. The conclusions point to the existence of a substantial measure of overlap in the fundamental characteristics of the hospital and hostel regimes.

KSC-02pd1913

NASA Image and Video Library

2002-12-11

KENNEDY SPACE CENTER, FLA. -- KSC technicians supervise the offloading of the Integrated Equipment Assembly (IEA), one of two major components of the Starboard 6 (S6) truss segment for the International Space Station (ISS), onto a cargo transporter following its arrival at the Shuttle Landing Facility. The IEA will be joined to its companion piece, the Long Spacer, before launch early in 2004. The S6 truss segment will be the 11th and final piece of the Station's Integrated Truss Structure and will support the fourth and final set of solar arrays, batteries, and electronics.

Analysis of ERTS imagery using special electronic viewing/measuring equipment

NASA Technical Reports Server (NTRS)

Evans, W. E.; Serebreny, S. M.

1973-01-01

An electronic satellite image analysis console (ESIAC) is being employed to process imagery for use by USGS investigators in several different disciplines studying dynamic hydrologic conditions. The ESIAC provides facilities for storing registered image sequences in a magnetic video disc memory for subsequent recall, enhancement, and animated display in monochrome or color. Quantitative measurements of distances, areas, and brightness profiles can be extracted digitally under operator supervision. Initial results are presented for the display and measurement of snowfield extent, glacier development, sediment plumes from estuary discharge, playa inventory, phreatophyte and other vegetative changes.

KSC-02pd1914

NASA Image and Video Library

2002-12-11

KENNEDY SPACE CENTER, FLA. -- KSC technicians supervise the transfer of the Integrated Equipment Assembly (IEA), one of two major components of the Starboard 6 (S6) truss segment for the International Space Station (ISS), onto a cargo transporter following its arrival at the Shuttle Landing Facility. The IEA will be joined to its companion piece, the Long Spacer, before launch early in 2004. The S6 truss segment will be the 11th and final piece of the Station's Integrated Truss Structure and will support the fourth and final set of solar arrays, batteries, and electronics.

Factors influencing the implementation of integrated management of childhood illness (IMCI) by healthcare workers at public health centers & dispensaries in Mwanza, Tanzania.

PubMed

Kiplagat, Augustine; Musto, Richard; Mwizamholya, Damas; Morona, Domenica

2014-03-25

Integrated Management of Childhood Illness (IMCI) was developed by the World Health Organization (WHO) and the United Nations International Children's Fund (UNICEF) and aims at reducing childhood morbidity and mortality in resource-limited settings including Tanzania. It was introduced in 1996 and has been scaled up in all districts in the country. The purpose of this study was to identify factors influencing the implementation of IMCI in the health facilities in Mwanza, Tanzania since reports indicates that the guidelines are not full adhered to by the healthcare workers. A cross-sectional study design was used and a sample size of 95 healthcare workers drawn from health centers and dispensaries within Mwanza city were interviewed using self-administered questionnaires. Structured interview was also used to get views from the city IMCI focal person and the 2 facilitators. Data were analyzed using SPSS and presented using figures and tables. Only 51% of healthcare workers interviewed had been trained. 69% of trained Healthcare workers expressed understanding of the IMCI approach. Most of the respondents (77%) had a positive attitude that IMCI approach was a better approach in managing common childhood illnesses especially with the reality of resource constraint in the health facilities. The main challenges identified in the implementation of IMCI are low initial training coverage among health care workers, lack of essential drugs and supplies, lack of onsite mentoring and lack of refresher courses and regular supportive supervision. Supporting the healthcare workers through training, onsite mentoring, supportive supervision and strengthening the healthcare system through increasing access to essential medicines, vaccines, strengthening supply chain management, increasing healthcare financing, improving leadership & management were the major interventions that could assist in IMCI implementation. The healthcare workers can implement better IMCI through the collaboration of supervisors, IMCI focal person, Council Health Management Teams (CHMT) and other stakeholders interested in child health. However, significant barriers impede a sustainable IMCI implementation. Recommendations have been made related to supportive supervision and HealthCare system strengthening among others.

Routine health information system utilization and factors associated thereof among health workers at government health institutions in East Gojjam Zone, Northwest Ethiopia.

PubMed

Shiferaw, Atsede Mazengia; Zegeye, Dessalegn Tegabu; Assefa, Solomon; Yenit, Melaku Kindie

2017-08-07

Using reliable information from routine health information systems over time is an important aid to improving health outcomes, tackling disparities, enhancing efficiency, and encouraging innovation. In Ethiopia, routine health information utilization for enhancing performance is poor among health workers, especially at the peripheral levels of health facilities. Therefore, this study aimed to assess routine health information system utilization and associated factors among health workers at government health institutions in East Gojjam Zone, Northwest Ethiopia. An institution based cross-sectional study was conducted at government health institutions of East Gojjam Zone, Northwest Ethiopia from April to May, 2013. A total of 668 health workers were selected from government health institutions, using the cluster sampling technique. Data collected using a standard structured and self-administered questionnaire and an observational checklist were cleaned, coded, and entered into Epi-info version 3.5.3, and transferred into SPSS version 20 for further statistical analysis. Variables with a p-value of less than 0.05 at multiple logistic regression analysis were considered statistically significant factors for the utilization of routine health information systems. The study revealed that 45.8% of the health workers had a good level of routine health information utilization. HMIS training [AOR = 2.72, 95% CI: 1.60, 4.62], good data analysis skills [AOR = 6.40, 95%CI: 3.93, 10.37], supervision [AOR = 2.60, 95% CI: 1.42, 4.75], regular feedback [AOR = 2.20, 95% CI: 1.38, 3.51], and favorable attitude towards health information utilization [AOR = 2.85, 95% CI: 1.78, 4.54] were found significantly associated with a good level of routine health information utilization. More than half of the health workers working at government health institutions of East Gojjam were poor health information users compared with the findings of others studies. HMIS training, data analysis skills, supervision, regular feedback, and favorable attitude were factors related to routine health information system utilization. Therefore, a comprehensive training, supportive supervision, and regular feedback are highly recommended for improving routine health information utilization among health workers at government health facilities.

Placement, support, and retention of health professionals: national, cross-sectional findings from medical and dental community service officers in South Africa.

PubMed

Hatcher, Abigail M; Onah, Michael; Kornik, Saul; Peacocke, Julia; Reid, Stephen

2014-02-26

In South Africa, community service following medical training serves as a mechanism for equitable distribution of health professionals and their professional development. Community service officers are required to contribute a year towards serving in a public health facility while receiving supervision and remuneration. Although the South African community service programme has been in effect since 1998, little is known about how placement and practical support occur, or how community service may impact future retention of health professionals. National, cross-sectional data were collected from community service officers who served during 2009 using a structured self-report questionnaire. A Supervision Satisfaction Scale (SSS) was created by summing scores of five questions rated on a three-point Likert scale (orientation, clinical advising, ongoing mentorship, accessibility of clinic leadership, and handling of community service officers' concerns). Research endpoints were guided by community service programmatic goals and analysed as dichotomous outcomes. Bivariate and multivariate logistical regressions were conducted using Stata 12. The sample population comprised 685 doctors and dentists (response rate 44%). Rural placement was more likely among unmarried, male, and black practitioners. Rates of self-reported professional development were high (470 out of 539 responses; 87%). Participants with higher scores on the SSS were more likely to report professional development. Although few participants planned to continue work in rural, underserved communities (n = 171 out of 657 responses, 25%), those serving in a rural facility during the community service year had higher intentions of continuing rural work. Those reporting professional development during the community service year were twice as likely to report intentions to remain in rural, underserved communities. Despite challenges in equitable distribution of practitioners, participant satisfaction with the compulsory community service programme appears to be high among those who responded to a 2009 questionnaire. These data offer a starting point for designing programmes and policies that better meet the health needs of the South African population through more appropriate human resource management. An emphasis on professional development and supervision is crucial if South Africa is to build practitioner skills, equitably distribute health professionals, and retain the medical workforce in rural, underserved areas.

How to use an inhaler - with spacer

MedlinePlus

... MDIs) usually have 3 parts: A mouthpiece A cap that goes over the mouthpiece A canister full ... Take the cap off the inhaler and spacer. Shake the inhaler hard. Attach the spacer to the inhaler. If you have ...

Modeling Deposition of Inhaled Particles

EPA Science Inventory

The mathematical modeling of the deposition and distribution of inhaled aerosols within human lungs is an invaluable tool in predicting both the health risks associated with inhaled environmental aerosols and the therapeutic dose delivered by inhaled pharmacological drugs. Howeve...

MODELING DEPOSITION OF INHALED PARTICLES

EPA Science Inventory

Modeling Deposition of Inhaled Particles: ABSTRACT

The mathematical modeling of the deposition and distribution of inhaled aerosols within human lungs is an invaluable tool in predicting both the health risks associated with inhaled environmental aerosols and the therapeut...

Age of Inhalant First Time Use and Its Association to the Use of Other Drugs

ERIC Educational Resources Information Center

Ding, Kele; Chang, G. Andy; Southerland, Ron

2009-01-01

Inhalants are the 4th most commonly abused drugs after alcohol, tobacco, and marijuana. Although inhalants are often referred as Gateway Drugs this hypothesis is less examined. Using the 2003 National Survey on Drug Use and Health data, age of first time inhalant use was compared with the age of onset of other drugs among 6466 inhalant users who…

Distribution and determinants of pneumonia diagnosis using Integrated Management of Childhood Illness guidelines: a nationally representative study in Malawi.

PubMed

Uwemedimo, Omolara T; Lewis, Todd P; Essien, Elsie A; Chan, Grace J; Nsona, Humphreys; Kruk, Margaret E; Leslie, Hannah H

2018-01-01

Pneumonia remains the leading cause of child mortality in sub-Saharan Africa. The Integrated Management of Childhood Illness (IMCI) strategy was developed to standardise care in low-income and middle-income countries for major childhood illnesses and can effectively improve healthcare worker performance. Suboptimal clinical evaluation can result in missed diagnoses and excess morbidity and mortality. We estimate the sensitivity of pneumonia diagnosis and investigate its determinants among children in Malawi. Data were obtained from the 2013-2014 Service Provision Assessment survey, a census of health facilities in Malawi that included direct observation of care and re-examination of children by trained observers. We calculated sensitivity of pneumonia diagnosis and used multilevel log-binomial regression to assess factors associated with diagnostic sensitivity. 3136 clinical visits for children 2-59 months old were observed at 742 health facilities. Healthcare workers completed an average of 30% (SD 13%) of IMCI guidelines in each encounter. 573 children met the IMCI criteria for pneumonia; 118 (21%) were correctly diagnosed. Advanced practice clinicians were more likely than other providers to diagnose pneumonia correctly (adjusted relative risk 2.00, 95% CI 1.21 to 3.29). Clinical quality was strongly associated with correct diagnosis: sensitivity was 23% in providers at the 75th percentile for guideline adherence compared with 14% for those at the 25th percentile. Contextual factors, facility structural readiness, and training or supervision were not associated with sensitivity. Care quality for Malawian children is poor, with low guideline adherence and missed diagnosis for four of five children with pneumonia. Better sensitivity is associated with provider type and higher adherence to IMCI. Existing interventions such as training and supportive supervision are associated with higher guideline adherence, but are insufficient to meaningfully improve sensitivity. Innovative and scalable quality improvement interventions are needed to strengthen health systems and reduce avoidable child mortality.

Does human resource management improve family planning service quality? Analysis from the Kenya Service Provision Assessment 2010.

PubMed

Thatte, Nandita; Choi, Yoonjoung

2015-04-01

Human resource (HR) management is a priority for health systems strengthening in developing countries, yet few studies have empirically examined associations with service quality. The purpose of this study was to assess the relationship between HR management and family planning (FP) service quality. Data came from the 2010 Kenya Service Provision Assessment, a nationally representative health facility assessment. In total, 912 FP consultations from 301 facilities were analysed. Four indices were created to measure quality on reproductive history taking, physical examination, sexually transmitted infections prevention and pill/injectable specific counselling. HR management variables included training in the past year, any and supportive (i.e. with feedback, technical updates and discussion) in-person supervision in the past 6 months and having a written job description. Multivariate linear regression analyses were conducted to estimate coefficients of HR management variables on each of the four quality indices, adjusting for background characteristics of clients, provider and facilities. The level of service quality ranged from 16 to 53 out of a maximum score of 100 across the indices. Fifty-two per cent of consultations were done by providers who received supportive in-person supervision in the previous 6 months. In 23% and 38% of consultations, the provider was trained in the past year and had a written job description, respectively. Multivariate analyses indicated that having a written job description was associated with higher service quality in history taking, physical examination and the pill/injectable specific counselling. Other HR management variables were not significantly associated with service quality. Having a written job description was significantly associated with higher service quality and may be a useful tool for strengthening management practices. The details of such job descriptions and the quality of other management indicators should be explored to better understand the relationship between HR management and FP service quality. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Skills in Handling Turbuhaler, Diskus, and Pressurized Metered-Dose Inhaler in Korean Asthmatic Patients

PubMed Central

Lee, Sang Min; Chang, Yoon-Seok; Kim, Cheol-Woo; Kim, Tae-Bum; Kim, Sang-Heon; Kwon, Yong-Eun; Lee, Jong-Myung; Lee, Soo-Keol; Jeong, Jae-Won; Park, Jung-Won; Cho, Sang-Heon; Moon, Hee-Bom

2011-01-01

Purpose The objective of this study was to evaluate skills in handling inhalers and factors associated with these skills among patients with asthma who had undergone treatment at special asthma and allergy clinics in Korea. Methods We enrolled 78 subjects who used Turbuhaler and 145 who used Diskus for asthma control at special clinics in 10 university hospitals and visually assessed their skills in handling these inhalers. We also evaluated skills in 137 subjects who had used pressurized metered-dose inhalers (pMDIs) for symptom relief. Age, sex, duration of asthma and inhaler use, smoking status, monthly income, highest grade completed in school and previous instruction for handling inhalers were also measured to evaluate their association with overall inhaler skills. Results Performance grade was inadequate for 12.8% of participants using Turbuhaler, 6.2% for Diskus, and 23.4% for pMDIs. The success rates for each step in handling the inhalers were relatively high except for the "exhale slowly to residual volume" step, in which success rates ranged from 24.2% to 28.5%. Older age, male sex, lower educational grade, and absence of previous instruction for handling inhalers were associated with inadequate inhaler technique in univariate analysis; however, only older age and absence of previous instruction remained significant independent risk factors in multivariate analysis. Conclusions Among Korean asthmatic patients in special asthma and allergy clinics, skills in handling their inhalers were mostly excellent; meanwhile, older age and absence of previous instruction for handling inhalers were associated with inadequate techniques. PMID:21217925

Exploring the role of quantitative feedback in inhaler technique education: a cluster-randomised, two-arm, parallel-group, repeated-measures study.

PubMed

Toumas-Shehata, Mariam; Price, David; Basheti, Iman Amin; Bosnic-Anticevich, Sinthia

2014-11-13

Feedback is a critical component of any educational intervention. When it comes to feedback associated with inhaler technique education, there is a lack of knowledge on its role or its potential to solve the major issue of poor inhaler technique. This study aims to explore the role of feedback in inhaler technique education and its impact on the inhaler technique of patients over time. A parallel-group, repeated-measures study was conducted in the community pharmacy in which the effectiveness of current best practice inhaler technique education utilising qualitative visual feedback (Group 1) was compared with a combination of qualitative and quantitative visual feedback (Group 2). The impact of these two interventions on inhaler technique maintenance was evaluated. Community pharmacists were randomly allocated to recruit people with asthma who were using a dry powder inhaler. At Visit 1 their inhaler technique was evaluated and education delivered and they were followed up at Visit 2 (1 month later). Both educational interventions resulted in an increase in the proportion of patients with correct inhaler technique: from 4% to 51% in Group 1 and from 6% to 83% in Group 2 (Pearson's Chi-Squared, P=0.03, n=49, and Pearson's Chi-Squared, P=0.01, n=48, respectively). The magnitude of improvement was statistically significantly higher for Group 2 compared with Group 1 (n=97, P=0.02, Pearson's Chi-Square test). The nature of feedback has an impact on the effectiveness of inhaler technique education with regard to correct inhaler technique maintenance over time.

Nurses' knowledge of inhaler technique in the inpatient hospital setting.

PubMed

De Tratto, Katie; Gomez, Christy; Ryan, Catherine J; Bracken, Nina; Steffen, Alana; Corbridge, Susan J

2014-01-01

High rates of inhaler misuse in patients with chronic obstructive pulmonary disease and asthma contribute to hospital readmissions and increased healthcare cost. The purpose of this study was to examine inpatient staff nurses' self-perception of their knowledge of proper inhaler technique compared with demonstrated technique and frequency of providing patients with inhaler technique teaching during hospitalization and at discharge. A prospective, descriptive study. A 495-bed urban academic medical center in the Midwest United States. A convenience sample of 100 nurses working on inpatient medical units. Participants completed a 5-item, 4-point Likert-scale survey evaluating self-perception of inhaler technique knowledge, frequency of providing patient education, and responsibility for providing education. Participants demonstrated inhaler technique to the investigators using both a metered dose inhaler (MDI) and Diskus device inhaler, and performance was measured via a validated checklist. Overall misuse rates were high for both MDI and Diskus devices. There was poor correlation between perceived ability and investigator-measured performance of inhaler technique. Frequency of education during hospitalization and at discharge was related to measured level of performance for the Diskus device but not for the MDI. Nurses are a key component of patient education in the hospital; however, nursing staff lack adequate knowledge of inhaler technique. Identifying gaps in nursing knowledge regarding proper inhaler technique and patient education about proper inhaler technique is important to design interventions that may positively impact patient outcomes. Interventions could include one-on-one education, Web-based education, unit-based education, or hospital-wide competency-based education. All should include return demonstration of appropriate technique.

A garage sale bargain: A leaking 2.2 GBq Ra-226 source, Phase II - Internal dose assessment

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

Toohey, R.E.; Goans, R.E.

1996-06-01

The Radiation Emergency Assistance Center and Training Site (REAC/TS) at the Oak Ridge Institute for Science and Education (ORISE) in Oak Ridge was asked by the Department of Energy to assist the Tennessee Division of Radiological Health in assessing the potential health consequences of this incident. The purchaser of the radium source and his wife visited the REAMS facility on 8 May 1995, approximately 50 d after the purchase. Medical histories were taken and physical exams were performed by the REAC/TS physician, and blood samples were collected for complete blood counts (CBC), differentials, chemistry panels, and cytogenetic testing. The clinicalmore » results were normal, and a chromosome analysis of cultured peripheral lymphocytes showed no aberrations (rings or dicentrics) above background levels found in unexposed controls. A whole-body count was performed on the purchaser in the ORISE facility, but his wife declined because of discomfort with the enclosed space within the shield. In the energy band from 1.61 to 1.87 MeV, bracketing the 1.76-MeV peak from {sup 214}Bi, the subject had a net count rate of 0. 1 5 {+-} 0.04, counts per second, corresponding to a {sup 214}Bi body content of 400 {+-} 100 Bq. With the assumption that the {sup 222}Rn retention fraction was 0.37, this figure corresponded to a {sup 226}Ra content of 1.1 {+-} 0.3 kBq. With the further assumption that the primary intake route was Inhalation of 1.0-micron AMAD particles of class W {sup 226}Ra, the intake was computed to be 13 {+-} 3 kBq. The annual limit of intake by inhalation for class W {sup 226}Ra is based on the stochastic limit and is 20 kBq; therefore, the committed effective dose equivalent for this subject was 30 {+-} 7 mSv. A separate whole-body count of the subject`s wife was performed with an unshielded detector at the REAC/TS facility, with negative results.« less

Intake-to-delivered-energy ratios for central station and distributed electricity generation in California

NASA Astrophysics Data System (ADS)

Heath, Garvin A.; Nazaroff, William W.

In previous work, we showed that the intake fraction (iF) for nonreactive primary air pollutants was 20 times higher in central tendency for small-scale, urban-sited distributed electricity generation (DG) sources than for large-scale, central station (CS) power plants in California [Heath, G.A., Granvold, P.W., Hoats, A.S., Nazaroff, W.W., 2006. Intake fraction assessment of the air pollutant exposure implications of a shift toward distributed electricity generation. Atmospheric Environment 40, 7164-7177]. The present paper builds on that study, exploring pollutant- and technology-specific aspects of population inhalation exposure from electricity generation. We compare California's existing CS-based system to one that is more reliant on DG units sited in urban areas. We use Gaussian plume modeling and a GIS-based exposure analysis to assess 25 existing CSs and 11 DG sources hypothetically located in the downtowns of California's most populous cities. We consider population intake of three pollutants—PM 2.5, NO x and formaldehyde—directly emitted by five DG technologies—natural gas (NG)-fired turbines, NG internal combustion engines (ICE), NG microturbines, diesel ICEs, and fuel cells with on-site NG reformers. We also consider intake of these pollutants from existing CS facilities, most of which use large NG turbines, as well as from hypothetical facilities located at these same sites but meeting California's best-available control technology standards. After systematically exploring the sensitivity of iF to pollutant decay rate, the iFs for each of the three pollutants for all DG and CS cases are estimated. To efficiently compare the pollutant- and technology-specific exposure potential on an appropriate common basis, a new metric is introduced and evaluated: the intake-to-delivered-energy ratio (IDER). The IDER expresses the mass of pollutant inhaled by an exposed population owing to emissions from an electricity generation unit per quantity of electric energy delivered to the place of use. We find that the central tendency of IDER is much greater for almost every DG technology evaluated than for existing CS facilities in California.

3-D SIMULATIONS OF AIRWAYS WITHIN HUMAN LUNGS

EPA Science Inventory

Information regarding the deposition patterns of inhaled particles has important application to the fields of toxicology and medicine. The former concerns the risk assessment of inhaled air pollutants (inhalation toxicology); the latter concerns the targeted delivery of inhaled ...

Ease-of-use preference for the ELLIPTA® dry powder inhaler over a commonly used single-dose capsule dry powder inhaler by inhalation device-naïve Japanese volunteers aged 40 years or older

PubMed Central

Komase, Yuko; Asako, Akimoto; Kobayashi, Akihiro; Sharma, Raj

2014-01-01

Background In patients receiving inhaled medication, dissatisfaction with and difficulty in using the inhaler can affect treatment adherence. The incidence of handling errors is typically higher in the elderly than in younger people. The aim of the study was to assess inhaler preference for and handling errors with the ELLIPTA® dry powder inhaler (DPI), (GSK), compared with the established BREEZHALER™, a single-dose capsule DPI (Novartis), in inhalation device-naïve Japanese volunteers aged ≥40 years. Methods In this open-label, nondrug interventional, crossover DPI preference study comparing the ELLIPTA DPI and BREEZHALER, 150 subjects were randomized to handle the ELLIPTA or BREEZHALER DPIs until the point of inhalation, without receiving verbal or demonstrative instruction (first attempt). Subjects then crossed over to the other inhaler. Preference was assessed using a self-completed questionnaire. Inhaler handling was assessed by a trained assessor using a checklist. Subjects did not inhale any medication in the study, so efficacy and safety were not measured. Results The ELLIPTA DPI was preferred to the BREEZHALER by 89% of subjects (odds ratio [OR] 70.14, 95% confidence interval [CI] 33.69–146.01; P-value not applicable for this inhaler) for ease of use, by 63% of subjects (OR 2.98, CI 1.87–4.77; P<0.0001) for ease of determining the number of doses remaining in the inhaler, by 91% for number of steps required, and by 93% for time needed for handling the inhaler. The BREEZHALER was preferred to the ELLIPTA DPI for comfort of the mouthpiece by 64% of subjects (OR 3.16, CI 1.97–5.06; P<0.0001). The incidence of handling errors (first attempt) was 11% with ELLIPTA and 68% with BREEZHALER; differences in incidence were generally similar when analyzed by age (< or ≥65 years) or sex. Conclusion These data, obtained in an inhalation device-naïve population, suggest that the ELLIPTA DPI is preferred to an established alternative based on its ease-of-use features and is associated with fewer handling errors. PMID:25525354

Study of inhaler technique in asthma patients: differences between pediatric and adult patients

PubMed Central

Manríquez, Pablo; Acuña, Ana María; Muñoz, Luis; Reyes, Alvaro

2015-01-01

Objective: Inhaler technique comprises a set of procedures for drug delivery to the respiratory system. The oral inhalation of medications is the first-line treatment for lung diseases. Using the proper inhaler technique ensures sufficient drug deposition in the distal airways, optimizing therapeutic effects and reducing side effects. The purposes of this study were to assess inhaler technique in pediatric and adult patients with asthma; to determine the most common errors in each group of patients; and to compare the results between the two groups. Methods: This was a descriptive cross-sectional study. Using a ten-step protocol, we assessed inhaler technique in 135 pediatric asthma patients and 128 adult asthma patients. Results: The most common error among the pediatric patients was failing to execute a 10-s breath-hold after inhalation, whereas the most common error among the adult patients was failing to exhale fully before using the inhaler. Conclusions: Pediatric asthma patients appear to perform most of the inhaler technique steps correctly. However, the same does not seem to be true for adult patients. PMID:26578130

Awareness of environmental issues and the acceptance of CFC-free inhalers.

PubMed

Goh, S Y; Arulanandam, S; Ho, C L; Zhang, L; Goh, D Y; Chew, F T; Lee, B W

1998-09-01

With the recent availability of a chlorofluorocarbon (CFC)-free metered dose inhaler (MDI) (Airomir), a patient survey was carried out to evaluate awareness of the role of CFCs in our environment and acceptance of this new inhaler. A questionnaire survey was conducted on parents and guardians of 201 children. Depending on respondents' preference, the interview was conducted in English (71%), Chinese (23%), Malay (5%) or Tamil (1%). A 'taste' test was also conducted on 103 of these children. Only 13% (26/201) of parents/guardians were aware that MDIs contained CFCs. Although 70% of children were in favour of the new taste of the CFC-free inhaler, the cost of the new inhaler was an important consideration for parents and guardians in their decision to switch to the new inhaler. The majority (93%) were willing to switch if its cost were equivalent to their current inhaler. This study has provided pertinent information with regard to acceptance of CFC-free inhalers which should be considered when making the inevitable switch to environmentally friendly inhalers.

Use of nitrite inhalants ("poppers") among American youth.

PubMed

Wu, Li-Tzy; Schlenger, William E; Ringwalt, Chris L

2005-07-01

We examined the patterns and correlates of nitrite inhalant use among adolescents aged 12 to 17 years. Study data were drawn from the 2000 and 2001 National Household Surveys on Drug Abuse. Logistic regression was used to identify the characteristics associated with nitrite inhalant use. Among adolescents aged 12 to 17 years, 1.5% reported any lifetime use of nitrite inhalants. The prevalence of lifetime nitrite inhalant use increased to 12% and 14% among adolescents who were dependent on alcohol and any drug in the past year, respectively. Many nitrite inhalant users used at least three other types of inhalants (68%) and also met the criteria for alcohol (33%) and drug (35%) abuse or dependence. Increased odds of nitrite inhalant use were associated with residing in nonmetropolitan areas, recent utilization of mental health services, delinquent behaviors, past year alcohol and drug abuse and dependence, and multi-drug use. Adolescents who had used nitrite inhalants at least once in their lifetime tend to engage in delinquent activities and report co-occurring multiple drug abuse and mental health problems in the past year.

The Emperor's New Clothes II--time for regulators to wake up and take responsibility for unnecessary asthma morbidity: time for the second aerosol 'transition'.

PubMed

Everard, Mark L

2013-09-01

The rate of technological improvement continues to accelerate. Regulators in every field dealing with consumer products continue to set ever higher standards to protect consumers from adverse events and use 'recalls' to remove products that prove to be harmful from the market. In the field of medical products in general the issues of 'human factors' and 'usability' are now, quite rightly, a major issue at least among regulators in the USA. The elephant in the inhaled therapy room is of course the continued use of obsolete, portable inhalers which few patients can use effectively for the treatment of asthma. Countless studies have demonstrated that the inability of patients to use these devices effectively is a major factor in perpetuating unnecessarily high levels of morbidity. They fail to meet basic usability standards and do not incorporate the facility to provide feedback to patient and clinician. More than 20 years ago regulators deemed that pressurised metered dose inhalers containing chlorofluorocarbons should be removed from the market on environmental grounds even though their use accounted for less than 0.5% of chlorofluorocarbon use. Surely asthmatic patients require the same level of protection. Unfortunately regulators appear determined to fossilise the field in a 1950's time warp by ensuring that the failings of obsolete technology are perpetuated in any 'generic' device. The time has come for regulators to meet their obligations to 'protect the public health by assuring the safety, effectiveness, and security of drugs, vaccines and other biological products, medical devices….' and mandate the phasing out of these antiquated devices within the next decade in order to reduce the unacceptably high burden of preventable morbidity and death associated with their use.

Inhalation Injury: State of the Science 2016.

PubMed

Foster, Kevin N; Holmes, James H

This article summarizes research conducted over the last decade in the field of inhalation injury in thermally injured patients. This includes brief summaries of the findings of the 2006 State of the Science meeting with regard to inhalation injury, and of the subsequent 2007 Inhalation Injury Consensus Conference. The reviewed studies are categorized in to five general areas: diagnosis and grading; mechanical ventilation; systemic and inhalation therapy; mechanistic alterations; and outcomes.

Optimizing inhalation technique using web-based videos in obstructive lung diseases.

PubMed

Müller, Tobias; Müller, Annegret; Hübel, Christian; Knipel, Verena; Windisch, Wolfram; Cornelissen, Christian Gabriel; Dreher, Michael

2017-08-01

Inhaled agents are widely used in the treatment of chronic airway diseases. Correct technique is required to ensure appropriate drug deposition, but poor technique is common. This study investigated whether inhalation technique could be improved by patient training using short videos from the German Airway League. Outpatients from a university hospital respiratory clinic who had incorrect inhalation technique were asked to demonstrate this again immediately after viewing the training videos, and after 4-8 weeks' follow-up. Inhalation technique was rated by a study nurse using specific checklists. One hundred and twelve patients with obstructive lung disease treated with inhaled bronchodilators or corticosteroids were included. More than half (51.8%) had at least one mistake in inhalation technique at baseline. Of these, most (88%) understood the training videos, 76% demonstrated correct device use immediately after training, and 72% were still able to demonstrate correct inhalation technique at follow-up (p = 0.0008 for trend). In addition, the number of mistakes decreased significantly after video training (by 1.82 [95% confidence interval 1.39-2.25]; p < 0.0001 vs. baseline). German Airway League inhalation technique training videos were easy to understand and effectively improved inhalation technique in patients with airway diseases. Copyright © 2017 Elsevier Ltd. All rights reserved.

Estimation of chloroform inhalation dose by other routes based on the relationship of area under the blood concentration-time curve (AUC)-inhalation dose to chloroform distribution in the blood of rats.

PubMed

Take, Makoto; Takeuchi, Tetsuya; Haresaku, Mitsuru; Matsumoto, Michiharu; Nagano, Kasuke; Yamamoto, Seigo; Takamura-Enya, Takeji; Fukushima, Shoji

2014-01-01

The present study investigated the time-course changes of concentration of chloroform (CHCl3) in the blood during and after exposure of male rats to CHCl3 by inhalation. Increasing the dose of CHCl3 in the inhalation exposed groups caused a commensurate increase in the concentration of CHCl3 in the blood and the area under the blood concentration-time curve (AUC). There was good correlation (r = 0.988) between the inhalation dose and the AUC/kg body weight. Based on the AUC/kg body weight-inhalation dose curve and the AUC/kg body weight after oral administration, inhalation equivalent doses of orally administered CHCl3 were calculated. Calculation of inhalation equivalent doses allows the body burden due to CHCl3 by inhalation exposure and oral exposure to be directly compared. This type of comparison facilitates risk assessment in humans exposed to CHCl3 by different routes. Our results indicate that when calculating inhalation equivalent doses of CHCl3, it is critical to include the AUC from the exposure period in addition to the AUC after the end of the exposure period. Thus, studies which measure the concentration of volatile organic compounds in the blood during the inhalation exposure period are crucial. The data reported here makes an important contribution to the physiologically based pharmacokinetic (PBPK) database of CHCl3 in rodents.

Influence of respiratory tract disease and mode of inhalation on detectability of budesonide in equine urine and plasma.

PubMed

Barton, Ann Kristin; Heinemann, Henrike; Schenk, Ina; Machnik, Marc; Gehlen, Heidrun

2017-02-01

OBJECTIVE To evaluate the influence of respiratory tract disease (ie, recurrent airway obstruction [RAO]) and mode of inhalation on detectability of inhaled budesonide in equine plasma and urine samples. ANIMALS 16 horses (8 healthy control horses and 8 horses affected by RAO, as determined by results of clinical examination, blood gas analysis, bronchoscopy, and cytologic examination of bronchoalveolar lavage fluid). PROCEDURES 4 horses of each group inhaled budesonide (3 μg/kg) twice daily for 10 days while at rest, and the remaining 4 horses of each group inhaled budesonide during lunging exercise. Plasma and urine samples were obtained 4 to 96 hours after inhalation and evaluated for budesonide and, in urine samples, the metabolites 6β-hydroxybudesonide and 16α-hydroxyprednisolone. RESULTS Detected concentrations of budesonide were significantly higher at all time points for RAO-affected horses, compared with concentrations for the control horses. All samples of RAO-affected horses contained budesonide concentrations above the limit of detection at 96 hours after inhalation, whereas this was found for only 2 control horses. Detected concentrations of budesonide were higher, but not significantly so, at all time points in horses that inhaled budesonide during exercise, compared with concentrations for inhalation at rest. CONCLUSIONS AND CLINICAL RELEVANCE Results of this study indicated that the time interval between inhalation of a glucocorticoid and participation in sporting events should be increased when inhalation treatment is administered during exercise to horses affected by respiratory tract disease.

COPD Medicine

MedlinePlus

... Rotahaler® Turbuhaler® Twisthaler® Metered-Dose Inhaler (MDI) HFA Propellant Metered-Dose Inhaler and Spacer AeroChamber® AeroChamber® with ... Rotahaler® Turbuhaler® Twisthaler® Metered-Dose Inhaler (MDI) HFA Propellant Metered-Dose Inhaler and Spacer AeroChamber® AeroChamber® with ...

The Ellipta® in asthma and chronic obstructive pulmonary disease: device characteristics and patient acceptability.

PubMed

Jones, Thomas L; Neville, Daniel M; Chauhan, Anoop J

2018-02-01

Asthma and chronic obstructive pulmonary disease are primarily treated with inhaled medication, but delivery of that medication to its site of action is problematic; patients' ability to use inhalers will affect therapeutic response. Multiple inhaler devices are available but they are variably easy to use with consequent effects on compliance, intentional or otherwise. The Ellipta ® device is a novel blister strip dry powder inhaler with medium resistance and a consistent delivered dose across a range of inspiratory flow rates. The Ellipta has proven easy to use and is preferred by patients across several evaluations and compared with other inhaler devices. The Ellipta is used to administer multiple inhaled medications, all in single daily-dose regimens, making it ideal for patients who struggle with complex inhaled therapy regimens.

Impact of multiple-dose versus single-dose inhaler devices on COPD patients’ persistence with long-acting β2-agonists: a dispensing database analysis

PubMed Central

van Boven, Job FM; van Raaij, Joost J; van der Galiën, Ruben; Postma, Maarten J; van der Molen, Thys; Dekhuijzen, PN Richard; Vegter, Stefan

2014-01-01

Background: With a growing availability of different devices and types of medication, additional evidence is required to assist clinicians in prescribing the optimal medication in relation to chronic obstructive pulmonary disease (COPD) patients’ persistence with long-acting β2-agonists (LABAs). Aims: To assess the impact of the type of inhaler device (multiple-dose versus single-dose inhalers) on 1-year persistence and switching patterns with LABAs. Methods: A retrospective observational cohort study was performed comparing a cohort of patients initiating multiple-dose inhalers and a cohort initiating single-dose inhalers. The study population consisted of long-acting bronchodilator naive COPD patients, initiating inhalation therapy with mono-LABAs (formoterol, indacaterol or salmeterol). Analyses were performed using pharmacy dispensing data from 1994 to 2012, obtained from the IADB.nl database. Study outcomes were 1-year persistence and switching patterns. Results were adjusted for initial prescriber, initial medication, dosing regimen and relevant comorbidities. Results: In all, 575 patients initiating LABAs were included in the final study cohort. Among them, 475 (83%) initiated a multiple-dose inhaler and 100 (17%) a single-dose inhaler. Further, 269 (47%) initiated formoterol, 9 (2%) indacaterol and 297 (52%) salmeterol. There was no significant difference in persistence between users of multiple-dose or single-dose inhalers (hazard ratio: 0.98, 95% confidence interval: 0.76–1.26, P=0.99). Over 80% re-started or switched medication. Conclusions: There seems no impact of inhaler device (multiple-dose versus single-dose inhalers) on COPD patients’ persistence with LABAs. Over 80% of patients who initially seemed to discontinue LABAs, re-started their initial medication or switched inhalers or medication within 1 year. PMID:25274453

The enhancement model of ICT competence for the teachers of SMP Terbuka in Central Java to support long distance learning program

NASA Astrophysics Data System (ADS)

Widowati, Trisnani; Purwanti, Dwi

2017-03-01

ICT-based learning for SMP Terbuka is a manifestation of the first pillar of DEPDIKNAS Strategic Plan 2005-2009, about the use of ICT as the facility of long distance learning. By implementing ICT-based learning, the communication between the teacher and the students is possible to happen although both parties are in differnet places. The problem in implementing ICT-based learning for SMP Terbuka is the low competence of the teachers in ICT mastery, because this research is aimed to formulate the enhancement model of ICT competence for the teachers of SMP Terbuka in Central Java to support long distance learning program. This research shows that Supervised-Teachers and Tutor Teachers Competence in ICT is still low with the average of Supervised-Teachers competence in operating Ms.Word application of 59.6%, Ms.Excel 55.40%, Power Point 43.40% and internet mastery of 41.8%; while the competence of Tutor Teachers is lower with the average of 40.40% in operating Ms. Word, 35.20% in Ms.Excel, 28.00% in Power Point, and 29% in internet mastery. It means that Supervised-Teachers understand ICT, but they do not master it; while Tutor Teachers have just understood ICT and have a low mastery in Ms.Word. The output of this research is: The new findings of the enhancement model of ICT competence for the teachers of SMP Terbuka in Central Java to support long distance learning program.

Evidence from district level inputs to improve quality of care for maternal and newborn health: interventions and findings.

PubMed

Salam, Rehana A; Lassi, Zohra S; Das, Jai K; Bhutta, Zulfiqar A

2014-09-04

District level healthcare serves as a nexus between community and district level facilities. Inputs at the district level can be broadly divided into governance and accountability mechanisms; leadership and supervision; financial platforms; and information systems. This paper aims to evaluate the effectivness of district level inputs for imporving maternal and newborn health. We considered all available systematic reviews published before May 2013 on the pre-defined district level interventions and included 47 systematic reviews. Evidence suggests that supervision positively influenced provider's practice, knowledge and client/provider satisfaction. Involving local opinion leaders to promote evidence-based practice improved compliance to the desired practice. Audit and feedback mechanisms and tele-medicine were found to be associated with improved immunization rates and mammogram uptake. User-directed financial schemes including maternal vouchers, user fee exemption and community based health insurance showed significant impact on maternal health service utilization with voucher schemes showing the most significant positive impact across all range of outcomes including antenatal care, skilled birth attendant, institutional delivery, complicated delivery and postnatal care. We found insufficient evidence to support or refute the use of electronic health record systems and telemedicine technology to improve maternal and newborn health specific outcomes. There is dearth of evidence on the effectiveness of district level inputs to improve maternal newborn health outcomes. Future studies should evaluate the impact of supervision and monitoring; electronic health record and tele-communication interventions in low-middle-income countries.

Protective Immunization Against Inhalational Anthrax: A Comparison of Minimally Invasive Delivery Platforms

DTIC Science & Technology

2004-12-15

278 • JID 2005:191 (15 January) • Mikszta et al. M A J O R A R T I C L E Protective Immunization against Inhalational Anthrax: A Comparison of...provides complete protection against inhalational anthrax in rabbits. The novel vaccine/device combi- nations described here have the potential to...have produced documented fatali- ties, the fatality rate of inhalational anthrax is nearly 100% without antibiotic intervention. Inhalational an

Maintenance inhaler preference, attribute importance, and satisfaction in prescribing physicians and patients with asthma, COPD, or asthma–COPD overlap syndrome consulting for routine care

PubMed Central

Ding, Bo; Small, Mark; Scheffel, Gina; Holmgren, Ulf

2018-01-01

Background In respiratory disorders, patient- and physician-perceived satisfaction with the maintenance inhaler device is an important factor driving treatment compliance and outcomes. We examine inhaler preferences in asthma and COPD from patient and physician perspectives, particularly focusing on the relative importance of individual device attributes and patient characteristics guiding inhaler choice. Materials and methods Real-world data from >7,300 patients with asthma, COPD, or asthma–COPD overlap syndrome (ACOS) consulting for routine care were derived from respiratory Disease Specific Programs conducted in Europe, USA, Japan, and China. Outcome variables included current pattern of inhaled maintenance therapy and device type, physician preference, patient-reported device attribute importance, and satisfaction. Results The most commonly prescribed inhalers for maintenance therapy of asthma, COPD, and ACOS were dry powder inhalers (62.8%–88.5% of patients) and pressurized metered dose inhalers (18.9%–35.3% of patients). One-third of physicians stated no preference for maintenance device when prescribing treatment, and less than one-third of patients reported being “extremely satisfied” with any attribute of their device. Instructions being “simple and easy to follow” was the inhaler attribute most commonly selected as important. For approximately one-third of patients across all groups, “ease of use/suitability of inhaler device” was a reason for the prescribing decision, as stated by the physician. Device characteristics were more likely to impact the prescribing decision in older patients (in asthma and COPD; P<0.01) and those with worse disease severity (in COPD; P<0.001). Conclusion A relatively high proportion of physicians had no preference for inhaler type across asthma, COPD, and ACOS. Simplicity of use was the most important inhaler attribute from a patient’s perspective. Physicians appeared to place most importance on ease of use and device suitability when selecting inhalers for older patients and those with more severe disease, particularly in COPD. PMID:29588581

TARGETED DELIVERY OF INHALED PHARMACEUTICALS USING AN IN SILICO DOSIMETRY MODEL

EPA Science Inventory

We present an in silico dosimetry model which can be used for inhalation toxicology (risk assessment of inhaled air pollutants) and aerosol therapy ( targeted delivery of inhaled drugs). This work presents scientific and clinical advances beyond the development of the original in...

A review of the value of innovation in inhalers for COPD and asthma

PubMed Central

Virchow, Johann Christian; Akdis, Cezmi A.; Darba, Josep; Dekhuijzen, Richard; Hartl, Sylvia; Kobelt, Gisela; Roger, Albert; Simoens, Steven; Toumi, Mondher; Woodhouse, Ben; Plich, Adam; Torvinen, Saku

2015-01-01

Background Appropriate use of inhaled therapies for asthma and chronic obstructive pulmonary disease (COPD) is critical to ensuring good patient outcomes, efficient use of healthcare resources and limiting the effects of high-morbidity. The appropriate choice of inhaler and active therapy, incorporating patient preferences, can help improve treatment adherence and long-term outcomes. Despite this, many current inhalers are non-intuitive to use, and require extensive training. Methods In this review, an expert panel considers the evidence for the use of inhaler devices in management of COPD and asthma. The panel also evaluates the value of innovation in inhaler technologies, which optimise the use of existing molecules from a clinical, economic and societal perspective. Conclusions The panel conclusion is that there remains a substantial unmet need in inhaler technology and that innovation in inhaler devices can provide real-world health benefits to patients. Furthermore, we recommend that these innovations should be supported by healthcare systems through appropriate pricing and reimbursement mechanisms. PMID:27123170

A review of the value of innovation in inhalers for COPD and asthma.

PubMed

Virchow, Johann Christian; Akdis, Cezmi A; Darba, Josep; Dekhuijzen, Richard; Hartl, Sylvia; Kobelt, Gisela; Roger, Albert; Simoens, Steven; Toumi, Mondher; Woodhouse, Ben; Plich, Adam; Torvinen, Saku

2015-01-01

Appropriate use of inhaled therapies for asthma and chronic obstructive pulmonary disease (COPD) is critical to ensuring good patient outcomes, efficient use of healthcare resources and limiting the effects of high-morbidity. The appropriate choice of inhaler and active therapy, incorporating patient preferences, can help improve treatment adherence and long-term outcomes. Despite this, many current inhalers are non-intuitive to use, and require extensive training. In this review, an expert panel considers the evidence for the use of inhaler devices in management of COPD and asthma. The panel also evaluates the value of innovation in inhaler technologies, which optimise the use of existing molecules from a clinical, economic and societal perspective. The panel conclusion is that there remains a substantial unmet need in inhaler technology and that innovation in inhaler devices can provide real-world health benefits to patients. Furthermore, we recommend that these innovations should be supported by healthcare systems through appropriate pricing and reimbursement mechanisms.

LPG Dependence after a Suicide Attempt

PubMed Central

Aldemir, Ebru; Akyel, Betül; Altıntoprak, A. Ender; Aydın, Rezzan; Coşkunol, Hakan

2015-01-01

Inhalant abuse is a problem that is getting more common all around the world. The increase in prevalence of inhalant abuse escalates morbidity and mortality rates. About 22% of people using inhalant have died at their first attempt. Particularly propane, butane, or propane-butane mixture has highest mortality rates. Sudden sniffing death syndrome, cardiomyopathy, central nervous system toxicity, hematological abnormalities, kidney toxicity, and hepatocellular toxicities are the major complications of inhalant abuse. Herein we present a patient with inhalant use disorder. At the age of 19, after a stressful life event he had unsuccessfully tried to suicide by inhaling LPG (liquefied petroleum gas, a mixture of butane and propane gases). After he realized that he had hallucinations and felt better during the inhalation, he started to abuse it. He was addicted to LPG for 10 years at the time of admission. Besides being dangerous for the society security, this intense level of LPG inhalation (12 liters a day) not giving any physical harm makes this case interesting. PMID:25664196

[Evaluation of an education program for patients with asthma who use inhalers].

PubMed

Lee, Jong Kyung; Yang, Young Hee

2010-04-01

This study was done to evaluate the effectiveness of an education program for patients with asthma who use inhalers. The research design for this study was a non-equivalent control group quasi-experimental study. Participants in this study were 36 patients for the control group, and 43 patients for the experimental group. The experimental group participated in the education program. The control group received the usual care. Data were collected before and 1 month and 2 months after the program finished and were analyzed using the SPSS 12.0 program. The experimental group had significantly higher scores of knowledge of inhalers, and inhalation technique compared to the control group. However, no significant differences were found between two groups for PEFR, asthma instability, and satisfaction with inhalers. According to the results, the education program was effective in improving knowledge of inhalers, and inhalation technique. Therefore, it is recommended that this education program be used in clinical practice as an effective nursing intervention for patients with asthma on inhalers.

Inhaled antibiotics in non-cystic fibrosis bronchiectasis: A meta-analysis.

PubMed

Xu, Li; Zhang, Fei; Du, Shuai; Yu, Qi; Chen, Lin; Long, Li-Hui; Li, Ya-Ming; Jia, Ai-Hua

2016-09-01

To evaluate the efficacy and safety of inhaled antibiotics for the treatment of non-cystic fibrosis bronchiectasis (NCFB). Pubmed, Cochrane library, Embase, Elsevier, OVID, Springerlink, Web of knowledge and NEJM were searched for randomized controlled trials (RCTs) on inhaled antibiotics in treatment of NCFB from inception until April 2015. Meta-analysis was conducted to assess the efficacy and safety of inhaled antibiotics in the treatment of NCFB. Twelve RCTs involving 1154 participants were included. They showed that inhaled antibiotics were more effective in reduction of sputum bacterial density, eradication of P. aeruginosa, prolonged time to exacerbation and reduction of new pathogens emergence with no significant difference in adverse events compared with control groups. However, we did not find significant benefits of inhaled antibiotics in reducing the risk of acute exacerbation, improving health-related quality of life and reduction of P. aeruginosa resistance. Moreover, inhaled antibiotics exerted a statistically significant reduction in FEV1%. Inhaled antibiotics may be an alternative pathway to inhibit airway inflammation with no more adverse events in patients with NCFB.

LPG Dependence after a Suicide Attempt.

PubMed

Aldemir, Ebru; Akyel, Betül; Altıntoprak, A Ender; Aydın, Rezzan; Coşkunol, Hakan

2015-01-01

Inhalant abuse is a problem that is getting more common all around the world. The increase in prevalence of inhalant abuse escalates morbidity and mortality rates. About 22% of people using inhalant have died at their first attempt. Particularly propane, butane, or propane-butane mixture has highest mortality rates. Sudden sniffing death syndrome, cardiomyopathy, central nervous system toxicity, hematological abnormalities, kidney toxicity, and hepatocellular toxicities are the major complications of inhalant abuse. Herein we present a patient with inhalant use disorder. At the age of 19, after a stressful life event he had unsuccessfully tried to suicide by inhaling LPG (liquefied petroleum gas, a mixture of butane and propane gases). After he realized that he had hallucinations and felt better during the inhalation, he started to abuse it. He was addicted to LPG for 10 years at the time of admission. Besides being dangerous for the society security, this intense level of LPG inhalation (12 liters a day) not giving any physical harm makes this case interesting.

The impact of expired and empty quick-relief asthma inhalers: The Asthma and Allergy Foundation of America's Asthma Inhaler Design Survey.

PubMed

Storms, William W; Tringale, Mike; Ferro, Thomas J

2015-01-01

Despite the available treatments, asthma remains a serious illness, with a considerable socioeconomic burden associated with a high number of unscheduled visits to the emergency department (ED). Poor adherence and inadequate inhaler technique are contributing factors to poor asthma management and control. The Asthma Inhaler Design Survey assessed the behaviors, attitudes, needs, and preferences of patients with asthma and their caregivers with regard to quick-relief inhaler usage and device design. The Asthma and Allergy Foundation of America invited 19,157 adult patients and parents of children with asthma to take part in an online survey that focused on previous asthma diagnosis, symptom severity, and quick-relief and controller medication use. Opinions were also collected. Data from 590 respondents (366 adults; 224 children) were included in the final analysis. Relief inhalers were needed and found to be past the expiration date by 284 of 561 (50.6%) and relief inhalers were found to be empty by 270 of 560 (48.2%). Of the empty inhaler group, 28 of 270 (10.4%) had to visit the ED for treatment, 18 of 270 (6.7%) missed work or school for an unscheduled physician office visit, and 54 of 270 (20%) went without treatment. Although 78.5% indicated that they had at least two quick-relief inhalers nearby, these were not always easily accessible. Few respondents (194/578 [33.6%]) indicated that they and/or their child were very confident that they were using their inhaler properly, even though the majority had received some instruction. When asked what they would do to improve satisfaction with their quick-relief inhalers, 173 of 558 (31%) responded that they would add a dose counter. Unnecessary health care utilization and avoidable loss of time at work or school were associated with the lack of full availability of properly functioning quick-relief inhalers when needed. Adding a dose counter was the most frequently cited response for improving satisfaction with quick-relief inhalers. Confidence about proper inhaler use was low, despite previous instruction.

Inhaled alpha 1-antitrypsin: gauging patient interest in a new treatment.

PubMed

Monk, Richard; Graves, Michael; Williams, Pamela; Strange, Charlie

2013-08-01

Given the high cost of plasma derived intravenous alpha 1-antitrypsin (AAT), a more efficient method of delivery to the lungs is desirable. Inhaled AAT has been shown feasible for the treatment of alpha 1-antitrypsin deficiency (AATD) and is currently in clinical trials. To better understand patient preferences about possible inhaled AAT therapy, a survey was conducted to explore patient attitudes. We conducted an email based survey of patients in the Alpha-1 Foundation Research Registry with AATD on intravenous AAT replacement. Respondents were asked to rate their interest in hypothetical nebulized or dry powder inhaled AAT. Respondents reported high levels of interest in both dried powder inhaler and nebulizer delivered inhaled AAT. The interest in dried powder inhaled was higher than interest in nebulized AAT (71% vs 64%, p = 0.0001). The interest in dried powder inhaled AAT was particularly high in respondents currently on bronchodilator therapy (p = 0.0053). Patients were just as likely to use or not use the product if it required 20% more out of pocket cost. There is a high level of patient interest in the development of a commercially available inhaled AAT replacement product.

Reliability of Use, Abuse, and Dependence of Four Types of Inhalants in Adolescents and Young Adults

PubMed Central

Ridenour, Ty A.; Bray, Bethany C.; Cottler, Linda B.

2007-01-01

Inhalants, as a class of drugs, consists of heterogeneous substances that include some of the most dangerous drugs on a per use basis. Research on inhalant abuse has lagged behind other drugs partly because of the need for a diagnostic instrument of different types of inhalants. This study was conducted to obtain reliability estimates for the new Substance Abuse Module DSM-IV inhalants diagnoses for four types of inhalants: aerosols, gases, nitrites, and solvents as well as different diagnostic configurations of inhalant use. Participants were 162 community sample adolescents or young adults (mean age = 20.3 years, SD = 2.4). Two-thirds of the sample was male and 83.3% was Caucasian. Kappas and intraclass correlation coefficients were computed to estimate test-retest reliabilities. Results suggested (a) abuse was more common than dependence (34.6% vs. 12.3%), (b) reliabilities of abuse criteria and diagnosis were good to excellent across subtypes, and (c) reliabilities of dependence criteria and diagnoses were poor to good across subtypes. Alternative configurations of DSM-IV criteria that were consistent with previous research on adolescents provided excellent reliabilities across subtypes of inhalants. Moreover, 11.1% of participants experienced inhalants withdrawal. PMID:17576041

Toxicological perspectives of inhaled therapeutics and nanoparticles.

PubMed

Hayes, Amanda J; Bakand, Shahnaz

2014-07-01

The human respiratory system is an important route for the entry of inhaled therapeutics into the body to treat diseases. Inhaled materials may consist of gases, vapours, aerosols and particulates. In all cases, assessing the toxicological effect of inhaled therapeutics has many challenges. This article provides an overview of in vivo and in vitro models for testing the toxicity of inhaled therapeutics and nanoparticles implemented in drug delivery. Traditionally, inhalation toxicity has been performed on test animals to identify the median lethal concentration of airborne materials. Later maximum tolerable concentration denoted by LC0 has been introduced as a more ethically acceptable end point. More recently, in vitro methods have been developed, allowing the direct exposure of airborne material to cultured human target cells on permeable porous membranes at the air-liquid interface. Modifications of current inhalation therapies, new pulmonary medications for respiratory diseases and implementation of the respiratory tract for systemic drug delivery are providing new challenges when conducting well-designed inhalation toxicology studies. In particular, the area of nanoparticles and nanocarriers is of critical toxicological concern. There is a need to develop toxicological test models, which characterise the toxic response and cellular interaction between inhaled particles and the respiratory system.

A blended supervision model in Australian general practice training.

PubMed

Ingham, Gerard; Fry, Jennifer

2016-05-01

The Royal Australian College of General Practitioners' Standards for general practice training allow different models of registrar supervision, provided these models achieve the outcomes of facilitating registrars' learning and ensuring patient safety. In this article, we describe a model of supervision called 'blended supervision', and its initial implementation and evaluation. The blended supervision model integrates offsite supervision with available local supervision resources. It is a pragmatic alternative to traditional supervision. Further evaluation of the cost-effectiveness, safety and effectiveness of this model is required, as is the recruitment and training of remote supervisors. A framework of questions was developed to outline the training practice's supervision methods and explain how blended supervision is achieving supervision and teaching outcomes. The supervision and teaching framework can be used to understand the supervision methods of all practices, not just practices using blended supervision.

“People Knew They Could Come Here to Get Help”: An Ethnographic Study of Assisted Injection Practices at a Peer-Run ‘Unsanctioned’ Supervised Drug Consumption Room in a Canadian Setting

PubMed Central

McNeil, Ryan; Small, Will; Lampkin, Hugh; Shannon, Kate; Kerr, Thomas

2013-01-01

People who require help injecting are disproportionately vulnerable to drug-related harm, including HIV transmission. North America’s only sanctioned SIF operates in Vancouver, Canada under an exemption to federal drug laws, which imposes operating regulations prohibiting assisted injections. In response, the Vancouver Area Network of Drug Users (VANDU) launched a peer-run unsanctioned SIF in which trained peer volunteers provide assisted injections to increase the coverage of supervised injection services and minimize drug-related harm. We undertook qualitative interviews (n=23) and ethnographic observation (50 hours) to explore how this facility shaped assisted injection practices. Findings indicated that VANDU reshaped the social, structural, and spatial contexts of assisted injection practices in a manner that minimized HIV and other health risks, while allowing people who require help injecting to escape drug scene violence. Findings underscore the need for changes to regulatory frameworks governing SIFs to ensure that they accommodate people who require help injecting. PMID:23797831

Quick-Relief Medications for Lung Diseases

MedlinePlus

... Rotahaler® Turbuhaler® Twisthaler® Metered-Dose Inhaler (MDI) HFA Propellant Metered-Dose Inhaler and Spacer AeroChamber® AeroChamber® with ... Rotahaler® Turbuhaler® Twisthaler® Metered-Dose Inhaler (MDI) HFA Propellant Metered-Dose Inhaler and Spacer AeroChamber® AeroChamber® with ...

78 FR 70531 - Foreign-Trade Zone (FTZ) 93-Raleigh/Durham, North Carolina; Notification of Proposed Production...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-26

.... The finished products include devices such as respiratory placebo inhalers, Relenza anti-viral inhalers, Seretide/Advair, Serevent and Flovent diskus respiratory inhalers, Advair and Ventolin HFA respiratory inhalers, and the following tablets and capules--Lovaza antihyperlipidemic, Paxil depression...

The role of nicotine content information in smokers' subjective responses to nicotine and placebo inhalers.

PubMed

Darredeau, Christine; Barrett, Sean P

2010-11-01

A growing body of evidence suggests that non-pharmacological factors may play an important role in smoking cessation outcomes using nicotine replacement therapies. This study examined the role of information about nicotine content in smokers' subjective responses to nicotine and placebo inhalers, using the four conditions of the balanced-placebo design in a mixed within/between-subjects design. Twenty-four adult smokers (12 male) completed two laboratory sessions following overnight abstinence from smoking. Participants were randomly assigned to receive either nicotine inhalers or placebo inhalers in both sessions but were told that they received a nicotine-containing inhaler in one session and a nicotine-free inhaler in the other. In each session participants completed subjective assessments before and after inhaler administration using visual analogue scales and the Brief Questionnaire of Smoking Urges. While neither nicotine content nor information about it significantly affected cigarette craving associated with withdrawal relief, participants reported a greater reduction in craving associated with intention to smoke when told the inhalers contained nicotine than when told the inhalers were nicotine-free, regardless of actual nicotine content. Findings suggest that psychological factors play an important role in smokers' subjective responses to nicotine inhalers, the effects of which cannot be solely attributed to the direct pharmacological effects of nicotine. Copyright © 2011 John Wiley & Sons, Ltd.

SPHERES National Lab Facility

NASA Technical Reports Server (NTRS)

Benavides, Jose

2014-01-01

SPHERES is a facility of the ISS National Laboratory with three IVA nano-satellites designed and delivered by MIT to research estimation, control, and autonomy algorithms. Since Fall 2010, The SPHERES system is now operationally supported and managed by NASA Ames Research Center (ARC). A SPHERES Program Office was established and is located at NASA Ames Research Center. The SPHERES Program Office coordinates all SPHERES related research and STEM activities on-board the International Space Station (ISS), as well as, current and future payload development. By working aboard ISS under crew supervision, it provides a risk tolerant Test-bed Environment for Distributed Satellite Free-flying Control Algorithms. If anything goes wrong, reset and try again! NASA has made the capability available to other U.S. government agencies, schools, commercial companies and students to expand the pool of ideas for how to test and use these bowling ball-sized droids. For many of the researchers, SPHERES offers the only opportunity to do affordable on-orbit characterization of their technology in the microgravity environment. Future utilization of SPHERES as a facility will grow its capabilities as a platform for science, technology development, and education.

Advances in Audio-Based Systems to Monitor Patient Adherence and Inhaler Drug Delivery.

PubMed

Taylor, Terence E; Zigel, Yaniv; De Looze, Céline; Sulaiman, Imran; Costello, Richard W; Reilly, Richard B

2018-03-01

Hundreds of millions of people worldwide have asthma and COPD. Current medications to control these chronic respiratory diseases can be administered using inhaler devices, such as the pressurized metered dose inhaler and the dry powder inhaler. Provided that they are used as prescribed, inhalers can improve patient clinical outcomes and quality of life. Poor patient inhaler adherence (both time of use and user technique) is, however, a major clinical concern and is associated with poor disease control, increased hospital admissions, and increased mortality rates, particularly in low- and middle-income countries. There are currently limited methods available to health-care professionals to objectively and remotely monitor patient inhaler adherence. This review describes recent sensor-based technologies that use audio-based approaches that show promising opportunities for monitoring inhaler adherence in clinical practice. This review discusses how one form of sensor-based technology, audio-based monitoring systems, can provide clinically pertinent information regarding patient inhaler use over the course of treatment. Audio-based monitoring can provide health-care professionals with quantitative measurements of the drug delivery of inhalers, signifying a clear clinical advantage over other methods of assessment. Furthermore, objective audio-based adherence measures can improve the predictability of patient outcomes to treatment compared with current standard methods of adherence assessment used in clinical practice. Objective feedback on patient inhaler adherence can be used to personalize treatment to the patient, which may enhance precision medicine in the treatment of chronic respiratory diseases. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Infusion of guaifenesin, ketamine, and medetomidine in combination with inhalation of sevoflurane versus inhalation of sevoflurane alone for anesthesia of horses.

PubMed

Yamashita, Kazuto; Muir, William W; Tsubakishita, Sae; Abrahamsen, Eric; Lerch, Phillip; Izumisawa, Yasuharu; Kotani, Tadao

2002-10-15

To evaluate effects of infusion of guaifenesin, ketamine, and medetomidine in combination with inhalation of sevoflurane versus inhalation of sevoflurane alone for anesthesia of horses. Randomized clinical trial. 40 horses. Horses were premedicated with xylazine and anesthetized with diazepam and ketamine. Anesthesia was maintained by infusion of guaifenesin, ketamine, and medetomidine and inhalation of sevoflurane (20 horses) or by inhalation of sevoflurane (20 horses). A surgical plane of anesthesia was maintained by controlling the inhaled concentration of sevoflurane. Sodium pentothal was administered as necessary to prevent movement in response to surgical stimulation. Hypotension was treated with dobutamine; hypoxemia and hypercarbia were treated with intermittent positive-pressure ventilation. The quality of anesthetic induction, maintenance, and recovery and the quality of the transition to inhalation anesthesia were scored. The delivered concentration of sevoflurane (ie, the vaporizer dial setting) was significantly lower and the quality of transition to inhalation anesthesia and of anesthetic maintenance were significantly better in horses that received the guaifenesin-ketamine-medetomidine infusion than in horses that did not. Five horses, all of which received sevoflurane alone, required administration of pentothal. Recovery time and quality of recovery were not significantly different between groups, but horses that received the guaifenesin-ketamine-medetomidine infusion required fewer attempts to stand. Results suggest that in horses, the combination of a guaifenesin-ketamine-medetomidine infusion and inhalation of sevoflurane resulted in better transition and maintenance phases while improving cardiovascular function and reducing the number of attempts needed to stand after the completion of anesthesia, compared with inhalation of sevoflurane.

The importance of continuity in inhaler device choice for asthma and chronic obstructive pulmonary disease.

PubMed

Bjermer, Leif

2014-01-01

Inhaled therapies are central to the treatment of asthma and chronic obstructive pulmonary disease. Physicians consider many factors when selecting the most appropriate inhaler device, including device efficacy and the cost to the health care system. This review aims to discuss the factors that are important when considering inhaler devices and the importance of continuity in the choice of inhaler device. A large number of factors can contribute to therapeutic outcomes with inhalation devices. The inhalation technique is critical to treatment success and differs substantially between inhaler devices. Misuse of an inhaler is common, and thorough training of patients and physicians is important to ensure correct utilization. Patient satisfaction is an important consideration because it is significantly correlated with compliance and better outcomes. Financial pressures contribute to decision making: although selecting the less expensive inhaler device might reduce direct treatment costs, it can have a large impact on disease control and the patient's well-being. Switching may be associated with a poor inhalation technique, reduced disease control and quality of life, increased use of other treatments and health care resources, and a greater chance of unsuccessful treatment. Nonconsensual switches can result in patient discontent, reduced confidence in the medication, and uncertainty regarding the degree of disease control. It is recommended that patients with stable disease remain on their current device. If a switch is considered, the patient should be consulted and the physician should take into account the patient's preference, their ability to correctly use the device, and the availability of the preferred drug in the preferred device.

Inhalant use among schoolchildren in northeast India: a preliminary study.

PubMed

Akoijam, Brogen Singh; Jamir, M Nukshisangla; Phesao, Ebenezer; Senjam, Gojendra Singh

2013-01-01

Inhalant use by children leads to poor performance in school and has been observed to precede substance use later in life. There is paucity of data on inhalant use among school children in India, particularly in the Northeast region of the country. We determined the prevalence and documented inhalant use characteristics among schoolchildren in the Northeast region of India. This cross sectional study was conducted in six states in the Northeast region of India. Schoolchildren between eighth and eleventh standards from the capital areas of the states were included in the study. Data were collected using a questionnaire. Analysis was done using descriptive statistics and Chi-square test. Of the 4074 enrolled students, data from 3943 students who responded to the inhalant use question were analyzed. Mean age was 14.8 ± 1.2 years and 51.2% of participants were male. The proportion of students who had ever used inhalants (ever user) was 18.8% and adhesive/glue was the inhalant misused by most of the students. A higher proportion of males than females were ever users (P ≤ 0.001) and the most common place of use was at home (33.1%). Being in the presence of an older person using an inhalant or tobacco was found to be associated with use of inhalants among students. Nearly one-fifth of the students had used inhalants and nearly half used inhalants in the past month. Sensitization of the parents and school authorities to the problem, as well as preventive and curative services, should be considered.

Evaluation of Inhaled Versus Deposited Dose Using the Exponential Dose-Response Model for Inhalational Anthrax in Nonhuman Primate, Rabbit, and Guinea Pig.

PubMed

Gutting, Bradford W; Rukhin, Andrey; Mackie, Ryan S; Marchette, David; Thran, Brandolyn

2015-05-01

The application of the exponential model is extended by the inclusion of new nonhuman primate (NHP), rabbit, and guinea pig dose-lethality data for inhalation anthrax. Because deposition is a critical step in the initiation of inhalation anthrax, inhaled doses may not provide the most accurate cross-species comparison. For this reason, species-specific deposition factors were derived to translate inhaled dose to deposited dose. Four NHP, three rabbit, and two guinea pig data sets were utilized. Results from species-specific pooling analysis suggested all four NHP data sets could be pooled into a single NHP data set, which was also true for the rabbit and guinea pig data sets. The three species-specific pooled data sets could not be combined into a single generic mammalian data set. For inhaled dose, NHPs were the most sensitive (relative lowest LD50) species and rabbits the least. Improved inhaled LD50 s proposed for use in risk assessment are 50,600, 102,600, and 70,800 inhaled spores for NHP, rabbit, and guinea pig, respectively. Lung deposition factors were estimated for each species using published deposition data from Bacillus spore exposures, particle deposition studies, and computer modeling. Deposition was estimated at 22%, 9%, and 30% of the inhaled dose for NHP, rabbit, and guinea pig, respectively. When the inhaled dose was adjusted to reflect deposited dose, the rabbit animal model appears the most sensitive with the guinea pig the least sensitive species. © 2014 Society for Risk Analysis.

Physical Symptoms and Psychological Distress among Inhalant Users.

ERIC Educational Resources Information Center

Joe, George W.; And Others

1991-01-01

Among 110 Mexican-American adolescents with varying drug use histories, self-reported physical health problems were not related to inhalant use history, but blood analyses indicated a relationship between extensive inhalant use and liver problems. Psychological distress symptoms were related to inhalant use and physical symptoms. Contains 23…

78 FR 63227 - Determination That INTAL (cromolyn sodium) Inhalation Capsule, 20 Milligrams, Was Not Withdrawn...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-23

...] Determination That INTAL (cromolyn sodium) Inhalation Capsule, 20 Milligrams, Was Not Withdrawn From Sale for... Food and Drug Administration (FDA) has determined that INTAL (cromolyn sodium) Inhalation Capsule, 20... allow FDA to approve abbreviated new drug applications (ANDAs) for cromolyn sodium inhalation capsule...

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

Belinsky, S. A.; Hoover, M. D.; Bradley, P. L.

This document from the Inhalation Toxicology Research Institute includes annual reports in the following general areas: (I) Aerosol Technology and Characterization of Airborne Materials; (II) Deposition, transport, and clearance of inhaled Toxicants; (III) Metabolism and Markers of Inhaled Toxicants; (IV) Carcinogenic Responses to Toxicants; (V) Mechanisms of carcinogenic response to Toxicants; (VI) Non carcinogenic responses to inhaled toxicants; (VII) Mechanisms of noncarcinogenic Responses to Inhaled Toxicants; (VIII) The application of Mathematical Modeling to Risk Estimates. 9 appendices are also included. Selected papers are indexed separately for inclusion in the Energy Science and Technology Database.

Laboratory approach for diagnosis of toluene-based inhalant abuse in a clinical setting

PubMed Central

Jain, Raka; Verma, Arpita

2016-01-01

The steady increase of inhalant abuse is a great challenge for analytical toxicologists. This review describes an overview of inhalant abuse including the extent of the problem, types of products abused, modes of administration, pharmacology and effects of inhalants, the role of laboratory, interpretation of laboratory results and clinical considerations. Regular laboratory screening for inhalant abuse as well as other substance abuse and health risk behaviors must be a part of standard clinical care. PMID:26957863

Langley Aerospace Research Summer Scholars. Part 2

NASA Technical Reports Server (NTRS)

Schwan, Rafaela (Compiler)

1995-01-01

The Langley Aerospace Research Summer Scholars (LARSS) Program was established by Dr. Samuel E. Massenberg in 1986. The program has increased from 20 participants in 1986 to 114 participants in 1995. The program is LaRC-unique and is administered by Hampton University. The program was established for the benefit of undergraduate juniors and seniors and first-year graduate students who are pursuing degrees in aeronautical engineering, mechanical engineering, electrical engineering, material science, computer science, atmospheric science, astrophysics, physics, and chemistry. Two primary elements of the LARSS Program are: (1) a research project to be completed by each participant under the supervision of a researcher who will assume the role of a mentor for the summer, and (2) technical lectures by prominent engineers and scientists. Additional elements of this program include tours of LARC wind tunnels, computational facilities, and laboratories. Library and computer facilities will be available for use by the participants.

The quality of feeding assistance care practices for long-term care veterans: implications for quality improvement efforts.

PubMed

Simmons, Sandra F; Sims, Nichole; Durkin, Daniel W; Shotwell, Matthew S; Erwin, Scott; Schnelle, John F

2013-09-01

The primary purpose of this study was to determine the quality of feeding assistance care and identify areas in need of improvement for a sample of long-term care veterans. A secondary purpose was to compare these findings with the results of previous studies in community facilities to determine ways in which the VA sample might differ. A repeated measures observational study was conducted in two VA facilities with 200 long-stay residents. Research staff conducted standardized observations during and between meals for 3 months. There was a trend for better feeding assistance care quality during meals in the VA sample, but there were still multiple aspects of care in need of improvement both during and between meals. Higher licensed nurse staffing levels in the VA should enable effective supervision and management, but observation-based measures of care quality are necessary for accurate information about daily feeding assistance care provision.

Perceptions of final-year nursing students on the facilities, resources and quality of education provided by schools in Turkey.

PubMed

Güner, Perihan

2015-01-01

The purpose of this study is to determine the perceptions of final-year nursing students regarding the adequacy of education, resources and internships in preparation for graduation. The study design was a descriptive cross-sectional study of nursing students (n: 1804) in their final year of education and questionnaires were used to collect data. Information related to student-to-instructor ratios and internships was obtained from each institution. Most students reported receiving instruction or supervision by lecturers and clinicians who did not specialise in the field. Overall, students did not find the facilities, educational or technological resources and the quality of education offered by their respective schools adequate. The proportion of students who found the level of theoretical education, clinical practice and instructor support adequate was higher in state university colleges of nursing/faculties of health sciences than in state university schools of health sciences.

Providing safe surgery for neonates in sub-Saharan Africa.

PubMed

Ameh, Emmanuel A; Ameh, Nkeiruka

2003-07-01

Advances in neonatal intensive care, total parenteral nutrition and improvements in technology have led to a greatly improved outcome of neonatal surgery in developed countries. In many parts of sub-Saharan Africa, however, neonatal surgery continues to pose wide-ranging challenges. Delivery outside hospital, delayed referral, poor transportation, and lack of appropriate personnel and facilities continue to contribute to increased morbidity and mortality in neonates, particularly under emergency situations. Antenatal supervision and hospital delivery needs to be encouraged in our communities. Adequate attention needs to be paid to providing appropriate facilities for neonatal transport and support and training of appropriate staff for neonatal surgery. Neonates with surgical problems should be adequately resuscitated before referral where necessary but surgery should not be unduly delayed. Major neonatal surgery should as much as possible be performed by those trained to operate on neonates. Appropriate research and international collaboration is necessary to improve neonatal surgical care in the environment.

Ohio Space Grant Funds for Scholarship/Fellowship Students

NASA Technical Reports Server (NTRS)

1996-01-01

The Ohio Aerospace Institute (OAT), a consortium of university, industry, and government, was formed to promote collaborative aerospace-related research, graduate education, and technology transfer among the nine Ohio universities with doctoral level engineering programs, NASA Lewis Research Center, Air Force Wright Laboratory, and industry. OAT provides enhanced opportunities for affiliates to utilize federal government research laboratories and facilities at Lewis Research Center (LeRC) and Wright Laboratory. As a component of the graduate education and research programs, students and faculty from the member universities, LeRC engineers and scientists, and visiting investigators from industry, government and non-member universities conduct collaborative research projects using the unique facilities at LeRC, and will participate in collaborative education programs. Faculty from the member universities who hold collateral appointments at OAT, and government and industry experts serving as adjunct faculty, can participate in the supervision of student research.

Technical Reports: Langley Aerospace Research Summer Scholars. Part 1

NASA Technical Reports Server (NTRS)

Schwan, Rafaela (Compiler)

1995-01-01

The Langley Aerospace Research Summer Scholars (LARSS) Program was established by Dr. Samuel E. Massenberg in 1986. The program has increased from 20 participants in 1986 to 114 participants in 1995. The program is LaRC-unique and is administered by Hampton University. The program was established for the benefit of undergraduate juniors and seniors and first-year graduate students who are pursuing degrees in aeronautical engineering, mechanical engineering, electrical engineering, material science, computer science, atmospheric science, astrophysics, physics, and chemistry. Two primary elements of the LARSS Program are: (1) a research project to be completed by each participant under the supervision of a researcher who will assume the role of a mentor for the summer, and (2) technical lectures by prominent engineers and scientists. Additional elements of this program include tours of LARC wind tunnels, computational facilities, and laboratories. Library and computer facilities will be available for use by the participants.

Development of alternative data analysis techniques for improving the accuracy and specificity of natural resource inventories made with digital remote sensing data

NASA Technical Reports Server (NTRS)

Lillesand, T. M.; Meisner, D. E. (Principal Investigator)

1980-01-01

An investigation was conducted into ways to improve the involvement of state and local user personnel in the digital image analysis process by isolating those elements of the analysis process which require extensive involvement by field personnel and providing means for performing those activities apart from a computer facility. In this way, the analysis procedure can be converted from a centralized activity focused on a computer facility to a distributed activity in which users can interact with the data at the field office level or in the field itself. A general image processing software was developed on the University of Minnesota computer system (Control Data Cyber models 172 and 74). The use of color hardcopy image data as a primary medium in supervised training procedures was investigated and digital display equipment and a coordinate digitizer were procured.

Educational initiative for EE/RE engineering skills: Solar Two student interns. Final report

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

Norbeck, J.M.

1997-07-01

The US Department of Energy sponsored five student interns from the University of California, Riverside, College of Engineering to work during the summer of 1996 at the Solar Two Energy facility in the Mojave Desert. Through the DOE intern program, engineering students supported the Solar Two Project under the supervision of engineers from Southern California Edison. The prime purpose was to provide outreach and educational support for expanding interactions with university students to increase awareness of careers in renewable energy and energy efficiency fields. The College of Engineering-Center for Environmental Research and Technology (CE-CERT) coordinated this project. CE-CERT is primarilymore » a research facility focusing on air pollution and energy efficiency. CE-CERT serves undergraduate and graduate students by employing them on research projects, supporting them in the research and experimentation required for Senior Design Projects, and sponsoring them in student engineering competitions.« less

Control technology for fiber reinforced plastics industry at AMF Hatteras Yachts, New Bern Division, New Bern, North Carolina

NASA Astrophysics Data System (ADS)

Todd, W. F.

1984-05-01

Area and breathing zone samples were analyzed for styrene (100425) at AMF Hatteras Yachts (SIC-3079), New Bern, North Carolina, in September, 1983. Control technology at the facility was inspected. Breathing zone styrene concentrations were 8 to 74 parts per million (ppm), the highest concentrations occurring in the lamination and gel coating departments. Area samples ranged from 1 to 20ppm. The OSHA standard is 100ppm. The hull lamination and assembly areas were ventilated by air make up units and exhaust blowers. Air exhausted through the lamination booths in the small parts work area was considerably less than the supply air from the make up units. The air flow in two of the three lamination booths was considered inadequate. Respirators were available if needed. Industrial hygiene sampling at the facility was supervised by the industrial hygienist.

Using classification tree modelling to investigate drug prescription practices at health facilities in rural Tanzania.

PubMed

Kajungu, Dan K; Selemani, Majige; Masanja, Irene; Baraka, Amuri; Njozi, Mustafa; Khatib, Rashid; Dodoo, Alexander N; Binka, Fred; Macq, Jean; D'Alessandro, Umberto; Speybroeck, Niko

2012-09-05

Drug prescription practices depend on several factors related to the patient, health worker and health facilities. A better understanding of the factors influencing prescription patterns is essential to develop strategies to mitigate the negative consequences associated with poor practices in both the public and private sectors. A cross-sectional study was conducted in rural Tanzania among patients attending health facilities, and health workers. Patients, health workers and health facilities-related factors with the potential to influence drug prescription patterns were used to build a model of key predictors. Standard data mining methodology of classification tree analysis was used to define the importance of the different factors on prescription patterns. This analysis included 1,470 patients and 71 health workers practicing in 30 health facilities. Patients were mostly treated in dispensaries. Twenty two variables were used to construct two classification tree models: one for polypharmacy (prescription of ≥3 drugs) on a single clinic visit and one for co-prescription of artemether-lumefantrine (AL) with antibiotics. The most important predictor of polypharmacy was the diagnosis of several illnesses. Polypharmacy was also associated with little or no supervision of the health workers, administration of AL and private facilities. Co-prescription of AL with antibiotics was more frequent in children under five years of age and the other important predictors were transmission season, mode of diagnosis and the location of the health facility. Standard data mining methodology is an easy-to-implement analytical approach that can be useful for decision-making. Polypharmacy is mainly due to the diagnosis of multiple illnesses.

COPD - control drugs

MedlinePlus

Chronic obstructive pulmonary disease - control drugs; Bronchodilators - COPD - control drugs; Beta agonist inhaler - COPD - control drugs; Anticholinergic inhaler - COPD - control drugs; Long-acting inhaler - COPD - ...

Inhalation delivery of protein therapeutics.

PubMed

Kane, Colleen; O'Neil, Karyn; Conk, Michelle; Picha, Kristen

2013-04-01

Inhaled therapeutics are used routinely to treat a variety of pulmonary diseases including asthma, COPD and cystic fibrosis. In addition, biological therapies represent the fastest growing segment of approved pharmaceuticals. However, despite the increased availability of biological therapies, nearly all inhaled therapeutics are small molecule drugs with only a single inhaled protein therapeutic approved. There remains a significant unmet need for therapeutics in pulmonary diseases, and biological therapies with potential to alter disease progression represent a significant opportunity to treat these challenging diseases. This review provides a background into efforts to develop inhaled biological therapies and highlights some of the associated challenges. In addition, we speculate on the ideal properties of a biologic therapy for inhaled delivery.

Protective effects of radon inhalation on carrageenan-induced inflammatory paw edema in mice.

PubMed

Kataoka, Takahiro; Teraoka, Junichi; Sakoda, Akihiro; Nishiyama, Yuichi; Yamato, Keiko; Monden, Mayuko; Ishimori, Yuu; Nomura, Takaharu; Taguchi, Takehito; Yamaoka, Kiyonori

2012-04-01

We assessed whether radon inhalation inhibited carrageenan-induced inflammation in mice. Carrageenan (1% v/v) was injected subcutaneously into paws of mice that had or had not inhaled approximately 2,000 Bq/m(3) of radon for 24 h. Radon inhalation significantly increased superoxide dismutase (SOD) and catalase activities and significantly decreased lipid peroxide levels in mouse paws, indicating that radon inhalation activates antioxidative functions. Carrageenan administration induced paw edema and significantly increased tumor necrosis factor-alpha (TNF-α) and nitric oxide in serum. However, radon inhalation significantly reduced carrageenan-induced paw edema. Serum TNF-α levels were lower in the radon-treated mice than in sham-treated mice. In addition, SOD and catalase activities in paws were significantly higher in the radon-treated mice than in the sham-treated mice. These findings indicated that radon inhalation had anti-inflammatory effects and inhibited carrageenan-induced inflammatory paw edema.

Are healthcare aides underused in long-term care? A cross-sectional study on continuing care facilities in Canada.

PubMed

Arain, Mubashir A; Deutschlander, Siegrid; Charland, Paola

2017-05-17

Over the last 10 years, appropriate workforce utilisation has been an important discussion among healthcare practitioners and policy-makers. The role of healthcare aides (HCAs) has also expanded to improve their utilisation. This evolving role of HCAs in Canada has prompted calls for standardised training, education and scope of practice for HCAs. The purpose of this research was to examine the differences in HCAs training and utilisation in continuing care facilities. From June 2014 to July 2015, we conducted a mixed-method study on HCA utilisation in continuing care. This paper presents findings gathered solely from the prospective cross-sectional survey of continuing care facilities (long-term care (LTC) and supportive living (SL)) on HCA utilisation. We conducted this study in a Western Canadian province. The managers of the continuing care facilities (SL and LTC) were eligible to participate in the survey. The pattern of HCAs involvement in medication assistance and other care activities in SL and LTC facilities. We received 130 completed surveys (LTC=64 and SL=52). Our findings showed that approximately 81% of HCAs were fully certified. We found variations in how HCAs were used in SL and LTC facilities. Overall, HCAs in SL were more likely to be involved in medication management such as assisting with inhaled medication and oral medication delivery. A significantly larger proportion of survey respondents from SL facilities reported that medication assistance training was mandatory for their HCAs (86%) compared with the LTC facilities (50%) (p value <0.01). The utilisation of HCAs varies widely between SL and LTC facilities. HCAs in SL facilities may be considered better used according to their required educational training and competencies. Expanding the role of HCAs in LTC facilities may lead to a cost-effective and more efficient utilisation of workforce in continuing care facilities. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Focus on Inhalants.

ERIC Educational Resources Information Center

Challenge: Safe, Disciplines, and Drug-Free Schools, 1994

1994-01-01

The use of inhalants is a major health concern among the school-age population. Information presented in this publication dispels the myths about inhalant use and presents common warning signs that alert teachers to a student's use. The short- and long-term effects of inhalant use are described to shed light on the health risks involved. Lesson…

STATUS REPORT: EVIDENCE BASED ADVANCES IN INHALATION DOSIMETRY FOR GASES WITH EFFECTS IN THE LOWER RESPIRATORY TRACT AND IN THE BODY

EPA Science Inventory

This report summarizes the status of specific inhalation dosimetry procedures for gases as outlined in U.S. EPA’s 1994 Methods for Derivation of Inhalation Reference Concentrations and Applications of Inhalation Dosimetry (U.S. EPA 1994) and reviews recent scientific advances in...

Hydrazine inhalation hepatotoxicity.

PubMed

Kao, Yung Hsiang; Chong, C H; Ng, W T; Lim, D

2007-10-01

Abstract Hydrazine is a hazardous chemical commonly used as a reactant in rocket and jet fuel cells. Animal studies have demonstrated hepatic changes after hydrazine inhalation. Human case reports of hydrazine inhalation hepatotoxicity are rare. We report a case of mild hepatotoxicity following brief hydrazine vapour inhalation in a healthy young man, which resolved completely on expectant management.

49 CFR 172.429 - POISON INHALATION HAZARD label.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false POISON INHALATION HAZARD label. 172.429 Section... REQUIREMENTS, AND SECURITY PLANS Labeling § 172.429 POISON INHALATION HAZARD label. (a) Except for size and color, the POISON INHALATION HAZARD label must be as follows: ER22JY97.023 (b) In addition to complying...

49 CFR 172.429 - POISON INHALATION HAZARD label.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 2 2012-10-01 2012-10-01 false POISON INHALATION HAZARD label. 172.429 Section... REQUIREMENTS, AND SECURITY PLANS Labeling § 172.429 POISON INHALATION HAZARD label. (a) Except for size and color, the POISON INHALATION HAZARD label must be as follows: ER22JY97.023 (b) In addition to complying...

49 CFR 172.555 - POISON INHALATION HAZARD placard.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 2 2011-10-01 2011-10-01 false POISON INHALATION HAZARD placard. 172.555 Section... REQUIREMENTS, AND SECURITY PLANS Placarding § 172.555 POISON INHALATION HAZARD placard. (a) Except for size and color, the POISON INHALATION HAZARD placard must be as follows: ER22JY97.025 (b) In addition to...

49 CFR 172.555 - POISON INHALATION HAZARD placard.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 2 2014-10-01 2014-10-01 false POISON INHALATION HAZARD placard. 172.555 Section... REQUIREMENTS, AND SECURITY PLANS Placarding § 172.555 POISON INHALATION HAZARD placard. (a) Except for size and color, the POISON INHALATION HAZARD placard must be as follows: ER22JY97.025 (b) In addition to...

49 CFR 172.555 - POISON INHALATION HAZARD placard.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 2 2012-10-01 2012-10-01 false POISON INHALATION HAZARD placard. 172.555 Section... REQUIREMENTS, AND SECURITY PLANS Placarding § 172.555 POISON INHALATION HAZARD placard. (a) Except for size and color, the POISON INHALATION HAZARD placard must be as follows: ER22JY97.025 (b) In addition to...

49 CFR 172.555 - POISON INHALATION HAZARD placard.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false POISON INHALATION HAZARD placard. 172.555 Section... REQUIREMENTS, AND SECURITY PLANS Placarding § 172.555 POISON INHALATION HAZARD placard. (a) Except for size and color, the POISON INHALATION HAZARD placard must be as follows: ER22JY97.025 (b) In addition to...

49 CFR 172.429 - POISON INHALATION HAZARD label.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 2 2014-10-01 2014-10-01 false POISON INHALATION HAZARD label. 172.429 Section... REQUIREMENTS, AND SECURITY PLANS Labeling § 172.429 POISON INHALATION HAZARD label. (a) Except for size and color, the POISON INHALATION HAZARD label must be as follows: ER22JY97.023 (b) In addition to complying...

49 CFR 172.555 - POISON INHALATION HAZARD placard.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 2 2013-10-01 2013-10-01 false POISON INHALATION HAZARD placard. 172.555 Section... REQUIREMENTS, AND SECURITY PLANS Placarding § 172.555 POISON INHALATION HAZARD placard. (a) Except for size and color, the POISON INHALATION HAZARD placard must be as follows: ER22JY97.025 (b) In addition to...

49 CFR 172.429 - POISON INHALATION HAZARD label.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 2 2013-10-01 2013-10-01 false POISON INHALATION HAZARD label. 172.429 Section... REQUIREMENTS, AND SECURITY PLANS Labeling § 172.429 POISON INHALATION HAZARD label. (a) Except for size and color, the POISON INHALATION HAZARD label must be as follows: ER22JY97.023 (b) In addition to complying...

49 CFR 172.429 - POISON INHALATION HAZARD label.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 2 2011-10-01 2011-10-01 false POISON INHALATION HAZARD label. 172.429 Section... REQUIREMENTS, AND SECURITY PLANS Labeling § 172.429 POISON INHALATION HAZARD label. (a) Except for size and color, the POISON INHALATION HAZARD label must be as follows: ER22JY97.023 (b) In addition to complying...

Inhaled antibiotics for lower respiratory tract infections: focus on ciprofloxacin.

PubMed

Serisier, D J

2012-05-01

The administration of antibiotics by the inhaled route offers an appealing and logical approach to treating infectious respiratory conditions. Studies in the cystic fibrosis (CF) population have established the efficacy of this therapeutic concept and inhaled antibiotic therapy is now one of the pillars of management in CF. There are now a number of new inhaled antibiotic formulations that have shown impressive preliminary evidence for efficacy in CF and are commencing phase III efficacy studies. Translation of this paradigm into the non-CF bronchiectasis population has proven difficult thus far, apparently due to problems with tolerability of inhaled formulations. Inhaled versions of ciprofloxacin have shown good tolerability and microbiological efficacy in preliminary studies, suggesting that effective inhaled antibiotics are finally on the horizon for this previously neglected patient population. The increased use of long-term inhaled antibiotics for a wider range of non-CF indications presents risks to the broader community of greater antimicrobial resistance development that must be carefully weighed against any demonstrated benefits. Copyright 2012 Prous Science, S.A.U. or its licensors. All rights reserved.

Hydrodynamics of Low Reynolds Respiratory-type Flows

NASA Astrophysics Data System (ADS)

Connor, Erin; True, Aaron; Crimaldi, John

2017-11-01

Both aquatic and terrestrial animals inhale surrounding fluid for metabolic and sensory purposes. As organisms inhale and exhale, complex fluid interactions occur both internal and external to the physiological orifice. Using both numerical and experimental approaches, we model an idealized respiratory flow consisting of cyclic inhalation and exhalation through a single cylindrical tube. We investigate the effect of varying Reynolds number (Re) as well as the ratio of the inhalation time to the exhalation time (I:E ratio) for a fixed inhalation volume. The numerical model is used for laminar cases at lower Re, whereas the experimental model permits the study to be extended into higher Reynolds numbers that include transitions to turbulence. We map the spatial distribution of both inhaled and exhaled fluid volumes. By comparing these two maps, we can compute the volume of exhaled fluid that is reingested during the subsequent inhalation. The models of interacting inhalation and exhalation exhibit a rich range of flow behaviors across Re number and I:E ratio. This study builds a foundation for more complex studies of animal respiration that will include more realistic morphologies.

Supervision in neuropsychological assessment: a survey of training, practices, and perspectives of supervisors.

PubMed

Shultz, Laura A Schwent; Pedersen, Heather A; Roper, Brad L; Rey-Casserly, Celiane

2014-01-01

Within the psychology supervision literature, most theoretical models and practices pertain to general clinical or counseling psychology. Supervision specific to clinical neuropsychology has garnered little attention. This survey study explores supervision training, practices, and perspectives of neuropsychology supervisors. Practicing neuropsychologists were invited to participate in an online survey via listservs and email lists. Of 451 respondents, 382 provided supervision to students, interns, and/or fellows in settings such as VA medical centers (37%), university medical centers (35%), and private practice (15%). Most supervisors (84%) reported supervision was discussed in graduate school "minimally" or "not at all." Although 67% completed informal didactics or received continuing education in supervision, only 27% reported receiving training specific to neuropsychology supervision. Notably, only 39% were satisfied with their training in providing supervision and 77% indicated they would likely participate in training in providing supervision, if available at professional conferences. Results indicate that clinical neuropsychology as a specialty has paid scant attention to developing supervision models and explicit training in supervision skills. We recommend that the specialty develop models of supervision for neuropsychological practice, supervision standards and competencies, training methods in provision of supervision, and benchmark measures for supervision competencies.

Quantification of Aerosol Hydrofluoroalkane HFA‐134a Elimination in the Exhaled Human Breath Following Inhaled Corticosteroids Administration

PubMed Central

Barletta, Barbara; Yoonessi, Leila; Meinardi, Simone; Leu, Szu‐Yun; Radom‐Aizik, Shlomit; Randhawa, Inderpal; Nussbaum, Eliezer; Blake, Donald R.; Cooper, Dan M.

2015-01-01

Abstract Inhaled corticosteroids (ICS) and β2‐agonists are the primary pharmacotherapies of asthma management. However, suboptimal medication compliance is common in asthmatics and is associated with increased morbidity. We hypothesized that exhaled breath measurements of the aerosol used in the inhaled medications might prove useful as surrogate marker for asthma medication compliance. To explore this, 10 healthy controls were recruited and randomly assigned to ICS (Flovent HFA) or short acting bronchodilators (Proventil HFA). Both inhalers contain HFA‐134a as aerosol propellant. Exhaled breath sampling and pulmonary function tests were performed prior to the inhaler medication dispersion, immediately after inhalation, then at 2, 4, 6, 8, 24, and 48 hours postadministration. At baseline, mean (SD) levels of HFA‐134a in the breath were 252 (156) pptv. Immediately after inhalation, HFA‐134a breath levels increased to 300 × 106 pptv and were still well above ambient levels 24 hours postadministration. The calculated ratio of forced expiratory volume in 1 second over forced vital capacity did not change over time following inhaler administration. This study demonstrates, for the first time, that breath HFA‐134a levels can be used to assess inhaler medication compliance. It may also be used to evaluate how effectively the medicine is delivered. PMID:26155923

Inhaler use in adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema in the city of Pelotas, Brazil*

PubMed Central

de Oliveira, Paula Duarte; Menezes, Ana Maria Baptista; Bertoldi, Andréa Dâmaso; Wehrmeister, Fernando César

2013-01-01

OBJECTIVE: To evaluate the characteristics of users of inhalers and the prevalence of inhaler use among adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema. METHODS: A population-based study conducted in the city of Pelotas, Brazil, involving 3,670 subjects ≥ 10 years of age, evaluated with a questionnaire. RESULTS: Approximately 10% of the sample reported at least one of the respiratory diseases studied. Among those individuals, 59% reported respiratory symptoms in the last year, and, of those, only half reported using inhalers. The use of inhalers differed significantly by socioeconomic status (39% and 61% for the lowest and the highest, respectively, p = 0.01). The frequency of inhaler use did not differ by gender or age. Among the individuals reporting emphysema and inhaler use, the use of the bronchodilator-corticosteroid combination was more common than was that of a bronchodilator alone. Only among the individuals reporting physician-diagnosed asthma and current symptoms was the proportion of inhaler users higher than 50%. CONCLUSIONS: In our sample, inhalers were underutilized, and the type of medication used by the individuals who reported emphysema does not seem to be in accordance with the consensus recommendations. PMID:23857689

Anxiety symptoms in crack cocaine and inhalant users admitted to a psychiatric hospital in southern Brazil.

PubMed

Zubaran, Carlos; Foresti, Katia; Thorell, Mariana Rossi; Franceschini, Paulo Roberto

2013-01-01

The occurrence of psychiatric comorbidity among individuals with crack or inhalant dependence is frequently observed. The objective of this study was to investigate anxiety symptoms among crack cocaine and inhalant users in southern Brazil. The study investigated two groups of volunteers of equal size (n=50): one group consisted of crack cocaine users, and the other group consisted of inhalant users. Research volunteers completed the Portuguese versions of the State-Trait Anxiety Inventory (STAI), Hamilton Anxiety Rating Scale (HAM-A), and Self-Report Questionnaire (SRQ). Both crack and inhalant users experience significant symptoms of anxiety. Inhalant users presented significantly more anxiety symptoms than crack users according to the HAM-A questionnaire only. In contrast to the results of the HAM-A, the STAI failed to demonstrate a significant difference between the two groups of substance users. SRQ scores revealed that crack and inhalants users had significant degrees of morbidity. A significant difference regarding anxiety symptomatology, especially state anxiety, was observed among inhalant and crack users. Anxiety and overall mental psychopathology were significantly correlated in this sample. The results indicate that screening initiatives to detect anxiety and additional psychiatric comorbidities among crack and inhalant users are feasible and relevant. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

Introduction of Inhaled Nitrous Oxide and Oxygen for Pain Management during Labour – Evaluation of Patientsʼ and Midwivesʼ Satisfaction

PubMed Central

Dammer, U.; Weiss, C.; Raabe, E.; Heimrich, J.; Koch, M. C.; Winkler, M.; Faschingbauer, F.; Beckmann, M. W.; Kehl, S.

2014-01-01

Aim: Effective pain management during labour is important because pain affects the birth experience. Epidural analgesia is effective but often it may not be possible; however, inhaled analgesia offers another option. Use of inhaled nitrous oxide and oxygen for pain management in labour is well established in obstetrics but is still not used much in Germany. This study aimed to investigate the acceptance of the inhaled analgesia of inhaled nitrous oxide and oxygen by midwives and pregnant women during labour. Material and Methods: In this observational study carried out between April and September 2013, a total of 66 pregnant women received inhaled nitrous oxide and oxygen during labour on request and after prior assessment of suitability. After the birth, all of the women and the responsible midwives were interviewed about their experience and satisfaction with the inhaled analgesia. Results: A statistically significant reduction of pain was achieved with nitrous oxide and oxygen. The inhaled analgesia was mostly used by women who refused epidural analgesia. The likelihood of using inhaled nitrous oxide and oxygen again was reported as higher for patients who tolerated it well (p = 0.0129) and used it in the second stage of labour (p = 0.0003) and when bearing down (p = 0.0008). Conclusion: Inhaled nitrous oxide and oxygen is an effective method for pain management during labour and is accepted well by women in labour and by midwives. PMID:25100880

Age-related differences in recovery from inhalational anesthesia: a retrospective study.

PubMed

Tsukamoto, Masanori; Yamanaka, Hitoshi; Yokoyama, Takeshi

2018-03-03

It is important to understand the anesthetic requirements of elderly patients. However, little is known about age-related recovery from inhalational anesthetics. In this retrospective study, we compared age-related differences in recovery from three inhalational anesthetics  in elderly subjects. Patients were investigated as three age groups which can be defined as age ranges pediatric (< 15 years), adult (15-64 years), and elderly patients ( > 65 years) under general anesthesia using inhalational anesthetics. Anesthesia and surgery times, drug end-tidal concentrations, the time to first movement, time to eye opening, body movement, extubation, and discharge were recorded. The data were analyzed using a Kruskal-Wallis test and Steel-Dwass multiple comparisons. A total of 594 patients were included in the study. In inhalational anesthetics such as sevoflurane, isoflurane, or desflurane, recovery from general anesthesia was not significantly different among age groups (P > 0.05). In inhalational group, recovery was significantly 5-40% faster in desflurane group than in other inhalational anesthetics groups (P < 0.05). There were 20% faster recovery in pediatric and adult groups with desflurane than in elderly with desflurane group. Drug end-tidal inhalational concentrations in pediatric group were significantly higher than that in adult and elderly groups of all inhalational anesthetics, respectively (P < 0.05). In the current study, we have found that recovery from desflurane was faster in younger patients than in other inhalational anesthetics and aged patients.

Economic considerations in the use of inhaled anesthetic agents.

PubMed

Golembiewski, Julie

2010-04-15

To describe the components of and factors contributing to the costs of inhaled anesthesia, basis for quantifying and comparing these costs, and practical strategies for performing pharmacoeconomic analyses and reducing the costs of inhaled anesthetic agents. Inhaled anesthesia can be costly, and some of the variable costs, including fresh gas flow rates and vaporizer settings, are potential targets for cost savings. The use of a low fresh gas flow rate maximizes rebreathing of exhaled anesthetic gas and is less costly than a high flow rate, but it provides less control of the level of anesthesia. The minimum alveolar concentration (MAC) hour is a measure that can be used to compare the cost of inhaled anesthetic agents at various fresh gas flow rates. Anesthesia records provide a sense of patterns of inhaled anesthetic agent use, but the amount of detail can be limited. Cost savings have resulted from efforts to reduce the direct costs of inhaled anesthetic agents, but reductions in indirect costs through shortened times to patient recovery and discharge following the judicious use of these agents are more difficult to demonstrate. The patient case mix, fresh gas flow rates typically used during inhaled anesthesia, availability and location of vaporizers, and anesthesia care provider preferences and practices should be taken into consideration in pharmacoeconomic evaluations and recommendations for controlling the costs of inhaled anesthesia. Understanding factors that contribute to the costs of inhaled anesthesia and considering those factors in pharmacoeconomic analyses and recommendations for use of these agents can result in cost savings.

Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting

PubMed Central

Westerik, Janine A. M.; Carter, Victoria; Chrystyn, Henry; Burden, Anne; Thompson, Samantha L.; Ryan, Dermot; Gruffydd-Jones, Kevin; Haughney, John; Roche, Nicolas; Lavorini, Federico; Papi, Alberto; Infantino, Antonio; Roman-Rodriguez, Miguel; Bosnic-Anticevich, Sinthia; Lisspers, Karin; Ställberg, Björn; Henrichsen, Svein Høegh; van der Molen, Thys; Hutton, Catherine; Price, David B.

2016-01-01

Abstract Objective: Correct inhaler technique is central to effective delivery of asthma therapy. The study aim was to identify factors associated with serious inhaler technique errors and their prevalence among primary care patients with asthma using the Diskus dry powder inhaler (DPI). Methods: This was a historical, multinational, cross-sectional study (2011–2013) using the iHARP database, an international initiative that includes patient- and healthcare provider-reported questionnaires from eight countries. Patients with asthma were observed for serious inhaler errors by trained healthcare providers as predefined by the iHARP steering committee. Multivariable logistic regression, stepwise reduced, was used to identify clinical characteristics and asthma-related outcomes associated with ≥1 serious errors. Results: Of 3681 patients with asthma, 623 (17%) were using a Diskus (mean [SD] age, 51 [14]; 61% women). A total of 341 (55%) patients made ≥1 serious errors. The most common errors were the failure to exhale before inhalation, insufficient breath-hold at the end of inhalation, and inhalation that was not forceful from the start. Factors significantly associated with ≥1 serious errors included asthma-related hospitalization the previous year (odds ratio [OR] 2.07; 95% confidence interval [CI], 1.26–3.40); obesity (OR 1.75; 1.17–2.63); poor asthma control the previous 4 weeks (OR 1.57; 1.04–2.36); female sex (OR 1.51; 1.08–2.10); and no inhaler technique review during the previous year (OR 1.45; 1.04–2.02). Conclusions: Patients with evidence of poor asthma control should be targeted for a review of their inhaler technique even when using a device thought to have a low error rate. PMID:26810934

Cerebrovascular, cardiovascular and strength responses to acute ammonia inhalation.

PubMed

Perry, Blake G; Pritchard, Hayden J; Barnes, Matthew J

2016-03-01

Ammonia is used as a stimulant in strength based sports to increase arousal and offset fatigue however little is known about its physiological and performance effects. The purpose of this study was twofold (1) establish the physiological response to acute ammonia inhalation (2) determine whether the timing of the physiological response corresponds with a performance enhancement, if any. Fifteen healthy males completed two trials. Trial one investigated the beat-to-beat middle cerebral artery blood flow velocity (MCAv), heart rate (HR) and mean arterial pressure (MAP) response to ammonia inhalation. During trial two, participants performed a maximal single mid-thigh pull (MTP) at various time points following ammonia inhalation in a randomised order: MTPs were conducted immediately, 15, 30 and 60 s following ammonia inhalation. A MTP with no ammonia inhalation served as the control. During this trial maximal MTP force, rate of force development (RFD) and electromyography (EMG) activity were recorded. MCAvmean increased and peaked on average by 6 cm s(-1) (P < 0.001), 9.4 ± 5.5 s following ammonia inhalation. Similarly, HR was increased by 6 ± 11 beats per minute 15 s following ammonia inhalation (P < 0.001). MAP remained unchanged following inhalation (P = 0.51). The use and timing of ammonia inhalation had no effect on maximal force, RFD or EMG (all P > 0.2) compared to control. MCAv was elevated despite no increase in MAP occurring; this is indicative of a cerebrovascular vasodilation. Despite the marked cerebrovascular and cardiovascular response to ammonia inhalation no ergogenic effect was observed during the MTP, irrespective of the timing of administration.

Inhaler technique maintenance: gaining an understanding from the patient's perspective.

PubMed

Ovchinikova, Ludmila; Smith, Lorraine; Bosnic-Anticevich, Sinthia

2011-08-01

The aim of this study was to determine the patient-, education-, and device-related factors that predict inhaler technique maintenance. Thirty-one community pharmacists were trained to deliver inhaler technique education to people with asthma. Pharmacists evaluated (based on published checklists), and where appropriate, delivered inhaler technique education to patients (participants) in the community pharmacy at baseline (Visit 1) and 1 month later (Visit 2). Data were collected on participant demographics, asthma history, current asthma control, history of inhaler technique education, and a range of psychosocial aspects of disease management (including adherence to medication, motivation for correct technique, beliefs regarding the importance of maintaining correct technique, and necessity and concern beliefs regarding preventer therapy). Stepwise backward logistic regression was used to identify the predictors of inhaler technique maintenance at 1 month. In total 145 and 127 participants completed Visits 1 and 2, respectively. At baseline, 17% of patients (n = 24) demonstrated correct technique (score 11/11) which increased to 100% (n = 139) after remedial education by pharmacists. At follow-up, 61% (n = 77) of patients demonstrated correct technique. The predictors of inhaler technique maintenance based on the logistic regression model (X(2) (3, N = 125) = 16.22, p = .001) were use of a dry powder inhaler over a pressurized metered-dose inhaler (OR 2.6), having better asthma control at baseline (OR 2.3), and being more motivated to practice correct inhaler technique (OR 1.2). Contrary to what is typically recommended in previous research, correct inhaler technique maintenance may involve more than repetition of instructions. This study found that past technique education factors had no bearing on technique maintenance, whereas patient psychosocial factors (motivation) did.

Parameters affecting inhalation therapy adherence in elderly patients with chronic obstructive lung disease and asthma.

PubMed

Turan, Onur; Turan, Pakize Ayse; Mirici, Arzu

2017-06-01

One of the most significant problems in the treatment of elderly patients is incorrect use of inhaler devices. The purpose of the present study was to assess the parameters affecting treatment adherence among elderly patients. Spirometry, the Mini-Mental State Examination for cognitive impairment and the Morisky Medication Adherence Scale-4 were carried out in 121 (88 chronic obstructive lung disease patients according to the Global Initiative for Chronic Obstructive Lung Disease, 33 asthma patients according to The Global Initiative for Asthma (GINA) criteria) participants aged over 65 years. The patients with cognitive impairment, low socioeconomic status, a high number of admissions to an emergency service in past year and the presence of dyspnea or sputum had significantly lower inhalation device use scores (P = 0.017, 0.03, 0.025, 0.03 and 0.02). The patients with high Mini-Mental State Examination scores and forced expiratory volume in 1 s (as liter and percentage) were found to be more successful in using inhaler devices (P = 0.005, 0.007 and 0.022). There was a negative correlation between number of hospitalizations and inhalation device score (P = 0.021).The participants without education/training by a doctor about the inhaler device had a significantly poorer treatment adherence (P < 0.001). Older chronic obstructive lung disease and asthmatic patients have more difficulty with the correct use of inhaler devices. Cognitive impairment might be an important parameter that can affect inhalation device technique. Socioeconomic status, smoking, pulmonary symptoms and admissions to hospital were also thought to have effects on the adherence to inhalation therapy. The type of chronic respiratory disease (chronic obstructive lung disease/asthma) is not a major factor influencing therapy adherence. Assessment of cognitive functions, choosing suitable inhalation devices and educational programs for inhaler use could improve the success of inhaler technique in elderly patients. Geriatr Gerontol Int 2017; 17: 999-1005. © 2016 Japan Geriatrics Society.

"My body breaks. I take solution." Inhalant use in Delhi as pleasure seeking at a cost.

PubMed

Gigengack, Roy

2014-07-01

Inhalant use has existed in India since the 1970s and has increased significantly over the last decades, especially among street-oriented young people. The latter constitute a heterogeneous category: children from street families, children 'of' the street, rag pickers, and part-time street children. There are also inhalant-using schoolchildren and young people in slums. Fieldwork was conducted for 1 year. Team ethnography, multi-sited and comparative research, flexibility of methods and writing field notes were explicit parts of the research design. Most research was undertaken with six groups in four areas of Delhi, exemplifying six generic categories of inhalant-using street-oriented young people. Inhalants in India are branded: Eraz-Ex diluter and whitener, manufactured by Kores, are used throughout Delhi; Omni glue in one specific area. There is a general lack of awareness and societal indifference towards inhalant use, with the exception of the inhalant users themselves, who possess practical knowledge. They conceive of inhalants as nasha, encapsulating the materiality of the substances and the experiential aspects of intoxication and addiction. Fragments of group interviews narrate the sensory appeal of inhalants, and an ethnographic vignette the dynamics of a sniffing session. These inhalant-using street children seek intoxication in a pursuit of pleasure, despite the harm that befalls them as a result. Some find nasha beautiful, notwithstanding the stigmatization, violence and bodily deterioration; others experience it as an overpowering force. A source of attraction and pleasure, inhalants ravage street children's lives. In this mysterious space of lived experience, their self-organization evolves. Distinguishing between hedonic and side effects, addiction helps to understand inhalant use as at once neurobiological, cultural, and involving agency. The implications are that India needs to develop a policy of treatment and employment to deal with the addiction. Copyright © 2014 Elsevier B.V. All rights reserved.

Is the ‘blue’ colour convention for inhaled reliever medications important? A UK-based survey of healthcare professionals and patients with airways disease

PubMed Central

Fletcher, Monica; Scullion, Jane; White, John; Thompson, Bronwen; Capstick, Toby

2016-01-01

In many countries, short-acting β2-agonist inhalers have traditionally been coloured blue. This inhaled therapy has also conventionally been known as a ‘reliever’ by patients and healthcare professionals (HCPs), in comparison with ‘preventer’ medications (inhaled steroids). With the rapidly changing market in inhaled therapy for COPD and asthma and growing numbers of devices, there has been some concern that the erosion of traditional colour conventions is leading to patients (and HCPs) becoming confused about the role of different therapies. In order to assess whether there was concern over the perceived changing colour conventions, the UK Inhaler Group carried out a large online survey of patients and HCPs. The aim was to determine how patients and HCPS identify and describe inhaled drugs, and how this might impact on use of medicines and safety. The results of the survey highlighted the importance of the term ‘blue inhaler’ for patients with only 11.3% never referring to the colour when referring to their inhaler. For HCPs, 95% felt colour conventions were important when referring to reliever medication. In addition, HCPs appear to refer to inhalers mainly by colour when talking to patients. Our conclusions were that the concept of a ‘blue inhaler’ remains important to patients and healthcare professionals. These results add to the debate about the need to formalise the colour coding of inhaled therapies, in particular using the colour blue for inhalers for rapid relief of symptoms, as this convention may be an important measure and contributor to patient safety. Our survey should provide impetus for all interested parties to discuss and agree a formal industry-wide approach to colour coding of inhaled therapies for the benefit of patients and carers and HCPs. PMID:27808097

28 CFR 2.206 - Travel approval and transfers of supervision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... supervision. 2.206 Section 2.206 Judicial Administration DEPARTMENT OF JUSTICE PAROLE, RELEASE, SUPERVISION... Supervised Releasees § 2.206 Travel approval and transfers of supervision. (a) A releasee's supervision officer may approve travel outside the district of supervision without approval of the Commission in the...

28 CFR 2.206 - Travel approval and transfers of supervision.

Code of Federal Regulations, 2011 CFR

2011-07-01

... supervision. 2.206 Section 2.206 Judicial Administration DEPARTMENT OF JUSTICE PAROLE, RELEASE, SUPERVISION... Supervised Releasees § 2.206 Travel approval and transfers of supervision. (a) A releasee's supervision officer may approve travel outside the district of supervision without approval of the Commission in the...

28 CFR 2.206 - Travel approval and transfers of supervision.

Code of Federal Regulations, 2013 CFR

2013-07-01

... supervision. 2.206 Section 2.206 Judicial Administration DEPARTMENT OF JUSTICE PAROLE, RELEASE, SUPERVISION... Supervised Releasees § 2.206 Travel approval and transfers of supervision. (a) A releasee's supervision officer may approve travel outside the district of supervision without approval of the Commission in the...

[Management of chemical burns and inhalation poisonings in acute medical care procedures of the State Fire Service].

PubMed

Chomoncik, Mariusz; Nitecki, Jacek; Ogonowska, Dorota; Cisoń-Apanasewicz, Urszula; Potok, Halina

2013-01-01

Emergency Medical Services (EMS) were founded by the government to perform tasks aimed at providing people with help in life-threatening conditions. The system comprises two constituent parts. The first one is public administrative bodies which are to organise, plan, coordinate and supervise the completion of the tasks. The other constituent is EMS units which keep people, resources and units in readiness. Supportive services, which include: the State Fire Service (SFS) and the National Firefighting and Rescue System (NFRS), are of great importance for EMS because they are eligible for providing acute medical care (professional first aid). Acute medical care covers actions performed by rescue workers to help people in life-threatening conditions. Rescue workers provide acute medical care in situations when EMS are not present on the spot and the injured party can be accessed only with the use of professional equipment by trained workers of NFRS. Whenever necessary, workers of supportive services can assist paramedics' actions. Cooperation of all units of EMS and NFRS is very important for rescue operations in the integrated rescue system. Time is a key aspect in delivering first aid to a person in life-threatening conditions. Fast and efficient first aid given by the accident's witness, as well as acute medical care performed by a rescue worker can prevent death and minimise negative effects of an injury or intoxication. It is essential that people delivering first aid and acute medical care should act according to acknowledged and standardised procedures because only in this way can the process of decision making be sped up and consequently, the number of possible complications following accidents decreased. The present paper presents an analysis of legal regulations concerning the management of chemical burn and inhalant intoxication in acute medical care procedures of the State Fire Service. It was observed that the procedures for rescue workers entitled to provide acute medical care should be correlated with the procedures for emergency medical teams.

'We just do the dirty work': dealing with incontinence, courtesy stigma and the low occupational status of carework in long-term aged care facilities.

PubMed

Ostaszkiewicz, Joan; O'Connell, Beverly; Dunning, Trisha

2016-09-01

To systematically examine, describe and explain how continence care was determined, delivered and communicated in Australian long aged care facilities. Incontinence is a highly stigmatising condition that affects a disproportionally large number of people living in long-term aged care facilities. Its day-to-day management is mainly undertaken by careworkers. We conducted a Grounded theory study to explore how continence care was determined, delivered and communicated in long-term aged care facilities. This paper presents one finding, i.e. how careworkers in long-term aged care facilities deal with the stigma, devaluation and the aesthetically unpleasant aspects of their work. Grounded theory. Eighty-eight hours of field observations in two long-term aged care facilities in Australia. In addition, in-depth interviews with 18 nurses and careworkers who had experience of providing, supervising or assessment of continence care in any long-term aged care facility in Australia. Occupational exposure to incontinence contributes to the low occupational status of carework in long-term aged care facilities, and continence care is a symbolic marker for inequalities within the facility, the nursing profession and society at large. Careworkers' affective and behavioural responses are characterised by: (1) accommodating the context; (2) dissociating oneself; (3) distancing oneself and (4) attempting to elevate one's role status. The theory extends current understandings about the links between incontinence, continence care, courtesy stigma, emotional labour and the low occupational status of carework in long-term aged care facilities. This study provides insights into the ways in which tacit beliefs and values about incontinence, cleanliness and contamination may affect the social organisation and delivery of care in long-term aged care facilities. Nurse leaders should challenge the stigma and devaluation of carework and careworkers, and reframe carework as 'dignity work'. © 2016 John Wiley & Sons Ltd.

Deprescribing: a new goal focused on the patient.

PubMed

Machado-Alba, Jorge Enrique; Gaviria-Mendoza, Andrés; Machado-Duque, Manuel Enrique; Chica, Laura

2017-02-01

It is estimated that one-fifth of adult patients are treated with polypharmacy (five or more drugs) and the prevalence of this phenomenon in the elderly is even higher, ranging from 30% to 70%, even reaching 90% in residents of residential aged care facilities. Polypharmacy in the elderly increases the risk of adverse reactions, inappropriate prescriptions, drug interactions, number of hospitalizations, costs, and even death. In a recent systematic review, the authors proposed defining deprescribing as 'the process of withdrawal of inappropriate medication supervised by a health care professional with the goal of managing polypharmacy and improving outcomes'.

Academician Basov, high-power lasers, and the antimissile defense problem

NASA Astrophysics Data System (ADS)

Zarubin, Peter Vasilievich

2013-02-01

A review of the extensive program of the pioneering research and development of high-power lasers and laser radar undertaken in the USSR during the years 1964 to 1978 under the scientific supervision of N.G. Basov is presented. In the course of this program, many high-energy lasers with unique properties were created, new big research and design teams were formed, and the laser production and testing facilities were extended and developed. The program was fulfilled at many leading research institutions and design bureaus of the USSR Academy of Sciences and defense industry.

KSC-07pd1764

NASA Image and Video Library

2007-07-03

KENNEDY SPACE CENTER, FLA. -- On the KSC Shuttle Landing Facility, workers supervise the movement of the sling above the orbiter Atlantis. The sling will be attached and lift the orbiter away from the shuttle carrier aircraft (SCA) underneath. The SCA carried the orbiter piggyback from California. Atlantis landed at Edwards Air Force Base in California on June 22 to end mission STS-117. It returned to Kennedy atop the SCA on July 3 after a three-day, cross-country flight due to fuel stops and weather delays. Touchdown was at 8:27 a.m. EDT. Photo credit: NASA/Kim Shiflett

KSC-08pd3089

NASA Image and Video Library

2008-10-09

CAPE CANAVERAL, FIa. -- In the Space Station Processing Facility at NASA's Kennedy Space Center in Florida, workers supervise as an overhead crane lowers the flexible hose rotary coupler onto the Lightweight Multi-Purpose Experiment Support Structure Carrier for installation. The carrier will be installed in space shuttle Endeavour for the STS-126 mission to the International Space Station. The 15-day flight will deliver equipment and supplies to the space station in preparation for expansion from a three- to six-person resident crew aboard the complex. The mission also will include four spacewalks to service the station’s Solar Alpha Rotary Joints. Photo credit: NASA/Jim Grossmann

News in Brief

NASA Astrophysics Data System (ADS)

2011-12-01

China Accomplishes International Evaluation on Science Funding and Management Performance Panel Meeting of NSFC-NIH Joint Program in Beijing NSFC and CAS's New Round Collaboration for Large Scientific Facilities Vice President Shen Wenqing Meets with President of the Helmholtz Association NSFC Supervision Delegation Visits to Japan and Korea NSFC Strengthens Ties with PIs of the Research Fund for International Young Scientists The 9th ASIAHORCs Meeting Held in Daejoen, Korea NSFC Vice President Meets with ICTP Director First U.S.-China Women Chemists Workshop in Beijing Vice President Attends 5th ASIAHORCs Meeting NSFC Vice President Attended IIASA Council Meeting NSFC Vice President Meets With JST Guests

Inhalant Use and Delinquent Behaviors among Young Adolescents. The NSDUH Report

ERIC Educational Resources Information Center

US Department of Health and Human Services, 2005

2005-01-01

This report presents the prevalence of inhalant use among young adolescents aged 12 or 13, the association between inhalant use and delinquent behaviors within this age group, and the association between early onset of inhalant use and problems later in life. Early onset of substance use has been linked to substance use disorders, delinquent…

Inhalant Initiation and the Relationship of Inhalant Use to the Use of Other Substances

ERIC Educational Resources Information Center

Shamblen, Stephen R.; Miller, Ted

2012-01-01

Conventional wisdom suggests that inhalant use is primarily isolated to youthful experimentation; however, a growing body of evidence suggests that inhalant use (a) occurs after use of common substances of experimentation (e.g., alcohol, marijuana), (b) can persist into later life, and (c) is associated with severe consequences. The current study…

A Care Pathway for Children Unable to Accept Dental Care Within the General Dental Services Involving the Use of Inhalation Sedation and General Anaesthesia.

PubMed

Shepherd, Allyson R; Ali, Halimah

2015-05-01

Dental treatment is the commonest reason for a child to be in hospital in the UK. This is a shocking statistic for a preventable disease. How can we reduce the high numbers of dental general anaesthetics? It is essential that dental treatment under general anaesthesia (GA) is fully justifiable, ensuring that the right patients receive the right treatment. Guidance for general dental practitioners on when to refer a child for a dental GA is discussed. Treatment planning for this dentally high-risk group of children requires a holistic approach. It is complex and requires an experienced and competent clinical team, including dental care professionals with additional postgraduate qualifications. Often, alternative treatments are successful and a GA can be avoided. An audit of 85 patients referred for GA with Oldham Community Dental Service demonstrated 35% of patients accepted treatment with local anaesthesia only, 25% required inhalation sedation and only 25% were actually referred on for GA. Treatment for this group of patients must include the availability and provision of appropriate alternative treatment modalities, with the right staff and facilities, including those for dental general anaesthetic sessions. Ongoing follow-up within the general dental services is essential for this group of patients.

Environmental Exposure to Manganese in Air: Associations ...

EPA Pesticide Factsheets

BACKGROUND: Manganese (Mn) inhalation has been associated with neuropsychological and neurological sequelae in exposed workers. Few environmental epidemiologic studies have examined the potentialy neurotoxic effects of Mn exposure in ambient air on motor function and hand tremor in adult community residents. Mn exposed residents were recruited in two Ohio towns: Marietta, a town near a ferro-manganese smelter, and East Liverpool, a town adjacent to a facility processing, crushing, screening, and packaging Mn products.METHODS: Chronic (≥10years) exposure to ambient air Mn in adult residents and effects on neuropsychological and neurological outcomes were investigated. Participants from Marietta (n=100) and East Liverpool (n=86) were combined for analyses. AERMOD dispersion modeling of fixed-site outdoor air monitoring data estimated Mn inhalation over a ten year period. Adult Mn­ exposed residents' psychomotor ability was assessed using Finger Tapping, Hand Dynamometer, Grooved Pegbcard, and the Computerized Adaptive Testing System (CATSYS) Tremor system.Bayesian structural equation modeling was used to assess associations between air-Mn and motor function and tremor .RESULTS: Air-Mn exposure was significantly correlated in bivariate analyses with the tremor test (CATSYS) for intensity, center frequency and harmonic index. The Bayesian path analysis model showed associations of air-Mn with the CATSYS non-dominant center frequency and harmonic ind

The Ecology of Pneumocystis: Perspectives, Personal Recollections, and Future Research Opportunities

PubMed Central

Walzer, Peter D.

2013-01-01

I am honored to receive the second Lifetime Achievement Award by International Workshops on Opportunistic Protists (IWOP) and to give this lecture. My research involves Pneumocystis, an opportunistic pulmonary fungus that is a major cause of pneumonia (“PcP”) in the immunocompromised host. I decided to focus on Pneumocystis ecology here because it has not attracted much interest. Pneumocystis infection is acquired by inhalation, and the cyst stage appears to be the infective form. Several fungal lung infections, such as coccidiomycosis, are not communicable, but occur by inhaling < 5μ spores from environmental sources (buildings, parks), and can be affected by environmental factors. PcP risk factors include environmental constituents (temperature, humidity, SO2, CO) and outdoor activities (camping). Clusters of PcP have occurred, but no environmental source has been found. Pneumocystis is communicable and outbreaks of PcP, especially in renal transplant patients, are an ongoing problem. Recent evidence suggests that most viable Pneumocystis organisms detected in the air are confined to a patient’s room. Further efforts are needed to define the risk of Pneumocystis transmission in healthcare facilities; to develop more robust preventive measures; and to characterize the effects of climatological and air pollutant factors on Pneumocystis transmission in animal models similar to those used for respiratory viruses. PMID:24001365

Using Data to Improve Programs: Assessment of a Data Quality and Use Intervention Package for Integrated Community Case Management in Malawi.

PubMed

Hazel, Elizabeth; Chimbalanga, Emmanuel; Chimuna, Tiyese; Nsona, Humphreys; Mtimuni, Angella; Kaludzu, Ernest; Gilroy, Kate; Guenther, Tanya

2017-09-27

Health Surveillance Assistants (HSAs) have been providing integrated community case management (iCCM) for sick children in Malawi since 2008. HSAs report monthly iCCM program data but, at the time of this study, little of it was being used for service improvement. Additionally, HSAs and facility health workers did not have the tools to compile and visualize the data they collected to make evidence-based program decisions. From 2012 to 2013, we worked with Ministry of Health staff and partners to develop and pilot a program in Dowa and Kasungu districts to improve data quality and use at the health worker level. We developed and distributed wall chart templates to display and visualize data, provided training to 426 HSAs and supervisors on data analysis using the templates, and engaged health workers in program improvement plans as part of a data quality and use (DQU) package. We assessed the package through baseline and endline surveys of the HSAs and facility and district staff in the study areas, focusing specifically on availability of reporting forms, completeness of the forms, and consistency of the data between different levels of the health system as measured through results verification ratio (RVR). We found evidence of significant improvements in reporting consistency for suspected pneumonia illness (from overreporting cases at baseline [RVR=0.82] to no reporting inconsistency at endline [RVR=1.0]; P =.02). Other non-significant improvements were measured for fever illness and gender of the patient. Use of the data-display wall charts was high; almost all HSAs and three-fourths of the health facilities had completed all months since January 2013. Some participants reported the wall charts helped them use data for program improvement, such as to inform community health education activities and to better track stock-outs. Since this study, the DQU package has been scaled up in Malawi and expanded to 2 other countries. Unfortunately, without the sustained support and supervision provided in this project, use of the tools in the Malawi scale-up is lower than during the pilot period. Nevertheless, this pilot project shows community and facility health workers can use data to improve programs at the local level given the opportunity to access and visualize the data along with supervision support. © Hazel et al.

Assessing supply-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: a qualitative study and document and record review in two regions of Uganda.

PubMed

Rassi, Christian; Graham, Kirstie; Mufubenga, Patrobas; King, Rebecca; Meier, Joslyn; Gudoi, Sam Siduda

2016-07-04

Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), provided as part of routine antenatal care (ANC), is one of three malaria-in-pregnancy prevention and control mechanisms recommended by the World Health Organization (WHO). However, despite high ANC attendance and increased efforts to address known obstacles, IPTp uptake figures have remained low. This study aimed to identify and assess barriers that continue to impede IPTp uptake in Uganda, in particular for women who attend ANC. The paper focuses on supply-side barriers, i.e., challenges relating to the health service provider. In-depth interviews were conducted in two regions of Uganda in November 2013 and April/May 2014 with four different target audiences: seven district health officials, 15 health workers, 19 women who had attended ANC, and five opinion leaders. In addition, a document and record review was carried out at four health facilities. Guidelines with regard to IPTp provision in Uganda have been shown to be inconsistent and, at the time of the research, did not reflect the most recent WHO policy recommendation. There is a lack of training and supervision opportunities for health workers, resulting in poor knowledge of IPTp guidelines and uncertainty about the safety and efficacy of SP. ANC is not consistently offered in health facilities, leading to some women being denied services. While strengthening of the supply chain appears to have reduced the occurrence of stock-outs of SP in public facilities, stock-outs reportedly continue to occur in the private sector. There are also sources of data inaccuracy along the data recording and reporting chain, limiting policy makers' ability to react adequately to trends and challenges. Given the high ANC attendance rates in Uganda, supply-side barriers are likely to account for many missed opportunities for the provision of IPTp in Uganda. Improvements will require consistent provision of ANC, implementation of current WHO IPTp policy recommendations, supply of SP to the private sector, availability of clear guidelines, as well as improved training and supervision for health workers. Improving facility and district-level recording and reporting will further strengthen the country's ability to address uptake of IPTp.

Air modelling as an alternative to sampling for low-level radioactive airborne releases

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

Morgenstern, M.Y.; Hueske, K.

1995-05-01

This paper describes our efforts to assess the effect of airborne releases at one DOE laboratory using air modelling based on historical data. Among the facilities affected by these developments is Los Alamos National Laboratory (LANL) in New Mexico. RCRA, as amended by the Hazardous and Solid Waste Amendments (HSWA) in 1984, requires all facilities which involve the treatment, storage, and disposal of hazardous waste obtain a RCRA/HSWA waste facility permit. LANL complied with CEARP by initiating a process of identifying potential release sites associated with LANL operations prior to filing a RCRA/HSWA permit application. In the process of preparingmore » the RCRA/HSWA waste facility permit application to the U.S. Environmental Protection Agency (EPA), a total of 603 Solid Waste Management Units (SWMUs) were identified as part of the requirements of the HSWA Module VIH permit requirements. The HSWA Module VIII permit requires LANL to determine whether there have been any releases of hazardous waste or hazardous constituents from SWMUs at the facility dating from the 1940`s by performing a RCRA Facility Investigation to address known or suspected releases from specified SWMUs to affected media (i.e. soil, groundwater, surface water, and air). Among the most troublesome of the potential releases sites are those associated with airborne radioactive releases. In order to assess health risks associated with radioactive contaminants in a manner consistent with exposure standards currently in place, the DOE and LANL have established Screening Action Levels (SALs) for radioactive soil contamination. The SALs for each radionuclide in soil are derived from calculations based on a residential scenario in which individuals are exposed to contaminated soil via inhalation and ingestion as well as external exposure to gamma emitters in the soil. The applicable SALs are shown.« less

Promising Practices in E-Supervision: Exploring Graduate Speech-Language Pathology Interns’ Perceptions

PubMed Central

Carlin, Charles H.; Milam, Jennifer L.; Carlin, Emily L.; Owen, Ashley

2012-01-01

E-supervision has a potential role in addressing speech-language personnel shortages in rural and difficult to staff school districts. The purposes of this article are twofold: to determine how e-supervision might support graduate speech-language pathologist (SLP) interns placed in rural, remote, and difficult to staff public school districts; and, to investigate interns’ perceptions of in-person supervision compared to e-supervision. The study used a mixed methodology approach and collected data from surveys, supervision documents and records, and interviews. The results showed the use of e-supervision allowed graduate SLP interns to be adequately supervised across a variety of clients and professional activities in a manner that was similar to in-person supervision. Further, e-supervision was perceived as a more convenient and less stressful supervision format when compared to in-person supervision. Other findings are discussed and implications and limitations provided. PMID:25945201

The experience of clinical supervision for nurses and healthcare assistants in a secure adolescent service: Affecting service improvement.

PubMed

McCarron, R H; Eade, J; Delmage, E

2018-04-01

WHAT IS KNOWN ON THE SUBJECT?: Regular and effective clinical supervision for mental health nurses and healthcare assistants (HCAs) is an important tool in helping to reduce stress and burnout, and in ensuring safe, effective and high-quality mental health care. Previous studies of clinical supervision within secure mental health environments have found both a low availability of clinical supervision, and a low level of staff acceptance of its value, particularly for HCAs. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: In previous studies, the understanding shown by HCAs and nurses around the benefits of clinical supervision may have been limited by the methods used. This study was specifically designed to help them best express their views. In contrast to previous studies, both nurses and HCAs showed a good understanding of the function and value of clinical supervision. Significant improvements in the experience of, and access to, clinical supervision for nurses and HCAs working in secure mental health services may be achieved by raising staff awareness, demonstrating organizational support and increasing monitoring of clinical supervision. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Organizations should consider reviewing their approach to supervision to include raising staff awareness, multidisciplinary supervision, group supervision, and recording and tracking of supervision rates. Organizations should be mindful of the need to provide effective clinical supervision to HCAs as well as nurses. Introduction Studies have found a low availability and appreciation of clinical supervision, especially for healthcare assistants (HCAs). Qualitative research is needed to further understand this. Aims Increase understanding of nurses' and HCAs' experiences of, and access to, clinical supervision. Identify nurses' and HCAs' perceptions of the value and function of clinical supervision. Assess how interventions affect staff's experiences of clinical supervision. Methods In 2013, HCAs and nurses in a secure adolescent service were surveyed about clinical supervision. Forty-nine HCAs and 20 nurses responded. In 2014, interventions to facilitate supervision were introduced. In 2016, the study was repeated. Forty HCAs and 30 nurses responded. Responses were analysed using a mixed methods approach. Results Significantly more HCAs found supervision to be a positive experience in 2016, and both nurses and HCAs reported significantly fewer challenges in accessing supervision. HCAs and nurses understood the value of clinical supervision. Discussion Significant improvements in the experience of clinical supervision were achieved following increased staff awareness, multidisciplinary and group supervision, and recording supervision rates. HCAs and nurses understood the consequences of inadequate supervision. Implications for practice Organizations could adopt the interventions to facilitate clinical supervision. Supervision should not be overlooked for HCAs. © 2017 John Wiley & Sons Ltd.

Asthma management and inhalation techniques among community pharmacists in 2009: a comparison with the 1999 survey.

PubMed

Casset, Anne; Meunier-Spitz, Marion; Rebotier, Pauline; Lefèvre, Hassina; Barth, Christian; Heitz, Christiane; de Blay, Frédéric

2014-11-01

In a 1999 survey, community pharmacists from the Alsace region of France had a reasonably good knowledge of asthma treatment and prevention, but their skill in the use of asthma inhalation devices left room for improvement. Since then, health authorities have encouraged the involvement of community pharmacists in patient care and education in order to improve asthma control. The aim of this study was to assess the change in the knowledge of asthma management and inhaler technique skills of community pharmacists in the same geographic area after a 10-year interval. In 2009, 86 randomly selected community pharmacists from the Alsace region answered a standardized questionnaire about their theoretical knowledge of and practical attitude toward asthma management and inhaled delivery systems, following which their skills in the use of four inhalation devices (pressurized metered-dose inhaler (pMDI) with/without a spacer, breath-actuated pMDI and dry powder inhaler (DPI)) were evaluated. Very few pharmacists were required to manage an acute asthma exacerbation at the pharmacy, but all responded well by administering a short-acting inhaled β2-agonist. Theoretical knowledge of asthma management (criteria of severity of asthma exacerbation, guidelines and drugs triggering asthma exacerbations) was still average. Compared with 1999, they were twice as confident in demonstrating inhaler use, and their skills in using the pMDI, breath-actuated pMDI and DPI had improved significantly (p < 0.001). Since 1999, pharmacists' skill in the use of inhalers has improved, but theoretical knowledge of asthma management is still average, pointing to the importance of continuing pharmaceutical education.

The effect of inhaled K+ channel openers on bronchoconstriction and airway microvascular leakage in anaesthetised guinea pigs.

PubMed

Kidney, J C; Lotvall, J O; Lei, Y; Chung, K F; Barnes, P J

1996-01-18

Since orally administered K+ channel openers may have cardiovascular side effects, it is possible that inhaled administration would be preferred for the treatment of asthma. We have investigated whether inhaled levcromakalim and HOE 234 inhibit histamine-induced bronchoconstriction and airway plasma exudation in anaesthetised guinea pigs. We have also investigated whether inhaled HOE 234 inhibits the bronchoconstriction and plasma exudation induced by vagus nerve stimulation, which is due to the release of tachykinins from sensory nerves. Lung resistance was measured by airway resistance (RL) computed from airway and transpulmonary pressures and plasma exudation by measurement of Evans blue dye extravasation. Inhaled levcromakalim (25 mu g/ml) had a short duration of action, being effective against histamine-induced bronchoconstriction 2 min after pretreatment, but not at 10 min. Inhaled HOE 234 (25 mu g/ml) was similarly effective against histamine-induced bronchoconstriction but had a longer duration of action. Inhaled levcromakalim partially attenuated histamine-induced plasma extravasation in small airways, but not in the trachea or main bronchi, whereas inhaled HOE 234 had no effect. HOE 234 protected against non-adrenergic non-cholinergic nerve-induced bronchoconstriction, but had no effect on neurogenic- or substance P-induced plasma extravasation in the airway. Inhaled K+ channel openers protect against induced bronchoconstriction, but provide little or no protection against plasma exudation, possibly because of an increase in airway blood flow. In addition, inhaled HOE 234 had no effect on neurogenic leakage, suggesting that its vagal inhibitory effect on bronchoconstriction was on airway smooth muscle, rather than on release of neuropeptides from sensory nerves.

Error estimation of deformable image registration of pulmonary CT scans using convolutional neural networks.

PubMed

Eppenhof, Koen A J; Pluim, Josien P W

2018-04-01

Error estimation in nonlinear medical image registration is a nontrivial problem that is important for validation of registration methods. We propose a supervised method for estimation of registration errors in nonlinear registration of three-dimensional (3-D) images. The method is based on a 3-D convolutional neural network that learns to estimate registration errors from a pair of image patches. By applying the network to patches centered around every voxel, we construct registration error maps. The network is trained using a set of representative images that have been synthetically transformed to construct a set of image pairs with known deformations. The method is evaluated on deformable registrations of inhale-exhale pairs of thoracic CT scans. Using ground truth target registration errors on manually annotated landmarks, we evaluate the method's ability to estimate local registration errors. Estimation of full domain error maps is evaluated using a gold standard approach. The two evaluation approaches show that we can train the network to robustly estimate registration errors in a predetermined range, with subvoxel accuracy. We achieved a root-mean-square deviation of 0.51 mm from gold standard registration errors and of 0.66 mm from ground truth landmark registration errors.

Protective effect of inhalation of hydrogen gas on radiation-induced dermatitis and skin injury in rats

PubMed Central

Watanabe, Sadahiro; Fujita, Masanori; Ishihara, Masayuki; Tachibana, Shoichi; Yamamoto, Yoritsuna; Kaji, Tatsumi; Kawauchi, Toshio; Kanatani, Yasuhiro

2014-01-01

The effect of inhalation of hydrogen-containing gas (1.3% hydrogen + 20.8% oxygen + 77.9% nitrogen) (HCG) on radiation-induced dermatitis and on the healing of healing-impaired skin wounds in rats was examined using a rat model of radiation-induced skin injury. An X-ray dose of 20 Gy was irradiated onto the lower part of the back through two holes in a lead shield. Irradiation was performed before or after inhalation of HCG for 2 h. Inhalation of HCG significantly reduced the severity of radiodermatitis and accelerated healing-impaired wound repair. Staining with terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) and 8-hydroxy-2′-deoxyguanosine (8-OHdG) showed that the proportion of apoptotic keratinocytes and the level of staining in the X-irradiated skin of rats that pre-inhaled HCG were significantly lower than that of rats which did not pre-inhale HCG. Cutaneous full-thickness wounds were then created in the X-irradiated area to examine the time-course of wound healing. X-irradiation significantly increased the time required for wound healing, but the inhalation of HCG prior to the irradiation significantly decreased the delay in wound healing compared with the control and post-inhalation of HCG groups. Therefore, radiation-induced skin injury can potentially be alleviated by the pre-inhalation of HCG. PMID:25034733

Inhalants

MedlinePlus

... Drug Facts Chat Day: Inhalants Drug Facts Chat Day: Inhalants Print Expand All Can you get high ... Cool Order Free Materials National Drugs & Alcohol Chat Day Newsletter Sign up to receive National Drug & Alcohol ...

Effects of Chronic Solvent Abuse on Public School Youth.

ERIC Educational Resources Information Center

Fullwood, Harry L.; Fournet, Glenn P.

School youth have been increasingly involved in the dangerous abuse of volatile inhalants. The basic reason to inhale substances is to reach an altered state of consciousness. The 12-17 and 18-25-year-old age groups had the highest rates of inhalant abuse in 1993. Among eighth graders, almost one in five (19%) said they have used inhalants and 5%…

A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial. (The Supervised Walking In comparison to Fitness Training for Back Pain (SWIFT) Trial)

PubMed Central

Hurley, Deirdre A; O'Donoghue, Grainne; Tully, Mark A; Moffett, Jennifer Klaber; van Mechelen, Willem; Daly, Leslie; Boreham, Colin AG; McDonough, Suzanne M

2009-01-01

Background Chronic low back pain (CLBP) is a persistent disabling condition with rising significant healthcare, social and economic costs. Current research supports the use of exercise-based treatment approaches that encourage people with CLBP to assume a physically active role in their recovery. While international clinical guidelines and systematic reviews for CLBP support supervised group exercise as an attractive first-line option for treating large numbers of CLBP patients at low cost, barriers to their delivery include space and time restrictions in healthcare settings and poor patient attendance. The European Clinical Guidelines have identified the need for research in the use of brief/minimal contact self-activation interventions that encourage participation in physical activity for CLBP. Walking may be an ideally suited form of individualized exercise prescription as it is easy to do, requires no special skills or facilities, and is achievable by virtually all ages with little risk of injury, but its effectiveness for LBP is unproven. Methods and design This study will be an assessor-blinded randomized controlled trial that will investigate the difference in clinical effectiveness and costs of an individualized walking programme and a supervised general exercise programme compared to usual physiotherapy, which will act as the control group, in people with chronic low back pain. A sample of 246 patients will be recruited in Dublin, Ireland through acute general hospital outpatient physiotherapy departments that provide treatment for people with CLBP. Patients will be randomly allocated to one of the three groups in a concealed manner. The main outcomes will be functional disability, pain, quality of life, fear avoidance, back beliefs, physical activity, satisfaction and costs, which will be evaluated at baseline, and 3, 6 and 12 months [follow-up by pre-paid postage]. Qualitative telephone interviews and focus groups will be embedded in the research design to obtain feedback about participants' experiences of the interventions and trial participation, and to inform interpretation of the quantitative data. Planned analysis will be by intention to treat (quantitative data) and thematic analysis (qualitative data) Discussion The trial will evaluate the effectiveness of a walking programme and a supervised general exercise programme compared to usual physiotherapy in people with CLBP. Trial registration Current controlled trial ISRCTN17592092 PMID:19573247

Supervised and Unsupervised Self-Testing for HIV in High- and Low-Risk Populations: A Systematic Review

PubMed Central

Pant Pai, Nitika; Sharma, Jigyasa; Shivkumar, Sushmita; Pillay, Sabrina; Vadnais, Caroline; Joseph, Lawrence; Dheda, Keertan; Peeling, Rosanna W.

2013-01-01

Background Stigma, discrimination, lack of privacy, and long waiting times partly explain why six out of ten individuals living with HIV do not access facility-based testing. By circumventing these barriers, self-testing offers potential for more people to know their sero-status. Recent approval of an in-home HIV self test in the US has sparked self-testing initiatives, yet data on acceptability, feasibility, and linkages to care are limited. We systematically reviewed evidence on supervised (self-testing and counselling aided by a health care professional) and unsupervised (performed by self-tester with access to phone/internet counselling) self-testing strategies. Methods and Findings Seven databases (Medline [via PubMed], Biosis, PsycINFO, Cinahl, African Medicus, LILACS, and EMBASE) and conference abstracts of six major HIV/sexually transmitted infections conferences were searched from 1st January 2000–30th October 2012. 1,221 citations were identified and 21 studies included for review. Seven studies evaluated an unsupervised strategy and 14 evaluated a supervised strategy. For both strategies, data on acceptability (range: 74%–96%), preference (range: 61%–91%), and partner self-testing (range: 80%–97%) were high. A high specificity (range: 99.8%–100%) was observed for both strategies, while a lower sensitivity was reported in the unsupervised (range: 92.9%–100%; one study) versus supervised (range: 97.4%–97.9%; three studies) strategy. Regarding feasibility of linkage to counselling and care, 96% (n = 102/106) of individuals testing positive for HIV stated they would seek post-test counselling (unsupervised strategy, one study). No extreme adverse events were noted. The majority of data (n = 11,019/12,402 individuals, 89%) were from high-income settings and 71% (n = 15/21) of studies were cross-sectional in design, thus limiting our analysis. Conclusions Both supervised and unsupervised testing strategies were highly acceptable, preferred, and more likely to result in partner self-testing. However, no studies evaluated post-test linkage with counselling and treatment outcomes and reporting quality was poor. Thus, controlled trials of high quality from diverse settings are warranted to confirm and extend these findings. Please see later in the article for the Editors' Summary PMID:23565066

Dynamics of airflow in a short inhalation

PubMed Central

Bates, A. J.; Doorly, D. J.; Cetto, R.; Calmet, H.; Gambaruto, A. M.; Tolley, N. S.; Houzeaux, G.; Schroter, R. C.

2015-01-01

During a rapid inhalation, such as a sniff, the flow in the airways accelerates and decays quickly. The consequences for flow development and convective transport of an inhaled gas were investigated in a subject geometry extending from the nose to the bronchi. The progress of flow transition and the advance of an inhaled non-absorbed gas were determined using highly resolved simulations of a sniff 0.5 s long, 1 l s−1 peak flow, 364 ml inhaled volume. In the nose, the distribution of airflow evolved through three phases: (i) an initial transient of about 50 ms, roughly the filling time for a nasal volume, (ii) quasi-equilibrium over the majority of the inhalation, and (iii) a terminating phase. Flow transition commenced in the supraglottic region within 20 ms, resulting in large-amplitude fluctuations persisting throughout the inhalation; in the nose, fluctuations that arose nearer peak flow were of much reduced intensity and diminished in the flow decay phase. Measures of gas concentration showed non-uniform build-up and wash-out of the inhaled gas in the nose. At the carina, the form of the temporal concentration profile reflected both shear dispersion and airway filling defects owing to recirculation regions. PMID:25551147

An Approach to Supervision for Doctoral and Entry-Level Group Counseling Students

ERIC Educational Resources Information Center

Walsh, Robyn; Bambacus, Elizabeth; Gibson, Donna

2017-01-01

The purpose of this article is to provide a supervision approach to experiential groups that replaces professors with doctoral students in the chain of supervision, enlists a faculty member to provide supervision of supervision to the doctoral students, and translates supervision theory to meet the unique needs of group counseling supervision.…

Verified Centers, Nonverified Centers or Other Facilities: A National Analysis of Burn Patient Treatment Location

PubMed Central

Zonies, David; Mack, Christopher; Kramer, Bradley; Rivara, Frederick; Klein, Matthew

2009-01-01

Background Although comprehensive burn care requires significant resources, patients may be treated at verified burn centers, non-verified burn centers, or other facilities due to a variety of factors. The purpose of this study was to evaluate the association between patient and injury characteristics and treatment location using a national database. Study Design We performed an analysis of all burn patients admitted to United States hospitals participating in the Healthcare Cost and Utilization Project over 2 years. Univariate and multivariate analyses were performed to identify patient and injury factors associated with the likelihood of treatment at designated burn care facilities. Definitve care facilities were categorized as American Burn Association verified centers, non-verified burn centers, or other facilities. Results Over the two years, 29,971 burn patients were treated in 1,376 hospitals located in 19 participating states. A total of 6,712 (22%) patients were treated at verified centers, with 26% and 52% treated at non-verified or other facilities, respectively. Patients treated at verified centers were younger than those at non-verified or other facilities (33.1 years vs. 33.7 years vs. 41.9 years, p<0.001) and had a higher rate of inhalation injury (3.4% vs. 3.2% vs. 2.2%, p<0.001). Independent factors associated with treatment at verified centers include burns to the head/neck (RR 2.4, CI 2.1-2.7), hand (RR 1.8, CI 1.6-1.9), electrical injury (RR 1.4, CI 1.4, CI 1.2-1.7), and fewer co-morbidities (RR 0.55, CI 0.5-0.6). Conclusions More than two-thirds of significantly burned patients are treated at non-verified burn centers in the U.S. Many patients meeting ABA criteria for transfer to a burn center are being treated at non-burn center facilities. PMID:20193892

The formal electronic recycling industry: Challenges and opportunities in occupational and environmental health research.

PubMed

Ceballos, Diana Maria; Dong, Zhao

2016-10-01

E-waste includes electrical and electronic equipment discarded as waste without intent of reuse. Informal e-waste recycling, typically done in smaller, unorganized businesses, can expose workers and communities to serious chemical health hazards. It is unclear if formalization into larger, better-controlled electronics recycling (e-recycling) facilities solves environmental and occupational health problems. To systematically review the literature on occupational and environmental health hazards of formal e-recycling facilities and discuss challenges and opportunities to strengthen research in this area. We identified 37 publications from 4 electronic databases (PubMed, Web of Science, Environmental Index, NIOSHTIC-2) specific to chemical exposures in formal e-recycling facilities. Environmental and occupational exposures depend on the degree of formalization of the facilities but further reduction is needed. Reported worker exposures to metals were often higher than recommended occupational guidelines. Levels of brominated flame-retardants in worker's inhaled air and biological samples were higher than those from reference groups. Air, dust, and soil concentrations of metals, brominated flame-retardants, dioxins, furans, polycyclic-aromatic hydrocarbons, or polychlorinated biphenyls found inside or near the facilities were generally higher than reference locations, suggesting transport into the environment. Children of a recycler had blood lead levels higher than public health recommended guidelines. With mounting e-waste, more workers, their family members, and communities could experience unhealthful exposures to metals and other chemicals. We identified research needs to further assess exposures, health, and improve controls. The long-term solution is manufacturing of electronics without harmful substances and easy-to-disassemble components. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Inhalant Abuse and Dextromethorphan.

PubMed

Storck, Michael; Black, Laura; Liddell, Morgan

2016-07-01

Inhalant abuse is the intentional inhalation of a volatile substance for the purpose of achieving an altered mental state. As an important, yet underrecognized form of substance abuse, inhalant abuse crosses all demographic, ethnic, and socioeconomic boundaries, causing significant morbidity and mortality in school-aged and older children. This review presents current perspectives on epidemiology, detection, and clinical challenges of inhalant abuse and offers advice regarding the medical and mental health providers' roles in the prevention and management of this substance abuse problem. Also discussed is the misuse of a specific "over-the-counter" dissociative, dextromethorphan. Copyright © 2016 Elsevier Inc. All rights reserved.

Biokinetics and effects of titania nano-material after inhalation and i.v. injection

NASA Astrophysics Data System (ADS)

Landsiedel, Robert; Fabian, Eric; Ma-Hock, Lan; Wiench, Karin; van Ravenzwaay, Bennard

2009-05-01

Within NanoSafe2 we developed a special inhalation model to investigate deposition of inhaled particles in the lung and the further distribution in the body after. Concurrently, the effects of the inhaled materials in the lung were examined. The results for nano-Titania were compared to results from inhalation studies with micron-sized (non-nano) Titania particles and to quartz particles (DQ12, known to be potent lung toxicants). To build a PBPK model for nano-Titania the tissue distribution of the material was also examined following intravenous (i.v.) administration.

Studies on the Inhalation Toxicity of Dyes Present in Colored Smoke Munitions. Phase III, Studies: Four-Week Inhalation Exposures of Rats to Dye Aerosols.

DTIC Science & Technology

1984-09-10

0") AD STUDIES ON THE INHALATION TOXICITY CO• OF DYES PRESENT IN COLORED Ln SMOKE MUNIlIONS U FINAL REPORT FOR PHASE III STUDIES : SFOUR- ELK...3 RECIIEPIT’S CATA6.0G NUMBE.• 4. TITLE (and ,ubiltI.e) S. TYPE OF REPORT & PERIOD COygC r., Studies on the Inhalation Toxicity of Dyes Final: Phase...III Present in Colored Smoke Munitions. Final Report Fh for Phase 111 Studies : FoLr-Week Inhalation G. PERFORMING ORO. REPORT N,’,ER Exposures of Rats

Timing of dornase alfa inhalation for cystic fibrosis.

PubMed

Dentice, Ruth; Elkins, Mark

2016-07-26

Inhalation of the enzyme dornase alfa reduces sputum viscosity and improves clinical outcomes of people with cystic fibrosis. This is an update of a previously published Cochrane review. To determine the effect of timing of dornase alfa inhalation on measures of clinical efficacy in people with cystic fibrosis (in relation to airway clearance techniques or time of day). Relevant randomised and quasi-randomised controlled trials were identified from the Cochrane Cystic Fibrosis Trials Register, Physiotherapy Evidence Database (PEDro), and international cystic fibrosis conference proceedings.Date of the most recent search: 25 April 2016. Any trial of dornase alfa in people with cystic fibrosis where timing of inhalation was the randomised element in the study with either: inhalation before compared to after airway clearance techniques; or morning compared to evening inhalation. Both authors independently selected trials, assessed risk of bias and extracted data with disagreements resolved by discussion. Relevant data were extracted and, where possible, meta-analysed. We identified 115 trial reports representing 55 studies, of which five studies (providing data on 122 participants) met our inclusion criteria. All five studies used a cross-over design. Intervention periods ranged from two to eight weeks. Four trials compared dornase alfa inhalation before versus after airway clearance techniques. Inhalation after instead of before airway clearance did not significantly change forced expiratory volume at one second. Similarly, forced vital capacity and quality of life were not significantly affected; forced expiratory flow at 25% was significantly worse with dornase alfa inhalation after airway clearance, mean difference -0.17 litres (95% confidence interval -0.28 to -0.05), based on the pooled data from two small studies in children (seven to 19 years) with well-preserved lung function. All other secondary outcomes were statistically non-significant.In one trial, morning versus evening inhalation had no impact on lung function or symptoms. The current evidence derived from a small number of participants does not indicate that inhalation of dornase alfa after airway clearance techniques is more or less effective than the traditional recommendation to inhale nebulised dornase alfa 30 minutes prior to airway clearance techniques, for most outcomes. For children with well-preserved lung function, inhalation before airway clearance may be more beneficial for small airway function than inhalation after. However, this result relied on a measure with high variability and studies with variable follow up. In the absence of strong evidence to indicate that one timing regimen is better than another, the timing of dornase alpha inhalation can be largely based on pragmatic reasons or individual preference with respect to the time of airway clearance and time of day. Further research is warranted.

Asthma Inhalers

MedlinePlus

... an inhaler into the lungs. But CFCs are ozone-depleting substances (ODSs) that hurt the environment. Manufacturers ... inhalers, that do not rob the atmosphere of ozone. “The FDA [Food and Drug Administration] and various ...

Zanamivir Oral Inhalation

MedlinePlus

... prescribed by your doctor.Zanamivir comes with a plastic inhaler called a Diskhaler (device for inhaling powder) ... to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in ...

Mometasone Oral Inhalation

MedlinePlus

... or she watches.The dose counter on the base of your mometasone inhaler tells you how many ... Hold the inhaler straight up with the colored base on the bottom. Twist the white cap counterclockwise ...

Digital communication to support clinical supervision: considering the human factors.

PubMed

Mather, Carey; Marlow, Annette; Cummings, Elizabeth

2013-01-01

During the last three years the School of Nursing and Midwifery at the University of Tasmania has used a needs assessment survey to explore the needs of organizations and nursing professionals that facilitate and clinically supervise Bachelor of Nursing students in the workplace. Findings from the survey indicated that staff at healthcare organizations wanted a communication strategy that was easily accessible by clinicians who supervised students during work integrated learning placements. In particular they wanted to receive timely information related to the role and function of supervisors in practice. The development of the digital strategy to strengthen the development of a community of practice between the University, organizations, facilities and clinical supervisors was identified as the key method of improving communication. Blogging and micro blogging were selected as methods of choice for the implementation of the digital strategy because they were easy to set up, use and enable equity of access to geographically dispersed practitioners in urban and rural areas. Change champions were identified to disseminate information about the strategy within their workplaces. Although clinicians indicated electronic communication as their preferred method, there were a number of human factors at a systems and individual level identified to be challenges when communicating with clinical supervisors who were based off-campus. Information communication technology policies and embedded culture towards social presence were impediments to using this approach in some organizations. Additionally, it was found that it is necessary for this group of clinicians to be educated about using digital methods to undertake their role as clinical supervisors in their varied clinical practice environments.

Feasibility of Deploying Inhaler Sensors to Identify the Impacts of Environmental Triggers and Built Environment Factors on Asthma Short-Acting Bronchodilator Use.

PubMed

Su, Jason G; Barrett, Meredith A; Henderson, Kelly; Humblet, Olivier; Smith, Ted; Sublett, James W; Nesbitt, LaQuandra; Hogg, Chris; Van Sickle, David; Sublett, James L

2017-02-01

Epidemiological asthma research has relied upon self-reported symptoms or healthcare utilization data, and used the residential address as the primary location for exposure. These data sources can be temporally limited, spatially aggregated, subjective, and burdensome for the patient to collect. First, we aimed to test the feasibility of collecting rescue inhaler use data in space-time using electronic sensors. Second, we aimed to evaluate whether these data have the potential to identify environmental triggers and built environment factors associated with rescue inhaler use and to determine whether these findings would be consistent with the existing literature. We utilized zero-truncated negative binomial models to identify triggers associated with inhaler use, and implemented three sensitivity analyses to validate our findings. Electronic sensors fitted on metered dose inhalers tracked 5,660 rescue inhaler use events in space and time for 140 participants from 13 June 2012 to 28 February 2014. We found that the inhaler sensors were feasible in passively collecting objective rescue inhaler use data. We identified several environmental triggers with a positive and significant association with inhaler use, including: AQI, PM10, weed pollen, and mold. Conversely, the spatial distribution of tree cover demonstrated a negative and significant association with inhaler use. Utilizing a sensor to capture the signal of rescue inhaler use in space-time offered a passive and objective signal of asthma activity. This approach enabled detailed analyses to identify environmental triggers and built environment factors that are associated with asthma symptoms beyond the residential address. The application of these new technologies has the potential to improve our surveillance and understanding of asthma. Citation: Su JG, Barrett MA, Henderson K, Humblet O, Smith T, Sublett JW, Nesbitt L, Hogg C, Van Sickle D, Sublett JL. 2017. Feasibility of deploying inhaler sensors to identify the impacts of environmental triggers and built environment factors on asthma short-acting bronchodilator use. Environ Health Perspect 125:254-261; http://dx.doi.org/10.1289/EHP266.

Inhaled nitric oxide, oxygen, and alkalosis: dose-response interactions in a lamb model of pulmonary hypertension.

PubMed

Heidersbach, R S; Johengen, M J; Bekker, J M; Fineman, J R

1999-07-01

Inhaled nitric oxide (NO) is currently used as an adjuvant therapy for a variety of pulmonary hypertensive disorders. In both animal and human studies, inhaled NO induces selective, dose-dependent pulmonary vasodilation. However, its potential interactions with other simultaneously used pulmonary vasodilator therapies have not been studied. Therefore, the objective of this study was to determine the potential dose-response interactions of inhaled NO, oxygen, and alkalosis therapies. Fourteen newborn lambs (age 1-6 days) were instrumented to measure vascular pressures and left pulmonary artery blood flow. After recovery, the lambs were sedated and mechanically ventilated. During steady-state pulmonary hypertension induced by U46619 (a thromboxane A2 mimic), the lambs were exposed to the following conditions: Protocol A, inhaled NO (0, 5, 40, and 80 ppm) and inspired oxygen concentrations (FiO2) of 0.21, 0.50, and 1.00; and Protocol B, inhaled NO (0, 5, 40, and 80 ppm) and arterial pH levels of 7.30, 7.40, 7.50, and 7.60. Each condition (in randomly chosen order) was maintained for 10 min, and all variables were allowed to return to baseline between conditions. Inhaled NO, oxygen, and alkalosis produced dose-dependent decreases in mean pulmonary arterial pressures (P < 0.05). Systemic arterial pressure remained unchanged. At 5 ppm of inhaled NO, alkalosis and oxygen induced further dose-dependent decreases in mean pulmonary arterial pressures (P < 0.05). At inhaled NO doses > 5 ppm, alkalosis induced further dose-independent decreases in mean pulmonary arterial pressure, while oxygen did not. We conclude that in this animal model, oxygen, alkalosis, and inhaled NO induced selective, dose-dependent pulmonary vasodilation. However, when combined, a systemic arterial pH > 7.40 augmented inhaled NO-induced pulmonary vasodilation, while an FiO2 > 0.5 did not. Therefore, weaning high FiO2 during inhaled NO therapy should be considered, since it may not diminish the pulmonary vasodilating effects. Further studies are warranted to guide the clinical weaning strategies of these pulmonary vasodilator therapies.

Long-Acting β-Agonist in Combination or Separate Inhaler as Step-Up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids.

PubMed

Turner, Steve; Richardson, Kathryn; Murray, Clare; Thomas, Mike; Hillyer, Elizabeth V; Burden, Anne; Price, David B

Adding a long-acting β 2 -agonist (LABA) to inhaled corticosteroids (ICS) using a fixed-dose combination (FDC) inhaler is the UK guideline recommendation for children aged more than 4 years with uncontrolled asthma. The evidence of benefit of adding an FDC inhaler over a separate LABA inhaler is limited. The objective of this study was to compare the effectiveness of a LABA added as an FDC inhaler, and as a separate inhaler, in children with uncontrolled asthma. Two UK primary care databases were used to create a matched cohort study with a 2-year follow-up period. We included children prescribed their first step-up from ICS monotherapy. Two cohorts were formed for children receiving an add-on LABA as an FDC inhaler, or a separate LABA inhaler. Matching variables and confounders were identified by comparing characteristics during a baseline year of follow-up. Outcomes were examined during the subsequent year. The primary outcome was an adjusted odds ratio for overall asthma control (defined as follows: no asthma-related hospital admission or emergency room visit, prescription for oral corticosteroids or antibiotic with evidence of respiratory consultation, and ≤2 puffs of short-acting β-agonist daily). The final study consisted of 1330 children in each cohort (mean age 9 years; 59% male). In the separate ICS+LABA cohort, the odds of achieving overall asthma control were lower (adjusted odds ratio, 0.77 [95% confidence interval, 0.66-0.91]; P = .001) compared with the FDC cohort. The study demonstrates a small but significant benefit in achieving asthma control from an add-on LABA as an FDC, compared with a separate inhaler and this supports current guideline recommendations. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Inhalants in Peru.

PubMed

Lerner, R; Ferrando, D

1995-01-01

In Peru, the prevalence and consequences of inhalant abuse appear to be low in the general population and high among marginalized children. Inhalant use ranks third in lifetime prevalence after alcohol and tobacco. Most of the use appears to be infrequent. Among marginalized children, that is, children working in the streets but living at home or children living in the street, the problem of inhalant abuse is a serious problem. Among children working in the streets but living at home, the lifetime prevalence rate for inhalant abuse is high, ranging from 15 to 45 percent depending on the study being cited. For children living in the streets, the use of inhalant is even more severe. As mentioned earlier in this chapter, most of these street children use inhalants on a daily basis. The lack of research on the problem of inhalant abuse is a serious impediment to development of intervention programs and strategies to address this problem in Peru. Epidemiologic and ethnographic research on the nature and extent of inhalant abuse are obvious prerequisites to targeted treatment and preventive intervention programs. The urgent need for current and valid data is underscored by the unique vulnerability of the youthful population at risk and the undisputed harm that results from chronic abuse of inhalants. Nonetheless, it is important to mention several programs that work with street children. Some, such as the Information and Education Center for the Prevention of Drug Abuse, Generation, and Centro Integracion de Menores en Abandono have shelters where street children are offered transition to a less marginal lifestyle. Teams of street educators provide the children with practical solutions and gain their confidence, as well as offer them alternative socialization experiences to help them survive the streets and avoid the often repressive and counterproductive environments typical of many institutions. Most of the children who go through these programs tend to abandon inhalant use as they mature out of street life.

A randomised open-label cross-over study of inhaler errors, preference and time to achieve correct inhaler use in patients with COPD or asthma: comparison of ELLIPTA with other inhaler devices.

PubMed

van der Palen, Job; Thomas, Mike; Chrystyn, Henry; Sharma, Raj K; van der Valk, Paul Dlpm; Goosens, Martijn; Wilkinson, Tom; Stonham, Carol; Chauhan, Anoop J; Imber, Varsha; Zhu, Chang-Qing; Svedsater, Henrik; Barnes, Neil C

2016-11-24

Errors in the use of different inhalers were investigated in patients naive to the devices under investigation in a multicentre, single-visit, randomised, open-label, cross-over study. Patients with chronic obstructive pulmonary disease (COPD) or asthma were assigned to ELLIPTA vs DISKUS (Accuhaler), metered-dose inhaler (MDI) or Turbuhaler. Patients with COPD were also assigned to ELLIPTA vs Handihaler or Breezhaler. Patients demonstrated inhaler use after reading the patient information leaflet (PIL). A trained investigator assessed critical errors (i.e., those likely to result in the inhalation of significantly reduced, minimal or no medication). If the patient made errors, the investigator demonstrated the correct use of the inhaler, and the patient demonstrated inhaler use again. Fewer COPD patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS, 9/171 (5%) vs 75/171 (44%); MDI, 10/80 (13%) vs 48/80 (60%); Turbuhaler, 8/100 (8%) vs 44/100 (44%); Handihaler, 17/118 (14%) vs 57/118 (48%); Breezhaler, 13/98 (13%) vs 45/98 (46%; all P<0.001). Most patients (57-70%) made no errors using ELLIPTA and did not require investigator instruction. Instruction was required for DISKUS (65%), MDI (85%), Turbuhaler (71%), Handihaler (62%) and Breezhaler (56%). Fewer asthma patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS (3/70 (4%) vs 9/70 (13%), P=0.221); MDI (2/32 (6%) vs 8/32 (25%), P=0.074) and significantly fewer vs Turbuhaler (3/60 (5%) vs 20/60 (33%), P<0.001). More asthma and COPD patients preferred ELLIPTA over the other devices (all P⩽0.002). Significantly, fewer COPD patients using ELLIPTA made critical errors after reading the PIL vs other inhalers. More asthma and COPD patients preferred ELLIPTA over comparator inhalers.

A cross-sectional questionnaire study of the rules governing pupils' carriage of inhalers for asthma treatment in secondary schools in North East England.

PubMed

Funston, Wendy; Howard, Simon J

2016-01-01

Objectives. The primary objective of this study was to assess the rules governing secondary school pupils' carriage of inhalers for emergency treatment of asthma in the North East of England. Design. This study was based upon a postal questionnaire survey. Setting. The setting for this study was mainstream free-to-attend secondary schools which admit 16 year old pupils within the 12 Local Authority areas which make up the North East of England. Participants. All 153 schools meeting the inclusion criteria were invited to participate in the study, of which 106 (69%) took part. Main Outcome Measures. Our three main outcome measures were: whether pupils are permitted to carry inhalers on their person while at school; whether advance permission is required for pupils to carry inhalers, and from whom; and whether the school has an emergency 'standby' salbutamol inhaler for use in asthma emergencies, as permitted since October 2014 under recent amendments to The Human Medicines Regulations 2012. Results. Of 98 schools submitting valid responses to the question, 99% (n = 97) permitted pupils to carry inhalers on their person while at school; the remaining school stored pupils' inhalers in a central location within the school. A total of 22% of included schools (n = 22) required parental permission before pupils were permitted to carry inhalers. Of 102 schools submitting valid responses to the question, 44% (n = 45) had purchased a 'standby' salbutamol inhaler for use in asthma emergencies. Conclusions. Most secondary schools in North East England permit pupils to carry inhalers on their person. The requirement in a minority of schools for parental permission to be given possibly contravenes the standard ethical practices in clinical medicine for children of this age. Only a minority of schools hold a 'standby' salbutamol inhaler for use in asthma emergencies. Wider availability may improve outcomes for asthma emergencies occurring in schools.

An Acoustic-Based Method to Detect and Quantify the Effect of Exhalation into a Dry Powder Inhaler.

PubMed

Holmes, Martin S; Seheult, Jansen N; O'Connell, Peter; D'Arcy, Shona; Ehrhardt, Carsten; Healy, Anne Marie; Costello, Richard W; Reilly, Richard B

2015-08-01

Dry powder inhaler (DPI) users frequently exhale into their inhaler mouthpiece before the inhalation step. This error in technique compromises the integrity of the drug and results in poor bronchodilation. This study investigated the effect of four exhalation factors (exhalation flow rate, distance from mouth to inhaler, exhalation duration, and relative air humidity) on dry powder dose delivery. Given that acoustic energy can be related to the factors associated with exhalation sounds, we then aimed to develop a method of identifying and quantifying this critical inhaler technique error using acoustic based methods. An in vitro test rig was developed to simulate this critical error. The effect of the four factors on subsequent drug delivery were investigated using multivariate regression models. In a further study we then used an acoustic monitoring device to unobtrusively record the sounds 22 asthmatic patients made whilst using a Diskus(™) DPI. Acoustic energy was employed to automatically detect and analyze exhalation events in the audio files. All exhalation factors had a statistically significant effect on drug delivery (p<0.05); distance from the inhaler mouthpiece had the largest effect size. Humid air exhalations were found to reduce the fine particle fraction (FPF) compared to dry air. In a dataset of 110 audio files from 22 asthmatic patients, the acoustic method detected exhalations with an accuracy of 89.1%. We were able to classify exhalations occurring 5 cm or less in the direction of the inhaler mouthpiece or recording device with a sensitivity of 72.2% and specificity of 85.7%. Exhaling into a DPI has a significant detrimental effect. Acoustic based methods can be employed to objectively detect and analyze exhalations during inhaler use, thus providing a method of remotely monitoring inhaler technique and providing personalized inhaler technique feedback.

Assessment of inhaler techniques employed by patients with respiratory diseases in southern Brazil: a population-based study*

PubMed Central

de Oliveira, Paula Duarte; Menezes, Ana Maria Baptista; Bertoldi, Andréa Dâmaso; Wehrmeister, Fernando César; Macedo, Silvia Elaine Cardozo

2014-01-01

OBJECTIVE: To identify incorrect inhaler techniques employed by patients with respiratory diseases in southern Brazil and to profile the individuals who make such errors. METHODS: This was a population-based, cross-sectional study involving subjects ≥ 10 years of age using metered dose inhalers (MDIs) or dry powder inhalers (DPIs) in 1,722 households in the city of Pelotas, Brazil. RESULTS: We included 110 subjects, who collectively used 94 MDIs and 49 DPIs. The most common errors in the use of MDIs and DPIs were not exhaling prior to inhalation (66% and 47%, respectively), not performing a breath-hold after inhalation (29% and 25%), and not shaking the MDI prior to use (21%). Individuals ≥ 60 years of age more often made such errors. Among the demonstrations of the use of MDIs and DPIs, at least one error was made in 72% and 51%, respectively. Overall, there were errors made in all steps in 11% of the demonstrations, whereas there were no errors made in 13%.Among the individuals who made at least one error, the proportion of those with a low level of education was significantly greater than was that of those with a higher level of education, for MDIs (85% vs. 60%; p = 0.018) and for DPIs (81% vs. 35%; p = 0.010). CONCLUSIONS: In this sample, the most common errors in the use of inhalers were not exhaling prior to inhalation, not performing a breath-hold after inhalation, and not shaking the MDI prior to use. Special attention should be given to education regarding inhaler techniques for patients of lower socioeconomic status and with less formal education, as well as for those of advanced age, because those populations are at a greater risk of committing errors in their use of inhalers. PMID:25410839

The Contributing Risk of Tobacco Use for ARDS Development in Burn-Injured Adults With Inhalation Injury.

PubMed

Afshar, Majid; Netzer, Giora; Mosier, Michael J; Cooper, Richard S; Adams, William; Burnham, Ellen L; Kovacs, Elizabeth J; Durazo-Arvizu, Ramon; Kliethermes, Stephanie

2017-11-01

This study aims to determine the relationship between tobacco use, inhalation injury, and ARDS in burn-injured adults. This study was an observational cohort of 2,485 primary burn admissions to a referral burn center between January 1, 2008 and March 15, 2015. Subjects were evaluated by methods used to account for mediation and traditional approaches (multivariable logistic regression and propensity score analysis). Mediation analysis examined both the (1) indirect effect of tobacco use via inhalation injury as the mediator on ARDS development and (2) the direct effect of tobacco use alone on ARDS development. ARDS development occurred in 6.8% ( n = 170) of the cohort. Inhalation injury occurred in 5.0% ( n = 125) of the cohort, and ARDS developed in 48.8% ( n = 83) of the subjects with inhalation injury. Tobacco use was 2-fold more common in subjects with ARDS. In the mediated model, the direct effect of tobacco use on ARDS, including interaction between tobacco use and inhalation injury, was not significant (odds ratio [OR] 1.63, 95% CI 0.91-2.92, P = .10). However, the indirect effect of tobacco use via inhalation injury as the mediator was significant (OR 1.61, 95% CI 1.25-2.07, P < .001), and the proportion of the total effect of tobacco use operating through the mediator was 55.6%. In the non-mediation models (multivariable logistic regression and propensity score analysis), which controlled for inhalation injury and other covariables, the OR for the association between tobacco use and ARDS was 1.84 (95% CI 1.22-2.81, P < .001) and 1.69 (95% CI 1.04-2.75, P = .03), respectively. In mediation analysis, inhalation injury was the overwhelming predictor for ARDS development, whereas tobacco use has its strongest effect indirectly through inhalation injury. Patients with at least moderate inhalation injury are at greatest risk for ARDS development despite baseline risk factors like tobacco use. Copyright © 2017 by Daedalus Enterprises.

A randomised open-label cross-over study of inhaler errors, preference and time to achieve correct inhaler use in patients with COPD or asthma: comparison of ELLIPTA with other inhaler devices

PubMed Central

van der Palen, Job; Thomas, Mike; Chrystyn, Henry; Sharma, Raj K; van der Valk, Paul DLPM; Goosens, Martijn; Wilkinson, Tom; Stonham, Carol; Chauhan, Anoop J; Imber, Varsha; Zhu, Chang-Qing; Svedsater, Henrik; Barnes, Neil C

2016-01-01

Errors in the use of different inhalers were investigated in patients naive to the devices under investigation in a multicentre, single-visit, randomised, open-label, cross-over study. Patients with chronic obstructive pulmonary disease (COPD) or asthma were assigned to ELLIPTA vs DISKUS (Accuhaler), metered-dose inhaler (MDI) or Turbuhaler. Patients with COPD were also assigned to ELLIPTA vs Handihaler or Breezhaler. Patients demonstrated inhaler use after reading the patient information leaflet (PIL). A trained investigator assessed critical errors (i.e., those likely to result in the inhalation of significantly reduced, minimal or no medication). If the patient made errors, the investigator demonstrated the correct use of the inhaler, and the patient demonstrated inhaler use again. Fewer COPD patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS, 9/171 (5%) vs 75/171 (44%); MDI, 10/80 (13%) vs 48/80 (60%); Turbuhaler, 8/100 (8%) vs 44/100 (44%); Handihaler, 17/118 (14%) vs 57/118 (48%); Breezhaler, 13/98 (13%) vs 45/98 (46%; all P<0.001). Most patients (57–70%) made no errors using ELLIPTA and did not require investigator instruction. Instruction was required for DISKUS (65%), MDI (85%), Turbuhaler (71%), Handihaler (62%) and Breezhaler (56%). Fewer asthma patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS (3/70 (4%) vs 9/70 (13%), P=0.221); MDI (2/32 (6%) vs 8/32 (25%), P=0.074) and significantly fewer vs Turbuhaler (3/60 (5%) vs 20/60 (33%), P<0.001). More asthma and COPD patients preferred ELLIPTA over the other devices (all P⩽0.002). Significantly, fewer COPD patients using ELLIPTA made critical errors after reading the PIL vs other inhalers. More asthma and COPD patients preferred ELLIPTA over comparator inhalers. PMID:27883002

Oral candidiasis associated with inhaled corticosteroid use: comparison of fluticasone and beclomethasone.

PubMed

Fukushima, Chizu; Matsuse, Hiroto; Tomari, Shinya; Obase, Yasushi; Miyazaki, Yoshitsugu; Shimoda, Terufumi; Kohno, Shigeru

2003-06-01

Inhaled steroids such as fluticasone propionate and beclomethasone dipropionate play a central role in the treatment of bronchial asthma. Fluticasone exhibits excellent clinical effectiveness; however, oral adverse effects can occur. To compare the frequency of oral candidiasis in asthmatic patients treated with fluticasone and beclomethasone, to evaluate the effect of gargling with amphotericin B, and to measure the inhalation flow rate on candidiasis. The study consisted of 143 asthmatic patients who were treated with inhaled steroids, 11 asthmatic patients not treated with inhaled steroids, and 86 healthy volunteers. Quantitative fungal culture was performed by aseptically obtaining a retropharyngeal wall swab from these patients. Patients with positive results were treated with gargling using a 1:50 dilution amphotericin B solution. In asthmatic patients treated with fluticasone, the inhalation flow rate was measured using an inspiratory flow meter. The amount of Candida spp. was significantly greater in asthmatic patients taking inhaled steroids compared with those who were not. It was also significantly greater in patients with oral symptoms than asymptomatic patients and significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone. Although the presence of Candida did not correlate with the inhaled dose of beclomethasone, it did increase with the dose of fluticasone. Gargling with amphotericin B was effective in most asthmatic patients with candidiasis. Candidiasis was not due to inappropriate flow rates during inhalation of steroids. Fungal culture of a retropharyngeal wall swab may be useful for predicting the risk of developing oral candidiasis in asthmatic patients treated with inhaled steroids. The amount of isolated Candida was significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone. Attention to dosage is required as the amount of Candida increased with dose of fluticasone. Gargling with a 1:50 dilution of amphotericin B is effective in treating oral candidiasis of asthmatic patients treated with inhaled steroids.

Social stigma stops adolescents from using inhalers for asthma.

PubMed

2017-07-10

Forgetfulness, poor routines, inadequate inhaler technique, organisational difficulties and families not understanding or accepting their children's asthma are described as barriers to the use of inhalers among adolescents with asthma.

46 CFR 160.041-4 - Contents.

Code of Federal Regulations, 2013 CFR

2013-10-01

... inhalants 10 do 1 Iodine applicators (1/2 ml swab type) 10 do 1 Aspirin, phenacetin and caffeine compound... Ammonia inhalants Break one and inhale for faintness, fainting, or collapse. Aspirin, phenacetin, caffeine...

46 CFR 160.041-4 - Contents.

Code of Federal Regulations, 2014 CFR

2014-10-01

... inhalants 10 do 1 Iodine applicators (1/2 ml swab type) 10 do 1 Aspirin, phenacetin and caffeine compound... Ammonia inhalants Break one and inhale for faintness, fainting, or collapse. Aspirin, phenacetin, caffeine...