Canada’s highest court unchains injection drug users; implications for harm reduction as standard of healthcare

PubMed Central

2012-01-01

North America’s only supervised injection facility, Insite, opened its doors in September of 2003 with a federal exemption as a three-year scientific study. The results of the study, evaluated by an independent research team, showed it to be successful in engaging the target group in healthcare, preventing overdose death and HIV infections while increasing uptake and retention in detox and treatment. The research, published in peer-reviewed medical and scientific journals, also showed that the program did not increase public disorder, crime or drug use. Despite the substantial evidence showing the effectiveness of the program, the future of Insite came under threat with the election of a conservative federal government in 2006. As a result, the PHS Community Services Society (PHS), the non-profit organization that operates Insite, launched a legal case to protect the program. On 30 September 2011, Supreme Court of Canada ruled in favour of Insite and underscored the rights of people with addictions to the security of their person under section 7 of the Charter of Rights and Freedoms (Charter of Rights). The decision clears the ground for other jurisdictions in Canada, and perhaps North America, to implement supervised injection and harm reduction where it is epidemiologically indicated. The legal case validates the personhood of people with addictions while metaphorically unchaining them from the criminal justice system. PMID:22817679

Initial experiences and innovations in supervising community health workers for maternal, newborn, and child health in Morogoro region, Tanzania.

PubMed

Roberton, Timothy; Applegate, Jennifer; Lefevre, Amnesty E; Mosha, Idda; Cooper, Chelsea M; Silverman, Marissa; Feldhaus, Isabelle; Chebet, Joy J; Mpembeni, Rose; Semu, Helen; Killewo, Japhet; Winch, Peter; Baqui, Abdullah H; George, Asha S

2015-04-09

Supervision is meant to improve the performance and motivation of community health workers (CHWs). However, most evidence on supervision relates to facility health workers. The Integrated Maternal, Newborn, and Child Health (MNCH) Program in Morogoro region, Tanzania, implemented a CHW pilot with a cascade supervision model where facility health workers were trained in supportive supervision for volunteer CHWs, supported by regional and district staff, and with village leaders to further support CHWs. We examine the initial experiences of CHWs, their supervisors, and village leaders to understand the strengths and challenges of such a supervision model for CHWs. Quantitative and qualitative data were collected concurrently from CHWs, supervisors, and village leaders. A survey was administered to 228 (96%) of the CHWs in the Integrated MNCH Program and semi-structured interviews were conducted with 15 CHWs, 8 supervisors, and 15 village leaders purposefully sampled to represent different actor perspectives from health centre catchment villages in Morogoro region. Descriptive statistics analysed the frequency and content of CHW supervision, while thematic content analysis explored CHW, supervisor, and village leader experiences with CHW supervision. CHWs meet with their facility-based supervisors an average of 1.2 times per month. CHWs value supervision and appreciate the sense of legitimacy that arises when supervisors visit them in their village. Village leaders and district staff are engaged and committed to supporting CHWs. Despite these successes, facility-based supervisors visit CHWs in their village an average of only once every 2.8 months, CHWs and supervisors still see supervision primarily as an opportunity to check reports, and meetings with district staff are infrequent and not well scheduled. Supervision of CHWs could be strengthened by streamlining supervision protocols to focus less on report checking and more on problem solving and skills development. Facility health workers, while important for technical oversight, may not be the best mentors for certain tasks such as community relationship-building. We suggest further exploring CHW supervision innovations, such as an enhanced role for community actors, who may be more suitable to support CHWs engaged primarily in health promotion than scarce and over-worked facility health workers.

Methodology for the Randomised Injecting Opioid Treatment Trial (RIOTT): evaluating injectable methadone and injectable heroin treatment versus optimised oral methadone treatment in the UK

PubMed Central

Lintzeris, Nicholas; Strang, John; Metrebian, Nicola; Byford, Sarah; Hallam, Christopher; Lee, Sally; Zador, Deborah

2006-01-01

Whilst unsupervised injectable methadone and diamorphine treatment has been part of the British treatment system for decades, the numbers receiving injectable opioid treatment (IOT) has been steadily diminishing in recent years. In contrast, there has been a recent expansion of supervised injectable diamorphine programs under trial conditions in a number of European and North American cities, although the evidence regarding the safety, efficacy and cost effectiveness of this treatment approach remains equivocal. Recent British clinical guidance indicates that IOT should be a second-line treatment for those patients in high-quality oral methadone treatment who continue to regularly inject heroin, and that treatment be initiated in newly-developed supervised injecting clinics. The Randomised Injectable Opioid Treatment Trial (RIOTT) is a multisite, prospective open-label randomised controlled trial (RCT) examining the role of treatment with injected opioids (methadone and heroin) for the management of heroin dependence in patients not responding to conventional substitution treatment. Specifically, the study examines whether efforts should be made to optimise methadone treatment for such patients (e.g. regular attendance, supervised dosing, high oral doses, access to psychosocial services), or whether such patients should be treated with injected methadone or heroin. Eligible patients (in oral substitution treatment and injecting illicit heroin on a regular basis) are randomised to one of three conditions: (1) optimized oral methadone treatment (Control group); (2) injected methadone treatment; or (3) injected heroin treatment (with access to oral methadone doses). Subjects are followed up for 6-months, with between-group comparisons on an intention-to-treat basis across a range of outcome measures. The primary outcome is the proportion of patients who discontinue regular illicit heroin use (operationalised as providing >50% urine drug screens negative for markers of illicit heroin in months 4 to 6). Secondary outcomes include measures of other drug use, injecting practices, health and psychosocial functioning, criminal activity, patient satisfaction and incremental cost effectiveness. The study aims to recruit 150 subjects, with 50 patients per group, and is to be conducted in supervised injecting clinics across England. PMID:17002810

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.

33 CFR 6.12-1 - General supervision and control.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false General supervision and control... GENERAL PROTECTION AND SECURITY OF VESSELS, HARBORS, AND WATERFRONT FACILITIES Supervision and Control of Explosives or Other Dangerous Cargo § 6.12-1 General supervision and control. The Captain of the Port may...

33 CFR 6.12-1 - General supervision and control.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false General supervision and control... GENERAL PROTECTION AND SECURITY OF VESSELS, HARBORS, AND WATERFRONT FACILITIES Supervision and Control of Explosives or Other Dangerous Cargo § 6.12-1 General supervision and control. The Captain of the Port may...

33 CFR 6.12-1 - General supervision and control.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false General supervision and control... GENERAL PROTECTION AND SECURITY OF VESSELS, HARBORS, AND WATERFRONT FACILITIES Supervision and Control of Explosives or Other Dangerous Cargo § 6.12-1 General supervision and control. The Captain of the Port may...

33 CFR 6.12-1 - General supervision and control.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false General supervision and control... GENERAL PROTECTION AND SECURITY OF VESSELS, HARBORS, AND WATERFRONT FACILITIES Supervision and Control of Explosives or Other Dangerous Cargo § 6.12-1 General supervision and control. The Captain of the Port may...

33 CFR 6.12-1 - General supervision and control.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false General supervision and control... GENERAL PROTECTION AND SECURITY OF VESSELS, HARBORS, AND WATERFRONT FACILITIES Supervision and Control of Explosives or Other Dangerous Cargo § 6.12-1 General supervision and control. The Captain of the Port may...

33 CFR 126.29 - Supervision and control of dangerous cargo.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 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...

33 CFR 126.29 - Supervision and control of dangerous cargo.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 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...

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.

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.

A novel non-opioid protocol for medically supervised opioid withdrawal and transition to antagonist treatment.

PubMed

Rudolf, Gregory; Walsh, Jim; Plawman, Abigail; Gianutsos, Paul; Alto, William; Mancl, Lloyd; Rudolf, Vania

2018-01-01

The clinical feasibility of a novel non-opioid and benzodiazepine-free protocol was assessed for the treatment of medically supervised opioid withdrawal and transition to subsequent relapse prevention strategies. A retrospective chart review of DSM-IV diagnosed opioid-dependent patients admitted for inpatient medically supervised withdrawal examined 84 subjects (52 males, 32 females) treated with a 4-day protocol of scheduled tizanidine, hydroxyzine, and gabapentin. Subjects also received ancillary medications as needed, and routine counseling. Primary outcomes were completion of medically supervised withdrawal, and initiation of injectable extended release (ER) naltrexone treatment. Secondary outcomes included the length of hospital stay, Clinical Opiate Withdrawal Scale (COWS) scores, and facilitation to substance use disorder treatment intervention. Ancillary medication use and adverse effects were also assessed. A total of 79 (94%) of subjects completed medically supervised withdrawal. A total of 27 (32%) subjects chose to pursue transition to ER naltrexone, and 24 of the 27 (89%) successfully received the injection prior to hospital discharge. The protocol subjects had a mean length of hospital stay of 3.6 days, and the mean COWS scores was 3.3, 3.4, 2.8, and 2.4 on Day 1, 2, 3, and 4, respectively. Furthermore, 71 (85%) engaged in an inpatient or outpatient substance use disorder (SUD) treatment program following protocol completion. This retrospective chart review suggests the feasibility of a novel protocol for medically supervised opioid withdrawal and transition to relapse prevention strategies, including injectable ER naltrexone. This withdrawal protocol does not utilize opioid agonists or other controlled substances.‬‬‬‬.

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

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...

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...

Drug use in business bathrooms: An exploratory study of manager encounters in New York City

PubMed Central

Wolfson-Stofko, Brett; Bennett, Alex S.; Elliott, Luther; Curtis, Ric

2017-01-01

Background Though public bathroom drug injection has been documented from the perspective of people who inject drugs, no research has explored the experiences of the business managers who oversee their business bathrooms and respond to drug use. These managers, by default, are first-responders in the event of a drug overdose and thus of intrinsic interest during the current epidemic of opioid-related overdoses in the United States. This exploratory study assists in elucidating the experiences that New York City business managers have with people who inject drugs, their paraphernalia, and their overdoses. Methods A survey instrument was designed to collect data on manager encounters with drug use occurring in their business bathrooms. Recruitment was guided by convenience and purposive approaches. Results More than half of managers interviewed (58%, n = 50/86) encountered drug use in their business bathrooms, more than a third (34%) of these managers also found syringes, and the vast majority (90%) of managers had received no overdose recognition or naloxone training. Seven managers encountered unresponsive individuals who required emergency assistance. Conclusion The results from this study underscore the need for additional research on the experiences that community stakeholders have with public injection as well as educational outreach efforts among business managers. This research also suggests that there is need for a national dialogue about potential interventions, including expanded overdose recognition and naloxone training and supervised injection facilities (SIF)/drug consumption rooms (DCR), that could reduce public injection and its associated health risks. PMID:27768996

Sterilizable syringes: excessive risk or cost-effective option?

PubMed Central

Battersby, A.; Feilden, R.; Nelson, C.

1999-01-01

In recent years, many poorer countries have chosen to use disposable instead of sterilizable syringes. Unfortunately, the infrastructure and management systems that are vital if disposables are to be used safely do not exist. WHO estimates that up to 30% of injections administered are unsafe. The traditional sterilizable syringe had many disadvantages, some of which have been minimized through better design and the use of modern materials; others have been overcome because staff are able to demonstrate that they have performed safely. For example, the time-steam saturation-temperature (TST) indicator has enabled staff to demonstrate that a sterilizing cycle has been successfully completed. Health facility staff must be able to sterilize equipment, and the sterilizable syringe remains the least costly means of administering an injection. Data from countries that have acceptable systems for processing clinical waste indicate that safe and environmentally acceptable disposal, destruction and final containment cost nearly as much as the original cost of a disposable syringe. By careful supervision of staff behaviour and good management, some countries have demonstrated that they are able to administer safe injections with sterilizable syringes at a price they can afford. PMID:10593029

[Developing traditional Chinese medicine injection is the need for curing sickness to save patients].

PubMed

He, Ping; Li, Feng-Jie; Li, Lian-da; Li, Yi-Kui

2017-03-01

Safety issues of traditional Chinese medicine injections has been heated debate. There are two diametrically opposed views: it should be used reasonable and developed healthily or be forbidden to use. Some people have many misunderstandings and prejudices about the safety of traditional Chinese medicine injections. Compared with western medicine,traditional Chinese medicine has its own particularity. Traditional Chinese medicine has complex components. Its research and clinical application is different from western medicine. Adverse reactions of traditional Chinese medicine injections are related to many factors,such as a large number of irrational use,blind use of traditional Chinese medicine injections and western medicine injections,counterfeit and substandard drugs,incorrect methods of intravenous infusion,toxicity of supplementary materials,drug ingredients. Developing traditional Chinese medicine injection is the need for curing sickness to save patients. The purposeful, targeted, organized and planned systematic research of traditional Chinese medicine injections should be strengthened,especially the safety of traditional Chinese medicine. Strengthen supervision and control of rational drug use.Strengthen the examination and approval,supervision and management of all aspects to ensure the safety of patients. Copyright© by the Chinese Pharmaceutical Association.

Diversion and injection of buprenorphine-naloxone film two years post-introduction in Australia.

PubMed

Larance, Briony; Mattick, Richard; Ali, Robert; Lintzeris, Nicholas; Jenkinson, Rebecca; White, Nancy; Kihas, Ivana; Cassidy, Rosemary; Degenhardt, Louisa

2016-01-01

We report 2 years of post-marketing surveillance of the diversion and injection of buprenorphine-naloxone (BNX) film following its introduction in 2011. Interviews were conducted with people who inject drugs regularly (PWID) (2004-2013), opioid substitution therapy clients (2013, n = 492) and key experts (n = 44). Key outcomes were unsanctioned removal of supervised doses, diversion, injection and street price. Prevalence of past 6-month injection among PWID was adjusted for background availability of opioid substitution therapy medications using sales data. Among out-of-treatment PWID, the levels of regular (weekly+) BNX film injection were comparable to methadone and BNX tablets, and lower than mono-buprenorphine, adjusting for background availability. Fewer BNX film clients [3%; 95% (CI) 1-5] regularly injected their medication than mono-buprenorphine clients (25%; 95% CI 11-39), but at levels equivalent to those among methadone (3%; 95% CI 1-6) and BNX tablet clients (2%; 95% CI 0-6). Key experts perceived BNX film needed less supervised dosing time as it dissolved rapidly and was harder to remove from the mouth than sublingual tablets; however, removal of supervised doses was higher among BNX film clients (15%; 95% CI: 10-20) than methadone clients (3%; 95% CI 1-6), and not significantly different from BNX tablet (11%; 95% CI 2-21) and mono-buprenorphine clients (31%; 95% CI 16-46). Two years post-introduction, levels of BNX film diversion and injection remained comparable with those for methadone and BNX tablets, and lower than mono-buprenorphine. We found no evidence that BNX film has lower non-adherence and diversion than the tablet formulation. [Larance B, Mattick R, Ali R, Lintzeris N, Jenkinson R, White N, Kihas I, Cassidy R, Degenhardt L. Diversion and injection of buprenorphine-naloxone film two years post-introduction in Australia. Drug Alcohol Rev 2015]. © 2015 Australasian Professional Society on Alcohol and other Drugs.

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.

Drug use in business bathrooms: An exploratory study of manager encounters in New York City.

PubMed

Wolfson-Stofko, Brett; Bennett, Alex S; Elliott, Luther; Curtis, Ric

2017-01-01

Though public bathroom drug injection has been documented from the perspective of people who inject drugs, no research has explored the experiences of the business managers who oversee their business bathrooms and respond to drug use. These managers, by default, are first-responders in the event of a drug overdose and thus of intrinsic interest during the current epidemic of opioid-related overdoses in the United States. This exploratory study assists in elucidating the experiences that New York City business managers have with people who inject drugs, their paraphernalia, and their overdoses. A survey instrument was designed to collect data on manager encounters with drug use occurring in their business bathrooms. Recruitment was guided by convenience and purposive approaches. More than half of managers interviewed (58%, n=50/86) encountered drug use in their business bathrooms, more than a third (34%) of these managers also found syringes, and the vast majority (90%) of managers had received no overdose recognition or naloxone training. Seven managers encountered unresponsive individuals who required emergency assistance. The results from this study underscore the need for additional research on the experiences that community stakeholders have with public injection as well as educational outreach efforts among business managers. This research also suggests that there is need for a national dialogue about potential interventions, including expanded overdose recognition and naloxone training and supervised injection facilities (SIF)/drug consumption rooms (DCR), that could reduce public injection and its associated health risks. Copyright © 2016 Elsevier B.V. All rights reserved.

Supervised Injectable Heroin: A Clinical Perspective.

PubMed

Bell, James; Waal, Rob van der; Strang, John

2017-07-01

Six recent randomised control trials (RCTs) have suggested that supervised injectable heroin (SIH) can be effective in patients who persist in street heroin use during methadone treatment. However, short-term randomised control trials have limitations in assessing the effectiveness of treatments for addictive disorders, which are chronic and relapsing disorders of motivation. These RCTs particularly fail to capture the process of the SIH treatment and the diversity of influence and change over time. This narrative review is based on the analysis of published data. Conclusions are drawn from a process of reflection informed by experience in delivering one of the published trials, subsequent experiences in varying the way SIH is delivered, and through consideration of possible mechanisms of action of SIH. Many long-term, socially marginalised and demoralised people who are addicted to heroin experience few rewards from the stability afforded by methadone treatment. Supervised injected heroin is sufficiently reinforcing for many of these individuals to attend daily and participate in highly structured treatment. With an adequate daily dose of supervised methadone to avoid withdrawal dysphoria, occasional diamorphine injections-not necessarily twice daily, or even every day-is enough to hold people in treatment. Participation was associated with reduced amounts of non-prescribed drug use, a gradual change in self-image and attitude, and for some subjects, a movement towards social reintegration and eventual withdrawal from SIH. Prescribed heroin is sufficiently motivating to hold a proportion of recidivist addicts in long-term treatment. Participation in structured treatment provides respite from compulsive drug use, and a proportion of subjects develop sufficient rewards from social reintegration to successfully withdraw from treatment. Such change, when it occurs, is slow and stuttering.

An integrated approach to care attracts people living with HIV who use illicit drugs in an urban centre with a concentrated HIV epidemic.

PubMed

Fernando, S; McNeil, R; Closson, K; Samji, H; Kirkland, S; Strike, C; Turje, R Baltzer; Zhang, W; Hogg, R S; Parashar, S

2016-11-22

People living with HIV (PLHIV) who are also marginalized by social and structural inequities often face barriers to accessing and adhering to HIV treatment and care. The Dr. Peter Centre (DPC) is a non-profit integrated care facility with a supervised injection room that serves PLHIV experiencing multiple barriers to social and health services in Vancouver, Canada. This study examines whether the DPC is successful in drawing in PLHIV with complex health issues, including addiction. Using data collected by the Longitudinal Investigations into Supportive and Ancillary health services (LISA) study from July 2007 to January 2010, linked with clinical variables available through the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program, we identified DPC and non-DPC clients with a history of injection drug use. Bivariable and multivariable logistic regression analyses compared socio-demographic and clinical characteristics of DPC clients (n = 76) and non-DPC clients (n = 482) with a history of injection drug use. Of the 917 LISA participants included within this analysis, 100 (10.9%) reported being a DPC client, of which 76 reported a history of injection drug use. Adjusted results found that compared to non-DPC clients with a history of injection drug use, DPC-clients were more likely to be male (AOR: 4.18, 95% CI = 2.09-8.37); use supportive services daily vs. less than daily (AOR: 3.16, 95% CI = 1.79-5.61); to have been diagnosed with a mental health disorder (AOR: 2.11; 95% CI: 1.12-3.99); to have a history of interpersonal violence (AOR: 2.76; 95% CI: 1.23-6.19); and to have ever experienced ART interruption longer than 1 year (AOR: 2.39; 95% CI: 1.38-4.15). Our analyses suggest that the DPC operating care model engages PLHIV with complex care needs, highlighting that integrated care facilities are needed to support the multiple intersecting vulnerabilities faced by PLHIV with a history of injection drug use living within urban centres in North America and beyond.

Negotiating place and gendered violence in Canada's largest open drug scene.

PubMed

McNeil, Ryan; Shannon, Kate; Shaver, Laura; Kerr, Thomas; Small, Will

2014-05-01

Vancouver's Downtown Eastside is home to Canada's largest street-based drug scene and only supervised injection facility (Insite). High levels of violence among men and women have been documented in this neighbourhood. This study was undertaken to explore the role of violence in shaping the socio-spatial relations of women and 'marginal men' (i.e., those occupying subordinate positions within the drug scene) in the Downtown Eastside, including access to Insite. Semi-structured qualitative interviews were conducted with 23 people who inject drugs (PWID) recruited through the Vancouver Area Network of Drug Users, a local drug user organization. Interviews included a mapping exercise. Interview transcripts and maps were analyzed thematically, with an emphasis on how gendered violence shaped participants' spatial practices. Hegemonic forms of masculinity operating within the Downtown Eastside framed the everyday violence experienced by women and marginal men. This violence shaped the spatial practices of women and marginal men, in that they avoided drug scene milieus where they had experienced violence or that they perceived to be dangerous. Some men linked their spatial restrictions to the perceived 'dope quality' of neighbourhood drug dealers to maintain claims to dominant masculinities while enacting spatial strategies to promote safety. Environmental supports provided by health and social care agencies were critical in enabling women and marginal men to negotiate place and survival within the context of drug scene violence. Access to Insite did not motivate participants to enter into "dangerous" drug scene milieus but they did venture into these areas if necessary to obtain drugs or generate income. Gendered violence is critical in restricting the geographies of men and marginal men within the street-based drug scene. There is a need to scale up existing environmental interventions, including supervised injection services, to minimize violence and potential drug-related risks among these highly-vulnerable PWID. Copyright © 2013 Elsevier B.V. All rights reserved.

NEGOTIATING PLACE AND GENDERED VIOLENCE IN CANADA’S LARGEST OPEN DRUG SCENE

PubMed Central

McNeil, Ryan; Shannon, Kate; Shaver, Laura; Kerr, Thomas; Small, Will

2014-01-01

Background Vancouver’s Downtown Eastside is home to Canada’s largest street-based drug scene and only supervised injection facility (Insite). High levels of violence among men and women have been documented in this neighbourhood. This study was undertaken to explore the role of violence in shaping the socio-spatial relations of women and ‘marginal men’ (i.e., those occupying subordinate positions within the drug scene) in the Downtown Eastside, including access to Insite. Methods Semi-structured qualitative interviews were conducted with 23 people who inject drugs (PWID) recruited through the Vancouver Area Network of Drug Users, a local drug user organization. Interviews included a mapping exercise. Interview transcripts and maps were analyzed thematically, with an emphasis on how gendered violence shaped participants’ spatial practices. Results Hegemonic forms of masculinity operating within the Downtown Eastside framed the everyday violence experienced by women and marginal men. This violence shaped the spatial practices of women and marginal men, in that they avoided drug scene milieus where they had experienced violence or that they perceived to be dangerous. Some men linked their spatial restrictions to the perceived 'dope quality' of neighbourhood drug dealers to maintain claims to dominant masculinities while enacting spatial strategies to promote safety. Environmental supports provided by health and social care agencies were critical in enabling women and marginal men to negotiate place and survival within the context of drug scene violence. Access to Insite did not motivate participants to enter into “dangerous” drug scene milieus but they did venture into these areas if necessary to obtain drugs or generate income. Conclusion Gendered violence is critical in restricting the geographies of men and marginal men within the street-based drug scene. There is a need to scale up existing environmental interventions, including supervised injection services, to minimize violence and potential drug-related risks among these highly-vulnerable PWID. PMID:24332972

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.

Assessing support for supervised injection services among community stakeholders in London, Canada.

PubMed

Bardwell, Geoff; Scheim, Ayden; Mitra, Sanjana; Kerr, Thomas

2017-10-01

Few qualitative studies have examined support for supervised injection services (SIS), and these have been restricted to large cities. This study aimed to assess support for SIS among a diverse representation of community stakeholders in London, a mid-sized city in southwestern Ontario, Canada. This qualitative study was undertaken as part of the Ontario Integrated Supervised Injection Services Feasibility Study. We used purposive sampling methods to recruit a diversity of key informants (n=20) from five sectors: healthcare; social services; government and municipal services; police and emergency services; and the business and community sector. Interview data, collected via one-to-one semi structured interviews, were coded and analyzed using thematic analyses through NVivo 10 software. Interview participants unanimously supported the implementation of SIS in London. However, participant support for SIS was met with some implementation-related preferences and/or conditions. These included centralization or decentralization of SIS; accessibility of SIS for people who inject drugs; proximity of SIS to interview participants; and other services and strategies offered alongside SIS. The results of this study challenge the assumptions that smaller cities like London may be unlikely to support SIS. Community stakeholders were supportive of the implementation of SIS with some preferences or conditions. Interview participants had differing perspectives, but ultimately supported similar end goals of accessibility and reducing community harms associated with injection drug use. Future research and SIS programming should consider these factors when determining optimal service delivery in ways that increase support from a diversity of community stakeholders. Copyright © 2017 Elsevier B.V. All rights reserved.

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.

Closed to reason: time for accountability for the International Narcotic Control Board

PubMed Central

Small, Dan; Drucker, Ernest

2007-01-01

For more than two decades, the International Narcotic Control Board (INCB) has tried to stop harm reduction and its HIV prevention programs. This posture is based on a fundamental misunderstanding of their responsibilities and of drug addiction itself – i.e. as a public health and clinical care matter made criminal by decree. A recent focal point for the Board's action has been rejecting the use of supervised injection facilities to reduce morbidity and mortality of drug injectors. They single out individual countries and attempt to bully them into rejecting such programs under the banner of the United Nations (falsely) and in the name of international treaties. Their unrelenting and unjustified badgering of signatories to the international treaties that established the INCB is not only unjustified; it is an affront to one of the core purposes of the Board itself: to ensure adequate medical supplies and safe use of controlled substances. The INCB's ill-conceived obsession with intravenousaddiction as a crime flies in the face of the medical view and policies of the World Health Organization and the universally endorsed principles of the General Assembly of the United Nations. The latest target of the INCB is North America's only supervised injection facility, Insite, located in the inner city of Vancouver, Canada. Using the power of their office to meddle in matters of public health for individual nations is without medical, scientific or legal justification. But, most importantly, it is a matter of lifeand death for these most marginalized of citizens. The empirical evidence remains that a significant portion of the continued growth of the AIDS pandemic is due to injecting drug use, and the INCB's intrusion will inevitably result in additional deaths due to preventable HIV infections and drug overdoses. So we are very pleased to call to our readers' attention to a recent report produced by the Canadian HIV/AIDS Legal Network and the International Harm Reduction Development Program (IHRD) joined by former United Nations Special Envoy for HIV/AIDS in Africa, the respected Canadian statesman Stephen Lewis. The full report, "Closed to Reason: The International Narcotics Control Board and HIV/AIDS" is attached along [see Additional file 1] with a Russian translation of the key findings of the authors [see Additional files 2] as well as Russian and Chinese translations of this abstract [see Additional 3 and 4]. As the report makes very clear, the time to inject some accountability and reason into the INCB is now. Howmany times must a man look up Before he can see the sky Yes and how many ears Must one man have Before he can hear people cry? Yes, and how many deaths Will it take till he knows That too many people have died? Bob Dylan PMID:17488506

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.

‘Safer Environment Interventions’: A qualitative synthesis of the experiences and perceptions of people who inject drugs

PubMed Central

McNeil, Ryan; Small, Will

2014-01-01

There is growing acknowledgment that social, structural, and environmental forces produce vulnerability to health harms among people who inject drugs (PWID), and safer environment interventions (SEI) have been identified as critical to mitigating the impacts of these contextual forces on drug-related harm. To date, however, SEIs have been under-theorized in the literature, and how they minimize drug-related risks across intervention types and settings has not been adequately examined. This article presents findings from a systematic review and meta-synthesis of qualitative studies reporting PWID’s experiences with three types of SEIs (syringe exchange programmes, supervised injection facilities and peer-based harm reduction interventions) published between 1997 and 2012. This meta-synthesis seeks to develop a comprehensive understanding of SEIs informed by the experiences of PWID. Twenty-nine papers representing twenty-one unique studies that included an aggregate of more than 800 PWID were included in this meta-synthesis. This meta- synthesis found that SEIs fostered social and physical environments that mitigated drug-related harms and increased access to social and material resources. Specifically, SEIs: (1) provided refuge from street-based drug scenes; (2) enabled safer injecting by reshaping the social and environmental contexts of injection drug use; (3) mediated access to resources and health care services; and, (4) were constrained by drug prohibition and law enforcement activities. These findings indicate that it is critical to situate SEIs in relation to the lived experiences of PWID, and in particular provide broader environmental support to PWID. Given that existing drug laws limit the effectiveness of interventions, drug policy reforms are needed to enable public health, and specifically SEIs, to occupy a more prominent role in the response to injection drug use. PMID:24561777

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

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...

A randomized, controlled trial of interventions to improve adherence to isoniazid therapy to prevent tuberculosis in injection drug users.

PubMed

Chaisson, R E; Barnes, G L; Hackman, J; Watkinson, L; Kimbrough , L; Metha, S; Cavalcante, S; Moore, R D

2001-06-01

To determine the effect of several interventions on adherence to tuberculosis preventive therapy. We conducted a randomized trial with a factorial design comparing strategies for improving adherence to isoniazid preventive therapy in 300 injection drug users with reactive tuberculin tests and no evidence of active tuberculosis. Patients were assigned to receive directly observed isoniazid preventive therapy twice weekly (Supervised group, n = 99), daily self-administered isoniazid with peer counseling and education (Peer group, n = 101), or routine care (Routine group, n = 100). Patients within each arm were also randomly assigned to receive an immediate or deferred monthly $10 stipend for maintaining adherence. The endpoints of the trial were completing 6 months of treatment, pill-taking as measured by self-report or observation, isoniazid metabolites present in urine, and bottle opening as determined by electronic monitors in a subset of patients. Completion of therapy was 80% for patients in the Supervised group, 78% in the Peer group, and 79% in the Routine group (P = 0.70). Completion was 83% (125 of 150) among patients receiving immediate incentives versus 75% (112 of 150) among patients with deferred incentives (P = 0.09). The proportion of patients who were observed or reported taking at least 80% of their doses was 82% for the Supervised arm of the study, compared with 71% for the Peer arm and 90% for the Routine arm. The proportion of patients who took 100% of doses was 77% for the Supervised arm (by observation), 6% for the Peer arm (by report), and 10% for the Routine arm (by report; P <0.001). Direct observation showed the median proportion of doses taken by the Supervised group was 100%, while electronic monitoring in a subset of patients showed the Peer group (n = 27) took 57% of prescribed doses and the Routine group (n = 32) took 49% (P <0.001). Patients in the Routine arm overreported adherence by twofold when data from electronic monitoring were used as a gold standard. There were no significant differences in electronically monitored adherence by type of incentive. Adherence to isoniazid preventive therapy by injection drug users is best with supervised care. Peer counseling improves adherence over routine care, as measured by electronic monitoring of pill caps, and patients receiving peer counseling more accurately reported their adherence. More widespread use of supervised care could contribute to reductions in tuberculosis rates among drug users and possibly other high-risk groups.

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

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;…

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.

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)

Affordance Templates for Shared Robot Control

NASA Technical Reports Server (NTRS)

Hart, Stephen; Dinh, Paul; Hambuchen, Kim

2014-01-01

This paper introduces the Affordance Template framework used to supervise task behaviors on the NASA-JSC Valkyrie robot at the 2013 DARPA Robotics Challenge (DRC) Trials. This framework provides graphical interfaces to human supervisors that are adjustable based on the run-time environmental context (e.g., size, location, and shape of objects that the robot must interact with, etc.). Additional improvements, described below, inject degrees of autonomy into instantiations of affordance templates at run-time in order to enable efficient human supervision of the robot for accomplishing tasks.

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...

[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.

Assessment of injection practice in primary health care facilities of Shiraz, Iran.

PubMed

Mclaws, Mary-Louise; Ghahramani, Sulmaz; Palenik, Charles John; Keshtkar, Vahid; Askarian, Mehrdad

2014-03-01

Occupational risk for several bloodborne viruses is attributable to unsafe injection practices. To understand injection frequency and safety, we surveyed injection rates and factors influencing injection prescription in primary health care facilities and associated health clinics in Shiraz, Iran. We used both quantitative and qualitative approaches to study the frequency and safety of injections delivered in 27 primary health care facilities. We used observations and 3 data collecting tools. Patterns of 600 general practice physicians' (GPs) prescriptions were also reviewed. In-depth interviews to elicit the factors contributing to injection prescriptions were conducted. The annual per capita injection rate was 3.12. Corticosteroids were prescribed more frequently than antibiotics (P < .001). Knowledge of participants concerning transmission risks for 3 of the most common bloodborne infections (BBIs) was less than 75%. Factors affecting use of injections by GPs included strong patient preference for injections over oral medications and financial benefit for GPs, especially those in private practice settings. Frequency of therapeutic injections in the participating facilities in Shiraz was high. Sociocultural factors in the patient community and their beliefs in the effectiveness of injections exerted influence on GP prescribing practices. Programs for appropriate and safe injection practices should target GP and injection providers, as well as patients, informing them about alternative treatments and possible complications of unnecessary and unsafe injections. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Safer injections following a new national medicine policy in the public sector, Burkina Faso 1995 – 2000

PubMed Central

Logez, Sophie; Hutin, Yvan; Somda, Paul; Thuault, Jérôme; Holloway, Kathleen

2005-01-01

Background The common failure of health systems to ensure adequate and sufficient supplies of injection devices may have a negative impact on injection safety. We conducted an assessment in April 2001 to determine to which extent an increase in safe injection practices between 1995 and 2000 was related to the increased access to injection devices because of a new essential medicine policy in Burkina Faso. Methods We reviewed outcomes of the new medicine policy implemented in1995. In April 2001, a retrospective programme review assessed the situation between 1995 and 2000. We visited 52 health care facilities where injections had been observed during a 2000 injection safety assessment and their adjacent operational public pharmaceutical depots. Data collection included structured observations of available injection devices and an estimation of the proportion of prescriptions including at least one injection. We interviewed wholesaler managers at national and regional levels on supply of injection devices to public health facilities. Results Fifty of 52 (96%) health care facilities were equipped with a pharmaceutical depot selling syringes and needles, 37 (74%) of which had been established between 1995 and 2000. Of 50 pharmaceutical depots, 96% had single-use 5 ml syringes available. At all facilities, patients were buying syringes and needles out of the depot for their injections prescribed at the dispensary. While injection devices were available in greater quantities, the proportion of prescriptions including at least one injection remained stable between 1995 (26.5 %) and 2000 (23.8 %). Conclusion The implementation of pharmaceutical depots next to public health care facilities increased geographical access to essential medicines and basic supplies, among which syringes and needles, contributing substantially to safer injection practices in the absence of increased use of therapeutic injections. PMID:16364178

Acceptability and design preferences of supervised injection services among people who inject drugs in a mid-sized Canadian City.

PubMed

Mitra, Sanjana; Rachlis, Beth; Scheim, Ayden; Bardwell, Geoff; Rourke, Sean B; Kerr, Thomas

2017-07-14

Supervised injection services (SIS) have been shown to reduce the public- and individual-level harms associated with injection drug use. While SIS feasibility research has been conducted in large urban centres, little is known about the acceptability of these services among people who inject drugs (PWID) in mid-sized cities. We assessed the prevalence and correlates of willingness to use SIS as well as design and operational preferences among PWID in London, Canada. Between March and April 2016, peer research associates administered a cross-sectional survey to PWID in London. Socio-demographic characteristics, drug-use patterns, and behaviours associated with willingness to use SIS were estimated using bivariable and multivariable logistic regression models. Chi-square tests were used to compare characteristics with expected frequency of SIS use among those willing to use SIS. Design and operational preferences are also described. Of 197 PWID included in this analysis (median age, 39; interquartile range (IQR), 33-50; 38% female), 170 (86%) reported willingness to use SIS. In multivariable analyses, being female (adjusted odds ratio (AOR) 0.29; 95% confidence interval (CI) 0.11-0.75) was negatively associated with willingness to use, while public injecting in the last 6 months (AOR 2.76; 95% CI 1.00-7.62) was positively associated with willingness to use. Participants living in unstable housing, those injecting in public, and those injecting opioids and crystal methamphetamine daily reported higher expected frequency of SIS use (p < 0.05). A majority preferred private cubicles for injecting spaces and daytime operational hours, while just under half preferred PWID involved in service operations. High levels of willingness to use SIS were found among PWID in this setting, suggesting that these services may play a role in addressing the harms associated with injection drug use. To maximize the uptake of SIS, programme planners and policy makers should consider the effects of gender and views of PWID regarding SIS design and operational preferences.

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.

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...

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.

Production and Injection data for NV Binary facilities

DOE Data Explorer

Mines, Greg

2013-12-24

Excel files are provided with well production and injection data for binary facilities in Nevada. The files contain the data that reported montly to the Nevada Bureau of Mines and Geology (NBMG) by the facility operators. this data has been complied into Excel spreadsheets for each of the facilities given on the NBMG web site.

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

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.

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.

"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...

Study of status of safe injection practice and knowledge regarding injection safety among primary health care workers in Baglung district, western Nepal.

PubMed

Gyawali, Sudesh; Rathore, Devendra S; Kc, Bhuvan; Shankar, P Ravi

2013-01-03

Unsafe injection practices and injection overuse are widespread in developing countries harming the patient and inviting risks to the health care workers. In Nepal, there is a dearth of documented information about injection practices so the present study was carried out: a) to determine whether the selected government health facilities satisfy the conditions for safe injections in terms of staff training, availability of sterile injectable equipment and their proper disposal after use and b) to assess knowledge and attitudes of healthcare workers in these health care facilities with regard to injection safety. A descriptive cross-sectional mixed type (qualitative and quantitative) survey was carried out from 18th May to 16th June 2012. In-depth interviews with the in-charges were conducted using a semi-structured questionnaire. Observation of the health facilities using a structured observation tool was done. The data were analysed manually by summarizing, tabulating and presenting in various formats. The in-charges (eight males, two females) who participated in the study ranged in age from 30 to 50 years with a mean age of 37.8 years. Severe infection followed by pain was the most important cause for injection use with injection Gentamicin being most commonly prescribed. New single use (disposable) injections and auto-disable syringes were used to inject curative drugs and vaccines respectively. Sufficient safety boxes were also supplied to dispose the used syringe. All health care workers had received full course of Hepatitis B vaccine and were knowledgeable about at least one pathogen transmitted through unsafe injection practices. Injection safety management policy and waste disposal guideline was not available for viewing in any of the facilities. The office staff who disposed the bio-medical wastes did so without taking any safety measures. Moreover, none of these staff had received any formal training in waste management. Certain safe injection practices were noticed in the studied health care facilities but there remain a number of grey areas where unsafe practices still persists placing patient and health workers at risk of associated hazards. Training concentrating on injection safety, guidelines to dispose biomedical waste and monitoring of the activity is needed.

Study of status of safe injection practice and knowledge regarding injection safety among primary health care workers in Baglung district, western Nepal

PubMed Central

2013-01-01

Background Unsafe injection practices and injection overuse are widespread in developing countries harming the patient and inviting risks to the health care workers. In Nepal, there is a dearth of documented information about injection practices so the present study was carried out: a) to determine whether the selected government health facilities satisfy the conditions for safe injections in terms of staff training, availability of sterile injectable equipment and their proper disposal after use and b) to assess knowledge and attitudes of healthcare workers in these health care facilities with regard to injection safety. Methodology A descriptive cross-sectional mixed type (qualitative and quantitative) survey was carried out from 18th May to 16th June 2012. In-depth interviews with the in-charges were conducted using a semi-structured questionnaire. Observation of the health facilities using a structured observation tool was done. The data were analysed manually by summarizing, tabulating and presenting in various formats. Results The in-charges (eight males, two females) who participated in the study ranged in age from 30 to 50 years with a mean age of 37.8 years. Severe infection followed by pain was the most important cause for injection use with injection Gentamicin being most commonly prescribed. New single use (disposable) injections and auto-disable syringes were used to inject curative drugs and vaccines respectively. Sufficient safety boxes were also supplied to dispose the used syringe. All health care workers had received full course of Hepatitis B vaccine and were knowledgeable about at least one pathogen transmitted through unsafe injection practices. Injection safety management policy and waste disposal guideline was not available for viewing in any of the facilities. The office staff who disposed the bio-medical wastes did so without taking any safety measures. Moreover, none of these staff had received any formal training in waste management. Conclusions Certain safe injection practices were noticed in the studied health care facilities but there remain a number of grey areas where unsafe practices still persists placing patient and health workers at risk of associated hazards. Training concentrating on injection safety, guidelines to dispose biomedical waste and monitoring of the activity is needed. PMID:23286907

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...

Return to Galileo? The Inquisition of the International Narcotic Control Board.

PubMed

Small, Dan; Drucker, Ernest

2008-05-07

Nearly 400 years after Galileo Galilei of Florence was arraigned and convicted of suspected heresy by the ten member Congregation of the Holy Office (Inquisition), the International Narcotic Control Board (INCB) is similarly inserting itself into matters pertaining to innovations in healthcare and the public health response to addiction throughout the world. Like that earlier Inquisition of 1633 that convicted Galileo of heresy for holding that the sun is the centre of the universe with the earth revolving around it (in contradiction to church doctrine of the time) the INCB and its thirteen-member panel, now rails against any evidence out of sync with the established doctrine of the war on drugs--particularly those innovations in public health called harm reduction. The latest healthcare and harm reduction practices to attract the ire of the INCB Inquisition are elements of Canada's most effective and innovative measures to minimize the harms of drugs in Vancouver--supervised injection facilities and, recently, the potential establishment of supervised inhalation rooms--along with the long established practice of providing safer mouthpieces for pulmonary inhalation in British Columbia. This is particularly significant as it comes in the midst of a crucial battle between municipal and provincial authorities in BC with the federal government in Ottawa, which seems determined to undermine all the most effective HR programs that are the result of years of steady local and governmental support in Vancouver and now threatens to derail all these programs and spread doubt about their usefulness despite the overwhelmingly positive findings of serous research.

Return to Galileo? The Inquisition of the International Narcotic Control Board

PubMed Central

Small, Dan; Drucker, Ernest

2008-01-01

Nearly 400 years after Galileo Galilei of Florence was arraigned and convicted of suspected heresy by the ten member Congregation of the Holy Office (Inquisition), the International Narcotic Control Board (INCB) is similarly inserting itself into matters pertaining to innovations in healthcare and the public health response to addiction throughout the world. Like that earlier Inquisition of 1633 that convicted Galileo of heresy for holding that the sun is the centre of the universe with the earth revolving around it (in contradiction to church doctrine of the time) the INCB and its thirteen-member panel, now rails against any evidence out of sync with the established doctrine of the war on drugs – particularly those innovations in public health called harm reduction. The latest healthcare and harm reduction practices to attract the ire of the INCB Inquisition are elements of Canada's most effective and innovative measures to minimize the harms of drugs in Vancouver – supervised injection facilities and, recently, the potential establishment of supervised inhalation rooms – along with the long established practice of providing safer mouthpieces for pulmonary inhalation in British Columbia. This is particularly significant as it comes in the midst of a crucial battle between municipal and provincial authorities in BC with the federal government in Ottawa, which seems determined to undermine all the most effective HR programs that are the result of years of steady local and governmental support in Vancouver and now threatens to derail all these programs and spread doubt about their usefulness despite the overwhelmingly positive findings of serous research. PMID:18462501

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.

Harm-reduction activism: a case study of an unsanctioned user-run safe injection site.

PubMed

Kerr, Thomas; Oleson, Megan; Wood, Evan

2004-08-01

Due to the ongoing health crisis among injection drug users in Vancouver, Canada, there have been repeated calls for the establishment of safe injection sites (SISs) since the early 1990s. In April 2003, in response to a large-scale police crackdown and government inaction, a group of activists opened an unsanctioned SIS in Vancouver's Downtown Eastside (DTES). The 327 Carrall Street SIS operated for 181 days despite considerable police harassment and limited financial support. During the operation of the SIS, volunteers supervised over 3000 injections and demonstrated the feasibility of a user-run low-threshold SIS. The experience of the SIS provides valuable lessons for those seeking to advance the interests of injection drug users through community mobilization and direct action approaches. In this article, Thomas Kerr, Megan Oleson, and Evan Wood describe the events surrounding the establishment, operation, and closing of the unsanctioned SIS, and outline the lessons learned.

Automated transient identification in the Dark Energy Survey

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

Goldstein, D. A.

2015-08-20

We describe an algorithm for identifying point-source transients and moving objects on reference-subtracted optical images containing artifacts of processing and instrumentation. The algorithm makes use of the supervised machine learning technique known as Random Forest. We present results from its use in the Dark Energy Survey Supernova program (DES-SN), where it was trained using a sample of 898,963 signal and background events generated by the transient detection pipeline. After reprocessing the data collected during the first DES-SN observing season (2013 September through 2014 February) using the algorithm, the number of transient candidates eligible for human scanning decreased by a factormore » of 13.4, while only 1.0 percent of the artificial Type Ia supernovae (SNe) injected into search images to monitor survey efficiency were lost, most of which were very faint events. Here we characterize the algorithm's performance in detail, and we discuss how it can inform pipeline design decisions for future time-domain imaging surveys, such as the Large Synoptic Survey Telescope and the Zwicky Transient Facility.« less

Automated transient identification in the Dark Energy Survey

DOE PAGES

Goldstein, D. A.; D'Andrea, C. B.; Fischer, J. A.; ...

2015-09-01

We describe an algorithm for identifying point-source transients and moving objects on reference-subtracted optical images containing artifacts of processing and instrumentation. The algorithm makes use of the supervised machine learning technique known as Random Forest. We present results from its use in the Dark Energy Survey Supernova program (DES-SN), where it was trained using a sample of 898,963 signal and background events generated by the transient detection pipeline. After reprocessing the data collected during the first DES-SN observing season (2013 September through 2014 February) using the algorithm, the number of transient candidates eligible for human scanning decreased by a factormore » of 13.4, while only 1.0% of the artificial Type Ia supernovae (SNe) injected into search images to monitor survey efficiency were lost, most of which were very faint events. Furthermore, we characterize the algorithm's performance in detail, and we discuss how it can inform pipeline design decisions for future time-domain imaging surveys, such as the Large Synoptic Survey Telescope and the Zwicky Transient Facility.« less

Knowledge and Practice on Injection Safety among Primary Health Care Workers in Kaski District, Western Nepal

PubMed Central

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, P Ravi; Kc, Vikash Kumar; Jha, Nisha; Sharma, Damodar

2016-01-01

Background Unsafe injection practice can transmit various blood borne infections. The aim of this study was to assess the knowledge and practice of injection safety among injection providers, to obtain information about disposal of injectable devices, and to compare the knowledge and practices of urban and rural injection providers. Methods The study was conducted with injection providers working at primary health care facilities within Kaski district, Nepal. Ninety-six health care workers from 69 primary health care facilities were studied and 132 injection events observed. A semi-structured checklist was used for observing injection practice and a questionnaire for the survey. Respondents were interviewed to complete the questionnaire and obtain possible explanations for certain observed behaviors. Results All injection providers knew of at least one pathogen transmitted through use/re-use of unsterile syringes. Proportion of injection providers naming hepatitis/jaundice as one of the diseases transmitted by unsafe injection practice was significantly higher in urban (75.6%) than in rural (39.2%) area. However, compared to urban respondents (13.3%), a significantly higher proportion of rural respondents (37.3%) named Hepatitis B specifically as one of the diseases transmitted. Median (inter-quartile range) number of therapeutic injection and injectable vaccine administered per day by the injection providers were 2 (1) and 1 (1), respectively. Two handed recapping by injection providers was significantly higher in urban area (33.3%) than in rural areas (21.6%). Most providers were not aware of the post exposure prophylaxis guideline. Conclusion The knowledge of the injection providers about safe injection practice was acceptable. The use of safe injection practice by providers in urban and rural health care facilities was almost similar. The deficiencies noted in the practice must be addressed. PMID:27540325

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. ...

Audit study of the new hospitalization for assessment scheme for forensic mental health in Japan

PubMed Central

Shiina, Akihiro; Iyo, Masaomi; Hirata, Toyoaki; Igarashi, Yoshito

2015-01-01

AIM: To clarify the components of hospitalization for assessment (HfA) and the management changes from the beginning of the scheme to the present. METHODS: This study is composed of two surveys. In 2013 survey, we created two paper questionnaires (facility and case questionnaires) for psychiatrists working in psychiatric hospitals accepting HfA patients. Questionnaires were sent to 205 hospitals that were identified as accepting the HfA cases, and responses were requested via mail. The facility questionnaire was designed to clarify the following specifications and characteristics of each facility: the facility organizer (public sector or private hospital), and the number of beds, psychiatrists, psychiatric nurses, occupational therapists, psychiatric social workers, psychotherapists, public health nurses, and patients treated through HfA during the survey period. The case questionnaire was then used to collect data of the patients under HfA based on the Medical Treatment and Supervision (MTS) Act who were discharged between July 1, 2012 and June 30, 2013. Gathered information included: legal information of each case, demographic data, past history of the offenders, issued offense and the relationship to the victim, information regarding past psychiatric testimonies, psychiatric diagnoses, contents of the treatment during HfA, information regarding seclusion and restraint during the HfA, the verdict of the District Court panel, and so forth. Next, we compared those results with relevant data obtained in 2007. The 2007 survey comprised data of HfA patients from July 15, 2005 (the date the MTS Act was enforced) to January 15, 2007. RESULTS: We obtained 171 cases, approximately a half of whole contemporary cases of HfA, from 134 facilities, of which 46 were national, prefectural, or semi-official hospitals, and 88 were private hospitals, in 2013 survey. The majority of subjects were male, schizophrenic, and experienced previous psychiatric treatment. The most frequent type of the offense was injury, followed by arson. Most of the subjects were medicated, and a few cases took psychotropic injection during the HfA. The frequency of injection was decreased in 2013 (χ2 = 7.54, df = 1, P = 0.006) than in 2007. Psychiatric testimony was more likely to be conducted in 2013 (χ2 = 8.56, df = 1, P = 0.004). The examiner psychiatrist was more likely to belong to the HfA facility to which the patient was hospitalized (χ2 = 5.32, df = 1, P = 0.02). Hospitalization orders were more frequently selected in 2013 (χ2 = 19.76, df = 3, P < 0.001), although the characteristics of the subjects had not changed. CONCLUSION: Although the management of HfA has improved in recent years, structural problems remain. PMID:26110125

Audit study of the new hospitalization for assessment scheme for forensic mental health in Japan.

PubMed

Shiina, Akihiro; Iyo, Masaomi; Hirata, Toyoaki; Igarashi, Yoshito

2015-06-22

To clarify the components of hospitalization for assessment (HfA) and the management changes from the beginning of the scheme to the present. This study is composed of two surveys. In 2013 survey, we created two paper questionnaires (facility and case questionnaires) for psychiatrists working in psychiatric hospitals accepting HfA patients. Questionnaires were sent to 205 hospitals that were identified as accepting the HfA cases, and responses were requested via mail. The facility questionnaire was designed to clarify the following specifications and characteristics of each facility: the facility organizer (public sector or private hospital), and the number of beds, psychiatrists, psychiatric nurses, occupational therapists, psychiatric social workers, psychotherapists, public health nurses, and patients treated through HfA during the survey period. The case questionnaire was then used to collect data of the patients under HfA based on the Medical Treatment and Supervision (MTS) Act who were discharged between July 1, 2012 and June 30, 2013. Gathered information included: legal information of each case, demographic data, past history of the offenders, issued offense and the relationship to the victim, information regarding past psychiatric testimonies, psychiatric diagnoses, contents of the treatment during HfA, information regarding seclusion and restraint during the HfA, the verdict of the District Court panel, and so forth. Next, we compared those results with relevant data obtained in 2007. The 2007 survey comprised data of HfA patients from July 15, 2005 (the date the MTS Act was enforced) to January 15, 2007. We obtained 171 cases, approximately a half of whole contemporary cases of HfA, from 134 facilities, of which 46 were national, prefectural, or semi-official hospitals, and 88 were private hospitals, in 2013 survey. The majority of subjects were male, schizophrenic, and experienced previous psychiatric treatment. The most frequent type of the offense was injury, followed by arson. Most of the subjects were medicated, and a few cases took psychotropic injection during the HfA. The frequency of injection was decreased in 2013 (χ (2) = 7.54, df = 1, P = 0.006) than in 2007. Psychiatric testimony was more likely to be conducted in 2013 (χ (2) = 8.56, df = 1, P = 0.004). The examiner psychiatrist was more likely to belong to the HfA facility to which the patient was hospitalized (χ (2) = 5.32, df = 1, P = 0.02). Hospitalization orders were more frequently selected in 2013 (χ (2) = 19.76, df = 3, P < 0.001), although the characteristics of the subjects had not changed. Although the management of HfA has improved in recent years, structural problems remain.

Injectable contraceptive sales at licensed chemical seller shops in ghana: access and reported use in rural and periurban communities.

PubMed

Lebetkin, Elena; Orr, Tracy; Dzasi, Kafui; Keyes, Emily; Shelus, Victoria; Mensah, Stephen; Nagai, Henry; Stanback, John

2014-03-01

Most women in Ghana obtain oral contraceptives and condoms from shops run by licensed chemical sellers, but such shops are not legally permitted to sell the country's most widely used method, the injectable. Allowing shops to sell the injectable could increase access to and use of the method. In 2012-2013, semistructured telephone interviews were conducted among convenience samples of 94 licensed chemical seller shop operators in two districts who were trained to sell the injectable and of 298 women who purchased the method from these shops. Follow-up interviews were conducted with 92 clients approximately three months after their initial injectable purchase. Ninety-seven percent of shop operators reported selling the injectable, and 94% felt sufficiently trained to provide family planning methods and services. Virtually all sellers (99%) referred clients to a hospital or health facility for injection; none provided injections themselves. Fifty-six percent of injectable clients were new family planning users. Of those who completed a follow-up interview, 79% had purchased the injectable again from a shop. Virtually all clients (97%) reported getting their injection at the health facility to which they were referred by the seller. Women cited trust, convenience and commodities being in stock as key reasons for purchasing from a shop. Licensed chemical seller shop operators can safely sell the injectable and refer clients to health facilities for screening, counseling and injection.

The impact of China's national essential medicine system on improving rational drug use in primary health care facilities: an empirical study in four provinces.

PubMed

Song, Yan; Bian, Ying; Petzold, Max; Li, Lingui; Yin, Aitian

2014-10-25

The National Essential Medicine System (NEMS) is a new policy in China launched in 2009 to improve the appropriate use of medications. This study aims to examine the outcomes of the NEMS objectives in terms of the rational use of medicines in primary health care facilities in China. A total of 28,651 prescriptions were collected from 146 township health centers in four provinces of China by means of a field survey conducted in 2010-2011. Indicators of rational drug use were extracted and compared using a pre/post design and then evaluated with regard to the World Health Organization (WHO) Standard Guidelines and data from previous research. The average number of drugs per prescription decreased from 3.64 to 3.46 (p < 0.01) between 2009 and 2010. Little effect was found for the NEMS on the average number of antibiotics per prescription, but the percentage of prescriptions including antibiotics decreased from 60.26 to 58.48% (p < 0.01). Prescriptions for injections or adrenal corticosteroids also decreased, to 40.31 and 11.16% of all prescriptions, respectively. All these positive issues were also recorded in 2011. However, each of the above values remained higher than WHO standards. The percentage of drugs prescribed from the Essential Drug List increased after the implementation of the NEMS (p < 0.01). Where the available data allowed changes in costs to be assessed, the average expense per prescription increased significantly, from 25.77 to 27.09 yuan (p < 0.01). The NEMS effectively improved rational medicine use in China. However, polypharmacy and the over-prescription of antibiotics and injections remain common. There is still a large unfinished agenda requiring policy improvements. Treatment guidelines, intensive support supervision, and continuing training for both professionals and consumers are the essential actions that need to be taken.

Stigmatizing harm reduction through language: a case study into the use of "addict" and opposition to supervised injection sites in Canada.

PubMed

Cortina, Sandra C

2013-01-01

Stigma continues to be the largest barrier for accessing treatment among people experiencing drug addiction. The dominant portrayals that exist about people who use drugs are often damaging and act to dehumanize the group as a whole. When left unchallenged, stereotypes can act as truthful depictions and facilitate the resistance against harm reduction services that are based on a human rights model. The use of labels is one way stigma is perpetuated by eliciting the label's stereotyped narratives onto an individual or group. Within harm reduction discourse, the word "addict" can have detrimental effects on how the public perceives people experiencing addiction and their deservingness of pragmatic services. This article aims to draw attention to the inattention we give "addict" in language and explain how its routine use in society acts to perpetuate addiction stigma. Using the example of supervised injection site opposition in Canada, the use of "addict" is used as a way to understand how stigma through language works to impede the expansion of harm reduction initiatives.

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.

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

Safe injection practice among health-care workers in Gharbiya Governorate, Egypt.

PubMed

Ismail, N A; Aboul Ftouh, A M; El-Shoubary, W H; Mahaba, H

2007-01-01

We assessed safe injection practices among 1100 health-care workers in 25 health-care facilities in Gharbiya Governorate. Questionnaires were used to collect information and 278 injections were observed using a standardized checklist. There was a lack of infection control policies in all the facilities and a lack of many supplies needed for safe injection. Proper needle manipulation before disposal was observed in only 41% of injections, safe needle disposal in 47.5% and safe syringe disposal in 0%. Reuse of used syringes and needles was reported by 13.2% of the health-care workers and 66.2% had experienced a needle-stick injury. Only 11.3% had received a full course of hepatitis B vaccination.

The Use of Virtual Reality Computer Simulation in Learning Port-A Cath Injection

ERIC Educational Resources Information Center

Tsai, Sing-Ling; Chai, Sin-Kuo; Hsieh, Li-Feng; Lin, Shirling; Taur, Fang-Meei; Sung, Wen-Hsu; Doong, Ji-Liang

2008-01-01

Cost-benefit management trends in Taiwan healthcare settings have led nurses to perform more invasive skills, such as Port-A cath administration of medications. Accordingly, nurses must be well-prepared prior to teaching by the mentor and supervision method. The purpose of the current study was to develop a computer-assisted protocol using virtual…

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…

Triamcinolone Acetonide Decreases Outflow Facility in C57BL/6 Mouse Eyes

PubMed Central

Kumar, Sandeep; Shah, Shaily; Deutsch, Emily Rose; Tang, Hai Michael; Danias, John

2013-01-01

Purpose. To determine the effect of triamcinolone acetonide (TA) on outflow facility in mice. Methods. Animals received 20 μL of TA (40 mg/mL) suspension subconjunctivally either bilaterally or unilaterally and were euthanized after either 1 week or 3 weeks. Before mice were killed, IOP was measured with a rebound tonometer. Outflow facility was determined using simultaneous pressure and flow measurements. Another set of animals received bilateral injection of anecortave acetate (AA) with or without bilateral TA injection and their outflow facility was also determined. Myocilin expression was investigated in a subset of eyes using quantitative PCR (qPCR). Results. Outflow facility of eyes in animals receiving bilateral TA injection (TABL) and TA-treated eyes of animals receiving unilateral injection (TAUL) was significantly decreased compared to naïve control eyes (Cnaive) after 1 week and 3 weeks of TA treatment (ANOVA P < 0.01, P < 0.001, respectively). Eyes treated with AA (with or without TA) had higher outflow facility than animals treated with TA (P < 0.05). IOP data did not show any significant difference between groups. qPCR analysis revealed significant decrease in myocilin expression in eyes receiving AA compared to naïve control and TA-treated eyes (ANOVA P < 0.001). Conclusions. Steroid treatment significantly decreases outflow facility in C57BL/6 mice despite having small effect on IOP. This animal model can be useful for studying the pathogenesis of steroid-induced glaucoma. PMID:23322580

Willingness to use drug checking within future supervised injection services among people who inject drugs in a mid-sized Canadian city.

PubMed

Kennedy, Mary Clare; Scheim, Ayden; Rachlis, Beth; Mitra, Sanjana; Bardwell, Geoff; Rourke, Sean; Kerr, Thomas

2018-04-01

Esclating epidemics of fatal overdose are affecting communities across Canada. In many instances, the unanticipated presence of powerful opioids, such as fentanyl, in street drugs is a contributing factor. Drug checking offered within supervised injection services (SIS) is being considered as a potential measure for reducing overdose and related harms. We therefore sought to characterize the willingness of people who inject drugs (PWID) to use drug checking within SIS. Data were derived from a cross-sectional survey examining the feasibility of SIS in London, Canada, a mid-sized city. Multivariable logistic regression was used to examine factors associated with willingness to frequently (always or usually) use drug checking at SIS. Between March and April 2016, 180 PWID were included in the present study, including 68 (38%) women. In total, 78 (43%) reported that they would frequently check their drugs at SIS if this service were available. In multivariable analyses, female gender (Adjusted Odds Ratio [AOR] = 2.31; 95% confidence interval [CI]: (1.20-4.46), homelessness (AOR = 2.36; 95% CI: 1.14-4.86), and drug dealing (AOR = 2.16; 95% CI: 1.07-4.33) were positively associated with willingness to frequently check drugs at SIS. These findings highlight the potential of drug checking as a complement to other services offered within SIS, particularly given that subpopulations of PWID at heightened risk of overdose were more likely to report willingness to frequently use this service. However, further research is needed to determine the possible health impacts of offering drug checking at SIS. Copyright © 2018 Elsevier B.V. All rights reserved.

University of Minnesota Aquifer Thermal Energy Storage Field Test Facility

NASA Astrophysics Data System (ADS)

Walton, M.; Hoyer, M. C.

1982-12-01

The University of Minnesota Aquifer Thermal Energy Storage (ATES) Field Test Facility became operational. Experiments demonstrated that the Franconia-Ironton-Galesville aquifer will accept injection of 300 gpm (18.9 1 sec (-1)) at reasonable pressures with a heat buildup in the injection well of about 44 psi (31.6 m) over 8 days. Heating of the ground water caused precipitation of carbonate in the piping and injection well, but with proper water conditioning, the system will work satisfactorily at elevated temperatures.

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...

HIV-risk characteristics in community corrections.

PubMed

Clark, C Brendan; McCullumsmith, Cheryl B; Waesche, Matthew C; Islam, M Aminul; Francis, Reginald; Cropsey, Karen L

2013-01-01

Individuals in the criminal justice system engage in behaviors that put them at high risk for HIV. This study sought to identify characteristics of individuals who are under community corrections supervision (eg, probation) and at risk for HIV. Approximately 25,000 individuals under community corrections supervision were assessed for HIV risk, and 5059 participants were deemed high-risk or no-risk. Of those, 1519 exhibited high sexual-risk (SR) behaviors, 203 exhibited injection drug risk (IVR), 957 exhibited both types of risk (SIVR), and 2380 exhibited no risk. Sociodemographic characteristics and drug of choice were then examined using univariate and binary logistic regression. Having a history of sexual abuse, not having insurance, and selecting any drug of choice were associated with all forms of HIV risk. However, the effect sizes associated with the various drugs of choice varied significantly by group. Aside from those common risk factors, very different patterns emerged. Female gender was a risk factor for the SR group but was less likely to be associated with IVR. Younger age was associated with SR, whereas older age was associated with IVR. Black race was a risk factor for SR but had a negative association with IVR and SIVR. Living in a shelter, living with relatives/friends, and being unemployed were all risk factors for IVR but were protective factors for SR. Distinct sociodemographic and substance use characteristics were associated with sexual versus injection drug use risk for individuals under community corrections supervision who were at risk for HIV. Information from this study could help identify high-risk individuals and allow tailoring of interventions.

Safe Injection Practices in Primary Health Care Settings of Naxalbari Block, Darjeeling District, West Bengal.

PubMed

Chaudhuri, Sudip Banik; Ray, Kuntala

2016-01-01

Unsafe injection can transmit many diseases to patients, injection providers and healthy people of community. To find out critical steps whether executed according to recommended best practice methods, availability of equipments in health facilities for safe injection practices and some important steps of waste disposal methods. This facility-based cross-sectional observational study was conducted among 30 Auxiliary nurse midwives (ANM) & 27 nursing staffs (NS) to assess certain aspects of their practice while administrating injection and disposal of the disposables. Health facilities were also observed to asses necessary equipments of safe injection and waste disposal methods. Among the health workers 93.3% ANM and 100% NS took sterile syringe from sterile unopened packet, all of the study subjects washed hand before giving injection, 13.3% of ANMs and 8% of NS are fully vaccinated against Hep B, 53.3% of ANM and all NS are practices non recapping. Only 13.33% sub centres along with PHC & BPHC had at least one puncture resistant leak proof container, 86.7% sub centres, PHC are free from loose needles. Transport for off side treatment is the method of waste disposal in case of 73.3% cases sub centres, PHC & BPHC. There is need to educate, train and motivate service providers in proper methods of giving injection along with improve the adequacy of supply of required equipments.

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.

Wastewater disposal from unconventional oil and gas development degrades stream quality at a West Virginia injection facility

USGS Publications Warehouse

Akob, Denise M.; Mumford, Adam; Orem, William H.; Engle, Mark A.; Klinges, Julia (Grace); Kent, Douglas B.; Cozzarelli, Isabelle M.

2016-01-01

The development of unconventional oil and gas (UOG) resources has rapidly increased in recent years; however, the environmental impacts and risks are poorly understood. A single well can generate millions of liters of wastewater, representing a mixture of formation brine and injected hydraulic fracturing fluids. One of the most common methods for wastewater disposal is underground injection; we are assessing potential risks of this method through an intensive, interdisciplinary study at an injection disposal facility in West Virginia. In June 2014, waters collected downstream from the site had elevated specific conductance (416 μS/cm) and Na, Cl, Ba, Br, Sr, and Li concentrations, compared to upstream, background waters (conductivity, 74 μS/cm). Elevated TDS, a marker of UOG wastewater, provided an early indication of impacts in the stream. Wastewater inputs are also evident by changes in 87Sr/86Sr in streamwater adjacent to the disposal facility. Sediments downstream from the facility were enriched in Ra and had high bioavailable Fe(III) concentrations relative to upstream sediments. Microbial communities in downstream sediments had lower diversity and shifts in composition. Although the hydrologic pathways were not able to be assessed, these data provide evidence demonstrating that activities at the disposal facility are impacting a nearby stream and altering the biogeochemistry of nearby ecosystems.

A survey of local anaesthesia education in European dental schools.

PubMed

Brand, H S; Kuin, D; Baart, J A

2008-05-01

A survey of European dental schools was conducted in 2006 to determine the curricular structure, techniques and materials used in local anaesthesia teaching to dental students. A questionnaire was designed to collect information about local anaesthesia education. The questionnaires were sent to the Dean of each dental school in Europe and Israel; 49 returned the completed survey, resulting in a response rate of 18.4%. Results from this survey show that dental schools are managing local anaesthesia education in different ways. At most schools, theoretical teaching begins during the first half of the third year (41%), half a year before the practical instruction (43%). In 37% of the dental schools, students use non-human objects to practice before they inject an anaesthetic in humans. The first injection in humans, usually a fellow student (61%), is mostly supervised by an oral and maxillofacial surgeon (65%). The number of injections under supervision usually depends on the individual capabilities of the student (41%). Ten per cent of the schools need permission of a medical ethics committee for the practical instruction on fellow students. All dental curricula include teaching of mandibular block anaesthesia. The majority also include instruction of infiltration anaesthesia of the upper (98%) and lower (92%) jaws in addition to infra-orbital block anaesthesia (57%). Although 82% of the schools are satisfied with the current curriculum with regard to local anaesthesia, 43% are planning changes, frequently the introduction of preclinical training models. Local anaesthesia teaching programmes show considerable variation across the surveyed European dental schools.

Monitoring of subsurface injection of wastes, Florida

USGS Publications Warehouse

Vecchioli, John

1979-01-01

Injection of waste liquids into Florida's subsurface is physically feasible in many places but should be accompanied by monitoring of the waste-receiving aquifer system in addition to the injection facility. Monitoring of the interaction of factors including hydrogeologic conditions, well construction, waste volumes and characteristics, and potable-water sources is desirable to assure that fresh-water resources are not being adversely affected. An effective aquifer-system monitoring program includes on-site wells located close to an injection well and open to the next-higher permeable stratum, satellite wells located hundreds to several thousands of feet from an injection well and open to the receiving aquifer, and regional wells located miles from individual injection wells and open to the receiving aquifer. An extensive aquifer-system monitoring program associated with two waste-injection facilities near Pensacola, Florida, has provided data which have aided hydrologists to understand the aquifer system's response to the injection and, accordingly, to evaluate the potential for affecting the area's fresh-water resources.

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

Automated Transient Identification in the Dark Energy Survey

NASA Astrophysics Data System (ADS)

Goldstein, D. A.; D'Andrea, C. B.; Fischer, J. A.; Foley, R. J.; Gupta, R. R.; Kessler, R.; Kim, A. G.; Nichol, R. C.; Nugent, P. E.; Papadopoulos, A.; Sako, M.; Smith, M.; Sullivan, M.; Thomas, R. C.; Wester, W.; Wolf, R. C.; Abdalla, F. B.; Banerji, M.; Benoit-Lévy, A.; Bertin, E.; Brooks, D.; Carnero Rosell, A.; Castander, F. J.; da Costa, L. N.; Covarrubias, R.; DePoy, D. L.; Desai, S.; Diehl, H. T.; Doel, P.; Eifler, T. F.; Fausti Neto, A.; Finley, D. A.; Flaugher, B.; Fosalba, P.; Frieman, J.; Gerdes, D.; Gruen, D.; Gruendl, R. A.; James, D.; Kuehn, K.; Kuropatkin, N.; Lahav, O.; Li, T. S.; Maia, M. A. G.; Makler, M.; March, M.; Marshall, J. L.; Martini, P.; Merritt, K. W.; Miquel, R.; Nord, B.; Ogando, R.; Plazas, A. A.; Romer, A. K.; Roodman, A.; Sanchez, E.; Scarpine, V.; Schubnell, M.; Sevilla-Noarbe, I.; Smith, R. C.; Soares-Santos, M.; Sobreira, F.; Suchyta, E.; Swanson, M. E. C.; Tarle, G.; Thaler, J.; Walker, A. R.

2015-09-01

We describe an algorithm for identifying point-source transients and moving objects on reference-subtracted optical images containing artifacts of processing and instrumentation. The algorithm makes use of the supervised machine learning technique known as Random Forest. We present results from its use in the Dark Energy Survey Supernova program (DES-SN), where it was trained using a sample of 898,963 signal and background events generated by the transient detection pipeline. After reprocessing the data collected during the first DES-SN observing season (2013 September through 2014 February) using the algorithm, the number of transient candidates eligible for human scanning decreased by a factor of 13.4, while only 1.0% of the artificial Type Ia supernovae (SNe) injected into search images to monitor survey efficiency were lost, most of which were very faint events. Here we characterize the algorithm’s performance in detail, and we discuss how it can inform pipeline design decisions for future time-domain imaging surveys, such as the Large Synoptic Survey Telescope and the Zwicky Transient Facility. An implementation of the algorithm and the training data used in this paper are available at at http://portal.nersc.gov/project/dessn/autoscan.

Associations of criminal justice and substance use treatment involvement with HIV/HCV testing and the HIV treatment cascade among people who use drugs in Oakland, California.

PubMed

Lambdin, Barrot H; Kral, Alex H; Comfort, Megan; Lopez, Andrea M; Lorvick, Jennifer

2017-06-14

People who smoke crack cocaine and people who inject drugs are at-risk for criminal justice involvement as well as HIV and HCV infection. Compared to criminal justice involvement, substance use treatment (SUT) can be cost-effective in reducing drug use and its associated health and social costs. We conducted a cross-sectional study of people who smoke crack cocaine and people who inject drugs to examine the association between incarceration, community supervision and substance use treatment with HIV/HCV testing, components of the HIV treatment cascade, social and physical vulnerability and risk behavior. Targeted sampling methods were used to recruit people who smoke crack cocaine and people who inject drugs (N = 2072) in Oakland, California from 2011 to 2013. Poisson regression models were used to estimate adjusted prevalence ratios between study exposures and outcomes. The overall HIV prevalence was 3.3% (95% CI 2.6-4.1). People previously experiencing incarceration were 21% (p < 0.001) and 32% (p = 0.001), respectively, more likely to report HIV and HCV testing; and were not more likely to report receiving HIV care or initiating ART. People previously experiencing community supervision were 17% (p = 0.001) and 15% (p = 0.009), respectively, more likely to report HIV and HCV testing; and were not more likely to report receiving HIV care or initiating ART. People with a history of SUT were 15% (p < 0.001) and 23% (p < 0.001), respectively, more likely to report receiving HIV and HCV testing, 67% (p = 0.016) more likely to report HIV care, and 92% (p = 0.012) more likely to report HIV treatment initiation. People previously experiencing incarceration or community supervision were also more likely to report homelessness, trouble meeting basic needs and risk behavior. People with a history of substance use treatment reported higher levels of HCV and HIV testing and greater access to HIV care and treatment among HIV-positive individuals. People with a history of incarceration or community supervision reported higher levels of HCV and HIV testing, but not greater access to HIV care or treatment among HIV-positive individuals., Substance use treatment programs that are integrated with other services for HIV and HCV will be critical to simultaneously address the underlying reasons drug-involved people engage in drug-related offenses and improve access to essential medical services.

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.

Prevalence of HIV and hepatitis C virus infections among inmates of Ontario remand facilities

PubMed Central

Calzavara, Liviana; Ramuscak, Nancy; Burchell, Ann N.; Swantee, Carol; Myers, Ted; Ford, Peter; Fearon, Margaret; Raymond, Sue

2007-01-01

Background Each year more than 56 000 adult and young offenders are admitted to Ontario's remand facilities (jails, detention centres and youth centres). The prevalence of HIV infection in Ontario remand facilities was last measured over a decade ago, and no research on the prevalence of hepatitis C virus (HCV) infection has been conducted in such facilities. We sought to determine the prevalence of HIV infection, HCV infection and HIV–HCV coinfection among inmates in Ontario's remand facilities. Methods A voluntary and anonymous cross-sectional prevalence study of HIV and HCV infections was conducted among people admitted to 13 selected remand facilities across Ontario between Feb. 1, 2003, and June 20, 2004. Data collection included a saliva specimen for HIV and HCV antibody screening and an interviewer-administered survey. Prevalence rates and 95% confidence intervals were calculated and examined according to demographic characteristics, region of incarceration and self-reported history of injection drug use. Results In total, 1877 participants provided both a saliva specimen and survey information. Among the adult participants, the prevalence of HIV infection was 2.1% among men and 1.8% among women. Adult offenders most likely to have HIV infection were older offenders (≥ 30 years) and injection drug users. The prevalence of HCV infection was 15.9% among men, 30.2% among women and 54.7% among injection drug users. Adult offenders most likely to have HCV infection were women, older offenders (≥ 30 years) and injection drug users. The prevalence of HCV–HIV coinfection was 1.2% among men and 1.5% among women. It was highest among older inmates and injection drug users. Among the young offenders, none was HIV positive and 1 (0.4%) was HCV positive. On the basis of the study results, we estimated that 1079 HIV-positive adults and 9208 HCV-positive adults were admitted to remand facilities in Ontario from Apr. 1, 2003, to Mar. 31, 2004. Interpretation Adult offenders entering Ontario remand facilities have a considerably higher prevalence of HIV and HCV infections than the general population. PMID:17664449

The law (and politics) of safe injection facilities in the United States.

PubMed

Beletsky, Leo; Davis, Corey S; Anderson, Evan; Burris, Scott

2008-02-01

Safe injection facilities (SIFs) have shown promise in reducing harms and social costs associated with injection drug use. Favorable evaluations elsewhere have raised the issue of their implementation in the United States. Recognizing that laws shape health interventions targeting drug users, we analyzed the legal environment for publicly authorized SIFs in the United States. Although states and some municipalities have the power to authorize SIFs under state law, federal authorities could still interfere with these facilities under the Controlled Substances Act. A state- or locally-authorized SIF could proceed free of legal uncertainty only if federal authorities explicitly authorized it or decided not to interfere. Given legal uncertainty, and the similar experience with syringe exchange programs, we recommend a process of sustained health research, strategic advocacy, and political deliberation.

Injected with controversy: sales and administration of injectable contraceptives in drug shops in Uganda.

PubMed

Stanback, John; Otterness, Conrad; Bekiita, Martha; Nakayiza, Olivia; Mbonye, Anthony K

2011-03-01

Informal drug shops are the first line of health care in many poor countries. In Uganda, these facilities commonly sell and administer the injectable contraceptive depot medroxyprogesterone acetate (DMPA), even though they are prohibited by law from selling any injectable drugs. It is important to understand drug shop operators' current practices and their potential to provide DMPA to hard-to-reach populations. Between November 2007 and January 2008, 157 drug shops were identified in three rural districts of Uganda, and the operators of the 124 facilities that sold DMPA were surveyed. Data were analyzed with descriptive methods. Only 35% of operators reported that the facility in which they worked was a licensed drug shop and another 9% reported that the facility was a private clinic; all claimed to have some nursing, midwifery, or other health or medical qualification. Ninety-six percent administered DMPA in the shop. Operators gave a mean of 10 injections (including three of DMPA) per week. Forty-three percent of those who administered DMPA reported disposing of used syringes in sharps containers; in the previous 12 months, 24% had had a needle-stick injury and 17% had had a patient with an injection-related abscess. Eleven percent said they had ever reused a disposable syringe. Overall, contraceptive knowledge was low, and attitudes toward family planning reflected common traditional biases. Provision of DMPA is common in rural drug shops, but needs to be made safer. Absent stronger regulation and accreditation, drug shop operators can be trained as community-based providers to help meet the extensive unmet demand for family planning in rural areas.

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

The effect of on-site and outreach-based needle and syringe programs in people who inject drugs in Kermanshah, Iran.

PubMed

Nazari, Seyed Saeed Hashemi; Noroozi, Mehdi; Soori, Hamid; Noroozi, Alireza; Mehrabi, Yadollah; Hajebi, Ahmad; Sharifi, Hamid; Higgs, Peter; Mirzazadeh, Ali

2016-01-01

Needle and syringe programs (NSPs) are widely used to reduce harms associated with drug injecting. This study assessed the effect of facility-based (on-site services at drop-in centre) and outreach models of NSP on injection risk behaviours. Self-reported data from 455 people who injected drugs (PWID) during 2014 in Kermanshah, Iran, were examined to measure demographic characteristics and risk behaviors. Self-reported and program data were also assessed to identify their main source of injection equipment. Participants were divided into three sub-groups: facility-based NSP users, outreach NSP users and non-users (comparison group). Coarsened exact matching was used to make the three groups statistically equivalent based on age, place of residence, education and income, and groups were compared regarding the proportion of borrowing or lending of syringes/cookers, reusing syringes and recent HIV testing. Overall, 76% of participants reported any NSP service use during the two months prior to interview. Only 23% (95%CI: 17-27) reported outreach NSP as their main source of syringes. Using facility-based NSP significantly decreased recent syringe borrowing (OR: 0.27, 95%CI: 0.10-0.70), recent syringe reuse (OR: 0.38, 95%CI: 0.23-0.68) and increased recent HIV testing (OR: 2.60, 95%CI: 1.48-4.56). Similar effects were observed among outreach NSP users; in addition, the outreach NSP model significantly reduced the chance of lending syringes (OR: 0.31, 95%CI: 0.15-0.60), compared to facility-based NSP (OR: 1.25, 95%CI: 0.74-2.17). These findings suggest that the outreach NSP model is as effective as facility-based NSP in reducing injection risk behaviours and increasing the rate of HIV testing. Outreach NSP was even more effective than facility-based in reducing the lending of syringes to others. Scaling up outreach NSP is an effective intervention to further reduce transmission of HIV via needle sharing. Copyright © 2015 Elsevier B.V. All rights reserved.

Distribution of injected wastewater in the saline-lava aquifer, Wailuku-Kahului wastewater treatment facility, Kahului, Maui, Hawaii

USGS Publications Warehouse

Burnham, Willis L.; Larson, S.P.; Cooper, Hilton Hammond

1977-01-01

Field studies and digital modeling of a lava rock aquifer system near Kahului, Maui, Hawaii, describe the distribution of planned injected wastewater from a secondary treatment facility. The aquifer contains water that is almost as saline as seawater. The saline water is below a seaward-discharging freshwater lens, and separated from it by a transition zone of varying salinity. Injection of wastewater at an average rate of 6.2 cubic feet per second is planned through wells open only to the aquifer deep within the saline water zone. The lava rock aquifer is overlain by a sequence of residual soil, clay, coral reef deposits, and marine sand that form a low-permeability caprock which semiconfines the lava rock aquifer. Under conditions measured and assumed without significant change. After reaching a new steady state, the wastewater will discharge into and through the caprock sequence within an area measuring approximately 1,000 feet inland, 1,000 feet laterally on either side of the injection site, and about 2,000 feet seaward. Little, if any, of the injected wastewater may be expected to reach the upper part of the caprock flow system landward of the treatment plant facility. (Woodard-USGS)

INCINERATION RESEARCH FACILITY

EPA Science Inventory

The Cincinnati-based Risk Reduction Engineering Laboratory, ORD, U.S. EPA operates the Incineration Research Facility *IRF) in Jefferson, Arkansas. This facility's pilot-scale experimental incineration systems include a Rotary Kiln System and a Liquid Injection System. Each syste...

Impact of Unconventional Shale Gas Waste Water Disposal on Surficial Streams

NASA Astrophysics Data System (ADS)

Cozzarelli, I.; Akob, D.; Mumford, A. C.

2014-12-01

The development of unconventional natural gas resources has been rapidly increasing in recent years, however, the environmental impacts and risks are not yet well understood. A single well can generate up to 5 million L of produced water (PW) consisting of a blend of the injected fluid and brine from a shale formation. With thousands of wells completed in the past decade, the scope of the challenge posed in the management of this wastewater becomes apparent. The USGS Toxic Substances Hydrology Program is studying both intentional and unintentional releases of PW and waste solids. One method for the disposal of PW is underground injection; we are assessing the potential risks of this method through an intensive, interdisciplinary study at an injection disposal facility in the Wolf Creek watershed in WV. Disposal of PW via injection begun in 2002, with over 5.5 mil. L of PW injected to date. The facility consists of the injection well, a tank farm, and two former holding ponds (remediated in early 2014) and is bordered by two small tributaries of Wolf Creek. Water and sediments were acquired from these streams in June 2014, including sites upstream, within, and downstream from the facility. We are analyzing aqueous and solid phase geochemistry, mineralogy, hydrocarbon content, microbial community composition, and potential toxicity. Field measurements indicated that conductivity downstream (416 μS/cm) was elevated in comparison to upstream (74 μS/cm) waters. Preliminary data indicated elevated Cl- (115 mg/L) and Br- (0.88 mg/L) concentrations downstream, compared to 0.88 mg/L Cl- and <0.03 mg/L Br- upstream of the facility. Because elevated TDS is a marker of PW, these data provide a first indication that PW from the facility is impacting nearby streams. In addition, total Fe concentrations downstream were 8.1 mg/L, far in excess of the 0.13 mg/L found upstream from the facility, suggesting the potential for microbial Fe cycling. We are conducting a broad suite of experiments to assess the potential for microbial metabolism of the organic components of PW, and to determine the effects of this metabolism on the geochemistry of the site. We anticipate that this study will prove to be a useful model for the potential impact of a PW disposal facility on adjoining surface- and shallow groundwater.

Cost, cost-efficiency and cost-effectiveness of integrated family planning and HIV services.

PubMed

Shade, Starley B; Kevany, Sebastian; Onono, Maricianah; Ochieng, George; Steinfeld, Rachel L; Grossman, Daniel; Newmann, Sara J; Blat, Cinthia; Bukusi, Elizabeth A; Cohen, Craig R

2013-10-01

To evaluate costs, cost-efficiency and cost-effectiveness of integration of family planning into HIV services. Integration of family planning services into HIV care and treatment clinics. A cluster-randomized trial. Twelve health facilities in Nyanza, Kenya were randomized to integrate family planning into HIV care and treatment; six health facilities were randomized to (nonintegrated) standard-of-care with separately delivered family planning and HIV services. We assessed costs, cost-efficiency (cost per additional use of more effective family planning), and cost-effectiveness (cost per pregnancy averted) associated with the first year of integration of family planning into HIV care. More effective family planning methods included oral and injectable contraceptives, subdermal implants, intrauterine device, and female and male sterilization. We collected cost data through interviews with study staff and review of financial records to determine costs of service integration. Integration of services was associated with an average marginal cost of $841 per site and $48 per female patient. Average overall and marginal costs of integration were associated with personnel costs [initial ($1003 vs. $872) and refresher ($498 vs. $330) training, mentoring ($1175 vs. $902) and supervision ($1694 vs. $1636)], with fewer resources required for other fixed ($18 vs. $0) and recurring expenses ($471 vs. $287). Integration was associated with a marginal cost of $65 for each additional use of more effective family planning and $1368 for each pregnancy averted. Integration of family planning and HIV services is feasible, inexpensive to implement, and cost-efficient in the Kenyan setting, and thus supports current Kenyan integration policy.

'It's Fast, It's Quick, It Stops Me Being Sick': How to influence preparation of opioid tablets for injection.

PubMed

Lafferty, Lise; Treloar, Carla; van Breda, Nick; Steele, Maureen; Hiley, Sarah; Flaherty, Ian; Salmon, Allison

2017-09-01

Injection of pharmaceutical opioids (PO) among people who inject drugs has increased in many countries. The common method for preparing PO tablets for injection uses heat, resulting in greater particulate matter and therefore increased risk of local infection risk and damage to veins and organs. A cold preparation process has fewer risks, but this preparation method is not commonly used. This study seeks to explore how people who inject PO learn to prepare injections and how health promotion efforts could influence practice. Between March and December 2013, qualitative interviews were undertaken with 33 clients of Sydney's Medically Supervised Injecting Centre who inject PO tablets regarding sources of knowledge and current preparation methods for injection of POs. Overwhelmingly, the most commonly reported source of knowledge around injection of tablets was others who inject. Most participants reported heating the solution as the quickest way to administer the drug. Attitudes to the use of wheel filters varied, with some participants reporting that they would use the filters if they were shown how, while others reported a number of barriers to using filters, including complexity of use. Harnessing the power of social connections may provide avenues for education about safer injecting of tablets, including the use of wheel filters. Further work is required to debunk myths about the relative potencies of cold versus hot drug solution. Collaborations between harm reduction workers and peer workers would assist in knowledge dissemination regarding safer injecting practices. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Assessment of the safety of injection practices and injection-related procedures in family health units and centers in Alexandria.

PubMed

Elhoseeny, Taghareed A; Mourad, Juidan K

2014-08-01

The Safe Injection Global Network (SIGN) developed an intervention strategy for reducing overuse of injections and promoting the administration of safe injections. Tool C--Revised is designed to assess the safety of the most common procedures that puncture the skin within health services. The aim of the study was to assess injection safety within the primary healthcare facilities in Alexandria using Tool C--Revised. A total of 45 family health units and centers in Alexandria were selected by proportional allocation from the eight regions of Alexandria. The Tool C--Revised of the WHO was used for observation of the entire facility, injection practices and injection-related procedures, and sterilization practices. Interview of different health providers and immediate supervisor of injections was carried out. Indicators that reflect risk included: deficiency of alcohol-based hand rub for cleansing hands (13.3%), compliance with hand wash before preparing a procedure (56.9% before injection practices, 61.3% before phlebotomy, and 67.6% before lancet puncture), and wearing a new pair of gloves before new procedures (48.6% before injection practices, 9.7% for phlebotomy, 11.8% for lancet puncture, and 80% for both intravenous injections and infusions). Enough disposable equipment in all facilities for at least 2 weeks dependent on the statement of the average numbers of procedures per week was shown. Only 38% of the providers had received training regarding injection safety in the last 2 years and 62.5% had completed their three doses of hepatitis B vaccine. Only 42.2% of staffs who handled healthcare waste had access to heavy gloves. Indicators related to injection and injection-related practices that reflect risk to patients include deficiency of alcohol-based hand rub tools, nonadherence to hand hygiene before preparing an injection, and inadequate adherence to using a clean barrier when opening a glass ampule and use of gloves. Indicators that may reflect risk to patients and providers include inadequate injection safety training and incomplete hepatitis B vaccination of healthcare providers. Indicators that may reflect risk to providers include nonadherence to safety precautions related to injection practices, such as inadequate access to heavy gloves by staff handling healthcare waste.

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

Remedial site evaluation report for the waste area grouping 10 wells associated with the new hydrofracture facility at Oak Ridge National Laboratory, Oak Ridge, Tennessee. Volume 1: Evaluation, interpretation, and data summary

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

NONE

1996-08-01

The Oak Ridge National Laboratory (ORNL) in Oak Ridge, Tennessee, is operated for the U.S. Department of Energy (DOE) by Lockheed Martin Energy System (Energy Systems). ORNL has pioneered waste disposal technologies since World War II as part of its DOE mission. In the late 1950s, at the request of the National Academy of Sciences, efforts were made to develop a permanent disposal alternative to the surface and tanks at ORNL. One such technology, the hydrofracture process, involved inducing fractures in a geologic host formation (a low-permeability shale) at depths of up to 1100 ft and injecting a radioactive groutmore » slurry containing low-level liquid or tank sludge waste, cement, and other additives at an injection pressure of 2000 to 8500 psi. The objective of the effort was to develop a grout dig could be injected as a slurry and would solidify after injection, thereby entombing the radioisotopes contained in the low-level liquid or tank sludge waste. Four sites at ORNL were used: two experimental (HF-1 and HF-2); one developmental, later converted to batch process [Old Hydrofracture Facility (BF-3)]; and one production facility [New Hydrofracture Facility (BF-4)]. This document provides the environmental, restoration program with information about the the results of an evaluation of WAG 10 wells associated with the New Hydrofracture Facility at ORNL.« less

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...

Avelumab Injection

MedlinePlus

... doctor or nurse in a medical facility or infusion center. It is usually given once every 2 ... Avelumab injection may cause serious reactions during the infusion of the medication. You may be given other ...

Pilot Research as Advocacy: The Case of Sayana Press in Kinshasa, Democratic Republic of the Congo

PubMed Central

Binanga, Arsene; Bertrand, Jane T

2016-01-01

ABSTRACT In the Democratic Republic of the Congo (DRC), the Ministry of Health authorizes only physicians and nurses to give injections, with one exception—medical and nursing students may also give injections if supervised by a clinical instructor. The emergence of the injectable contraceptive Sayana Press in some African countries prompted the DRC to test the acceptability and feasibility of distributing Sayana Press and other contraceptive methods at the community level through medical and nursing students. Sayana Press is similar in formulation to the injectable contraceptive Depo-Provera but contains a lower dose and is administered subcutaneously using a single-use syringe with a short needle called the Uniject system. The Uniject system allows Sayana Press to be administered by community health workers without clinical training or by self-injection. In this pilot, the advocacy objective was to obtain approval from the Ministry of Health to allow medical and nursing students to inject Sayana Press, as a first step toward authorization for community health workers to provide the method. The pilot described in this article documents a process whereby an innovative approach moved from concept to implementation to replication in less than 2 years. It also paved the way for testing additional progressive strategies to increase access to contraception at the community level. Because the pilot project included a research component designed to assess benefits and challenges, it provided the means to introduce the new task-shifting approach, which might not have been approved otherwise. Key pilot activities included: (1) increasing awareness of Sayana Press among family planning stakeholders at a national conference on family planning, (2) enlisting the support of key decision makers in designing the pilot, (3) obtaining marketing authorization to distribute Sayana Press in the DRC, (4) implementing the pilot from July to December 2015, (5) conducting quantitative and qualitative studies to assess acceptability and feasibility, and (6) disseminating the findings to family planning stakeholders. Before the pilot, Sayana Press was relatively unknown in the DRC, and there was no precedent for medical and nursing students providing family planning methods or giving injections at the community level. In less than 12 months, the approach gained legitimacy and acceptance. The key Ministry of Health decision maker orchestrated the closing session of the dissemination meeting on next steps, paving the way for pilot tests of 3 new task-shifting approaches: insertion of Implanon NXT by medical and nursing students, self-injection for Sayana Press with supervision by students, and injection of Sayana Press by community health workers with no formal clinical training. PMID:27979874

Pilot Research as Advocacy: The Case of Sayana Press in Kinshasa, Democratic Republic of the Congo.

PubMed

Binanga, Arsene; Bertrand, Jane T

2016-12-23

In the Democratic Republic of the Congo (DRC), the Ministry of Health authorizes only physicians and nurses to give injections, with one exception-medical and nursing students may also give injections if supervised by a clinical instructor. The emergence of the injectable contraceptive Sayana Press in some African countries prompted the DRC to test the acceptability and feasibility of distributing Sayana Press and other contraceptive methods at the community level through medical and nursing students. Sayana Press is similar in formulation to the injectable contraceptive Depo-Provera but contains a lower dose and is administered subcutaneously using a single-use syringe with a short needle called the Uniject system. The Uniject system allows Sayana Press to be administered by community health workers without clinical training or by self-injection. In this pilot, the advocacy objective was to obtain approval from the Ministry of Health to allow medical and nursing students to inject Sayana Press, as a first step toward authorization for community health workers to provide the method. The pilot described in this article documents a process whereby an innovative approach moved from concept to implementation to replication in less than 2 years. It also paved the way for testing additional progressive strategies to increase access to contraception at the community level. Because the pilot project included a research component designed to assess benefits and challenges, it provided the means to introduce the new task-shifting approach, which might not have been approved otherwise. Key pilot activities included: (1) increasing awareness of Sayana Press among family planning stakeholders at a national conference on family planning, (2) enlisting the support of key decision makers in designing the pilot, (3) obtaining marketing authorization to distribute Sayana Press in the DRC, (4) implementing the pilot from July to December 2015, (5) conducting quantitative and qualitative studies to assess acceptability and feasibility, and (6) disseminating the findings to family planning stakeholders. Before the pilot, Sayana Press was relatively unknown in the DRC, and there was no precedent for medical and nursing students providing family planning methods or giving injections at the community level. In less than 12 months, the approach gained legitimacy and acceptance. The key Ministry of Health decision maker orchestrated the closing session of the dissemination meeting on next steps, paving the way for pilot tests of 3 new task-shifting approaches: insertion of Implanon NXT by medical and nursing students, self-injection for Sayana Press with supervision by students, and injection of Sayana Press by community health workers with no formal clinical training. © Binanga and Bertrand.

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.

Geophysical Monitoring of Two types of Subsurface Injection

EPA Science Inventory

Nano-scale particles of zero-valent iron (ZVI) were injected into the subsurface at the 100-D area of the DOE Hanford facility. The intent of this iron injection was to repair a gap in the existing in-situ redox manipulation barrier located at the site. A number of geophysical me...

Computational and Experimental Characterization of the Mach 6 Facility Nozzle Flow for the Enhanced Injection and Mixing Project at NASA Langley Research Center

NASA Technical Reports Server (NTRS)

Drozda, Tomasz G.; Cabell, Karen F.; Passe, Bradley J.; Baurle, Robert A.

2017-01-01

Computational fluid dynamics analyses and experimental data are presented for the Mach 6 facility nozzle used in the Arc-Heated Scramjet Test Facility for the Enhanced Injection and Mixing Project (EIMP). This project, conducted at the NASA Langley Research Center, aims to investigate supersonic combustion ramjet (scramjet) fuel injection and mixing physics relevant to flight Mach numbers greater than 8. The EIMP experiments use a two-dimensional Mach 6 facility nozzle to provide the high-speed air simulating the combustor entrance flow of a scramjet engine. Of interest are the physical extent and the thermodynamic properties of the core flow at the nozzle exit plane. The detailed characterization of this flow is obtained from three-dimensional, viscous, Reynolds-averaged simulations. Thermodynamic nonequilibrium effects are also investigated. The simulations are compared with the available experimental data, which includes wall static pressures as well as in-stream static pressure, pitot pressure and total temperature obtained via in-stream probes positioned just downstream of the nozzle exit plane.

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.

Non-physician delivered intravitreal injection service is feasible and safe - a systematic review.

PubMed

Rasul, Asrin; Subhi, Yousif; Sørensen, Torben Lykke; Munch, Inger Christine

2016-05-01

Non-physicians such as nurses are trained to give injections into the vitreous body of the eye to meet the increasing demand for intravitreal therapy with vascular endothelial growth factor inhibitors against common eye diseases, e.g. age-related macular degeneration and diabetic retinopathy. We systematically reviewed the existing literature to provide an overview of the experiences in this transformational process. We searched for literature on 22 September 2015 using PubMed, Embase, the Cochrane Library, CINAHL and the Web of Science. Eligible studies had to address any outcome based on non-physician delivered intravitreal therapy regardless of the study design. Being non-physician was defined as the injecting personnel not being a physician, but no further restrictions were made. Five studies were included with a total of 31,303 injections having been performed by 16 nurses. The studies found that having nurses perform the intravitreal injections produced to a short-term capacity improvement and liberated physicians for other clinical work. Training was provided through courses and direct supervision. The rates of endophthalmitis were 0-0.40‰, which is comparable to reported rates when the intravitreal therapy is given by physicians. Non-physician delivered intravitreal therapy seems feasible and safe.

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

40 CFR 144.65 - Use of State-required mechanisms.

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROGRAMS (CONTINUED) UNDERGROUND INJECTION CONTROL PROGRAM Financial Responsibility: Class I Hazardous Waste Injection Wells § 144.65 Use of State-required mechanisms. (a) For a facility located in a State...

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...

ERRATUM: “Automated Transient Identi cation in the Dark Energy Survey” (2015, AJ, 150, 82)

DOE PAGES

Goldstein, D. A.; D’Andrea, C. B.; Fischer, J. A.; ...

2015-08-20

Here, we describe an algorithm for identifying point-source transients and moving objects on reference-subtracted optical images containing artifacts of processing and instrumentation. The algorithm makes use of the supervised machine learning technique known as Random Forest. We present results from its use in the Dark Energy Survey Supernova program (DES-SN), where it was trained using a sample of 898,963 signal and background events generated by the transient detection pipeline. After reprocessing the data collected during the first DES-SN observing season (2013 September through 2014 February) using the algorithm, the number of transient candidates eligible for human scanning decreased by amore » factor of 13.4, while only 1.0% of the artificial Type Ia supernovae (SNe) injected into search images to monitor survey efficiency were lost, most of which were very faint events. Here we characterize the algorithm's performance in detail, and we discuss how it can inform pipeline design decisions for future time-domain imaging surveys, such as the Large Synoptic Survey Telescope and the Zwicky Transient Facility. An implementation of the algorithm and the training data used in this paper are available at at http://portal.nersc.gov/project/dessn/autoscan.« less

Automatic, sterile, and apyrogenic delivery of PET radiotracers from the cyclotron to the patient

NASA Astrophysics Data System (ADS)

Votaw, J. R.; Cashion, D. B.; Clanton, J. A.

1991-05-01

An automatic delivery remote injection system has been developed to administer either 13N-labelled ammonia, or 15O-labelled water or 18F-labelled FDG to patients. Automation increases the throughout and efficiency of the PET center, and remote dose administration ensures patient safety and reduces the radiation exposure to the technologist supervising the radiopharmaceutical injection. The remote dose administration apparatus utilizes a syringe pump to transfer liquid activity and a solenoid three-way valve to switch between lines connected to a patient and a receiving vial. To ensure apyrogenicity and sterility of the injected product, the entire system is washed with sterile water before it is used. Since the tracer is delivered in an ~ 8 ml bolus of water, the next delivery through the system is considered safe for injection if pyrogens are not detected at a threshold of 3 endotoxin units per ml (EU/ml) in the wash. Time delayed tests shows that the system may be left unused for up to 6 h before the wash must be repeated.

CARS Temperature and Species Concentration Measurements in a Supersonic Combustor with Normal Injection

NASA Technical Reports Server (NTRS)

Tedder, S. A.; OByrne, S.; Danehy, P. M.; Cutler, A. D.

2005-01-01

The dual-pump coherent anti-Stokes Raman spectroscopy (CARS) method was used to measure temperature and the absolute mole fractions of N2, O2 and H2 in a supersonic combustor. Experiments were conducted in the NASA Langley Direct-Connect Supersonic Combustion Test Facility. CARS measurements were performed at the facility nozzle exit and at three planes downstream of fuel injection. Processing the CARS measurements produced maps of the mean temperature, as well as quantitative N2 and O2 and qualitative H2 mean mole fraction fields at each plane. The CARS measurements were also used to compute correlations between fluctuations of the different simultaneously measured parameters. Comparisons were made between this 90 degree angle fuel injection case and a 30 degree fuel injection case previously presented at the 2004 Reno AIAA Meeting.

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.

Cytarabine Lipid Complex Injection

MedlinePlus

Cytarabine lipid complex comes as a liquid to be injected intrathecally (into the fluid-filled space of the spinal canal) over 1 to 5 minutes by a doctor or nurse in a medical facility. At first, cytarabine lipid ...

43 CFR 3272.11 - How do I describe the proposed utilization facility?

Code of Federal Regulations, 2011 CFR

2011-10-01

...) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) GEOTHERMAL RESOURCE... proposed facility operations, including estimated total production and injection rates; estimated well flow... site(s); (e) The source, quality, and proposed consumption rate of water to be used during facility...

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.

43 CFR 3270.10 - What types of geothermal operations are governed by these utilization regulations?

Code of Federal Regulations, 2011 CFR

2011-10-01

... of geothermal resources. This includes: (1) Electrical generation facilities; (2) Direct use facilities; (3) Related utilization facility operations; (4) Actual and allocated well field production and injection; and (5) Related well field operations. (b) The utilization regulations in subparts 3270 through...

LABORATORY SCALE STEAM INJECTION TREATABILITY STUDIES

EPA Science Inventory

Laboratory scale steam injection treatability studies were first developed at The University of California-Berkeley. A comparable testing facility has been developed at USEPA's Robert S. Kerr Environmental Research Center. Experience has already shown that many volatile organic...

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…

Procedural Headache Medicine in Neurology Residency Training: A Survey of US Program Directors.

PubMed

Robbins, Matthew S; Robertson, Carrie E; Ailani, Jessica; Levin, Morris; Friedman, Deborah I; Dodick, David W

2016-01-01

To survey neurology residency program directors (PDs) on trainee exposure, supervision, and credentialing in procedures widely utilized in headache medicine. Clinic-based procedures have assumed a prominent role in headache therapy. Headache fellows obtain procedural competence, but reliance on fellowship-trained neurologists cannot match the population eligible for treatments. The inclusion of educational modules and mechanisms for credentialing trainees pursuing procedural competence in residency curricula at individual programs is not known. A web-based survey of US neurology residency PDs was designed by the American Headache Society (AHS) procedural special interest section in collaboration with AHS and American Academy of Neurology's Headache and Facial Pain section leadership. The survey addressed exposure, training, and credentialing in: (1) onabotulinumtoxinA (onabotA) injections, (2) extracranial peripheral nerve blocks (PNBs), and (3) trigger point injections (TPIs). Fifty-five PDs (42.6%) completed the survey. Compared to noncompleters, survey completers were more likely to feature headache fellowships at their institutions (38.2% vs 10.8%, P=0.0002). High exposure (onabotA=90.9%, PNBs=80.0%, TPIs=70.9%) usually featured hands-on patient instruction (66.2%) and lectures (55.7%). Supervised performance rates were high (onabotA=65.5%, PNBs=60.0%, TPIs=52.7%), usually in continuity clinic (60.0%) or headache elective (50.9%). Headache specialists (69.1%) or general neurology (32.7%) faculty most commonly trained residents. Formal credentialing was uncommon (16.4-18.2%), mostly by documenting supervised procedures (25.5%). Only 27.3% of programs permitted trainees to perform procedures independently. Most PDs felt procedural exposure (80.0-90.9%) and competence (50.9-56.4%) by all trainees was important. Resident exposure to procedures for headache is high, but credentialing mechanisms, while desired by most PDs, are not generally in place. Implementation of a credentialing process may ensure trainees enter practice with the ability to perform procedures safely and effectively. © 2015 American Headache Society.

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.

The effect of access to contraceptive services on injectable use and demand for family planning in Malawi.

PubMed

Skiles, Martha Priedeman; Cunningham, Marc; Inglis, Andrew; Wilkes, Becky; Hatch, Ben; Bock, Ariella; Barden-O'Fallon, Janine

2015-03-01

Previous studies have identified positive relationships between geographic proximity to family planning services and contraceptive use, but have not accounted for the effect of contraceptive supply reliability or the diminishing influence of facility access with increasing distance. Kernel density estimation was used to geographically link Malawi women's use of injectable contraceptives and demand for birth spacing or limiting, as drawn from the 2010 Demographic and Health Survey, with contraceptive logistics data from family planning service delivery points. Linear probability models were run to identify associations between access to injectable services-measured by distance alone and by distance combined with supply reliability-and injectable use and family planning demand among rural and urban populations. Access to services was an important predictor of injectable use. The probability of injectable use among rural women with the most access by both measures was 7‒8 percentage points higher than among rural dwellers with the least access. The probability of wanting to space or limit births among urban women who had access to the most reliable supplies was 18 percentage points higher than among their counterparts with the least access. Product availability in the local service environment plays a critical role in women's demand for and use of contraceptive methods. Use of kernel density estimation in creating facility service environments provides a refined approach to linking women with services and accounts for both distance to facilities and supply reliability. Urban and rural differences should be considered when seeking to improve contraceptive access.

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.

MECHANICAL INTEGRITY TESTING AND TRAINING FACILITY

EPA Science Inventory

Underground injection control regulations of the U.S. Environmental Protection Agency require that all injection wells demonstrate mechanical integrity, which is defined as no significant leak in the casing, tubing or packer, and no significant fluid movement into an underground ...

Dairy cow handling facilities and the perception of Beef Quality Assurance on Colorado dairies.

PubMed

Adams, A E; Olea-Popelka, F J; Grandin, T; Woerner, D R; Roman-Muniz, I N

2014-02-01

A survey was conducted on Colorado dairies to assess attitudes and practices regarding Dairy Beef Quality Assurance (DBQA). The objectives were to (1) assess the need for a new handling facility that would allow all injections to be administered via DBQA standards; (2) establish if Colorado dairy producers are concerned with DBQA; and (3) assess differences in responses between dairy owners and herdsmen. Of the 95 dairies contacted, 20 (21%) agreed to participate, with a median herd size of 1,178. When asked to rank the following 7 traits--efficiency, animal safety, human safety, ease of animal handling, ease of operation, inject per Beef Quality Assurance (BQA) procedures, and cost--in order of priority when designing a new handling facility, human and animal safety were ranked highest in priority (first or second) by the majority of participants, with ease of animal handling and efficiency ranked next. Interestingly, the administration of injections per BQA standards was ranked sixth or seventh by most participants. Respondents estimated the average annual income from the sale of cull cows to be 4.6% of all dairy income, with 50% receiving at least one carcass discount or condemnation in the past 12 mo. Although almost all of the participating dairy farmers stated that the preferred injection site for medications was the neck region, a significant number admitted to using alternate injection sites. In contrast, no difference was found between responses regarding the preferred and actual location for intravenous injections. Although most participating producers are aware of BQA injection guidelines, they perceive efficiency as more important, which could result in injections being administered in locations not promoted by BQA. Dairy owners and herdsmen disagreed in whether or not workers had been injured in the animal handling area in the last 12 mo. Handling facilities that allow for an efficient and safe way to administer drugs according to BQA guidelines and educational opportunities that highlight the effect of improved DBQA on profitability could prove useful. Dairy producers play a key role in ensuring that dairy beef is safe and high quality, and just as they are committed to producing safe and nutritious milk for their customers, they should be committed to producing the best quality beef. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

"Who has ever loved a drug addict? It's a lie. They think a 'teja' is as bad person": multiple stigmas faced by women who inject drugs in coastal Kenya.

PubMed

Mburu, Gitau; Ayon, Sylvia; Tsai, Alexander C; Ndimbii, James; Wang, Bangyuan; Strathdee, Steffanie; Seeley, Janet

2018-05-25

A tenth of all people who inject drugs in Kenya are women, yet their social contexts and experiences remain poorly understood. This paper reports how multiple forms of stigma are experienced by women who inject drugs in coastal Kenya and the impact that they have on their ability to access essential health services. In 2015, in-depth interviews and focus group discussions were held with 45 women who inject drugs in two coastal towns. These data were supplemented with in-depth interviews with five individual stakeholders involved in service provision to this population. Data were analyzed thematically using NVivo. Women who inject drugs experience multiple stigmas, often simultaneously. These included the external stigma and self-stigma of injection drug use, external gender-related stigma of being a female injecting drug user, and the external stigma of being HIV positive (i.e., among those living with HIV). Stigma led to rejection, social exclusion, low self-esteem, and delay or denial of services at health facilities. HIV and harm reduction programs should incorporate interventions that address different forms of stigma among women who inject drugs in coastal Kenya. Addressing stigma will require a combination of individual, social, and structural interventions, such as collective empowerment of injecting drug users, training of healthcare providers on issues and needs of women who inject drugs, peer accompaniment to health facilities, addressing wider social determinants of stigma and discrimination, and expansion of harm reduction interventions to change perceptions of communities towards women who inject drugs.

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.

Cogeneration systems and processes for treating hydrocarbon containing formations

DOEpatents

Vinegar, Harold J [Bellaire, TX; Fowler, Thomas David [Houston, TX; Karanikas, John Michael [Houston, TX

2009-12-29

A system for treating a hydrocarbon containing formation includes a steam and electricity cogeneration facility. At least one injection well is located in a first portion of the formation. The injection well provides steam from the steam and electricity cogeneration facility to the first portion of the formation. At least one production well is located in the first portion of the formation. The production well in the first portion produces first hydrocarbons. At least one electrical heater is located in a second portion of the formation. At least one of the electrical heaters is powered by electricity from the steam and electricity cogeneration facility. At least one production well is located in the second portion of the formation. The production well in the second portion produces second hydrocarbons. The steam and electricity cogeneration facility uses the first hydrocarbons and/or the second hydrocarbons to generate electricity.

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

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

New York City pharmacists' attitudes toward sale of needles/syringes to injection drug users before implementation of law expanding syringe access.

PubMed

Coffin, P O; Linas, B P; Factor, S H; Vlahov, D

2000-12-01

In May 2000, New York State passed legislation permitting the sale, purchase, and possession of up to 10 needles and syringes (hereafter "syringes") without a prescription, intended to reduce blood-borne pathogen transmission among injection drug users (IDUs). To obtain baseline data on pharmacists' attitudes and practices related to human immunodeficiency virus (HIV) prevention and IDUs, a telephone survey was administered to 130 pharmacists systematically selected in New York City. Less than half of pharmacists were aware of the new law; 49.6% were willing to or supported providing nonprescription sales of syringes to IDUs. Pharmacists in support tended to be less likely to consider customer appearance "very important." Managing and supervising pharmacists were more likely than staff pharmacists to support syringe sales to IDUs. Managing and supervising pharmacists who stocked packs of 10 syringes and personal sharps disposal containers, pharmacists who supported syringe exchange in the pharmacy, and pharmacists who were willing to sell syringes to diabetics without a prescription were more likely to support syringe sales to IDUs. Syringe disposal was a prominent concern among all pharmacists. Those not in support of syringe sales to IDUs tended to be more likely to believe the practice would increase drug use. These data suggest the need for initiatives to address concerns about syringe disposal and tailored continuing education classes for pharmacists on HIV and viral hepatitis prevention among IDUs.

Semi-Supervised Tripled Dictionary Learning for Standard-dose PET Image Prediction using Low-dose PET and Multimodal MRI

PubMed Central

Wang, Yan; Ma, Guangkai; An, Le; Shi, Feng; Zhang, Pei; Lalush, David S.; Wu, Xi; Pu, Yifei; Zhou, Jiliu; Shen, Dinggang

2017-01-01

Objective To obtain high-quality positron emission tomography (PET) image with low-dose tracer injection, this study attempts to predict the standard-dose PET (S-PET) image from both its low-dose PET (L-PET) counterpart and corresponding magnetic resonance imaging (MRI). Methods It was achieved by patch-based sparse representation (SR), using the training samples with a complete set of MRI, L-PET and S-PET modalities for dictionary construction. However, the number of training samples with complete modalities is often limited. In practice, many samples generally have incomplete modalities (i.e., with one or two missing modalities) that thus cannot be used in the prediction process. In light of this, we develop a semi-supervised tripled dictionary learning (SSTDL) method for S-PET image prediction, which can utilize not only the samples with complete modalities (called complete samples) but also the samples with incomplete modalities (called incomplete samples), to take advantage of the large number of available training samples and thus further improve the prediction performance. Results Validation was done on a real human brain dataset consisting of 18 subjects, and the results show that our method is superior to the SR and other baseline methods. Conclusion This work proposed a new S-PET prediction method, which can significantly improve the PET image quality with low-dose injection. Significance The proposed method is favorable in clinical application since it can decrease the potential radiation risk for patients. PMID:27187939

Permanent downhole fiber optic pressure and temperature monitoring during CO2 injection

NASA Astrophysics Data System (ADS)

Schmidt-Hattenberger, C.; Moeller, F.; Liebscher, A.; Koehler, S.

2009-04-01

Permanent downhole monitoring of pressure and temperature, ideally over the entire length of the injection string, is essential for any smooth and safe CO2 injection within the framework of geological CO2 storage: i) To avoid fracturing of the cap-rock, a certain, site dependent pressure threshold within the reservoir should not be exceeded; ii) Any CO2 phase transition within the injection string, i.e. either condensation or evaporation, should be avoided. Such phase transitions cause uncontrolled and undetermined P-T regimes within the injection string that may ultimately result in a shut-in of the injection facility; and iii) Precise knowledge of the P and T response of the reservoir to the CO2 injection is a prerequisite to any reservoir modeling. The talk will present first results from our permanent downhole P-T monitoring program from the Ketzin CO2 storage test site (CO2SINK). At Ketzin, a fiber Bragg grating pressure sensor has been installed at the end of the injection string in combination with distributed temperature profiling over the entire length (about 550 m) of the string for continuous P-T monitoring during operation. Such fiber optic monitoring technique is used by default in the oil and gas industry but has not yet been applied as standard on a long-term routine mode for CO2 injection. Pressure is measured every 5 seconds with a resolution of < 1 bar. The data are later processed by user-defined program. The temperature logs along the injection string are measured every 3 minutes with a spatial resolution of one meter and with a temperature resolution of about 0.1°C. The long-term stability under full operational conditions is currently under investigation. The main computer of the P-T system operates as a stand-alone data-acquisition unit, and is connected with a secure intranet in order to ensure remote data access and system maintenance. The on-line measurements are displayed on the operator panel of the injection facility for direct control. The monitoring program started already prior to CO2 injection and runs since 6 months without any fatal errors. The recorded data cover the pre-injection well-testing phase, the initial injection phase as well as several shut-in and re-start phases during routine injection. Especially during the initial and re-start phases the monitoring results significantly optimized and improved the operation of the injection facility in terms of injection rate and injection temperature. Due to the high qualitative and also quantitative resolution of this technique even shortest-term transient disturbances of the reservoir and injection regime could be monitored as they may occur due to fluid sampling or logging in neighboring wells. Such short-term transient effects are normally overlooked using non-permanent monitoring techniques. On the long-term perspective, this monitoring technique will also support the control of CO2 injection tubing integrity, which is a prerequisite for any secure long-lasting CO2 injection and storage.

From Site Characterization through Safe and Successful CO2 Injection Operation to Post-injection Monitoring and Site Closure - Closing the Full Life Cycle Research at the Ketzin Pilot Site, Germany

NASA Astrophysics Data System (ADS)

Liebscher, Axel

2017-04-01

Initiated in 2004, the Ketzin pilot site near Berlin, Germany, was the first European onshore storage project for research and development on geological CO2 storage. After comprehensive site characterization the site infrastructure was build comprising three deep wells and the injection facility including pumps and storage tanks. The operational CO2 injection period started in June 2008 and ended in August 2013 when the site entered the post-injection closure period. During these five years, a total amount of 67 kt of CO2 was safely injected into an Upper Triassic saline sandstone aquifer at a depth of 630 m - 650 m. In fall 2013, the first observation well was partially plugged in the reservoir section with CO2 resistant cement; full abandonment of this well finished in 2015 after roughly 2 years of cement plug monitoring. Abandonment of the remaining wells will be finished by summer 2017 and hand-over of liability to the competent authority is scheduled for end of 2017. The CO2 injected was mainly of food grade quality (purity > 99.9%). In addition, 1.5 kt of CO2 from the oxyfuel pilot capture facility "Schwarze Pumpe" (purity > 99.7%) was injected in 2011. The injection period terminated with a CO2-N2 co-injection experiment of 650 t of a 95% CO2/5% N2 mixture in summer 2013 to study the effects of impurities in the CO2 stream on the injection operation. During regular operation, the CO2 was pre-heated on-site to 40°C prior to injection to ensure a single-phase injection process and avoid any phase transition or transient states within the injection facility or the reservoir. Between March and July 2013, just prior to the CO2-N2 co-injection experiment, the injection temperature was stepwise decreased down to 10°C within a "cold-injection" experiment to study the effects of two-phase injection conditions. During injection operation, the combination of different geochemical and geophysical monitoring methods enabled detection and mapping of the spatial and temporal in-reservoir behaviour of the injected CO2 even for small quantities. After the cessation of CO2 injection, post-injection monitoring continues and is guided by the three high-level criteria set out in the EU Directive for transfer of liability: i) observed behaviour of the injected CO2 conforms to the modelled behaviour, ii) no detectable leakage, and iii) site is evolving towards a situation of long-term stability. In addition, two further field experiments have been performed since end of injection. A CO2 back-production experiment was run in autumn 2014 to study the physicochemical properties of the back-produced CO2 as well as the pressure response of the reservoir. From October 2015 to January 2016, a brine injection experiment aimed at studying the imbibition process and residual gas saturation. Just prior to final well abandonment, drilling of two sidetracks in one of the wells is scheduled for summer 2017 to recover unique core samples from reservoir and cap rocks that reflect 9 years of in-situ CO2 exposure and will provide first-hand information on CO2-triggered mineralogical, mechanical and petrophysical rock property changes.

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.

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.

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.

The introduction of a potentially abuse deterrent oxycodone formulation: Early findings from the Australian National Opioid Medications Abuse Deterrence (NOMAD) study.

PubMed

Degenhardt, Louisa; Bruno, Raimondo; Ali, Robert; Lintzeris, Nicholas; Farrell, Michael; Larance, Briony

2015-06-01

There is increasing concern about tampering of pharmaceutical opioids. We describe early findings from an Australian study examining the potential impact of the April 2014 introduction of an abuse-deterrent sustained-release oxycodone formulation (Reformulated OxyContin(®)). Data on pharmaceutical opioid sales; drug use by people who inject drugs regularly (PWID); client visits to the Sydney Medically Supervised Injecting Centre (MSIC); and last drug injected by clients of inner-Sydney needle-syringe programmes (NSPs) were obtained, 2009-2014. A cohort of n=606 people tampering with pharmaceutical opioids was formed pre-April 2014, and followed up May-August 2014. There were declines in pharmacy sales of 80mg OxyContin(®) post-introduction of the reformulated product, the dose most commonly diverted and injected by PWID. Reformulated OxyContin(®) was among the least commonly used and injected drugs among PWID. This was supported by Sydney NSP data. There was a dramatic reduction in MSIC visits for injection of OxyContin(®) post-introduction of the new formulation (from 62% of monthly visits pre-introduction to 5% of visits, August 2014). The NOMAD cohort confirmed a reduction in OxyContin(®) use/injection post-introduction. Reformulated OxyContin(®) was cheaper and less attractive for tampering than Original OxyContin(®). These data suggest that, in the short term, introduction of an abuse-deterrent formulation of OxyContin(®) in Australia was associated with a reduction in injection of OxyContin(®), with no clear switch to other drugs. Reformulated OxyContin(®), in this short follow-up, does not appear to be considered as attractive for tampering. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Supervised detection of exoplanets in high-contrast imaging sequences

NASA Astrophysics Data System (ADS)

Gomez Gonzalez, C. A.; Absil, O.; Van Droogenbroeck, M.

2018-06-01

Context. Post-processing algorithms play a key role in pushing the detection limits of high-contrast imaging (HCI) instruments. State-of-the-art image processing approaches for HCI enable the production of science-ready images relying on unsupervised learning techniques, such as low-rank approximations, for generating a model point spread function (PSF) and subtracting the residual starlight and speckle noise. Aims: In order to maximize the detection rate of HCI instruments and survey campaigns, advanced algorithms with higher sensitivities to faint companions are needed, especially for the speckle-dominated innermost region of the images. Methods: We propose a reformulation of the exoplanet detection task (for ADI sequences) that builds on well-established machine learning techniques to take HCI post-processing from an unsupervised to a supervised learning context. In this new framework, we present algorithmic solutions using two different discriminative models: SODIRF (random forests) and SODINN (neural networks). We test these algorithms on real ADI datasets from VLT/NACO and VLT/SPHERE HCI instruments. We then assess their performances by injecting fake companions and using receiver operating characteristic analysis. This is done in comparison with state-of-the-art ADI algorithms, such as ADI principal component analysis (ADI-PCA). Results: This study shows the improved sensitivity versus specificity trade-off of the proposed supervised detection approach. At the diffraction limit, SODINN improves the true positive rate by a factor ranging from 2 to 10 (depending on the dataset and angular separation) with respect to ADI-PCA when working at the same false-positive level. Conclusions: The proposed supervised detection framework outperforms state-of-the-art techniques in the task of discriminating planet signal from speckles. In addition, it offers the possibility of re-processing existing HCI databases to maximize their scientific return and potentially improve the demographics of directly imaged exoplanets.

18 CFR 157.213 - Underground storage field facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., well logs, quantitative porosity and permeability data, and any other relevant data for both the.../withdrawal wells and observation wells; and the lengths of open-hole sections of existing and proposed injection/withdrawal wells; (3) Isobaric maps (data from the end of each injection and withdrawal cycle) for...

18 CFR 157.213 - Underground storage field facilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., well logs, quantitative porosity and permeability data, and any other relevant data for both the.../withdrawal wells and observation wells; and the lengths of open-hole sections of existing and proposed injection/withdrawal wells; (3) Isobaric maps (data from the end of each injection and withdrawal cycle) for...

40 CFR 148.14 - Waste specific prohibitions-first third wastes.

Code of Federal Regulations, 2013 CFR

2013-07-01

... underground injection at off-site injection facilities. (e) Effective August 8, 1990, the wastes specified in... 40 Protection of Environment 24 2013-07-01 2013-07-01 false Waste specific prohibitions-first third wastes. 148.14 Section 148.14 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...

40 CFR 148.14 - Waste specific prohibitions-first third wastes.

Code of Federal Regulations, 2012 CFR

2012-07-01

... underground injection at off-site injection facilities. (e) Effective August 8, 1990, the wastes specified in... 40 Protection of Environment 24 2012-07-01 2012-07-01 false Waste specific prohibitions-first third wastes. 148.14 Section 148.14 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...

40 CFR 148.14 - Waste specific prohibitions-first third wastes.

Code of Federal Regulations, 2014 CFR

2014-07-01

... underground injection at off-site injection facilities. (e) Effective August 8, 1990, the wastes specified in... 40 Protection of Environment 23 2014-07-01 2014-07-01 false Waste specific prohibitions-first third wastes. 148.14 Section 148.14 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...

40 CFR 144.26 - Inventory requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... requirements. The owner or operator of an injection well which is authorized by rule under this subpart shall... the well upon failure to submit inventory information for the well within the time frame specified in...) Name and address of legal contact; (3) Ownership of facility; (4) Nature and type of injection wells...

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.

Pharmacokinetic-pharmacodynamic study of subcutaneous injection of depot nandrolone decanoate using dried blood spots sampling coupled with ultrapressure liquid chromatography tandem mass spectrometry assays.

PubMed

Singh, Gurmeet K S; Turner, Leo; Desai, Reena; Jimenez, Mark; Handelsman, David J

2014-07-01

Testosterone (T) and nandrolone (N) esters require deep im injections by medical personnel but these often deposit injectate into sc fat so that more convenient sc self-administration may be feasible. To investigate the feasibility and pharmacology of sc injection of N decanoate in healthy men using dried blood spot (DBS) for frequent blood sampling without clinic visits. Healthy male volunteers received 100 mg N decanoate by a single sc injection. Finger-prick capillary blood was spotted onto filter paper before injection daily at home for 21 d and stored at room temperature. Venous whole blood was also spotted onto filter paper before and weekly for 3 wk after injection. DBS were extracted for assay of N and T by liquid chromatography tandem mass spectrometry in a single batch with serum concentrations estimated with adjustment for capillary blood sample volume and hematocrit to define peak (N) or nadir (T) time and concentration from individual daily measurements. Daily serum N peaked 2.50 ± 0.25 (SEM) ng/mL at a median (range) of 6 (4-13) days causing a reduction in serum T from 3.50 ± 0.57 ng/mL at baseline to a nadir of 0.38 ± 0.13 (SEM) ng/mL (89 ± 3% suppression) at a median (range) of 8 (5-16) days. Simultaneously sampled capillary, venous whole blood, and serum gave almost identical results for serum T and N. Finger-pricks and sc injections were well tolerated. This study demonstrates that A) DBS sampling with liquid chromatography mass spectrometry steroid analysis achieves frequent time sampling in the community without requiring clinic visits, venesection, or frozen serum storage, and B) androgen esters in an oil vehicle can be delivered effectively by sc injection, thus avoiding the need for medically supervised deep-im injections.

A chance to stop and breathe: participants’ experiences in the North American Opiate Medication Initiative clinical trial

PubMed Central

2014-01-01

Background The North American Opiate Medication Initiative (NAOMI) clinical trial compared the effectiveness of injectable diacetylmorphine (DAM) or hydromorphone (HDM) to oral methadone maintenance treatment (MMT). This study aimed to determine participants’ perceptions of treatment delivered in NAOMI. Methods A qualitative sub-study was conducted with 29 participants (12 female): 18 (62.1%) received injectable DAM or HDM and 11 (37.9%) received MMT. A phenomenological theoretical framework was used. Semi-structured interviews were audio-recorded and transcribed verbatim. A thematic analysis was used over successive phases and was driven by the semantic meanings of the data. Results Participants receiving injectable medications suggested that the supervised delivery model was stringent but provided valuable stability to their lives. Females discussed the adjustment required for the clinical setting, while males focused on the challenging clinic schedule and its impact on employment abilities. Participants receiving MMT described disappointment with being randomized to this treatment; however, positive aspects, including the quick titration time and availability of auxiliary services, were also discussed. Conclusion Treatment with injectable DAM (or HDM) is preferred by participants and considered effective in reducing the burden of opioid dependency. Engaging patients in research regarding their perceptions of treatment provides a comprehensive assessment of treatment needs and barriers. Clinical trial registration NCT00175357 PMID:25262567

Hazardous Waste Cleanup: Boricua Wood Processing Incorporated in Toja Baja, Puerto Rico

EPA Pesticide Factsheets

Boricua Wood Processing, Inc. is located on State Road 865 at kilometer 5.5, in Toja Baja. The facility is a manufacturing plant for the pressure injection of liquid preservative solutions into untreated cut lumber. The facility began its activity in 1957.

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

Community Health Workers as Social Marketers of Injectable Contraceptives: A Case Study from Ethiopia.

PubMed

Weidert, Karen; Gessessew, Amanuel; Bell, Suzanne; Godefay, Hagos; Prata, Ndola

2017-03-24

Ethiopia has made notable progress in increasing awareness and knowledge of family planning and is considered a success story among funders and program planners. Yet unmet need among rural women (28.6%) is almost double that of urban women (15.5%), with a wide gap in total fertility rate depending on urban (2.6) or rural (5.5) residence. This study investigates the impact of a service delivery model that combines community-based distribution (CBD) of contraception with social marketing in Tigray, Ethiopia, to create a more sustainable approach to CBD. Between September 2011 and October 2013, 626 volunteer CHWs were recruited and trained to administer depot medroxyprogesterone acetate (DMPA) injections and provide counseling and referrals to the health post for other methods; the project implementation period ended in June 2014. The CHWs received a supply of DMPA injections in the form of a microloan from a drug revolving fund; the CHWs charged women a minimal fee (5 birr, or US$0.29), determined based on willingness-to-pay data, for each DMPA injection; and the CHWs returned part of the fee (3 birr) to the drug revolving fund while keeping the remaining portion (2 birr). The CHWs also promoted demand for family planning through door-to-door outreach and community meetings. Existing health extension workers (HEWs) provided regular supervision of the CHWs, supplemented by in-depth supervision visits from study coordinators. Baseline and endline representative surveys of women of reproductive age, as well as of participating CHWs, were conducted. In addition, DMPA provision data from the CHWs were collected. Between October 2011 and June 2014, the CHWs served in total 8,604 women and administered an estimated 15,410 DMPA injections, equivalent to providing 3,853 couple-years of protection. There was a 25% significant increase in contraceptive use among surveyed women, from 30.1% at baseline to 37.7% at endline, with DMPA use largely responsible for this increase. Changes in quality of family planning markers from baseline suggested services improved between baseline and endline: nearly 50% more women reported being told about side effects and what to do if they experience side effects, and 25% more women said they were told about other methods of contraception. The results from household surveys at baseline and endline suggest that CHWs in this model made a significant contribution to family planning in the region. © Weidert et al.

Community Health Workers as Social Marketers of Injectable Contraceptives: A Case Study from Ethiopia

PubMed Central

Weidert, Karen; Gessessew, Amanuel; Bell, Suzanne; Godefay, Hagos; Prata, Ndola

2017-01-01

ABSTRACT Ethiopia has made notable progress in increasing awareness and knowledge of family planning and is considered a success story among funders and program planners. Yet unmet need among rural women (28.6%) is almost double that of urban women (15.5%), with a wide gap in total fertility rate depending on urban (2.6) or rural (5.5) residence. This study investigates the impact of a service delivery model that combines community-based distribution (CBD) of contraception with social marketing in Tigray, Ethiopia, to create a more sustainable approach to CBD. Between September 2011 and October 2013, 626 volunteer CHWs were recruited and trained to administer depot medroxyprogesterone acetate (DMPA) injections and provide counseling and referrals to the health post for other methods; the project implementation period ended in June 2014. The CHWs received a supply of DMPA injections in the form of a microloan from a drug revolving fund; the CHWs charged women a minimal fee (5 birr, or US$0.29), determined based on willingness-to-pay data, for each DMPA injection; and the CHWs returned part of the fee (3 birr) to the drug revolving fund while keeping the remaining portion (2 birr). The CHWs also promoted demand for family planning through door-to-door outreach and community meetings. Existing health extension workers (HEWs) provided regular supervision of the CHWs, supplemented by in-depth supervision visits from study coordinators. Baseline and endline representative surveys of women of reproductive age, as well as of participating CHWs, were conducted. In addition, DMPA provision data from the CHWs were collected. Between October 2011 and June 2014, the CHWs served in total 8,604 women and administered an estimated 15,410 DMPA injections, equivalent to providing 3,853 couple-years of protection. There was a 25% significant increase in contraceptive use among surveyed women, from 30.1% at baseline to 37.7% at endline, with DMPA use largely responsible for this increase. Changes in quality of family planning markers from baseline suggested services improved between baseline and endline: nearly 50% more women reported being told about side effects and what to do if they experience side effects, and 25% more women said they were told about other methods of contraception. The results from household surveys at baseline and endline suggest that CHWs in this model made a significant contribution to family planning in the region. PMID:28275087

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.

Experimental demonstration of low laser-plasma instabilities in gas-filled spherical hohlraums at laser injection angle designed for ignition target

NASA Astrophysics Data System (ADS)

Lan, Ke; Li, Zhichao; Xie, Xufei; Chen, Yao-Hua; Zheng, Chunyang; Zhai, Chuanlei; Hao, Liang; Yang, Dong; Huo, Wen Yi; Ren, Guoli; Peng, Xiaoshi; Xu, Tao; Li, Yulong; Li, Sanwei; Yang, Zhiwen; Guo, Liang; Hou, Lifei; Liu, Yonggang; Wei, Huiyue; Liu, Xiangming; Cha, Weiyi; Jiang, Xiaohua; Mei, Yu; Li, Yukun; Deng, Keli; Yuan, Zheng; Zhan, Xiayu; Zhang, Haijun; Jiang, Baibin; Zhang, Wei; Deng, Xuewei; Liu, Jie; Du, Kai; Ding, Yongkun; Wei, Xiaofeng; Zheng, Wanguo; Chen, Xiaodong; Campbell, E. M.; He, Xian-Tu

2017-03-01

Octahedral spherical hohlraums with a single laser ring at an injection angle of 55∘ are attractive concepts for laser indirect drive due to the potential for achieving the x-ray drive symmetry required for high convergence implosions. Laser-plasma instabilities, however, are a concern given the long laser propagation path in such hohlraums. Significant stimulated Raman scattering has been observed in cylindrical hohlraums with similar laser propagation paths during the ignition campaign on the National Ignition Facility (NIF). In this Rapid Communication, experiments demonstrating low levels of laser-driven plasma instability (LPI) in spherical hohlraums with a laser injection angle of 55∘ are reported and compared to that observed with cylindrical hohlraums with injection angles of 28 .5∘ and 55∘, similar to that of the NIF. Significant LPI is observed with the laser injection of 28 .5∘ in the cylindrical hohlraum where the propagation path is similar to the 55∘ injection angle for the spherical hohlraum. The experiments are performed on the SGIII laser facility with a total 0.35 -μ m incident energy of 93 kJ in a 3 nsec pulse. These experiments demonstrate the role of hohlraum geometry in LPI and demonstrate the need for systematic experiments for choosing the optimal configuration for ignition studies with indirect drive inertial confinement fusion.

Estimating the number of HIV-infected injection drug users in Bangkok: a capture--recapture method.

PubMed

Mastro, T D; Kitayaporn, D; Weniger, B G; Vanichseni, S; Laosunthorn, V; Uneklabh, T; Uneklabh, C; Choopanya, K; Limpakarnjanarat, K

1994-07-01

The purpose of the study was to estimate the number of injection drug users infected with the human immunodeficiency virus (HIV) in Bangkok to allow planning for health services for this population. A two-sample capture-recapture method was used. The first capture listed all persons on methadone treatment for opiate addiction from April 17 through May 17, 1991, at 18 facilities in Bangkok. The second capture involved urine testing of persons held at 72 Bangkok police stations from June 3 through September 30, 1991. Persons whose urine tests were positive for opiate metabolites or methadone were included on the second list. The first capture comprised 4064 persons and the recapture 1540 persons. There were 171 persons included on both lists, yielding an estimate of 36,600 opiate users in Bangkok. Existing data indicate that 89% of opiate users in Bangkok inject drugs and that about one third are infected with HIV, yielding an estimate of approximately 12,000 HIV-infected injection drug users in Bangkok in 1991. During the 1990s the number of cases of acquired immunodeficiency syndrome (AIDS) and other HIV-related diseases, including tuberculosis, in the population of HIV-infected injection drug users in Bangkok will increase dramatically, placing new demands on existing health care facilities. The capture-recapture method may be useful in estimating difficult-to-count populations, including injection drug users.

Injections during labor and intrapartum-related hypoxic injury and mortality in rural southern Nepal

PubMed Central

Mullany, Luke C.; Khatry, Subarna K.; Katz, Joanne; Stanton, Cynthia K.; Lee, Anne C.C.; Darmstadt, Gary L.; LeClerq, Steven C.; Tielsch, James M.

2013-01-01

Objective To estimate the association between unmonitored use of injections during labor and intrapartum-related neonatal mortality and morbidity among home births. Methods Recently delivered women in Sarlahi, Nepal, reported whether they had received injections during labor. Data on breathing and crying status at birth, time to first breath, respiratory rate, sucking ability, and lethargy were gathered. Neonatal respiratory depression (NRD) and encephalopathy (NE) were compared by injection receipt status using multivariate regression models. Results Injections during labor were frequently reported (7108 of 22 352 [31.8%]) and were predominantly given by unqualified village “doctors.” Multivariate analysis (excluding facility births and complicated deliveries) revealed associations with intrapartum-related NRD (relative risk [RR] 2.52; 95% CI, 2.29–2.78) and NE (RR 3.48; 95% CI, 2.46–4.93). The risks of neonatal death associated with intrapartum-related NRD (RR 3.78; 95% CI, 2.53–5.66) or NE (RR 4.47; 95% CI, 2.78–7.19) were also elevated. Conclusion Injection during labor was widespread at the community level. This practice was associated with poor outcomes and possibly related to the inappropriate use of uterotonics by unqualified providers. Interventions are required to increase the safety of childbirth in the community and in peripheral health facilities. Parent trial registered at clinicaltrials.gov (NCT00 109616). PMID:23523332

Experimental demonstration of low laser-plasma instabilities in gas-filled spherical hohlraums at laser injection angle designed for ignition target.

PubMed

Lan, Ke; Li, Zhichao; Xie, Xufei; Chen, Yao-Hua; Zheng, Chunyang; Zhai, Chuanlei; Hao, Liang; Yang, Dong; Huo, Wen Yi; Ren, Guoli; Peng, Xiaoshi; Xu, Tao; Li, Yulong; Li, Sanwei; Yang, Zhiwen; Guo, Liang; Hou, Lifei; Liu, Yonggang; Wei, Huiyue; Liu, Xiangming; Cha, Weiyi; Jiang, Xiaohua; Mei, Yu; Li, Yukun; Deng, Keli; Yuan, Zheng; Zhan, Xiayu; Zhang, Haijun; Jiang, Baibin; Zhang, Wei; Deng, Xuewei; Liu, Jie; Du, Kai; Ding, Yongkun; Wei, Xiaofeng; Zheng, Wanguo; Chen, Xiaodong; Campbell, E M; He, Xian-Tu

2017-03-01

Octahedral spherical hohlraums with a single laser ring at an injection angle of 55^{∘} are attractive concepts for laser indirect drive due to the potential for achieving the x-ray drive symmetry required for high convergence implosions. Laser-plasma instabilities, however, are a concern given the long laser propagation path in such hohlraums. Significant stimulated Raman scattering has been observed in cylindrical hohlraums with similar laser propagation paths during the ignition campaign on the National Ignition Facility (NIF). In this Rapid Communication, experiments demonstrating low levels of laser-driven plasma instability (LPI) in spherical hohlraums with a laser injection angle of 55^{∘} are reported and compared to that observed with cylindrical hohlraums with injection angles of 28.5^{∘} and 55^{∘}, similar to that of the NIF. Significant LPI is observed with the laser injection of 28.5^{∘} in the cylindrical hohlraum where the propagation path is similar to the 55^{∘} injection angle for the spherical hohlraum. The experiments are performed on the SGIII laser facility with a total 0.35-μm incident energy of 93 kJ in a 3 nsec pulse. These experiments demonstrate the role of hohlraum geometry in LPI and demonstrate the need for systematic experiments for choosing the optimal configuration for ignition studies with indirect drive inertial confinement fusion.

Acute hepatitis B outbreaks in 2 skilled nursing facilities and possible sources of transmission: North Carolina, 2009-2010.

PubMed

Seña, Arlene C; Moorman, Anne; Njord, Levi; Williams, Roxanne E; Colborn, James; Khudyakov, Yury; Drobenuic, Jan; Xia, Guo-Liang; Wood, Hattie; Moore, Zack

2013-07-01

Acute hepatitis B virus (HBV) infections have been reported in long-term care facilities (LTCFs), primarily associated with infection control breaks during assisted blood glucose monitoring. We investigated HBV outbreaks that occurred in separate skilled nursing facilities (SNFs) to determine factors associated with transmission. Outbreak investigation with case-control studies. Two SNFs (facilities A and B) in Durham, North Carolina, during 2009-2010. Residents with acute HBV infection and controls randomly selected from HBV-susceptible residents during the outbreak period. After initial cases were identified, screening was offered to all residents, with repeat testing 3 months later for HBV-susceptible residents. Molecular testing was performed to assess viral relatedness. Infection control practices were observed. Case-control studies were conducted to evaluate associations between exposures and acute HBV infection in each facility. Six acute HBV cases were identified in each SNF. Viral phylogenetic analysis revealed a high degree of HBV relatedness within, but not between, facilities. No evaluated exposures were significantly associated with acute HBV infection in facility A; those associated with infection in facility B (all odds ratios >20) included injections, hospital or emergency room visits, and daily blood glucose monitoring. Observations revealed absence of trained infection control staff at facility A and suboptimal hand hygiene practices during blood glucose monitoring and insulin injections at facility B. These outbreaks underscore the vulnerability of LTCF residents to acute HBV infection, the importance of surveillance and prompt investigation of incident cases, and the need for improved infection control education to prevent transmission.

78 FR 14951 - State of Washington; Underground Injection Control (UIC) Program Revision

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-08

... of Ecology to the Energy Facility Site Evaluation Council to issue UIC permits at energy facilities... telephone number for the Library is (206) 553-1289. (2) Washington Department of Ecology, Water Quality... the Environmental Protection Agency, and MOUs between the Department of Ecology and the Department of...

Full Life Cycle Research at the Ketzin Pilot Site, Germany - From Safe and Successful CO2 Injection Operation to Post-Injection Monitoring and Site Closure

NASA Astrophysics Data System (ADS)

Liebscher, A. H.

2016-12-01

The Ketzin pilot site near Berlin, Germany, was initiated in 2004 as the first European onshore storage project for research and development on geological CO2 storage. The operational CO2 injection period started in June 2008 and ended in August 2013 when the site entered the post-injection closure period. During these five years, a total amount of 67 kt of CO2 was safely injected into a saline aquifer (Upper Triassic sandstone) at a depth of 630 m - 650 m. In fall 2013, the first observation well was partially plugged in the reservoir section; full abandonment of this well finished in 2015 after roughly 2 years of well closure monitoring. Abandonment of the remaining 4 wells will be finished by 2017 and hand-over of liability to the competent authority is planned for end of 2017. The CO2 injected was mainly of food grade quality (purity > 99.9%). In addition, 1.5 kt of CO2 from the pilot capture facility "Schwarze Pumpe" (oxyfuel power plant CO2 with purity > 99.7%) was injected in 2011. The injection period terminated with a CO2-N2 co-injection experiment of 650 t of a 95% CO2/5% N2 mixture in summer 2013 to study the effects of impurities in the CO2 stream on the injection operation. During regular operation, the CO2 was pre-heated on-site to 40 - 45°C prior to injection to ensure a single-phase injection process and avoid any phase transition or transient states within the injection facility or the reservoir. Between March and July 2013, just prior to the CO2-N2 co-injection experiment, the injection temperature was stepwise decreased down to 10°C within a "cold-injection" experiment to study the effects of two-phase injection conditions. During injection operation, the combination of different geochemical and geophysical monitoring methods enabled detection and mapping of the spatial and temporal in-reservoir behaviour of the injected CO2 even for small quantities. After the cessation of CO2 injection, post-injection monitoring continued and two additional field experiments have been performed. A CO2 back-production experiment was run in autumn 2014 to study the physicochemical properties of the back-produced CO2 as well as the pressure response of the reservoir. In October 2015 to January 2016, a brine injection experiment studied the imbibition process and residual gas saturation.

Prevention of Prespawning Mortality: Cause of Salmon Headburns and Cranial Lesions

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

Neitzel, Duane A.; Elston, R A.; Abernethy, Cary S.

2004-06-01

This project was to undertaken to provide information about a condition known as ''headburn''. Information from the project will enable U.S. Corps of Engineers managers to make adjustments in operational procedures or facilities on the Columbia and Snake rivers to prevent loss of pre-spawning adult salmonids that migrate through the facilities. Headburn is a descriptive clinical term used by fishery biologists to describe scalping or exfoliation of skin and ulceration of underlying connective tissue and muscle, primarily of the jaw and cranial region of salmonids observed at fish passage facilities. Headburn lesions are primarily caused when fish collide with concretemore » or other structures at dams and fish passage facilities, and may be exacerbated in some fish that ''fallback'' or pass over spillways or through turbine assemblies after having passed the dam through a fish ladder. Prespawning mortality of headburned salmonids can be prevented or greatly reduced by therapeutic treatment of both hatchery and wild fish. Treatments would consist of topical application of an anti-fungal agent, injection of replacement plasma electrolytes into the peritoneal cavity, and injection of a broad-spectrum antibacterial agent at fish passage and trapping facilities or hatcheries.« less

Fluidic Thrust Vectoring of an Axisymmetric Exhaust Nozzle at Static Conditions

NASA Technical Reports Server (NTRS)

Wing, David J.; Giuliano, Victor J.

1997-01-01

A sub-scale experimental static investigation of an axisymmetric nozzle with fluidic injection for thrust vectoring was conducted at the NASA Langley Jet Exit Test Facility. Fluidic injection was introduced through flush-mounted injection ports in the divergent section. Geometric variables included injection-port geometry and location. Test conditions included a range of nozzle pressure ratios from 2 to 10 and a range of injection total pressure ratio from no-flow to 1.5. The results indicate that fluidic injection in an axisymmetric nozzle operating at design conditions produced significant thrust-vector angles with less reduction in thrust efficiency than that of a fluidically-vectored rectangular jet. The axisymmetric geometry promoted a pressure relief mechanism around the injection slot, thereby reducing the strength of the oblique shock and the losses associated with it. Injection port geometry had minimal effect on thrust vectoring.

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

Use of Activated Carbon to Control Volatilization of Organic Contaminants from the Indiana Harbor Confined Disposal Facility

DTIC Science & Technology

2012-09-01

PAHs (17 priority pollutant PAHs) were extracted from sediment by USEPA SW-846 Method 3545 and analyzed by gas chromatography /mass spectrometry...slurry at concentrations of 0.025, 0.05, and 0.10 g/L. The carbon- sediment mixture was equilibrated by tumbling in zero headspace jars for 15 minutes...cooled injection gas chromatography injection system at -40 °C. Once the analytes were transferred, the injection port was heated to 240 °C and

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

40 CFR 62.15275 - How do I monitor the injection rate of activated carbon?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 9 2012-07-01 2012-07-01 false How do I monitor the injection rate of activated carbon? 62.15275 Section 62.15275 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS Federal Plan Requirements fo...

40 CFR 62.15275 - How do I monitor the injection rate of activated carbon?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 9 2014-07-01 2014-07-01 false How do I monitor the injection rate of activated carbon? 62.15275 Section 62.15275 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS Federal Plan Requirements fo...

CONVERSION OF WIND POWER TO HYDROGEN FUEL: DESIGN OF AN ALTERNATIVE ENERGY SYSTEM FOR AN INJECTION MOLDING FACILITY

EPA Science Inventory

Injection molding plants are large consumers of electricity. At its current level of operations, Harbec Plastics (Ontario, NY) uses about 2,000,000 kilowatt-hours of electricity per year. Based on the US average fuel mix, approximately 1.5 pounds of CO2